Gender perspectives of reproductive health


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  • Gender values & norms are not fixed , they evolve over time , vary substantially from place to place and subject to change.Gender roles usually taken for granted - reflected in:family structures, household responsibilities, labour markets, schools,health care systems, laws,public policies, The influence of gender is similar in strength to religion, race, social status and wealth
  • Masculine: means risk taking behaviour,strong, too aggresive, violent, uncaring, no shows of emotion, no flamboyance, no huggingFeminine: understanding, empathetic, sensitive, submissive, gentle, modest, willowy, and pretty
  • Gender Equality is intrinsic dimension of equitable and sustainable human development.
  • Gender roles impact both men and women, women remain more affected by gender inequities and inequalities, especially in sexual and reproductive health.
  • Globally, women bear a greater burden of blindness than men Yet gender may also be the least understood characteristic in terms of how women’s and men’s health needs differ and how those differences can best be addressed.
  • Reproductive health is very important for both men and women throughout life.
  • World Bank: Gender Equality Is Key to Achieving the MDGs. An integrated approach that recognizes that our ability to meet the health-related MDGs is also related to our ability to achieve MDG 3 “promote gender equality and empower women” is required. Countries that invest in promoting the social and economic status of women tend to have lower poverty rates. For example, an extra year of secondary schooling for girls can increase their future wages by 10 to 20 %
  • Reproductive health is a lifetime concern for both women and men, from infancy to old age.four basic stages of the life cycle: Infancy and Childhood; Adolescence; Adulthood; and Older Ages. in utero sex selection; infanticide in situation of economic crisis; Differential allocation of food and medical treatment ; Concepts of womanhood -3S –secondary , subsequent and supportive rather than leadership role
  • A woman cannot receive needed health care because norms in her community prevent her from travelling alone to a clinic. Power relations between men &womendetermine whether women can purchase or use a contraceptive, and therefore, how vulnerable they might be to an unintended pregnancy or to a sexually transmitted infection.
  • the discrimination against girls and women that begins in infancy can determine the trajectory of their lives
  • 914 females against 1,000 males, a drop from 927 in 2001 - the lowest since India’s independence.estimating that eight million female fetuses may have been aborted in the past decade
  • Empowerment of women to control their fertility and enable her to make reproductive choices. Encourage men to assume responsibility on birth control , to assume responsible sexual behaviour and to share responsibility in child rearing care and housework. high quality , comprehensive, women centered services based on womens needs and choices. Service provision to women throughout their life cycle- married women, unmarried women, adolescents, older women, menopausal women.IEC to enable women to understand the changes within themselves. IEC to men& women so that they are able to control over the risk of STD/HIV. FP for men, STDs, HIV/AIDS education, infertility IEC programme tailored to men Train health providers on counseling male clients and couples in RH.
  • addressing adolescents will yield dividends in terms of delaying age at marriage, reducing incidence of teenage pregnancy, prevention and management of obstetric complications including access to early and safe abortion services and reduction of unsafe sexual behaviour. lack of adequate privacy and confidentiality and judgmental attitudes of service providers, who often lack counseling skills, are barriers that limit access to services
  • As far as the girl child is concerned, her care cannot be the responsibility of her parents alone. It is equally the responsibility of the government
  • NABARD estimates that there are 2.2 million SHGs in India
  • Under the scheme, the Government deposits in the account of a new born girl child account Rs. 1 lakh by the time she attains age of 18.The objective of the scheme is to raise the status of the girl child in the family and in the society and to change the mindsets of the people for proper rearing of the girl children  and providing them the right to birth and the right to survival.
  • Joint counseling of women attending ANC services and their partners can lead to improved couple communication and reproductive health benefits.
  • reducing the imbalance in power between women and men requires policies that are designed to empower women
  • For upliftng the status of women in society and for protecting her against the social evils, especially the female foeticide, it is necessary that awareness in gender sensitization is generated in the rural society. HIV/AIDS programmes can address harmful gender norms and stereotypes including by working with men and boys to change norms related to fatherhood, sexual responsibility, decision-making and violence, and by providing comprehensive, age-appropriate HIV/AIDS education for young people.Participatory approach involving adolescents in identifying problem and finding solutions.Research is needed to identify ways to overcome the barriers to couple counseling and to test the effectiveness of this method in creating more gender-equitable relationships and in reducing vulnerability and stigma. Research on male knowledge, attitudes and practices, male contraceptive methods and effective interventions.
