RH -PROGRAMMING FROM GENDER PERSPECTIVE

•

PROF.(DR.)SUNEELA GARG,M.D., F.I.P.H.ADEPTT. OF COMMUNITY MEDICINEMAULANA AZAD MEDICAL COLLEGENEW 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, WHO-SEARO 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 roles-Men 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

• Literacy

• Employment opportunities

• Land ownership.

• Nutrition and food security.

Gender and medical education

• 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

User40%

Non user60%

UserNon user

Gender and Reproductive health issues

Include:- Alcoholism in menProblems such as :- violence, rape and impotence- Frequent and rough sexStress - 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 Men’s Responsibility

• Encourages men to assume responsibility on 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 mutual respect.

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 include-

contraception, infertility, breast-feeding, STDs, RTIs, HIV/ AIDs, cancer screening, violence against women.

• Service provision to women throughout their life cycle- married 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 costlyInsufficient 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.