Reproductive Health Package CSR PFI Section VI GENDER :: PFI Publication :: KNOWLEDGE MANAGEMENT CENTRE PORTAL, POPULATION FOUNDATION OF INDIA

Expand document

Collapse document

Reproductive Health Package CSR PFI Section VI GENDER

1 Pages 1-10

1.1 Page 1

1.2 Page 2

1.3 Page 3

1.4 Page 4

1.5 Page 5

1.6 Page 6

1.7 Page 7

1.8 Page 8

1.9 Page 9

1.10 Page 10

2 Pages 11-20

2.1 Page 11

2.2 Page 12

2.3 Page 13

2.4 Page 14

2.5 Page 15

2.6 Page 16

2.7 Page 17

2.8 Page 18

2.9 Page 19

2.10 Page 20

3 Pages 21-30

3.1 Page 21

Reproductive Health Package CSR PFI Section VI GENDER

1 Pages 1-10

▲back to top

1.1 Page 1

▲back to top

Section VI

Gender

1.2 Page 2

▲back to top

Section VI

GENDER

Gender Issues

Violence against Women and Reproductive Health

1.3 Page 3

▲back to top

chapter 16

GENDER ISSUES

A gender perspective should be adopted in all processes of policy formulation and

implementation and in the delivery of services, especially in sexual and reproductive

health, including family planning.

– United Nations, 1999

The determinants of health include biological (sex, genes), social (gender, education, family roles,

community support), economic (poverty), environmental (pollution, workplace environment), and

related to lifestyle (eating patterns, smoking, sexual behaviours). They may reinforce or impact the

others in a variety of ways.

In many countries, gender significantly influences a person’s ability to access health services. Differences

in influence or power relations between women and men may, for example, determine whether

women can purchase or use a contraceptive, and therefore, how vulnerable they might be to an

unintended pregnancy or to a sexually transmitted infection. Wrong notions of attitudes towards

“masculinity” may result in some men continuing sexual practices that affect their own health and

endanger the health and lives of their families. Awareness of such conditions and the adoption of

appropriate responses can help women and men to improve their health and advance in life. This can

contribute towards enriching the quality of life in their communities. Reproductive health services that

meet both men’s and women’s needs will encourage increased use of services and promote sound

reproductive decisions.

The International Conference on Population and

Development in Cairo in 1994 stressed the importance

of gender and noted that reproductive health

programmes should be implemented from a gender

perspective. The Fourth World Conference on Women

in Beijing in 1995, and the fifth-year reviews of both

these conferences in 1999 and 2000, respectively,

highlighted gender as an essential part of equitable,

sustainable development. The conferences encouraged

reproductive health programmes to examine gender

issues that underlie health problems and address

women’s health needs throughout their life span. They

also recognized sexuality as a positive part of a

woman’s life and men’s responsibility to respect

women’s reproductive rights.

1.4 Page 4

▲back to top

- - - - - - - - -C-O-R-P-O- R- -A-T-E-S-O-C-I-A-L-R-E-S-P-O- -N-S-IB-I-L-IT-Y- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -

Gender Terms and Concepts

The following are a few key definitions of gender terms and concepts used in our discussion on

gender-related issues:

Sex refers to the biological differences between men and women. These differences are generally

universal and unchanging.

Gender refers to the socially constructed roles and responsibilities of women and men in a given

culture or location. These roles are influenced by perceptions and expectations arising from cultural,

political, environmental, economic, social, and religious factors, as well as from custom, law, class,

ethnicity, and individual or institutional biases. Gender attitudes and behaviours are learned and can

be changed.

The differences between Sex and Gender may be presented graphically as follows:

Sex

Biological

Gender

Cultural

Given by birth

Learned through socialization

(Therefore)

(therefore)

Cannot be changed

Can be changed

Sexuality refers to the capacity for sexual feelings and their expression, e.g. heterosexuality, homosexuality

and bisexuality.

Equality refers to similarity of treatment as legally and constitutionally given. It is a fundamental right.