  • Gender perspectives of reproductive health

    2. 2. Gender ? Gender is not a natural phenomenon but it is socially constructed roles, behaviour, activities and attributes that a particular society considers appropriate for men and women. It identifies the relationship between men and women in the context of power relations.  Social and economic activities  Access to resources  Decision making authority Gender relations can be changed by the every society that created them.
    3. 3. What do we mean by "sex" and "gender"?  "Sex" refers to the genetical, biological and physiological characteristics that define male and female. Ex: female menstruate while male do not .  "Gender" constructed socially using institutions such as the family, religion, school , health care system, labour market and the state and laws. Ex: women earn significantly less money than men for similar work.  "Male" and "female" are sex categories, while "masculine" and "feminine" are gender categories.
    4. 4. FEW IMPORTANT DEFINITIONS • Gender equality means equal treatment of women and men in laws and policies, and equal access to resources and services within the society. • Gender equity means fairness and justice in the distribution of benefits and responsibilities between women and men. This often requires specific programmes and policies to end existing inequalities. • Gender discrimination means any distinction, exclusion or restriction made on the basis of socially constructed gender roles and norms which prevent a person from enjoying full
    5. 5. Why gender and health? • The distinct roles and behaviours of men and women in a given culture, dictated by that culture's gender norms and values, give rise to gender differences. Ex. men generally wear trousers while women often wear skirts and dresses. • Gender inequalities - that is differences between men and women which systematically empower one group to the detriment of the other. Ex . women do more housework than men . • Both gender differences and gender inequalities can give rise to inequities between men and women in health status and access to health care.
    6. 6. GENDER AND HEALTH BLINDNESS R0AD TRAFFIC ACCIDENT MENTAL HEALTH GENDER TOBACCO MALARIA Malaria in pregnant women AGEING •Notification rate •Development and outcome of TB TUBERCULOSIS •Genital tuberculosis- Infertility HIV / AIDS •Gender norms increase vulnerability to HIV Infection •Health-seeking behaviour
    7. 7. REPRODUCTIVE HEALTH • Reproductive Health : A state of complete physical, mental and social well being, and not merely the absence of disease or infirmity in all matters relating to reproductive system and to its processes and functions at all stages of life.
    8. 8. REPRODUCTIVE RIGHTS - The right to decide about marriage and no. of children -The right to well being throughout life for all matters, relating to reproductive health - The right to a responsible, healthy, safe, and satisfying sex life. -The right to have unrestricted access to information in order to make informed choices. -The right to have safe, effective, affordable, and acceptable family planning methods of choice. - The right to safe pregnancy and birth. -The right to be free from sexual violence and assault
    9. 9. REPRODUCTIVE RIGHTS (contd.) - The right to privacy in relation to reproductive health. - A wanted pregnancy. - A responsible and empowered young man. Reproductive health rights are not possible to be achieved alone, it is partnership with one or more people.
    10. 10. Why gender perspective? • Yet gender be the least understood characteristic in terms of how women’s and men’s health need differ and how those differences can be addressed • Gender plays an important part in the achievement of population, health, and nutrition (PHN) program goals. • It have important role in designing, managing and delivering reproductive health services. • International initiatives to achieve desired reproductive health (RH) outcomes such as  Reducing unintended pregnancy,  Stopping the spread of HIV/AIDS, and  Improving maternal health—are increasingly recognizing that these outcomes are affected by gender relations, norms, and roles commonly applied to women and men, and associated inequalities.
    11. 11. EVOLUTION OF GENDER PERSPECTIVE • International conference on population and development (ICPD) 1994 Cairo. • Fourth World Conference on Women, held in Beijing in 1995 • Both had highlighted the direct connection between gender equality and women’s empowerment with health, including sexual and reproductive health. • They also emphasize the importance of achieving gender equality for both individuals’ health and well being, and for sustainable development.
    12. 12. Goal 1:Eradicate extreme poverty and hunger Goal 6: Combating HIV and AIDS, Malaria and TB Gender Goal 5: Improving maternal health Goal 3: To promote gender equality and empower women Goal 4: Reducing child mortality
    13. 13. Community approval & Support Childhood The Life Cycle Approach In RH
    14. 14. VULNERABILITY •Menstruation •Pregnancy •Child birth BIOLOGICAL FACTORS SOCIAL FACTORS •Less access to health services •Early marriage and childbearing •Education •Financial •Nutrition •Violence •power
    15. 15. Reproductive health issues and concerned:  Pregnancy  Maternal mortality and morbidity  Family planning  Unsafe Abortion  Violence Against Women  Infertility  RTI,STI & HIV/AIDS  Ageing  Cancers “Over one-third of all healthy life lost in women is due to reproductive health problems, compared to 12% for men (WHO).”
