Transcript Document

RH -PROGRAMMING FROM GENDER
PERSPECTIVE
•
PROF.(DR.)SUNEELA GARG,
M.D., F.I.P.H.A
DEPTT. OF COMMUNITY MEDICINE
MAULANA AZAD MEDICAL COLLEGE
NEW DELHI-110002, INDIA
RH -PROGRAMMING FROM
GENDER PERSPECTIVE
• Gender is currently recognised as a term that
reflects the complex social relations between
men and women ( Kannabiran 1997, WHOSEARO 1998).
• Accepting biologically determined differences as
being more unchangeable, the focus is on
socially constructed roles that have developed
historically within and across cultures.
Gender Roles
Three types:
• Reproductive roles- women’s biological capacity to
give birth -assumes that child rearing and household
maintenance is women’s role
• Productive roles- informal economic activities
considered not productive, yet contributes to society
• Community rolesMen usually dominate in leadership and political roles,
whereas women usually perform service oriented or
cultural activities
Gender Equity
• If men and women are equal, they should be
treated fairly, this includes:
• The right of choice and security in marriage,
right to land and property,
• Reproductive rights, freedom from violence, etc.
However, in practice, gender equality and equity
are often different
Social and economic structures and conditions,
which disqualify women from receiving the same
treatment
Gender in RH-ICPD
• ICPD, 1994 addressed complex
relationships regarding individuals’ sexual
and reproductive health needs, global
population & development policies
• Devised a new reproductive framework,
addressing women subordination & made
the improvement in womens’ status
Gender and Reproductive
Health
• Reproductive Health has been defined by
WHO as 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 function and processes
Gender and Reproductive
Health
• Reproductive Health includes men and women,
older people, youths and includes sexuality
education, sexually transmitted disease, health
issues related to child bearing family planning
and safe sex.
• A fact realization that stabilization of population
and development of healthy children into healthy
adults can not be achieved until the status of
women is improved.
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 system
• 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
Reproductive Rights
• 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; and
• The right to privacy in relation to
Reproductive Health
Reproductive Rights
• A wanted pregnancy
• A responsible and empowered young man
• A respected elder, including spiritual leaders,
parents etc
• Respect initially for oneself and then for other
people
• Reproductive Health Rights are not possible to
achieve alone, it is a partnership with one and
more people
Reproductive Rights
• For these aspirations to be achieved there
is a need to improve ones’ individual
development, boosting the inner viability
and potential within an individual.
• To achieve this there is need for
successful communication and
understanding between the different
groups.
Gender Issues R H Concerns
• Many unspoken problems which men and
women suffer silently in relation to their
Reproductive Health due to :
• cultural sensitivity,
• conditioned behaviour, ignorance
• fear and embarrassment
Many of these can be prevented and treated if
present. However, many men & women suffer
pain, stress and even death from inability to
seek assistance.
Gender inequality reflected
through health indicators
• Adverse sex ratio.
• Prevalence of female foeticide has been
documented from all parts of India .
• Ethical issues underlying these practices have
been neglected by professional bodies.
• High stress levels among women lead to
increased vulnerability to behavioral problems.
• Limited and unequal access to health care.
Gender inequality in other
spheres
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Literacy
Employment opportunities
Land ownership.
Nutrition and food security.
Gender and medical education
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Focus on biological aspects.
Social factors neglected.
Lack of gender sensitivity.
Decreased emphasis on community based
gender sensitive approaches.
• Gender differences in admission into
graduate and post graduate courses.
• Sexual harassment at the workplace.
Observations MAMC
SEARO Study
• Poor knowledge of anatomy & physiology Very few
women aware of menstruation prior to its onset
• Poor obstetric care home deliveries preferred
• Deliveries conducted by dais, sweepress, family
members
• No postpartum care
• Husband discouraged their wives for contraceptives
usage and preferred abortion as a contraceptive
method
• Most stable and reliable method was permanent
sterilization, which was accepted after 4-5 deliveries
• Extra marital sex for men was an accepted fact and
sex was viewed as male right.
Reproductive profile
Mean age at marriage
15.2 Yrs. (± 3.25)
Mean ACM
16.2 Yrs. (± 2.56)
Mean age at first childbirth
18.4 Yrs. (± 2.85)
Mean gravidity
3.8 (± 2.20)
Mean parity
3.2 (± 2.14)
Still births
9.4 %
Abortions (spontaneous or
induced)
29.2 %
HEALTH CARE SEEKING WITH
REPRODUCTIVE MORBIDITY
Morbidity
% Of Seeking Any Treatment
Menstrual Problem
13.7
Vaginal Discharge
13.2
Low Backache
11.6
Lower Abdominal Pain
7.4
Uterine Prolapse
7.7
Burning Micturition
5.2
Dyspareunia
6.4
Ulcers
0.0
Infertility
81.1
Current users of contraceptive
methods
User
40%
Non user
60%
User
Non user
Gender and Reproductive
health issues
Include:
- Alcoholism in men
Problems such as :
- violence, rape and impotence
- Frequent and rough sex
Stress - since husbands are out roving;
wives considered too delicate and boring
in pregnant state or post delivery
Conditioning of Gender Roles
and Reproductive Health Contd..
