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Gender and Global Health . Women Gender and 10/90 GapHIV/AIDS and WomenMaternal and Reproductive HealthMissing WomenGender Based ViolenceResearch on Gender and Global Health. Gender and 10/90 GAP. 10/90 GAP = only 10% current global funding for research is spent on diseases that afflict 90%
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1. Global Health and Gender Michele Barry, M.D., FACP
Professor of Medicine and Global Health
Yale University School of Medicine
Director of Office of International Health
AYA April 30, 2004
2. Gender and Global Health Women Gender and 10/90 Gap
HIV/AIDS and Women
Maternal and Reproductive Health
Missing Women
Gender Based Violence
Research on Gender and Global Health
3. Gender and 10/90 GAP 10/90 GAP = only 10% current global funding for research is spent on diseases that afflict 90% of the world’s population
In developing countries-
• Women have less access to health care and
gender analysis to health research is lacking.
• There are distinct differences in patterns of
health and health outcomes when gender analysis is applied
4. Leading Causes of Death in WomenWorldwide - 2001 HIV/AIDS 1.3 million
Malaria 592,000
Maternal Conditions 509,000
Tuberculosis 500,000
Source: World Health Report 2002,
World Health Organization
5. Gender and Global Health Women Gender and 10/90 Gap
HIV/AIDS and Women
Maternal and Reproductive Health
Missing Women
Gender Based Violence
Research on Gender and Global Health
6. HIV/AIDS and Women
More than 50% of those living with HIV are women
< 1% globally have access to anti-retrovirals
In sub-Saharan Africa nearly twice as many
women as men are infected
7. HIV/AIDS and Women Potential reasons
• Biological differences of risk of acquisition
• Economic vulnerability leading to transactional sex
• Coerced sex/rape/marriage
• Inability to negotiate condom use
8. HIV/AIDS and WomenBiological differences of risk of acquisition • Several studies have shown that it is easier for a woman to
contract HIV/AIDS from a sexual contact with an infected
man than it is for a man with an infected woman
• The presence of an untreated STI increases the risk to
contract 10X. STIs often do not give rise to any
symptoms in women so they remain untreated or
unrecognised
• Coerced sex increases risk of micro-lesions; more frequent
for women, although also important in young boys
9. Gender and Global Health Women Gender and 10/90 Gap
HIV/AIDS and Women
Maternal and Reproductive Health
Missing Women
Gender Based Violence
Research on Gender and Global Health
10. Maternal Deaths
13. Safe Motherhood Projects NGOs
White Ribbon Alliance – www.whiteribbonalliance.org
Family Care International – www.familycareintl.org
Save the Children – www.savethechildren.org
Technology in Health (PATH) (technical assistance to discourage FGM) – www.path.org
Gates Institute for Population and Reproductive Health
www.jhsph.edu/GatesInstitute
14. Gender and Global Health Women Gender and 10/90 Gap
HIV/AIDS and Women
Maternal and Reproductive Health
Missing Women
Gender Based Violence
Research on Gender and Global Health
15. Missing WomenNumber of Women per 1000 Men, India
16. Missing Women 60 million “missing girls” mostly in Asia
Reasons:
Neglect of female children in health care, admissions to hospitals and feedings
Female infanticide/abortions/dowry deaths
Maternal mortality
17. Missing Women – Young Adults DOWRY DEATHS:
Bride burning - Dowry Deaths India
1987 - 1,786 dowry deaths in India (frequently kerosene burning)
Maharashtra state 19% deaths women 15-44 “accidental burns”
< 1% in Guatemala, Ecuador
HONOR KILLINGS: (1000 Pakistan – 1999)
18. Gender and Global Health Women Gender and 10/90 Gap
HIV/AIDS and Women
Maternal and Reproductive Health
Missing Women
Gender Based Violence
Research on Gender and Global Health
19. Violence Against Women - Internationally Female Circumcision and Mutilation
>80 million women in 39 countries worldwide have
undergone female mutilation of the external sex organs.
2 million annually undergo circumcision
20. Violence Against Women - Internationally Definitions: 3 types of “female mutilation”
Circumcision (type I - sunna) cutting of the hood of the clitoris (least severe) - least practiced
Excision (type II - reduction) removal of clitoris and labia minora
3. Infibulation (Type III - “pharaonic circumcision”) cutting of clitoris, labia minora and medial part of labia. Two sides of the vulva are sewn with catgut and a small opening is left for menses
Age: few days old (Ethiopia), 7 years (Egypt, Central Africa), Adolescence (Nigeria, Tanzania)
21. Documented Female Circumcision
22. Violence Against Women-InternationallyHealth Sequelae of Female Circumcision 83% women will have a medical complication
Immediate:
hemorrhage (within 10 days)
urethral damage or other adjacent organs, tetanus, infection, urinary retention from pain
Long term:
chronic infections, scarring, pelvic infections, dysmenorrhea, dyspareunia (painful intercourse), difficulty with urination
Effects on Childbirth:
need for de-infibulation
delayed labor-increased mortality
fistulas
Unknown Effects:
?HIV transmission, sexuality, psychological trauma
23. Violence Against Women - Internationally Potential Solutions
Cultural consciousness (WHO position papers on female mutilation)
Education (street theater-India describing dowry deaths)
Grassroot activism (e.g. Brazil’s all female police station)
Legal reform (female mutilation)
Shelters
International cooperation/funding
24. A Life Cycle Approach
25. A Life Cycle Approach
26. A Life Cycle Approach
27. A Life Cycle Approach
28. Gender and Global Health Women Gender and 10/90 Gap
HIV/AIDS and Women
Maternal and Reproductive Health
Missing Women
Gender Based Violence
Research on Gender and Global Health
29. Gender “Mainstreaming” Mainstream gender issues and awareness into programs at WHO, UN, World Bank, public health initiatives
Mainstream gender issues into research
www.who.int/gender/en
www.globalforumhealth.org
31. Higher prevalence of blindnessamong women:Why? Do the greater life spans of women account for the
greater burden of degenerative blindness?
- But more women are blind at all older ages. Must be
another explanation.
Is there differential mortality among blind
men/women?
Available evidence does not seem to suggest this.
32. Higher prevalence of blindness among women: Why? • Studies show that women have a higher biological predisposition
to cataract than men, and a socio-cultural predisposition to
trachoma (i.e. through child care activities, household
environment etc).
• Differential use of eye-care services due to differences
in gender roles and behaviors.
• Studies have found distinct differences between men and women
in surgical coverage across age groups – access to cataract
surgery/trachoma
33. Gender Mainstreaming at World Health Organization Gender and Women’s Health Department at WHO
Gender Team at WHO -
promote awareness into programs at WHO and
public health work
Gender Task Force –
senior level managers report gender mainstreaming to Director General