gender issue

1. Gender issues in
health
Presenter
Mrs. Monika Sharma
lecturer,CON,DMCH.

2. Gender
 This term is used to describe those
characteristics of women and men, which are
socially constructed .
 The different behaviour, roles, expectations, and
responsibilities all women and men learn in the
context of their own societies.

3. sex
 refers to those which are biologically
determined.
People are born female or male but learn to
be girls and boys who grow into women and
men.
This learned behaviour makes up gender
identity and determines gender roles.

4. Gender roles
 The responsibilities and activities assigned to
women and men based on gender perceptions
 Gender roles and relations are not fixed and
universal.
 societies are different and every society
develops and changes in its practices and
norms over the course of time.

5.  Specific consequences of inequality of women
and men in different spheres which requires
redressal to bring about gender equity.
GENDER ISSUES / CONCERNS

6. Gender equality
 The absence of discrimination on the basis of a
person's sex in opportunities, in the allocation of
resources and benefits or in access to services.
 "Gender equality is more than a goal in itself. It
is a precondition for meeting the challenge of
reducing poverty, promoting sustainable
development and building good governance."
Kofi Annan

7. Gender equity
 refers to fairness and justice in the distribution of
benefits and responsibilities between women
and men.
 Women and men have different needs and
power and that these differences should be
identified and addressed in a manner that
rectifies the imbalance between the sexes.

8. GENDER DISCRIMINATION
 Prejudicial treatment of an individual based on
gender stereotype .

9. GENDER BIAS
 The tendency to make decisions or take actions
based on prevalent perceptions of gender.
 This particularly refers to the unfavorable
atmosphere to women compared to men.

10. GENDER RELATIONS
 Ways in which a society defines rights, responsibilities
and identities of men and women in relation to one
another.

11. EMPOWERMENT
 The process of generating and building capacities to
exercise control over one’s life and resources.
 Women’s empowerment refers to the processes of
enabling women to take a more active role in decision
making planning and monitoring activities for their own
welfare and development.

12. Access
 Availability of services in the form of
infrastructure, personnel and material is
potential access. This facilitates utilization of
services

13. CHARACTERISTICS OF GENDER
 Gender roles are socially constructed.
 Gender roles and relations are held in place by
ideology ((underlying beliefs about the way society
should be).
 Gender is relational; gender roles and
characteristics do not exist in isolation, but are
defined in relation to one another and through the
relationships between men and women
 Gender roles and relations are unequal and
hierarchical

14. Gender differences
(physiological)
 Heart
Average female heart 25% smaller than male
heart
Heart rate 5 –8 beats slow in males
 Lungs
Lung capacity 25 – 30% more in men
than women

15. Gender differences
(physiological)
 Bones
Men have more bone mass but pelvic
structure is narrow as compared to women
 Muscles
Men - 50% greater muscle mass based on
weight - hence require high calorie and
protein intake.

16. Gender differences
(physiological)
 Fat
 Women – 10% more body fat than men of same age
 In men – fat accumulation more in back, chest and
abdomen
 In women – fat accumulation more in buttocks, arms
and thighs
 Fat distribution influence the action of many drugs
 Size
 Average 18 year old man 180 cm / 60Kg
 Average 18 year old woman 165 / 60 Kg

17. Gender differences
(physiological)
 Temperature fluctuations are more in women, may be
due to various hormones in action.
 Women and men differ from each other in response to
pain.
 Different communication styles, may have different
interpretation of the same thought

18. Gender Differences
(psychological)
 Women
 women most often turn to other women in a "tend-
and-befriend" response.
 mothers focus more often on their children or other
family members
 In the U.S. nearly twice as many women as men
experience depression (12% vs. 6.6%)
 In anxiety disorders women outnumber men in each
category except for OCD and social phobia
 Women attempt suicide more often than men

19. Gender Differences
(psychological)
 Men
Men tend to respond out of the ancient "fight-
or-flight" response
Fathers are more likely to withdraw in stress.
Men are more successful than women in
suicide attempts.

