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Sterilization (also spelled sterilisation) refers to any of a number of medical techniques that intentionally leave a person unable to reproduce. It is a method of birth control. For other causes of sterility, see infertility. Sterilization methods include both surgical and non-surgical, and exist for both males and females. Sterilization procedures are intended to be permanent; reversal is generally difficult or impossible. Most female sterilizations occur in developing countries, while vasectomies are mainly the product of industrialized, Western countries. Women mostly make up sterilization rates worldwide, but their motivations behind the procedure vary depending on demographic factors. While physical effects are the most commonly though of, sterilization can also affect the psych, family, and community at large.

Surgical
Surgical sterilization methods include:
 * Tubal ligation in females, known popularly as "having one's tubes tied". The Fallopian tubes, which allow the sperm to fertilize the ovum and would carry the fertilized ovum to the uterus, are closed. This generally involves a general anesthetic and a laparotomy or laparoscopic approach to cut, clip or cauterize the fallopian tubes.
 * Vasectomy in males. The vasa deferentia, the tubes that connect the testicles to the prostate, are cut and closed. This prevents sperm produced in the testicles from entering the ejaculated semen (which is mostly produced in the seminal vesicles and prostate). Although the term vasectomy is established in the general community, the correct medical terminology is deferentectomy, since the structure known as the vas deferens has been renamed the ductus deferens.
 * Hysterectomy in females. The uterus is surgically removed, permanently preventing pregnancy and some diseases, such as uterine cancer.
 * Castration in males. The testicles are surgically removed. This is frequently used for the sterilization of animals, but rarely for humans. It was also formerly used on some human male children for other reasons; see castrato and eunuch.

Transluminal
Transluminal procedures are performed by entry through the female reproductive tract. These generally use a catheter to place a substance into the Fallopian tubes that eventually causes blockage of the tract in this segment. Such procedures are generally called non-surgical as they use natural orifices and thereby do not necessitate any surgical incision.
 * The Essure procedure is one such transluminal sterilization technique. In this procedure, polyethylene terephthalate fiber inserts are placed into the fallopian tubes, eventually inducing scarring and occlusion of the tubes. Following successful insertion and occlusional response, the Essure procedure is 99.74% effective based on 5 years of follow-up, with zero pregnancies reported in clinical trials.
 * Quinacrine has also been used for transluminal sterilization, but despite a multitude of clinical studies on the use of quinacrine and female sterilization, no randomized, controlled trials have been reported to date and there is some controversy over its use.

Pharmacological
There is no working "sterilization pill" that causes permanent inability to reproduce, although there have been hoaxes involving fictitious drugs that would purportedly have such effects, notably progesterex.

United States
Sterilization is the most common form of contraception in the United States when female and male usage is combined. However, usage varied across demographic categories such as gender, age, education, etc. According to the Centers for Disease Control and Prevention, 16.7% of of women aged 15-44 used female sterilization as a method of contraception in 2006-2008 while 6.1% of their partners used male sterilization. . The proportion of women using female sterilization was highest for black women-22%, followed by hispanic women-20% and white women-15%. Reverse sterilization trends by race occurred for the male partners of the women: 8% of male partners of white women used male sterilization, but it dropped to 3% of the partners of hispanic women and only 1% of the partners of black women. White women were more likely to rely on male sterilization and the pill. While use of the pill declined with age, the report found that female sterilization increased with age. Correspondingly, female sterilization was the leading method among currently and formerly married women; the pill was the leading method among cohabiting and never married women. 59% of women with three or more children used female sterilization. Thus, women who do not intend to have more children primarily rely on this method of contraception in contrast with women who only aim to space or delay their next birth. Regarding education, "[l]ess-educated women aged 22-44 years were much more likely to rely on female sterilization than those with more education." For example, female sterilization was used among 55% of women who had no complete high school compared with 16% of women who had graduated from college. Because national surveys of contraceptive methods have generally relied on the input of women, information about male sterilization is not as widespread. A survey using data from the 2002 National Survey of Family Growth found similar trends to those reported for female sterilization by the Centers for Disease Control and Prevention in 2006-2008. Among men aged 15-44 years, vasectomy prevalence was highest in older men and those with 2 or more biological children. Men with less education were more likely to report female sterilization in their partner. In contrast to female sterilization trends, vasectomy was associated with white males and those who had ever visited a family planning clinic. Several factors can explain the different findings between female and male sterilization trends in the United States. Women are more likely to receive reproductive health services. "Additionally, overall use of contraception is associated with higher socioeconomic status, but for women, use of contraceptive tubal sterilization has been found to be related to lower socioeconomic status and lack of health insurance." This particular finding could be related to Medicaid-funded sterilizations in the postpartum period that are not available to men.

