Gender and Health [Archives:1998/44/Focus]

November 2 1998

This is an OPINION page. 
Every week, a different intellectual writes a FOCUS on a pertinent issue!  
Dr. Husnia Al-Qadri, 
Lecturer, Faculty of Medicine, 
Sanaa University 
Head of Health Group in the Women National Committee, Sanaa 
Health policies and programs usually focus on biological aspects such as diagnosis, treatment and prevention. Likewise when considering the differences between women and men, there is a tendency to emphasize biological or sex differences as explanatory factors of well being and illness. 
A gender approach to health while not excluding biological factors, considers the critical roles that social and cultural factors and power relations play between the sexes. These inequalities can create, maintain or exacerbate exposure to risk factors that endanger health. They can also affect access to and control of resources, including decision-making and education, which protect and promote health. 
Since these inequalities most often disadvantage women, a gender analysis must be used to explain and address women’s health problems. 
Gender and Health 
Patterns of health and illness in women and men show marked differences. Women in most communities report more illness and distress than men. 
Even though elsewhere women generally live longer than men, in Yemen men outlive women. This demonstrates the complex relationship between biological and social influences in the determination of human health and illness. 
Women are more likely than men to suffer health problems connected with their reproductive system such as breast cancer. Pregnancy is a natural process, but it can sometimes go wrong. Although these difficulties take the form of biological disorders, social factors such as gender discrimination in nutrition and health care, play a major part in causing them. Some women face difficulties in completing pregnancy successfully because of childhood discrimination. 
Depression is reported more frequently among women than men. This is linked on the one hand to the stresses and strains of daily life, especially in our present conditions of poverty; and on the other hand, to gender socialization which leads so many women to undervalue themselves and their potential. 
Gender Inequalities in Health Care: 
1) Bias in Medical Research 
The topics chosen, the methods used and the subsequent data analysis all reflect a male bias in a number of important ways. Common problems that cause considerable distress for women have received little attention if they are not central to women’s reproductive role. Incontinence, dysmenorrhea and osteoporosis are frequently cited as examples of such neglect. In developed countries the failure to reduce high rates of mortality from breast cancer has also led to accusations that research into the disease is not adequately funded. 
2) Access to Health Care 
Women use medical services more than men. Therefore the low expenditure on health care and the general inadequacy of services, resulting from the country’s economic problems, affect women more than men. 
Another problems is that in some settings, customs and traditions deny women the right to travel alone or to be in the company of men outside their immediate family. When female health workers are not available and where treatment by a man is seen to dishonor the woman and her family, she may go without necessary care. 
In addition the emotional development of women themselves may limit their access to health care. In our culture women learn to believe that suffering is natural. For example problems such as backache may be so widespread that they are accepted as normal. Low self-esteem limits women’s ability to make demands and this may be reinforced by embarrassment if the problem is one that the community does not acknowledge. The lack of education contributes to this low self-esteem while also denying women the opportunity to understand their own bodies or to make an accurate assessment of their need for health care. 
Changing the Focus of Research 
Most statistics are not disaggregated by sex. This makes it difficult to understand the specific situation of women or men and therefore to plan in ways that take these differences into account. In other words making projects “gender sensitive”. So special care is needed in the collection of data, and its analysis and presentation. The failure to provide a complete picture of women’s health status stems in part from the lack of a complete and accurate census. 
Gender sensitive research focuses on the differences between: 
*  women’s and men’s roles and responsibilities; 
*  women’s and men’s position in society; 
*  women’s and men’s assess to and use of resources; 
*  social codes governing women’s and men’s behavior which affect health and well-being. 
There are a number of factors that need to be considered in order for health policies and programs to adequately address the inequalities between women and men in relation to their health. 
All data collected should be disaggregated by sex, age and social class. Quantitative and qualitative methods should be used to examine gender inequalities. This would contribute to making research more gender sensitive. 

If gender inequalities in health care are to be clearly identified, women must be involved in the design, implementation and evaluation of health policies and programs. As a result of the relative invisibility of women in public life and their absence from many of the most important areas of decision-making, special care has to be taken to ensure their voices are heard. 
If gender sensitive health plans are to be put into effective operation, the importance of educating health workers and policy makers to better understand the importance of gender sensitivity in their work cannot be underestimated. Capacity building programs must be designed for both female and male workers and these must include broadly based gender awareness courses and more detailed briefings on gender-related topics not generally included in the medical or nursing curriculum. 

All policies and programs require a clear strategy for monitoring and evaluation if policy makers and services providers are to take gender issues seriously. This strategy must include an assessment of the differential impact of health care on women and men. A gender based monitoring and evaluation plan enables health professionals to clearly identify the effects of the project or programme on women and men. It also shows how far a project or programme is effective for both sexes and enables the necessary management decisions to be taken.