Gender & Reproductive Health Needs A CHIEVING MDG5: POVERTY REDUCTION, REPRODUCTIVE HEALTH A ND HEALTH SYSTEMS STRENGTHENING FEBRUARY 2 9, 2012
Positive discrimination - Yes, Minister - BBC - YouTube
Session Outline 1. Session objectives and expectations. 2. Frameworks Gender and Pathways to better health outcomes. 3. Disparities in RH outcomes/service utilization 4. Linkages between gender equality and RH outcomes 5. Summing Up: Gender diagnostic of Pathways 6. Summing Up: Discussing case studies from 4 countries
Session objectives 1 Describe the principal dimensions of gender disparities in health. Identify some of the principal policy implications of a gendered analysis of poverty and health. Provide examples of how these issues might influence the health policy agenda.
Frameworks G E N D E R E Q U A L I T Y + P A T H W A Y S T O I M P R O V E D H E A L T H O U T C O M E S
Unpacking Gender Equality (WDR 2012)
Pathways to Improved Health Outcomes Health outcomes Households/ Communities Health system & other sectors Government policies & actions Household behaviors & risk factors Community factors Health outcomes Household resources Health service supply Other parts of health system Supply in related sectors Health reforms Actions in other sectors
Combining the Frameworks What does gender refer to? Differences between men and women in economic opportunities, endowments (health), agency Markets, institutions, and households can combine to limit progress in gender equality Where is gender in the pathways? Households, markets and communities and informal institutions norms about care work, decisionmaking Health systems ( institutions ) delivery of services, human resources Policy making policy priorities Poverty exacerbates gender differences and worsens outcomes for poor women and girls
Poverty and RH Outcomes
Disparities in Fertility Total fertility rate and adolescent fertility rate, by wealth quintile, by region (latest available year) 7 6 Poorest Second Third Fourth Richest 5 4 3 2 1 0 East Asia and the Pacific South Asia Sub-Saharan Africa Latin America Caribbean East Asia and the Pacific South Asia Sub-Saharan Africa Total fertility rate Adolescent fertility rate
East Asia Pacific South Asia Sub- Saharan Africa Latin America East Asia Pacific South Asia Sub- Saharan Africa Latin America East Asia Pacific South Asia Sub- Saharan Africa Latin America Disparities in RH Service Utilization I Contraceptive prevalence, antenatal care and tetanus toxoid immunization coverage, by wealth quintile, by region (latest available year) 100 Poorest Second Third Fourth Richest 90 80 70 60 50 40 30 20 10 0 Contraceptive prevalence among women (%) Antenatal care visits to a medicallytrained person (%) Tetanus toxoid immunization (%)
East Asia Pacific South Asia Sub- Saharan Africa Latin America East Asia Pacific South Asia Sub- Saharan Africa Latin America East Asia Pacific South Asia Sub- Saharan Africa Latin America Disparities in Service Utilization II Iron supplementation coverage, deliveries attended by trained personnel and deliveries at home, by wealth quintile, by region (latest available year) 100 Poorest Second Third Fourth Richest 90 80 70 60 50 40 30 20 10 0 Iron supplementation (%) Delivery attended by a medically-trained person (%) Delivery at home (%)
HIV awareness by gender, wealth and education % aware of how HIV is transmitted, by quintile and gender Bangladesh 2004 Average Lowest 2nd 3rd 4th Highest Urban Rural Men 51.5 27.5 36.6 47.6 59.8 78.4 45.7 69.7 Women 31.6 9.7 17.0 26.4 40.2 64.2 25.7 51.7
Linkages G E N D E R E Q U A L I T Y RH O U T C O M E S RH O U T C O M E S G E N D E R E Q U A L I T Y
Better Gender Equality, Better RH Outcomes? Educated women have fewer children which reduces risk of maternal morbidity and deaths Expanding women s labor market opportunities for paid work can do more for fertility reduction than family planning programs alone Improving women s control over resources improves RH services utilization, reduces MMR, and reduces fertility
Better RH Outcomes, Better Gender Equality? Reductions in MMR spur investments in children s education, especially girls education Access to family planning improves women s nutritional status, ownership of assets Fertility reduction helps support women s participation in paid work
Summing Up C O N D U C T I N G G E N D E R D I A G N O S T I C
Gender Diagnostic of the Pathways Households, communities, markets Look for gender differences in Schooling/literacy norms about care work/household chores participation in household decisionmaking health information/knowledge opportunities for paid work Are these differences exacerbate by poverty? Health system and complementary sectors Is service delivery responsive to gender-based constraints? Are men being reached with RH messages? Female staff at primary health centers? Where do Gender and RH fit in health policy priority?
Gender-sensitive Approaches to RH Gender blind or Gender-sensitive service delivery Some gender-sensitive approaches: Encourage male/husband involvement Encourage couple communication Train healthcare providers to adequately serve women Include a gender perspective in promoting use of health services (mapping when and where women and men use RH services) Reduce harmful behaviors rooted in gender inequality (eg Gender Based Violence) Other gender-sensitive approaches: Cash transfers to women
Some examples Source: PRB: A Summary Report of new evidence that Gender Perspectives Improve Reproductive Health Outcomes; January 2011.
More examples Source: PRB: A Summary Report of new evidence that Gender Perspectives Improve Reproductive Health Outcomes; January 2011.
The Entire System Needs to Work to reduce maternal mortality, the entire system needs to work. Women need folic acid before their pregnancy, antenatal visits, identification of potentially dangerous conditions, institutionalized delivery, and a functioning hospital. Again, the myriad choices that the current system imposes on households (which hospital, where do I get the blood, where do I get the medicines, how should I get to the doctor?) need to be taken out of the equation. These institutional solutions reduce the choices that people make and move them from a situation where they are forced to choose to one where they are free to choose. -- WDR 2012, page 138
Summing Up D I S C U S S I N G RH P R O F I L E S F R O M K E N Y A N I G E R I A P A K I S T A N B U R K I N A F A S O
Case studies from Four Countries What is the status of gender equality in the country? What are women saying about accessing health services? Human resources for maternal health? What are the implications for how health system strengthening efforts should be designed taking a gender perspective?