Desired lifestyle
Motherhood is seen as a major defining feature of femininity and has become deeply entrenched in the gendered experiences of women in many cultures. Because of the emphasis placed on childbearing as the most important role of women, not having children was traditionally seen as a deficiency or due to fertility problems. However, access to contraception and abortion, new economic and educational opportunities, and changing ideas about motherhood has led to new reproductive experiences for women in the United States, particularly for women who choose to be childless. Scholars define "voluntarily childless" women as "women of childbearing age who are fertile and state that they do not intend to have children, women of childbearing age who have chosen sterilization, or women past childbearing age who were fertile but chose not to have children." In industrialized countries such as the United Kingdom, Western Europe, and the United States, the fertility rate has declined below or near the population replacement rate of two children per woman. Women are having children at a later age, and most notably, an increasing number of women are choosing not to bear children at all. According to the U.S. Census Bureau's American Community Survey, 46% of women aged 15 to 44 were childless in June 2008 compared to 35% of childless women in 1976. The personal freedoms of a childless lifestyle and the ability to focus on other relationships were common motivations underlying the decision to be voluntarily childless. Such personal freedoms included increased autonomy and improved financial positions. The couple could engage in more spontaneous activities because they didn't need a babysitter or to consult with someone else. Women had more time to devote to their careers and hobbies. Regarding other relationships, some women chose to forgo children because they wanted to maintain the "type of intimacy that they found fulfilling" with their partners. Although voluntary childlessness was a joint decision for many couples, "studies have found that women were more often the primary decision makers. There is also some evidence that when one partner (either male or female) was ambivalent, a strong desire not to have children on the side of the other partner was often the deciding factor." 'Not finding a suitable partner at an appropriate time in life" was another deciding factor, particularly for ambivalent women.

Economic
Economic incentives and career reasons also motivate women to choose sterilization. Public funding for contraceptive services come from a variety of federal and state sources in the United States. Until the mid-1990s, "[f]ederal funds for contraceptive services [were] provided under Title X of the Public Health Service Act, Title XIX of the Social Security (Medicaid), and two block-grant programs, Maternal and Child Health (MCH) and Social Services." The Temporary Assistance for Needy Families was another federal block granted created in 1996 and is the main federal source of financial "welfare" aid. The U.S. Department of Health and Human Services administers Title X, which is the sole federal program dedicated to family planning. Under Title X, public and nonprofit private agencies receive grants to operate clinics that provide care largely to the uninsured and the underinsured. Unlike Title X, Medicaid is an entitlement program that is jointly funded by federal and state governments to "provide medical care to various low-income populations." Medicaid provided the majority of publicly funded sterilizations. In 1979, regulations were implemented on sterilizations funded by the Department of Human and Health and Services. The regulations included "a complex procedure to ensure women's informed consent, a 30-day waiting period between consent and the procedure, and a prohibition on sterilization of anyone younger than 21 or who is mentally incompetent." Concerning women who are voluntarily childless, studies show that there are higher "opportunity costs" for women of higher socioeconomic status, especially because women are more likely than men to forfeit labor force participation once they have children. On the other hand, some women stated the lack of financial resources as a reason why they remained childfree. Combined with the costliness of raising children, having children was viewed as a negative impact of financial resources. Thus, childlessness is generally correlated with working full time. "Many women expressed the view that women ultimately have to make a choice between motherhood and career." On the other hand, childlessness was also found among adults who were not overly committed to careers. In these finding, the importance of leisure time and the potential to retire early was emphasized over career ambitions.

