GENDER

1. GENDER WORKSHOP
FOR PHYSICIANS
Dr Sreeparna
Chattopadhyay,
Associate Professor,
FLAME University

2. OVERVIEW
•Gender, sex, gender identity, sexual orientation
• Impacts of gender on health
•Management of illness
•Recognition of illness
•Do we have enough knowledge?
•Policy and program dimensions
•Gender mainstreaming in health

3. GENDER AND
SEXUALITY – A VERY
BRIEF PRIMER

4. LEARNING OBJECTIVES
1. Understand the meaning of sex, gender, sex/gender,
sexuality and related concepts.
 Appreciate that there is variation across cultures regarding these
concepts
 Learn that the outward representation of an individual’s gender
identity can change over a period
2. Identify why learning about these concepts is crucial
for researchers, practitioners, and educators working
in health and allied areas.
3. Why gender matters in diagnosing, treating, and
managing illnesses?
4. Gendered impacts of health policies.

10. SEX VERSUS GENDER
SEX GENDER
Sex=Biology(?) Socially constructed
Biological characteristics
(including genetics, anatomy
and physiology) that generally
define humans as female and
male.
Socially constructed set of roles,
responsibilities, privileges,
resources, access, rights,
associated with being women
and men, and (other gender)
Natural Learned
Universal, Ahistorical. No
variation from culture to
culture or time to time.
Gender roles vary greatly in
different societies, cultures and
historical periods. They are also
shaped by socio-economic
factors, age, education,
ethnicity and religion.
Cannot be changed, except
with medical treatment
Although deeply rooted, gender
roles can be changed over time,
since social values and norms
are not static.
For example: only women can
give birth.
Only women can breastfeed.
For example: The expectation of
men to be economic providers
of the family and for women to
be care givers is a gender norm
in many contexts.

11. GENDER
Our external appearance
as either male or female
or intersexed. When
babies are born, they
have no gender.
Watch this video to learn
how socialization
produces gendered
behaviours especially in
the ways in which
children are nurtured.
(Duration 3:25 minutes)
.
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12. GENDER- FURTHER CLARIFICATION
OF TERM
For example, if we are biologically male and
choose to represent ourselves as male by
behaving in a way that our social context
associates with being typically male, we are
cisgendered male.
If we choose to present ourselves in the gender
which is the opposite of the sex we were born
into, we are transgendered. So if one is
biologically female (XX) but believes that one
should be biologically male, and acts like one,
then she is a female to male transgendered
person.
Increasingly in many parts of the world,
younger people are choosing to not identify
with either gender (non-binary).
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13. MASCULINITY AND FEMININITY
Masculinity is a word used to describe qualities
associated with a man or with maleness.
 In many cultures, typically male characteristics are
associated with physical strength, higher levels of
aggression, dominance, competitiveness, restrained
emotions and higher sexual needs.
Femininity or Feminity is a term used to describe
qualities association with a woman or with
femaleness.
 In many cultures, typically female characteristics are
associated with a lack of physical strength, care and
nurturance, excessive display of emotions and sexual
restraint.
Much of what is classified as typically female or
typically male varies from one society to another
and is a projection of what that society considers
behaviours appropriate to that gender.
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14. Gender often
viewed as an
add-on
Used to
disaggregate
data

15. • Who has what?
Access to
resources
• Who does what?
Division of
labour and
everyday
practices
•How are values defined?
Social norms:
•How is power negotiated
and changed?
Rules and
decision
making
Instead, ask the following questions

16. GENDER INEQUALITY
Gender inequality refers to:
1)Differences in outcomes between men
and women (e.g. life expectancy,
wages, educational levels, percentage
represented in political office etc.)
2)Differences in outcomes between
groups with different sexual
orientations/gender identities for
instance differences between
heterosexual and straight men,
between straight women and trans-
women and so on. 16

17. GENDER INEQUALITY
CONTINUED…
These differences assume greater importance
in the area of health, since health systems are
not always sensitive or responsive to the
different needs of these different groups.
Also, many of these groups have health needs
which require more attention because of other
intersecting disadvantages associated with
poverty, racial or ethnic inequality, geography
and residence.
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18. GENDER INEQUALITY
CONTINUED..
There are many
reasons why there
are inequalities
between men and
women in areas
such as livelihood,
education, health
and political
representation
among others.
Some are structural and
institutional. For
example women not
being given the right to
vote or not being given
access to education.
These not only have
impacts for individual
girls and women but
have macro-level
impacts for women as a
group.
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19. 19
The figure above represents share of people who believe that going to
University is more important for boys than for girls in different
countries around the world. The lower the percentage, the higher the
support for women’s higher education in that country.

