Psychosocial Adjustment of Women with Work-related Disabilities in Rural China Karen Y. L. Lo-Hui Hong Kong Workers’ Health Centre, Hong Kong SAR, People’s Republic of China Lilian Luo & Xiaoshan Yang Guangdong Provincial Work Injury Rehabilitation Centre, People’s Republic of China Abstract: The impact of gender roles on the psychosocial adjustment of women in rural China with work related disabilities is explored. The influence of economic reform, traditional family orientation, and gender expectations on the ability of women to work in rural China are discussed via three case studies. Keywords: Gender, China, disability experience In the past few years, there were a number of reforms of the work injury insurance system in China. The purpose of these reforms is to establish a well-organized policy framework and rehabilitation services delivery in addressing the needs of people with work injury disability. Since 2003, the staff from the Hong Kong Workers’ Health Centre and the Guangdong Provincial Work Injury Rehabilitation Center have worked together to explore the psychosocial and vocational rehabilitation needs of people with work injury disability and have begun to apply the case management model to develop the first occupational and social rehabilitation service protocol for people with work injury in China (Lo-Hui et al., 2005). In the process of exploring the psychosocial and vocational rehabilitation needs of people with work injury disability, it was clear that a portion of these workers were coming from rural China and experienced a work injury while they worked in urban cities. In supporting the occupational and social rehabilitation of these injured migrant workers, the authors, as the rehabilitation practitioners, started to recognize a gender difference related to their psychosocial adjustment. The awareness of this gender difference stimulated this discussion of the psychosocial adjustment of women with work-related disabilities who originated from rural China. The Economic Reform of China After a 29 year experiment in establishing a communist economic system in China, a drastic economic reform began in 1978 commonly referred to as an “open door policy.” For the past few decades since 1978, many Hong Kong, Taiwan, and overseas enterprises have moved their production base to the coastal areas of Mainland China. By setting up the production lines in these coastal areas, many of the multinational companies captured the competitive advantage via lowering labor costs associated with production. More and more products in the world have been tagged as “Made in China” as China positioned herself as a “world factory.” The rapid economic changes also parallel drastic social changes. This economic reform provided an opportunity for people from rural China to work in the factories in the cities of China as migrant workers. The hukou system (residential registration) in China officially limits people to change their residential registration other than their birth place. Therefore, many of these migrant workers are growing up in rural China while they are temporarily and unofficially working in the factories in coastal cities. They are counted as the “floating population” in China (Jacka & Gaetano, 2004); the estimated size of the floating population was around 211 million in 2009 (Takungpao, 2010). A proportion of the floating population consists of young females coming from rural China; they are named dagonmei (working sisters). Most of these migrant women are single and either in their teenage years or early twenties. Traditional Culture and Gender Roles in Rural China One of the core traditional cultural aspects in rural China is the value system of familism (Yuen, Law, & Ho, 2004). One of the common understandings of familism refers to core values of a family type which emphasizes commitment to the family as a unit (Sociologyindex, 2010). The key relationship in Chinese familism is the bonding of father-son as the center of other relationships within the family. Women, on the other hand, are subservient within the family. Therefore, a male dominated “patriarchal culture” is one of the characteristics of Chinese familism (Yuen, Law & Ho, 2004). This implies that men are treated as superior while women are treated as inferior and expected to follow the commands of the men. One of the famous Confucian teachings on the traditional role of women is: a woman has to obey her father in her maidenhood, her husband in married life, and her son in her old age. This clearly illustrates the expectation of women in the traditional Chinese culture to stick to the family role by following the decisions of the males in the family. In fact, the traditional patriarchal Chinese culture still predominates in rural China even after decades of economic reform. The daughters are expected to leave their natal families upon marriage. These daughters would then be considered members of another family and temporary members of their natal homes (Beynon, 2004). Therefore, the educational opportunities are less for young women; many quit their study after primary school and a significant proportion are illiterate (Fan, 2004). For a rural woman, marriage is not just about finding a partner but also finding a secure home that provides stability in her life. The pressure for rural women to get married escalates once they have reached their early twenties. Traditionally, rural