20. GENDER DIFFERENCES IN
DAILY LIFE
 Economic
 Educational
 Family
 Occupational
 Political
 Social

21. ECONOMIC
 More economic power lies with men
 Men goes to highly paid jobs
 Men handle financial matters
 Women may / may not add to family income

22. EDUCATIONAL
 There is no difference in the proportion of male
and female children who complete primary
schooling
 More financial support for the boys
 Better opportunities of education for boys

23. EDUCATIONAL
 Literacy rate is much higher for male children
than female children
 A higher proportion of male children are
attending school than female children

24. Year
Age
Group
Literacy
Rates
Male
Literacy
Rates
Female
Male/ Female difference in
literacy rate
(% age points)
1961
5 and
over
40.40 15.34 25.06
1971
5 and
over
45.95 21.97 23.98
1981*
5 and
over
53.45 28.46 24.99
1981*
7 and
over
56.37 29.75 26.62
1991*
*
7 and
over
64.13 39.29 24.84
2001***
7 and
over 75.85 54.16 21.70
Gender Disparity in Literacy Rates
in INDIA : 1961 - 2001

25. FAMILY
 Man is seen as the head of the household, the
breadwinner and provider
 Woman is the nurturer and caregiver
 Unequal opportunities, different roles and
responsibilities in the family and community

26. Occupational
 Men go into professions requiring technicality,
challenge and leadership
 Women are steered into nurturing occupations
like teaching, nursing etc.
 Men comprise of major part of the labour force

27. Occupational
 Women make up about 42% of the estimated global
working population, making them indispensable as
contributors to national and global economies
 Women are more likely to work in the informal economy
sector and they do specific types of informal work, such
as domestic work, street vending and sex work
(Acevedo, 2002, p. 84; Bumiller, 1990:Shivdas in WHO,
2005)
 They may work from their homes, in which case their
work is invisible and may not be considered as work
even by the women themselves (Acevedo, 2002 )

28. POLITICAL
 Men are greatly involved in the high or national level politics while women
are in the local politics.
 They just meet the required number. In India, the 74th amendment requires
that 33 percent of the seats in local municipal bodies are reserved for
women
 “The highest national priority must be the unleashing of woman
power in governance. That is the single most important source of
societal energy that we have kept corked for half a century.”
--Mani Shankar Aiyar

29. POLITICAL
 In the society the men occupy all top level
positions
 Very few women come forward into leadership
roles
 Leadership may be considered in any field of life
including family, society, and occupations.

30. GENDER DIFFERENCES THROUGH
THE LIFE CYCLE
 At Conception
 Infancy
 Childhood
 Adolescence
 Adulthood
 Elderly

31. AT CONCEPTION
 Preference for the male child
 Boys are perceived as capable of earning and supporting the family
 Males believed to became the heirs to the ancestral property
 Prenatal sex determination followed by female feticide is rampant.
 The number of female feticides is closer to 250,000 per year as per
the I.M.C.
 ‘ Save the girl child’ campaign by the government has no been
effective.
 Haryana, Punjab, Delhi, and Gujarat, where the ratio is less than
900 girls for every 1,000 boys.

32. INFANCY
 Newborn male babies are provided better care
as compared to female babies
 Breastfeeding duration is longer in males .
 Immunization coverage is more among male
babies
 Finances devoted to the care of the male
children is more

33. INFANCY
 In case of illness male children are treated from
healthcare settings while female children are
treated from the local vaids
 Female infanticide is not uncommon
 Parent sometimes may not be willing to treat
chronic diseases in girls and death may be
taken for granted

34. CHILDHOOD
Girls
 Child neglect, abuse and exploitation
 Child prostitution and sexual abuse
 Overburdened with family activities

35. Childhood
 Boys
Better nutrition
More family support and positive
reinforcement
Risk taking behavior is tolerated
Good facilities of education

