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Gender and sexual =
and
reproductive
health
health
=
=
World Health Organization
Acknowledgement: Department of Gender, Women and Health, WHO<= /span>
Acknowledgement: Department of Gender, Women and Health, WHO<= /span>
<=
span
lang=3DEN-GB style=3D'font-family:Arial;font-size:63%;color:#010000'>Genev=
a, March
2006
Training Course in Reproductive Health / Sexual
Health Research
Geneva 2006
Geneva 2006
Overview of the Session
=
=
<=
span
style=3D'font-family:Arial;font-size:88%;color:#010000'>•Clari=
fy
definitions and concepts
<=
span
style=3D'font-family:Arial;font-size:88%;color:#010000'>•Exami=
ne
gender-related data
•Exami=
ne what
"engendering research" implies
<=
span
style=3D'font-family:Arial;font-size:88%;color:#010000'>•Summa=
ry
<=
span
style=3D'font-family:Arial;font-size:88%;color:#010000;visibility:hidden'>=
•
Concepts for gender analysis
<=
span
lang=3DEN-GB style=3D'font-family:Arial;font-size:63%'>- refers to the biological and physiological
characteristics of male and female animals: genitalia, reproductive orga=
ns, chromosomal complem=
ent,
hormonal environment etc.
•
<=
span
lang=3DEN-GB style=3D'font-family:Arial;font-size:63%'>- refers to the socially constructed roles, rights,
responsibilities, possibilities and limitations that, in a given societ=
y,
are assigned to men and women.
Common elements=
in
gender-based differences
•
<=
span
style=3D'font-family:Arial;font-size:75%'>•Men and women perform different tasks =
and activities, occupy different =
physical
spaces, different social networks
•
•
•
Common elements=
in
gender-based differences
•
<=
span
style=3D'font-family:Arial;font-size:75%'>•Gender-based inequality often written in laws =
and policies e.g. marriage and =
divorce,
inheritance, guardianship of children.=
•
Impact of gender
differences on health:
Blindness
<= /div>
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<= /div>
Source:
Abou-Gareeb, I., et=
al.
Gender and blindness: a meta-analysis of population-based
prevalence surveys. Ophthalmic Epide=
miology 2001;8(1):39-56.&#=
13;
=
Source: Abou-Gareeb, Lewallen, Bassett and
Coutright. Gender and blindness: a meta-analysis of population based
prevalence surveys. Opthalmic Epidemiology 2001; 8:39-56
Higher prevalence =
of
blindness
among women: why?
among women: why?
<=
span
style=3D'font-family:Arial;font-size:81%'>•Longer life spans of women?
<=
span
style=3D'font-family:Arial;font-size:81%'>•Differential mortality among bli=
nd
men/women?
•<=
span
lang=3DEN-GB style=3D'font-family:Arial;font-size:88%'>
Higher prevalence =
of
blindness
among women: why?
among women: why?
•Women with cataract are much less likely to have surgery than men wi=
th
cataract.
•An estimated 12.5%
reduction in cataract blindness if women received surgery at the=
same
rate as men.
•Gender-based elemen=
ts:
–cost
–inability to travel=
–differences in the
perceived value of surgery
–lack of access to
information and resources
–fear of poor outcom=
e
•=
•=
•
Impact of gender
differences on health:
road traffic accidents
road traffic accidents
Source:
Gender and road tra=
ffic
injuries. January 2002 (Fact sheet). World Health Organizatio=
n,
Department of Gender, Women and HealthWorldwide mortalit=
y rate
per 100,000 population from road traffic
accidents. 2000.
Differential morta=
lity
for men from
road traffic accidents. Why?
road traffic accidents. Why?
<=
span
style=3D'font-family:Arial;font-size:75%'>•Exposure: More men employed as
drivers; machines assumed to be “male” domain; restrictions <=
/span>on women’s
movements/greater mobility of men.
•=
Impact of gender
differences on health:
HIV/AIDS
Sources:
1.Gender and HIV/AIDS (Fact Sheet).
World Health Organization, Department of Gender, Women and Health August 2003.
<=
/span>
=
2.Messersmith Lisa J. Gender and
HIV/AIDS. Kennedy School of Government, Harvard Universit=
y.
November 2005. Unpublished paper.
Sex and gender
differences in sexual transmission of HIV/AIDS
<=
span
style=3D'font-family:Arial;font-size:75%;color:#CC0000'>•Biological<=
/span> (s=
ex)
-Women are more than twice as lik=
ely as
men to be infected in a single act of vaginal intercourse.