women are expected to do the housework and support the family farming before and after marriage (Fan, 2004). The contributions of rural women, especially unmarried daughters in general, are undervalued. Working Before Marriage After finishing school, while most of the young women are still too young to get married, they become a surplus labor force in rural China. As previously stated, marriage is then expected in the mid-twenties (Fan, 2004). Thus, the production lines of manufacturing products as “Made in China” in coastal areas creates an opportunity for these women and girls to work as dagonmei (working sisters) and become more economically independent while living in the cities. In exploring the subjective experience of migrant women, motives for the out-migration from rural to urban cities was due to several reasons: (1) the escape from enduring gender oppression or violence; (2) the expectation of having autonomy from the patriarchal authority of parents; and (3) a broadening of horizons by working in urban areas (Jacka & Gaetano, 2004). As the majority of these migrant women are young and single, this may also provide an opportunity to evade early marriage and early motherhood by seeking a sense of independence (Beynon, 2004). While most of these women had earned an independent living and were exposed to a more modern city when they worked in the factories of cities, they were mostly nurtured in traditional Chinese culture with a clear division of work and expectations of the female role in the family. They were still expected to return to their village to get married and find a permanent home for themselves. The beginning of married life is a critical turning point for these migrant women. They become settled and their “career” as migrant women ends. (Some may still move out to work again in the city as migrant women after marriage, and economic expectations are the major motivation for this migration in order to support child and family expenditures.) Under this social and cultural context, work accidents occurred in the factories, resulting in an impairment of these single migrant women. Problem of Work Injury The statistics provided by the Ministry of Human Resources and Social Security of the People’s Republic of China showed that the country has approximately 148 million workers joining the work injury insurance scheme. This program is provided by the government’s social security department. . In 2009, 950,000 workers experienced a work injury; 390,000 resulted in a disability. Considering those workers were injured in prior years, approximately 1.3 million workers experience a work injury and were covered under the work injury compensation system in China during 2009. The number of work injuries is increasing (China Economic Net, 2010). Work accidents occurring in the workplace result in a range of severity levels from cutting fingers to burn injuries to spinal cord injuries. Methods The study aim is to explore how the gender role of traditional Chinese culture in rural China impacts the psychosocial adjustment of single migrant women after experiencing a physical disability due to work injury. A qualitative case study approach was utilized. Case study is one of the research methodologies for researchers to study complex phenomena within their contexts (Baxter & Jack, 2008). This approach allows a close collaboration between the research and the research participant enabling the participant to tell her story. This in turn provides insight into our comprehension of specific social phenomenon. Three cases were selected from the list of female patients of Guangdong Provincial Work Injury Rehabilitation Center. These are single migrant women who grew up in rural China. Afterwards, each moved from rural China in order to work in Guangdong Province (one of the coastal provinces in South China). Each experienced a work injury resulting in different functional impairments. Case Background Case 1: Ms A, is a single, currently 19 year old woman with a junior high school education. She moved from a rural village in Henan Province of China and began working at a coastal city in early 2009. After only two months of working in the coastal city, she experienced a neck injury due to a work accident which resulted in paralysis. Her parents live in a rural village and she has a younger brother studying at primary school in a home village. At the time of the interview, she was still receiving rehabilitation treatment in the Guangdong Provincial Work Injury Rehabilitation Center. Case 2: Ms B, is a single, 24 year old woman with a high school education. She moved from a rural village in Guangxi Province of China to work in a coastal city. She experienced a crush injury at work in 2007 which resulted in a right-hand impairment. Her parents live in a rural village. At the time of interview, she was still searching for a job in the city. Case 3: Ms C, is a single, 25 year old woman with a junior high school education. She moved from a rural village in Henan Province of China and worked in a factory of a coastal city. She experienced a burn injury at work in 2006. This resulted in an 85% burn scar and facial disfigurement. Her parents are farmers in a rural village and she has an elder brother who also worked in the city at the time of her work injury. At the time of interview, she was working as an instructor of handicrafts for a vocational