    16. 16. MATERNAL HEALTH • India accounts for nearly 20% of the global burden of both maternal and child deaths. • 136,000 maternal deaths occur annually. • The MMR – 212 maternal deaths per 100,000 live births, • Assam has the highest MMR of 390 per 100,000 live births followed by Uttar Pradesh (359/1000 live births) • Direct Obstetric causes account for more than 70% of maternal deaths in our country. The proportion of maternal deaths due to direct obstetric causes have remained unchanged over a period of last two decades.
    17. 17. • As per NFHS III (2005-06) only 52% women receive full antenatal care. • Only 37% of women underwent post natal checkups. • Coverage of institutional deliveries was 40.7% for India. • In rural areas, about 69% of births take place at home. • Our FRUs studies indicate that only 1.5% to 8% of complicated pregnancies and deliveries could reach hospitals. As a result, many deaths occur from complications during pregnancy, at the time of delivery or after delivery
    18. 18. Family planning  56 percent of women using contraception in 2005-06 (NFHS-3).  Most prevalent method is sterilization that too tubectomy (37%) as compared to vasectomy (1%).  Use of spacing methods less.  Unmet need for contraception remains high, 27% among the young.  Proportion of unmarried sexually active using any method is very less. Unsafe abortions  Unmarried girls seeking abortion services may face stigma.
    19. 19. RTIs/STIs • 39 percent of women reported at least one reproductive health problem; 36 percent reported problems with vaginal discharge or urinary tract infection • More than 2.5 million HIV +ve estimated in India. • Only 38% of young women have accurate, comprehensive knowledge of HIV/AIDS according to the 2008 UNAIDS global figures. • HIV positive women bear a double burden: they are infected and they are women. • High risk population group and high risk behaviour group. • Use of condoms less prevalent.
    20. 20. Percent distribution of adults (15+) living with HIV by gender, 1991-2009 100% 90% 80% 70% Female (15+) living with HIV 60% Male (15+) living with HIV 50% 40% 30% 20% 10% 0% 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009
    21. 21. ADOLESCENTS REPRODUCTIVE HEALTH ISSUE • Adolescents (10-19 years) in India represent almost one-third of the total country's population. • A large number of them are out of school, get married early, work in vulnerable situations, are sexually active, and are exposed to peer pressure. • An estimated 14 million girls aged 15 to 19 give birth each year. Their risk of dying from pregnancy related causes is twice as high when compared to 20 to 29 year old women. • Some of the public health challenges for adolescents include pregnancy, excess risk of maternal and infant mortality, STI/RTI in adolescence, and the rapidly rising incidence of HIV in this age group.
    22. 22. GENDER DISCRIMINATION Source : SRS data
    23. 23. Facts reflecting gender discrimination Adverse sex ratio. – Sex ratio: In rural India, sex ration is 946 while in the urban areas it is 900. – National child sex ratio(0-6 years): – in the case of rural population is higher at 934 if compared to 906 of urban population. Census year Sex ratio 1901 972 2001 933 2011 940 Census Child sex year ratio 2001 927 2011 914 Prenatal sex selection: Estimating that 8 million female foetuses may have been aborted in the past decade. Prevalence of female foeticide has been documented from all parts of India .
    24. 24. Facts reflecting gender discrimination contd.. Female literacy rate:The female literacy in 2001 was 53.67 per cent and it has gone up to 65.46 per cent in 2011. The male literacy, in comparison, rose from 75.26 to 82.14 per cent. Violence : • 37.2% of women have reported spousal violence • 1 in 5 women being sexually abused before the age of 15. High stress among women:Number of studies provide strong evidence that higher prevalence of depression and anxiety disorders in girls and women when compared to boys and men. Limited and unequal access to health care: few studies reported that less no. OPD attendees compared to male.
