Module: Gender Dimensions of Family Planning and Reproductive Health

REVIVING EVIDENCE–BASED FAMILY PLANNING IN MEDICAL EDUCATION AND TRAINING IN THE PHILIPPINES

Training Objectives

◦Locate gender in the overall reproductive health framework of the Department of Health

◦Explain the gender concepts and how it affects the reproductive health of men and women

◦Apply gender concepts in family planning

OverviewSession 1: DefinitionsSession 2: DOH Integrated

RH FrameworkSession 3: Rights-Based

Approach to RH and FP

Reproductive Health

A state of complete physical, mental and social well-being and not merely the absence of disease or infirmity in all matters relating to the reproductive system and to its function and processes. (Source: ICPD, para 7.2, SPFA para 94, Beijing+5 Review Document 2000 p.25 )

10 elements of RH

VAWC

SexualHealth

STI/ HIV/AIDS

PMACMCHN

FertilityManagement

Infertility/Sexual

Disorders

ARH

Men’sResponsibilities

/ RHCancersof the

Repro. Tract

SRH

What is a rights-based approach?

A recognition that reproductive health is part of human rights

13 Sexual & Reproductive Health Rights

The Right to LifeThe Right to Liberty and Security of the PersonThe Right to Equality, and to be Free from all Forms of

DiscriminationThe Right to PrivacyThe Right to Freedom of ThoughtThe Right to Information and EducationThe Right to Choose Whether or Not to Marry and to

Found and Plan a FamilyThe Right to Decide Whether or When to Have

ChildrenThe Right to Health Care and Health ProtectionThe Right to the Benefits of Scientific ProgressThe Right to Freedom of Assembly and Political

ParticipationThe Right to Be Free From Torture and Ill-TreatmentThe Right to Development

Taken from a presentation on sexual and reproductive rights by Reproductive Rights Resource Group (3RG-Philippines)

Sex and Gender SessionsSession 1: Gender & SexSession 2: Gender AnalysisSession 3: Integrating

Gender and FP/RH

Exercise: Sex and Gender(metacards)

Because I am a (woman/man), I can….◦____◦____

If I were a (man/woman), I could….◦____◦____

Sex & GenderSEX GENDER

Primarily refers to physical attributes—body characteristics notably sex organs and secondary sex characteristics which are distinct in majority of individuals

Gender is what makes one masculine or feminine; socially determined; culturally defined;

Is biologically determined—by genes and hormones

Is learned and perpetuated primarily through: the family, education, religion (where dominant) and media; thus, it is an acquired identity

Universal, fixed, and is a valid distinguishing variable.

A cultural, contrived distinguishing variable. It is concerned with differentiatingpeople based on perceptions, roles, and social expectations

Is relatively fixed/constant through time and across cultures

Changes across time; changes across places and cultures; learned behavior

Sex & GenderSEX GENDER

Primarily refers to physical attributes—body characteristics notably sex organs and secondary sex characteristics which are distinct in majority of individuals

Gender is what makes one masculine or feminine; socially determined; culturally defined;

Is biologically determined—by genes and hormones

Is learned and perpetuated primarily through: the family, education, religion (where dominant) and media; thus, it is an acquired identity

Universal, fixed, and is a valid distinguishing variable.

A cultural, contrived distinguishing variable. It is concerned with differentiatingpeople based on perceptions, roles, and social expectations

Is relatively fixed/constant through time and across cultures

Changes across time; changes across places and cultures; learned behavior

Gender refers to “the economic, social, political and cultural attributes and opportunities associated with being male and female.” (DAC Guidelines for Gender Equality and Women’s Empowerment in Development Co-operation. OECD: Paris. 1998).

Note…Gender Roles are NOT inborn; not biologically

determined; But what is biological can be socially

constructed to justify certain roles, responsibilities and activities (e.g., gender division of labor) and the values given to such roles (e.g., female labor is usually considered cheap, low-skilled)

Gender influences the ways women and men are involved in different types of work, take up roles and obligations, acquire traits and behavioral patterns, are allocated opportunities and benefits and decision-making in private and public spheres.

