For Participants
 
‘‘Yes’’ to Abortion but ‘‘No’’ to Sexual Rights: The Paradoxical Reality of Married Women in Rural Tamil Nadu, India

This study in rural Tamil Nadu, India, explored the reasons why many married women in India undergo induced abortions rather than use reversible contraception to space or limit births in terms of women’s sexual and reproductive rights within marriage, and in the context of gender relations between couples more generally. It is based on in-depth interviews with two generations of ever married women, some of whom had had abortions and others who had not, from 98 rural hamlets. The respondents were 66 women and 44 of their husbands. Non-consensual sex, sexual violence and women’s inability to refuse their husband’s sexual demands appeared to underlie the need for abortion in both younger and older women. Many men seemed to believe that sex within marriage was their right, and that women had no say in the matter. The findings raise questions about the presumed association between legal abortion and the enjoyment of reproductive and sexual rights. A large number of women who had abortions in this study were denied their sexual rights but were permitted, even forced, to terminate their pregnancies for reasons unrelated to their right to choose abortion. The study brings home the need for activism to promote women’s sexual rights and a campaign against sexual violence in marriage.
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A Guide for Advocating for Respectful Maternity Care

In every country and community worldwide, pregnancy and childbirth are momentous events in the lives of women and families, and represent a time of intense vulnerability. The concept of “safe motherhood” is usually restricted to physical safety, but childbearing is also an important rite of passage, with deep personal and cultural significance for a woman and her family. Issues of gender equity and gender-based violence are also at the core of maternity care, so the notion of safe motherhood must be expanded beyond the prevention of morbidity or mortality to encompass respect for women’s basic human rights. Women’s autonomy, dignity, feelings, choices, and preferences must be respected, including their choice of companionship wherever possible.
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A Theoretical Model for Analysing Gender Bias in Medicine

During the last decades research has reported unmotivated differences in the treatment of women and men in various areas of clinical and academic medicine. There is an ongoing discussion on how to avoid such gender bias. We developed a three-step-theoretical model to understand how gender bias in medicine can occur and be understood. In this paper the model is presented and its usefulness in the efforts to avoid gender bias has been discussed. In the model gender bias is analysed in relation to assumptions concerning difference/sameness and equity/inequity between women and men. Our model illustrates that gender bias in medicine can arise from assuming sameness and/or equity between women and men when there are genuine differences to consider in biology and disease, as well as in life conditions and experiences. However, gender bias can also arise from assuming differences when there are none, when and if dichotomous stereotypes about women and men are understood as valid. This conceptual thinking can be useful for discussing and avoiding gender bias in clinical work, medical education, career opportunities and documents such as research programs and health care policies. Too meet the various forms of gender bias, different facts and measures are needed. Knowledge about biological differences between women and men will not reduce bias caused by gendered stereotypes or by unawareness of health problems and discrimination associated with gender inequity. Such bias reflects unawareness of gendered attitudes and will not change by facts only. It suggests consciousness-rising activities and continuous reflections on gender attitudes among students, teachers, researchers and decisionmakers.
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A walk down memory lane

The campaign against sex-selective abortions has been valiantly carried on in India for the past two decades, mainly due to the relentless efforts of women’s groups and sensitive health professionals. The campaign has seen ups and downs, successes and failures – just as every other campaign would. To my mind this campaign has been a great learning experience, mainly because of the complexity of the issue. This campaign straddles patriarchy, son-preference and discrimination against women, the abortion issue, the politics of population control, use of modern technology, questions the ethics and role of doctors, re-visits the notion of ‘choice’ and involves advocacy as well as legal intervention at the state and national level in the country. It highlights the fact that abortion and reproductive rights are applied differently (and often unfairly), for women in diverse settings and that the enjoyment of these rights is dependent on the priorities, strategies and whims of nation states. It misses out concerns around eugenics and is not very clear about it’s messages related to the right to abortion, just as western feminism is unclear about the difference between the right to abortion and sex-selective abortions. Having been involved in this campaign ever since it began and being still involved with issues that surround it, I am taking this opportunity to reflect upon the same. I am doing this as an insider, taking full responsibility for it’s pitfalls and feeling proud of it’s achievements.
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A Walk Down Memory Lane: An Insider’s Reflections on the Campaign against Sex-Selective Abortions