    25. 25. Fundamental Barriers of RH Improvement  Bureaucratic divisions and poor communication between relevant Gos, NGO’s and civil society--decreasing ability to implement a holistic approach to improving health and reducing gender inequalities.  Ingrained attitudes among health providers, with real concern for clients
    26. 26. Fundamental Barriers of RH Improvement  Infrastructure and available human resources are often weak particularly in rural, urban slum and tribal areas.  Every service improvement and new programme requires training or retraining: timely and costly  Insufficient Financial resources and at times misuse of funds
    27. 27. INITIATIVES
    28. 28. INTERNATIONAL AGENCY WORK ON GENDER AND RH • The IGWG :Promotes gender equity within population, health, and nutrition programs (PHN) with the goal of improving RH, HIV/AIDS outcomes and fostering sustainable development. • UNFPA: Promotes the right of every woman, man and child to enjoy a life and equal opportunity. It supports countries for policies and programmes to reduce poverty and to ensure that every pregnancy is wanted, every birth is safe, every young person is free of HIV/AIDS, and every girl and woman is treated with dignity and respect. • WHO: Integrating Gender Analysis and Actions into the Work of WHO. • World Bank: In 2007 launched the Gender Action Plan (GAP) to focus on gender in the land, labour, agriculture, finance, and infrastructure sectors.
    29. 29. NATIONAL INITIATIVES ON GENDER AND RH The Family Welfare Programme :Community Needs Assessment Approach since 1997 : a decentralized participatory planning strategy. The National Health Policy 2001: Increased access to women for basic health care and highest priority to programmes relating to women's health. The Reproductive and Child Health (RCH) Programme (first phase 1997-2003, second phase starting 2005) aims at: • The reduction of maternal and infant mortality •Diagnosis & treatment of RTI/STI •Gender mainstreaming and health equity •Male participation strategy.
    30. 30. STRATEGIES ENVISAGED UNDER RCH ll Empowerment of women  Holistic approach to health needs  Enhancement of Men’s responsibility  Quality of care  Wide and Comprehensive range of services  Information and education  Reaching out to men
    31. 31. RCH II and NRHM: an attempt to address Reproductive health issues .
    32. 32. Addressing Maternal mortality  ASHA, Panchayati raj institution  Janani Suraksha Yojna: (JSY) is proposed to promote Safe Motherhood and to improve institutional delivery. The scheme is 100% centrally sponsored and provides cash assistance linked to institutional delivery for Below Poverty Line (BPL) pregnant women in both urban and rural areas  ‘Referral Transport Scheme’: A sum of Rs.5000/- is placed with ANM/ASHA to arrange transportation and other logistics.  Vande Mataram Scheme: launched in 2004 provide free opd services including antenatal checkup of all the pregnant women and family planning and counselling to new mothers by govt. & private doctors on 9th of every month
    33. 33. ARSH Strategy under NRHM / RCH-II • This strategy focuses on reorganizing the existing public health system in order to meet the service needs of adolescents. • Steps are to be taken to ensure improved service delivery for adolescents during routine sub-centre clinics and ensure service availability on fixed days and timings at the PHC and CHC levels. This is to be in tune with outreach activities. • A core package of services includes preventive, promotive, curative and counselling services.
    34. 34. • INDIRA GANDHI MATRITVA SAHYOG YOJANA (IGMSY) – Is a Conditional Cash Transfer scheme for pregnant and lactating (P&L) women introduced in the October 2010 to contribute to better enabling environment by providing cash incentives for improved health and nutrition to pregnant and nursing mothers. • GARIMA: Community-based organizations to further strengthen Indian women's ability to proactively fight against gender-based violence; support women's ability to address reproductive health issues more effectively; and to increase women's access to and information about the justice system. • The FAM Project’s goal is to increase access to and use of fertility awareness-based family planning methods within the framework of informed choice by scaling up the Standard Days Method (SDM) and the Lactation Amenorrhea Method (LAM) in family planning programs.
    35. 35. Women Empowerment • Political: • In 1993 with the 73rd and 74th Constitutional Amendments that give women 1/3rd of elected seats • Special reservations for women from SC&ST • Bill for reservation of seats for women in Parliament • Economic: • Rashtriya Mahila Kosh(1993) facilitate credit support or micro finance to poor women • Many SHG especially in India, under NABARD's SHG-bank-linkage program
    36. 36. Women Empowerment • Social: • Central Social Welfare Board : Networks the activities of State Social Welfare Boards and voluntary organizations. It implements a number of schemes including Family Counseling Centres, Short Stay Homes, Rape Crisis Intervention Centres, creches . • At state level, the State Departments of Women and Child Development and the State Commissions for Women • The ICDS programme :special focus to health and nutrition of girls. • Kishori Shakti Yojana (2000-01):Health and nutrition of adolescent girls (11-18 years) was launched as part of ICDS. • Gender focal points (Women's Cells) formed in the ministries in the development sector, including Education, Rural Development, Labour, Agriculture. • NATIONAL MISSION FOR EMPOWERMENT OF WOMEN (NMEW) :Centrally Sponsored Scheme sanctioned in April 2011 and acts as an umbrella Mission
    37. 37. Gender Mainstreaming • • • • Gender Mainstreaming:- process of assessing the implications for women and men of any planned action, including legislation, policies or programmes, in any area and at all levels. The National Commission for women (1992) safeguards women’s rights The National Health policy gives highest priority to programs relating to women’s health Special programs in the education sector have helped to increase women’s literacy and reduced the gender gap in the school system. The Gender budgeting concept was emphatically implemented in India’s national budget 2005 – 06 where it was specified that 30% of funds must go to women related sectors.
