Health responsibility among marginalized women in Mashhad, northeastern Iran: a critical ethnographic study

Health responsibility is a cornerstone of self-care and health promotion. However, for marginalized women, this concept is intricately shaped by intersecting cultural, social, economic, and political forces that often impede their access to care and limit their decision-making autonomy. This study, therefore, utilizes critical ethnography to explore how these structural and cultural conditions shape marginalized women’s understanding and practice of health responsibility in their daily lives. This critical ethnographic study, based on Carspecken’s (1996) methodology, was conducted between September 2023 and October 2024 in a marginalized neighborhood on the periphery of Mashhad, one of Iran’s largest metropolises. Data collection involved extensive fieldwork, encompassing participatory observations, in-depth interviews, analysis of documentary materials and cultural artifacts, and data gathered through virtual interactions with women in the community via social media platforms. All collected data were meticulously analyzed using MAXQDA software. One of the main categories identified in this study was “Maintaining Women’s Health Amidst Inequality and Cultural Norms.” This overarching category is further explained by three intermediate categories that collectively illustrate how women’s health responsibility is socially constructed rather than a matter of individual choice. The first intermediate category, “Self-Regulated Health Practices beyond Formal Medicine,” highlights women’s reliance on accessible and culturally familiar healing methods, often stemming from a distrust of formal biomedical services. The second, “Health within the Spiritual Sphere,” demonstrates how faith, divine providence, and ritualistic practices offer moral fortitude and meaning when confronting illness. The third, “Health Constrained by Inequalities,” encapsulates the pervasive economic hardship, gender-specific restrictions, and institutional neglect that narrow women’s choices and perpetuate their vulnerability. This critical ethnographic study found that women’s health responsibility in the marginalized neighborhoods of Mashhad is socially constructed rather than individually chosen. Everyday practices such as herbal healing, faith-based rituals, and self-medication serve as adaptive strategies within structural inequality. Interpreting the findings through Bourdieu’s logic of practice shows a habitus shaped by necessity, while Foucault’s concept of biopower reveals how moral and spiritual discourses transform deprivation into self-discipline. Promoting health equity, therefore, requires shifting responsibility from individuals to social and institutional structures.