Gender perspectives of reproductive health

PRESENTER:Dr. Jitendra Kr Meena
MODERATOR: Dr. Nandini Sharma
GENDER PERSPECTIVES OF
REPRODUCTIVE HEALTH

 Gender and related definitions
 Gender and health
 Reproductive health
 Reproductive rights of women
 Gender Equality and MDGs
 Life cycle approach to RH
 International and national
initiatives
 Barriers and challenges to
reproductive health programs
 Way forward

Gender ?
• Gender can be seen as the full range of personality
traits, attitudes, feelings, values, behaviors and
activities that society ascribes to the two sexes on a
differential basis. It is a social construct, which varies
from society to society and over time.
• It identifies the relationship between men and
women in the context of power relations.
• Social and economic activities
• Access to resources
• Decision making authority

• Gender equality means equal treatment of women and men in laws
and policies, and equal access to resources and services within the
society.
• Gender equity means fairness and justice in the distribution of
benefits and responsibilities between women and men..
• Gender discrimination means any distinction, exclusion or
restriction made on the basis of socially constructed gender roles and
norms which prevent a person from enjoying full human rights.
• Gender integration means taking into account both the differences
and the inequalities between men and women in service provision.

Gender perspectives
• Gender plays an important part in the achievement of population,
health, and nutrition (PHN) program goals. It has important role in
designing, managing and delivering reproductive health services.
• Initiatives to achieve desired reproductive health (RH) outcomes
such as:
Reducing unintended pregnancy,
Stopping the spread of HIV/AIDS, and
Improving maternal health
Experts are increasingly recognizing that these outcomes are
affected by gender relations, norms, and roles commonly
applied to women and men, and associated inequalities.

At the 1994 International Conference on Population and
Development (ICPD), held in Cairo, recognized the importance of
men to women’s reproductive health and also recognized the importance of
men’s own reproductive health. The shift from the medical model to the rights
model challenges the cultural and economic conditions under which women in
diverse cultures receive RH services.
The 1995 United Nations Fourth World Conference on Women,
held in Beijing, encouraged men to take steps toward achieving gender
equality and better reproductive health.
• Both had highlighted the direct connection between gender
equality and women’s empowerment with health, including sexual
and reproductive health
EVOLUTION

Gender
Goal 4: Reducing
child mortality
Goal 1:Eradicate
extreme poverty and
hunger
Goal 3: To
promote gender
equality and
empower women
Goal 5: Improving
maternal health
Goal 6: Combating HIV
and AIDS, Malaria and TB

• Reproductive Health : A state of complete physical, mental
and social well being, and not merely the absence of disease
or infirmity in all matters relating to reproductive system and
to its processes and functions at all stages of life.
Reproductive Health
1. Income and social status
2. Social support network
3. Employment and working
conditions
4. Education
5. Social environment
6. Physical environment
7. Housing
8. Personal health practices and
coping
9. Healthy child development
10. Biology and genetic endowment
11. Access to health services
12. Culture , ethnicity , immigration,
refugee status etc.
Determinants of health

Speak Up…
• Many unspoken problems which men and women
suffer silently in relation to their Reproductive Health
due to :
• cultural sensitivity,
• conditioned behavior, ignorance
• fear and embarrassment
Many of these can be prevented and treated if
present. However, many men & women suffer pain,
stress and even death from inability to seek
assistance.

Gender perspectives of reproductive health

Reproductive Rights of Women :
1. - The right to decide about marriage and no. of children
2. -The right to well being throughout life for all matters,
relating to reproductive health
3. - The right to a responsible, healthy, safe, and satisfying
sex life.
4. -The right to have unrestricted access to information in
order to make informed choices.
5. -The right to have safe, effective, affordable, and
acceptable family planning methods of choice.
6. - The right to safe pregnancy and birth.
7. -The right to be free from sexual violence and assault
8. - The right to privacy in relation to reproductive health.
9. - A wanted pregnancy.
10. - A responsible and empowered young husband.

