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Gender Issues in RH MELY K. S
Rationale: Discrimination, inequities and stereotypes are gender issues, which often impede behavioural change and put people’s reproductive health at risk. Stereotypes of submissive females and powerful males restrict access to health information, hinder communication between couples, and encourage risky behaviour among young women and men in different but equally dangerous ways. Therefore, gender issues must be systematically considered and addressed in all reproductive health activities.
Broad Objective: To acquire knowledge, attitudes and skills in gender issues related to reproductive health so as to be able to offer quality reproductive health services to men, women and the adolescent/youth
Specific Objectives: By the end of this module, the learners will be able to: 1. Describe Gender, its roles and effects in RH 2. Describe effects of Gender in the development of society 3. Describe Gender issues that affect RH 4. Discuss male participation in RH
Gender and Development
Objectives: By the end of this unit the learner will be able to: 1. Define terms, in relation to gender 2. Explain the difference between gender and sex 3. Identify gender role expectations and how they can limit life options 4. Describe the social construction of Gender 5. Explain basic gender and development concepts 6. Explain the purpose of gender analysis 7. Explain the purpose of gender mainstreaming
Definition of gender terms Gender: The socially constructed roles and responsibilities assigned to women and men in a given culture or location and societal structures that support them. It can also be defined as the division of roles by sex, determined by any given society and dictated by cultural, religious or other values that have little to do with the anatomy or genetic make-up of a person.
Definition of gender terms Cont’d: Gender Roles: Activities assigned to individuals on the basis of socially determined characteristics, such as stereotypes, ideologies, values, attitudes, beliefs and practices. Gender roles are established through the influence of family, community, schools, religious, institutions, culture /tradition/ folklore/history, media, policies, peer groups and the workplace.
Definition of gender terms Cont’d: Gender Stereotypes: Is a standardized idea or character. Gender stereotypes that emerge from confusion between sex roles and gender roles believed that gender roles are based on biological differences rather than socially constructed expectations. For example the belief that women are shy and gentle because of their biology rather than because of social expectations. Gender stereotypes categorizes men and women according to rigid constructs and promote the belief that these differences are biological.
Definition of gender terms Cont’d: Gender Sensitivity: Ability to recognise gender issues Gender Responsive: A higher level of gender sensitivity where one is not only able to recognise but is also empowered to address the gender issues and hence take action to solve a gender problem. Gender discrimination: It is the unequal or unfair treatment of men or women based solely on their sex rather than on their individual skills, talents and capabilities.
Definition of gender terms Cont’d: Gender analysis A systematic way of understanding the roles of both men and women within a given context/society. It is a close examination of a problem or situation in order to identify the gender issues.
Definition of gender terms Cont’d: Gender equity Implies to fairness in access to and control of opportunities and resources among sexes. Gender Equality Absence of discrimination on the basis of a person sex in opportunities and the allocation of resources or benefits or in access to services Gender Needs It’s the practical gender and the needs women and men identify in their socially accepted roles in society
Difference between Sex and Gender Sex Gender Does not vary Varies within and between cultures Biological (penis, vagina, ovaries, testes, uterus etc) Socially constructed roles responsibilities, behaviour Universal (factors related to sex are the same around the world men have penises and women have vaginas in every country) Cultural (Elements related to gender vary within and between cultures; the roles of men and women in may be different from the roles of men and women in ) Born with Learned behaviour Generally unchanging (change is now possible with surgical intervention) Changes overtime (in the past, few women became lawyers and physicians; today it is very common to find women in these professions
Gender role expectations and how they limit life options Social: Different perceptions of men’s and women’s social roles; the man is seen as the head of the household and chief breadwinner, while the woman is seen as a nurturer and caregiver. Political: Differences in the ways in which women and men assume and share power and authority. Men are more involved in national and higher level politics, while women are more involved at the local level in activities linked to their domestic roles.
Gender role expectations and how they limit life options cont’d: Education Differences in the educational opportunities and expectations of girls and boys. Family resources are directed to boys rather than girls’ education, and girls are streamed into less-challenging academic tasks. Economic Differences in women’s and men’s access to lucrative careers and control over financial and other productive resources, such as credit, loans and land ownership
Social construction of Gender: Social construction of gender can be through myths and popular culture. Culture and societies perpetuate gender roles and stereotypes through folklore (songs, stories, games, proverbs, rhymes etc). Some of the meanings/messages may contribute to gender discrimination. Social construction of gender through institutions and systems. Institutions and systems may create and maintain gender stereotypes. At the same time the functioning of institutions and systems may create a more genderequitable society.
