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Last update 2019-03-20 15:06:18.257

Nathalie Bajos Gender and Health

Course and current status

Since joining the INSERM as a research fellow in 1992, my research has focused on the “Gendered social construction of risk”, an innovative scientific issue at that time both in France and abroad. I have applied and refined this issue in my various research studies.

My research focuses on sexual and reproductive health, defined by WHO as a continuous process of physical, psychological and social well-being associated with sexuality, and covers different aspects: contraception, abortion, STIs, HIV prevention, sexual dysfunction, sexual violence, and menopause. My work is based on the general problem of the analysis of social inequalities, in a context of increasing medicalization of sexuality, which favors a theoretical approach in terms of social relations, gender but also class, generation and doctor-patient relations. I develop multidisciplinary approaches based on quantitative (cross-sectional and cohort) and qualitative surveys in the general population and among health professionals. My research is conducted in France and other regions of the world with a view to comparing sexual health issues in different social, political, cultural and health contexts.

The first research theme aimed to analyse the social context of sexuality and HIV prevention in France.

In 2006, I was scientifically responsible, with M Bozon (INED), for the major national survey on sexuality, at the request of and funded by the National AIDS Research Agency (CSF survey of 12,000 people, qualitative survey of 80 people). This research, involving twenty researchers in social sciences and epidemiology, provided an opportunity to test very closely the effect of gender on representations, sexual practices and risk-taking. It has given rise to numerous publications, including a book translated into English "Sexuality: Practices, Gender and Health" that I presented to multiple scientific audiences (France, UK, Brazil). Our results   contributed to the current international debate on the new biomedical paradigm for HIV prevention Treatment as Prevention.

The second theme deals with contraception and abortion, analysed in different contexts.

I set up a research program on contemporary sexual health issues (2010-2011 FECOND survey of 8,000 women and men interviewed by telephone, 8,000 interviewed by Internet, 1,000 doctors; ANR funding), as well as a survey conducted in 2013 to assess the impact of the December 2012 pill crisis (n=6,000). The project involved a multidisciplinary team of 20 researchers in sociology and epidemiology.  At the same time, I have set up a qualitative survey on the same subject to shed light on the processes of risk taking. This project has given rise to a large number of international publications, including comparisons between France and the United States. I developed an original conceptual model on the abortion process that allowed me to show that social determinants can play a cumulative role or cancel each other out throughout the process, from the first sexual intercourse to the occurrence of an unplanned pregnancy, to the decision to continue or terminate the pregnancy to access to the health care system for women who use abortion. Our results were used by the French government to amend the law on the use of abortion and by those responsible for prevention to establish recommendations for good professional practices in contraception.

I then conducted a similar survey among men and health professionals, two central actors in sexual health who are almost always forgotten in research on the subject because gender norms construct these issues as exclusively the responsibility of women.

These projects have been extended internationally with a comparative qualitative survey of women, men and health professionals on contraceptive failures in Burkina Faso, Ghana, Morocco and Senegal. This project was funded by the 6th European PCRD and carried out under my scientific direction (2004-2007). In addition to researchers and doctoral students from the countries concerned, the project has involved colleagues from the London School of Hygiene and Tropical Medicine and the University of Louvain in Belgium. A special issue of Population review (French and English) was devoted to the main results and several international articles were published. Within the framework of this project, we developed an original problem on normative tensions and contraceptive practices, the heuristic nature of which was established by comparing the 360 interviews we conducted.

Finally, the last three years have been devoted to work on the political valorisation of research within the Defender of Rights, an Independent Constitutional Authority, in charge of assuring that fundamental human rights are being respected in France. The head of this institution asked me to come and take over the management of the fight against discrimination and the defence of children's rights, since he considered it necessary for this mission to be carried out by a person from the world of social science research who was a specialist in gender and discrimination issues. At the head  of a multidisciplinary team of 30 people (lawyers, political scientists , demographers, sociologists), I advised on draft laws, carried out several national surveys, proposed training and awareness-raising activities, highlighting an intersectional gender approach. All this work was done in collaboration with similar structures and relevant European equality bodies.

Since  my return to research in 2018, I have set up a new research project on “Sexuality and intersectionality”, requested and funded by the National AIDS Research Agency. This project will be an opportunity to develop a true intersectional approach, allowing gender effects to be understood while taking into account social class and race/ethnicity relations.It will also allow us to study many contemporary issues such as sexuality in the digital age, the social impact of the #metoo movement, and gynaecological violence.

I am also developing a research programme on "Gender and Health", the general objective of which is to study  how gender intersects with other social hierarchies (social class and race/ethnicity) to produce social inequalities in health from early childhood to late adulthood.

Scientific summary

In all European countries, social inequalities in health remain pervasive. Much research has identified a number of social stratifiers of health while others have specified the role of the health care system in contributing to the evolution of health inequalities. However, gender, as a social relation of power between men and women, is rarely considered as a key determinant of health inequalities, and when it is, theoretical frameworks are rarely relevant. Furthermore, while social science studies generally ignore biological processes, sex differences in biomedical research are often interpreted as biologically irreducible.  

My research aims to explain how gender intersects with other social hierarchies (social class and race/ethnicity) to produce social inequalities in health from early childhood to late adulthood:

1)"gendered embodied health" or how (un)healthy bodies are socially constructed,

2) "gendered health care cascade" or how health-seeking behaviours and patterns of care are shaped by gender. Within this framework, we focus on hypertension and myocardial infarction, depression, Alzheimer’s disease and colorectal cancer.

My approach is  multidisciplinary, associating social sciences and epidemiology, in close collaboration with clinicians. It is studied in the field of mental health, cardiovascular diseases, cancer and Alzheimer's disease, through quantitative and qualitative surveys.

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