gender training ha1 9th july

Gender and Gender and HealthHealth

Understanding Sex and GenderUnderstanding Sex and Gender Sex refers to the Sex refers to the universaluniversal biological biological

differencesdifferences between women and men between women and men

---eg ---eg only women can bear childrenonly women can bear children

What is sex?What is sex?

Sex is determined by Sex is determined by ------

the chromosomes the chromosomes (determined before (determined before birth) birth)

That a person is That a person is born male or born male or female is pure female is pure chancechance

What is sex?What is sex?Sex is differentiated by ---Sex is differentiated by --- the reproductive system----external the reproductive system----external

genitaliagenitalia internal reproductive organsinternal reproductive organs secondary sex secondary sex

characteristics characteristics

of men/womenof men/women SEX does not change SEX does not change

What is gender?What is gender? Gender refers to the economic, social, Gender refers to the economic, social,

and cultural attributes and opportunities and cultural attributes and opportunities associated with being male or female in associated with being male or female in a particular social setting at a particular a particular social setting at a particular point of timepoint of time

Gender refers to roles that men and Gender refers to roles that men and women play and the relations that arise women play and the relations that arise out of these rolesout of these roles

A person is A person is notnot born with gender born with gender characteristics but develops as she/he grows characteristics but develops as she/he grows up (influenced by social factors, environment, up (influenced by social factors, environment, culture, customs –different in different culture, customs –different in different settings)settings)

Dress and appearanceDress and appearance play and gamesplay and games Study and careerStudy and career Work and occupation Work and occupation

promote difference between boys and promote difference between boys and girls.girls.

GenderGender Refers to the way of thinking and behaving of men and Refers to the way of thinking and behaving of men and

women that is learned through socializationwomen that is learned through socialization

Socially constructed, not physically determinedSocially constructed, not physically determined

About genderAbout gender Gender roles are not constantGender roles are not constant It changes over timeIt changes over time Have wide variations within and Have wide variations within and

between culturesbetween cultures eg: in Canada it has become more eg: in Canada it has become more

common to see women bus drivers and common to see women bus drivers and male nurse than beforemale nurse than before

Characteristics of GenderCharacteristics of Gender

Relational -Socially constructed

Hierarchical -Power relations

Change -Changes over time

Context -Varies with ethnicity, class, culture, etc

Institutional -Systemic

Differences between Sex & GenderDifferences between Sex & GenderSexSex

The biological differences with which men and women are born

Fixed and unchanging over time

Do not vary between different cultures

Are not influenced by economic and social factors

Are the same for women as well as for men

GenderGender

The socially defined roles and responsibilities assigned to men and women

Changes over time

Differ from one culture to another

Are influenced by many factors—education, income level, age, social class, religion & others

Are different amongst women depending on age, ethnic group, income, culture, tradition & other factors as well as amongst men

Exercise on Sex and GenderSort and put into boxes of Sex/Gender

1. Only women can conceive and give birth

2. Most men are taller than women

3. Women are more loving and caring

4. Men are the best chefs

5. The most important role of a woman is to become a mother

6. Women suffer from pre-menstrual tension, men do not

7. Men think and act more rationally than women

8. Only men can supply sperm for fertilization

9. The most important role of the man is to be a bread-winner

10. Men cannot breast feed babies

11. Women are poor managers

12. Men’s voices break at puberty, women’s don’t

Correct grouping of statementsCorrect grouping of statements

SexSex

Only women can conceive and Only women can conceive and give birthgive birth

Most men are taller than Most men are taller than womenwomen

Only men can supply the sperm Only men can supply the sperm for fertilizationfor fertilization

Men cannot breast feed babiesMen cannot breast feed babies

Men’s voices break at puberty, Men’s voices break at puberty, women’s don’twomen’s don’t

Women suffer from pre-Women suffer from pre-menstrual tension, men do notmenstrual tension, men do not

Gender

• Women are more loving and caring

• Men are the best chefs

• The most important role of the woman is to be a mother

• Men think and act more rationally than woman

• The most important role of the man is to be a bread-winner

• Women are poor managers

Impact of Impact of GenderGender

on Healthon Health

In what way does gender In what way does gender influence health?influence health?

