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RHO archives : Topics : Gender and Sexual Health

Annotated Bibliography

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Gender-sensitive services

Barnett, B. What people want from services. Network 18(4):23-28 (1998). Available at: www.fhi.org/en/fp/fppubs/network/v184/nt1846.html.
Available in English, French, and Spanish, this article reports results from the Women's Studies Project (WSP) conducted by Family Health International. It discusses what clients want from reproductive health programs, focusing especially on concerns about side-effects and the need to accommodate men. The author concludes that designing services with an awareness of gender roles can help programs achieve their expectations. The elements of a gender-sensitive program are reviewed, including a discussion of the problems of matching male providers with female clients.

Barnett, B. and Stein, J. Women's Voices, Women's Lives: The Impact of Family Planning: A Synthesis of Findings from the Women's Studies Project . Research Triangle Park, NC: Family Health International, 144 pp. (1998). Available at: www.fhi.org/en/wsp/wssyn/index.html.
This book describes the methodology, conceptual framework, and results of the Women's Studies Project (WSP) at Family Health International (FHI). This 5-year project consisted of 26 studies in 10 countries that collected qualitative and quantitative data on the impact of family planning on every aspect of women's lives. This synthesis presents themes that were common to women in all countries. It discusses the importance of gender norms, the benefits and costs of family planning for women, barriers to contraceptive benefits, and service delivery issues. Its recommendations concern the need to address gender issues, improve service delivery, and improve effective use of methods.

Baume E, Mercedes J, Standing Hl. Gender and Health Equity Network: Gender and Health Equity Resource Guide. Brighton, UK: Institute of Development Studies, University of Sussex; 2001. Available at: www.eldis.org/static/DOC11754.htm.
This reference guide gives an overview of gender-sensitive interventions and initiatives directly or indirectly related to health, including information on lessons learned, results achieved, and challenges revealed. There are sections on gender mainstreaming and organizational change, implementing rights and accountability through networks and advocacy, tools to enhance and implement gender equity, the lifespan perspective in gender and health, and issues in gender and health equity. After a brief review of each topic, there is a list of useful print and online references. The guide is illustrated with case studies and examples of good practice from around the world.

Blanc, A.K. The effect of power in sexual relationships on sexual and reproductive health: an examination of the evidence. Studies in Family Planning 32(3):189-213 (2001).
This article proposes a framework linking power in sexual relationships with sexual and reproductive health and then reviews data about the issues raised, including communication between partners, gender-based violence, reproductive decision-making, mens opposition to family planning, covert use of contraception, access to health services, sexual health and pleasure, and vulnerability to HIV/AIDS and STIs. Based on this research, multiple interventions have been fielded to influence power relations in sexual relationships. Programs have provided information to women, trained providers to directly acknowledge the consequences of gender-based power differentials, encouraged peer communication, invited partners participation, and worked to change community norms. In the course of their activities, they have faced serious challenges, including a reluctance to intervene in cultural traditions, the difficulty of balancing womens independence against male participation, the influence of family and community members, the discomfort of program staff in discussing sex and sexual violence, and the need to reach men during adolescence.

Bruce, J. Women's interests: how can family planning managers respond? In: Managing Quality of Care in Population Programs edited by Anrudh K. Jain, West Hartford, Connecticut: Kumarian Press, pp. 35-50 (1992).
This article focuses on how family planning managers can best serve women's interests. The first step is for managers to broaden their knowledge about women's lives and reproductive health needs. Managers must understand the realities of women's living arrangements, status, and work load and recognize that women's health needs go beyond family planning to reproductive tract infections, smoking, obesity, and other issues. The second step is for managers to solicit women's perspectives on services offered and change their programs' agendas accordingly. Other quality of care issues that are important for women are: respect for clients' rights, taking care in introducing new technologies, gender-sensitive staffing, and using appropriate measures of care.

