1. Sex and Gender Ann-Maree Nobelius Monash University Australia
Faculty of Medicine, Nursing and Health Sciences
Monash University Australia
Education Program in Reproductive Biology Lecture
For Reproductive Health Services and Policy Unit
29th of July 2003

2. Ann-Maree Nobelius
Monash graduate, Physiology and Pharmacology & Masters in Reproductive Sciences!!!!
medical research background
further studies in sociological research methodology particularly gender studies
fieldwork for PhD in Public Health on AIDS in Uganda with UK MRC
Employed by School of Rural Health to report on Gender Issues in Rural Medical Practice Project
Project Officer for Gender Working Party with goal of mainstreaming a gender perspective into entire curriculum

3. Where are you all from?

4. Definitions What is the difference between sex and gender?
Sex = male and female
Gender = masculine and feminine

5. SEX
refers to biological differences; chromosomes, hormonal profiles, internal and external sex organs.

6. GENDER
describes the qualities that a society or culture delineates as masculine or feminine.

7. It’s culturally defined
‘man’ = male + masculine social role
a real ‘man’, ‘masculine’ or ‘manly’
‘woman’ = female + feminine social role
a real ‘woman’, ‘feminine’ or ‘womanly’

8. Society and Culture Groups of people acting in organised ways
Social institutions are reproduced and changed over time (innovation)
Sub-cultures exist within institutions

9. Policy is a set of rules that govern those institutions (ideals)
…but not necessarily enforced (because of sub-culture)
Within all social institutions (religion/health systems/state) we see behaviour outside the ideals
Opportunity exists to change social institutions and therefore policy

10. Policy change at Monash
Gender Issues in Rural Practice Project
New 5 year Curriculum
Gender Working Party
Mainstreaming an Gender Perspective into the new curriculum

11. Misunderstandings… ‘gender’ does not mean sex, female or feminism
‘a gender perspective in medicine’ is not a euphemism for women’s health, feminism or for men needing to ‘get in touch with their feminine side’
at times impossible to differentiate the biological from the social determinants of health; convention dictates the use of ‘gender’ rather than ‘sex’ in those cases
misuse of terms is widespread (we use WHO and UN definitions)
MEN HAVE GENDER TOO

12. A gender perspective in medicine is multidimensional …because all players in healthcare have a gender
So from the patient’s perspective
gender perspective in medicine simply acknowledges the differential roles that masculinity and femininity play in men’s and women’s health
From the providers perspective
a gender perspective acknowledges the ways in which the gender of the provider impacts on the health care event

13. From an educational perspective
identifies the gendered nature of medical education/texts/teaching styles
From an evidence based perspective
acknowledges the clinical consequences of gender blind medical research and the resulting medical evidence
…this last one is a good and accessible example...

14. Gender-blindness in medical research
2/3 of all pharmaceuticals used to treat both men and women have only been tested in men
2/3 of all diseases that affect men and women have only been researched in men
women have only made up 7% of all cardiac research subjects

15. Mainstreaming
…acknowledging where difference is important throughout the entire curriculum and teaching process, in clinical practice and policy development and providing balance where needed.

16. But why should we care about difference?
More or less you are either one or the other on the basis of biological difference
Difference has profound consequences for clinical practice
Truly evidence based curriculum
Improved clinical practices
Improved outcomes for patients
More competent graduates

17. For your purposes… In what ways are our health services gendered?
Medicine is an institutionalised form of social behaviour with deep historical roots
Medicine has many hierarchies
These hierarchies are very gendered

18. Some examples of Gendered Hierarchies
Surgery
Nursing
Midwifery
IVF programme

19. IVF Male factor contributes equally to a couple’s infertility
Most research has been done on female factor infertility
Infertility equally challenging to male identity
Very few male counsellors
Run out of O & G

20. What can be done about it?
Identify issues through gender analysis
Advocate for change in thinking and policy
Funding for change
Andrology Australia is a good example