    38. 38. NACP : Strategies  Respect for the legal, ethical, and human rights of PLHIV  Universal access to HIV prevention, care, support and t/t  Equity NACP III adapted SCM as a policy for implementing STI/RTI program. STRATEGIC APPROACH OF NACP IV Vision: “To provide universal, comprehensive quality standardized STI/RTI services to all population groups through convergence and integration mechanisms and facilitate reduction in HIV transmission and reproductive morbidity.  To provide STI/RTI services at all government health facilities (Medical colleges, district hospitals, sub-divisional hospitals, PHC, CHC etc)
    39. 39. Violence against Women Actions : Women police stations have been set up in all states. Voluntary Action Bureaus and Family Counselling Centres in police stations: rehabilitative services. Family Courts in some states to adjudicate cases relating to maintenance, custody and divorce. The Parivarik Mahila Lok Adalat an alternative justice delivery system (part of the Lok Adalats- People's Courts): provides speedy justice to women. Swadhar(2001-2) by NCW : scheme for holistic rehabilitation of women in difficult circumstances. The protection of women from domestic violence act 2005
    40. 40. Women Development Initiatives in Delhi Stree Shakti- Taking hospital services to slums. Gender Resource Centers- Economic Empowerment of Women Mission for Development of Women- Reducing IMR, MMR, female foeticide, School Drop Out Rate among Girls & Economic Empowerment through microenterprises of Women. Laadli: launched in 2008 state govt. deposite Rs 10,0000 in the account of every girl child by the times she attains the age of 18
    41. 41. WHY INVOLVE MEN? • More than half population of the country constitutes of males and we fail to address their reproductive needs. • Men have their own sexual and RH concerns and needs which are not always met. • Engaging men in the sexual and reproductive health care system promises benefits for men, women and families. • Talking of female alone or male alone is not an adequate approach to RH issues. • Involving men gives the opportunity for increasing communication on the issue of equality between men and women. • Men’s involvement is crucial to addressing sexual and reproductive health concerns such as sexually transmitted infections (STIs) and unwanted pregnancies.
    42. 42. WHY INVOLVE MEN? Contd.. • Initiation of sexual relationships Most men have sex before age 20. Many young men have more than one sexual partner. Young men’s use of contraception varies • Marriage and the beginning of family building By their 20s, many men have married. By their late 20s, most men are fathers. • Fatherhood and the end of family building Men in developing countries often have more children than they desire. Some men do not use contraceptives even though they do not want a child.
    43. 43. BENEFITS OF ADDRESSING MEN’S in RH • Increase societal awareness of men’s needs • Improve the provision of information and services men need to protect their own health and that of their family. • Expand the scope of services available for men and women • Reduce unintended pregnancies and sexually transmitted infections • Promote healthier pregnancies and better parenting
    44. 44. We can achieve gender equality by:  Educating girls  Increasing literacy rates among women  Increasing early childhood development interventions  Increasing women’s labour force participation and strengthening labour policies affecting women  Improving women’s access to credit, land and other resources  Promoting women’s political rights and participation  Expanding reproductive health programs and family support policies
    45. 45. 12th PLAN RECOMMENDATION  Must break the vicious cycle of multiple deprivations faced by girls and women because of gender discrimination and undernutrition.  Ending gender based inequities, discrimination and violence faced by girls and women must be accorded the highest priority and these needs to be done in several ways such as achievement of optimal learning outcomes in primary education, interventions for reducing under-nutrition and anaemia, and promoting menstrual hygiene in adolescent girl & providing maternity support.  The effort to promote women’s health cannot be without participation of men; hence, imaginative programs to draw men into taking part in their health seeking behaviour and practices must be devised.
    46. 46. • Capacity building • Gender sensitization program • Advocacy and IEC/BCC strategy directed to both parents and children • Communication and Publicity • Partnership with voluntary organization • Research
    47. 47. REFERENCES • • • • file_life-cycle • • • Gender, Sexuality, and HIV/AIDS:The What, the Why, and the How: Geeta Rao, Gupta: July 12, 2000