Men & women face some specific health Men & women face some specific health problems due to problems due to biological differencesbiological differences

Women face health problems not only due to Women face health problems not only due to biological disadvantages but also due to biological disadvantages but also due to social social inequalitiesinequalities

The influence of gender is manifested at every The influence of gender is manifested at every phase of the life cycle of women & men, phase of the life cycle of women & men, it has it has particular impact on the health of womenparticular impact on the health of women

At pregnancy (Conception and Birth)

Prenatal sex Prenatal sex detection tests detection tests are carried out.are carried out.

- These tests - These tests reveal the foetus reveal the foetus to be a girl, some to be a girl, some families resort to families resort to abortion due to abortion due to the predominant the predominant son preference.son preference.

At birth

Birth of a baby boy

Birth of a baby girl

• The family rejoices at the birth of a boy• The male child is favored The male child is favored because boys are perceived because boys are perceived as capable of earning and as capable of earning and adding to family wealth, adding to family wealth, carrying on the family name carrying on the family name and supporting parents in and supporting parents in old age etc.old age etc.

• Some continue bearing Some continue bearing children repeatedly till a son children repeatedly till a son is born great strain to the is born great strain to the health of womenhealth of women

• The birth of girls is not The birth of girls is not celebrated as the birth of celebrated as the birth of boys.boys.

At Childhood

•There are marked differences There are marked differences in the child rearing practices in the child rearing practices for boys and girls.for boys and girls.• School enrolment and School enrolment and retention are lower in the case retention are lower in the case of girls.of girls.

• The nutritional intake of girls The nutritional intake of girls is lower than that of boys.is lower than that of boys.

• Girls start participation in Girls start participation in work at a younger age. work at a younger age. Physical abuse & child neglect Physical abuse & child neglect prevail more commonly for prevail more commonly for girlsgirls •Aggressive & risk taking Aggressive & risk taking behaviour is tolerated and behaviour is tolerated and encouraged in boys, leading to encouraged in boys, leading to more injuries and accidentsmore injuries and accidents

Adolescent Girls- Nutritional deficiency diseases like - Nutritional deficiency diseases like IDA are common among adolescent IDA are common among adolescent girl. girl.

- Movement and social interaction of - Movement and social interaction of girls is curtailed with the onset of girls is curtailed with the onset of menarchemenarche

- Education is discontinued and - Education is discontinued and access to information is reduced. access to information is reduced. Adolescent girls share a great deal of Adolescent girls share a great deal of domestic workdomestic work

- Early marriage of girls makes them - Early marriage of girls makes them vulnerable to malnutrition and vulnerable to malnutrition and incomplete physical and mental incomplete physical and mental development.development.

- Early marriage places heavy - Early marriage places heavy responsibility and burden on girls responsibility and burden on girls beyond their age and maturity.beyond their age and maturity.

- Teenage pregnancy places girls at - Teenage pregnancy places girls at high risk of morbidity and mortality. high risk of morbidity and mortality.

- Prone to violence eg rape, STI, Prone to violence eg rape, STI, HIV/AIDSHIV/AIDS

- Prone to trafficking (for sex, for - Prone to trafficking (for sex, for labour)labour)

Adolescent Boys

- Alcohol, drug abuse and - Alcohol, drug abuse and tobacco use are more tobacco use are more common in boys.common in boys.

- Accidents, homocide and - Accidents, homocide and violence associated with violence associated with stereo typed masculine stereo typed masculine attitudes are common in attitudes are common in boys.boys.

-Exploration into sexual Exploration into sexual behavior before marriage is behavior before marriage is more common among boys more common among boys placing them at risk of STDs placing them at risk of STDs and HIV/AIDS placing their and HIV/AIDS placing their partners after marriage also partners after marriage also at riskat risk

Adult FemaleWomen suffer a greater burden Women suffer a greater burden related to reproductive health system related to reproductive health system & gender inequalities.& gender inequalities.

- Double burden of productive and - Double burden of productive and reproductive life.reproductive life.

-Prone to Anemia, obstetrical & Prone to Anemia, obstetrical & gynaecological diseases and lack of gynaecological diseases and lack of access to MCH careaccess to MCH care

-Prone to domestic violence (physical Prone to domestic violence (physical and mental) and mental)

- Depression is also frequent.- Depression is also frequent.

