1. Nancy Yinger & Charlotte Feldman-Jacobs Population Reference Bureau May 17, 2005 A Gender Perspective

2. Recent Headlines  Sri Lanka Maids’ High Price for Foreign Jobs, NYT, 5/8/05.  Charlotte, Grace, Janet and Caroline Come Home, NYT Magazine, 5/8/05.

3. Gender not Sex  Gender refers to the roles that women and men play in society and the relative power they wield.  Sex refers to the innate biological differences between women and men.  Most health inequities are rooted in gender inequities.

4. 8 Leading Causes of Adult Disease Burden (2002) 1.HIV/AIDS 2.Ischaemic heart disease 3.Cerebrovascular disease 4.Unipolar depressive disorders 5.Road traffic injuries 6.Tuberculosis 7.Alcohol use disorders 8.Violence 1.Unipolar depressive disease 2.HIV/AIDS 3.Ischaemic heart disease 4.Cerebrovascular disease 5.Cataracts 6.Hearing loss (adult onset) 7.Pulmonary disease 8.Tuberculosis MalesFemales Source: WHO, World Health Report, 2003

5. Areas of Progress; Areas of Stagnation Positives:  Girls’ school enrollments up.  Use of modern contraception up.  Women’s share of the nonfarm labor up slightly. Negatives:  Girls’ schooling lags behind boys’ in the world’s poorest regions.  Childbearing begins early in these regions.  Maternal mortality not abating.  Women hold less than one-fifth of seats in national parliaments.

6. Measuring Gender  Social scientists have a long history of studying gender.  Used to be “status of women” and was measured by “proxies,” especially female education.  Measurement now more precise, but also more complex.  Variables now define power to act in healthy ways, e.g. control fertility.

7. Example of Empowerment Variables Who in your family usually makes decisions about:  Health care for yourself?  Major household purchases?  Purchases for daily household needs?  Visits to your family or relatives? In your opinion, is a husband justified in hitting or beating his wife in the following situations:  If she goes out without telling him?  If she neglects the children?  If she argues with him?  If she refuses to have sex with him?

8. Moving Beyond Proxies  IGWG’s “So What” paper presents 25 examples of reproductive health projects that have included and evaluated a gender perspective.  Interventions that include efforts to transform gender relations report positive reproductive health outcomes.

9. Gender and Fertility The Navrongo experiment in N. Ghana:  Gender explicitly included in the design.  Three models of service delivery compared with a control area.  In most intensive experimental area, fertility down by 16%.  Gender-based violence increased.

10. Gender and Very Low Fertility Proposition: In high fertility countries, gender inequities tend to support high fertility, and in low fertility country they tend to support very low fertility.

11. Risk of Dying of Maternal Causes Industrialized Countries.................…….…. 1 in 2,800 East Asia/Pacific...........….…………………… 1 in 283 Latin America........………………....………… 1 in 160 Southeast Asia…………………………………. 1 in 140 South Asia………………….…………………… 1 in 46 Sub-Saharan Africa…..………………………… 1 in 16 World Health Organization, UNICEF, and UNFPA, Maternal Mortality in 2000.

12. Addressing Maternal and Neonatal Mortality from a Gender Perspective The Warmi Project in Peru included  Participatory problem solving through women’s groups.  Support for interventions such as emergency transportation funds and efforts to include husbands. Evaluation from 1990-1998 showed a decline in  maternal mortality (from 141 to 99 deaths per 10,000 births).  neonatal mortality (from 70 deaths to 16 per 1,000 live births).

13. Sex distribution of adults living with HIV/AIDS in Sub-Saharan Africa Source: UNAIDS, Report on the Global HIV/AIDS Epidemic, July 2002. Number infected: 13,256,189 Number infected: 9,776,646

14. Addressing Gender and HIV/AIDS The Sonagachi Project in Calcutta included  Free health clinics and HIV/AIDS education.  Training to deal with legal issues.  Literacy classes. Evaluation of activities showed  An increase in HIV/AIDs knowledge (31% in 1992 to 86% in 1993).  A decrease in gonorrhea (13% to 4%).  An increase in condom use (from 4% in 1995 to 30% in 1999).

15. Conclusions  Social science now has better tools to measure gender; they need to be applied more broadly.  The evidence is mounting: health programs that incorporate gender better achieve their objectives; but many projects still not well evaluated.  PRB looks forward to working with many partners to continue disseminating life-saving gender and health information.