• Time spent for waiting and attending
antenatal consultations – extensive,
deterring many from attending
• Poor medical treatment predisposing to
future problems, e.g incompetent cervix,
rupture of uterus, loss of libido due to pain,
poorly sewn episiotomies
Conditioning of Gender Roles
Men specific Issues
• Social pressures in conforming to a
stereotype gender role;
• Lack of emotional outlets and support
• Traditionally assigned economic
responsibility
• Dependence of women on men
Stress and Reproductive health
Issues
• IMPLICATIONS
Poor diet
Fatigue, Lethargy
Low resistance to Infection
Cancer
Suicides
Violence against women and Children
Right to Privacy and
Reproductive Health?
• Embarrassment due to lack of Privacy,both
Physical and spoken
• Coconut wireless-everyone knows all the men
who had vasectomies
• Poor Facilities
• Relationship of staff to person can deter many,
especially in cultural context
• When contacting an STD or HIV what are your
rights?
Reproductive Approach
• Traditional reproductive health programmes
aimed at meeting predominantly individual
needs:
• male or female whereas;
• gender and reproductive health approach
considers all elements, including culture
environment, social and economic background
when developing programs in response to
needs.
Key essential components
Gender and RH programme
• Understanding of what men and women do
• Who has access and control in relationship to
reproductive health Rights
• What are practical and strategic RH needs men
and women
• How this access and control be improved to
equal and control of R H dimensions?
• What are other factors social,cultural political
economic and environmental which have an
impact on RH
Operationalizing gender
perspective in RH
• Recognition of fact- gender base discrimination
and inequality as contributing factors to women’s
health needs.
• Strategy must respond to manifestations and
consequences of social patterns and support
empowerment.
• Better gender-disaggregated data and research
to provide a more accurate assessment for
planning purposes of health problems, needs
and use of health services.
Operationalizing gender
perspective RH (cont)
• Strategies for health care delivery should be
gender sensitive and accessible.
• Strategies should consider women’s concerns
and needs as well as individuals in relation to
children and child birth.
• Strategies should target men as well as women
for activities related to child health, fertility
regulation and safe sex practices and recognize
men’s rights and responsibilities in these areas.
Operationalizing gender
perspective RH (cont)
• Recognition that women provide most of paid
and unpaid health care in society by
expanding women’s role in decision making
about policies and priorities at national level
and within communities.
• Health sector policies that result in an
equitable distribution of the cost and benefits
of investments and approaches to health care
provision at national and community level.
Operationalizing gender
perspective RH (cont)
• Identification of ways in which the health
authorities can support the initiatives of other
agencies that create the conditions for health,
with particular benefit to women: such as
- investments in water and sanitation;
- food security policies that target women for
extension services and productivity
enhancement etc.
Operationalizing gender
perspective RH (cont)
• Following ICPD, countries have started to
reorient their population programmes in order to
institutionalize the concept of reproductive
health.
• Initiatives taken have ranged from
• nominal change such as substituting the term
reproductive health for family planning,
• to moderate responses like adding one or two
new services to existing traditional FP/ MCH,
and to comprehensive changes overhauling the
entire health system.
Gender Strategies envisaged in
RH programme
• Empower
women
• Empowers to understand
factors and forces that
shape women’s health
status.
• Empowers women to
control their fertility.
• Enables women to make
reproductive choice.
Strategies envisaged in RH
programme
• Holistic
approach
to health
needs
• Views women in the totality
of their health needs,
particularly reproductive
health, arising from their
multiple roles in society.
Strategies envisaged in RH
programme
• Enhancement of • Encourages men to
Men’s
assume responsibility on
Responsibility
birth control and unwanted
pregnancies.
• Encourages men to
assume responsible
sexual behaviour.
• Encourages men to share
responsibility in child
rearing care house work.
• Facilities promotion of
gender equality and
Strategies envisaged in RH programme
• Quality of
care
• High-quality, comprehensive,
women-centered services
based on women’s needs and
choices to improve their health.
• No targets, incentives, or
disincentives.
• Set up an effective information
system for individual client
identification, follow-up and
remotivation to enable
sustained contraceptive use
and to obtain client feedback.
Strategies envisaged RH programme
• Wider prospects
• Range of services to includecontraception, infertility,
breast-feeding, STDs, RTIs,
HIV/ AIDs, cancer screening,
violence against women.
• Service provision to women
throughout their life cyclemarried women, unmarried
women, adolescents, older
women, menopausal women.
Strategies envisaged RH programme
• Information
and
education
• IEC to men& women so that they
are able to exert control of their
bodies (e.g. control over the risk
of STD/HIV.)
• IEC to enable women to
understand the changes within
themselves and their bodies as
they pass thorough various
phases of the reproductive cycle.
• Education for men to instill joint
responsibility for reproductive
functions & care of children.
Strategies envisaged in RH programme
Reaching
out to
men
• Package of interventions to reach out to
men FP for men, STDs, HIV/AIDS
education, infertility.)
• IEC programme tailored to men (e.g. on
reproduction and sexuality, male
involvement and gender equality.)
• Train health providers on counseling
male clients and couples in RH.
• Male FP motivators, counselors,
community-based health workers.
• Education and services for young men.
• Research on male knowledge, attitudes
and practices, male contraceptive
methods and effective interventions.
Fundamental Barriers 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
Fundamental Barriers 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
CONCLUSION
• A gender responsiveness programme
where men are reached out to, motivated
and sensitized would mean men
supporting women in contraceptive choice,
practice of safe sex, valuing and
respecting women’s bodies and the right
to have a safe and satisfying sexual life
including freedom from violence.