GENDER

1. GENDER

2. Gender and Reproductive Behaviour • Understanding gender provides: • insights into men’s and women’s behaviour • relationships and • reproductive decisions • These insights are crucial to communicating with and serving both men and women effectively.

3. Gender and Reproductive Behaviour • “Gender” refers to the different roles that men and women play in society • Also to the rights and responsibilities that come with these roles • “Gender” differs from “sex”, which refers to the biological and physical differences between men and women

4. Gender and Reproductive Behaviour • Gender roles usually taken for granted - reflected in: • family structures • household responsibilities • labour markets • schools • health care systems • laws • public policies • The influence of gender is similar in strength to religion, race, social status and wealth

5. Gender and Reproductive Behaviour • Gender roles begin at birth and span a lifetime: very young boys and girls learn from their families and peers how they are expected to act • around people of the same sex • around people of the opposite sex

6. From WOMB Oldest Old >75yrs In Utero Young Old (65-74 yrs) Pre - Puberty To TOMB technical advances Family & Community family influences Family support Near Old (55-64 yrs) Puberty Community approval & Support School influences Cultural and societal pressure peer influence Socio cultural influence peer pressure Early Adolescence Adulthood Late Adolescence Young Adulthood The Life Cycle In RH

7. GENDER PERSPECTIVES IN RH: A LIFE CYCLE MODEL In Utero • Sex selection - abortion - infanticide • Value of the girlchild • Biological vulnerability

8. Pre-Puberty Conditioning to gender roles - nutrition - education - abuse - violence - work allocation Child Pornography Child Prostitution Conditioning to gender roles - nutrition - education - work allocation - domestic violence - abuse GENDER PERSPECTIVES IN RH: A LIFE CYCLE MODEL

9. Puberty Menarche Virginity FGM Pregnancy Violence Rites of passage Gender Role conditioning Abuse GENDER PERSPECTIVES IN RH: A LIFE CYCLE MODEL

10. Early Teens Hormonal Changes Curiosity Violence Exploitation Pregnancy Gender role imprinting peer influence abuse GENDER PERSPECTIVES IN RH: A LIFE CYCLE MODEL

11. Late Teens Sexual Bonding Pregnancy STD/HIV Gender roles enacted High risk behaviour Violence and Abuse Gender roles acted out Sexual activity High risk behaviour Abuse GENDER PERSPECTIVES IN RH: A LIFE CYCLE MODEL

12. Young Adulthood Gender Roles internalized (or questioned) productive role (non NSA/NSA) reproductive role - household - child minding - contraception - pregnancy/abortion - sexual - nurturing & care giving Gender roles internalized productive role sexual role

13. Adulthood Gender role entrenched - low economic power - community respect important - low legal power - domestic violence - STD/AIDS - health risks * malnutrition * maternal depletion syndrome * gynaecological morbidity, * cancer cervix and breast risks * high risk abortion and sequelae - uneven access to RH services - Use of FP services Gender roles entrenched - productive - decision makers - little involvement in contraception - domestic violence - marital infidelity - little household/ care giving roles GENDER PERSPECTIVES IN RH: A LIFE CYCLE MODEL

14. Near Old (55-64) Gender roles still entrenched menopause - osteoporosis - c. v. risks - body image - depression - loneliness - care giving - gynae. cancers - lifestyle diseases - DM. HPT, CVD, cancers Gender roles still entrenched but weakening loss of sexual drive less economic power loss of health greater dependence on caregiving of wife/females risk of infidelity depression GENDER PERSPECTIVES IN RH: A LIFE CYCLE MODEL

15. Old Age (65-74) Widowed or in care giving role - social alienation - poverty - failing health Weakening or reversal of gender roles - dependence on women for care-due to disability - lifestyle diseases - cancers - mental health GENDER PERSPECTIVES IN RH: A LIFE CYCLE MODEL

16. Oldest Old (75 years) Mental health Economic dependency Cancers Physical disability Reversal of gender roles Dependence of female care givers Mental health Cancers Physical disability GENDER PERSPECTIVES IN RH: A LIFE CYCLE MODEL

17. Gender and Reproductive Behaviour • adolescent males experience more sexual freedom than adolescent females • Potentially harmful sexual attitudes and behaviour that can develop during youth are often difficult to change during adulthood.

18. Gender and Reproductive Behaviour • Traditional male and female gender roles: • deter couples from discussing sexual matters • condone risky sexual behaviour • ultimately contribute to poor reproductive health among both men and women

19. Gender and Reproductive Behaviour • Programmes can encourage men to adopt positive gender roles and be: • supportive husbands, and • caring fathers

20. Gender and Reproductive Behaviour Health care providers, policy-makers, and donors recognize: • the direct connection between men and women’s gender roles • their reproductive health • the effect that inequities in gender roles have on women’s well being

21. Understanding Gender • gender roles and gender norms are culturally specific and thus vary tremendously around the world. • however, men and women differ substantially from each other in power, status and freedom. • men have more power than women in all societies

22. Understanding Gender • “Power” is a broad concept that describes the ability or freedom of individuals to make decisions and behave as they choose a person’s access to resources and ability to control them.