Gender inequality is reflected in adverse sex ratio, female foeticide, and limited and unequal access

to healthcare.

Equity refers to a fair sharing of resources, opportunities and benefits according to a given framework.

Equity is one of the measures of equality. Equity is measurable and manifested in parity. If men and

women are equal, they should be treated fairly. This includes:

• the right of choice and security in marriage, right to land and property,

• reproductive rights, freedom from violence, etc.

1.5 Page 5

▲back to top

- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -G-E-N-D-E- R- -I-S-S-U-E-S- - - - - - - - -

Gender sensitivity/awareness/perspective refers to the understanding of socially determined differences

between women and men that lead to inequities in their respective access to and control of resources.

Gender sensitivity includes the willingness to address these inequities through strategies and actions

for social and economic development.

Mainstreaming gender implies the incorporation of gender considerations into the analysis, formulation,

and monitoring of strategies and activities that can address and help reduce inequities between women

and men. It addresses gender issues in all aspects of development, including decision-making structures

and planning processes such as policymaking, budgeting, and programming.

Gender roles are activities assigned to individuals on the basis of socially determined characteristics,

including stereotypes, ideologies, values, attitudes, beliefs, and practices. Gender roles are established

through the influence of family, community, schools, religious institutions, culture/tradition/folklore/

history, media, policies, peer groups, and the workplace. These roles may be of three kinds:

• Reproductive roles: Women’s biological capacity to give birth assumes that child rearing and

household maintenance is women’s role.

• Productive roles: Informal economic activities considered not productive, yet contribute to

society, e.g. agricultural and household work.

• Community roles: Men usually dominate in leadership and political roles, whereas women

usually perform service-oriented or cultural activities.

Some situations in which we see gender differences are:

Social: The man is seen as head of the household and chief breadwinner, while the woman is seen

as nurturer and care-giver.

Political: Men are more involved in national and higher-level politics, while women are more

involved at the local level in activities linked to their domestic roles.

Educational: Family resources are directed to boys’ rather than girls’ education, and girls are streamed

into less challenging academic tracks.

Economic: Differences in women’s and men’s access to lucrative careers and control over financial

and other productive resources, such as credit, loans, and land ownership. Access gives a person the

use of a resource, e.g. land to grow crops. Control allows a person to make decisions about who uses

the resource or to dispose of the resource, e.g. sell land.

1.6 Page 6

▲back to top

Common Perceptions about Men and Women

Suzanne Williams, Janet Seed, and Adelina Mwau

in The Oxfam Gender Training Manual (United

Kingdom and Ireland: Oxfam Publications, 1994)

list some common perceptions about men and

women and their gender roles in history:

• Sex difference: Women give birth to babies,

men do not; women can breast-feed babies,

men can bottle-feed babies; men’s voices break

at puberty, women’s voices do not.

• Gender roles: Women cook and clean the

house, men earn income through paying jobs

outside of the home; in ancient Egypt men stayed at home and did weaving while the women

handled family business; also in ancient Egypt women inherited property and men did not; in

one study of 224 cultures, there were 5 in which men did all the cooking and 36 in which

women did all the house building.

• Gender stereotype: Girls are gentle, boys are tough; women are soft-spoken and gentle, men are

assertive and strong; men are better than women at mathematics, physics, and science.

• Gender discrimination: According to UN statistics women do 67 per cent of the world’s work,

but their earnings amount to only 10 per cent of the world’s income; amongst Indian agricultural

workers, women are paid 40 to 60 per cent of the male wage; most building site workers in

Britain are men; men make decisions about family planning and the number of children they

together will have.

Gender-related Constraints in Reproductive Health Programmes

Gender-related constraints come in the way of women exercising their basic reproductive rights, on

account of beliefs such as:

• that women are not able to make decisions about seeking reproductive health services on their

own;

• that women are not able to travel alone;

1.7 Page 7

▲back to top

• that unmarried women and adolescent girls should not use reproductive health services; and

• that men should not go to family planning or maternal and child health clinics.

