Analysis – conducting gender analysis Module 2 WHO Gender Mainstreaming Manual For Health Managers: A practical Approach

Analysis – conducting gender analysis

Module 2

WHO Gender Mainstreaming Manual For Health Managers: A practical Approach

Learning objectives of Module 2

• Outline the principles of gender analysis

• Understand the health and gender related considerations when conducting gender analysis

• Be familiar with WHO gender analysis tools for gender analysis of a health problem.

What is gender analysis?

Gender analysis is an essential step in gender mainstreaming

Gender analysis identifies, analyses and informs actions to address inequality that come from:

• Different gender norms, roles and relations

• Unequal power relations between and among men and women

• The interaction with other determinants such as sex, sexual orientation, ethnicity, education, employment status and physical environment.

Gender analysis in health…… looks at how gender inequality

affects health and well-being.

• Examines how biological and sociocultural factors interact to influence health behaviour, outcomes and services.

• Highlights how gender-based inequality disadvantages the health of women and girls and/or men and boys.

• Uncovers health risks and problems among men and boys and/or women and girls as a result of gender norms, roles and relations.

Guiding principles of gender analysis

• Sex ≠ gender / Women and men are different

• Policies and programmes do not affect men and women in the same way.

• Diverse types of evidence are needed to understand how gender operates as a determinant of health.– Evidence based– Critical questions– Requires looking for information where there is no

evidence

• Sustained commitment is necessary

Gender analysis helps to identify and respond to practical and strategic

needsPractical gender needs Strategic gender needs

Necessities such as adequate living conditions, water provision, health care and employment

Requirements to overcome women’s unequal status, for example by engaging men in domestic responsibilities

Introducing WHO Gender Analysis

Tools

Section 2.2

Factors that influence health outcomes

Health-related considerations

Factors that influence health outcomesGender-related considerations

Biological factors

Sociocultural factors Access to and control over resources

Risk factors and vulnerability

Access to and use of health services

Health-seeking behaviour

Treatment options

Experiences in health care settings

Health and social outcomes and consequences

WHO Gender Analysis Matrix

WHO Gender Analysis Questio

ns


health-related considerations


• Types of risk factors – Socioeconomic: poverty, age,

ethnic affiliation, gender inequality

– Geographical location: rural, urban, housing and/or working conditions, physical access to services

– Psychosocial or lifestyle factors: tobacco or alcohol consumption, nutrition, physical activity

– Physiological factors: sex, body type, genetics, blood pressure, cholesterol levels


• Vulnerability refers to …- the degree of susceptibility of exposure to risk factors. - the degree of diminished capacity to cope with exposure to risk factors.

• Susceptibility does not mean that such populations are automatically at risk.

• Differential vulnerability refers to differences in access to and control of resources.

e.g. nutritious food


• Appropriate access to and use of health services are crucial factors for positive health outcomes.

• Gender norms, roles and relations affect the access to and use of health services.


• Action carried out by a person who perceives a need for health services with the purpose of addressing a given health problem. – This includes seeking help from allopathic and complementary or

alternative health services.

• Factors that can influence health-seeking behaviour– Socioeconomic status– Proximity to health facilities– Type, duration, perceived

severity of illness – Long waiting times– Inadequate/negative staff attitudes– Adequate health education– Sex and gender

Treatment options

• Range from self-care to complementary or alternative therapy (such as local healers) to allopathic therapy delivered in health facilities, in the community or at home.

• Factors that can influence treatment uptake or adherence– Inappropriate options (such as

those that are culturally insensitive) – Costs– Time involved– Effort or behaviour change needed– Stigma associated with the health

condition– Interference with daily tasks


• Previous experiences in health care settings, positive or negative, influence future health-seeking behaviour.

• Health care can be provided in discriminatory, harmful or ineffective ways that discourage women and men from seeking treatment.

• Health care settings that do not address gender norms, roles and relations in culturally sensitive and appropriate ways may fail to reach those in greatest need of health services.