Gender and Development It focuses on social, economic, political and cultural forces that determine how women and men benefit from the control of resources and participate in activities differently.
Concept Productive: The production of goods and services for income, trade, or subsistence; tasks that contribute economically to the household and community includes wage-earning, crop and livestock production, handicraft production, marketing, fishing, manufacturing, and construction. Reproductive: The care and maintenance of human life within the household includes childcare, food preparation, collection of water and firewood, cleaning, washing, building and maintaining shelter, and health care.
Concept Cont’d: Community: Maintenance and improvement of the community as a whole includes building schools or clinics, planning celebrations, judging disputes, making laws, and advocating for community needs, such as access to water. Gender division of labour Every society assigns different tasks to women and men. This is known as the gender division of labour in most cultures; both women and men do productive work but women mainly responsible for reproductive work while women and men are both involved in community work, men tend to have the more public and high-status tasks, such as chairing boards and leading ceremonies. Productive work is recognised and valued, while reproductive work (performed primarily inside the house) is not. Women are often overburdened because they are expected to engage in productive reproductive and community work.
Concept Cont’d: Practical Gender Needs These are needs of women and men that are related to the responsibilities and tasks associated with traditional gender roles or to immediate necessity. Responding to practical needs can improve quality of life, but it does not challenge gender divisions or men’s and women’s positions in society. Practical needs generally involve issues of access or conditions. Conditions refer to the material in the environment in which men and women live.
Concept Cont’d: Strategic Gender Interests These are interests concerning the positions of women and men in relation to each other in a given society. Strategic interests may involve decision making power or control over resources. Addressing strategic gender interests helps women and men achieve greater equality to change existing gender roles and stereotypes. Gender interests generally involve issues of position, control, and power. Position refers to women’s and men’s places in society in relation to each other; it involves power, status, and control over decisions, resources and benefits. In order to implement effective and sustainable programs it is often necessary to consider strategic issues – issues of power, control and status because they can serve as obstacles to the attainment of reproductive health. Addressing strategic issues enables us to get at the underlying structures that perpetrate the problems.
Concept Cont’d: Gender Inequality and Inequity Ø The inequality of men and women is an important factor contributing to their equal participation in the development process. Ø Gender inequality means unequal access to resources by men and women and therefore holds back the growth of individuals, development of countries and evolution of societies. For example, unequal power relations in the household, coupled with reduced or lack of access to reproductive health care, and reduced power in decision making over reproductive functions may increase incidences of maternal mortality (causes related to Pregnancy and childbirth). Ø Equity implies fairness in access to and control of opportunities and resources.
Gender Analysis Is a systematic way of exploring the current and potential roles and responsibilities of men and women and their access to and control over resources and benefits within a particular setting. Gender analysis is carried out because of the following: Helps ensure that both women and men participate in and benefit from development. Looks for the root causes of gender inequality and enables us to address them Look at equity of impact Focuses on transforming attitudes and practices to bring about change Helps ensure that traditional power imbalances do not work against women and men advancement Enhances effectiveness of RH activities Ensures long-term sustainability by addressing underlying
Gender Analysis Tools/Frameworks In order for one to undertake gender analysis, gender analysis tools (frameworks) are used for example: Harvard Analytical Framework - One of the first gender analysis models, it uses three diagnostic tools to develop a description and analysis of gender roles and relations in a community. A fourth component applies the gender analysis to a needs assessment, proposal, project, evaluation or other activity. It describes: - Who does each activity? - Who has access to resources? - Who controls resources?
Gender Analysis Tools/Frameworks Cont’d: Women’s Empowerment Framework – This model emphasizes women’s participation and women’s issues at every stage of the development cycle, with the overall goal of overcoming women’s inequality. The framework consists of a five level scale of increasing equality and empowerment.
