Gender sensitivity and gender politics in health care

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Gender sensitivity and gender politics in health
care

• Lesley Doyal

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What do we mean by gender equity?

• Cannot give everyone equal health
• can only ensure equal right to optimise
  whatever potential for health individuals may
  have

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How to promote gender equity

• eliminate unfair and avoidable inequalities in
  health outcomes between women and men through
  ensuring that both groups have equal access to
  the resources needed to realise their potential
  for health

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Putting this definition into practice equity and
equality

• Promoting equality means treating all individuals
  the same
• But not appropriate if they have different needs
• Women and men have many needs in common
• But also have different needs for both biological
  and social reasons
• Also face different constraints on meeting those
  needs
• Policies should therefore be based on principle
  of equity
• Means design of specific services to optimise the
  health outcomes/realise the health potential of
  each group

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Preliminary agenda for gender equity in health
care

• Promote universal access to effective,
  appropriate and gender-sensitive sexual and
  reproductive health care
• Reshape all health services through gender
  mainstreaming strategies
• Promote gender equity in wider economic and
  social policies

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Sexual and reproductive health care

• Many gaps in available services leading to global
  inequalities and harm to health of poorest women
• Reflected in high maternal mortality and
  morbidity rates and incidence of STIs in both
  women and men

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Major inequalities in access to health care in
pregnancy
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Obstacles to meeting sexual and reproductive
needs of poor women

• availability
• affordability
• acceptability
• accountability
• (framework from Sen et al (2007)
• http//www.ids.ac.uk/ghen/resources/index.html

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Also need to include men

• Crucial to meet needs of men as well as women
• Important in promotion of mens own health (eg
  prevention of HIV and other STIs)
• But also central to promotion of womens health
  in sexual /reproductive arena
• In SA NGOs such as Men as Partners (MAP) well
  known for working with men on HIV and violence
  and other gender issues in health
• For discussion of men and reproductive health in
  South African context see http//www.hst.org.za/up
  loads/files/chap9_06.pdf
• For systematic analysis of effectiveness of
  gender sensitivity in reproductive health
  interventions see WHO/IDGG report
  http//www.who.int/gender/documents/SoWhatReportSe
  pt.05.pdf

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gender mainstreaming across health sector

• Integration of gender issues into planning,
  formulation and monitoring of all health (and
  other) policies, programmes and services to
  reduce the inequalities in outcomes between women
  and men

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The emergence of concept of gender mainstreaming

• Importance of gender issues in health care first
  identified by women who campaigned locally and
  globally for their interests to be taken more
  seriously
• Led to strategy of gender mainstreaming in
  Cairo (1994) Beijing (1995) and at other UN
  conferences
• Based on principles of equity as part of wider
  strategy to integrate women into development
• Spread very quickly as policy framework
  especially in international organisations and
  NGOs
• Last few years attention increasingly paid to
  mens sex and gender specific needs

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Dimensions of gender mainstreaming

• Analysis of health care needs of women and men as
  part of planning process
• Building capacity of health care workers to
  deliver gender sensitive care (knowledge and
  attitudes)
• Provision of protocols and other resources to
  facilitate sex and gender-sensitive diagnosis and
  treatment
• Promotion of equal opportunities policies in
  health care labour force
• Development of appropriate monitoring and
  evaluation strategies to measure gender
  sensitivity of policies
• For related policies in South African public
  health sector see http//www.doh.gov.za/docs/facts
  heets/guidelines/gender/chap3.pdf

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Health care and gender inequalities political
perspectives

• Pursuit of gender equity not just a technical
  issue but a political one
• Interventions may be gender blind and reinforce
  existing inequalities
• Gender sensitive policies ensure women and men
  are treated the same/different as appropriate to
  meet their immediate needs
• Gender transformative interventions use
  policies/programmes to empower women and change
  gender relations

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Illustrations from HIV /AIDS policies

• Gender sensitive policies provide appropriate
  services for women and men according to different
  needs, desires, material circumstances, cultural
  expectations, status and power
• But gender transformative policies challenge
  typical male roles especially those associated
  with violence and sexual demands
• Need to be linked to wider polices that give
  women greater power socially and economically
• South Africa has developed important innovations
  in this area through work of NGOs (eg MAP and
  Stepping Stones)
• For report on randomised controlled trial
  of Stepping Stones in South Africa see
  http//www.mrc.ac.za/policybriefs/steppingstones.p
  df

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Link to wider global equity goals through MDGs
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But is there a political will to change gender
relations?

• Need changes in gender division of labour
• More equality between women and men in access to
  resources
• Greater freedom for women and men from
  constraints of gender roles
• Can these changes be achieved in health care in
  wider society and if so how?
• And very importantly, how does this fit into SA
  policies/politics of transformation?

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