The campaign against sex-selective abortions has been valiantly carried on in India for the past two decades, mainly due to the relentless efforts of women’s groups and sensitive health professionals. The campaign has seen ups and downs, successes and failures – just as every other campaign would. To my mind this campaign has been a great learning experience, mainly because of the complexity of the issue. This campaign straddles patriarchy, son-preference and discrimination against women, the abortion issue, the politics of population control, use of modern technology, it questions the ethics and role of doctors, re-visits the notion of ‘choice’ and involves advocacy as well as legal intervention at the state and national level in the country. It highlights the fact that abortion and reproductive rights are applied differently (and often unfairly) for women in diverse settings and that the enjoyment of these rights is dependent on the priorities, strategies and whims of nation states. It misses out concerns around eugenics and is not very clear about it’s messages related to the right to abortion, just as western feminism is unclear about the difference between the right to abortion and sex-selective abortions. Having been involved in this campaign ever since it began and being still involved with issues that surround it, I am taking this opportunity to reflect upon the same. I am doing this as an insider, taking full responsibility for its pitfalls and feeling proud of it’s achievements.
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Abortion and Sex Determination: Conflicting Messages in Information Materials in a District of Rajasthan, India

Public information campaigns are an integral component of reproductive health programmes, including on abortion. In India, where sex selective abortion is increasing, public information is being disseminated on the illegality of sex determination. This paper presents findings from a study undertaken in 2003 in one district in Rajasthan to analyse the content of information materials on abortion and sex determination and people’s perceptions of them. Most of the informational material about abortion was produced by one abortion service provider, but none by the public or private sector. The public sector had produced materials on the illegality of sex determination, some of which failed to distinguish between sex selection and other reasons for abortion. In the absence of knowledge of the legal status of abortion, the negative messages and strong language of these materials may have contributed to the perception that abortion is illegal in India. Future materials should address abortion and sex determination, including the legal status of abortion, availability of providers and social norms that shape decision-making. Married and unmarried women should be addressed and the participation of family members acknowledged, while supporting independent decisions by women. Sex determination should also be addressed, and the conditions under which a woman can and cannot seek an abortion clarified, using media and materials accessible to low-literate audiences. Based on what we learned in this research, a pictorial booklet and educator’s manual were produced, covering both abortion and sex determination, and are being distributed in India.
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Abortion Law, Policy and Services in India: A Critical Review

Despite 30 years of liberal legislation, the majority of women in India still lack access to safe abortion care. This paper critically reviews the history of abortion law and policy in India since the 1960s and research on abortion service delivery. Amendments in 2002 and 2003 to the 1971 Medical Termination of Pregnancy Act, including devolution of regulation of abortion services to the district level, punitive measures to deter provision of unsafe abortions, rationalization of physical requirements for facilities to provide early abortion, and approval of medical abortion, have all aimed to expand safe services. Proposed amendments to the MTP Act to prevent sex-selective abortions would have been unethical and violated confidentiality, and were not taken forward. Continuing problems include poor regulation of both public and private sector services, a physician-only policy that excludes mid-level providers and low registration of rural compared to urban clinics; all restrict access. Poor awareness of the law, unnecessary spousal consent requirements, contraceptive targets linked to abortion, and informal and high fees also serve as barriers. Training more providers, simplifying registration procedures, de-linking clinic and provider approval, and linking policy with up-to-date technology, research and good clinical practice are some immediate measures needed to improve women’s access to safe abortion care.
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Abortion Needs of Women in India: A Case Study of Rural Maharashtra