Gender and HealthGender differences and

disadvantages in the field of health are manifested in the way: ◦health and disease are distributed in

a population◦health is promoted, ◦disease is prevented and controlled, ◦patients are cared for, ◦models are adapted for structuring

health social security systems

Socialization of GenderExercise: “Magpakalalaki Ka!;

Kababae mong tao!”

Gender Socialization Exercise

MAGPAKALALAKI KA! KABABAE MONG TAO!

Question: Ano ang kailangan ninyong gawin/dapat maging, para matawag kayo o mapatunayan na kayo ay isang lalaki/o babae? (Magsalita bilang isang anak, ama o ina, asawa, kapatid, lolo/lola, tiyo/tiya, at iba pa).

Gender Socialization ExerciseWho are the major influencers of

actions both inside and outside the box? Who or what institutions ensure that a person acts like a man or a woman?

SWS Survery: Trait of a “Real” Man?

Responsible: 36 %Mabait: 9 %May paninindigan: 7 %Mapagmahal: 6 %Matapat: 5 %Hindi pabaya sa pamilya: 5 %Masipag: 5 %Word of honor: 3 %Maalaga: 3 %May takot sa diyos: 3 %

Gender SocializationThe process through which the individual

learns and accepts roles is called socialization. Socialization works by encouraging wanted and discouraging unwanted behavior.

Gender socialization refers to the learning of behavior and attitudes considered appropriate for a given sex. Boys learn to be boys and girls learn to be girls. This "learning" happens by way of many different agents of socialization. (Henslin, 1999)

Stereotyping and Gender Biases: ExerciseStatements: “Agree” “Disagree” “Neutral”

1. Ok lang pagmahaba ang buhok nang lalaki, pero ang babae na nagpapakalbo ay masagwang tingnan.

2. Ang babaeng nakadamit at kumilos ng sexy pagnarape ay kasalanan niya.

3. Hindi na uso ngayon ang nagpapaupo ng babae sa bus.

4. Kasalanan ng babae kapag taon-taon siyang nangaganak.

5. Ok lang kung magkaroon ng kabit ang lalaki pero kung ang babae ay may ibang lalaki, hindi katangap-tangap.

6. Pagsumipol ang mga lalake sa babae, ibig sabihin appreciate nila ang kagandahan ng babae.

7. Ang ama ang haligi ng tahanan at ang ina ay ang ilaw.8. Under the saya ang lalake kapag siya ay naglalaba,

nagluluto at namamalengke.9. Bading ang lalake kapag pink ang kanyang suot.10. Yung lalake na masyadong malinis sa katawan ay

bading.11. Karamihan ng mga STIs ay nanpapalaganap ng mga

babae na ‘GRO’.

Stereotyping and Gender Biases

Gender Stereotypes: are qualities, attitudes, behaviors that are arbitrarily attributed to any particular sex.

In line with these stereotypes, men are socialized to lead and dominate while women are socialized to follow and care for others.

Lead to biases and double standards

Stereotyping RH Clients and Gender Biases among Service Providers

Exercise – In meta cards…

Question 1: Which situation would be most difficult for you if you were that person?

You are 16, currently 2nd place in your class, pregnant You are gay but in a party got a girl pregnant and the girl

wants to marry you You are working in an entertainment establishment but

regularly go out with customers who pay bar fines and pay you extra for sex. Now you have abdominal pains, foul smelling greenish to yellowish vaginal discharge and intensive itchiness

You are pregnant with your 8th child. Your 7th child was born 14 months ago

Your wife is pregnant with another man’s baby. You are a woman who wants an abortion You just learned you are HIV positive. You are a 32-year old married women with five children

with multiple bruises on your thigh and upper arm

Question 2: Which situation would be most difficult for you to counsel or treat ？ You are 16, currently 2nd place in your class, pregnant You are gay but in a party got a girl pregnant and the girl

wants to marry you You are working in an entertainment establishment but

regularly go out with customers who pay bar fines and pay you extra for sex. Now you have abdominal pains, foul smelling greenish to yellowish vaginal discharge and intensive itchiness

You are pregnant with your 8th child. Your 7th child was born 14 months ago

Your wife is pregnant with another man’s baby. You are a woman who wants an abortion You just learned you are HIV positive. You are a 32-year old married women with five children

with multiple bruises on your thigh and upper arm

Exercise, continued

What were the differences between your choice of scenario for the personal (first round choice) and for the professional (second round choice)?