support program in a hospital in the city. In order to provide a framework of the interview, a semi-structured interview guideline was written for reference. The questions and answers of these interviews were documented for review and analysis. Common concerns were identified in reviewing participant experiences in psychosocial adjustment to a disability. Results After reviewing the participant interview records, the major reasons for moving out from rural China to work in coastal areas were to earn more money and expand their horizons. This is similar to the other female migrant workers in other studies (Jacka & Gaetano, 2004). The following issues were identified as important concerns related to adjustment to disability. Became a Burden to the Family In all the cases, the migrant women shared that one of their strong worries over the course of having a work injury was their “becoming a burden for the family.” Instead of presenting shock, denial, or anger feelings immediately after the work injury, they claimed that they had strong guilt feelings toward their parents due to having a disability. This became a strong motivation to commit to training in self-care by improving their functions in performing activities of daily living. Ms A: “My first reaction immediately after the injury was to practice rehabilitation and hope to recover as soon as possible, so that I don’t add a burden into my family. I did worry about my parents as they are old now and physically not healthy. It is such a trauma for them to witness the suffering of disability of me.” Ms B: “I was worrying that I need to be cared by my parents in the future. I hope to less the burden of my parents by learning the rehabilitation”. Ms C: “My parents did cries out strongly in visiting me at hospital and I was worrying about bringing more burdens to the family after suffering from work injury. So, I told myself that I need to be tough and if I could learn to perform the self-care, then maybe I will be able to live independently without bordering [bothering] my parents.” Marriage Concern Ms C said that she was planning to return to the village just before the work injury for marriage as she was approaching her mid-twenties, which is the expected latest marriage age for females in rural China. Ms B also mentioned her plan to get married in her mid-twenties and then settle down in a rural village after giving birth to a child. While for Ms A, she said that she was too young to consider marriage. For both the cases of Ms B and Ms C, they indirectly shared their hopelessness in having a partner for marriage in the future after suffering from a disability. They worry about being “looked down upon” by the man or his family members due to the disability. Ms B: “I don’t want to talk about marriage with others after suffering from disability. Even when I can get marriage (sic), I may still worry as being look down by the partner and in-law family due to the disability.” Ms C: “I still hope to try to find a husband but it is important for finding a man who will not discriminate [against] me due to the disability.” Community Inclusion and Discrimination The worry of discrimination, no matter if it is from the strangers on the street or from close relatives, creates a strong pressure on these migrant women after experiencing a disability. They did not just worry about the discrimination on themselves but also that of their family members by revealing a feeling of shame after suffering from a disability. Ms A: “I am worrying to return back to my home village to meet all the close friends and relatives as I was once an able person before but now became disabled.” Ms B: “Since people in my village know me well before suffering from disability, I don’t know how to response with their pity on my existing situation in returning back home. I also worry about my parents as how they cope with the reactions of other relatives on my disability.” Ms C: “Originally, I planned to stay in Guangzhou (the city in coastal area) instead of returning back to village as I was worrying over the reactions of friends and relatives to me and also to my family. However, I also found the curious expression of the strangers when they looked at me and I felt being discriminated.” Personal Life Planning When asked about the most major impact of the disability upon their personal life planning, all of them voiced that the disruption of their plan to get married was the most problematic issue they faced. The disability also limited their choice in job searching. For the future life planning, they all shared ambivalence in returning back to their home village versus staying in the city for independent living. Ms A: “I will probably return back home as all my family members and friends or relatives were staying here. . .but it is not clear for how I could continue to live in the village.” Ms B: “I hope to stay in Guangzhou (the city in coastal area) if there is still a possibility for me to work in a shelter workshop as it might be less discriminative in these workshops. However, my parents would like me to return to home village. I am still thinking about this.” Ms C: “I was fluctuating in considering whether or not to return to home village. Originally, I planned to live independently in the city and tried to find a job. However, the living standard was very high in the city and I once decided to go home even though I worried about