How do masculinity, paternity leave, and mortality associate? –A study of fathers in the Swedish parental & child cohort of 1988/89

https://doi.org/10.1016/j.socscimed.2010.05.008Get rights and content

Abstract

One of the proposed causes for the gender gap in longevity is the attitudes and practices culturally prescribed for men, often conceptualised as ‘masculinity’. It has also been suggested that paternity leave, indicating a change from breadwinning to caring, could benefit men’s lifetime health. In this study, the objective was to examine associations between ‘masculinity’ (assessed at the age of 18–19 years), paternity leave (1988–1990), and mortality patterns (1991–2008) based on a population of Swedish men who had a child in 1988/89 (N = 72,569). ‘Masculinity’ was measured during the compulsory military conscription process by a psychologist based on leisure and occupational interests, and paternity leave was measured in fulltime days by registry data. The main finding was that low ‘masculinity’ ranking increased the risk of all-cause mortality, and mortality from alcohol and violent causes, while taking paternity leave between 30 and 135 days decreased the risk of all-cause mortality. However, the weak association found between ‘masculinity’ and paternity leave indicates that entering a caring role as a father is not predicted by ‘masculinity’ assessed in late adolescence, and that the studied phenomena influence male mortality independently of each other.

Introduction

The question as to why men live shorter lives than women has been asked and examined many times. Yet, it is our belief that it deserves continued attention. Potential causes are still disregarded and strategies targeting them may well generate health and welfare gains among both sexes. In this paper, the focus is on two likely contributors to the gender gap in longevity. The first regards the fact that life-threatening attitudes and practices not only vary according to sex, but also are likely to vary according to type of ‘masculinity’. The second regards the changes brought about in the traditional division between male breadwinning and female caring resulting from paternity leave.

Freud was certainly right when stating that the concepts of ‘masculinity’ and ‘femininity’ are among the most confused in science (Connell, 1995). Yet, much research has been done in order to clarify and measure them for their possible impact on health and well-being (Connell, 1995, Constantinop1e, 1973). Among the early tests of ‘masculinity’–‘femininity’ were the Strong Vocational Interest Blank based on men’s and women’s preferences for various careers (Strong, 1936), and the Minnesota Multiphase Personality Inventory (Hathaway & McKinley, 1943) based on interest patterns among soldiers. These measurements were basically bipolar, dichotomising ’masculinity’ and ’femininity’ into instrumentality and expressiveness on a uni-dimensional scale. The most utilised test in recent health-related research has been the Bem Sex Role Inventory (Bem, 1974) in which ‘masculinity’ and ‘femininity’ are defined as traits particularly desirable or acceptable in men and women, respectively; for men, this involves for example defending their own beliefs, strong personality, forcefulness, leadership abilities, willingness to take risks, and aggressiveness. This measurement introduces, not only a step away from essentialism, but also a two-dimensionality in its focus on culturally desirable-undesirable traits.

Several links have been proposed between ‘masculinity’–‘femininity’ and health. An early belief was that high scores of ‘masculinity’ would link to healthiness among men, while high scores of ‘femininity’ would link to healthiness among women (Holmlund, 2006). Yet, it has also been suggested that central to the very essence of ‘masculinity’ is choosing hazardous professions, taking risks in traffic, drinking alcohol in excess, refusing health care, etc., which generally makes ‘masculinity’ more life-threatening than ‘femininity’ (Courtenay, 2000, Sabo and Gordon, 1995). Further, Bem hypothesised when introducing her Sex Role Inventory, those individuals who scored high on both masculine and feminine traits (androgyny) were most likely to be flexible and thus healthy individuals.

Another role-related theory is that the risk of morbidity and mortality among men varies by the type of ‘masculinity’ they adopt (Courtenay, 2000, Person, 2006, Pyke, 1996). Connell, 1995, Connell, 2002 has proposed three main categories: “hegemonic masculinity” refers to the situation where men achieve the mostly highly valued ‘masculine’ ideals at any given place and time, “complicit masculinity” refers to the situation where men do not achieve but support in principle the hegemonic ideals, and “subordinated masculinity” refers to the situation where men neither achieve nor support the hegemonic ideals. A potential hypothesis is that achieving the hegemonic ‘masculinity’ of strength, ambition, and self-reliance promotes healthiness through physical activity, educational aspiration, high incomes, etc. It could also be hypothesised that failing to achieve these ideals involves stress and mental ill-health as well as increased mortality through adopting risky behaviour patterns in order to compensate for a threatened social position (Messerschmidt, 1993).