• At all ages women are more likely to be poorer than men owing
to poverty, lack of education and the lack of decision–
making power in the household.
• Poor women are likely to live in unsanitary housing, have poor
quality meals, and limited access to even free health care.
• Domestic violence and violence against women of all ages is an
engendered phenomenon with strong inter-generational links on
the part of both men (the right to hit) and women (conditioned to
suffer in silence).
70 per cent of married women in India between the age of 15 and 49 are victims of
beating, rape
Gender inequality

Gender inequality
• Cultural conditions are mediated by religion, gender
and tradition. Religion may influence interpretations
about use of certain contraceptives, use of blood or life
support systems in emergency obstetrics, etc.
• Cultural pressures may force girls to marry and bear
children at a very young age with serious reproductive
health consequences. Obstructed labour, ruptured
uterus, fistula formation etc.
• Mental and physical abuse of women blamed (often
unfairly) for infertility, or poor pregnancy outcomes is a
cruel engendered cultural practice. This may contribute
to depression and suicide or violence against the
woman from the in-laws.

Gender inequality
• Incomplete knowledge about health and human sexuality;
gender bias; high-risk sexual behaviour; and the unavailability
or poor quality of reproductive health care services.
• Violence against women such as domestic abuse and rape
leads to STDs and unwanted pregnancies, as well as to
physical injury and mental illness.
• The growing incidence of STDs including HIV/AIDS also
negatively affects reproductive health as does the continuation
of harmful practices such as female genital mutilation.

ChildhoodCommunity
approval &
Support
The Life Cycle
Approach In RH

BIOLOGICAL
FACTORS
SOCIAL
FACTORS
VULNERABILITY
•Menstruation
•Pregnancy
•Child birth
•Less access to health services
•Early marriage and childbearing
•Education
•Financial
•Nutrition
•Violence
•power

Reproductive health issues :
 Pregnancy
 Maternal mortality and morbidity
 Family planning
 Unsafe Abortion
 Violence Against Women
 Infertility
 RTI,STI & HIV/AIDS
 Ageing
 Cancers
“Over one-third of all healthy life lost in women is due to reproductive health
problems, compared to 12% for men (WHO).”

Women and HIV/AIDS
• Women are more susceptible than men to infection
from HIV in any given heterosexual encounter.
• Gender norms influence women's vulnerability to
HIV. In many places, these norms allow men to have
more sexual partners .
• Violence (physical, sexual and emotional) - Forced
sex, inability to negotiate safer sex and treatment
access, Fear from learning and/or sharing their HIV
status.
• Caretaking in the family – additional burden PLHIV

Gender inequality reflected through
health indicators
• Adverse sex ratio.
• Prevalence of female feticide.
• High stress levels among women.
• Limited and unequal access to health care.
• Maternal mortality rate
• Anemia prevalence among females.
• Malnutrition among girl child. etc

Gender Inequality Index
• The Gender Inequality Index (GII) is a new index for
measurement of gender disparity that was introduced in
the 2010 Human Development Report .
• captures the loss of achievement, within a country, due
to gender inequality, and uses three dimensions to do so:
1. Reproductive health,
2. Empowerment,
3. Labor market participation.
• GII is a pioneering index, in that it is the first index to
include reproductive health indicators as a measurement
for gender inequality. (India ranks 132 out of 148 countries)
• Maternal Mortality Ratio (MMR) & adolescent fertility
rate (AFR)

MATERNAL HEALTH
• India accounts for nearly 20% of the global burden of both
maternal and child deaths.
• The MMR – 212 maternal deaths per 100,000 live births,
• Assam has the highest MMR of 390 per 100,000 live births
followed by Uttar Pradesh (359/100000 live births)
• Direct Obstetric causes account for more than 70% of
maternal deaths in our country.
The proportion of maternal deaths due to direct obstetric causes
have remained unchanged over a period of last two decades.