Psychological effects
Most people undergoing sterilization experience no change in sexual activity, quality of marital relationships or work-related behavior. Few regret their choice. Risk factors for negative consequences after sterilization include:
 * being coerced into the procedure
 * lacking understanding of the consequences of the procedure
 * having health complications after the procedure
 * having an unstable marriage, as it increases the risk of divorce followed by a new relationship in which the couple desires to have children
 * disagreeing with partner about the decision to perform sterilization

Physical effects
Understanding the physical effects of sterilization is important because it is a common method of contraception. Among women who interval tubal sterilization, studies have shown a null or positive effect on female sexual interest and pleasure. Similar results were discovered for men who had vasectomies. Vasectomies did not negatively influence the satisfaction of men and there was no significant change in communication and marital satisfaction among couples where the man had a vasectomy. According to John Hopkins Medicine, tubal sterilizations results in serious problems in less than 1 out of 1000 women. However, some potential risks of tubal sterilization include "bleeding from a skin incision or inside the abdomen, infection, damage to other organs inside the abdomen, side effects from anesthesia, ectopic pregnancy (an egg that becomes fertilized outside the uterus), [and] incomplete closing of a fallopian tube that results in pregnancy." Tubal sterilization is an effective procedure, but pregnancy can still result in about 1 out of 200 women. Potential risks of vasectomies include "pain continuing long after surgery, bleeding and bruising, a (usually mild) inflammatory reaction to sperm that spill during surgery called sperm granuloma, [and] infection". Additionally, the vas deferens may grow back together, which could result in unintended pregnancy.

Pre-World War II
The traditional female homemaker-male breadwinner model characterized female employment prior to World War II. At the turn of the 20th century in the United States, "only 18 percent of women over the age of 13 participated in the labor force." These women were typically young, single, white, and native-born. In contrast, married women in the labor force were "were predominantly blacks or immigrants and very poor." Working mothers often exited the labor force once their children were old enough to earn money. The outpouring of occupational opportunities in the early 1920s, such as in "cafeterias, nurseries, laundries and other facilities seemed to release women from domestic chores and freed them to participate fully in the sphere of production." This migration of women into the workforce shook the traditional ideology of gender roles, but importantly, it was the catalyst to the double burden becoming noticeable. The 1930s "encouraged women to fulfill what Stalin termed the "great and honorable duty that nature has given" them. Evident in the Soviet Union, "an officially sponsored cult of motherhood, buttressed by anti-abortion legislation" accompanied by a "depression of living standards" lead to industry's immense demand for laborers which got women into the industrial workforce in unprecedented numbers." Urban women thus found themselves assuming the "double burden" (also known as the "double shift") of waged work outside the home and the lion's share of unpaid labor within it." The Second World War is typically seen as a catalyst for increasing female employment. Best exemplified by Rosie the Riveter propaganda of an efficient, patriotic, woman worker, World War II increased demand for female labor to replace that of the "16 million men mobilized to serve in the Armed Forces". While a substantial number of women worked in war factories, the majority of jobs were in the service sector. This caused the gendered expectations for that time to be altered and roles to be both tested and re-assigned for the incoming decades.

Post-World War II
The post-World War II period is marked by relatively high levels of female participation in the workforce, particularly in industrialized countries. Although a large proportion of women exited the workforce immediately following World War II, the idea of working class women was able to take root and normalize. "In 2001, 47 percent of U.S. workers were women, and 61 percent of women over the age of 15 were in the labor force." Besides an increased demand for women's labor, other factors contributed to the growth of their participation, such as more educational opportunities and later marriage and childbearing ages. The idea of the double burden is more evolved with the times concerning both sexes and their newfound roles. The role of a provider and caregiver is sometimes expected of women, but as more women enter the workforce, an 'independent' ideology seems to take effect and forces some women to decide between a career and family. Some may choose strictly one or the other, others may choose to carry the burden of both lifestyles. Some modern "men tend to believe in the principle of equal sharing of domestic labor, but fail actually to live up to that belief." The constant tug of war regarding one's time and where it could, should but will be spent creates a new speed bump that is a little bit higher that the previous ones. Modern times illuminate the dilemma that many dual-income couples face when trying to reconcile unpaid domestic work and paid employment. The burden of encompassing both ideologies plays a tole on both sexes in today's societies.