36. ADOLESCENCE
Girls
 Education may stop after puberty
 Nutritional deficiency diseases are common– Fe deficiency anemia
Overall, 52 percent of women in India have some degree of anaemia
 Teenage pregnancy
 Early marriages
Thirty-four percent of women age 15–19 are already married

37. ADOLESCENCE
 Boys -the prevalence of the following is more
Accidents
 homicide
violence
alcohol and drug abuse

38. ADULTHOOD
 Health problems like anemia, diabetes, hypertension,
obesity, depression etc. are more common in women
 Women have pregnancy related problems and
complications
 Women have very little choice and control over family
planning.
91 percent of women are involved in decision-making on
at least one of four selected topics

39. ADULTHOOD
 Men are overburdened with the family
responsibilities
 Self care and health may be neglected for family
concerns. This is more true with women
 Physiological changes in women may decrease
the quality of life
 Smoking, alcohol consumption and drug abuse
is more prevalent among men

40. ELDERLY
 Osteoporosis and depression are more common
in women
 Elderly men are less productive and hence
neglected
 Elderly do not receive appropriate care, more
true with women

41. ELDERLY
 Elderly women have less access to health
services and are neglected
 They are deprived of financial and property
rights, especially women

42. GENDER DIFFERENCES IN
DAILY LIFE
 In almost all societies what is perceived to be masculine
is more highly valued and has a higher status than what
is perceived to be feminine;
 Masculine attributes, roles and behaviour are usually
given greater social and economic rewards.
 Gender is thus one of the principal sources of power and
inequality in most societies.
 “You can tell the condition of a nation by looking
at the status of its women”. (Prime Minister
Jawaharlal Nehru)

43. Why is gender difference relevant
to health?
 Gender differences in women’s and men’s roles
and responsibilities, and gender inequities are
reflected in
vulnerability to illness
health status
access to preventative and curative measures
burdens of ill-health
quality of care

44. Gender issues
 Key questions
 How effective are health services for women and men in
the client population? At the primary level? Secondary
level? Tertiary level? Are primary levels being bypassed
for higher levels of care?
 What socioeconomic or cultural constraints do people
face in accessing health services at each level?
 Are there differences in access between women and
men?

45. Gender issues
 What associated health services (water supply and
sanitation improvement, other disease control measures)
do women and men in the client population have access
to?
 To what extent do women and men actively participate in
planning and managing such programs?
 Are changes being proposed in the provision of health
services that will change gender relations?
 How will the changes affect women? Will the changes
be acceptable to women/men?

46. Gender issues
 What formal health delivery systems are available to the
client population, both clinical and nonclinical? To what
extent do women use them? What is the ratio of female
users to male users?
 Are there women health workers in the community?
What are their roles?
 Is traditional medical knowledge mainly the province of
men or women?
 Are traditional practitioners mainly male or female?

47. Gender issues
 What traditional health measures are practiced locally?
Do health delivery systems make use of traditional
knowledge?
 What are the constraints preventing more women from
being trained or being appointed as health providers?
 What factors reduce women’s access to health services?
Consider factors such as timing of services, lack of time for women,
distance, lack of money for transportation, restrictions on women’s
movement in public, lack of female staff in clinics, lack of privacy for
examination, complicated or intimidating procedures, poor facilities.

48. Gender and HIV/AIDS
 Women are probably more susceptible than men to
infection from HIV in any given heterosexual encounter,
due to biological factors
 Failure to engage men leaves women unable to
participate in Prevention of mother-to-child-transmission
(PMTCT) programs even if they, themselves, are
convinced.
 The Department of Gender and Women’s Health has
made focusing on gender and HIV a priority

49. ACCESS TO HEALTH SERVICES
 Resources
 Knowledge
 Man – decision maker
 Health worker – gender differences
 STD’s
 Transportation facilities