• As per NFHS III (2005-06) only 52% women receive full
antenatal care.
• Only 37% of women underwent post natal checkups.
• Coverage of institutional deliveries was 40.7% for India.
• In rural areas, about 69% of births take place at home.
• Our FRUs studies indicate that only 1.5% to 8% of complicated
pregnancies and deliveries could reach hospitals.
As a result, many deaths occur from complications during
pregnancy, at the time of delivery or after delivery

 Only 56 percent of women using contraception in 2005-06
(NFHS-3).
 Most prevalent method is sterilization that too tubectomy
(37%) as compared to vasectomy (1%).
 Unmet need for contraception remains high, 27% among
the young.
Unsafe abortions
 Unmarried girls are forced to seek abortion services and
also may face stigma.
 In absence contraception usage by male partner they are
constantly at risk of conceiving.
Family planning

• 39 percent of women reported at least one reproductive health
problem. (36% v. Discharge)
• More than 2.5 million HIV +ve estimated in India.
• Only 38% of young women have accurate, comprehensive
knowledge of HIV/AIDS.
RTIs/STIs
• Represent almost one-third of the total country's population.
•A large number of them are out of school, get married early,
work in vulnerable situations, are sexually active, and are
exposed to peer pressure.
• Some of the public health challenges for adolescents include
pregnancy, excess risk of maternal and infant mortality,
STI/RTI in adolescence.
ADOLESCENTS

GENDER DISCRIMINATION
 Adverse sex ratio.
– Sex ratio: In rural India, sex ratio is 946
while in the urban areas it is 900.
– National child sex ratio(0-6 years):
– in the case of rural population is higher
at 934 if compared to 906 of urban
population.
 Prenatal sex selection: Estimating that 8 million female foetuses may have
been aborted in the past decade.
 Female foeticide has been documented from all parts of India .
Census year Sex ratio
1901 972
2001 933
2011 940
Census year Child sex ratio
2001 927
2011 914

GENDER DISCRIMINATION
 Female literacy rate:The female literacy is 65.46 per cent. The
male literacy, in comparison 82.14 per cent.
 Violence :
• 37.2% of women have reported spousal violence
• 1 in 5 women being sexually abused before the age of 15.
 High stress among women:Number of studies provide strong
evidence that higher prevalence of depression and anxiety disorders
in girls and women when compared to boys and men.
 Limited and unequal access to health care: studies have reported
that less no. OPD attendees compared to male probably due to lack
of access, resource constraints, decision making.

• Gender blind refers to the absence of any proactive
consideration of the larger gender environment and specific
gender roles affecting program/policy beneficiaries.
• In contrast, Gender aware‖ programs/policies deliberately
examine and address the anticipated gender-related
outcomes during both design and implementation.

Gender Budgeting?
• Gender Budgeting is a dissection of the Government
budget to establish its gender-differential impacts and to
translate gender commitments into budgetary
commitments.
• Gender perspective to assess how it addresses the needs
of women in the areas like health, education,
employment, etc.
• Gender Budgeting does not seek to create a separate
budget but seeks affirmative action to address specific
needs of women.
• Gender Responsive Budgeting initiatives provide a way of
assessing the impact of Government revenue and
expenditure on women.

We can achieve gender equality by:
 Increasing literacy rates among women
 Increasing early childhood development interventions
 Increasing women’s labour force participation and
strengthening labour policies affecting women
 Improving women’s access to credit, land and other resources
 Promoting women’s political rights and participation
 Expanding reproductive health programs and family support
policies

Gender: Prime Strategies for RH
1. Women empowerment
2. Holistic approach
3. Enhance male responsibility
4. Quality of care
5. Wider prospects
6. IEC
7. Increasing male participation

INTERNATIONAL AGENCY WORK ON
GENDER AND RH
• The IGWG :Promotes gender equity within population, health, and nutrition
programs (PHN) with the goal of improving RH, HIV/AIDS outcomes and fostering
sustainable development.
• UNFPA: Promotes the right of every woman, man and child to enjoy a life and
equal opportunity. It supports countries for policies and programmes to reduce
poverty and to ensure that every pregnancy is wanted, every birth is safe, every
young person is free of HIV/AIDS, and every girl and woman is treated with dignity
and respect.
• WHO: Integrating Gender Analysis and Actions into the Work of WHO.
• World Bank: In 2007 launched the Gender Action Plan (GAP) to focus on
gender in the land, labour, agriculture, finance, and infrastructure sectors.

