This opinion article was written by Rosemary Morgan, PhD, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA. For more like this, see our health and wellbeing newsfeed.
I’m sure you’ve heard it before: make sure you consider gender in your health policies and programmes. In many cases, this is a key requirement for funding.
It is true that scholars and advocates have been pushing for gender equality for years — and for good reason and one which should not be ignored.
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All too often gender is inaccurately believed to be synonymous with women and, therefore, policies and programmes which focus on women’s health (or women in general) are used to “tick the gender box”.
It is sometimes thought, for example, that by increasing women’s access to maternal health care, an intervention is addressing gender inequality, that women’s health policies are gender policies. What this fails to recognise is that gender is so much more than focusing on women and girls.
Women ≠ Gender
Gender — and gender inequity — affects everyone.
Gender refers to the socially constructed roles, behaviours, activities, and attributes that a given society considers appropriate for men and women and people of other genders. Gender is context specific: what it means in your context may be different from what it means in another.
It is something which changes over time and differs for different groups of people depending on their age, race, income, sexuality, etc. It is not the same thing as a person’s biological sex and in some instances may differ from the sex they were assigned at birth.
While a focus on women’s health is important, it does not necessarily address determinants of gender inequality that perpetuate women and girl’s vulnerability and marginalisation
Women, men, girls, boys, and people of other genders are all affected by what society considers appropriate for men and boys and women and girls (and what this means for those who do not into each pre-defined box). Gender can have a significant impact on a person’s health, health-seeking behaviour, and access to health services, as well as the way in which health systems are structured and provided.
The roles that men and women are expected to play both within and outside the health system (such a breadwinner or homemaker), and the norms that dictate how they should act (for example, to not show emotion or to not show anger or be too direct) have negative repercussions on a person’s health and health systems experiences.
It affects whether they see a doctor, whether they have access to money to see a health provider, the type of profession they are allowed or not allowed to have, who gets to be in charge.
The spectrum of inequality
While a focus on women’s health is important, it does not necessarily address determinants of gender inequality that perpetuate women and girl’s vulnerability and marginalisation.
For example, programs “that are designed to address women’s and girls’ health typically focus on their health needs without examining how their subordinate positions in households, communities, and the larger societies in which they live contribute to their health-related behaviours, health status and outcomes.”
A health policy and programme cannot effectively address or account for gender inequality if it did not consider it while it was being developed
Equating gender with women’s health also underestimates ingrained power relations and men’s roles in perpetuating gender inequalities. As a result, men and boys are often not included within women’s health programmes.
It also ignores the ways in which gender negatively affects men and boys (and people of other genders). Men and boys, for example, are more likely to engage in activities which put them at increased risk of developing non-communicable diseases, such as cancer and diabetes, due to norms around what it means to be a man which encourage smoking, drinking, dangerous driving and other risk taking behaviours.
If we are to address gender inequality effectively these all need to be considered within health policies and programmes.
Moving beyond a tick box exercise
So how can you ensure that you address gender within your health policies and programmes in a meaningful and impactful way? Here are some tips to get you started:
- Move beyond the notion that gender equates to women and girls only.
- Health and health systems policies and programmes deal with people and gender affects everyone. As such, gender affects all health and health systems policies and programmes.
- Recognise that while gender inequality/inequity affects everyone, the ways in which it affects people is different.
- Consider the specific ways that gender inequality manifests in your local context, and how it affects women and girls and men and boys, as well as people of other genders, differently.
- Consider gender from the outset. A health policy and programme cannot effectively address or account for gender inequality if it did not consider it while it was being developed. In the report Transforming Gender Norms, Roles, and Power Dynamics for Better Health: Evidence from a Systematic Review of Gender-integrated Health Programs in Low-and Middle-Income Countries the authors present evidence on how gender-integrated programming influences health outcomes in low- and middle-income countries.
- Conduct a gender assessment of your context and identify how differential access to resources, norms and values, roles and distribution of labour and decision-making power affects health. JHPIEGO’s gender analysis toolkit for health systems provides guidance on how to conduct a gender assessment. The paper Expanding the agenda for addressing mistreatment in maternity care: a mapping review and gender analysis provides an example of conducting a gender analysis using a mapping review of peer-reviewed and grey literature.
- Analyse policies and programmes to see how gender is currently integrated or the integration of gender could be strengthened. Prevention of mother to child transmission of HIV in Tanzania: assessing gender mainstreaming on paper and in practice is an example of how policies can be assessed for their gender integration.
- Use a gender assessment scale to inform your programming and ensure all policies are gender-responsive. The WHO gender responsive assessment scale or the Gender Equality Continuum Tool can help you do this.
- Involve men and boys in programmes and interventions to address women’s and girl’s vulnerability and marginalisation, but be sure to do so in a way that does not further infringe upon their rights or autonomy.
- Allocate resources to address gender inequality and inequity within all health policies and programmes.
- Remember that changing gender norms, roles, and relations takes time and achieving gender equality will require considered changes within policy and programmes.
The inclusion of gender within health policies and programmes needs to move beyond a tick box exercise and meaningfully engage with the ways in which gender inequality leads to different health and health systems needs, experience, and outcomes. Only then will we see substantial and long lasting improvements in the health and well-being of everyone. — Rosemary Morgan
This article is part of a series exploring the intersection of gender and health leading up to the High-Level Meeting on Universal Health Coverage in New York 23 September 2019. Click here to read the first article in the series.
(Picture credit: Unsplash)