Elsevier

Health & Place

Volume 18, Issue 2, March 2012, Pages 199-208
Health & Place

Does non-employment contribute to the health disadvantage among lone mothers in Britain, Italy and Sweden? Synergy effects and the meaning of family policy

https://doi.org/10.1016/j.healthplace.2011.09.007Get rights and content

Abstract

This study analyses self-rated health and non-employment and potential synergy effects among lone and couple mothers aged 25–59 in Britain, Sweden and Italy, representing different family policy categories using data from national surveys (2000–2005). Synergy effects on health were calculated by synergy index. Non-employment only marginally contributed to the excess risk of poor health among lone mothers but there were synergy effects between lone motherhood and non-employment in all three countries, producing a higher risk of poor health than would be expected from a simple addition of these exposures. Results are discussed in relation to the different family policy and living contexts.

Introduction

Combating poverty and increasing the standard of living among disadvantaged groups is a basic purpose of developed welfare states. Lone mothers, being an economically vulnerable group of women, have been proposed as a litmus test as to how family policy regimes operate (Burstrom et al., 2010). This article builds on our previous study of health inequalities between lone and couple mothers in different family policy regimes (Burstrom et al., 2010), and adds sub-group analysis of a particularly vulnerable group of the lone mothers; the non-employed.

As Bambra and Eikemo (2009) recently showed, the associations between employment status and health play out differently in different countries. Several studies have found positive health effects of combining employment and family for women, including lone mothers (Fokkema, 2002, Lahelma and Arber, 2002, Artazcoz and Borrell, 2004, Zabkiewicz, 2010). Just as unemployment has been associated with worse physical and mental health (Bartley et al., 2006), and with negative health behaviours such as smoking (Waldron and Lye, 1989), women who are keeping house full time are more likely to report ill health, compared to those in employment (Bartley et al., 2006). Studies have shown that there may be health selection into non-employment (Jusot et al., 2008).

However, the relation between employment and health may be different among men and women, in different social groups, and in different national contexts, where the meaning of paid employment may vary because of norms, values and policies. Family policy encompasses policies for reconciling employment and parenthood (Gornick and Meyers, 2003). These are of particular salience to parents with dependent children, and especially for lone mothers. Labour market opportunities for women vary between different welfare systems and by social groups, and these country differences are further related to family policy. For example, in countries with “earner–carer” (dual earner) policies, employment rates are higher among women with low or medium education than in countries with “market-oriented” and “traditional-family” policies (Korpi and Ferrarini, 2011).

Drawing specific examples of distinctive family policy categories from the typology, originally developed by Korpi (2000), and elaborated by Ferrarini (2006), we analyse country level data from countries where we have in depth knowledge of the policy framework and living conditions among lone mothers. In this study, we aim to compare health and non-employment experiences of lone and couple mothers in different social positions in Britain, Sweden and Italy. We analyse empirically the social characteristics and composition of lone motherhood, exposures to non-employment, the association between non-employment and health and calculations of synergy effects between non-employment and lone motherhood on health. Finally we discuss the observed findings in relation to policy and living conditions for lone mothers in each country. As there are relatively few lone fathers in our datasets and both the explanations for poor health and the employment policy context are likely to differ for men and women, we have not included lone fathers in the study presented here, but they are the subject of future studies.

As arrangements differ widely between countries, various welfare state typologies have been proposed, including the most recent models based on institutional structures of relevance for both gender inequality and class inequality that take special account of the expansion of family policy and its effects on the lives of women (Korpi, 2000, Ferrarini, 2006, Lundberg and Yngwe, 2008, Ferrarini and Norstrom, 2010). Family policies are multidimensional and reflect conflicting political forces as well as religion. The main distinction is made by whether they favour traditional families, market reliance or mother's employment. This typology groups countries similarly to the well-known overall welfare typology of Esping-Andersen (1990). The difference, however, is that the focus here solely is on institutional dimensions of family policy.

Fig. 1 illustrates the categorisation of family policy along two dimensions: the degree to which policy supports a traditional, nuclear family (where benefits, tax relief and leave entitlements support the father as the main breadwinner and the mother to stay at home to care for children) and the degree to which policy supports a dual-earner family. The exact operationalization of the model is spelled out in detail in Ferrarini and Norstrom (2010). The categorisation of countries should not be regarded as fixed, but may change as policy shifts. Below we discuss what outcomes the institutional differences in family policy have in terms of arrangements for employment and parenting for mothers in our chosen countries.

In this typology, Britain falls into the ‘Market-oriented model’ with lower levels of support in both dimensions, leaving families to deal with family support and childcare privately through the market. Traditionally, employment rates have been low among mothers in Britain, especially among lone mothers, who have received financial support to stay at home with their children. Since the late 1990s and until recently, however, a range of social and employment policies have been introduced to support maternal employment (Cebulla and Flore, 2008, Lewis and Knijn, 2008) and these efforts have increased employment rates of lone mothers. Flexible employment and family friendly policies have been introduced through legislation and both maternal and paternal leave and benefits have been improved albeit from a comparatively low level (La Valle et al., 2008). At the same time, there was extensive investment in making childcare more available and affordable, with the National Childcare Strategy introducing 15 h per week of free early years education for three and four year olds and a subsidy for childcare for working low and middle income families (La Valle et al., 2008). Childcare for children aged below three is generally provided by parents, grandparents or child-minders (Lewis et al., 2008). Whilst these reforms have had a positive effect on lone mothers employment (Gregg et al., 2009), the limited provision of low-cost, flexible childcare for low income parents and lone mothers in particular, remains a barrier to employment (Finch, 2008, LaValle and Smith, 2009).