Gender Analysis Tools/Frameworks Cont’d: Change, Accessibility and Perception tool (CAP) – The CAP is a gender analysis tool designed to guide the development of gender-sensitive IEC activities and ensure that they actively promote gender equity and equality. The CAP is a simple tool consisting of three broad components and associated questions designed to promote dialogue on gender issues. The CAP components are Change, Accessibility/Control, and Perception. Other tools include the Gender Analysis Matrix and the Gender and Development Framework.
Gender Mainstreaming Gender mainstreaming is a process that ensures that gender inequalities between women, boys and girls are addressed in the design, planning, implementation, monitoring and evaluation of programs and ensures that the beneficial outcomes are shared equitably by all women, boys and girls. In gender mainstreaming, all gender biases are removed and everyone plans with the concern of women, boys and girls in mind and how the intended activity affects them differently. Where there is disparity, a deliberate trade-off is made to bring about gender equality. Mainstreaming addresses both practical gender needs and strategic interests. Gender mainstreaming is therefore based on the outcome of gender analysis.
Importance of gender mainstreaming Makes full use of human resources by involving men and women Takes into account the diversity among men and women
Limitations Lack of appropriate tools, methods and techniques for implementation of gender mainstreaming Lack of training for the actors involved resulted in non implementation of procedural changes needed Lack of resources
Gender issues in Reproductive Health
Specific Objectives By the end of this unit the learner will be able to: Discuss gender issues affecting RH services Discuss forms of gender violence and their management Define female genital mutilation and classification Describe female genital mutilation/cutting practice as a violation of fundamental human rights Describe complication of female genital mutilation/cutting Describe the management of girls and women with female genital mutilation/cutting complications Outline strategies for the prevention of female genital mutilation/cutting State policy, legislation and professional ethics in relation to FGM/FGC Analyse own values, attitudes and biases towards FGM/FGC in relation to human rights and reproductive health complications
Gender issues in RH can be categorised into: - Poverty Marriage practices Low Social, legal and economic status Sexual dimension organized on gender lines
Poverty Education attainment - Educating girls and women improves their health and that of their children. High literacy rate among women reduces infant mortality, increases of health services, help prevent diseases, delays marriage and child bearing, increases use of family planning, increasing decision making power and participation in training and credit programmes. Despite the above many girls in some Kenyan communities do not go to school or leave school early reason given for this include: to assist in productive work, lack of money to pay school fees, families reluctant to invest in the girls will be married off and a belief that topics taught in school are inappropriate or not useful or the girls will be exposed to wrong ways of living.
Poverty Cont’d: Access and control over resources – Very few women in Kenya have say in how to spend money even if they helped earn it. A woman without money will not be able to attend antenatal care get medicines or buy food needed especially during pregnancy. Women have little access to other resources e. g. machines, training or credit programmes, equipment which can make their work easier, technical advice & Supplies and information. In some Kenyan culture a woman is not allowed to have custody of children, inherit property earn income or participate in public affairs without permission of her husband, father, first born son or inlaws (father, mother, sister and brother).
Poverty Cont’d: Decision making – Women are not consulted when major decisions (family planning use, when to deliver, how many children to have, when to get married and to who) are made about them the family or the community. Nutrition and health – In many families men and boys eat first and have the biggest share followed by girls and finally the mother. If the family is poor this means that the girls and the mother will not have enough to eat. Under nutrition makes one weak and vulnerable to diseases and predisposes them to complications and problems during pregnancy.
Marriage practices Early marriage - Women in Africa tend to marry at a very early age (in some areas even at 12 years old) because poor families want to have dowry, to be relieved the burden of caring and to avoid risk of illegitimate birth. Most of these girls are married to older men which prevents them from making RH decisions as they are either shy or dependent on their husbands. Forced marriages –Women are not involved in decision making e. g. , who to marry them and when.
Marriage practices Polygamy Marriage – Women may not access resources when their husbands have other wives. They may be predisposed to harmful practices to impress the man. e. g. give birth to many boys Wife inheritance – When women are widowed a man is selected by the family to inherit her with her consent. Dowry – Dowry is seen as a source of income. Physical, psychological and sexual abuse by the husband may occur because he has paid dowry to the woman’s family.
