Social differentials in health among lone mothers in different policy contexts : financial difficulties and employment status in relation to health

Detta är en avhandling från Stockholm : Karolinska Institutet, Dept of Public Health Sciences

Sammanfattning: Lone mothers report worse health compared to couple mothers in most societies, regardless of which measure of health is chosen; whether it is mental or physical health. The poorer health of lone mothers has been linked to a lack of material resources. The aim of this thesis is to increase knowledge on how societal factors affect the health of lone mothers in different policy contexts, by specifically studying financial strain and employment status in relation to health. A key issue is also to consider the social differentials within the group lone mothers. In Study I we analysed whether economic strain is associated with excess risk of poor health among lone mothers in Sweden, by time period and income group. Data from the Swedish Survey of Living conditions (ULF) 1979-1998 were analysed using logistic regression analysis. Economic strain was associated with poor SRH and contributes to the excess risk of poor health among lone mothers. A polarisation of health was noticed among lone mothers over time, with improved health among the highest income groups, and a deterioration of health among the lowest income groups. Study II aimed to analyse whether social and policy changes in Sweden during the 1990s had adverse influence on the health of lone mothers. It was based on data from ULF (1983-2001) and routine statistics from health-data registers on severe morbidity and mortality (1985-2001), analysed by logistic regression and Poisson regression analysis respectively. The findings showed that despite an increase of poor health for lone mothers, and increased exposure to health risks such as lack of cash margin and economic strain, we did not find evidence of increased differentials in poor self-rated health, hospitalization or mortality over time between lone and couple mothers. Non-employed lone mothers had particularly poor health. In Study III, we analysed how non-employment and health is associated among lone and couple mothers in countries with different family policy models. Data from national surveys from Britain, Italy and Sweden (2000-2005) were analysed using logistic regression analysis and the synergy index. Non-employment only marginally contributed to the excess risk of poor health among lone mothers found in Britain and Sweden but there were indications of synergy effects between lone motherhood and non-employment, causing a higher risk of poor health than would be expected from a simple addition of these exposures, in Britain, Italy and Sweden. The aim of Study IV was to analyse the experiences and strategies of everyday life of Swedish lone mothers with financial strain in relation to maintaining health. The study was performed in Sweden 2010 and based on four focus group discussions with 15 participants. The thematic analysis was informed by critical discourse analysis, positioning theory and the concept of agency. The findings showed that lone mothers find themselves in a pressing context, where their financial situation and shortage of time to a high degree restrains their possibilities of maintaining health and to participate in society. Improving the economic conditions for lone mothers is important for their health, and for their social and financial participation in society. Improving the possibilities to combine employment and lone parenthood and ensuring sufficient economic conditions for lone mothers without employment is within the scope of social policy.

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