Global Women

Sức Khỏe Toàn Cầu và Giới Tính
Global Health and Gender
GS TS Lê Hoàng Ninh
Giới và sức khỏe toàn cầu
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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
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
Nguyên nhân tử vong hàng đầu ở phụ nữ
2001
HIV/AIDS
1.3 million
Malaria
592,000
Maternal Conditions
509,000
Tuberculosis
500,000
Source: World Health Report 2002,
World Health Organization
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 Women
Potential reasons
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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
Sự khác biệt nguy cơ thụ đắc
về mặt sinh học
• 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 Health
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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
Tử vong mẹ
(Maternal Deaths)
Reasons for Maternal Deaths in
Low Income Countries
Low income countries - 53% attended during delivery
30% receive postnatal care
Gender and Global Health
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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 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
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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 Health
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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
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 Internationally
Definitions: 3 types of “female mutilation”
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Circumcision (type I - sunna) cutting of the hood of the clitoris
(least severe) - least practiced
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Excision (type II - reduction) removal of clitoris and labia minora
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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
Violence Against Women-Internationally
Health 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
A Life Cycle Approach
Period of the Life Major Problems
Cycle
causing
undernutrition and
missing women
Priority Action
Infancy-childhood
Cultural
consciousness about
infanticide;
nutritional and health
needs of female
children
Male Preference
A Life Cycle Approach
Period of the Life Major Problems
Cycle
causing
undernutrition and
missing women
Priority Action
Adolescence
Delay early marriage;
Teach family planning;
Female literacy;
Nutritional
supplementation
Early Reproductive
Role
Female literacy and health:
1 additional year schooling = 3.4% reduction in mortality
A Life Cycle Approach
Period of the Life Major Problems
Cycle
causing
undernutrition and
missing women
Priority Action
Reproductive Years
Multiple roles for the
family
Reduction of women’s
workload;
Economic independence
Frequency cycling,
depleting with
pregnancies
Family planning;
Iron supplementation
A Life Cycle Approach
Period of the Life Major Problems
Cycle
causing
undernutrition and
missing women
Priority Action
Later Years
Public policy change for
female land ownership;
Social services for elder
abuse
Marginalization and
Dependency
Gender and Global Health
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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”
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
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
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?
• 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: 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 and Women’s Health Department at WHO
• Gender Team at WHO promote awareness into programs at WHO and
public health work
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Gender Task Force –
senior level managers report gender
mainstreaming to Director General