50. Women and Violence
 Every 26 minutes a woman is molested.
 Every 34 minutes a rape takes place.
 Every 42 minutes a sexual harassment incident occurs.
 Every 43 minutes a woman is kidnapped.
 And every 93 minutes a woman is burnt to death over
dowry.
 The number of girls and women who have been
undergone female genital mutilation is between 100
and 140 million.
 2 million girls are at risk EVERY YEAR

51. Strategies to address gender
inequities
 Gender equitable health procedures and services
 service provision to increase gender equity
 community work with men and women examining
gender patterns and norms in health, illness and
health care
 planning systems which ensure women’s and men’s
views and needs are taken into account
 supporting disadvantaged groups in making and
influencing health policy decisions
 mainstreaming gender into health policy
 sex disaggregated health information systems

52. Strategies to promote and sustain
gender equitable practice
 gender policy development
 gender awareness training
 gender planning training
 forming internal and external professional,
support and lobbying networks
 advocacy and lobbying
 accessing and marshalling information

53. Working within the health sector
 mainstreaming gender awareness in policy
 training and awareness raising
 changing service provision to improve access
and quality
 improving information systems

54.  Gender mainstreaming
The ECOSOC Resolution defines mainstreaming gender as
"...the 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. Such that inequality between men
and women is not perpetuated. The ultimate goal
is to achieve gender equality".

55. Working within the health sector
 The following strategies aim to address:
 barriers to different groups of men and
women accessing services such as
 costs
 distance to services, sensitivity of providers to
gendered norms
 availability of male and female care providers.
 gender stereotypes and inequities in the
provision of care such as
 provider attitudes
 understanding of gender issues.

56. Working with other sectors
 Improving the environment
 Personal and community development and
empowerment

57. Working with other sectors
 Improving the environment:
 assessing the gender equity impact of plans in each
sector which will change the physical environment
and providing recommendations for appropriate
modification,
 lobbying for improved housing and infrastructure for
deprived/ disadvantaged areas
 developing legislation to protect disadvantaged
groups of workers.

58. ‘Mainstreaming’ gender
awareness in policy
 An organized approach for examining factors
related to gender in the entire process of
program development from conceptualization,
assessment and design to implementation and
evaluation
 Developing a gender policy
 Institutional change

59. Gender Mainstreaming Tools
1. Gender analysis matrix
2. Gender mainstreaming matrix

61. Gender mainstreaming matrix
WHO, SEAR (2001)

62. Gender Analysis
 Gender analysis seeks to
recognise the ways in which gender roles,
resources and perceptions impact upon
women’s and men’s health,
to find ways to address inequities that arise
from this.

63. Gender analysis
 Identifies , analyses and informs action to address
inequalities that arise from
 the different roles of women and men
 the unequal power relationships between them
 the consequences of these inequalities on their lives,
their health and well-being.

64. The Gender Analysis Framework
 Offers a range of ways of assessing the
relationship of gender to the particular health
problem, issue or system being addressed.
 It also raises questions about how gender may
influence the methodology of research studies.

65. Gender analysis: its use
 Policy makers: to construct an overall picture of
how gender affects health needs and responses
in their policy context.
 Health managers :provide guidelines to
constructing a detailed picture of how gender
affects health needs and responses in their
specific area (geographical or disease)

66. Gender sensitive planning
 Being aware of differences between women’s and men’s needs,
roles, responsibilities and identities of men and women in relation to
one another.
 It focuses on:
 the formal health system
 health research

67. SOURCES OF DATA:
 National and local epidemiological surveys
( IMR, MMR etc.)
 Routine health information data
( health records, hospital records etc.)
 Census data

68. Gender sensitive strategies
 Collect sex-disaggregated data on the use of formal and
informal/traditional health services and access to medicine.
 To strenghten basic health services, focus on supporting primary
health care units.
 Locate family planning clinics or health centers where they are
conveniently accessible to women. Ensure that hours of service
delivery fit in with women’s work schedule.
 Improve the knowledge of the client population about health matters,
to enable them to participate in improving health and associated
services.
 Establish an emergency transport system
 Lower the cost of primary health services for poor individuals.