Doyal, L. A draft framework for designing national health policies with an integrated gender perspective . Discussion paper prepared for the UN Expert Group Meeting on Women and Health: Mainstreaming the Gender Perspective into the Health Sector, Tunis, 10 pp. (1998). Available at: www.un.org/womenwatch/daw/csw/draft.htm.
This paper reviews the impact of biological and gender inequalities on both women's and men's health. It documents a gender bias throughout medical practice, which is manifested in the exclusion of female subjects from most medical research, the de-emphasis of social causes of illness, limits on women's access to health care, and poor quality of care. It recommends: creating a formal set of policies to ensure that health-related research reflects women's interests; identifying gender concerns and making them a part of the planning process; inculcating respect for women in health workers; and including gender issues in monitoring and evaluation strategies.

Family Health International (FHI) and Center for Information and Development of Women (CIDEM). Rethinking Differences and Rights in Sexual and Reproductive Health: A Training Manual for Health Care Providers. Research Triangle Park, North Carolina: FHI (2001). Available at: www.fhi.org/en/RH/Training/trainmat/rethinkDiff/index.htm. Originally developed in Bolivia as part of the Womens Studies Project, this training package seeks to improve the quality of care in sexual and reproductive health by applying a gender perspective. It operationalizes the concepts of gender, sexual and reproductive health, sexual and reproductive rights, and quality care for a broad range of staff, including doctors, nurses, administrators, and receptionists. Training goals are (1) creating opportunities for reflection and action in the field of gender-sensitive quality care; (2) providing basic tools that providers can use in everyday practice; and (3) developing a capacity for critical analysis so that participants can recognize, analyze and respond to users realities and institutional practices. The manual includes a conceptual framework, facilitators guide, four training modules, background and resource materials, bibliography, and planning matrix.

Gage, A. Women's socioeconomic position and contraceptive behavior in Togo. Studies in Family Planning 26(5):264-277 (1995).
This study uses data from the 1988 Togo Demographic and Health Survey to test two hypotheses on spousal communication about family planning and the use of methods. The data supports the hypothesis that spousal communication and contraceptive use are greater when women choose their spouse and when women work for cash, especially if they participate in credit or savings schemes. Ethnicity, education, and age at marriage also were significant, but not polygyny. The author speculates about a woman's autonomy affects the marital relationship.

Gijsbers van Wijk, C. et al. Gender perspectives and quality of care: appropriate and adequate health care for women. Social Science and Medicine 43(5):707-720 (1996).
This article describes major gender inequalities in the access to health services and in the way men and women are treated by the system. Two examples of inadequate and inappropriate health care for women are (1) less frequent referrals and less aggressive treatment of serious diseases (such as heart disease, cancer, and renal disease) in women and (2) the medicalization of the female reproductive process, so that female organs and life events like pregnancy, childbirth, and menopause are viewed as medical problems requiring intervention. The authors argue that health care should not be based on a strictly biomedical model and that self-determination of female health care users should have a central place in any health care system. They recommend greater participation of women in medical research and the health care delivery system, gender-sensitive medical education, and integrated health services with a holistic perspective.

International Planned Parenthood Federation, Western Hemisphere Region, Inc. (IPPF/WHR). Manual to Evaluate Quality of Care from a Gender Perspective. New York: IPPF/WHR (January 2000). Available at: www.ippfwhr.org/publications/publication_detail_e.asp?PubID=7.
This manual is designed to help reproductive health organizations evaluate how thoroughly a gender perspective has been incorporated into its operations, to identify areas for improvement, and to strengthen staff's ability to critically analyze their own performance from a gender perspective. The manual discusses how to assemble an evaluation team, how to select a sample and implement the six instruments provided (clinic observation, observation of client reception, observation of consultation, client exit interview, service provider interview, and document review), how to analyze the results, and how to develop a plan of action. The instruments measure quality indicators in the areas of: institutional policies and practices, provider practices, convenience to client, client satisfaction, use of gender-sensitive language, IEC, and monitoring and evaluation.