Gender ideology
"Gender ideologies are linked to beliefs about appropriate behaviour for men and women" Socialization plays a major role in determining gender ideologies and what's valued in one time and culture may not necessarily transcend to another. Traditional gender ideologies have contributed to the double burden because it posits women as caretakers, men as providers, and each gender occupying their own sphere of influence. Although research has shown that attitudes about gender roles have become more egalitarian over the past few decades, "these changes in gender attitudes have not been accompanied by corresponding changes in the allocation of housework".

Labor market constraints
Despite women's increasing participation in the work force, a gender division of labor persist. There are a number of constraints in the labor market that contribute to the double burden. "Women are disproportionately represented in informal work and concentrated among lower-quality jobs within self-employment." The informal market is generally precarious and characterized by low wages, few benefits, and a lack of social protections that are offered in the formal market. Even within the formal market, there is occupational segregation and a gender wage gap. Occupational segregation can be either horizontal or vertical: horizontal segregation limits women to certain sectors and occupations, while vertical segregation restricts them to particular positions within occupational hierarchies. Men and women are even found at different levels of the occupational hierarchy. The "glass ceiling" refers to the dearth of women in senior or managerial positions due to institutional barriers and norms. Even in female-dominated occupations, men often occupy the more skilled and better paid positions.

The gender wage gap is a possible consequence of occupational segregation. The gender wage gap is the "difference between wages earned by women and men". In 2008, globally, men were estimated to earn 16.5 per cent more than women. The gender wage gap is narrowing, but progress remains slow. Additionally, the narrowing of the gender wage gap may be attributed to a decrease in men's wages instead of an increase in women's wages. "The persistent gender wage gap across regions may reflect a number of factors, including women’s continued disadvantage in terms of education and skills; their lack of an organized voice and bargaining power; gender-specific constraints on their labour market mobility; and their relatively high involvement in part-time or temporary jobs." Many characteristics of the labor market constrain the employment opportunities of women and make it easier for them to be responsible for care work.

The Second Shift
Coined after Arlie Hochschild's 1989 book, the term "second shift" is another way of describing the labor performed at home in addition to the paid work performed in the formal sector. In The Second Shift, Hochschild and her research associates "interviewed fifty couples very intensively" and observed in a dozen homes throughout the 1970s and 80s in an effort to explore the "leisure gap" between men and women. Through the depictions of the couples' daily lives, Hochschild applied three different attitudes about marital roles that she discovered in her research: traditional, transitional, and egalitarian. While the traditional women "wants to identify with her activities at home (as a wife, a mother, a neighborhood mom)", the egalitarian women "wants to identify with the same spheres her husband does, and to have an equal amount of power in the marriage". The transitional women is in between, blending the two other ideologies. Most of the chapters are dedicated to the routines of a different couple, delving into the apparent and unnoticed motivations behind their behaviors. Similar to earlier research that is cited in the book, The Second Shift found that women still take care of most of the household and childcare responsibilities despite their entrance into the labor market. The "second shift" affected the couples, as they reported feelings of guilt and inadequacy, marital tension, and a lack of sexual interest and sleep. On the other hand, Hochschild shared the stories of a few men who equally shared the burden of domestic work and childcare with their wives, showing that while this scenario is uncommon, it is a reality for some couples. Hochschild's research also presented a clear division between the ideology preferences of the genders and social classes: the working class and men preferred the traditional idea; the middle class and women preferred the egalitarian one.

Women
Many studies have been done in the past that have tried to relate the different effects of the double burden on different genders, and more specifically on the gender roles played by a variety of people worldwide. In most studies done it was found that when both parents are faced with a full-time job, the women are faced with a higher amount of a domestic workload than the males. "A mother that works and raises a family has to be pretty strong, very strong. I feel sorry for the mother with the little kids- have to bundle them up in the morning and take them to the daycare centre and pick them up again at night. I wouldn't go through that again that way. It's too hard." This quote is from a woman who was faced with the challenges of the double burden and made it to the point where her children were no longer depending on her. This shows the stress that is placed on some mothers who find themselves in situations similar to this.

A study done that can help show the difference between the effects on the double burden is a book entitled The Canadian Family in Crisis, written by John Fredrick Conway. In Conway's studies he discovers the physical, emotional, and psychological differences between men and women faced with the double burden in Canada. In these studies it was found that women who are raising children and are in the workforce are more prone to have anxiety and many other stress related effects than the women who are just faced with one of the two burdens.