the reaction of my friends and relatives on my disability. My grand-parents were hurt when they visualized my facial disfigurement. Then, I moved back to the city again and hope to settle myself down here.” Discussion In reviewing the case studies, we found that the four key concerns were rooted in the gender roles nurtured in the traditional Chinese culture in rural China. The concern of becoming a burden on the family was related to the fact that women are inferior in the traditional Chinese culture in rural China. The experience of disability will further de-value the role of these women in her natural family. This creates a stress in psychosocial adjustment of disability for these migrant women with work injury. The self value and self concept of these migrant women after suffering from disability will be, to a large extent, based on the reactions of the significant others in the natural family. Marriage is a critical concern voiced by these migrant women with disability. Migrant women working in cities are viewed by them and their parents as a temporary arrangement, and they are all expected to get married in their mid-twenties by finding a “home” to settle in. Therefore, the experience of disability will decrease their chance of getting married. Without the long term support from the members of their natural family, these women also have to worry about the discrimination from the potential husband and the in-law family. The concern of community inclusion and discrimination, especially from the friends or relatives of the village, was very distinctive in the migrant women with disabilities. These women are not just worrying about the discrimination on themselves, but also against their parents and members of the natural family. As culturally expected, unmarried young woman are only supposed to temporarily stay in the natural family until marriage. This will create a problem of her survival in the natural family when her disability brings more social and economic pressure to the parents or other members in the family. This will also help explain the reason why these migrant women will have ambivalence in choosing between the options of returning back to their home villages versus staying in the city after experiencing a disability. Unless there was a very strong social and family support in the home village, these single migrant women with disability will found it very harsh to stay permanently in the home village as they were all treated as “another family member” in the patriarchal marriage system in rural China. The above considerations were very different from the male migrant workers as served by the authors in the rehabilitation center. In general, the male migrant workers with disability secured more social and family support from their parents and relatives of the home village due to the fact that they are the “sons” in the family and are treated as permanent members in the existing family. Many of the parents and the relatives of these male migrant workers actively arranged the marriage for their sons with disability by identifying suitable girls in rural China to “take care” of their sons in the long run. The concern on whether to stay in the city or return back to the home village of these male migrant workers was mainly due to the consideration of more work opportunities or transportation accommodations for people with disability in the city. In conclusion, we found that as young women are treated as the temporary members of their natural family and are expected to find a new home by getting married due to the traditional Chinese culture in rural China, this creates further psychosocial stress for these single migrant women in adjusting to their disability due to work accidents. It also limits the potential family and social support from the home village for these migrant women compared to the male migrant workers with disability in rural China. This has an implication for rehabilitation practitioners in that they need to enhance sensitivity in understanding how the gender roles of the traditional Chinese culture in rural China of these single migrant women will cause an impact on their disability experience. The results indicate that these Chinese women with disability, especially single migrant women who are coming from rural China, may face more psychosocial stress in the process of disability adjustment. Therefore, it may be ideal for rehabilitation counseling personnel to increase the intensity of service provision for this population. The discussion of the rehabilitation plan should help empower these women in resolving their ambivalence related to a return back to their home village versus staying in the city and address their concern regarding marriage. It is also important for rehabilitation counselors to facilitate the communication of these women with members of their natural family in order to strengthen their social support for community re-integration. In the long run, an occupational and social rehabilitation program may need to be tailored for these single migrant women to facilitate psychosocial adjustment to disability due to work accidents. Limitations This is a small scale case study exploring how the gender roles of Chinese culture in rural China creates an impact on the psychosocial adjustment of the migrant women with disability due to work accidents. 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