Contextualising Health Agency : Exploration of Narratives from Marginalised Women in Varanasi, India

Abstract

Gender equality and women’s empowerment are critical development goals which are highlighted by global agendas such as the Beijing Declaration and Platform for Action and the Sustainable Development Goals. A key facet of these attempts is understanding and expanding women’s agency, particularly to advance their health. However, traditional metrics often impose ideals of agency from a western standpoint and struggle to define and measure agency within women’s contexts.

This qualitative study conducted in Varanasi, India, interviewed 17 ever-married marginalised women, aged 30-49, to explore their perceptions of health and agency. Participants were selected via snowball sampling, and semi-structured face-to-face interviews were employed for data collection. Data was analysed using saliency analysis, a thematic analysis approach that ensures themes that may not necessarily repeat but hold substantial importance for the study’s objectives are retained.

The findings reveal that despite economic constraints, marginalised women demonstrate health agency. Interestingly, increased agency did not consistently improve health outcomes, with women instead prioritising family well-being, especially their children’s. Moreover, gender interests were intertwined with family well-being, shaping agency towards communal alignment. Women exercised agency collaboratively via engaging in collective decision-making, cultural practices, and power negotiations. However, physically demanding, low-paying jobs drastically affected their health, highlighting the significance of structural constraints and suggesting a strong linkage between health outcomes and economic resources.

The study emphasises the importance of considering women’s values, goals and strategic gender interests in improving well-being, warning against detached Western notions of autonomy. It stresses the need for contextualisation and genuine acknowledgment of women’s narratives in interventions to increase their overall well-being and health.