-Prostitution and exposure to STDs Prostitution and exposure to STDs and HIV/AIDS is more likely in women. and HIV/AIDS is more likely in women.

-Breast cancer, ovarian cancer and Breast cancer, ovarian cancer and cervical cancer are specific. cervical cancer are specific.

- Women have very little choice and - Women have very little choice and control over family planning methods.control over family planning methods.

Adult male - Domestic violence, accidents - Domestic violence, accidents and injury are more common and injury are more common in women.in women.

- Violence in the street and - Violence in the street and occupational injuries are more occupational injuries are more common among men.common among men.

- Men are more exposed to - Men are more exposed to smoking , alcohol and suffer smoking , alcohol and suffer specific conditions like lung specific conditions like lung cancer, heart diseases and cancer, heart diseases and liver diseases.liver diseases.

- Men engaged in practices - Men engaged in practices that are harmful to them and that are harmful to them and their familiestheir families

ElderlyAdequate attention is not Adequate attention is not being paid to problems of the being paid to problems of the aged-both of men and women.aged-both of men and women.

- Women in general live longer - Women in general live longer than men. But this does not than men. But this does not mean that they lead healthier mean that they lead healthier lives because of economic lives because of economic dependence and low social dependence and low social status. status.

- Osteoporosis is eight times - Osteoporosis is eight times more common in women than more common in women than men.men.

Old suffer due to biological and social declineOld suffer due to biological and social decline

MaleMale

BiologicalBiological - Cancer of prostate- Cancer of prostate- Diseases of male - Diseases of male

genital tractgenital tract- HerniaHernia

SocialSocial- neglect, depression - neglect, depression

FemaleFemale

BiologicalBiological

- Osteoporosis is 8 times - Osteoporosis is 8 times than in malethan in male

- UVP , Ca Cervix, Ca - UVP , Ca Cervix, Ca endometriumendometrium

SocialSocial

- Depression is 2 or 3 times - Depression is 2 or 3 times than in menthan in men

- neglect, abuse mentally - neglect, abuse mentally

Gender Equity and Gender Equality

Gender Equity and Equality

Structure(Resources)

Process(Activities)

Outcome(Product)

Socio-cultural, economic and political context

Gender equality

… absence of discrimination on the basis of a person’s sex.

… equal rights in social, economic, civil, and political life.The concept of gender equality deals with equality of opportunity and the allocation of resources or benefits or in access to services:

eg:

• females as well as males should be able to go to school at school going age;

• females and males enjoy adequate health care and shelter;

• and females and males be able to access economic resources.

… the quality of being fair, just and right to men and women.

… includes fairness and justice in the distribution between women and men of responsibilities, access to resources, control over resources and access to benefits.

Gender equity

The concept of gender equity deals with how men and women are able to use these opportunities to achieve a fair and just balance between them.

What constitutes a fair and just outcome once equality of opportunity is achieved?

Guaranteeing fair outcomes depends on the balance of power and the ability to transform the structures and processes which buttress inequality.

Gender Equity ensures FAIR TREATMENT of both sexes

Gender Equity ensures EQUAL OPPORTUNITIES to boys and girls

Framework to measure Women’s Access to Quality, Gender Sensitive

Health Services

Framework to measure Women’s Access to Quality, Gender Sensitive Health Services

1. Comprehensiveness of information

2. Comprehensiveness of women’s health services

3. Respect of women’s human rights

4. Technical competence of providers

5. Infrastructure and facilities

Indicators to measure women’s human rights and gender, are integrated into each component of this framework. The five components are:

1. Comprehensiveness of Information

1. Adequacy of the content of information given to resolve or prevent the health problem… eg: Gender and TB

Causes, S/S Preventive measures Resolve

Risks of womangetting infection

Delay ingetting treatment by women


2. Extent to which the information includes the recognition of the promotion of the rights of clients to information and quality health care eg: Gender and pregnancy

“This labour room can be used only if the toilet is repaired. Let us repair this toilet for the women

in labour”