Management Sciences for Health (MSH). Managing reproductive health services with a gender perspective. The Manager (2001). Available at: http://erc.msh.org/mainpage.cfm?file=2.2.8.htm&module=chs&language=English.
This edition of The Manager shows how awareness of gender issues can improve the design, management, and delivery of health services and takes readers step by step through the process of assessing the influence of gender on organizational management. It outlines a practical, five-step process for gender mainstreaming: (1) introducing gender awareness and concepts at every level of the program, (2) conducting a gender analysis of the working environment, (3) assessing the programs readiness for gender mainstreaming, (4) determining gender-related goals and objectives, and (5) identifying strategies and activities to help meet those goals and objectives.

Newman C. Better Practices in Gender Sensitivity: Gender Sensitivity Assessment. Chapel Hill, NC: Prime II; 2003). Volume 1 available at: www.prime2.org/prime2/better/home/303.html?article=333. Volume 2 available at: www.prime2.org/prime2/better/home/303.html?article=334.
This two-volume set offers family planning and reproductive health programs some practical tools to assess and address gender issues at both the training and service delivery levels. The first volume consists of a tool to assess the gender sensitivity of training curricula and guidance on how to increase gender sensitivity during training. The second volume includes two tools to assess the gender sensitivity of services at the primary care level: a self-assessment tool for providers and a tool for managers. Each tool is accompanied by scoring instructions and guidelines for creating an action plan to improve gender sensitivity.

Paulson, S. Expanding beyond "mother-child" services. Network 18(4):29-31 (1998). Available at: www.fhi.org/en/fp/fppubs/network/v184/nt1847.html.
Based on the results of the Women's Studies Project, the author argues that reproductive health programs need to broaden their focus beyond maternal and child health; to consider couple relationships as well as client-doctor relationships; and to encourage male participation. This requires an awareness of gender issues. The article, which is available in English, French, and Spanish, discusses two Bolivian programs that take this approach and that encourage women to take on a more active decision-making role. Also considered are the effect of a repressive social environment on women's psychological status and sexual health. The author concludes that programs should take into account differences in the practices, expectations, and needs of the gender groups they serve, offer equitable care, and work to reduce gender inequalities in the larger society.

Population Council, Interagency Gender Working Group (IGWG). Power in Sexual Relationships: An Opening Dialogue among Reproductive Health Professionals. New York: International Planned Parenthood Federaton/Western Hemisphere Region (IPPF/WHR) and Population Council; 2003. Available in English at www.popcouncil.org/pdfs/power.pdf and in Spanish at www.ippfwhr.org/publications/download/monographs/powersex_spn.pdf.
This report summarizes the proceedings of a 2001 meeting on power in sexual relationships. Gender-based inequalities hinder communication between partners, their ability to achieve child spacing and family size goals, their ability to protect themselves against HIV/STIs, the effective use of reproductive health services, and men’s and women’s sexual health and pleasure. Participants described a range of field-based efforts to empower women and involve men in reproductive health, including: training service providers, addressing social norms and couple’s roles at the community level, and addressing male gender socialization.

Schuler, S. In: Accommodating, Reinforcing Gender Inequity in Family Planning Programs. JSI Working Paper Series, No. 14, Boston: JSI Research and Training Institute, Inc. (1998).
This paper analyzes how population and family planning programs have applied their growing knowledge of gender issues. The author concludes that family planning programs have accommodated to traditional gender relations rather than challenging gender inequities. Service delivery staffing patterns mirror gender biases in the larger society; program policies tacitly acknowledge male authority; counseling incorporates gender-based assumptions; and gender analyses are used to design culturally appropriate strategies that accept existing gender inequities in order to cultivate acceptance of family planning. The author advocates that family planning programs change their direction and deliberately undermine gender inequities.