Much of the critique against measurements of ‘masculinity’ and ‘femininity’ has concerned the validity of dichotomisation (Constantinop1e, 1973). Further, the concepts lack, as with all social constructions, essence and may be seen as non measurable properties; for example, concepts associated with sex change over time and it is not only men who behave in a ‘masculine’ way. The link between ‘masculinity’ and health is however not about the attribution (and idealisation) of good or bad practices, but about the consequences of actual practices. When relating any ‘masculinity’ measure to health, one must consider that ‘masculinity’ holds a plethora of aspects of ‘masculinities’. With regard to health effects these can be conceptualised as either the ”positive masculinity” of socially desirable traits like intellectual ambition and physical activity, or the “negative masculinity” of socially undesirable traits like aggression, egotism, and laziness (Helgesson, 1995).

The empirical evidence on ‘masculinity’ and mortality is not only limited, the adoption of different measures founded on different ideas of ‘masculinity’ makes comparisons between studies hard. From the United Kingdom it has been reported that those scoring high on ‘masculinity’ according to the Bem Sex Role Inventory had, relative to those scoring low or androgynously, an increased risk of coronary heart disease (Hunt, Lewars, Emslie, & Batty, 2007). A risk increase for the high ‘masculinity’ group was also found regarding consumption of alcohol and tobacco, which indicate subsequent gendered patterns of mortality (Emslie, Hunt, & Macintyre, 2002). However, the Bem Sex Role Inventory has also been used among the United Kingdom population to demonstrate that the higher the ‘masculinity’, the lower the risk of suicidal thoughts (Hunt, Sweeting, Keoghan, & Platt, 2006). Studies using a uni-dimensional ‘masculinity’ scale have also found contrasting results. From the United States it has been reported that high ‘masculinity’ scores defined by the Strong Vocational Interest Blank are associated with increased risk of all-cause mortality (Lippa, Martin, & Friedman, 2000). In contrast, a study among Swedish men scored by a psychologist on the ‘masculinity’ of their vocational and leisure interests, found that low ‘masculinity’ ranks were associated with increased risks of all-cause mortality and suicide after adjustment for several risk factors (Månsdotter, Lundin, Falkstedt, & Hemmingsson, 2009).

In 1974, Sweden was the first country in the world to offer fathers the chance to take paid parental leave. Since then, the parental insurance system has undergone several revisions regarding the number of days, level of payments, and opportunity to allocate reserved days to the other parent (Social Insurance Agency). However, the main goal of greater gender equality persists, i.e. to enhance the potential for males in the sphere of caring work and for females in the sphere of paid work (Ferrarini, 2002). The reforms contribution to this is indicated by the development of men’s share of parental leave: 4% in 1978, 6% in 1988, 10% in 1998, and 22% in 2008 (Statistics Sweden). However, the paternity leave reform was launched within a broader context of family and social policy (Korpi, 2000). Other fundamental gender equality reforms were a regulation strengthening the dual-earner norm by separate taxation for married people in 1971, and an extended and publicly financed day care system increasing the percentage of children in day care from 17% in 1975 to 57% in 1989 (National Agency for Education). In all, the opportunity for men to take parental leave was combined with strategies targeting opportunities for women in the labour market.

An increasingly common argument nowadays as to why men should adopt caring responsibilities is that this would benefit their health and well-being (Härenstam, Aronsson, & Hammarström, 2001), i.e. it is not only for the good of women and children (Jordan, 2007). The empirical basis is that a substantial part of the gender difference in premature mortality is caused by behaviours more socially encouraged in males than in females (Courtenay, 2000, Waldron, 1976). Further, it has been proposed that women are more averse to health risks, and live longer lives due to their prime and concrete caretaking of children, since, for example, heavy drinking may interfere with childcare duties, unhealthy food habits risk being adopted by the children, and risky behaviours threaten the children’s security (Waldron, 1976). Fathers who take on caring practices may therefore develop more health-promoting attitudes and behaviours (Månsdotter, Lindholm, Lundberg, Öhman, & Winkvist, 2006).