Mainstreaming the Gender-Sensitive Approach

Most organizations that try to bring a gender perspective

to their reproductive health programmes do not generate

a separate programme component or activity. They

mainstream gender across all services by building:

• awareness and understanding of gender issues and

concepts among all staff;

• managerial commitment to address gender issues;

• managerial ability to adapt systems and procedures to accommodate a gender perspective;

• knowledge and skills for designing, implementing, and evaluating gender-sensitive programmes,

services, and activities.

Strategies to meet gender-related goals and address obstacles are likely to fall into four broad categories,

to satisfy different purposes:

• To enhance women’s awareness of factors and forces that shape women’s health status and

related skill development, such as providing educational materials for illiterate women. This

awareness would also empower women to control their fertility and make autonomous reproductive

choice.

• To influence men’s attitudes and behaviour towards women within the household and the local

community, and their use of reproductive health services, such as initiating efforts to reach men

with services and information, and to encourage them to adopt, or support their partner’s

adoption, of contraceptive methods. Enhancing men’s responsibility would involve encouraging

men to assume responsibility on birth control and unwanted pregnancies, to assume responsible

sexual behaviour, and to share responsibility in child rearing and house work.

• To strengthen the gender sensitivity of the organization’s services, in order to expand access and

improve quality, such as promoting the participation of female and male staff members in

1.8 Page 8

▲back to top

designing, implementing, and evaluating services, and building staff expertise in counselling

clients of the opposite sex. This includes:

high-quality, comprehensive, women-centred services based on women’s needs and choices

to improve their health;

no targets, incentives, or disincentives;

setting up an effective information system for individual client identification, follow-up

and re-motivation to enable sustained contraceptive use and to obtain client feedback;

service provision to women throughout their lifecycle – married women, unmarried women,

adolescents, older women, menopausal women.

• To change social norms and legal frameworks that affect women’s status and rights, such as

building partnerships with other organizations to advocate for change in women’s status and

rights; supporting community-based initiatives that encourage men and women to discuss changing

social norms and gender roles.

Community-based interventions must include a package of interventions to reach out to men and

women separately, through provision of different trained health volunteers for counselling male and

female clients, by involving male and female family planning motivators and counsellors.

Unintended Reinforcement of Entrenched Attitudes and Stereotypes

Policy and programme interventions for addressing the gender differences in health intervention can

themselves end up reinforcing entrenched gender stereotypes. Some examples are given.

Gender-unequal privileges

• A policy which denies a married woman the right to medical insurance in her own name makes

her dependent on her husband for access to it. Where the husband is unemployed, they are

denied access to it.

• Service providers requiring a man’s consent before a woman can be sterilized gives men power

over women and denies women’s right to self-determination.1

1 Even if this practice were to be altered to require women to give permission for sterilization by their male partners,

this may not address the problem, because women in many settings do not have the power to disagree with decisions

made by their male partners.

1.9 Page 9

▲back to top

Gender-blindness ignores gender norms, is blind to differences in the allocation of gender roles and

resources. While not intentionally discriminatory, it reinforces gender discrimination nevertheless.

• Senior management recruitment policy in a department of health that requires all managers to

have a PhD may go some way in making women ineligible on account of their difficult access

to education.

• Community-based AIDS care programme says that the healthcare system cannot take responsibility

for caring for people with AIDS so that home-based care must be instituted, without finding

ways of involving men in home-based care. However unintentionally, the programme puts the

burden of care on women.

Gender-specific approach recognizes differences in gender roles, responsibilities and access to resources

and takes account of these differentials, in an instrumental sense, but does not try to change

them.

• Occupational health policy protects women from working in places that are hazardous to their

reproductive health. However, such a policy may in fact be gender-unequal if it does not take

into account damage to male reproductive functions from similar or other workplace exposures,

and offers them protection as well.

• Water supply policy establishes a mechanism to provide taps close to villages so that women

will not have to walk far to fetch water.

• Workplace provides a childcare facility for women with infants. This acknowledges women’s

role as primary carers and makes it easier for mothers to work. It does not necessarily encourage

men to share in childcare responsibilities. A redistributive policy would provide a childcare

facility to men as well as women with infants.