20. SOURCES OF GENDER
INEQUALITY…
Some are rooted in social norms where there are
different expectations and opportunities for men
and women that translates into different outcomes
for the two genders.
 For example, in some cultures, the norm for girls
may be early marriage, followed by early
childbearing and remaining in the caregiving role
of a wife and mother for the rest of their lives.
Such a norm has obvious effects on a woman’s
health and well-being as well as the realization of
her potential.
In Module 2, we will delve deeper into
understanding gender inequality, inequities and
other related concepts.
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21. GENDER NORMS AND
ROLES
Gender norms are
very crucial for
influencing
behaviours that can
either improve or
diminish health
outcomes.
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22. GENDER NORMS –EXAMPLE 1
Norms around women’s mobility can
determine whether women are able to
access prenatal and antenatal care
services and other health care services
to get contraception, for immunizing
children or for support during crisis.
In contexts, where women have
restricted mobility, they may not be able
to access these resources even if they
exist and are free.
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23. GENDER NORMS EXAMPLE # 2
Many countries do not penalize (legally
or socially) violence against wives. They
do not criminalize domestic violence
and/or marital rape because they do not
see this as a problem and believe that
husbands have the right to beat their
wives or have sex without consent.
Clearly this is a violation of women’s
rights to physical integrity and
autonomy and has negative
consequences for health.
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24. GENDER NORMS EXAMPLE # 3
Similarly, gender norms around
whether it is considered masculine to
drive at very high speeds may
disproportionately affect younger men.
Therefore interventions to tackle
accidents caused by speeding, need to
engage with gender norms around
acceptable masculine behaviours to
reduce these instances.
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25. IMPACTS OF GENDER
ON HEALTH
How does gender
affect health?

26. CASE STUDY OF WOMEN IN
RURAL UTTARAKHAND
In groups discuss the following:
1) What are the biological sources of vulnerability for
women?
2) What are the social, and economic cultural sources of
vulnerability?
3) What is discouraging treatment-seeking?
4) In this context, what interventions might be helpful?

27. RECOGNITION AND
MANAGEMENT OF ILLNESS
- Thinking about your experience as a physician, can you
reflect on how gender stereotypes that you hold or a
patient holds may harm the recognition of an illness?
- Can you think of the gendered difference in the
management of illness? Again this could be with regard
to patient behaviour, physician behaviour or both.
- Intersectional disadvantages – gender is one aspect but
also social and economic identities along with gender
identities influence health outcomes and have impacts on
equity, access and quality of health.

28. EDUCATION AND RESEARCH
- Do we have enough information and is there
enough research on how to differentially
diagnose, treat and manage conditions among
men and women?
 The inequality in how women are treated for pain in Europe
 How’s the situation in India? [For example, routine episiotomies
during childbirth without anaesthesia]

29. POLICY DECISIONS
Are we clear about how policy decisions influence health
and health care?
- For example, impacts of the Emergency on male
sterilization.
- India’s Family Planning program – why the excessive
focus on women? What have been the gendered impacts?
- Right to abortion for everyone regardless of marital
status (Recent SC decision)

30. RECAP
1. How does gender affect health and health care?
2. How do gender stereotypes influence our recognition
and management of women’s health issues?
3. Has education and research given us enough knowledge
about women’s health issues and the differences
between caring for men and women with regards to
prevention, pathogenesis, diagnosis, treatment and
prognosis?
4. Are we clear about how policy decisions influence health
and health care?
5. Are we able to disseminate the information on gender
mainstreaming in health to our peers, our community
and our policy makers?
6. Are we knowledgeable about how to implement the
concepts of gender mainstreaming in health?
Source: Training Manual for Gender Mainstreaming in Health