Global health and gender
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Global Health and Gender. Michele Barry, M.D., FACP Professor of Medicine and Global Health Yale University School of Medicine Director of Office of International Health AYA April 30, 2004. Gender and Global Health. Women Gender and 10/90 Gap HIV/AIDS and Women

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Global health and gender

Global Health and Gender

Michele Barry, M.D., FACP

Professor of Medicine and Global Health

Yale University School of Medicine

Director of Office of International Health

AYA April 30, 2004


Gender and global health

Gender and Global Health

  • Women Gender and 10/90 Gap

  • HIV/AIDS and Women

  • Maternal and Reproductive Health

  • Missing Women

  • Gender Based Violence

  • Research on Gender and Global Health


Gender and 10 90 gap

Gender and 10/90 GAP

10/90 GAP = only 10% current global funding for research is spent on diseases that afflict 90% of the world’s population

In developing countries-

• Women have less access to health care and

gender analysis to health research is lacking.

• There are distinct differences in patterns of

health and health outcomes when gender analysis is applied


Leading causes of death in women worldwide 2001

Leading Causes of Death in WomenWorldwide - 2001

HIV/AIDS1.3 million

Malaria 592,000

Maternal Conditions 509,000

Tuberculosis 500,000

Source: World Health Report 2002,

World Health Organization


Gender and global health1

Gender and Global Health

  • Women Gender and 10/90 Gap

  • HIV/AIDS and Women

  • Maternal and Reproductive Health

  • Missing Women

  • Gender Based Violence

  • Research on Gender and Global Health


Hiv aids and women

HIV/AIDS and Women

More than 50% of those living with HIV are women

< 1% globally have access to anti-retrovirals

In sub-Saharan Africa nearly twice as many

women as men are infected


Hiv aids and women1

HIV/AIDS and Women

Potential reasons

• Biological differences of risk of acquisition

• Economic vulnerability leading to transactional sex

• Coerced sex/rape/marriage

• Inability to negotiate condom use


Hiv aids and women biological differences of risk of acquisition

HIV/AIDS and WomenBiological differences of risk of acquisition

• Several studies have shown that it is easier for a woman to

contract HIV/AIDS from a sexual contact with an infected

man than it is for a man with an infected woman

• The presence of an untreated STI increases the risk to

contract 10X. STIs often do not give rise to any

symptoms in women so they remain untreated or

unrecognised

• Coerced sex increases risk of micro-lesions; more frequent

for women, although also important in young boys


Gender and global health2

Gender and Global Health

  • Women Gender and 10/90 Gap

  • HIV/AIDS and Women

  • Maternal and Reproductive Health

  • Missing Women

  • Gender Based Violence

  • Research on Gender and Global Health


Maternal deaths

Maternal Deaths


Global health and gender

Reasons for Maternal Deaths in

Low Income Countries

Low income countries - 53% attended during delivery

30% receive postnatal care


Safe motherhood projects

Safe Motherhood Projects

NGOs

White Ribbon Alliance – www.whiteribbonalliance.org

Family Care International – www.familycareintl.org

Save the Children – www.savethechildren.org

Technology in Health (PATH) (technical assistance to discourage FGM) – www.path.org

Gates Institute for Population and Reproductive Health

www.jhsph.edu/GatesInstitute


Gender and global health3

Gender and Global Health

  • Women Gender and 10/90 Gap

  • HIV/AIDS and Women

  • Maternal and Reproductive Health

  • Missing Women

  • Gender Based Violence

  • Research on Gender and Global Health


Missing women number of women per 1000 men india

Missing WomenNumber of Women per 1000 Men, India


Missing women

Missing Women

60 million “missing girls” mostly in Asia

Reasons:

  • Neglect of female children in health care, admissions to hospitals and feedings

  • Female infanticide/abortions/dowry deaths

  • Maternal mortality


Missing women young adults

Missing Women – Young Adults

  • DOWRY DEATHS:

    • Bride burning - Dowry Deaths India

    • 1987 - 1,786 dowry deaths in India (frequently kerosene burning)

    • Maharashtra state 19% deaths women 15-44 “accidental burns”

    • < 1% in Guatemala, Ecuador

  • HONOR KILLINGS: (1000 Pakistan – 1999)


Gender and global health4

Gender and Global Health

  • Women Gender and 10/90 Gap

  • HIV/AIDS and Women

  • Maternal and Reproductive Health

  • Missing Women

  • Gender Based Violence

  • Research on Gender and Global Health


Violence against women internationally

Violence Against Women - Internationally

Female Circumcision and Mutilation

>80 million women in 39 countries worldwide have

undergone female mutilation of the external sex organs.