The aim is to make policies and programmes gender-redistributive. Gender redistribution recognizes

differences in gender roles, norms and access to resources and supports changes in these so as to

promote gender equality. As a minimum, one should ensure that no harm is done through gender-

unequal or gender-blind health policies and programming. In some situations, gender-specific policies

may be more appropriate and relevant than gender-redistributive policies, as for example, when

designing subsidized maternity services for women.

1.10 Page 10

▲back to top

Tool for Integrating Gender Considerations in Programmes and Interventions (Tool 1)

This tool, adapted from Klugman (2001: 17), is widely used for addressing the gender differences in

health interventions. The tool involves some of the following aspects:

1. Is there an assessment of the potential impact of the project on women and on men? Are steps

being taken to ensure that the project does not result in a worsening of women’s position in

relation to men?

2. Is there an explicit statement as part of the project vision, goals or principles of its equity

intentions, including in relation to gender equity? Are these gender-specific, or gender-redistributive?

3. Does the project/intervention include scope for stakeholder participation in the design, monitoring

and evaluation of the project? Have steps been taken to ensure women’s participation equally

with men?

4. Does the programme design and planning take into account differences between women and

men in:

(a) Role and responsibilities?

(b) Norms and values?

5. Have gender-specific indicators been identified and included in the monitoring system through

the programme cycle?

(a) Input indicators regarding resources devoted to the intervention.

(b) Process indicators monitoring the implementation of the interventions.

6. Does the design take steps to address the influence of existing gender norms and practices at

relevant levels3 of the political and bureaucratic systems which may obstruct the intervention?

2 This may arise from gender discrimination in laws and policies, or may be a consequence of gender-based differences

between women and men in role and responsibilities or norms and values.

3 ‘Relevant levels’ refers to each of the levels of the political system and of the bureaucracy at which decisions about

this intervention will be made.

2 Pages 11-20

▲back to top

2.1 Page 11

▲back to top

Two examples are given here of how the questions provided in Tool 1 might be applied (a) in policy

and programming, and (b) in service delivery context at the level of a health facility.

Issue 1: Is there an assessment of the potential impact of the project on women and on men? Are

steps being taken to ensure that the project does not result in a worsening of women’s position in

relation to men?

In policy and programming: Ensure that involving women in maintaining data does not add to poor

women’s already excessive work burden (avoid gender-unequal).

In service delivery context: (i) Do not take women’s time for granted in community-based activities,

e.g. maintaining data and stock registers (avoiding gender-unequal). (ii) While introducing social

marketing, plan for mechanisms to ensure that women and other low-income groups are not excluded

from services (avoiding gender-blindness).

Issue 2: Is there an explicit statement as part of the project vision, goals or principles of its equity

intentions, including in relation to gender equity?

In policy and programming: (i) Build women’s as well as men’s responsibility for family planning and

reproductive health (gender-redistributive); (ii) improve accessibility of spacing methods at the community

level which lead to increased share of spacing method by women in overall contraceptive prevalence

rate (CPR) in the community (gender-specific).

In service delivery context: (i) Identify and address community-based obstacles to treatment experienced

by women and men, girls and boys (gender-specific). (ii) Ensure male participation in family planning

and reproductive health programmes (gender redistributive).

Issue 3: Does the project/intervention include scope for stakeholder participation in the design,

monitoring and evaluation of the project? Have steps been taken to ensure women’s participation

equally with men?

In policy and programming: Include women in project planning and advisory committees and in

community meetings. If necessary, hold separate community meetings with women and men so that

women’s voices can be heard. If consulting with ‘community leaders’, ensure that you talk to women

as well as men leaders (gender-specific/gender-redistributive), e.g. participation of men and women in

formation of village health and sanitation committee (VHSC) under the National Rural Health Mission.