This added stress can be attributed to the added workload around the house for the mother. In a study done by Statistics Canada's General Social Survey of 10,000 households the average man spent under two hours a day dealing with childcare and house work while women on average spent a little more than three. Also shown in this study is the scarcity in equal work for both partners in these situations. Of the people surveyed, under fifteen percent of the couples agreed on doing around the same amount of work in the house. In this study it was also shown that about 83 percent of women participate in housecleaning and food preparation compared to only 51 percent of men who were surveyed.

This stress can also be attributed to a loss of sleep that may come along with the responsibilities of maintaining raising children and having a career. In traditional gender roles it is usually the mother who is the one to get the family going in the morning as she fixes breakfast and takes the children to school before she goes to her own job. At night the mother cooks and does various other activities around the house that cause her to be the last person to retire for the night as well. Although this is merely just a few gender roles that are not set in stone, they may hold to be true. It was found that working women sleep twenty-five minutes less a night due solely to their responsibility for domestic work. Applying this statistic in larger scale leads to the assumption that women on average lose up to roughly thirteen hours a month of sleep due to domestic duties around the house. If applied to an even larger scale it can be assumed that it is possible for an average woman to lose up to one hundred and fifty-six hours of sleep during a year because of domestic work and motherly duties.

Although women faced with double burden usually have more stress than most women in today's society, it was proven that in most cases they are psychologically healthier than women who are not faced with these circumstances, for either being a stay at home mother or for being a working woman without children to take care of.

Men
Even though the effects of raising children and having a career simultaneously are mostly seen in women throughout many societies, the men in such situations are affected greatly as well. This is not seen in all situations in males because the effects on men differ greatly from how females are affected by this extra responsibility. In The Canadian Family in Crisis the author suggests a reason for these effects to go unnoticed in most studies and surveys. The reason that the effects on men go unnoticed is because women's stress can be seen through direct labor consisting of housework and career where as men's stress, in most cases, comes from decision making and work-family conflicts. The male's stress in these situations derive from work-family conflicts most of the time when situations arise where the male must make the best choice for the future of his family. That could involve a work/family conflict include things such as workload, overtime hours, shift decisions, and even accepting a promotion or a transfer. In these situations the man is forced to make major choices that will affect the entire family, which brings on more stress. The effects on the male in these situations also go unnoticed since in traditional gender roles the male is supposed to be the backbone of the family and in the past it would have been seen as weakness for the male to display his emotions to the rest of the family. In surveys and studies done, most males would not like to be seen as too weak to handle his responsibilities as the role of the adult male in the household, which in the past has consisted of being the major economical supporter and physical figure for the family, so it is very possible that some may have lied when surveyed about these topics.

Work vs. family
Parenting is a large task within itself, and when a parent has a career as well, it can cause a double burden, or work–family conflict. Strain begins to develop when women and men find that the demands of their family are conflicting with the demands from their job. When one is faced with a double burden like this, it affects how decisions are made within a career and in a family; this burden could potentially effect when a couple decides to have children. 75% of all women who have jobs are in their childbearing prime. When the conflict between one's family and work presents itself, the unpaid work that is being done in the home may be cut down, because of the certain health effects, or as a solution to deal with the greater demands from the workplace. Social outings and visits, and family dinners are two of the first things that get cut back on due to the work/family conflict. In a study by Ari Väänänen, May V. Kevin, et al. found that if a man put a higher importance on their family, were more likely to stay home from work in order to deal with extreme family demands. Ways that the double burden can be lessened for is with hired help in the house, day-care facilities, and longer maternity leaves for women. For instance, in Norway women are allowed the options of 10 months of maternity leave, where they will get 100% of their pay, or 12 months leave, where they will only paid 80% of their earnings. Some companies are realizing the effect the double burden of work and a family is having on their empolyees and are offering flexible work schedules in order to help their empolyes cope. Not only do these flexible hours help the empolyee deal with their stress, but i also benefits the company because workers are happier, less likely to be absent, more productive, and the turnover rate is lower for the company. As Sophia Mwangi says, "Parenthood is a joy. Let us never be burdened by it but let's celebrate the joy that it brings. Celebrate those first steps or words, the first school play, their graduation day, passing those exams, landing their first job, getting married, making you grandparents. Whatever it is, let's celebrate our children. It's not easy, but the art of juggling can always be mastered!"

