1. Gender sensitivity and gender politics in health care Lesley Doyal

2. What do we mean by gender equity? Cannot give everyone equal health …can only ensure equal right to optimise whatever potential for health individuals may have

3. How to promote gender equity ‘eliminate unfair and avoidable inequalities in health outcomes between women and men through ensuring that both groups have equal access to the resources needed to realise their potential for health’

4. Putting this definition into practice: equity and equality Promoting equality means treating all individuals the same But not appropriate if they have different needs Women and men have many needs in common But also have different needs for both biological and social reasons Also face different constraints on meeting those needs Policies should therefore be based on principle of equity Means design of specific services to optimise the health outcomes/realise the health potential of each group

5. Preliminary agenda for gender equity in health care Promote universal access to effective, appropriate and gender-sensitive sexual and reproductive health care Reshape all health services through gender mainstreaming strategies Promote gender equity in wider economic and social policies

6. Sexual and reproductive health care: Many gaps in available services leading to global inequalities and harm to health of poorest women Reflected in high maternal mortality and morbidity rates and incidence of STI’s in both women and men

8. Major inequalities in access to health care in pregnancy

11. Obstacles to meeting sexual and reproductive needs of poor women availability affordability acceptability accountability (framework from Sen et al (2007) http://www.ids.ac.uk/ghen/resources/index.html

12. Also need to include men Crucial to meet needs of men as well as women Important in promotion of men’s own health (eg prevention of HIV and other STI’s) But also central to promotion of women’s health in sexual /reproductive arena In SA NGO’s such as Men as Partners (MAP) well known for working with men on HIV and violence and other gender issues in health For discussion of men and reproductive health in South African context see http://www.hst.org.za/uploads/files/chap9_06.pdf http://www.hst.org.za/uploads/files/chap9_06.pdf For systematic analysis of effectiveness of gender sensitivity in reproductive health interventions see WHO/IDGG report http://www.who.int/gender/documents/SoWhatReportSept.05.pdf http://www.who.int/gender/documents/SoWhatReportSept.05.pdf

14. ‘gender mainstreaming’ across health sector ‘Integration of gender issues into planning, formulation and monitoring of all health (and other) policies, programmes and services to reduce the inequalities in outcomes between women and men’

15. The emergence of concept of gender mainstreaming Importance of gender issues in health care first identified by women who campaigned locally and globally for their interests to be taken more seriously Led to strategy of ‘gender mainstreaming’ in Cairo (1994) Beijing (1995) and at other UN conferences Based on principles of equity as part of wider strategy to integrate women into development Spread very quickly as policy framework especially in international organisations and NGO’s Last few years attention increasingly paid to men’s sex and gender specific needs

16. Dimensions of gender mainstreaming Analysis of health care needs of women and men as part of planning process Building capacity of health care workers to deliver gender sensitive care (knowledge and attitudes) Provision of protocols and other resources to facilitate sex and gender-sensitive diagnosis and treatment Promotion of equal opportunities policies in health care labour force Development of appropriate monitoring and evaluation strategies to measure gender sensitivity of policies For related policies in South African public health sector see http://www.doh.gov.za/docs/factsheets/guidelines/gender/chap3.pdf http://www.doh.gov.za/docs/factsheets/guidelines/gender/chap3.pdf

17. Health care and gender inequalities: political perspectives Pursuit of gender equity not just a technical issue but a political one Interventions may be ‘gender blind’ and reinforce existing inequalities ‘Gender sensitive’ policies ensure women and men are treated the same/different as appropriate to meet their immediate needs ‘Gender transformative’ interventions use policies/programmes to empower women and change gender relations

18. Illustrations from HIV /AIDS policies Gender sensitive policies provide appropriate services for women and men according to different needs, desires, material circumstances, cultural expectations, status and power But gender transformative policies challenge typical male roles especially those associated with violence and sexual demands Need to be linked to wider polices that give women greater power socially and economically South Africa has developed important innovations in this area through work of NGO’s (eg MAP and Stepping Stones) For report on randomised controlled trial of Stepping Stones in South Africa see http://www.mrc.ac.za/policybriefs/steppingstones.pdf http://www.mrc.ac.za/policybriefs/steppingstones.pdf

19. Link to wider global equity goals through MDG’s

20. But is there a political will to change gender relations…? Need changes in gender division of labour More equality between women and men in access to resources Greater freedom for women and men from constraints of gender roles Can these changes be achieved in health care in wider society …and if so how? And very importantly, how does this fit into SA policies/politics of transformation?