2 million annually undergo circumcision


Violence against women internationally1

Violence Against Women - Internationally

Definitions: 3 types of “female mutilation”

Circumcision (type I - sunna) cutting of the hood of the clitoris (least severe) - least practiced

Excision (type II - reduction) removal of clitoris and labia minora

3. Infibulation (Type III - “pharaonic circumcision”) cutting of clitoris, labia minora and medial part of labia. Two sides of the vulva are sewn with catgut and a small opening is left for menses

Age: few days old (Ethiopia), 7 years (Egypt, Central Africa), Adolescence (Nigeria, Tanzania)


Documented female circumcision

Documented Female Circumcision


Violence against women internationally health sequelae of female circumcision

Violence Against Women-InternationallyHealth Sequelae of Female Circumcision

83% women will have a medical complication

Immediate:

hemorrhage (within 10 days)

urethral damage or other adjacent organs, tetanus, infection, urinary retention from pain

Long term:

chronic infections, scarring, pelvic infections, dysmenorrhea, dyspareunia (painful intercourse), difficulty with urination

Effects on Childbirth:

need for de-infibulation

delayed labor-increased mortality

fistulas

Unknown Effects:

?HIV transmission, sexuality, psychological trauma


Violence against women internationally2

Violence Against Women - Internationally

Potential Solutions

  • Cultural consciousness (WHO position papers on female mutilation)

  • Education (street theater-India describing dowry deaths)

  • Grassroot activism (e.g. Brazil’s all female police station)

  • Legal reform (female mutilation)

  • Shelters

  • International cooperation/funding


A life cycle approach

A Life Cycle Approach


A life cycle approach1

A Life Cycle Approach

Female literacy and health:

1 additional year schooling = 3.4% reduction in mortality


A life cycle approach2

A Life Cycle Approach


A life cycle approach3

A Life Cycle Approach


Gender and global health5

Gender and Global Health

  • Women Gender and 10/90 Gap

  • HIV/AIDS and Women

  • Maternal and Reproductive Health

  • Missing Women

  • Gender Based Violence

  • Research on Gender and Global Health


Gender mainstreaming

Gender “Mainstreaming”

Mainstream gender issues and awareness into programs at WHO, UN, World Bank, public health initiatives

Mainstream gender issues into research

www.who.int/gender/en

www.globalforumhealth.org


Global health and gender

Source: Abou-Gareeb, Lewallen, Bassett and Coutright. Gender and blindness: a meta-analysis of population based prevalence surveys.

Opthalmic Epidemiology 2001; 8:39-56

BURDEN OF BLINDNESS IN MEN AND WOMEN

Source: Abou-Gareeb, Lewallen, Bassett and Coutright. Gender and blindness:

a meta-analysis of population based prevalence surveys.

Opthalmic Epidemiology 2001;8:39-56


Higher prevalence of blindness among women why

Higher prevalence of blindnessamong women:Why?

Do the greater life spans of women account for the

greater burden of degenerative blindness?

- But more women are blind at all older ages. Must be

another explanation.

Is there differential mortality among blind

men/women?

Available evidence does not seem to suggest this.


Higher prevalence of blindness among women why1

Higher prevalence of blindness among women: Why?

• Studies show that women have a higher biological predisposition

to cataract than men, and a socio-cultural predisposition to

trachoma (i.e. through child care activities, household

environment etc).

• Differential use of eye-care services due to differences

in gender roles and behaviors.

• Studies have found distinct differences between men and women

in surgical coverage across age groups – access to cataract

surgery/trachoma


Gender mainstreaming at world health organization

Gender Mainstreaming at World Health Organization

  • Gender and Women’s Health Department at WHO

  • Gender Team at WHO -

    promote awareness into programs at WHO and

    public health work

  • Gender Task Force –

    senior level managers report gender mainstreaming to Director General


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