Essay: Using a gender sensitive approach in health action/promotion

This essay will consider the value of using a gender sensitive approach in health action/promotion including examples of practice. Information used was carefully driven from reliable sources including peer reviewed articles, text books, international health actors’ studies, journals. Since the 1990’s the feminist perspective have expressed their participation in improvement of women’s health and access to health care services (Labonet et al., 2008). Furthermore, more recently the male folks have drawn in attention to the harmful impact of masculinity for their own health. This has increased conflict in the debate of this issue as the different sides thrive for public sensitivity and understanding. However, a good foundation for gender sensitive approaches to thrive, implies that for contradictions not to occur, a fair action will be taken as to the impact of gender on health and this will be a guide for gender sensitive policies that will approach the needs of men and women differently (Doyal, 2001).
Firstly, Gender inequality has caused a lot of damage in the health of numerous women and girls in the world today (??stlin, et al., 2006). According to Mccginnis, often times in most countries, the allocation invested by government in health promotion campaign is always limited (Mccginnis et al., 2002) for instance, Canada spends less than 3% of its health budget on health promotion (Hylton, 2003). Pirosaka argues that in health promotion, men and women’s social and biological health issues should be taken into cognisance differently to ensure a successful and cost effective outcomes (??stlin, et al., 2006).
Furthermore, the concept of health promotion was first adopted at the Ottawa conference in 1986, and before the emergence of Ottawa charter, a medical approach was applied, focusing on individual risk taking to tackling health challenges of the population (WHO, 2005). According to World Health Organisation (WHO), Health promotion is defined as ‘a process of enabling people and groups to increase control over, and to improve their health and quality of life’ (Schiavo, 2011). This approach makes known the active role played by people, organisations, groups in improving health and their wide influences on health. This concept recognised that an individual’s health or its community is influenced by several factors categorised as social determinants of health and gender being the discussed topic, is increasingly becoming a topic of debate on how relevant men and women experience, respond and intervene to programs on health promotion(Annandale, et al., 1996). This refers gender as an inter-related dimensions of psychological, social and biological differences and some of these biological differences men and women can be meant in terms of function in reproductory systems as well as hormones (Zaidi, 1996). However, the term sex connotes the biologically based differences in men and women; and gender is used to represent the economic, cultural, social and political differences between these two sexes (Labonte et. al., 2008) and the crossing between these elements shape people’s health needs. In other words, gender is broad term referring to ‘socially constructed roles, behaviours, activities and attributes that a particular society considers appropriate for both men and women’ (World Health Organisation, 2004). Gender being one of the social determinants of health, has roles to play in outlined health promotion behaviours, the existing bias bring about stereotypes that shape the wellbeing of people physically and mentally and this curbs access to other determinants of health (Labonte et al., 2008). Besides gender sensitivity is the proper recognition of gender issues differently, more especially perceiving women interest and health needs arising from various gender roles. Also gender awareness is identification of challenges arising from discrimination and gender inequality (Zaidi, 1996). Gender mainstreaming seeks to achieve the tackling of impartial women’s activeness at all stages of decision making. However, the United Economic and social Council defines Gender mainstreaming as; ‘a strategy for making both men and women’s concern an important dimension of the design, implementation, monitoring and evaluation of policies in all political, economic spheres to ensure that men and women benefit equally’ (UNDP, 2012). Gender mainstreaming activities during planning should consider whether or not a facultative conditions are there, including the establishment of constitutional groundwork supporting gender equity (CSDH, 2008). Most importantly, as power relationships is relative to gender, it affects largely a huge area of human existence, health inclusive (Zaidi, 1996). This can be argued that gender is important in expressing numerous variations among the population and using it in health promotion can be an essential tool in reducing the existing health inequalities in the health systems (CSDH, 2008).
World health Organisation explain health as ‘the state of complete, physical, mental and social wellbeing, rather than a mere absence of disease or infirmity’ (WHO, 1946). This describes health as a tangible resource for everyday life.
However, since the 1970’s gender inequality in health issues have been a relevant area of research and there has been a progress in addressing gender inequality using gender sensitive approach in health promotion as this has an influence in HIV prevention, and this posed a challenge to various theoretical perspectives varying from different dimensions (Keleher, 2004). According to Barker, the gender sensitivity approach in health promotion that fully involved male participation has diminished (Barker, 2005). This includes their non-challant attitude towards health information and their reluctance in visiting a doctor when health challenges arise. Pulerwitz opines that engaging men in health promotion actions will result to improved health (Pulerwitz, et al., 2006). For example, some health promotion programmes showed that whilst men and boys where fully involved in fight against HIV, increase in condom use was a measurable outcome, also decrease in other sexually transmitted disease and increase couple participation on sexual matters (??stlin et al., 2002).
