1. Gender, health and the MDGs Joanna Vogel Women in Health and Development EMRO-WHO World Health Organization

2. Outline • Gender and health • Gender analysis in health • WHO and gender analysis • Data used to inform gender analysis • WHO work in gender indicators • Proposed WHO gender indicators • Challenges of gender sensitive data collection • Recommendations World Health Organization

3. Gender and health • Gender in health looks at how social differences among males and females impact health outcomes and tries to ensure that differential needs of males and females are reflected in health systems. • Gender analysis in health identifies, analyses and informs action to address inequalities that arise from the different roles of women and men, or the unequal power relationships between them, and the consequences of these inequalities on their lives, their health and well-being. World Health Organization

4. Gender analysis in health • Reveals the different health needs of males & females; • Highlights impacts on health outcomes of inequitable gender norms; • Facilitates gender responsive policies and programmes; • Improves the quality of health interventions; • Promotes enhanced health information, documentation and use; • Advocates for empowerment, decision-making, informed choice, health rights and improvement of health for both men and women World Health Organization

5. WHO and gender analysis • Advocate the use gender analysis by programme managers in the Ministries of Health by provision of the WHO gender mainstreaming for health managers training • Yemen, Sudan, Iraq (UAE, Oman by end 2007) • Training comprised of 3 modules which lead participants through the completion of a gender analysis of selected health issues as well as the integration of outcomes from the gender analysis into health programmes and policies. World Health Organization

6. Handout 2-03: The Matrix: Gender Analysis of a health problem: the impact of different characteristics of gender on men and women’s health World Health Organization [1] Sources: adapted from Gender and Health Group 1999:26-27 (10); Hartigan et al 1997:35n-66(11); Ravindran TKS 2000 (12); Klugman, Fonn & Tint 2001:45-50 (13). [2] ** Are there any differences in the way in which society responds to this health problem? (e.g. Is there a difference in the way in which a woman and a man responds when a man/woman experiences this problem?

7. Data used to inform gender analysis • Sex disaggregated data; • Often data is collected by sex at community level but then aggregated at national levels • Secondary and published sources; • Rapid appraisals using both quantitative and qualitative methodologies such as: gathering health service-based data, or interviewing major stakeholders; • Participatory data gathering and analysis exercises in relevant sites; • NGO reports • Data from regions / countries with similar demographic, cultural, political and economic contexts World Health Organization

8. WHO work in gender indicators • Report on comparative evaluation of indicators for gender equity and health by the World Health Organization Centre for Health Development in Kobe, Japan • Department of Gender Women and Health isolation of 3 additional and alternate indicators on health and gender in MDG 3 • Selection criteria included: • Available data sources • Indicate multiple impacts on health outcomes • Reflect multiple gender issues World Health Organization

9. Proposed indicator 1: Measure of burden of violence against women • Definition: Proportion of women who have ever had a partner, 15-49 years old, who have ever experienced physical violence by an intimate partner (Sources: DHS, special surveys) • Derived from WHO Multi Country Study on Women’s Health and Domestic Violence • ‘Intimate partner’ is variable depending on cultural context • VAW questions offered as option in DHS but not all countries incorporate it World Health Organization

10. Proposed indicator 2: Early marriage • Definition: Proportion of 20-24 year olds married before the age of 18, by sex. (Sources: DHS, national surveys) • Early marriage leads to early childbearing which impacts child and maternal mortality and morbidity • Associated with wide age gaps between partners and low status of the wife • Low status impacts decision making power, mobility, and right to secure reproductive and sexual rights • Early marriage can reduce girl's access to education and gainful employment World Health Organization

11. Proposed indicator 3: Son preference • Definition: Ratio of female to male live births. (Sources: Census data, DHS) • Can potentially account for occurrences of female infanticide and sex selection practices which indicate gender inequality • Mandated within WHO data collection World Health Organization

12. Challenges of gender sensitive data collection • Ministries have multiple reporting requirements to different agencies and are stretched to human and financial resource capacity • MDGs not well understood. Gender even less understood. • Requires collection of both quantitative and qualitative data. • Qualitative indicators take more time, are resource heavy, and not perceived as credible as quantitative indicators because of generalization limitations World Health Organization

13. Challenges of gender sensitive data collection • Limited capacities of developing countries where vital records are available for 50% or less of the population • Conflicting data between international agencies and country official data • Lack of statistics on emerging gender issues • Time use • Poverty • Violence against women • Informal employment • How to maximize existing data? World Health Organization

14. Challenges of gender sensitive data collection • Requirements of retraining field data collectors • Sex disaggregation is only the first step • Debate on including new indicators in routine data collection versus collecting separate research data • Concentration of sex-disaggregated data or gender sensitive indicators? World Health Organization

15. Recommendations • Include national statistics offices in any data collection activities (central statistics institutes and health statistical offices) • Advocate use of gender module in DHS in countries of the Region • Limit addition of gender sensitive indicators to routine data collection to 1-3 or will exceed national capacities • Engage academic institutes as key partners in data collection activities as they often have more national space to address sensitive issues World Health Organization

16. Recommendations • Use a combination of systems to retrieve sensitive data (i.e.-civil society to measure abortion practices in countries where it is illegal) • Promote inclusion of other social determinants (ethnicity geographical locations, income) in gender sensitive data initiatives World Health Organization