Gender perspectives of reproductive health

GENDER PERSPECTIVES IN
REPRODUCTIVE HEALTH

PRESENTER:DR. VISHAL SOYAM
MODERATOR: DR. PRAGYA SHARMA

Gender ?
Gender is not a natural phenomenon but it is socially
constructed roles, behaviour, activities and attributes
that a particular society considers appropriate for men
and women. 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 relations can be changed by the every society
that created them.

What do we mean by "sex" and
"gender"?
 "Sex" refers to the genetical, biological and physiological
characteristics that define male and female. Ex: female menstruate

while male do not .
 "Gender" constructed socially using institutions such as the
family, religion, school , health care system, labour market and the
state and laws. Ex: women earn significantly less money than men
for similar work.
 "Male" and "female" are sex categories, while "masculine"
and "feminine" are gender categories.

FEW IMPORTANT DEFINITIONS
• 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. This often requires specific
programmes and policies to end existing
inequalities.

• 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

Why gender and health?
• The distinct roles and behaviours of men and women in a given
culture, dictated by that culture's gender norms and values, give
rise to gender differences. Ex. men generally wear trousers while
women often wear skirts and dresses.
• Gender inequalities - that is differences between men and women

which systematically empower one group to the detriment of the
other. Ex . women do more housework than men .
• Both gender differences and gender inequalities can give rise to
inequities between men and women in health status and access to
health care.

GENDER AND HEALTH
BLINDNESS
R0AD TRAFFIC ACCIDENT

MENTAL HEALTH

GENDER
TOBACCO

MALARIA
Malaria in
pregnant women

AGEING

•Notification rate
•Development and outcome of TB
TUBERCULOSIS
•Genital tuberculosis- Infertility

HIV / AIDS
•Gender norms increase
vulnerability to HIV Infection
•Health-seeking behaviour

REPRODUCTIVE HEALTH
• 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 RIGHTS
- The right to decide about marriage and no. of children
-The right to well being throughout life for all matters, relating to
reproductive health
- The right to a responsible, healthy, safe, and satisfying sex life.
-The right to have unrestricted access to information in order to make
informed choices.
-The right to have safe, effective, affordable, and acceptable family
planning methods of choice.
- The right to safe pregnancy and birth.
-The right to be free from sexual violence and assault

REPRODUCTIVE RIGHTS (contd.)
- The right to privacy in relation to reproductive health.
- A wanted pregnancy.
- A responsible and empowered young man.

Reproductive health rights are
not possible to be achieved
alone, it is partnership with
one or more people.

Why gender perspective?
• Yet gender be the least understood characteristic in terms of
how women’s and men’s health need differ and how those
differences can be addressed
• Gender plays an important part in the achievement of
population, health, and nutrition (PHN) program goals.
• It have important role in designing, managing and delivering
reproductive health services.
• International initiatives to achieve desired reproductive health
(RH) outcomes such as
 Reducing unintended pregnancy,
 Stopping the spread of HIV/AIDS, and
 Improving maternal health—are increasingly recognizing that
these outcomes are affected by gender relations, norms, and roles
commonly applied to women and men, and associated inequalities.

EVOLUTION OF GENDER PERSPECTIVE
• International conference on population and development (ICPD)
1994 Cairo.

• Fourth World Conference on Women, held in Beijing in 1995
• Both had highlighted the direct connection between gender
equality and women’s empowerment with health, including
sexual and reproductive health.
• They also emphasize the importance of achieving gender
equality for both individuals’ health and well being, and for
sustainable development.

Goal 1:Eradicate
extreme poverty and
hunger

Goal 6: Combating HIV
and AIDS, Malaria and TB

Gender

Goal 5: Improving
maternal health

Goal 3: To
promote gender
equality and
empower women

Goal 4: Reducing
child mortality

Community
approval &
Support

Childhood

The Life Cycle
Approach In RH

VULNERABILITY

•Menstruation
•Pregnancy
•Child birth
BIOLOGICAL
FACTORS

SOCIAL
FACTORS
•Less access to health services
•Early marriage and childbearing
•Education
•Financial
•Nutrition
•Violence
•power

Reproductive health issues and concerned:
 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).”

MATERNAL HEALTH
• India accounts for nearly 20% of the global burden of both
maternal and child deaths.
• 136,000 maternal deaths occur annually.
• 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 (359/1000 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

Family planning
 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%).
 Use of spacing methods less.
 Unmet need for contraception remains high, 27% among
the young.
 Proportion of unmarried sexually active using any method
is very less.

Unsafe abortions
 Unmarried girls seeking abortion services may face stigma.

RTIs/STIs
• 39 percent of women reported at least one
reproductive health problem; 36 percent reported
problems with vaginal discharge or urinary tract
infection
• More than 2.5 million HIV +ve estimated in India.
• Only 38% of young women have
accurate, comprehensive knowledge of HIV/AIDS
according to the 2008 UNAIDS global figures.
• HIV positive women bear a double burden: they are
infected and they are women.
• High risk population group and high risk behaviour
group.
• Use of condoms less prevalent.

