Slide 1

Sex and Gender
Ann-Maree Nobelius

Faculty of Medicine, Nursing and Health Sciences

Monash University Australia
Education Program in Reproductive Biology Lecture
For Reproductive Health Services and Policy Unit
29th of July 2003


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Ann-Maree Nobelius
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Monash graduate, Physiology and Pharmacology &
Masters in Reproductive Sciences!!!!
medical research background
further studies in sociological research methodology
particularly gender studies
fieldwork for PhD in Public Health on AIDS in
Uganda with UK MRC
Employed by School of Rural Health to report on
Gender Issues in Rural Medical Practice Project
Project Officer for Gender Working Party with goal
of mainstreaming a gender perspective into entire
curriculum


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Where are you all from?


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Definitions
What is the difference between sex
and gender?
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Sex = male and female

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Gender = masculine and feminine


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SEX

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refers to biological differences;
chromosomes, hormonal profiles, internal
and external sex organs.


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GENDER

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describes the qualities that a society or
culture delineates as masculine or
feminine.


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It’s culturally defined
‘man’ = male + masculine social role
a real ‘man’, ‘masculine’ or ‘manly’

‘woman’ = female + feminine social role
a real ‘woman’, ‘feminine’ or ‘womanly’


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Society and Culture
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Groups of people acting in organised
ways
Social institutions are reproduced and
changed over time (innovation)
Sub-cultures exist within institutions


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Policy is a set of rules that govern those
institutions (ideals)

…but not necessarily enforced (because of
sub-culture)
Within all social institutions (religion/health
systems/state) we see behaviour outside
the ideals

Opportunity exists to change social
institutions and therefore policy


Slide 10

Policy change at Monash
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Gender Issues in Rural Practice Project
New 5 year Curriculum
Gender Working Party
Mainstreaming an Gender Perspective
into the new curriculum


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Misunderstandings…
– ‘gender’ does not mean sex, female or feminism
– ‘a gender perspective in medicine’ is not a
euphemism for women’s health, feminism or for
men needing to ‘get in touch with their feminine
side’
– at times impossible to differentiate the biological
from the social determinants of health;
convention dictates the use of ‘gender’ rather
than ‘sex’ in those cases
– misuse of terms is widespread (we use WHO
and UN definitions)
– MEN HAVE GENDER TOO


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A gender perspective in medicine is
multidimensional
…because all players in healthcare have a gender

So from the patient’s perspective
 gender perspective in medicine simply
acknowledges the differential roles that
masculinity and femininity play in men’s and
women’s health
From the providers perspective
 a gender perspective acknowledges the ways
in which the gender of the provider impacts on
the health care event


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From an educational perspective
 identifies the gendered nature of
medical education/texts/teaching
styles
From an evidence based perspective
 acknowledges the clinical
consequences of gender blind medical
research and the resulting medical
evidence
…this last one is a good and accessible example...


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Gender-blindness in
medical research
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2/3 of all pharmaceuticals used to treat both
men and women have only been tested in
men
2/3 of all diseases that affect men and
women have only been researched in men

women have only made up 7% of all cardiac
research subjects


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Mainstreaming
…acknowledging where difference is
important throughout the entire
curriculum and teaching process, in
clinical practice and policy
development and providing balance
where needed.


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But why should we care
about difference?
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More or less you are either one or the other
on the basis of biological difference
Difference has profound consequences for
clinical practice
Truly evidence based curriculum
Improved clinical practices
Improved outcomes for patients
More competent graduates


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For your purposes…
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In what ways are our health services
gendered?
Medicine is an institutionalised form of
social behaviour with deep historical
roots
Medicine has many hierarchies
These hierarchies are very gendered


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Some examples of
Gendered Hierarchies
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Surgery
Nursing
Midwifery
IVF programme


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IVF
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Male factor contributes equally to a
couple’s infertility
Most research has been done on
female factor infertility
Infertility equally challenging to male
identity
Very few male counsellors
Run out of O & G


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What can be done about
it?
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Identify issues through gender
analysis
Advocate for change in thinking and
policy
Funding for change
Andrology Australia is a good example