2.2 Page 12

▲back to top

In service delivery context: (i) Set up routine feedback mechanisms that would represent women’s and

men’s views on the content and mode of delivery of the service (gender-specific). (ii) Include women

and men from the community in VHSC. Hold review meetings at regular intervals, and design

meetings to ensure that both participate actively and effectively (gender-redistributive).

Issue 4: Does the programme design and planning take into account differences between women and

men: (a) In role and responsibilities?

In policy and programming: Explore possibilities of reaching out to women according to the availability

of women during the day. Reach out to men through workplace-based intervention for specific

awareness generation building (gender-specific).

In service delivery context: (i) Ensure adequate supply of contraceptives (such as pill and condoms)

to avoid frequent visits of women to care provider (gender-specific). (ii) Ensure supply of contraceptives

for men at their workplace (gender-specific).

Issue 4: Does the programme design and planning take into account differences between women and

men: (b) In norms and values?

In policy and programming: Ensure that programme messages on family planning are addressed to both

women and men, thereby challenging the stereotype that only mothers are responsible for family

planning (gender-redistributive).

In service delivery context: (i) Ensure that women have access to women providers (in contexts where

this affects utilization of services) (gender-specific). (ii) Design information, education, communication

strategies which address the men’s responsibility in family planning and reproductive health (gender-

specific).

Issue 4: Does the programme design and planning take into account differences between women and

men: (c) In access to and control over resources?

In policy and programming: (i) Reduce or subsidize the cost of contraceptives through social marketing

and making women depot holders for contraceptives to make these more accessible to women (gender-

specific). (ii) Use different forms of media such as newspapers for men and radio for women

(depending on which medium they use) with message content matching their different vulnerabilities

and health-seeking behaviour (gender-specific).

2.3 Page 13

▲back to top

In service delivery context: (i) Design community-based pre- and post-payment schemes for family

planning services for women in reproductive age groups4 (gender-specific). (ii) Compensate women for

the time they spend on community-based interventions activities (avoid gender-blindness).

Issue 5: Have gender-specific indicators been identified and included in the monitoring system through

the programme cycle?

In service delivery context: (i) Ensure that health service records collect information on sex. (ii) Use

indicators such as participation of women and men in community health committees; increase in

service use by previously marginalized groups; or increase in men’s involvement in ensuring pregnant

women access to contraceptive services. (iii) Use qualitative indicators such as women’s and men’s

perspectives on service availability, costs and quality.

Issue 5: Have gender-specific indicators been identified and included in the monitoring system through

the programme cycle? (a) Input indicators regarding resources devoted to the intervention?

In policy and programming: (i) Both women and men community education officers or health

volunteers recruited for the programme; (ii) sufficient funds should be raised to cover the cost of

transport and honorarium for the time of women volunteers.

Issue 5: Have gender-specific indicators been identified and included in the monitoring system through

the programme cycle? (b) Process indicators monitoring the implementation of the intervention?

In policy and programming: The proportion of women and men utilizing the spacing method of

contraception every day, increasing contraceptive prevalence in eligible couples.

Issue 6: Does the design take steps to address the influence of existing gender norms and practices

at relevant levels of the political and bureaucratic systems that may obstruct the intervention?

In policy and programming: (i) Workshops have been conducted with members of community and

decision-making structures like VHSCs to identify potential gender-related barriers and ways to address

these (gender-redistributive). (ii) Key stakeholders and opinion leaders are given information on the

consequences of not addressing gender issues within the programme context (gender-redistributive).

In service delivery context: Run workshops with providers on gender issues in family planning and

quality of care (gender-redistributive).

4 Because a smaller proportion of women than men are engaged in formal employment and because many social insurance

schemes do not always provide coverage for dependants, women are less likely to be covered by health insurance schemes,

whether for the public sector or other workplace schemes.

2.4 Page 14

▲back to top

What the Corporate Sector Can Do for Gender Mainstreaming

Some of the successful interventions taken up by various corporate houses mainstreaming gender are

listed below.