Percent distribution of adults (15+) living with
HIV by gender, 1991-2009
100%
90%
80%
70%

Female
(15+) living
with HIV

60%

Male (15+)
living with
HIV

50%
40%
30%
20%
10%
0%
1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009

ADOLESCENTS REPRODUCTIVE
HEALTH ISSUE
• Adolescents (10-19 years) in India 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.
• An estimated 14 million girls aged 15 to 19 give birth each
year. Their risk of dying from pregnancy related causes is
twice as high when compared to 20 to 29 year old women.
• Some of the public health challenges for adolescents include
pregnancy, excess risk of maternal and infant
mortality, STI/RTI in adolescence, and the rapidly rising
incidence of HIV in this age group.

GENDER DISCRIMINATION

Source : SRS data

Facts reflecting gender discrimination
Adverse sex ratio.
– Sex ratio: In rural India, sex ration 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.

Census year

Sex ratio

1901

972

2001

933

2011

940

Census Child sex
year
ratio
2001

927

2011

914

Prenatal sex selection: Estimating that 8 million
female foetuses may have been aborted in the past
decade.
Prevalence of female foeticide has been documented
from all parts of India .

Facts reflecting gender discrimination
contd..
Female literacy rate:The female literacy in 2001 was 53.67
per cent and it has gone up to 65.46 per cent in 2011. The male
literacy, in comparison, rose from 75.26 to 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: few studies
reported that less no. OPD attendees compared to male.

Fundamental Barriers of RH Improvement
 Bureaucratic divisions and poor communication between
relevant Gos, NGO’s and civil society--decreasing

ability to implement a holistic approach to improving
health and reducing gender inequalities.

 Ingrained attitudes among health providers, with real
concern for clients

Fundamental Barriers of RH Improvement
 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

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.

NATIONAL INITIATIVES ON GENDER AND RH
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.
The Reproductive and Child Health (RCH) Programme
(first phase 1997-2003, second phase starting 2005) aims at:
• The reduction of maternal and infant mortality
•Diagnosis & treatment of RTI/STI
•Gender mainstreaming and health equity
•Male participation strategy.

STRATEGIES ENVISAGED UNDER RCH ll

Empowerment of women
 Holistic approach to health needs
 Enhancement of Men’s responsibility
 Quality of care
 Wide and Comprehensive range of
services
 Information and education
 Reaching out to men

RCH II and NRHM: an attempt to
address Reproductive health
issues .

Addressing Maternal mortality
 ASHA, Panchayati raj institution
 Janani Suraksha Yojna: (JSY) is proposed to promote Safe Motherhood and
to improve institutional delivery. The scheme is 100% centrally sponsored and
provides cash assistance linked to institutional delivery for Below Poverty
Line (BPL) pregnant women in both urban and rural areas
 ‘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

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.

• 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.

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

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.

NACP : Strategies
 Respect for the legal, ethical, and human rights of PLHIV
 Universal access to HIV prevention, care, support and t/t
 Equity
NACP III adapted SCM as a policy for implementing STI/RTI
program.
STRATEGIC APPROACH OF NACP IV
Vision:
“To provide universal, comprehensive quality standardized
STI/RTI services to all population groups through convergence
and integration mechanisms and facilitate reduction in HIV
transmission and reproductive morbidity.
 To provide STI/RTI services at all government health facilities
(Medical colleges, district hospitals, sub-divisional
hospitals, PHC, CHC etc)

Violence against Women
Actions :
Women police stations have been set up in all states.
Voluntary Action Bureaus and Family Counselling Centres in
police stations: rehabilitative services.
Family Courts in some states to adjudicate cases relating to
maintenance, custody and divorce.
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

Women Development Initiatives in Delhi
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. deposite Rs 10,0000 in the account of every
girl child by the times she attains the age of
18

WHY INVOLVE MEN?
• More than half population of the country constitutes of males
and we fail to address their reproductive needs.
• Men have their own sexual and RH concerns and needs which are
not always met.
• Engaging men in the sexual and reproductive health care system
promises benefits for men, women and families.
• Talking of female alone or male alone is not an adequate approach
to RH issues.
• 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.

WHY INVOLVE MEN? Contd..

• Initiation of sexual relationships
Most men have sex before age 20.
Many young men have more than one sexual partner.
Young men’s use of contraception varies
• Marriage and the beginning of family building
By their 20s, many men have married.
By their late 20s, most men are fathers.
• Fatherhood and the end of family building
Men in developing countries often have more children
than they desire.
Some men do not use contraceptives even though they
do not want a child.

BENEFITS OF ADDRESSING MEN’S in RH
• Increase societal awareness of
men’s needs
• Improve the provision of
information and services men
need to protect their own health
and that of their family.
• Expand the scope of services
available for men and women

• Reduce unintended pregnancies
and sexually transmitted
infections
• Promote healthier pregnancies
and better parenting

We can achieve gender equality by:
 Educating girls
 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

12th PLAN RECOMMENDATION
 Must break the vicious cycle of multiple deprivations faced by
girls and women because of gender discrimination and undernutrition.
 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.

• 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
•
•
•
•

http://www.unfpa.org/
http://www.fao.org
www.who.int/topics/gender
www.searo.who.int/.../Reporductive_Health_Pro
file_life-cycle
• www.gender.org/
• http://www.mohfw.nic.in/NRHM/ARSH.htm
• Gender, Sexuality, and HIV/AIDS:The What, the Why, and the
How: Geeta Rao, Gupta: July 12, 2000

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