Low Social, legal and economic status The status of women in most African communities depends on how many children she has. Desire for status makes women to continue having children even when pregnancy and childbirth carry serious health risk. Women don’t access to money, training, credit and other resources and freedom to make decision for themselves and their
Sexual dimensions organized on gender lines Sexual partnership – Society assumes men cannot control their libido and thus allows to have as many partners as they want. Men unlike women are allowed to make a choice of who to marry and when to marry. Men can be allowed to change their sexual partners frequently and as many times as possible. This predisposes to infections, e. g. , STIs/HIV Sexual art - Women are expected to be in full control of their sexuality all the time, not to initiate sex and not to express sexual enjoyment. Sex is centered on pleasure and satisfaction of men and this predisposes women to harmful practices e. g. , FGC, use of herbs to satisfy men, etc. Incase of infertility among either of the partner women are always blamed.
Sexual dimensions organized on gender lines Sexual meanings – This is a process by which sexual thoughts behaviours and conditions e. g. virginity are interpreted and ascribed cultural meanings. Perception of pleasure shows the nature of the body, what is considered erotic and when to talk about sexuality and with who. Men are supposed to demonstrate virility at all times. Sexual drives and enjoyment – it includes men and women knowledge of the body’s sexual and reproductive capacities and the ability to obtain physical and emotional pleasure form fantasy, sexual encounters or self stimulation. It involves formation of sexual identities, social conditioned sex drives and perception of pleasure.
GENDER BASED VIOLENCE Definition This refers to acts of violence with power inequities (in this case between women and men, girls and boys) that result in or are likely to result in physical, sexual or mental harm or suffering, including threats of such acts, coercion or arbitrary deprivation of liberty whether occurring in private or public life.
Types of Gender Violence Sexual violence e. g. , rape, incest, sexual harassment, female genital mutilation (FGM) Physical violence e. g. , domestic violence, husband/wife beating Psychological violence e. g. , early marriage, abuse, distribution of resources
Effects and consequences of Violence to individuals, family or community Separation/divorce Deaths Physical Psychological Delinquency Prostitution
Common examples of gender-based violence in Kenya I. Female Genital Mutilation (FGM) Definition - Female genital mutilation/cutting (FGM) constitutes all procedures which involves the partial or total removal of the female genital organs or other injury to the female genital organs whether for cultural or any other non-therapeutic reasons. Types of FGM 1. Type I - clitoridectomy 2. Type II - Excisim 3. Type III - Infubilation 4. Type IV - Unclassified
Complication of FGM Short-term physical complications: Severe pain Injury to the adjacent tissue of urethra, vagina, perineum and rectum Haemorrhage Shock Acute urine retention Infection Failure to heal Death
Complications Cont’d: Long-term physical complications Difficulties in passing urine Recurrent urinary tract infections Pelvic infections Infertility Keloid scar Abscess Cysts and abscesses on the vulva Clitoral neuroma Difficulties in menstrual flow Calculus formation in the vagina Vesico-vaginal fistula (VVF) Recto vaginal fistula (RVF) Problems in childbirth Failure to heal
Psychosocial consequences Fear, submission inhibition and suppression of feelings Reported pain during sexual intercourse and menstruation Emotional pain following the personal experience Feeling of betrayal, bitterness and anger For some girls and women the experiences are comparable to rape Reported disturbances in eating and sleeping habits and in mood and cognition Girls who have not been excised may be socially stigmatised, rejected by their communities and unable to marry locally which also causes psychological trauma.
Sexual complications of Female Genital Mutilation Various forms and degrees of sexual dysfunction Painful sexual intercourse (dyspareunnia) because of scarring, narrowing of the vaginal opening. Vaginisms may result from injury to the vulva area and repeated sexual acts.
