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Gender Equality

Jhpiego’s Track Record in Promoting Gender Equity Jhpiego, an affiliate of Johns Hopkins University, enhances the health and saves the lives of women, girls and families in limited-resource settings. Jhpiego is a global leader in strengthening the quality of—and access to—family planning; reproductive health; maternal, newborn and child health; malaria; cervical cancer; tuberculosis; and HIV/AIDS services. For more than four decades, Jhpiego has put evidence-based programs and technical innovation into everyday practice to ensure the world’s most vulnerable people have access to high-quality health care services, and has worked to ensure that global and national policy guidelines reflect these best practices. Enhancing the health and saving the lives of women, girls and families requires an understanding of gender-based needs, preferences, constraints and opportunities of males, females and other gender identities. Gender inequality, in particular female lack of rights and empowerment, gender-based violence (GBV), and limited male engagement, inhibits abilities to effectively understand, access and utilize health services. Jhpiego strives to consistently reflect this understanding in its programs and has a proven track record of doing so. The following are highlights of Jhpiego’s work to address gender in its programs: Fostering Gender-Sensitive Health Service Delivery In many settings worldwide, health facilities are inept at dealing with the gendered aspects of care and treatment, in terms of both the challenges that clients face in accessing or utilizing services and the actual delivery of services. In many cases, health care providers themselves enact gender discrimination toward clients. For example, in part due to gender norms that dictate propriety and overall low status of women in society, health workers disrespect and even abuse women seeking maternal health care. A woman may have overcome many challenges in being able to leave her home without a companion or in having the funds to travel to the clinic or pay for services, only to be insulted or abused. On the other hand, health care providers in many societies also see reproductive health services as a woman’s domain and alienate men from the environment. ! In Afghanistan, the Jhpiego-led Health Services Support Program improved basic health services for women and girls

through not only the expansion of services but also the assurance of service quality. As part of that effort, Jhpiego developed a set of standards for gender-sensitive health service delivery and trained managers of nongovernmental organizations as well as midwives, community health workers, midwifery faculty, doctors, reproductive health officers and community leaders on the standards. Key topics included the promotion of gender-sensitive interpersonal communication and counseling, women’s empowerment and decision-making, and male involvement in reproductive health. Jhpiego is currently building on the standards developed in Afghanistan to create a set of global standards for inclusion in a toolkit the organization is developing for Standards-Based Management and Recognition®: a process for improving the performance and quality of health services.

! In countries as varied as Yemen and Mozambique, Jhpiego has been working with its partners on the US Agency for International Development–sponsored Maternal and Child Health Integrated Program (MCHIP) to ensure respectful maternity care by birth attendants. Strategies include sensitizing women, their families and health care providers and developing and monitoring protocols and indicators for the various aspects of respectful maternity care, including dignified care, care that has been consented to, confidential care, nondiscrimination, nonabandonment in care (that is, the right to have a companion while delivering), no physical abuse, no abuse or detention related to inability to pay for services, and equity in access.

Combatting Gender-Based Violence Between 30 percent and 70 percent of women worldwide have experienced GBV, including intimate partner and sexual violence, in their lifetimes.1 Research shows that GBV is a significant cause of maternal death and a risk factor for contracting HIV, as well as a leading cause of other physical and mental problems, including chronic pain, depression and substance abuse. Given the magnitude of GBV as a public health issue, health care providers have a key role to play in responding to it.

                                                                                                                                                       1 World Health Organization, London School of Hygiene and Tropical Medicine, and South African Medical Research Council. Global and Regional Estimates of Violence against Women: Prevalence and Health Effects of Intimate Partner Violence and Non-Partner Sexual Violence. Geneva, Switzerland: World Health Organization, 2013.

       

 

 

In Guinea, Kenya, Mozambique, Tanzania and Nepal, Jhpiego has been working to integrate GBV screening, treatment, counseling and referral into health services. The work involves developing guidelines and training materials on GBV for the health sector, training health care providers to furnish comprehensive care for GBV survivors, linking community members with services, and monitoring progress. Empowering Women as Health Care Providers Gender equality and female empowerment have now been recognized as important development objectives both in themselves and as keys to the achievement of other health and development objectives, such as reducing maternal mortality and preventing the spread of HIV. When women flourish, society flourishes. Much evidence now exists that when women are empowered with resources, they invests not only in themselves but also in their families. Jhpiego empowers women to both provide health services as well as better access health services. ! Worldwide, Jhpiego supports training of women as midwives, which empowers women by giving them education, skills and

employment, ultimately improving their status in the community. Building a cadre of midwives working in communities also gives more pregnant women access to skilled birth attendants in societies where conservative gender norms prohibit women from being seen by male health care providers or from leaving their homes.

! In Ethiopia, Jhpiego’s Human Resources for Health project employs special strategies to support the retention and success of women studying health sciences in universities, including gender clubs, life skills training and special discussion forums for women.

Promoting Partnerships for Healthy Decision-Making among Couples Since the 1994 International Conference on Population and Development, it has been widely recognized that “special efforts should be made to emphasize men’s shared responsibility and promote their active involvement in responsible parenthood, sexual and reproductive behavior, including family planning; maternal and child health; [and] prevention of STIs, including HIV.”2 Thus, for Jhpiego, addressing gender inequalities means not just working with women but with women and men together to question and change gender norms and, ultimately, reverse the imbalance of power in relationships that results in negative decisions and impacts for health. Jhpiego’s efforts to increase partnership and joint decision-making include engaging in family planning, facilitating men’s support of and participation in antenatal care, and joint HIV counseling and testing. Specific project examples include the following: ! The Integrated Safe Motherhood, Newborn Care, and Family Planning Project in Bangladesh engages women and men to

actively participate in informed decision-making that will lead to healthy outcomes. ! In Nigeria, under MCHIP and its predecessor ACCESS Program, male motivators were identified and trained to educate

fellow men about the benefits of healthy timing and spacing of births and the use of modern contraceptive methods. These men counseled and referred 11,371 men, with over one-quarter of those counseled accepting a family planning method for themselves or their spouses.

! In Malawi, health facility standards for maternity care guide providers to involve husbands or partners in antenatal care and delivery. Jhpiego supports training and monitoring to implement this approach.

                                                                                                                                                       2 UNFPA. “Master Plans for Development: Programme of Action of the International Conference on Population and Development.” 1995. http://www.unfpa.org/public/home/sitemap/icpd/International-Conference-on-Population-and-Development/ICPD-Programme.