Dr.JAHANGIRI/School of HSE

Transcription

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3 دكتر كتايون جهانگيري MD-MPH-PhD 3

4 باليا بر روي همه آحاد جامعه از جمله زنان تاثيرگذار است. با توجه به نقش كليدي زنان به عنوان محور خانواده توجه بهه سهالمت زنان در باليا امري اجتناب ناپذير است. وجود نابرابري هاي جنسهيت در عرههه ههاي گونهاگون مسهدله جديهدي نيست اما در باليا اين جنبه ها ابعاد گسترده تر و پيچيده تري م يابد. 4

5 There is some evidence showing that women and men may suffer different negative health consequences following a disaster. It is not clear whether this is because of biological differences between the sexes, because of socially determined differences in women s and men s roles and status or because of an interaction of social and biological factors. 5

6 در نظام سالمت زنان در زمره گروه هاي آسيب پهذير طبقهه بنهدي مه شوند اين آسيب پذيري داراي ابعاد گوناگون است كه م توان آن را به هورت زير طبقه بندي كرد: آسيب پذيري جنسيت آسيب پذيري فيزيک آسيب پذيري فيزيولوژيک آسيب پذيري اجتماع آسيب پذيري رفتاري و انگيزش آسيب پذيري فرهنگ آسيب پذيري روان آسيب پذيري قانون آسيب پذيري آموزش 6

7 Vulnerable Groups Women & female-headed households Lactating female Pregnant female Children The Elderly The Disabled Ethnic, political or religious minorities Urban refugees in a rural setting 7

8 Conditions And Characteristics that increase health risks in women Age Social/cultural Health behaviors Substance use and abuse Nutrition Stress Sexual practices 8

9 CHILDHOOD Sex selective abortion Female mutilation Nutrition problems Neglect Cannot benefit from the services ADOLESENT/ADULT Unwanted pregnancies, STDs Sexuel harassment/abuse Turnpike sex Violence Smoking and substanve abuse Social pressure Increase in morbidity OLDERS Increase in morbidity /problems on quality of life 9

10 Barriers to seeking health care Financial issues Cultural issues Gender issues 10

11 This access may be gendered, in that women and girls in general tend to have less access to, or control over, assets than men and boys. Vulnerability may also be related to the roles women and men play in society. While in most societies men are assumed to be the main income earner, or play the key productive role, women have a triple burden. Typically, women (and especially poor women) juggle triple roles simultaneously: a reproductive role (this is mainly related to childbearing/rearing responsibilities, and domestic tasks); a productive role (this is paid work or subsistence/home production); a community managing role (these are voluntary, unpaid roles carried out in and for the community) (Moser 1993). 11

12 Perception of risk and access to relief services Gender differences may exist in the perception of hazard risks. It has been suggested that women perceive disaster events or threats as more serious and risky than men do, especially if they threaten their family members. Traditional gender roles are also played out in the response phase of disaster situations. In a study on hurricane Andrew in the US, women were responsible for caring for family members, stocking supplies and preparing the household while men were responsible for securing external areas of the house. 12

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14 In 1976 an accident in a chemical plant near Seveso, Italy, exposed the local population to dioxin. A twenty-year follow-up study which compared those in exposure zones with a reference population in a surrounding non-contaminated area found that fifteen years after the accident, mortality from rectal cancer and lung cancer increased among men in highexposure zones. An overall increase in diabetes mortality as compared to those living in the non-contaminated area was reported, notably among women. 14

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16 Studies have also reported adverse reproductive outcomes following disasters, including early pregnancy loss, premature delivery, stillbirths, delivery-related complications and infertility. In India, 24% of pregnant women exposed to isocyanide during the 1984 Bhopal explosion had spontaneous abortions, as against 6% in a comparison group. 16

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18 Social taboos around menstruation and norms about appropriate behavior for women and girls are reported to contribute to health problems in young women in disaster situations. During the 1998 floods in Bangladesh, adolescent girls reported perineal rashes and urinary tract infections because they were not able to wash out menstrual rags properly in private, often had no place to hang the rags to dry, or access to clean water. They reported wearing the still damp cloths, as they did not have a place to dry them. 18

