Understanding gender

UnderstandingSex & Gender

What is sex? Sex refers to the universal biological differences between

women and men

Sex is determined by ---the chromosomes (determined before birth)

Sex is Sex is differentiated bydifferentiated bythe reproductive the reproductive system----system----external genitalia external genitalia &&internal internal reproductive reproductive organsorgans

SEX does not changeSEX does not change

What is gender?• A person is not born with gender characteristics but

develops as she/he grows up (influenced by social factors, environment, culture, customs –different in different settings)

What is gender?• Gender refers to roles that men and women play and

the relations that arise out of these roles

“SEX” and “GENDER” are not the same!

SEX Biological Constant across time

and location Universal

GENDER Social Varies across time and

location Contextual

These roles and expectations are:Usually unequal in terms of • power and control over decision -making• assets and freedom of action• culturally specific• change over time

Characteristics of Gender

Relational Socially constructed man & woman

Hierarchical Power relations

Changes Changes over time

Context Varies with ethnicity, class, culture, etc

Institutional Systemic

Differences between Sex & GenderSex

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

Gender

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 and men depending on age, ethnic group, income, culture, tradition & other factors

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 statements

Sex

Only women can conceive and give birth

Most men are taller than women

Only men can supply the sperm for fertilization

Men cannot breast feed babies

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

Women suffer from pre-menstrual 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 Gender

on Health

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

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

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

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

At pregnancy (Conception and Birth)

Prenatal sex detection tests are carried out.

- These tests reveal the foetus to be a girl, some families resort to abortion due to the predominant 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 because boys are perceived as capable of earning and adding to family wealth, carrying on the family name and supporting parents in old age etc.

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

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

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

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

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

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

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

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

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

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

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

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

- Prone to trafficking (for sex, for labour)

Adolescent Boys

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

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

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

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

- Double burden of productive and reproductive life.

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

-Prone to domestic violence (physical and mental)

- Depression is also frequent.

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

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

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

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

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

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

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

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

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

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

Old suffer due to biological and social decline

Male

Biological - Cancer of prostate- Diseases of male genital tract- Hernia

Social- neglect, depression

Female

Biological- Osteoporosis is 8 times than in

male- UVP , Ca Cervix, Ca endometrium

Social- Depression is 2 or 3 times than in

men- neglect, abuse mentally

Women-Productive life+ Reproductive life

Do you see any imbalance?

Gender equality

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

… equal rights in social, economic, civil, and political life.

Gender equality A condition in which women and men participate as equals, have equal access to resources, and equal opportunities to exercise control over resources and decisions.

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.

… fairness and justice to both women and men according to their needs rather than biased perception based on gender stereotypes.

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 inequity to equity

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)

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.

Examples• ""My parents are simple and they allowed this man

to come to the house for examining me. He came when the parents were not at home and examined me by touching my breasts. Next time I did not see him anymore and discontinued treatment."

• (FGD 45 year old female leprosy patient)

• "With female provider we can speak more openly. When I started treatment I took it from a midwife as I have to show the patch on my back."

• (35 year old female PAL)

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

Understanding gender

Health & Medicine

Transcript of Understanding gender