Management of Girls and Women with FGM complications Assessment to identify physical complication due to FGM Managing immediate and short term complication Managing long-term physical complication Managing girls and women with psychosocial and sexual complication of FGM - Identification of the problem by history taking - Counselling to help her identify the real problem and accept it - Referral for more specialized care if needed - Use of appropriate family planning methods in the presence of FGM - Opening up of type III FGM Management of women with complication due to FGM during pregnancy. - Assessing problem associated with FGM - Identify complications due to FGM during pregnancy - Manage according to type of FGM
Management of Girls and Women with FGM complications Cont’d: Management of obstetric complication due to FGM during labour and delivery - Assessment - Identify complications due to FGM during labour and delivery e. g. , infibulations. Open it and stitch each side separately so that the raw areas do not come together. - Manage according to type of FGM
Management of Girls and Women with FGM complications Cont’d: Management of women with FGM during the post partum period - Identify the problems Immediate care - Haemorrhage – Suture - Neonatal asphyxia – Resuscitate Post partum follow-up Post partum care Information, counselling and support
Strategies for prevention of FGM
Community involvement Integrate education and counselling against FGM into health care service provision activities at community level. Involve and collaborate with influential leaders and other key individuals and groups within the community as change agents against FGM. Visiting individual people or groups in the community as appropriate. Establishing focus groups discussions on FGM. Assist the people to think through the practice of FGM and its gender and human rights dimensions. Identify and mobilize resources in the community that could be used in the prevention programme. Suggest strategies for changing practices e. g. culturally acceptable alternative rite of passage and teaching women problem solving skills. Supporting individuals and families to cope with the problems of FGM and with adjusting to change.
Involvement of political and government leaders Identification of influential people, both locally and nationally. Make contacts with relevant people and organize seminars or workshops. Lobby influential people in all relevant forums Advocacy in order to win support from the leader Identify providers’ values, attitudes and biases towards FGM
II. ) Rape/Sexual Violence Definitions: Rape is having sex with a woman or girl without her consent or with her consent if obtained under threat, force or intimidation of any kind, fear of bodily harm or misrepresentation as to the nature of the act or by a person impersonating her husband. If the girl is less than 18 years then she is deemed incapable of consenting to sex in law and therefore sex with her is considered rape event with her consent. Technically in law the rape of a girl below 18 years is termed defilement. For the act to be considered as rape or defilement, there must be penetration of the vagina with the penis.
Rape/Sexual Violence Cont’d: Attempted rape If someone tries to rape a girl or woman but fails then this is still an offence called attempted rape and it is punishable by life imprisonment. In attempted rape, there is no penetration. Penetration This is the partial or complete insertion of the penis into the vagina. No ejaculation is necessary.
Rape/Sexual Violence Cont’d: Sexual violence There is no generic definition of sexual abuse in law but a general definition is: Sexual violence is the use of physical sexual contact or erotic non-contact sexual exposure by one person to another against his or her will and may include acts such as rape (sex against a person’s will), kissing, touching the private parts of a person (such as the penis or vagina), oral sex (placing the mouth or tongue on a person’s vagina or penis), anal intercourse (placing the penis inside the buttocks opening), dry intercourse (the rubbing of a penis against another person’s body) and performing such acts with an animal. However, the law defines each of these activities differently.
Steps in post rape management Medical Management Pregnancy prevention HIV prevention Management of physical injuries STI prevention Hepatitis B prevention Tetanus toxoid Psychological support/Counselling Trauma counselling and on going support pre and post test counselling for HIV drug adherence counselling Laboratory Legal/Forensic issues Documentation of examination findings Specimen collection Reporting procedures (Refer to MOH Guidelines on Rape/Sexual Violence Management and MOH Clinical Training Manual) for details.
Male Participation in Reproductive Health
Specific Objectives By the end of this unit, the learners will be able to: - Identify barriers, which hinder male participation in Reproductive Health. Develop strategies and approaches for involving men in reproductive health.
Barriers to male participation in Reproductive Health Individual Personality Socialization ego Family barriers Taboos made against male interaction with small children. Cultural norms about family planning being a woman’s problem. Lack of role models for involved fathering Cultural assumption that anything domestic is women’s work.
Barriers to male participation in Reproductive Health Community/peer group barriers Fear of being viewed as not man enough by peer if caught doing housework or childcare. Family planning services are geared towards women’s needs and are not welcoming to men e. g. , (MCH/FP). Traditional male/female roles reinforced in mass media National Program/Policy barriers Separation laws are not favourable to male or joint custody of children. No legal paternity leave. Inadequate family life education in school to help change gender stereotypes. Hospital/clinic regulations not supportive of father involvement in birth and post partum care. Lack of specific interventions to address them.
Strategies and approaches Advocacy Create enabling environment, Policies, and appropriate legislation e. g. paternity leave and allowance Role models in male participation at Family level, Community level, Individual level and use them as change agents Male friendly Reproductive Health Services – privacy from reception to service provision site. Reorientation of service providers to be gender sensitive National planning for resources in all programmes to be shared equitably by both men and women.