Sciortino, R. The challenge of addressing gender in reproductive health programmes: examples from Indonesia. Reproductive Health Matters 6(11):33-44 (1998).
Based on experience in Indonesia, the author assesses how reproductive health programs can best address gender inequity. Early programs that focused exclusively on women suffered a fatal flaw: women could not act on their new understanding of reproductive health and gender relations as long as the society around them, especially the attitudes and expectations of their husbands, remained unchanged. More recent programs focusing on male involvement have proven to be counter-productive: involvement reinforces male authority and leaves women in a passive and powerless role. Attempts in Indonesia to focus instead on the family ignore the fact that husbands and wives do not function as a single unit. The author concludes that the most effective approach is to focus on relationships by first empowering women with knowledge and only then involving men.

Standing, H. Gender and equity in health sector reform programmes: a review. Health Policy and Planning 12(1):1-18 (1997).
This article examines how health sector reform programs in developing countries may affect women's health and gender equity, based on the assumption that gender is a significant indicator of inequality and disadvantage in health care. The author discusses: How do efforts to improve the performance of the civil service affect gender balance and gender relations among health professionals? Does decentralization improve access to health care for women or further marginalize them? What criteria do ministries of health use to set priorities, determine the health needs of women and other segments of the population, and measure cost-effectiveness? How do cost recovery schemes affect women's access to health care? Will increased competition in the health sector increase or decrease equity and access for women? How does increased provision of services by the private sector affect women? Based on a review of the literature, the author outlines research needs on gender issues and health sector reform.

Vlassoff, C. and Garcia Moreno, C. Placing gender at the centre of health programming: challenges and limitations. Social Science & Medicine 54:1713-1723 (2002).
Gender analysis can improve health planning and programming by: improving detection and treatment of health problems in underreported groups, improving understanding of the epidemiology of health problems, elucidating psych-social dimensions of disease for men and women, improving the relevance of public health services, and increasing the potential for greater public participation in health. To help incorporate gender into health programming, the authors suggest moving from the diagnosis of gender-related problems to identifying responses and interventions, adopting multi-disciplinary research methods that integrate social dimensions into biomedical research, recognizing that gender inequalities are an issue for developing as well as developed countries, restructuring the health system to allow for equal opportunities for women at all levels, incorporating gender sensitivity into the training and performance appraisals of health professionals, shifting resource allocations to support gender integration into the health care system, and developing practical gender analysis tools for health programming and policy making.

World Health Organization (WHO). Transforming Health Systems: Gender and Rights in Reproductive Health. Geneva: WHO (2001). Available at: www.who.int/reproductive-health/gender/modules.html.
Developed mainly in Southern countries, this unique training curriculum is designed to equip participants with the analytical tools and skills to integrate the promotion of gender equity and reproductive rights into their reproductive health policies, planning, and programs. The two to three week course is designed for health managers, planners, policy makers, and others with responsibilities in reproductive health. The curriculum is divided into six modules on gender, social determinants, rights, evidence, policy, and health systems. It uses case studies, exercises, and practical material to deal with a broad spectrum of reproductive health issues from maternal mortality to HIV/AIDS and sexual violence.

Yinger N et al. A Framework to Identify Gender Indicators for Reproductive Health and Nutrition Programming. Washington, DC: Population Reference Bureau; 2002.
Presented here is a framework for incorporating gender into the design and evaluation of population, health, and nutrition programs that was developed by a subcommittee of the Interagency Gender Working Group (IGWG). Gender-sensitive programming must consider: differential participation of men and women during a project’s design and implementation, gender equity and equality, women’s empowerment, and reproductive rights. The framework outlines a three-step process: (1) identify gender-related obstacles to and opportunities for achieving the objective, (2) include or modify activities aimed at reducing those obstacles, and (3) add indicators that measure the success of these activities to plans for monitoring and evaluation. The annex lists specific gender-related obstacles, intervention activities, indicators, and data sources for dozens of family planning, safe motherhood, STI, and other health objectives.