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20 Gender roles Women s vulnerability to the impact of disasters is also increased by socially determined differences in roles and responsibilities of women and men and inequalities between them in access to resource and decision-making power. Excess deaths among female following an earthquake in Maharashtra, India were attribute to women being in homes damaged by the earthquake and men be in open areas. Men were sleeping in fields during harvest time and were away from the home in preparation for a festival, boys were at school away from the village, and many men were away from affected areas as they were employed in other districts or states. 20

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22 One study on a 1991 cyclone in Bangladesh noted that many women perished with their children at home as they had to wait for their husbands to return and make an evacuation decision. When compounded by a calamity, the comparatively lower value ascribed to girls in some societies may take on lethal manifestations. One report from Bangladesh describes a father who, when unable to hold on to both his son and his daughter from being swept away by a tidal surge, helplessly released his daughter, because (this) son has to carry on the family line. 22

23 Men, on the other hand, may suffer other disadvantages in different situations and for different reasons from women, because of their gender-role socialization. Field notes from a Western Ethiopian refugee camp report an instance where young Sudanese men fleeing conscription continued to starve in refugee camps despite receiving prompt shipment of food aid. The food they were given needed to be cooked before it could be eaten, and as men, they had never learned to cook. 23

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25 Researchers reported that in the aftermath of Hurricane Andrew in the United States of America, men who had traditionally been the family providers and protectors struggled with their feelings of inadequacy and failure. 25

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27 Men s roles as protectors may place a greater responsibility on them for risk taking during and after a disaster, both within their households and as volunteers and rescue workers. The vast majority of the plus liquidators soldiers and civilians who helped clean up the Chernobyl site over several years, and were most exposed to the radiation were men 27

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29 In Disaster, Women with lower rates of education and years of education, more work at home, at disaster their preparedness and education are less, they have little information about the preparation and risk approach. 29

30 Differences are also reported around post-disaster relief. Cultural norms have been found to inhibit women from visibly accessing relief centers, or they cannot leave their homes to go to relief centers due to child care responsibilities. In settings where women are forbidden to interact with male members of the community who are not their kin, they may have difficulties in accessing relief services from male relief workers. Further, where food distribution targets household heads, women may be systematically marginalized, as they would only be registered as household heads if no adult male was present. 30

31 High mortality among women in the population may lead to more orphans Past studies have shown that orphans are highly vulnerable and exhibit higher mortality rates than their peers Impact of Tsunami on Women and Children, Indian Ocean tsunami in

32 The risks of artificial feeding were exposed in Botswana in 2005/06 where replacement feeding with infant formula was offered to all HIV-infected mothers as part of a national programme to prevent transmission of HIV from mother to child (PMTCT). National under five mortality increased by at least 18% over 1 year. Non-breastfed infants were 50 times more likely to need hospital treatment than breastfed infants, and much more likely to die. Key Issue: Flooding disasters can trigger outbreak of communicable diseases 32

33 High mortality rates among children under 15 years old and individuals over 50 years old Women ages years old are more vulnerable than men Swimming ability reduces mortality rate by 60% in flooding disasters Women and girls responsible for young children have higher mortality rates because of limited mobility Children under 5 years old are main victims of sanitation-related illnesses because of less developed immunity and greater exposure to pathogens Children, women and elderly more vulnerable in disasters 33

34 Nutrition for infants can be negatively impacted by interruptions in breastfeeding as well as exposure to abuse and trauma and degree of affection and physical stimulation received by the infant Nutrition in Emergencies: Factors that impact nutrition in disasters and steps to reduce these impacts 34

35 A systematic weapon : Rape In South Africa every 83 second one woman is raped report by the U.N. (1996) Special Reporter on Rwanda estimated that at least women were raped during the genocide. During the conflict in Bosnia- Herzegovina between and women were raped. WHO, Sexuel violence in conflict setting and the risk of HIV,

36 Sexually Transmitted Disease Young women know very little information on STDs and because of the fear of being branded as sexual active they hardly try to learn information. Woman equipping less power as a decision maker has resulted with late diagnosis and treatment. 36

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