Another reason why men could gain from alternating breadwinning with caring responsibilities is based on the concept of multiple roles (Biddle, 1986). The hypothesis of stress holds that individuals with many roles experience more stress, conflict, and ill-health since the primary life role, for men supporting duties and for women caring duties, is so hard that additional roles risk lifetime health (Goode, 1960). In contrast, the expansion hypothesis suggests that people with many roles have health advantages since they may compensate stress in one area with positive circumstances in other areas (Thoits, 1983). The conclusion from empirical research is that multiple roles benefit health among both sexes until the point of extreme stress (Barnett, 2004). In the Sweden of today, men could gain health from increased family involvement based on the expansion hypothesis, while women could gain health from decreased family involvement based on the stress hypothesis (Härenstam et al., 2001, Simon, 1995).

Included in the potential link between paternity leave and lifetime health, there are also other circumstances related to family and working life. It has for example been shown that those couples where the father takes parental leave are more stable than others (Oláh, 2001), and that moderately long paternity leave is associated with an increased chance of having a second and third child (Duvander & Andersson, 2006), both of which are associated with reduced risk of morbidity and mortality.

The research on how increased child-caring among fathers affects their health and longevity is scarce, and one evident reason is that this is still a rare phenomenon around the world. The premise in a Swedish study among men who had a child in 1978 was that the reform permitting fathers to take parental leave could have benefited men’s health by encouraging less risky lifestyles and expanding life roles (Månsdotter, Lindholm, & Winkvist, 2007). Because of the criticism that gender equality reforms are seldom economically examined for their impact on health, the study also included a cost-effectiveness analysis (Anand & Hanson, 1997). The results showed that taking paternity leave (1978–1979) was associated with a decreased risk of mortality (1980–2001) and that the paternity leave reform was cost-effective in terms of gained quality-adjusted life-years (QALYs). In another study on the same cohort, it was assumed that men’s excessive alcohol abuse relates to the expectations and practices of parenthood. Hence, a less gender stereotypical division indicated by paternity leave for men, and fulltime work soon after having a child for women, would be associated with a convergence of alcohol harm between the sexes. The result showed that less gender stereotypical fathers in the late 1970s had a decreased risk, while less gender stereotypical mothers had an increased risk, of morbidity and mortality caused by alcohol during the following two decades (Månsdotter, Backhans, & Hallqvist, 2008). However, from the parental cohort of 1978 it has also been reported that the relative taking of parental leave regarding mothers and fathers does not associate with risks of sickness leave and mortality (Månsdotter et al., 2006).

There are reasons to assume that the above discussed phenomenon of ‘masculinity’, paternity leave, and lifetime health are linked. It could be that taking paternity leave offers protection against the health-damaging attitudes and behaviours culturally associated with ‘masculinity’, making men less vulnerable to gendered causes of death (Månsdotter et al., 2007, Waldron, 1976). On the other hand, at the core of the concepts of ‘masculinity’ and ‘femininity’ is the presumption that men are supposed to support a family while women are supposed to take care of it (Connell, 2002, Harding, 1986) and that paternity leave may simply be a proxy of deviation from traditional ‘masculinity’. Another possibility is that the taking of paternity leave and ‘masculinity’ have more complex interactions with health and mortality; for example, men who achieve the hegemonic ‘masculinity’ can, more than complicit and subordinated men, “afford” to take on healthy (female) practices without risking their social position (Connell, 1995).

The overall objective of the study was to examine associations between ‘masculinity’ (assessed at age 18–19), paternity leave (1988–1990), and mortality patterns (1991–2008) among Swedish men who had a child in 1988/89. The specific questions were:

  • -

    What is the association between ‘masculinity’ and all-cause/cause-specific mortality?

  • -

    What is the association between paternity leave and all-cause/cause-specific mortality?

  • -

    Is there an association between ‘masculinity’ at late adolescence and paternity leave when becoming a father?