<=
span
style=3D'font-family:Arial;font-size:75%;color:#CC0000'>•Socio-cultural<=
/b> (g=
ender
roles)
•
Sex and gender
differences in sexual transmission of HIV/AIDS
<=
span
style=3D'font-family:Arial;font-size:69%'>•Violence against women puts them=
at
greater risk of HIV infection due to biological, psychological, economic =
and cultural factors. &=
#13;
<=
span
style=3D'font-family:Arial;font-size:69%'>•HIV-positive women have experienced more sexual coercion than HIV-negative women=
<=
span
style=3D'font-family:Arial;font-size:69%'>•Long-term effects o=
f sexual
violence include increased sexual risk taking (greater numb=
ers of
sexual partners, casual partners, transactional sex and lower condom
use.)
<=
span
style=3D'font-family:Arial;font-size:69%'>•Violence or fear of
violence keep women from disclosing their HIV status, from seeking V=
CT and
obtaining HIV/AIDS care and treatment.
Sex and gender
differences in sexual transmission of HIV/AIDS
<=
span
style=3D'font-family:Arial;font-size:69%'>•Men more likely to experience pr=
essure
to be sexually active before and outside of marriage
<=
span
style=3D'font-family:Arial;font-size:69%'>•Men more likely to be injecting =
drug
users than women
<=
span
style=3D'font-family:Arial;font-size:69%'>•Men who have sex with other men =
are
highly vulnerable to HIV infection
<=
span
style=3D'font-family:Arial;font-size:69%'>•Men less likely than women to ha=
ve
access to sexual and reproductive health services (less likely to receive =
appropriate
information)
<=
span
style=3D'font-family:Arial;font-size:69%'>•Men victims of sexual violence l=
ess
likely to report it and receive appropriate care.=
<=
/div>
Economic vulnerabi=
lity
and economic impact
<=
span
style=3D'font-family:Arial;font-size:75%'>•Women tend to be poorer than men=
and
more dependent financially (lack of access to and control over resources); li=
kely to
earn lower wages
<=
span
style=3D'font-family:Arial;font-size:75%'>•AIDS has a greater economic impa=
ct on
women and girls than on men and boys - women more likely to be home care givers; m=
ore HIV+
women divorced by their spouse than HIV+ men.
•
Key points=
•Gender inequalities yield a
disproportionate burden on women
•Social norms can also have a neg=
ative impact upon men's s=
exual
and reproductive health
•Gender is an important determina=
nt of health for BOTH wom=
en and
men
What to consider
•Biological factors
•Socio-cultural factors that defi=
ne and
determine individual behaviour, beliefs, norms and expectations in relation to gend=
er,
sexuality, ethnicity and class
•Economic factors that determine =
access
or lack of access to resources
•Programmatic effect of HIV/AIDS
programmes on women’s and men’s ability to protect themselves
<=
/span>
•Structural factors that reinforce
social and cultural norms
What can be done?
•Collect sex-disaggregated data on
ill-health and on use of services
•Design interventions that take i=
nto
consideration the needs of men and women
•Design research to examine reaso=
ns for
gender disparities – "engendering research"
<=
/span>
•Ensure gender roles are taken in=
to
account in the way in which research is conducted – male or female <=
/span>investigators/quest=
ionnaire
administrators
•=
• =
‘Engendering’ research
•Engendering research makes a
difference to the:
–What
–How
=
–Who
=
–Where & When=
3;
Engendering research : What ?
•<=
/span>Example 1: Studying
factors underlying high levels of stillbirth and LBW<=
span
style=3D'mso-spacerun:yes'> in an area
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Include in the research
issues such as:
-Workload of women: women working in strenuous =
manual tasks till late in
pregnancy
-Experience of domestic violence
-Inadequate intake of nutritious food
-Whether the pregnancy was wanted or planned
-Sex composition of previous children (in contexts =
where son-preference is v=
ery
strong)
<=
span
style=3D'font-size:88%;color:#EF0505;visibility:hidden'>•
Engendering research : How?=
•Literature review to incl=
ude
information from key people in the community or
population under study - gender may influence certain hea=
lth
dimension in context specific ways
<=
span
style=3D'font-family:Arial;font-size:69%'>•Variables chosen may have to be modified
=
•Sample size to be large
enough to permit analysis of sub-categories
•Integrate qualitative methods at different stages of =
the study
<=
span
style=3D'position:absolute;top:73.25%;left:17.04%;width:75.46%;height:4.75=
%'>•Gender is likely to influence informed consent procedures. Also,
participation in the study may affect women and men differently.