The Family Welfare Programme : Community Needs Assessment
Approach since 1997 : a decentralized participatory planning strategy.
The National Health Policy 2001: Increased access to women for basic
health care and highest priority to programmes relating to women's health.
National Population Policy 2000 : strategic theme “ empower women for
improved health and nutrition”
The Reproductive and Child Health (RCH) Programme (2005) aims at:
• The reduction of maternal and infant mortality
•Diagnosis & treatment of RTI/STI
•Gender mainstreaming and health equity
•Male participation strategy.
NATIONAL INITIATIVES ON GENDER AND RH

Maternal Health
 ASHA, Panchayati raj institution
 Janani Suraksha Yojna: (JSY) is proposed to promote Safe Motherhood and
to improve institutional delivery.
 ‘Referral Transport Scheme’: A sum of Rs.5000/- is placed with
ANM/ASHA to arrange transportation and other logistics.
 Vande Mataram Scheme: launched in 2004 provide free opd services
including antenatal checkup of all the pregnant women and family planning
and counselling to new mothers by govt. & private doctors on 9th of every
month

• INDIRA GANDHI MATRITVA SAHYOG YOJANA (IGMSY)
– Is a Conditional Cash Transfer scheme for pregnant and lactating (P&L)
women introduced in the October 2010 to contribute to better enabling
environment by providing cash incentives for improved health and nutrition
to pregnant and nursing mothers.
• GARIMA: Community-based organizations to further strengthen Indian
women's ability to proactively fight against gender-based violence; support
women's ability to address reproductive health issues more effectively; and to
increase women's access to and information about the justice system.
• The FAM Project’s goal is to increase access to and use of fertility awareness-
based family planning methods within the framework of informed choice by
scaling up the Standard Days Method (SDM) and the Lactation Amenorrhea
Method (LAM) in family planning programs.

ARSH Strategy under NRHM / RCH-II
• This strategy focuses on reorganizing the existing public health
system in order to meet the service needs of adolescents.
• Steps are to be taken to ensure improved service delivery for
adolescents during routine sub-centre clinics and ensure service
availability on fixed days and timings at the PHC and CHC
levels. This is to be in tune with outreach activities.
• A core package of services includes preventive, promotive,
curative and counselling services.

The National AIDS Control and Prevention
Policy 2002:
Special mention about the protection of rights of HIV
positive women in making decisions regarding
pregnancy and childbirth.
Prophylaxis for prevention of parent to child
transmission and the requisite counseling to all
infected mothers.
The Family Health Awareness Campaign: address the
management of STIs and HIV/AIDS by generating
awareness among the vulnerable groups, residents of
rural and urban slums and vulnerable women.

Women Empowerment
• Political:
• In 1993 with the 73rd and 74th Constitutional Amendments that
give women 1/3rd of elected seats
• Special reservations for women from SC&ST
• Bill for reservation of seats for women in Parliament
• Economic:
• Rashtriya Mahila Kosh(1993) facilitate credit support or micro
finance to poor women
• Many SHG especially in India, under NABARD's SHG-bank-
linkage program