• appointment of gender experts for Corporate Social Responsibility Projects;

• organizing gender awareness raising sessions for women and men among stakeholders, including

beneficiaries and the target groups;

• improving the capacity of the project leaders, managers and implementers to mainstream gender;

• conducting gender-based research and its documentation and dissemination;

• integrating gender in the project management, including human resources management (recruitment,

training, etc.);

• integrating gender mainstreaming in the project plan of action;

• developing specific project activities to address key gender disparities in areas where gender

inequality is identified;

• setting aside an adequate budget in the project to implement the planned mainstreaming

activities; preparing the gender-based budget to address the gender disparities;

• developing a monitoring system which integrates gender components;

• appointing gender focal point/group for sustaining and monitoring the mainstreaming activities,

and linking the project to the work done by others;

• making policy papers and formulation of further strategies for gender mainstreaming.

Reference

Williams. S., Seed J. Mwace. A., “The Oxfam Gender Training Manual”. United Kingdom and Ireland:

Oxfam Publications, 1994.

2.5 Page 15

▲back to top

chapter 17

VIOLENCE AGAINST WOMEN AND

REPRODUCTIVE HEALTH

The United Nations has defined violence against women as:

Any act of gender based violence that results in, or is likely to result in physical, sexual

or psychological harm or suffering to women, including threats of such acts, coercion or

arbitrary deprivation of liberty, whether occurring in public or private life.

NFHS 3 reports that the percentage of ever married women age 15–49 who have experienced

emotional, physical or sexual violence committed by their husband is almost 40 per cent. Physical

and sexual violence are the most common forms of violence. The incidence is highest for the state

of Bihar (60 per cent).

The International Conference on Population and Development (1994) recognized that gender-based

violence is an important factor detracting from poor women’s reproductive and sexual health. The

World Health Assembly adopted a resolution declaring violence a public health priority. Like any

other public health issue, violence against women can also be prevented and its impact reduced.

Women face violence even prior to birth. For reasons of son preference and pressure of dowry for a

girl, girl children are aborted. As infants, children and adolescents, they are subjected to infanticide,

child marriage, child prostitution, sexual abuse, unpaid domestic labour and poor access to food,

health and education. As adults women are subjected to domestic violence, dowry-related physical

and mental violence, rape, sexual harassment at the workplace, at home or in public, mental torture

leading to suicide, neglect, depression, burning, forced pregnancy, denial of food and money, abduction

and trafficking and commercial sex work. Young women are also subjected to violence related to

health services such as denial of healthcare, unnecessary caesarean or hysterectomy and irrational use

of drugs. Elderly women also experience domestic violence, restrictions related to widowhood, lack

of independence, rape and unpaid domestic labour.

The root cause of sexual violence is inherent in the way male sexuality is defined. Men often resort

to sexual violence to emphasize their power in society. Male sexuality uses the female body to

establish the primacy of the male gender. It is considered important for a man to be able to

impregnate a woman/wife and thus emphasize his superiority. Some often adopt oppressive behaviours

towards other women as a strategy to survive in the male-dominated world. There are some structural

factors that predispose society to violence against women. Gender-based violence serves the function

of maintaining unequal power relations between the sexes. The patriarchal disposition is reflected

through the control and domination of men over women. Patriarchal notions are further perpetuated

through a process of institutionalization of the social, cultural and religious practices in society and

2.6 Page 16

▲back to top

legitimized through the political, legal, educational, medical and economic systems of society. The

vulnerability of a woman from a lower caste to violence increases when the perpetrator is from an

upper caste. Similarly, women from minority communities (especially religious), face extreme forms

of violence from men belonging to majority/dominant communities in situations of communal

disturbance. The overall impact is to demean women by controlling their fertility, sexuality, labour

and mobility at the maternal and ideological levels.

Domestic Violence

Domestic violence is not just a problem between two

individuals: it needs to be seen in the context of

patriarchal social relations. Despite vigorous campaigns

to bring the so-called private matter of domestic

violence out in the public domain, it still remains

difficult to address the issue. The subjective

understanding of what constitutes violence depends

on various factors, such as – What was the context in which the act was carried out? who was at

fault? was the act part of a regular pattern or a one-off incident? Given these factors, women do not

identify every violent or abusive act as violence. The process of normalization of everyday violence

operates at various levels and socialization plays a significant part in normalizing this violence.