Eg: in HIV/AIDS Counseling servicesVCCT to pregnant woman


3. Adequacy of information given recognizing and promoting women’s self health care measures

Body mapping exerciseEg: ARH programme


4. Adequacy of pamphlet or written information content and promotion of pamphlet.

Condom promotion for prevention of pre-marital sex and prevention of STDs/HIV and AIDS

Mode of Transmissionof HIV/AIDS


5. Extent to which women providers are available for medical examination and childbirth.


6. Extent of provision of information during relevant women’s health services, on the following key gender and women’s rights issues

− Violence against women

− Contraception

− Sexual relations

− Rights and negotiation in decision-making between women and men towards gender-equality

7. Scheduling of service time and waiting time takes into consideration women’s and men’s gender roles in the household (eg: child care and cooking)


7. Scheduling of service time and waiting time takes into consideration women’s and men’s gender roles in the household (eg: child care and cooking)

Daily Time-Use Analysis (Daily Activity Clocks)

12

3

6

9

Female

12

3

6

9

Male

2. Comprehensiveness of Women’s Health Services

1. Adequacy of integration and provision of related health services in areas such as

• STDs

• RTIs

• cancer screening

• Sexuality

• HIV/AIDS

• VAW

• Contraception

• MCH & emergency obstetrics and

• mental health in order to meet the women’s total health needs.


2. Extent to which providers’ ask women if they want their men’s partners’ involvement in resolving their health needs and problems and extent that providers follow up by encouraging the men partners to take responsible action


3. Extent to which the service provided do not reinforce unequal gender roles and gender stereotyped behaviour but promote gender equality, eg: extent that men are allowed and encouraged to participate childbirth process, decision on contraceptive methods and STD screening and treatment

Eg: Ignoring labour pain

Eg: Perspective towards pain because of gender stereotyped behaviour

Eg: Involvement of male in STD and HIV/AIDS prevention

3. Respect for Women’s Human Rights (Interpersonal Relationship)

1. Adequacy of respect shown to women (eg: absence of scolding, rudeness and mistreatment).

2. Adequacy of care shown to women including emotional support.

3. Confidentiality principles practiced.

4. Extent to which women are allowed and encouraged to ask questions, express suggestions and give feedback and complaints to service providers

5. Extent to which women participate equally in decision making with partner and/or service provider when a choice has to be made such as family planning contraceptive method, childbirth position, Caesarean birth, and other routine and emergency medical procedures.

3. Respect for Women’s Human Rights (Interpersonal Relationship)

6. Extent to which women’s health decisions or agreements are based on informed consent (ie. Up to date and accurate information on the method and procedure is given including advantages and disadvantages, risks and benefits, costs, etc.

7. Adequacy of service provider’s language, both appropriateness of level of complexity of expression, and the use of local languages and medical terms.

8. Extent of acknowledgement and respect of women’s own knowledge, practice and experience related to the health problem including the links to culture and religion.

9. Extent to which husband’s notification and/or consent is not required for specific reproductive procedures (eg: ligation, abortion and caesarean births etc) procedures on this exist and women can decide autonomously.


1. Adequacy of protocols and procedures regarding health and treatment.

2. Adequacy of technical treatment, procedures and information.

3. Adequacy of medical records.

4. Extent mechanisms exist for eliciting regular feedback from women on the quality of services and evaluating their satisfaction with services

5. Extent of protocols to build in women’s feedback into provider-women interaction and service provision.


6. Existence and use of client suggestion or complaint boxes.

7. Capacity for conducting periodic qualitative research studies on quality of health care from women’s perspectives.

8. Extent evaluation procedures exist to assess the women’s overall satisfaction with the services provided.

9. Extent of provider knowledge on

poverty;

women’s rights;

gender issues in health;

sexuality and reproduction;

and on community services for referral of women who have been abused.

5. Infrastructure and facilities

1. Adequacy of quantity and quality of:

Health facilities

Equipment

Drugs

Child care areas

Security/safety features

Privacy for consultation and treatment

Allocation of toilets and hospital beds according to gender needs

2. Extent of gender bias of service availability or provision made for a particular sex (eg; allocation of hospital beds by gender)

Thank You

gender training ha1 9th july

Health & Medicine