Family vs. school
Raising a family is not an easy task, and deciding to go back to school while raising a family can be a monumentual decision for the family says Carol Jacobs of the Jewish Employ-ment & Vocational Service. Her advice to those considering going back to school is, "Talk to an educational consultant and people in the field you want to be in." She adds, "This is a commitment and the decision should involve your family. Will you be available to go to your child's softball game or have time to cook dinner?" There are many reasons why someone may put off to school until their children are older, such as not wanting to leave them in the hand of a baby sitter constantly at such a young age. However, once the children get older the parent pursuing an education, may start missing school events that they would have normally attended. The guilt of having to leave a child while attending to educational matters is less when the child is old enough to be able to ask questions about where their parent is and comprehend the response. Even though pursuing an education while nurturing a family will have its cost, the benefits include getting a higher paying job, gaining more knowledge, and becoming more stable financially. Most of the time this burden will include the person trying to balance a job along with their family and schooling, because they still need to work in order to provide for their family at the present moment. For people who have a hard time fitting classes into their schedule around the needs of their family, there are options where they will be required to do all of the work for a course, but it will all take place online. For example, the University of Delaware and the University of Phoenix Online have both Bachelor of Science in Nursing and Master of Science in Nursing programs for people to complete online.

Single parent double burdens
"Single Parents do not typically have the luxury of dividing tasks between two adults in the home." "The Parents in a married-couple family may be able to divide their tasks so that one parent specializes more in work-related and income-producing activities and the other parent specializes more in home-related, non-income producing activities." Married parents have that option to split the workload, even though it usually does not happen, but single parents do not have the option of sharing the workload with anyone.

The double burden is usually view as a primary problem for single women or married women. People fail to recognize that men can and often do go through the same trials and hard times as a parent trying to balance work and the family. Within the book The Canadian Family in Crisis, Conway addresses this issue with an argument from Eichler. Eichler says, "Social science fails to understand men" by tending "to downplay or ignore a potential conflict between work and home for men." Married men can avoid the full impact of the double burden but single fathers are totally incapable of avoiding the double burden of family and work. Though single fathers face the same amount of problems that single mothers face, they have two advantages that play in their favor. Men usually have a higher income and have a shorter time of being single than women. The thing is, until they are remarried or have a women to help them out around the house, men still must deal with the sexual and emotional frustration as a women does. They must deal with the balancing of work, childcare, and domestic responsibilities. Single fathers are usually doubtful about their ability be a parent, and they are challenged psychologically. "The problems faced by the working single father are more than merely the logistical problems shared by all working parents. He has to change the way he feels about himself as man." A man being a single parent and feelings the affects of the double burden can and will interfere with his career just as it does with a single mother that has a career. A study showed that five percent of single fathers were fired form their jobs due to the double burden and another eight percent quit because the double burden became too much of a burden for them to balance both work and the family. With that being said, single fathers feel the same if not more of the affect of the double burden as women do.

The double burden that single mothers endure really comes without much explanation as history has shown, women are likely to end up with this burden. Single mothers usually have higher rates of employment and children at home and have the highest levels overall of the double burden. Women also have less economic resources than men and have no partner to share the workload with. Single mothers fall heavily under economic vulnerability and one reason is that women's wages are less than seventy percent of men's wages. Single mothers may face job discrimination and not earn as much so it will be even harder on her to maintain the double burden. Single-mother families tend to be creeping around the poverty line with a poverty rate that is twice as high of that for men.

Married parents double burdens
Because of women's expanded roles in the workforce have generally not been accompanied by any relaxation of expectations for their family and domestic activities, many women today face the "double burden" of home and work responsibilities. Women take on the largest portion of the domestic obligations of the home, even when they are working full-time jobs. This describes how angry and frustrated women gets when they know that they are doing the majority of the housework on top of their careers. There have been said to be more reasons, other than gender roles, as to why there is a difference in the housework performed by men and women. Some theories have suggested that women's expectations for household cleanliness are higher than men's. Women feel like they must be responsible for the condition of the home in a way that men do not. Men do invest most of their time in their careers, but women spend double that time caring for the children, state of the home and taking care of the domestic responsibilities. In a graph from the U.S. Bureau of Labor Statistics in 2004, that compare the work load of married men and women between the ages of 25-54, women are displayed as doing one hundred percent more housework than men do, and men are displayed as having more leisure time then that of women. As the double burden increased in 1980, women became more critical of their marriages than men and wanted the men to do more around the house to ease the burden of a second shift. The double burden of women that have jobs and still have to come home and shoulder the majority of the housework leads to women filing or initiating divorce.