• Physical and emotional health outcomes – Recovery, disability, long-term illness, death, etc.

• Health problems often cause economic and social changes for both sick individuals and their social networks. – For example, what happens when the primary breadwinner falls ill and can

no longer carry out paid work?

• Some factors that affect health and social outcomes and consequences:

•Monetary costs •Duration of the health condition•Type of care needed and whether it is available and accessible •Severity of the condition •Available social networks•Stigma


Gender-related considerations

Gender-related considerations: factors that influence health outcomes

Gender Analysis Questions: Biological factors

Who gets ill? • Can biological factors explain why women, men, girls or boys are affected

differently by a condition? – Does the individual’s sex increase the risk of or vulnerability to this?

How? – Do age or other physiological factors, such as hormone levels, matter?

How?

What are the predominant health and social outcomes of this condition? • Who, other than the immediate person with the condition, is also affected?

Children? Partners? Families? Communities? How? – Do these effects differ by sex?

• How are men and women coping with the effects of this condition?– How do sex and other biological factors affect coping strategies for this

condition?

Gender Analysis Questions: Sociocultural factors

When does this condition occur? • Is it at any specific time in the life course?

– Are there any gender norms, roles and relations during this period that may explain increased vulnerability?

What are the people affected by the condition doing about it?

• Do sociocultural factors affect health-seeking behaviour related to this condition? How? – Are these factors different for women and men? How?

Do gender norms, roles or relations affect women’s or men’s willingness and ability to recognize that they are ill and/or to seek treatment? How?

• How do women’s and men’s access to and control over resources affect their willingness and ability to recognize that they are ill and/or to seek treatment? – Are women able to decide to seek treatment on their own?

Health-related resources are about more than money

• Economic resources– Money, credit or loans, land, other

assets

• Social resources– Community resources or networks,

social support networks (or supportive social relations), transport and other social services

– Education or training (formal or informal), information

• Political resources• Decision-making processes and leadership at the institutional, household,

community, district or national levels, civic participation• High-quality health care services (formal or informal), medication, health

insurance (public or provided by an employer) • Economic, social, political, civil and cultural rights

• Other resourcesBasic necessities: time, water, shelter, clothing, food

Gender Analysis Questions: Access to and control over resources

How do access to and control over resources affect the provision of care?

• Do women or men in the affected group have particular financial or social vulnerability that may affect their ability to access and use health services?– Is this vulnerability worsened by age, ethnic or religious

affiliation, sexual orientation or other factors?

Are user fees affordable for this condition?• Do they differ for men and women of different groups? How?

• Are there any individual indirect costs, such as transport or child care, related to accessing health services that may affect women and men differently?




Gender-related considerations Biological factors

Sociocultural factors

Access to and control over resources




Treatment options




Using WHO gender Using WHO gender analysis toolsanalysis tools

Section 2.3




Gender-related considerations Biological factors

Sociocultural factors

Access to and control over resources




Treatment options




WHO gender analysis tips

• Start with a process of questioning – use the GAQ to fill the GAM

• Overlap or duplication between questions is okay.– Gender related considerations (sociocultural factors and access to and

control over resources) sometimes overlap or are duplicated.

• All the boxes do not have to be filled in.• The column on biological differences often has only a few boxes filled in.

When this happens, it could mean the following:– Sociocultural factors have more explanatory power; – No evidence is available to answer the question at the time; – You need to consult with other experts or stakeholders; – More research and evidence may be needed

• More questions will arise … keep on going!

Group work on gender analysis• Elect a rapporteur and a presenter.

• Use the GAQ to guide your discussions.

• Refer to Participant Notes for definitions, examples and gender analysis tips as necessary.

• When evidence is missing, make assumptions based on your work experience, knowledge, trends and conventional wisdom.

• Remember, the point of the activity is to use the matrix and learn about ways to analyse a health problem using gender dimensions, not to provide concise epidemiological information.