Italy falls into the ‘Traditional family policy model’, orientated towards preserving traditional family patterns with highly gendered divisions of labour within families. Tax benefits for a working male with a dependent partner and flat-rate childcare leave benefits encourage mothers to stay at home. Family and relatives are expected to provide support and the welfare state has only a residual role to tackle very critical situations, when individuals and families are poor in a manifest way and are entitled to become public assistance recipients. Negative attitudes towards mothers' employment are more prevalent than in the other policy categories (Korpi, 2000). As in the rest of southern Europe, women tend either not to work at all, or work full-time and continuously, and lone mothers are often in the latter category (Orloff, 2002, Sabbadini, 2006). Childcare in Italy is generally high in quality, but availability is limited and heterogeneous across regions, and offers low flexibility in hours of service (Del Boca and Vuri, 2007). Family support is thus necessary, and the availability of informal childcare increases the probability of mothers' employment (Del Boca and Vuri, 2007). It is especially common that grandmothers mind children aged below three, for whom childcare is not readily available (Naldini and Saraceno, 2008). The downside to informal childcare is family dependency for lone mothers (Solera, 1998).

Sweden falls into the ‘Dual-earner model’, encouraging both fathers and mothers to work through family-friendly employment policies (including generous parental leave and possibilities to reduce work hours) and subsidised universal pre-school childcare provision. The employment rates of mothers including lone mothers' in Sweden are thus among the highest in Europe. However, the employment rate among lone mothers has declined during the last decade. Childcare in Sweden is generally considered to be of high quality and affordable, fees are income related (with a low ceiling) and heavily subsidised and available full time from the child's first birthday (Ferrarini and Duvander, 2010). Recent changes in family policy includes the implementation of the “daddy-months” in the parental leave system, but also a flat rate home care allowance that allows a parent to stay home and tend to small children and receive a relatively low monthly allowance for this (Ferrarini and Duvander, 2010). These observed differences between the countries might suggest that the relationship between lone motherhood, non-employment and health might vary.

Lone motherhood is associated with worse health in all three countries (Burstrom et al., 2010). Three main pathways to ill health have been proposed in the literature: material, behavioural and psychosocial pathways (Marmot, 2006). Discussing how non-employment may be related to poor health among lone mothers, the material aspect is important. Studies have shown that household labour market attachment has become increasingly important for alleviating poverty risks (Fritzell and Ritakallio, 2010). In many welfare systems, employment also generates eligibility for welfare resources. Being non-employed could result in poverty, which may affect health in several ways. Besides the direct effect of material scarcity, the alienation from society and stigma also affect health (Reid and Tom, 2006). This relates to the psychosocial pathway.

As noted by many researchers, life styles and health behaviours such as smoking, lack of exercise, poor nutrition, etc. are strongly linked to social position, and as such are more prevalent among persons with low education and the unemployed and among lone mothers in some countries. Non-employment in this study is regarded as a potential explanatory factor in the association between lone motherhood and poor health. As noted, mothers' employment rates vary between the countries. There are many reasons for women's economic inactivity, which may also differ between countries. A study analysing women's disconnection from the labour market in England showed that (excluding students) this group included: full time homemakers; retired people; those who are not in employment because of long term illness or disability; and those who were seeking employment but were not available for work in the next two weeks (Grant, 2009). Of those who are economically inactive, there may be a large proportion who want to work, but who are restrained from doing so (Grant, 2009). We also distinguish a group that is economically active but not employed; the unemployed. The ‘non-employed’ category is therefore made up of three main groups: people of working age who are available for employment and actively seeking employment but without jobs, labelled ‘unemployed’; people of working age who are not available for employment and not seeking it due to a variety of reasons: for example permanent sickness, early retirement, students in education, labelled ‘economically inactive’. A specific sub-group within the ‘economically inactive’ category are singled out for separate analysis and these are homemakers; people of working age who are not employed as they stay at home to care for the family (children or elder relatives). This represents a significant sub-group in the context of motherhood and employment.

Section snippets

Aim

This study analyses the relationship between non-employment and health among lone and couple mothers in three different family policy models. Furthermore, we investigate whether there are synergy effects between being a lone mother and non-employed on health in these different settings, and discuss the results related to policy and actual living conditions.

Datasets

National surveys based on a representative random sample of the population were used for analyses for each policy setting, identifying lone and couple mothers aged 25–59 years. For Britain we analysed data from the General Household Survey (GHS) (Office for National Statistics, 2002). The GHS is a continuous, cross-sectional survey of household in Britain, administered by face-to face interviews to all adults aged 16 and over in the selected households. Data were pooled for the years 2000–2003,

Results

Following the framework for studying pathways to inequalities in health from the social context to health outcomes (Diderichsen and Evans, 2001, Fritzell and Ringback Weitoft, 2007, Burstrom and Whitehead, 2010), we explored three principal explanations for health inequalities between non-employed lone and couple mothers; compositional factors, differential exposure to risk factors and finally, differential vulnerability to the same exposures.

Main results

The prevalence, social composition and employment status of lone motherhood differed between the countries. Lone motherhood in both Britain and Sweden was associated with increased risk of poor health, while lone mothers in Italy did not have higher risk of poor health compared to couple mothers. Poor health was more prevalent among the non-employed mothers compared to those employed, in all countries.

Non-employment only marginally contributed to the excess risk of poor health among lone

Conclusion

Being non-employed was relatively worse for lone than couple mothers' health, in all three countries studied. Lone motherhood and non-employment are dynamic states. From a public health perspective, this makes the poor health of non-employed lone mothers all the more important as it affects many women and their children, and potentially increasingly so, since lone motherhood is an increasing phenomenon. Theoretically, it could be remedied as family policy is shaped by politics. Further work

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    The paper reflects the author's personal opinions and does not involve the Italian National Institute of Statistics.

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