69. Gender sensitive strategies
 Discuss gender issues, the need for active participation by women
as health providers and recipients of health services, with the
executing agency/government ministry.
 Consider how women’s groups and networks can be encouraged to
assist women in learning about health issues and supporting one
another.
 train women as health providers at all levels of the health delivery
system.
 to increase the number of female health service providers by
recruiting women for all areas of health delivery, as community
health workers, health educators, doctors, health administrators and
manager, nurses, midwives, and paramedics

70. Gender sensitive strategies
 Encourage the executing agency to make use of the services of
community groups or NGOs in the delivery of health-based services
and family planning.
 Ensure that women are trained as health providers at all levels of
the health delivery system.
 Set quotas for the number of women to be trained by the project
and/or to be appointed to positions in the project, including
supervisory positions.
 Train health workers to treat and support preventive measures for
the health problems that primarily afflict women (such as backaches
caused by carrying heavy loads on the head, anemia from poor diet
or frequent childbirth, eye and lung diseases caused by cooking
smoke, lack of rest during pregnancy).

71. Changing international and national
policies
 Family-friendly policies need to be strengthened in all countries
inorder to promote gender equality at work.
 These policies should provide
 elder care,
 maternity and paternity leave,
 support for women during maternity and on return to work, child
care
 the possibility to nurse infants, for flexible starting and finishing
times determined by the worker,and the possibility for flexible
leave arrangements and career-break schemes determined by
the worker
 tele-working and home-working.
 Prevent irregular, unpredictable work schedules over which the
employee has little control.

72. Recommendations against
violence to women
 Promote gender equality and women’s human rights.
 Establish, implement and monitor multisectoral action plans to
address violence against women.
 Enlist social, political, religious, and other leaders in speaking out
against violence against women.
 Enhance capacity and establish systems for data collection to
monitor violence against women, and the attitudes and beliefs that
perpetuate it.
 Develop, implement and evaluate programmes aimed at primary
prevention of intimate-partner violence and sexual violence.
 Prioritize the prevention of child sexual abuse.

73. Recommendations against
violence to women
 Integrate responses to violence against women in
existing programmes for the prevention of HIV and AIDS,
and for the promotion of adolescent health.
 Use reproductive health services as entry points for
identifying and supporting women in abusive
relationships, and for delivering referral or support
services.

74. GENDER ISSUES AND NURSING
 Gender issues gaining importance in health
 Holistic care of individuals
 Good understanding of gender differences and
influences on health
 Female predominance
 Bias in Nursing education

75. GENDER ISSUES AND NURSING
 Relative absence of women, specifically nurses, in
health policy formulation, programme design, planning,
implementation and evaluation.
 Limited degree of control over decision–making that
many nurses (most of whom are female) experience with
respect to their work make a difference to the quality of
the service they provide
 Statistics in the United Kingdom show 93% of all nursing
staff are women, men represent approximately 45% of
all those who take up opportunities for higher education
courses and accept senior/management positions.

76. GENDER ISSUES AND NURSING
 Women workers are more likely to be the victims
of sexual discrimination and violence (e.g.
physical assault, verbal abuse, sexual
harassment, bullying).
 Certain areas in hospitals (such as labor and
delivery and nursing units) are still closed to
most male nurses.

77. Role of nurse in gender health
4.3 Valuing a human being
 Nursing care reflects gender sensitivity towards
the needs of women
It aims to provide gender sensitive care to
enhance dignity, individuality, self
determination of women,it also helps to
increase the utilization of health services.
(Practice standards for
nurses in India)

78. Role of nurse in gender health
 The nurse:
 Describes cultural, social,economic,and political
context in which women live
 Promotes and supports self awareness , self esteem,
and self determination among women
 Enhances the dignity of women as reflected in dealing
with them
 Promotes health seeking behaviour in women
 Mobilises support for educating health team
members, families, and communities for the rights of
women.