The WHO’s states that the enjoyment of the highest attainable standard
of health is one of the fundamental rights of every human being without
distinction of race, religion, political belief, economic or social condition.
During the mid-late 1990’s gender and social role became variables of social
analysis that explain recurring social, institutional and structural
disadvantage to women. It became clear that, unless structural adjustment and
health service reform and social service development programmes addressed
gender inequity at all levels, they would continue to be ineffective. The
outcome has been that ‘mainstreaming of a gender perspective’ has become an
integral part not only in UN and WHO development programmes but throughout the
entire UN system and into government, non-government and other social
institutions worldwide. In 2002, the World Health organization adopted a gender
policy committing itself to promoting gender equality and equity in health and
to redressing health inequities that are a consequence of gender roles and
unequal gender-relations in society.
Though there is widespread acceptance of gender equality, but when it comes to healthcare, we
see an inequality in health status between men and women, and women’s unequal
treatment in health care. In fact, in most medical, health and prevention
issues related to women’s health, the central issue is male-female power relations, and not
merely the lack of health services, medical technology or/and information. Women’s
experiences and realities, clearly testify the concerns that require urgent,
systematic and global intervention and change. Gender analysis is crucial to
distinguish between biological causes and social explanations for the health
differentials between men and women, and to understand that these gaps are
outcomes of the unequal social relations between men and women, and not merely
due to consequences of biology. Gender analysis will transform the biomedical
and gender bias currently imbedded in medical education and research, so as to
better serve the health needs of women.
Women’s health needs are often regarded to be restricted only to
reproduction. The gender bias is reflected clearly, such that, within medicine,
women’s health is relegated to only obstetrics and gynaecology; and within
public health, all women’s health needs are expected to be met by maternal and
child health programs. This is because women are primary seen as mothers and
wives, rather than human beings having health needs. Thus, women’s
non-reproductive health is either invisible or not emphasised. For instance,
despite women having been part of the labour force for so long, their
occupational health have often been ignored. Not only is women’s health defined
by their reproductive role, it is often misunderstood because women are always
viewed as a homogenous group. In reality, women’s health or illness, pertaining
to reproduction or not, are differentially experienced according to social
class, race/ethnicity and so forth. For instance, while among older women,
breast cancer is more common among the rich, cervical cancer tends to affect
more poor women than the affluent. Research has shown that black women, within
each income level, are more likely to suffer from hypertension than white
women.
Depression is found to be a major occupational illness among housewives
because women are brought up to express their problems in the form of
depression. In reproductive health, such as contraceptive use and family
planning, women lack decision-making power to negotiate about sex, childbearing
and contraception as husbands assume sexual access and control. While a husband
can, and often does, refuse to use contraceptives despite his persistent sexual
demands, women find themselves caught in their conflicting roles as solely
responsible for family planning, and at the same time are expected to be
sexually available to their husbands. In some developing countries, ill women
still need their husbands’ approval before they can go out to seek medical
treatment or health care. Or, when they do arrive at the hospital, there are
numerous medical procedures that require their husbands’ signatures. Thus, it
is clear that gender roles and male-female power relations rather than biology
that underpin women’s health and well-being.
Mainstreaming a gender perspective into medical curricula therefore
means integrating gender concepts, or making gender concepts more ‘mainstream’,
common or everyday within medical education and practice. The purpose is to
identify all points at which gender roles limit access to and equity in
improved health and social development in the social, structural and
institutional context of individuals. Practically it means acknowledging where
difference is important throughout the entire curriculum and teaching process,
in clinical practice and in policy development, and providing balance where
needed.
The integration of gender competence or ‘a gender mainstreaming programme’ is aimed at addressing the
imbalance between the male oriented medicine that is taught and practised in
medical school and the coherent ‘gender competent’ strategies that are needed
for modern clinical practice in health care settings internationally. Health care personnel are uniquely
placed to address issues related to gender and gender inequalities, sexuality,
violence, and many culturally defined norms that increase vulnerability to
human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) and
adversely affect the health of women in many societies. Integrating gender into
the curricula for health professionals with a focus on gender based violence
and discrimination will ensure that these issues will be addressed in health
policies and programmes.
Indeed, integrating the gender perspective into the medical curriculum
by incorporating the principles and practice of women’s health speciality is a
good beginning. Yet such a transformation will involve drastic ideological
changes and not mere reforms in the curriculum.
|