Women Empowerment
• Social:
• Central Social Welfare Board : Networks the activities of State Social
Welfare Boards and voluntary organizations. It implements a number of
schemes including Family Counseling Centres, Short Stay Homes, Rape Crisis
Intervention Centres, creches .
• At state level, the State Departments of Women and Child Development
and the State Commissions for Women
• The ICDS programme :special focus to health and nutrition of girls.
• Kishori Shakti Yojana (2000-01):Health and nutrition of adolescent girls (11-
18 years) was launched as part of ICDS.
• Gender focal points (Women's Cells) formed in the ministries in the
development sector, including Education, Rural Development, Labour,
Agriculture.
• NATIONAL MISSION FOR EMPOWERMENT OF WOMEN (NMEW)
:Centrally Sponsored Scheme sanctioned in April 2011 and acts as an umbrella
Mission

Health
& Nut.
Education
Water & San.
Skills
Technology Credit
Political
Participation
Marketing
Asset base
Holistic approach to Empowerment

Gender Mainstreaming
• Gender Mainstreaming:- process of assessing the implications
for women and men of any planned action, including legislation,
policies or programmes, in any area and at all levels.
• The National Commission for women (1992) safeguards women’s rights
• The National Health policy gives highest priority to programs relating to
women’s health
• Special programs in the education sector have helped to increase women’s
literacy and reduced the gender gap in the school system.
• The Gender budgeting concept was emphatically implemented in India’s
national budget 2005 – 06 where it was specified that 30% of funds must go to
women related sectors.

STRATEGY
EMPOWERING
WOMEN
INVOLVING
MEN
GENDER
EQUALITY

Actions :
Women police stations have been set up in all states.
Voluntary Action Bureaus and Family Counselling Centres
in police stations: rehabilitative services.
The Parivarik Mahila Lok Adalat an alternative justice
delivery system (part of the Lok Adalats- People's Courts):
provides speedy justice to women.
Swadhar(2001-2) by NCW : scheme for holistic rehabilitation
of women in difficult circumstances.
The protection of women from domestic violence act 2005
Violence

Stree Shakti- Taking hospital services to slums.
Gender Resource Centers- Economic Empowerment
of Women
Mission for Development of Women- Reducing IMR, MMR,
female foeticide, School Drop Out Rate among Girls & Economic
Empowerment through microenterprises of Women.
Laadli: launched in 2008 state govt. deposit Rs 1,00,000 in the
account of girl child by the times she attains the age of 18 .
Women Development Initiatives in Delhi

12th PLAN RECOMMENDATION
 Must break the vicious cycle of multiple deprivations faced by
girls and women because of gender discrimination and under-
nutrition.
 Ending gender based inequities, discrimination and violence
faced by girls and women must be accorded the highest priority
and these needs to be done in several ways such as achievement of
optimal learning outcomes in primary education, interventions
for reducing under-nutrition and anaemia, and promoting
menstrual hygiene in adolescent girl & providing maternity
support.
 The effort to promote women’s health cannot be without
participation of men; hence, imaginative programs to draw men
into taking part in their health seeking behaviour and practices
must be devised.

Male Reproductive health
• Reproductive health is an important component of men's overall
health and well-being. Too often, males have been overlooked in
discussions of reproductive health, especially when reproductive
issues such as contraception and infertility have been perceived as
female-related.
• Every day, men, their partners, and health care providers can
protect their reproductive health by ensuring effective
contraception, avoiding sexually transmitted diseases (STDs), and
preserving fertility.
• Common issues in male reproductive health include:
1. Contraception
2. Sexually transmitted diseases
3. Infertility/fertility
4. Genital infections

Involving Men !!
• More than half population of the country constitutes of
males and we fail to address their reproductive needs.
• Engaging men in the sexual and reproductive health care
system promises benefits for men, women and families.
• Involving men gives the opportunity for increasing
communication on the issue of equality between men and
women.
• Men’s involvement is crucial to addressing sexual and
reproductive health concerns such as sexually transmitted
infections (STIs) and unwanted pregnancies.