• Time limited? – Address at least one of the first three rows and one

of the last two rows to give you a chance to analyse the perspectives of both users of health services and the health sector.

• Leave at least 15 minutes to prepare your presentation to the group.

Factors that influence health outcomes (MH)


Factors that influence health outcomes (Maternal health)Gender-related considerations

Biological factors Sociocultural factors Access to and control over resources


Women’s anatomy and physiology e.g. anemia

Negotiation power e.g. age of marriage, spacing of pregnancies

Access to nutritious food


Pregnant women may have better access than other women and men to HIV services

Women’s restricted mobility; Pregnant women in rural settings required to walk long distances, which may not be safe

Lack of control over household transport


Women’s role as mothers and family caretakers may encourage them to give priority to others

Women may not be taken to a health centre or may not have access to household resources

Treatment options Antenatal care as entry point for other services

Pressure to follow traditional practices, such as forced positions for childbirth

Lack of accurate health information, possibly due to low education and literacy


Stigma/ disrespect esp. single mothers and pregnant adolescents

Availability of skilled attendant and quality care


Pregnant women are more vulnerable to malaria

Entire families affected/increased burden on women caregivers

Economic security and poverty, access to education

WHO Gender Mainstreaming Manual for Health Managers: A Practical Approach

Department of Gender, Women and Health

Factors that influence health outcomes (HIV)



Gender-related considerations Biological factors Sociocultural factors Access to and control

over resources


Both M/F

MSM, Women, Mother to child

Povery, migration, stigma, PP, married women, VAW

Condom negotiation, poverty, stigma against MSM


Women of reproductive age

Men’s paid work and benefits

User fees, affordability, poverty in Female HH, indirect costs (home care)


Delayed visible symptoms for both M/F

Stigma, rejection from spouse, families and communities

Women delay treatment for family, social norms on women’s mobility

Treatment options Same ART treatment, additional considerations for pregnant women

Roles tend to affect treatment compliance (daily routines), illiteracy

Poverty affects treatment compliance


Homophobia, labelled promiscuous

Information, awareness


Pregnant women are more vulnerable to malaria


L

Lack of education and economic security – may take high risk jobs



Factors that influence health outcomes (Malaria)Gender-related considerations

Biological factors Sociocultural factors Access to and control over resources


Both M/F, pregnant Women, HIV+, young children

Poverty, migration, sleeping patters, dress codes, occupations

Poverty, education, control of finances, household resources, social networks


Pregnant women and people with disabilities, older peoples

Geographic distance, security

Decision making power, social support, affordability


Delayed symptoms due to pregnancy

Men endure discomfort longer, women may have more chores and less time

Social norms on women’s mobility and access to education

Treatment options Women excluded from trials, pregnant women access through antenatal care

Roles tend to affect treatment compliance (daily routines), illiteracy

Poverty affects treatment compliance


Staff attitudes and perceptions

Information, awareness


Pregnant women are more vulnerable to malaria (4x more likely)


Lack of financial resources, linked to non-compliance

Conclusions

Module 2

Module 2: key messages

• Gender analysis of a health problem is about uncovering the interaction of gender-related considerations and health-related considerations. – Quick quiz: What are the gender-related considerations? What are

the health-related considerations?

• WHO gender analysis tools have been developed to guide you in uncovering the interaction of these two sets of considerations.– Quick quiz: What are these tools called?

• Gender analysis findings can do the following. – Provide an opportunity to raise awareness on potential harm due

to gender norms, roles or relations – Be used for advocacy work– Stimulate further research and assist in refining research

questions– Assist in planning and implementing health sector activities

29 Nov 2006

شكراشكرا 谢谢你谢谢你

Thank you! Thank you! Merci! Merci!

СпасибоСпасибо¡Gracias!¡Gracias! Salamat

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Analysis – conducting gender analysis Module 2 WHO Gender Mainstreaming Manual For Health Managers: A practical Approach