This have been recommended in gender expansion ranging from clarifications on changes in male rates in mortality and morbidity. The feminists’ view focuses on variations relating to social circumstances of the health of women, challenging the effect men’s rule in the society on the health of women (Annandale et al., 1998). Liberal feminism theoretically claims that differences in gender are not biologically based, this posit that men and women are not too far from each other i.e. their offspring differentiation overrule their humankind (Annandale et., 1998a). Arguably, If there is no gender difference as the above theory claims, then there should be equality even under the law (Kawachi et al., 1998) same rights, opportunities, health treatment, social rights should be allocated to the women as same as the men. For instance, status and income in most countries is more for men than for women and this is a large disparity varying greatly globally and locally in social status of the different gender (Annandale, et al., 1996). The rapid changes and variation in gender differences in social status delineate the relevance of the social environment in creating social inequalities in health not disputing the ones caused by gender (??stlin et al., 2006). Sensitivity in gender related issues in health requires the knowledge of the people in charge to perceive this actual differences in gender and incorporate it into the health action and decision making process. Therefore, gender sensitive approach recognizes and intervenes to the different needs of the individuals based on their gender and this defining response is that the needs of both men and women are met (Zaidi, 1996). For instance, in South Africa, a programme aimed at reducing HIV transmission was carried out, which targeted at behavioural intervention in building a more gender- fair relationships (WGEKN, 2007). The programme implied principles of democratic learning and talent building using men and women’s team, severe appraisal of programme in the region showed a discount in the sexual health of women, and wide change in the sexual risk health behaviour in men (WGEKN, 2007). Furthermore, programmes that aim at debate of masculinity and sexuality, are viewed to be more successful than the ones who only talk about gender responsibilities (Parker et al., 2011). Barker argued that the most successful are the health action strategies that involve individuals with men and the community (Barker, 2005).
However, in health promotion, gender sensitive approaches that ignore men’s exposure have failed to make an impact disputing the fact that both men and women are vulnerable to men’s gender behaviors (Barker, 2005). For instance men and boys are known to be engaged in some harmful behaviors such as forceful sex, dangerous driving, indecent use of alcohol and this is categorized as traditions as to justify their independence. This most times lead to having more chronic health conditions compared to women, causing them to die faster, and face high rate of morbidity linked with violence based injuries, sexually transmitted disease (ibid) and men from socially barred groups are more exposed to this trend leading to lack of access to health care services, and are more likely to have high rates of sexually transmitted diseases like HIV (ibid). This summarizes how men experience barrier in health due to gender based behaviors that affect their sexual associates (Barker, 2005), this results that gender sensitive approaches in health actions neglect planning to sexuality associated men’s exposure to improve their health (Barker, 2005). The Liberal feminism argues on how much level of discrimination against women in our modern society has impeded their health; CSDH (2008) further buttressed that for sustainable development to be achieved, partnership of women and men must be strengthened in all spheres of life especially on health related issues. For instance, it has been estimated that in South Asia, women’s lower status is great contributor to child malnutrition and sexually transmitted disease (Smith et al., 2000). These gender relations of power are visible because of the level at which laws and health promotion actions promote gender equality (PHM, 2003). This also have an impact on unfair division in employment, for instance, in most underdeveloped countries, girls have less education, and less feeding, less value compared to boys, and this is also applicable to the women who are employed in low paid jobs and unsafe work environments (WGEKN, 2007). This is argued by feminists as a major impact on the health of women’s occupational and sexual health (Scott-Samuel, 2007).
Gender inequality is majorly seen in most health care systems globally espe-cially in African countries where most women are deprived rights to make their own health decisions (CSDH, 2008). Feminist argue that if health care providers will improving in meeting women’s health needs, there will be minimal gender bias in the health systems (Parker et al, 2001). An illustra-tion of practise that affect girls and women is the issue of genital mutilation that is still being practised in Nigeria, this programme challenges gender ste-reotypes; this includes promoting more gender equitable behaviours in smaller groups and the community at large (WGEKN,2007). Nevertheless, an emerging evidence that incorporating gender approaches into health in-terventions yields a huge health result in various spheres (Boerder et al., 2004). In as much as there is a wide knowledge shown in several literatures on gender differences in health, it is rare to find it translated in health plan-ning and promotion realities and as mentioned earlier, this is a major cause of lack of productivity, weakness in success and misallocation of resources in health promotion.
A critical illustration of practise is an example of the knowledge of culture in a gender dimension in respect to tackling the issue of HIV in India, using a gender sensitive approach, it shaped and limited sexual identities (UNDP, 2012)
by gathering only the male folks and educating them on proper condom use (Keleher, 2004). Pirosaka argues that peer education is a more effective approach for various successful HIV education actions as it often acknowledges peer membership, as an important tool in addressing all individuals, thereby promoting gender oriented power balance. But the feminist sees peer education as not always gender sensitive. The outcome of this project causes a lot of psychological harm, sabotaging the socio-economic and emotional health of the women, as they will be forced to have sex with condoms without proper knowledge of the health promotion agenda (UNESCO, 2008). Particularly, the cost effect of the harm will lead to trust and dignity issues, a compromised self-esteem which will be addressed alongside housing, social welfare and legal issues as a gender perspective health promotion strategy (Eckermann, 2001).
A great value of tackling this issue using a gender sensitive approach will range from the need to recognize the relevance of good gender relationships in promoting health (Cohen, 2007).