23. Understanding Gender Two types of power help to describe the inequities in male and female gender roles - “power to” and “power over” • “Power to” describes the ability of individuals to control their own lives and to use resources for their own benefit • “Power over” means that individuals can assert their wishes, even in the face of opposition, and force others to act in ways that they may not want to

24. Understanding Gender • Calls for changes in gender roles, and hence behaviour, often touch emotional and political nerves • such change is perceived as threatening • is part of the global trend toward equality and justice • studying how gender affects reproductive behaviour is necessary for improving reproductive health for all

25. Understanding Gender • Differences in power between men and women are not absolute or universal. Some poor, illiterate, unemployed, or homosexual men have little power and few resources • Women’s gender roles do give them some power but is more limited and influenced by: • her culture • age • income and education

26. Understanding Gender • Type of marriage • A woman’s power to make decisions increases with her level of education also with her husband’s level of education • younger women who marry older men have less power gender roles are changing toward more equality for younger men and women in some cultures

27. How Gender Roles Affect Reproductive Behaviour • Gender has a powerful influence on reproductive decision-making and behaviour • men are the primary decision-makers about sexual activity, fertility, and contraceptive use

28. How Gender Roles Affect Reproductive Behaviour • Men are often called “gatekeepers” and have many power roles • husbands • fathers • uncles • religious leaders • doctors • policy-makers and • local and national leaders

29. How Gender Roles Affect Reproductive Behaviour Little is known about how gender roles affect these decisions to: • practice family planning • choose when and how to have sexual relations • engage in extramarital sexual relations • use condoms to prevent STDs • breastfeed • seek prenatal care

30. How Gender Roles Affect Reproductive Behaviour Gender is just one of many other factors such as: • Education level • family pressures • social expectations • socio-economic status • exposure to mass media • personal experience • expectations for the future • religion • Consequently, no two couples’ “decision-making environments” are identical

31. Gender Roles Can Harm Reproductive Health Traditional gender roles can jeopardize the reproductive health of both women and men. • Inequities in power make women more vulnerable to men’s risky sexual behaviour and irresponsible decisions. • Gender roles can be unhealthy for men too

32. Gender Roles Can Harm Reproductive Health • Women have difficulty communicating about sex or RH, because of their gender roles • Women may submit to men because they are afraid of retaliation. • Male gender roles can contribute to men contracting and transmitting STDs

33. Gender Roles Can Harm Reproductive Health • Male gender roles harm men’s health as well as women’s. • Men’s control over reproductive decision-making may be weakening • traditional gender roles are starting to change with social opportunities for women • power is being redistributed

34. Improving Reproductive Health • Couple, or spousal, communication can be a crucial step toward increasing men’s participation in reproductive health • Communication enables husbands and wives to know each other’s attitudes toward family planning and contraceptive use • Communication also can encourage shared decision-making and more equitable gender roles

35. Obstacles to Couple Communication • Research suggests that a complex web of social and cultural factors impede such discussions • In many societies sex is a taboo subject for men and women to discuss • Afraid of rejection by a sex partner • Women’s inferior status and lack of power limit couple communication

36. Obstacles to Couple Communication • Women’s status and communication. • Wide gap in education between the couple • Low Educational level of the couple

37. Obstacles to Couple Communication • Better-educated women can communicate more easily with their husbands. • Education may also increase a woman’s earning capacity - and thus her leverage in house-hold decision making. • A woman who has some economic power more likely to discuss family planning with her husband.

38. Obstacles to Couple Communication • The type of marriage - whether free choice, arranged, or polygymous - also affects the relative power of a woman • The age of a woman at first marriage relates to her ability to communicate

39. Gender and Risk • Being ‘male’ or being ‘female’ has a major effect on an individual’s health and well-being • Combination of their biological sex, the gendered nature of cultural, economic and social lives put individuals at risk of developing some health problems while protecting them from others

40. Gender and Risk • The subsequent effect of these health problems on the individuals will also be influenced by their gender roles and their sex • The ‘natural’ course of a disease may be different in women and men • women and men themselves often respond differently to illness

41. Gender and Risk • society responds differently to sick males and sick females • women and men: • may respond differently to treatment • may have different access to health care • be treated differently by health providers.

42. Gender and Risk • Infectious Diseases Differences are a function of the interaction between biological factors and gender roles and relations • Biological factors vary between the sexes and influence susceptibility and immunity to diseases

43. Gender and Risk • Gender roles and relations influence: • the degree of exposure to the relevant vectors • The access and control of the resources needed to protect women and men

44. Gender and Risk • Differences between female and male prevalence and incidence rates are difficult to measure since cases in women are more likely to be undetected.

45. Gender and Risk Even when diseases are shared by both sexes, they may have: • different manifestations or natural histories in women and men • differences in the severity of their consequences

46. Gender and Risk For example, malaria: • biologically, women’s immunity is compromised during pregnancy making them more likely to become infected during this period • implies differential severity of the consequences during her lifetime

47. Gender and Risk • Malaria during pregnancy is an important cause of maternal mortality, spontaneous abortion and stillbirths • Particularly during pregnancy, malaria contributes significantly to the development of chronic anemia Biological differences between the sexes can produce different health outcomes among women and men when exposed to the same environmental hazard.

48. Gender and Risk • How and where women and men carry out their daily activities will expose women and men to disease differentially: • women in seclusion • women’s more extensive clothing • domestic labour • water-related domestic work

49. Gender and Risk • Tuberculosis (TB) • Official figures show that twice as many male cases of TB as female cases • At young ages, the prevalence of infection in boys and girls is similar, but a higher prevalence has been found in men of older ages

50. Gender and Risk • propensity to develop disease after infection with Mycobacterium tuberculosis may be greater among women of reproductive age than among men of the same age.