REPRODUCTIVE HEALTH:
MEN’S PARTICIPATION
Men: Full partners and advocates for good reproductive health
• reaching men is a winning strategy
• to encourage sexual responsibility
• to foster men’s support of their partners’ contraceptive choices
• To address the reproductive health care of couples
Enhancing male participation
• Design IEC materials, communication programmes and
services, focus gender equality.
• RH information and services should focus the couple
rather than the individual.
• Remove myths about condom and vasectomy.

• Service providers to be sensitized for men’s
reproductive health needs.
• Separate clinic for males.
• Improved services at existing clinics.
• Workplace services.
• Community-based services.
• Commercial and social marketing.
• Increase contraceptive choice for men.
• Train providers about male FP/RH needs.

Barriers
 Bureaucratic divisions and poor communication between
relevant Gos, NGO’s and civil society.
 Ingrained attitudes among health providers, with real concern
for clients
 Infrastructure and available human resources are often weak
particularly in rural, urban slum and tribal areas.
 Every service improvement and new programme requires
training or retraining: timely and costly
 Insufficient Financial resources and at times misuse of funds

Barriers
• Waiting Time in antenatal consultations – extensive,
deterring many from attending
• Poor medical treatment predisposing to future
problems, e.g incompetent cervix, rupture of uterus,
loss of libido due to pain, poorly sewn episiotomies
• Social pressures in conforming to a stereotype
gender role; Lack of emotional outlets and support
• Traditionally assigned economic responsibility,
Dependence of women on men

Challenges
• The difficulty of acquiring and analyzing disaggregated data
without trained gender focal points in all Ministries and
organizations.
• No mechanism for women’s groups and Ministries of Health
and Women and NGOs to meet regularly for tactical planning
and feedback.
• Need to extend services to reach out to men, adolescents
within the existing health structures.
• IEC and Advocacy strategies must be modified to promote male
responsibility and to increase community education on
women’s rights and issues as an integral part of family health
development.
• The ratio of male/female RH service providers must be re-
examined to respond with appropriate gender sensitivity and a
long-term view to increase RH service utilization and quality.

Challenges
• Quality of Care supervision must be enabled through training
and tools particularly in the areas of informed choice and
consent, interpersonal process, reliability of services,
confidentiality and privacy, while strengthening all
management systems.
• The implementation of more gender and adolescent friendly
RH services through legislation, policy, and institutional
changes may need to be instituted within the existing health
care structures.
• Researchers may wish to collect and analyse data on women’s
health from the perspective of women. diseases affect men
and women differentlyand may have different risk and
exposure factors and may require different interventions. All of
which have long-term health planning implications.

• Capacity building
• Gender sensitization program
• Advocacy and IEC/BCC strategy directed to both
parents and children
• Communication and Publicity
• Partnership with voluntary organization
• Research

REFERENCES
• Gender, Sexuality, and HIV/AIDS:The What, the Why, and
the How: Geeta Rao, Gupta: July 12, 2000
• http://www.usaid.gov/what-we-do/gender-equality-and-
womens-empowerment
• Ministry of women and child development , GOI
• http://www.unfpa.org/
• http://www.fao.org
• www.who.int/topics/gender
• www.searo.who.int/.../Reproductive_Health_Profile_life-
cycle
• www.gender.org/
• http://www.mohfw.nic.in/NRHM/ARSH.htm
• http://www.nichd.nih.gov/health/topics/menshealth/Pages/de
fault.aspx

If Development is not
Engendered, it is Endangered

Observations MAMC
SEARO Study
• Poor knowledge of anatomy & physiology Very few
women aware of menstruation prior to its onset
• Poor obstetric care home deliveries preferred
• Deliveries conducted by dais, sweepress, family members
• No postpartum care
• Husband discouraged their wives for contraceptives usage
and preferred abortion as a contraceptive method
• Most stable and reliable method was permanent
sterilization, which was accepted after 4-5 deliveries
• Extra marital sex for men was an accepted fact and sex
was viewed as male right.

Gender perspectives of reproductive health

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