Sex and Gender Ann-Maree Nobelius Monash University Australia 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

Ann-Maree Nobelius 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

Where are you all from?

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

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

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

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’

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

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

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

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

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

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...

Gender-blindness in medical research 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

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

But why should we care about difference? 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

For your purposes… 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

Some examples of Gendered Hierarchies Surgery Nursing Midwifery IVF programme

IVF 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

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