  • -

    Do ‘masculinity’ and the taking of paternity leave interact in the mortality pattern?

Section snippets

Population

The population was selected from a cohort of all women and men in Sweden who had their first child together in 1988/89 (N = 118,595 parental/child units). The inclusion criteria were that data from the military conscription process on ‘masculinity’ should exist (which excludes fathers born before 1950) and that the father, and associated mother and child, were alive during the years 1988–1990 (which represents the period for measuring paternity leave). This leaves a study population of 72,569

Mortality patterns and socioeconomic factors by ‘masculinity’ and paternity leave

The distributions of mortality patterns and confounders by ‘masculinity’ rank and paternity leave category are reported in Table 1, Table 2. All-cause mortality follows a decreasing trend from lowest (3.9%) to highest ‘masculinity’ (1.3%), and from taking 0 days (2.3%) to 31–60 days (1.3%) of paternity leave. However, the two categories with more than 60 days of paternity leave are associated with increased proportions (1.5% and 1.9%, respectively). The age at parenthood is quite consistent

Main findings

In this study, we found that low ‘masculinity’ ranking was associated with an increased risk of all-cause mortality, alcohol related mortality, and mortality from violent causes other than suicide, while paternity leave of more than 30 days but less than 136 days was associated with a decreased risk of all-cause mortality among Swedish men who had a child in 1988/89. ‘Masculinity’ as assessed at age 18–19 years was not decisive for the level of future paternity leave (1988–1990), and neither

Conclusion

This study has shown that being ranked low on ‘masculinity’ is associated with a higher risk of mortality, while taking paternity leave is associated with a lower risk of mortality among middle-aged fathers in Sweden. It was also indicated that ‘masculinity’ and paternity leave work through separate causal pathways to mortality. Overall, strategies aimed at less gender-stereotypical expectations on what a man “should do” are on the whole likely to benefit male health, and potentially reduce the

Acknowledgments

Financial support from the Swedish Council for Working Life and Social Research (Dnr 2007-0091), and the Swedish Research Council (Dnr 2007-2804), is greatly acknowledged.

References (44)

  • R.W. Connell

    Gender

    (2002)
  • A. Constantinop1e

    Masculinity-femininity: an exception to a famous dictum

    Psychological Bulletin

    (1973)
  • A. Duvander et al.

    Gender equality and fertility in Sweden: a study on the impact of the father’s uptake of parental leave on continued childbearing

    Marriage and Family Review

    (2006)
  • R. Egbert et al.

    Fighter I: An analysis of combat fighters and non-fighters

    (1957)
  • C. Emslie et al.

    How similar are the smoking and drinking habits of men and women in non-manual jobs?

    European Journal of Public Health

    (2002)
  • Ferrarini, T. (2002). Parental leave institutions in eighteen post-war welfare states. Dissertation. Swedish Institute...
  • W.J. Goode

    A theory of role strain

    American Sociological Review

    (1960)
  • S. Harding

    The science questions in feminism

    (1986)
  • A. Härenstam et al.

    The future of gender inequalities in health

  • S.R. Hathaway et al.

    The Minnesota multiphasic personality inventory

    (1943)
  • V.S. Helgesson

    Masculinity, men’s roles, and coronary heart disease

  • U. Holmlund

    Change and stability of masculinity-femininity from adolescence to adulthood in a sample of Swedish women

    European Journal of Personality

    (2006)
  • Cited by (30)

    • Preventing intimate partner violence through paid parental leave policies

      2018, Preventive Medicine
      Citation Excerpt :

      This is particularly problematic for learning more about subpopulations in which gender role norms may differ from typical patriarchal gender norms (e.g., cisgender individuals and those in same sex relationships). Despite these unknowns, there are clear benefits of paid parental leave (Chatterji and Markowitz, 2012; Goodman, 2012; Huang and Yang, 2015; Johansson et al., 2014; Månsdotter et al., 2006; Månsdotter and Lundin, 2010; Saadé et al., 2010; Whitehouse et al., 2013). As such, exploring additional outcomes (i.e., IPV prevention) seems only logical.

    View all citing articles on Scopus
    View full text