Even in situations where a woman faces extreme

physical abuse, the first effort is to ‘resolve’ the problem

by appealing to the husband and his family members.

When the family is unable to resolve the situation,

the next step usually is to approach the community

elders. Domestic violence is still considered as an

internal matter of the family or the community. Police

complaint remains the last resort. In situations where

violent outbursts by husbands are not an everyday

occurrence and the intensity of violence is controlled,

most women deflect the blame on themselves and

deny experiencing violence in their marriage. However,

there are certain contexts in which incidents of violence are heightened, such as alcohol, inability to

reproduce or bear a male child, factors related to domestic chores, witch-hunting and dowry. Thus,

marital rape is a normal experience for many women, though it may not be named as such. In some

ways this behaviour is sanctioned in culture and by society.

2.7 Page 17

▲back to top

- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -V-I-O-L-E-N-C-E- -A-G-A-I-N-S-T- W- -O-M- -E-N-A- N- -D-R- -E-P-R-O-D-U- C- -T-IV-E- -H-E-A-L-T-H- - - - - - - - -

Some of the reasons why women do not break off a relationship with an abusive husband are:

• Fear of facing violence from other men.

• Lack of support from their natal families: it is socially unacceptable for a married woman to live

in her parents’ house.

• They see this violence as pervasive, happening everywhere: as children they have seen their

mothers being beaten up, their sisters being harassed, and men in the neighbourhood beating

their wives.

Women’s inability to resist or move out of violent situations encourages and enables men to continue

with violent behaviour.

Sexual Harassment at the Workplace

Women workers in offices, factories, fields or mines are usually vulnerable to exploitation by their

superiors. Objecting to such behaviour often means the loss of job. Sexual harassment often takes

place in subtle ways. The problem is further compounded in the rural areas, where feudal structures

of dominance and existing caste hierarchies make it even more difficult for women workers to protest.

Health Consequences of Violence against Women

The physical consequences may be minor cuts, bruises, fractures and even death. Apart from injury,

it can lead to gastric problems, chronic pain, deafness and blindness.

The psychological and mental consequences can erode self-esteem, leading to mental health problems.

Depression and anxiety are the most common mental health problems experienced by women who

face violence. Such women suffer from acute anxiety disorder, also known as post-traumatic stress

disorder. They have eating and sleeping disorders and show suicidal behaviour and self-harm.

Some of the consequences on reproductive and sexual health are unwanted pregnancy, miscarriage,

premature and low-birth-weight births, rupture of the uterus, maternal death, genital injuries, chronic

pelvic pain, chronic backache, pain while passing urine and during sex, lack of sexual desire, pre-

menstrual stress, irregular menstrual cycles, and spread of sexually transmitted infections.

Where the Healthcare System Fails Women

The situation of power and control also exists in the health system. Some of its manifestations are:

2.8 Page 18

▲back to top

* Violating confidentiality: Asking women’s health concerns, especially related to sexual health,

in front of family members or other patients.

* Not maintaining privacy: Performing health check-up in a semi-public place; e.g. vaginal check-

up in front of other patients.

* Using abusive language: Often, the healthcare providers abuse women in the labour room.

* Failing to maintain minimum health standards: Often the minimum standards related to hygiene

are not maintained in family planning camps.

* Failing to diagnose women’s illness: Often, due to socio-cultural barriers women fail to directly

communicate their reproductive concerns to healthcare providers. For example, a woman may

complain about headaches but a persistent and sensitive approach may reveal a problem of heavy

bleeding.

* Performing sex-selective abortion: The Pre-Natal Diagnostic Techniques (Regulation and Prevention

of Misuse) Act, 1994 was brought into operation from 1 January 1996. The amended Act and

rules have come into force with effect from 14 February 2003. Sex-selective abortion is illegal

in India.

