1. Gender and Health H.E. ADV Bience Gawanas Commissioner for Social Affairs, AUC

2. Overview Introduction Gender and the health related MDGs Gender and health and the context of Africa Successes Challenges/Gaps Issues for discussion

3. Introduction The Constitutive Act of AU has objectives specific to gender, health and development in Africa Gender is important to the causes and consequences of inequity in health Not just biological, such as hormones, but also social and cultural. Lower social autonomy of women exacerbates their biological vulnerabilities to infections such as HIV and malaria

4. Introduction It is therefore important to distinguish between possible biological and social and cultural factors to the causation of ill health A gendered approach to health therefore leads to appropriate responses from the health care system and from public policy. Women’s health is not just about their reproductive functions

5. Gender and the Health Related MDGs MDGs identified as “health related” include Goal 1: Eradicate extreme poverty and hunger –Women and girls are over represented among the poor, 70% of the poor in the world are women. –Allocation of food and nutrition often biased against women and girls; young girls suffer brunt of malnutrition

6. Gender and the Health Related MDGs Goal 4: Reducing child mortality –Child health and well-being, including nutritional health tied to the health, and mental health of their mothers. Goal 5: Improving maternal health –Young girls are still being married off before they are physically and emotionally mature –Link between education of girls and initiation of child bearing, number of children, attendance at antenatal clinics, and where deliveries are had

7. Gender and the Health Related MDGs Goal 6: Combating HIV and AIDS, Malaria and TB –There is a breakout session on HIV and AIDS and gender –Women more vulnerable to malaria infections, but interventions focus on intermittent treatment in pregnancy –Financial security –Women are the carers, whether sick of not

8. Gender and the Health Related MDGs Goal 7: Ensuring environmental sustainability –Access to safe drinking water and improvement in the lives of slum dwellers are the targets Goal 8: Global partnership for development –Access to affordable medicines, often not engendered –Access to social protection and employment

9. Gender and the Health Related MDGs Although Goal 2 on education is not considered to be ‘health related’, health of a household is directly related to the educational attainment of the mother Goal 3: on gender equity is also integral to women’s health; the social position of women, violence against women issues, trafficking, early marriage, and other harmful traditional practices

10. Africa, Gender and Health Poverty, conflicts, HIV and AIDS Very young populations, 50% made up of children and youth High rates of orphans and vulnerable children, from conflicts and HIV and AIDS Resulting in low social and human capital Human resources for health crisis; internal migration from rural to urban areas, from public sector to HIV AIDS programs and projects, and external migration from Africa to the diaspora

11. Africa, Gender and Health Poverty leads to poor health systems; poor access, poor quality of care. Highest rates of maternal mortality ratios globally are found in this region Alcohol and drug abuse rates are high in the region, women in the region use and abuse alcohol at high rates. Abuse of alcohol and drugs is linked to increased vulnerability to HIV infection

12. Africa, Gender and Health Alcohol and drug abuse programs often do not admit women, women often do not seek care, women who abuse alcohol and drugs are often stigmatised by health care workers,

13. Successes Endorsement by African Heads of State and Government of the Africa Health Strategy and Maputo Plan of Action on Reproductive Health Regional economic and health communities are at different levels of developing and implementing specific strategies All countries are scaling up towards universal access to primary health care All countries are scaling up towards universal access to primary health care

14. Successes The Pharmaceutical Manufacturing Plan for Africa was adopted in 2007 to promote access to affordable medicines Many countries offer free or subsidized sexual and reproductive health care services and commodities, affordable health services for rural communities, training of grassroots health workers Many countries are implementing the Roadmap on Reducing Maternal, Infant and Child Mortality Increase in contraceptive prevalence from 12% in 1990 to 21% in 2005.

15. Challenges Rates of maternal mortality are still high, 13 countries still have MMR over 1000 per 100,000 live births Inequitable distribution of health care services, especially in the rural areas Women’s health taken to refer to only reproductive functions, so other aspects, like mental health or access to ART when not in context of PMTCT is inequitable

16. Challenges Health care providers, although majority are women, are often gender blind, not inquiring about violence, or about HIV, or about alcohol and drug abuse, nor do they screen for common mental disorders, such as depression and anxiety Financing of health care is gender blind, not possible to track if women have access to same resources as men in relation to health care when it is not reproductive health care

17. Issues for Discussion Tracking of the MDGs indicators for the most part is not gender disaggregated, is it feasible to have all MDG data disaggregated for gender? Should institutionalisation of engendered tracking of all health financing be introduced? What models do we have for reducing maternal and child mortality in the region, how can they be scaled up and replicated in other countries? Determinants of health are multi-sectoral, how can key sectors work together to deliver a holistic health care package to all African women? How can men be mobilised to promote health for all and a society free of gender based violence?