What if you were the client, and fit into one of those descriptions◦What would you fear when you go to the

clinic?◦What would you want from the health worker?◦What could the clinic do to help you the most?

Manifestations of Gender BiasesGender Biases Manifestations

Marginalization Under or non-valuation/ non-recognition of women’s workUnequal pay for work of equal valueLast to be hired, first to be firedLimited opportunitiesExacting sexual favors

Subordination (political) PositionStatus

Decision-makingProcess of socialization

Multiple Burden Parenting Housework

Gender Stereotyping Child-rearingReligionOccupationsEducation Language

BehaviorGovernment ProgramsMediaPopular Culture

Violence Against Women Verbal, Psychological, physical, economicForms of violence: jokes, wolf-whistles, “chancing” or making sexual passes, sexual harassment, domestic violence, incest, rape, prostitution, sex trafficking

Effects of Personhood Lack or no self-esteemNo control over one’s body

Gender RolesProductive: Comprises the work done by both

women and men for payment in cash or kind.Reproductive: Comprises the

childbearing/rearing responsibilities and domestic tasks required to guarantee the maintenance and well-being of household members. It includes not only biological reproduction but also the care and maintenance of the persons who comprise the household.

Community Management Role: Comprises activities undertaken at the community level to contribute to the development or political organization of the community. It is usually voluntary, unpaid work. Women do community work that is maintenance in nature while men are usually policy-makers.

Gender Roles StudiesIn the 2000 Pilot Time Use Survey (TUS)

conducted by the National Statistics Office (NSO) for Batangas and Quezon City, results showed that for both areas, the number of hours spent by women on housework and child family care was higher than men, be it during weekdays or weekends.

In fact, hours spent by women for housework was, on the average, twice as much as by men.

This situation would of course mean less hours available to women to do other things such as engaging in economic activities.

Gender Roles

• Gender differential still remains as an issue in economic participation

Economic participation - 80% for men versus 50% for women in 2006

Employment rate - 74% for men versus 46% for women in 2005

Question

What implication would women’s multiple roles and burdens have on family planning methods, service delivery?

Gender Analysis: Access and Control of ResourcesAccess – ability to use a resourceControl – ability to define and

make decisions about the use of a resource

Resources: Internal, economic, political, social, information/education, time

Power and Decision-making

Access and Control Diagram (from WHO Training Curriculum, Gender and Rights in Reproductive Health)

ACCESS AND CONTROL OVER

Internal Resources

Economic and Social Resources

Political Resources

Information/ Education

Time

POWER AND DECISION-MAKING

Gender-responsive and Rights-Based Differences in RH and FP

Results in:◦ differential risks and vulnerabilities to

infections and health conditions; ◦ different perceptions of health needs and

appropriate forms of treatment; ◦ differential access to health services; different

consequences or outcomes from disease; and,

◦ differing social consequences as a result of ill health.

Gender and rights may influence health status in the following ways:

◦ exposure, risk or vulnerability◦ nature, severity and frequency of health

problems◦ ways in which symptoms are perceived◦ health seeking behavior◦ access to health services◦ ability to follow advised treatment◦ long term social and health consequences.

To end…

Without fully appreciating the implications and impact of gender roles and relations, health practitioners will fail in their treatment of certain groups and individuals, and health planners will inadequately serve the total population.

FOR EVERY WOMANFor every woman who is tired of acting

weak when she knows she is strong,There is a man who is tired appearing

strong when he feels vulnerable

For every woman who is tired of acting dumb, There is a man burdened with the constant expectation of knowing everything.

For every woman who is tired of being called an emotional female, There is a man who is denied the full right to weep and be gentle.

For every woman who feels tied down by her children, There is a man who is denied the full pleasure of shared parenthood.

For every woman who is denied meaningful

employment and equal pay, There is a man who must bear the full financial responsibility for another human being.

For every woman who has been taught the intricacies of an automobile, There is a man who was not taught.the satisfaction of cooking

For every woman who takes a step towards her own liberation There is a man who finds the way to freedom has been made a little easier.

Nancy Smith

Thank You!