This concept of the double burden with married couples is a worldwide phenomenon. Throughout different cultures of the world, women spend more total hours in work than men do. In Japan, once married, they are still expected to be devoted wives and mothers that give all off their effort to the home, even after a full day of work. Latin American women, now entering the work force in large numbers, still face what they call doble jornada, or double day's journey. Although in the Latin American culture, men are starting to interact more with the children and helping around the house more, the main domestic responsibilities still fall upon the women of the house. Sometimes the women can be the primary wage earners and still do most of the domestic work. European men are more likely to play and interact with their children but not likely to participate fully in those children's daily care. They are also more likely to help their wives at home but not likely to tackle all domestic task equally. The logic behind men acting this way is because men fail to live up to their belief of equal sharing of domestic labor. So they believe in an equal work load in the house but just do not follow through with their idea.

Health effects of the double burden
When faced with the double burden of having to deal with the responsibilities of both a career as well as domestic duties, sometimes a person's health is affected. Many people faced with these circumstances have a higher chance of being sick since health and stress seem to go hand in hand, as stress has been implicated in up to eighty percent of all illnesses, as found by a report done by the Canadian Advisory Council on the Status of Women. In an article that was written by a team of researchers it was found that both men and women faced with a "spillover" of work and family issues were 1.5-1.6 times more likely to have an absence due to sickness than others. Men and women in these situations have also been proven to be more likely to be faced with psychological stress and even see themselves as unhealthier than their colleagues who are not in their situation.

In a study done by Rosamund Weatherall, Heather Joshi and Susan Macran of the London School of Hygiene and Tropical Medicine in 1994, the research presented suggests that women presented with the double burden have a lower mortality rate than women who are simply housewives. The women who were observed that had part-time jobs had a mortality rate lower than the women with full-time jobs and children. The same study also suggests that women who have young children are less likely to die than women who have no children or have older children. Although this evidence can not be strictly attributed to the double burden of having children and a career field, it can give a good indication of a trend in society. Also, this study was conducted in multiple countries including England, Wales, and the United States which gives the information presented from the study a more global perspective on the double burden.

In several Western countries it has been seen that absences due to sickness for women are far greater than men. When investigating as to why this could be a study done in Sweden published in 1996 found that half of the difference between genders can be dismissed if you take out the days missed by pregnant women. When taking into account the health effects of double burden, child birth is always a possibility for mothers who already are faced with taking care of children and having a career and effects them and their health. In many studies people have tried to relate the difference in sickness absences directly to the double burden effect, and it has been somewhat done proving that women who are faced with work and taking care of children have been known to request more sick days than men in the same situation. It has been seen that working wives with children have twice the absence rate as men who are placed in the same position in work family conflicts.

Family-friendly initiatives
Family-friendly initiatives are a possible solution to redistributing the load of unpaid work and alleviating the double burden. Possible initiatives include flexible work hours; part-time and job-sharing options; parental leave; child care subsidies; and on-site daycare options. According to "Family-Friendly Workplace Reform", there are two primary approaches to assisting working families: "One stresses the importance of action from within, with emphasis on private, internal, local initiatives within firms and organizations to alter workplace norms, conventions, and practices. The other approach calls for government interventions designed to facilitate proper care for children with less sacrifice of parents' job opportunities, advancement, and compensation" The Nordic countries exemplify the use of family-friendly initiatives. For example, a nine month parental leave is divided into thirds in Iceland. Three months are for the mother. Three non-transferable months are for the father, and there are three months that both parents can share. "The reimbursement is 80 per cent of the salary. From 2001 to October 2003, the average number of days taken by men increased from 39 to 83, and 13 per cent of Icelandic fathers used more than their non-transferable part." Dual-income families are becoming the norm, especially in industrialized countries, so it is not uncommon for large corporations to practice some form of family-friendly initiative.