However, the need for gender sensitive approach have a great value in recognizing and responding to various needs on individuals based on their gender, for instance, counselling women to encourage condom use or addressing the issue of objection of some men in condom usage is practised in Kogi state Nigeria (WHO, 2003). And the several examples of these gender analysis have shown how stigmatisation is experienced by both men and women differently. According to Vlassoff this has led to formulation of interventions and integration of gender at the forefront of health promotion, this ranges from creating awareness, understanding and recognizing gender inequality as everyone’s concern (Vlassoff, et al., 2002). Rao argues that two other relevant approaches will be valuable in addressing power inequality in terms of gender (Rao, et al., 2005). These are empowerment and transformative strategies, been that the transformative strategy thrives above gender sensitivity towards transforming gender relations in the community (Rao, 2005). For instance developing a programme of working over a protracted period with men and women or adolescents in other to reconsider gender pattern, whilst encouraging healthful practises in terms of sexuality. This will create a sense of group identity and will encourage their involvement in decision making (Rao, et al., 2005). Thus much emphasises from other authors opines that programs should be mapped out with a gender perspective, taking into account diverse gender roles, socio economic relations, coercions, and favourable circumstances imposed on both men and women by the society (MSH, 2006).
A study in Thailand, shows that the nationwide ‘condom programme’ in other to prevent HIV infection has reduced the infection rate among men, and young women who engaged in commercial sex are yet to be protected from the infection as the men (Kilmarx et al., 1999). Apparently, there is pressing need for policy that recognizes and will address the gender differences in the status quo negating the women’s lack of decision to maintain use of condom.
Also a gender sensitive approach in promoting health focusing on HIV/AIDS prevention, education and tackling domestic violence for both partners is been practised in Tanzania, women in India are known to depend on their partners for decisions related to health especially (Sharif, 1993). And this sometimes lead to sexual abuse by the men and wide spread of sexually transmitted diseases as result of the men having numerous sexual partner outside their homes. The strategy for educating the supportive partners (men) on fighting prevention of STDs and HIV is critical for a reasonable outcome of the intervention action (Blooms et al., 2001). This is in line with the functionalist view of assisting people in making informed choices, where participation with men is neglected, women will fail to achieve gender equality in their sexual health (WHO, 2005). Furthermore, men want to participate when presented with relevant data, and this will become important in addressing sexual health issues from HIV infection to STDs (UNFPA, 2006). An example of another gender sensitive initiative in lagos, Nigeria to combat HIV (Community life project) shows the cooperative partnerships between the community, health activists and their participation with men and women including children at the same worked towards breaking the silence on sexuality and gender issues (Ojidoh et al., 2002). This initiative worked towards including sexuality education on the agenda of the community, in other words creating auxiliary atmosphere for advancement in women’s sexual health. This was buttressed by Ostlin saying that, health promotion policies need be gender sensitive because of the fact of men and women facing different health needs as argued by the feminist perspective (??stlin, et al., 2006).
Another very common example of gender inequality is violence among partners which often result in HIV infection caused by one of the partners (WHO, 2005). This has been observed by WHO as an ignored practise in health promotion services. Gender inequality have a strong link on sexual health rights of women (Glasier et al., 2006).
In Conclusion, this essay emphasized on the complex relationship between gender and health including the existing biological differences. In real life context, it cannot be over emphasized that there are obvious similarities in health needs of both men and women likewise bigger differences amongst the groups of men and women, but this does not neglect the masculinity and femininity matter. For better improvement in health care service and minimisation of biasness, gender sensitivity approaches will be needed in health promotion. This will be seen in service delivery and broader research contest. Acknowledging gender inequalities is very important when plotting health promotion strategies, this not in place, will threaten the effectiveness thereby increasing inequality among men and women. In as much as the action of gender inequalities are of thoughtful importance, there is still an existing gender bias forming a corrupt circle that disregard gender perspectives in health.
A famous quote from the Ford Foundation connotes that ‘The world has begun to recognize that the HIV pandemic cannot be confronted simply by applying a disease-based, biomedical, technological model of intervention; a new model must be applied that addresses sexuality, sexual rights, gender and power relations’ (The Ford Foundation 2005:17). If health promotion must be taken seriously, an approach such as gender sensitivity will be needed in programme strategy. Meanwhile, individual wellbeing of women are overlooked as a result of their proposed role as carers of other members of the family, while men often see health as the business of women, thereby pushing them off when it comes to health promotion communication. From one of the illustrations of practise above, prevention of HIV has influenced men and women to condom use ignoring the most important sexual encounters.
Health promotion is well affected by social structures, this is because the agency is also affected (Syme, 1986) and related power to agency is altered by social norms as argued by Kabeer (Kabeer, 1999). Kabeer defines agency as ‘people’s capacity to define their own life choices and to pursue their personal goals, even while facing opposition, dissent and resistance from others’ (Kabeer, 1999). Therefore, a joint commitment and a clear multisectoral approach is required for effective health promotion as seen in the practises above which where gender driven.