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Gender analysis

Asian Development Bank (ADB). Gender Checklist: Health. Manila: Asian Development Bank (2000). Available at: http://adb.org/Documents/Manuals/Gender_Checklists/Health/default.asp?p=gencheck.
This checklist provides a flexible and adaptable gender analysis framework and focuses on gender issues to be dealt with during the entire cycle of health projects. Areas include reproductive health, family planning, and health delivery systems. The checklist also provides strategies for gender mainstreaming in health projects, including locating family planning clinics where they are conveniently accessible to women and discussing gender issues with the executing agency or government ministry.

De Koning, K. et al. Guidelines for the Analysis of Gender and Health. Liverpool: Gender and Health Group, Liverpool School of Tropical Medicine (2000). Available at: www.liv.ac.uk/lstm/hsr/gg.html.
After exploring the interaction between gender and health, this guidebook presents detailed instructions for gender analysis and action in health planning, implementation, and research. The authors present a gender analysis framework to collect and analyze data on patterns of ill-health, factors affecting who gets ill, and factors affecting men's and women's responses to ill health. The next step is to use the results for gender-sensitive planning of policy, resources, service provision, information systems, and research.. The process culminates with strategies to address gender inequities, for example, by mainstreaming gender awareness in policy, gender training and awareness raising, and improving access to and quality of services. Examples from policy and practice are used to illustrate the discussion. The book concludes with four lengthy case studies that illustrate the use of gender analysis in an integrated health project in India, a tuberculosis research trial, a HIV vaccine trail in Uganda, and a program to improve the management of health personnel in Zambia.

International Labour Organization (ILO), South-East Asia and the Pacific Multidisciplinary Advisory Team (SEAPAT). Online Gender Learning and Information Module. Available at: www.ilo.org/public/english/region/asro/mdtmanila/training/homepage/main menu.htm. Accessed 2000.
This module is designed as a tool for self-learning about gender issues. It includes an excellent introduction to basic principles and techniques of gender analysis and planning, specifically the Harvard Analytical Framework, Moser's Gender Planning Framework, the Women's Empowerment Framework, and the Social Relations Framework. It also includes simple operations tools to help mainstream gender concerns into ILO's type of work.

Miller, C. and Razavi, S. Gender Analysis: Alternative Paradigms. UNRISD GIDP Monograph No 6 (May 1998). Available at: www.sdnp.undp.org/gender/resources/mono6.html.
This paper analyzes the strengths and weaknesses of the principal paradigms that have framed gender analysis: the Gender Roles Framework, the triple roles model, the Social Relations framework, and the feminist economics approach. It compares their conceptualization of gender, approach to development, and implications for institutions, and draws conclusions about how the notion of "gendered" has changed over time. An appendix reviews eclectic training frameworks that do not fit into these four paradigms but draw on their insights, including the Women's Empowerment Framework, UNDP Training for Gender Mainstreaming, and Socio-Economic and Gender Analysis (SEAGA) Approach.

Morris, M. Gender-based Analysis Backgrounder. Ottawa, Canada: Human Resources Development Canada, Women's Bureau Strategic Policy Branch (March 1997). Available at: www11.sdc.gc.ca/en/cs/sp/sac/gap/publications/1997-000032/1997-000032.pdf.
The goal of this document is to ensure that gender analysis is practiced on a consistent basis by Canadian government agencies. The definition and reasons for gender analysis are explained in terms of the policy-making process. The second half of the document outlines gender trends in Canada in various socioeconomic areas (including work, education, and violence), and links the data to possible policy implications.

