Visualizing drivers of gender health disparities: Ongoing participatory action research following the 2011 disaster in Japan

As part of an ongoing participatory action research project initiated following the 2011 Great East Japan Disaster to improve disaster policies and responses, this study examines social factors and processes that affect women's well-being in and after disasters. Using PhotoVoice methodology, the project has engaged women affected by the Great East Japan Disaster in participatory assessment and analysis over the last ten years. Begun in three sites in June 2011, the project is currently operating in seven locations: four in the coastal areas affected by the tsunami in the Iwate and Miyagi prefectures; two in Fukushima Prefecture; and one in the Tokyo Metropolitan Area, where the largest number of out-of-prefecture evacuees reside. Participating members, recruited in collaboration with local NGOs, are women affected by the disaster aged from in their 20s to over 70 years. They take photographs of their lives and attend facilitated group discussions on an ongoing basis. Participatory analysis of their photographs and narratives by members and group facilitators (including the author) uses the analytical approach of grounded theory's open and focused coding with constant comparison. The analysis identifies various ways the disaster affected women, compromising their livelihood, safety, and well-being. It reveals an interconnection between the evacuation of children and women of reproductive age, loss of employment in the female-dominated occupational sectors, and increased dependent care responsibilities, which in turn compromises women's financial and emotional well-being. The analysis also elucidates the gendered division of labor in private and public spheres, shortages of maternal and infant health care, and gender-based violence in the post-disaster context. Notably, many of these issues and connections correspond to known social determinants of health disparities. The study findings add a valuable but often neglected local perspective and call for increased policy attention to eliminating gender disparities in disasters.