(e.g. a study of RTIs)Engendering research : Who?=
•Talking only to men or only to women on problems related to women may give
only a partial picture. We need to understand both t=
he
male and female perspective about many issues, e.g. contraception, antenatal care, knowledge=
of
danger signals in pregnancy
•We may want to get information from different age-groups and social groups =
of
women and men, because gender relations change over time and the ways in which gender affe=
cts
maternal health may vary across generations and across social groups
Engendering research : When and Where?
•The timing of data collec=
tion
will have to take gender roles into consideration.
When are men more likely to be available? When will t=
hey
be able to speak at leisure? Women?
•The place most appropriate for the data gathering exercise to take place ma=
y be
different for women and men
The costs of not
addressing gender in health research
§Failure to assess health
risks for different sub groups of women, resulting in avoid=
able
mortality, morbidity and disability
§Possible delays in diagno=
sis
or inappropriate treatment for certain disorders
=
;
§The implementation of hea=
lth
programmes and services which do not address the
major factors associated with a health problem, or meet
population health needs, resulting in wasted
expenditures
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Population basaed surveys from 5
Asian and African countries show that women account f=
orr
between 53% and 72% of all people living with cataract
Trachoma
- since women and older girls are the primary chldcare providers they
acquire active trachoma from young children.
Survey carried out in trachoma-endemic areas show that
about 75% of adults with trachomatous trichiasis
(inturned eyelashes which abrade the cornea - the wstage of the disease
that leads to blindness) are female.
One of the quickest ways to reduce overall le=
vels
of blindness, and thus move toward Vision 2020 goals, may be to increase women=
’s acces=
s to and
utilization of eye-care services -- through projects that addre=
ss the
gender realities of the intervention area.
The largest sex differentials in mortality rates from
unintentional injury.
« Maculinity » may be hazardous to health.
Sexual and drug use behaviour are
shaped by cultural gender norms and epectations. Men
and women are expected to think and act differently with regard
to sex. Most cultures associate masculinity with earlier sexual activity, =
many
sexual partners/experiences, virility and pleasure.
Those
who do not conform to these gender and sexuality norms (e.g. women =
with
multiple partners, men who have never been sexually active, homosexual
and transgendered people) are often socially ostracized, stigmatized
and discriminated aggainst.
Men are more likely to make the
decisions about sexual behaviour: when, where and how to
have sex and whether to use a condom.
Men are much more likely to use condoms with s=
ex
workers than they are with caasual and marital
partners. Female sex workers are =
much
more likely to use condoms with their non-regular clients, l=
ess
so with their regular clients and rarely with husbands
or partners.
Denial of women being injecting drug users.
=
As sex between men is
socially stigmatized and often illegal, the risk for young men is not paid adequate attention
Early marriage for girls
increases the risk of HIV infection, as usually the partner is older and has had more sexual exposure
<=
/span>
AIDS has a greater economic impac=
t on
women and girls than on men and boys.
E.g. families are more likely to remove girls from school to help w=
ith care
and housework in the event of a family member living with hIV/AIDS. More
women are care givers than men, and must often limit or stop income generating
activities. HIV positive womena re more likely than HIV positive men
to be divorced by their spouse.
No difference:
For example, there may be no difference in the proporti=
on
of men and women who seek health services. However=
, as
a few studies on TB have shown, women may go to
series of health providers who are unable to provide appropriate
treatment, resulting in drug resistance; men on the other hand, Gathering of existing evidence is
always a first step in research. Including a gender
dimension may make it important to gather context-specific evidence from
the local setting, because the ways in which gender influences health is <=
/span>context-specific.
For example, the ways in which gender impacts on nutrition.
Integrating qualitative methods - as already mentioned,
talking to key informants before the start could
help generate the relevant variables; the study
itself may include a qualitative component - to get more insights <=
span
lang=3DEN-GB style=3D'font-family:"Times New Roman";mso-ascii-font-family:=
"Times New Roman"'>intopatterns
and associations seen from the quantitative part. .eg: educated women
are more likely to use health services:
Informed consent - because of women’s status, or their =
lack
of decision-making power, they may not feel
confident about saying yes or no.
Women’s
safety may be at risk because of
volunteering to participate in a gynaecological
examination, or if they report on RTIs.
Variables chosen have to be modified - already demonstr=
ated
this
if we have to analyse sex as a cross--cutting variable,
then we need to have a sample size that is not too small=
to
consider relevant variables
Unless this is a sex-specific study, of course.
For example:
Identifying ‘having
multiple partner’ as a risk factor for STIs had for many
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