It is the responsibility of the healthcare providers to empower their clients. Some points to be noted

in this regard are:

* Respect confidentiality: All discussion must occur in private.

* Believe and validate her experiences: Listen to her and believe her. Acknowledge her feelings and

let her know she is not alone, that many women have similar experiences.

* Acknowledge the injustice: The violence perpetrated against her is not her fault. No one deserves

to be abused.

* Respect her autonomy: Respect her right to make decisions about her own life, when she is

ready. She is the expert on her own life.

* Help her plan for future safety: What has she tried in the past to keep herself safe? Is it working?

Does she have a place to go if she needs to escape?

2.9 Page 19

▲back to top

* Promote access to community services: Know the resources in your community. Is there a hotline

or a shelter for battered women?

* Avoid performing sex-selective abortion: Counsel to value the girl child. Inform the family about

the PNDT Act.

Role of Healthcare Providers in Addressing Violence

Most women come into contact with healthcare

providers, may be to seek information on

contraceptives, pregnancy, childcare, RTIs, etc. This

provides the healthcare providers an opportunity to

take a proactive role to screen abused women.

Systematic screening can be done by asking questions.

A provider must ensure a safe, confidential environment

and establish a relationship of trust and respect for the

woman before asking questions. Display of posters

related to violence against women and education

material kept at the waiting area helps to build an amicable environment and also provides the

message that abuse can be discussed.

Some examples of how to ask questions of abused women are:

* “Before we discuss contraceptive choices, it might be good to know a bit more about your

relationship with your partner.”

* “Because violence is common in women’s lives, we have begun asking all clients about abuse.”

* “I do not know if this is a problem for you, but many of the women I see as clients are dealing

with tensions at home. Some are too afraid or uncomfortable to bring it up themselves, so I have

started asking about it routinely.”

* “Your symptoms may be related to stress. Do you and your partner tend to fight a lot? Have

you ever gotten hurt?”

* “Does your husband have any problems with alcohol, drugs or gambling? How does it affect

his behaviour with you and the children?”

2.10 Page 20

▲back to top

* “When considering which method of contraception is best for you, an important factor is

whether you can or cannot anticipate when you will have sex. Do you generally feel you can

control when you have sex? Are there times when your partner may force you?”

* “Does your partner ever want sex when you do not? What happens in such situations?”

* “As you may know, it is not uncommon these days for a person to have been emotionally,

physically, or sexually victimized at some time in their life, and this can affect their health many

years later. Has this ever happened to you?”

* “Sometimes, when I see an injury like yours, it is because somebody hit them. Did that happen

to you?”

* “Has your partner or ex-partner ever hit you or physically hurt you?”

* “Has your partner ever forced you to have sex when you did not want to?”

* “Did you ever have any upsetting sexual experiences as a child?”

* “Are you currently or have you ever been in a relationship where you were physically hurt,

threatened, or made to feel afraid?”

* “Have you ever been raped or forced to engage in sexual activity against your will?”

* “Did you ever have any unwanted sexual experience as a child?”

Women facing domestic violence and sexually abused women often need reproductive healthcare,

including treatment for sexually transmitted infections. They would also require information and

services for family planning. A woman who is raped may need emergency contraception. The healthcare

provider needs to refer abused women to the appropriate place for further action to be taken. Based

on the social, legal and community-based services needed, women need to be referred accordingly.

For effective referral work, good knowledge and coordination between healthcare providers and appropriate

legal and social service providers is required.

References

Kapur, A., Muttoo, S., Bisht, S., “From thought to Action: Building Strategies on Violence Against

Women”.

UNFPA AND CHETNA. “Violence against women: A health systems response. An information booklet

for medical officers in the Public Health System”. Collaborative effort of Nation Commission

for Women

3 Pages 21-30

▲back to top

3.1 Page 21

▲back to top

POPULATION FOUNDATION OF INDIA

B-28, Qutab Institutional Area, Tara Crescent, New Delhi 110 016

Tel. No : 42899770, Fax : 42899795

Website : www.popfound.org, E-mail : popfound@sify.com