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  the Health Services

Nursing Matters fact sheets provide quick reference information and international perspectives from the nursing profession on current health and social issues.

 

Mainstreaming a Gender Perspective
into the Health Services

The concept of gender refers to women's and men's roles and relationships that are shaped not by biology but by social, economic, political and cultural factors ⁱ.
 

Why take a gender perspective?
Worldwide, women experience inequality far more markedly than men, especially in sharing wealth, employment opportunities, participation in public life and access to services such as health and education. A gender perspective acknowledges the importance of both sexes in contributing to development and promotes the equitable distribution of resources, opportunities and benefits. A gender perspective: 

• Recognises different gender roles.
• Stresses the need for both men and women to have access to and control over resources and decision-making processes.
• Acknowledges that men and women have different experiences and needs.
• Gives equal weight to the knowledge, values and experiences of men and women.
• Ensures that both men and women are involved in identifying their needs and priorities.
• Integrates gender awareness and competence into 'mainstream' development.
   

What does mainstreaming the gender perspective mean?
The United Nations Social and Economic Council (ECOSOC) defined mainstreaming as:
... the process of assessing the implications for women and men of any planned action, including legislation, policies or programmes, in any area and at all levels. 
It is a strategy for making women's as well as men's concerns and experiences an integral dimension of the design, implementation, monitoring, and evaluation of polices in all political, economic, and societal spheres so that women and men benefit equally, and inequality is not perpetuated ⁱⁱ.

A major outcome of taking this approach is that gender equality will not be treated merely as a "women's issue". It is a central societal concern requiring acknowledgement that the different health experiences and health care needs of women and men need to be translated into health policy and planning ^iii,iv. 

Mainstreaming gender in health care delivery

Experience of the Commonwealth Secretariat in introducing a Gender Management System to governments and health services in member countries indicates that two critical elements need to be in place for success:

1.	Sensitisation and training in gender concepts. Poor awareness or 'gender blindness' is often at the root of bias and prioritisation of male interests by policy makers, planners and health service managers.
2.	Political commitment at the highest government level v .

In her paper for the meeting on Women and Health: Mainstreaming the Gender Perspective Into the Health Sector ^vi, Doyal identified a number of questions for health policy makers and planners to use in clarifying their understanding of gender issues that may be operating. The questions include:

• Do gender differences in daily life expose man and women to different kinds of health risks? For example how do sex and gender differences affect susceptibility to infectious diseases, including STDs and HIV/AIDS? Are male and female health care providers differently affected by violence in their daily work?
• How are gender differences in the utilisation of the services to be explained? For example do the hours when clinics are open make it difficult for women to attend? Do lack of mobility and other social constraints discourage women from seeking services? 
• Can any differences be observed in the quality of care women and men currently receive? For example socialisation and attitudes of many doctors and nurses may deprive women of having the capacity to give informed consent or refuse treatment. 
• Who currently controls access to health related resources, and do allocation criteria take account of the different needs of women and men? For example are women sufficiently represented as policy and decision-makers in the health sector so that their voice is heard when it comes to decisions about allocation of resources and health care priorities?
• Do gender relations in the health service affect the experience of users? For example does the limited degree of control over decision-making that many nurses (most of whom are female) experience with respect to their work make a difference to the quality of the service they provide?   

Policy makers and planners carrying out health sector reform need to ask a further series of questions to ascertain that reforms are indeed improving women's position with respect to men and not further aggravating it. It may be useful to examine the following areas:   

• What would be the impact of health sector reforms on the functioning of males and females who work in health care bureaucracies? For example how will reform affect promotion and professional and other aspects of personal development?  Will reform remove existing barriers such as civil service rules, rigid hierarchical structures and seniority patterns that often discriminate against women?
• Will de-centralisation of health care improve access or create even more barriers for vulnerable groups? For example will the resources be transferred to the periphery in a sufficiently equitable way so that poorer areas have the funds to meet the health needs of vulnerable groups such as poor women ^vii ?
• Will women's health needs be met in a mixed form of health services requiring funds from sources other than public funds? For example how will user fees affect women who tend to be poorer, have less access to paid work, and therefore less disposable income?  

Implications for nursing
 
Putting gender issues into the policy and planning process
 
There is a relative absence of women, and more specifically nurses, in most of the arena of health policy formulation, programme design, planning, implementation and evaluation. Experience indicates that success in reaching more equitable participation for women is more likely if there is a national or regional policy framework that makes gender equality one of its goals. National nurses associations (NNAs) ^viii can be effective in promoting this approach through:  

• Advocacy work at all health service levels, with legislators and other influential leaders. However, NNAs first must develop a clear position on gender mainstreaming, and identify strategies that will work in their political, legal and social structures.
• Using their relations with the media to promote a gender sensitive approach to health care.
• Forming partnerships with other groups who share common interests (for example women's and development groups) to promote the concept to the public.
• Promoting access of nurses to appropriate programmes that will enable them to acquire the competencies and confidence required for active participation in health policy and planning activities.  

Capacity Building
As well as increasing "gender awareness" through gender sensitivity training for both sexes, the United Nations Development Programme (UNDP) recommends that three skill areas be developed for both managerial and operational success in gender mainstreaming activities.

1.	Analytic skills to identify and understand the differences, inequalities and impact of gender in the political, social and economic aspects of a country, region or community.
2.	Advocacy and communication skills to advocate successfully for the consideration of gender perspectives.
3.	Decision-making skills to be able to contribute to key decision-making processes ix.

For further information please contact ICN at

References:

i.	NGO Forum for Health and Committee on the Status for Women (Geneva). Health for All Means Women and Men: A Gender Perspective. Report of a meeting held in Geneva, 28 October, 199
ii	United Nations. Substantive Session of 1997, Agenda item 4. E/1997/L.30, para. 4, Geneva, 1997
iii	International Council of Nurses. ICN on Women's Health. Nursing Matters, 1999
iv	International Council of Nurses. ICN on Men's Health. Nursing Matters, 1999.
v	United Nations & Commonwealth Secretariat. Women and Health: Mainstreaming the Gender Perspective Into the Health Sector. Report of the Expert Group Meeting. EGM/HEALTH/1998/Report. New York, UN, 1998.
vi	Doyal, Lesley. A Draft Framework for Designing National Health Policies With a Gender Perspective. Paper prepared for the Expert Group Meeting, Women and Health: Mainstreaming the Gender Perspective Into the Health Sector, Tunisia, October, 1998.
vii	International Council of Nurses. ICN on Poverty and Health: Breaking the Link Nursing Matters, 1999
viii	Haselgrave, M. The role of NGOs in Promoting a Gender Approach to Health Care,  Paper prepared for the Expert Group Meeting, Women and Health: Mainstreaming the Gender Perspective Into the Health Sector, Tunisia, October, 1998.
ix	United Nations Development Programme. Gender in Development at the web site http://www.undp.org/gender/

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