It is a great privilege for many of us who have been raising our voices on gender issues to come across a manual - Gender mainstreaming for health manager: a practical approach - that takes these issues seriously – especially in healthcare sectors. The fi

It is a great privilege for many of us who have been raising our voices on gender issues to come across a manual - Gender mainstreaming for health manager: a practical approach - that takes these issues seriously – especially in healthcare sectors. The WHO has come up with an updated edition of a very apt manual that addresses how gender norms, roles and relations affect health-related behaviours and outcomes as well as health sector responses. At the same time, it recognizes that gender inequality is a cross-cutting determinant of health that operates in conjunction with other forms of discrimination based on factors such as age, socioeconomic status, ethnicity or place of origin and sexual orientation. The manual provides a basis for addressing other forms of health-related discrimination.

The first edition of the manual dates from 2011, and WHO is now updating it in light of new scientific evidence and conceptual progress on gender, health and development

The review and update process will build on the extensive work already featured in the manual. It will focus on:

1. Updating key concepts around gender;

2. Highlighting and expanding on the concept of intersectionality, which looks at how gender power dynamics interact with other hierarchies of privilege or disadvantage, resulting in inequality and differential health outcomes for different people. Intersecting factors include sex, ethnicity, race, age, class, socioeconomic status, religion, language, geographical location, disability status, migration status, gender identity and expression, sexual orientation and political situation.

3. Going beyond binary approaches to gender and health to recognize gender and sexual diversity, or the concepts that gender identity exists on a continuum and that sex is not limited to males or females.

 4. Introducing new gender, equity and human rights frameworks and tools to further support capacity building around these concepts and the integration of their approaches in the work of WHO.

 

It is learnt that the manual review and update are being carried out in partnership with the United Nations University International Institute for Global Health. During the summer and fall of 2022, people will have the opportunity to provide inputs and feedback from reviews of the updates and participate in a validation workshop and/or the pilots. 

Gender norms, roles and relations, and gender inequality and inequity affect people’s health all around the world. This Q&A (derived from one of the WHO’s publications) examines the links between gender and health, highlighting WHO’s ongoing work to address gender-related barriers to healthcare, advance gender equality and the empowerment of women and girls in all their diversity, and achieve health for all. 

 

Let us re-visit this Q & A:

  1. What is Gender?  Gender refers to socially constructed characteristics of women and men – such as norms, roles and relations of and between groups of women and men.  Gender norms, roles and relations vary from society to society and evolve. They are often upheld and reproduced in the values, legislation, education systems, religion, media and other institutions of the society in which they exist. When individuals or groups do not “fit” established gender norms they often face stigma, discriminatory practices or social exclusion – all of which adversely affect health. Gender is also hierarchical and often reflects unequal relations of power, producing inequalities that intersect with other social and economic inequalities. 

     
  2. What is the difference between Gender and Sex? Gender interacts with but is different from sex. The two terms are distinct and should not be used interchangeably. It can be helpful to think of sex as a biological characteristic and gender as a social construct. Sex refers to a set of biological attributes in humans and animals. Sex is mainly associated with physical and physiological features including chromosomes, gene expression, hormone level and function, and reproductive and sexual anatomy.

    Sex is often categorized as females and males, but there are variations of sex characteristics called intersex. The term ‘intersex’ is used as an umbrella term for individuals born with natural variations in biological or physiological characteristics (including sexual anatomy, reproductive organs and/or chromosomal patterns) that do not fit traditional definitions of male or female. Infants are generally assigned the sex of male or female at birth based on the appearance of their external anatomy/genitalia.

     
  3. What is the difference between Gender, Sex, Gender Identity, Gender Expression and Sexual Orientation? Gender identity refers to a person’s innate, deeply felt internal and individual experience of gender, which may or may not correspond to the person’s physiology or designated sex at birth.

    Gender expression refers to how an individual expresses their gender identity, including dress and speech. Gender expression is not always indicative of gender identity. ‘Transgender’ is an umbrella term for people whose gender identity and expression do not conform to the norms and expectations traditionally associated with the sex assigned to them at birth; it includes people who are transsexual, transgender or otherwise gender non-conforming.

    Sexual orientation refers to a person’s physical, romantic and/or emotional attraction (or lack thereof) towards other people.  It encompasses hetero-, homo- and bisexuality and a wide range of other expressions of sexual orientation. Sexual orientation cannot be assumed from one’s assigned sex at birth, gender identity or gender expression. 

     
  4. How do Sex and Gender Influence Health? Sex and gender interact in complex ways to affect health outcomes. Sex can affect disease risk, progression and outcomes through genetics (e.g. function of X and Y chromosomes), cellular and physiological, including hormonal pathways. These pathways can produce differences in susceptibility to disease, progression of disease, treatment and health outcomes, and are likely to vary over the life course.  For example, data shows that men experience more severe COVID-19 outcomes in terms of hospitalizations and deaths than women. This is, in part, explained by higher quantities of angiotensin-converting enzyme found in men, which binds to the SARS-COV2 virus.

    Gender norms, socialization, roles, and differentials in power relations and access to and control over resources contribute to differences in vulnerabilities and susceptibilities to illness, how illness is experienced, health behaviours (including health-seeking), access to and uptake of health services, treatment responses and health outcomes. For example, gender can determine health risks faced and taken. Data show that men’s increased risk of acquiring SARS-COV2, is also linked to their lower rates of handwashing, higher rates of smoking and alcohol misuse and, related to that – higher comorbidities for severe COVID-19 symptoms as compared to women.

     
  5. How else does Gender link with Health? Gender has implications for health across the course of every person’s life. Gender can influence a person’s experiences of crises and emergencies, their exposure to diseases and their access to healthcare, water, hygiene and sanitation.

    Gender inequality disproportionately affects women and girls. In most societies, they have lower status and have less control over decision-making about their bodies, in their intimate relationships, families and communities, exposing them to violence, coercion and harmful practices. Women and girls face high risks of unintended pregnancies, and sexually transmitted infections including HIV, cervical cancer, malnutrition and depression, amongst others. Gender inequality also poses barriers for women and girls to access health information and critical services, including restrictions on mobility, lack of decision-making autonomy, limited access to finances, lower literacy rates and discriminatory attitudes toward healthcare providers.

    Gender diverse people are more likely to experience violence and coercion, stigma and discrimination, including from health workers. Data suggests that transgender individuals experience high levels of mental health illness – linked to the discrimination and stigma they face from societies and in healthcare settings.

WHO’s 13th General Programme of Work (2019-23) recognizes the need to promote gender equality and to mainstream gender in all of the Organization’s work. WHO develops norms, standards and guidelines deliver training on gender-responsive health service provision and delivery, and commissions research on gender equality, human rights and health equity issues.

The programme also supports country-level action to strengthen the health sector’s response to gender-based violence as well as to address gender equality in health workforce development and gender-related barriers to health services. Let us hope this works to challenge gender stereotypes and to implement programmes, services and policies that promote gender equality to achieve health equity and Universal Health Coverage.