Pan American Health Organization (PAHO). Workshop on Gender, Health, and Development: Facilitator's Guide. Washington, DC: PAHO (January 1997). Available at: www.paho.org/English/HDP/HDW/doc516.pdf.
This guide contains all the materials needed to conduct a two-day workshop on gender health for health policy makers and program managers. The goal of the workshop is to sensitize participants to the links between gender and health and to teach them how to analyze projects from a gender perspective and make recommendations to improve them. The gender diagnosis process used here includes analyzing gender roles, access and control over resources, and men's and women's health profiles. The object is to determine women's and men's health needs, the opportunities for meeting those needs, and the constraints on meeting them. When analyzing an existing project, participants are taught to examine which gender roles the project targeted, how the project affecte women's and men's health needs, the predominant development approach, and gender assumptions and stereotypes. The guide also distinguishes between a Practical Gender Approach that simply responds to concrete health needs and a Strategic Gender Approach that also tries to modify gender inequities that harm health and health-seeking behavior.

Pfannenschmidt, S. et al. Through a Gender Lens: Resources for Population, Health, and Nutrition Projects . Washington, DC : USAID, 44 p. (1997). Available at: www.fhi.org/en/wsp/wspubs/thrugen.html.
This publication reviews existing models and methodologies used to incorporate a gender perspective into USAID development initiatives. It justifies the need to integrate gender issues into population, health, and nutrition projects, describes the theoretical frameworks for doing so, and reviews a variety of training tools on gender training and gender analysis. The authors also list gender-sensitive questions to ask in designing, implementing, and evaluating population, health, and nutrition projects.

Status of Women Canada. Gender-Based Analysis: A Guide for Policy-Making. Ottawa, Canada: Status of Women Canada (1996). Available at: www.swc-cfc.gc.ca/pubs/gbaguide/gbaguide_e.html.
This working document was developed to assist with the implementation of the 1995 Canadian government policy that requires gender-based analysis of federal policies and legislation. After introducing gender-based analysis and the policy-development process, the guide outlines a ten-step process for conducting a gender analysis. The methodology begins with defining the issue and desired outcomes, moves on to identifying information sources and conducting research, and culminates with analyzing the options and making recommendations.

UNDP Gender in Development Programme. Gender Mainstreaming Learning & Information Pack. New York: UNDP (2001). Available at: www.undp.org/gender/infopack.htm.
This information pack covers gender mainstreaming; gender analysis; program and project entry points for gender mainstreaming; developing strategies for gender mainstreaming strategies; information, communication and knowledge-sharing; and process and advocacy skills. It is designed for use in a training setting, but can also serve as a basic resource for interested readers. The pack includes slides summarizing key points with an accompanying commentary; reading materials, handouts, and worksheets that amplify those key points, and references to related issues.

Vainio-Mattila, A. Navigating Gender: A Framework and a Tool for Participatory Development. Helsinki, Finland: Ministry for Foreign Affairs, Department for International Development (1999). Available at: http://global.finland.fi/julkaisut/taustat/nav_gender/.
This guide to gender analysis is designed to help program planners, administrators, and policy makers apply gender concepts and theories to their work in the development field. It can be used as an individual study guide or as the basis for group discussion. The manual explains how gender analysis can be applied to each step in a program, from planning to implementation to monitoring and evaluation. The author describes three different frameworks that can be used to collect and organize gender information: the Rapid Gender Analysis framework developed by Finland's Ministry for Foreign Affairs, the Gender Analysis framework developed by the Forests, Trees, and People Programme of the FAO, and the Gender Analysis Matrix developed by Rani Parker. The manual offers practical advice on selecting and using one of these frameworks, depending on the purpose of the Gender Analysis and the local context.

Women’s Health Bureau, Health Canada. Exploring Concepts of Gender and Health. Ottawa: Women’s Health Bureau (June 2003). Available at: www.hc-sc.gc.ca/english/women/exploringconcepts.htm.
Gender-based analysis ensures that the biological and social differences between men and women are considered in scientific research and policy and program development. After introducing the foundations and concepts underlying gender-based analysis in health care, this publication discusses how to integrate gender-based analysis into research, policy making, and program development. Four case studies are presented (on cardiovascular disease, mental health, violence, and tobacco) to illustrate how gender-based analysis changes data interpretation and program development.

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