This document outlines a framework for measuring women's access to quality, gender-sensitive health services. The framework includes 5 components: 1) Comprehensiveness of information, 2) Comprehensiveness of women's health services, 3) Respect for women's human rights, 4) Technical competence of providers, and 5) Infrastructure and facilities. Each component contains several indicators to assess gender equality and women's human rights in health services, such as availability of women providers, informed consent practices, integration of related services, and infrastructure meeting gender needs. The framework aims to evaluate health services based on women's experiences and promote equitable, rights-based care for women.

1. Understanding
Sex & Gender

2. What is sex?
Sex refers to the universal biological differences between
women and men
SEX does not change
Sex is determined by --the chromosomes
(determined before
birth)
Sex is differentiated
by
the reproductive
system---external genitalia &
internal
reproductive organs

3. 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)

4. What is gender?
• Gender refers to roles that men and women play and
the relations that arise out of these roles

5. “SEX” and “GENDER” are not the same!
SEX
 Biological
 Constant across time
and location
 Universal
GENDER
Social
 Varies across time and
location
 Contextual


6. 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

7. Characteristics of Gender
Relational
Socially constructed
man & woman
Hierarchical
Power relations
Changes
Changes over time
Context
Varies with ethnicity,
class, culture, etc
Institutional
Systemic

8. Differences between Sex & Gender
Sex
Gender
The biological differences with which
men and women are born
• Fixed and unchanging over time
The socially defined roles and
responsibilities assigned to men and
women
• Changes 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
•
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

9. Exercise on Sex and Gender
Sort and put into boxes of Sex/Gender
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
Only women can conceive and give birth
Most men are taller than women
Women are more loving and caring
Men are the best chefs
The most important role of a woman is to become a mother
Women suffer from pre-menstrual tension, men do not
Men think and act more rationally than women
Only men can supply sperm for fertilization
The most important role of the man is to be a bread-winner
Men cannot breast feed babies
Women are poor managers
Men’s voices break at puberty, women’s don’t

10. 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

11. Impact of Gender
on Health
In what way does gender
influence health?

12. 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

13. 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.

14. At birth
Birth of a baby boy
• 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
Birth of a baby girl
• The birth of girls is not
celebrated as the birth of boys.

15. 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

16. - 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 Girls

17. 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

18. Women 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 Female

19. 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

20. Adequate 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.
Elderly

21. Old suffer due to biological and social decline
Male
Female
Biological
Biological
- Cancer of prostate
- Osteoporosis is 8 times than in
male
- Diseases of male genital tract
- Hernia
- UVP , Ca Cervix, Ca endometrium
Social
- neglect, depression
Social
- Depression is 2 or 3 times than in
men
- neglect, abuse mentally

23. Women-Productive life
+ Reproductive life
Do you see any imbalance?

24. 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.

25. Gender equity
… 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.
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.

26. Gender inequity to equity

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

28. Framework to measure Women’s Access to Quality, Gender Sensitive Health Services
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
2. Comprehensiveness of women’s health services
3. Respect of women’s human rights
4. Technical competence of providers
5. Infrastructure and facilities

29. 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
Risks of woman
getting infection
Preventive measures
Delay in
getting
treatment
by women
Resolve

30. 1. Comprehensiveness of Information
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 services
VCCT to pregnant woman

31. 1. Comprehensiveness of Information
3. Adequacy of information given recognizing and promoting
women’s self health care measures
Body mapping exercise
Eg: ARH programme

32. 1. Comprehensiveness of Information
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 Transmission
of HIV/AIDS

33. 1. Comprehensiveness of Information
5. Extent to which women providers are available for medical examination and childbirth.

34. 1. Comprehensiveness of Information
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

35. 1. Comprehensiveness of Information
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)
Female
Male
12
9
12
3
6
9
3
6

36. 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.

37. 2. Comprehensiveness of Women’s Health Services
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

38. 2. Comprehensiveness of Women’s Health Services
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

39. 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.

40. 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)

41. 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.

42. 4. Technical competence of providers
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 providerwomen interaction and service provision.

43. 4. Technical competence of providers
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.

44. 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)

45. Thank You