The Indian Medical Termination of Pregnancy (MTP) Act came into force in 1972, in response to the high mortality and morbidity associated with illegal abortion. However, 25 years on, both restrictions in the law and the way it is implemented through service delivery have failed to meet the abortion needs of large numbers of women. Using data from a larger qualitative study in rural Maharashtra, this paper explores women’s perceptions of their rights and needs in relation to abortion. The women were ambivalent about abortion, based on their roles and identity as mothers, but they saw the necessity for abortion and supported each other to have abortions. They had conflicting feelings with regard to abortion on grounds of fetal sex, and problematic issues of sexuality, especially for single women in relation to abortion, also arose. Provided with the details of India’s abortion legislation, which they knew little about, the women had suggestions for making the law more women-sensitive. Their experiences make it clear that vast improvements in abortion policy and service delivery are needed in India.
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Abortion Providers and Safety of Abortion: A Community-Based Study in a Rural District of Tamil Nadu, India

This paper reports on a community-based study in 2001–02 in a rural district of Tamil Nadu, India, among 97 women who had had recent abortions, to examine their decision-making processes, the types of facility they attended and the extent of post-abortion complications they experienced. The 36 facilities they attended, both government and private, were ranked by 18 village health nurses, acting as key informants, as regards safety and quality of care. Three categories- qualified and safe, intermediate or unqualified and unsafe, were identified. Most of the providers were medically trained, and 75 of the 97 women went to facilities that were ranked as high or intermediate in quality. Government abortion services were mostly ranked intermediate in quality, and criticised by both women and village health nurses. There has been a substantial decrease in the numbers of traditional and unqualified providers. However, about 30% of the women experienced moderate to serious post-abortion complications, including women who went to facilities ranked high. We recommend that government facilities, both the district hospital and primary health centres, should improve their quality of care, that unqualified providers should be stopped from practising, and that all providers should be using the safer methods of vacuum aspiration and medical methods to reduce post-abortion complications.
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Addressing Sex and Gender in Epidemic-Prone Infectious Diseases

This paper presents a gender perspective on outbreaks of epidemic-prone infectious diseases. It discusses evidence of differences in the infectious disease process between males and females, and aims to show how, by taking such differences between men and women into account, it is possible to improve the understanding of the epidemiology and the clinical course and outcome of diseases, aid in their detection and treatment, and increase public participation in and the effectiveness of prevention and control activities.
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Gender Matters

In March, 2002, when WHO adopted a Gender Policy, the Director General of the Organization remarked that to not study the influence of gender on health would be bad science, given the many crucial ways in which gender influences the health of individuals and populations. The importance of gender as a determinant of health seems to be still not apparent to everyone. Too often, it seems that when the topic of gender comes up, a certain segment of the profession feels that those focused on saving lives cannot afford to waste time on such superfluous matters. Others seem to think that more than enough attention is paid to gender because there is so much emphasis on maternal health. The point of this presentation is to introduce to everyone why gender matters in all dimensions of health, and why an awareness of this is vital if effective health work is to be done at all. It tries to do so with concrete examples, as clearly and comprehensibly as possible.
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Gender as a System

This presentation shows how gender refers to society ascribes meaning to what it means to be a man or a woman in that society. Gender is ascribing differential value to what male and what is female. Gender goes beyond the binaries of male and female to include other sexualities. Gender is different from ‘sex’ which refers to the biological differences.
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Gender, Health Rights and Social Justice: Intersectional Approach: Moving Health Rights Forward

Intersectionality is a feminist critique against using gender, class and ethnicity as single analytic categories. It recognises that these social divisions are mutually modifying and reinforcing. Social categories of interest may include gender, race, ethnicity, religious affiliation, sexual orientation etc An intersectionality approach recognises that forms of difference that may seem separate at first are in fact ‘lived relationally’ (Moore, 1994). The approach looks at the ‘connection between aspects of identity’ that combined together will lead to different types of advantages and disadvantages that often ‘compound on each other and that are inseparable’ (Pru Goward 2002)
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The Links between Gender and Health

Women and men differ in relation to the physical spaces they occupy, the tasks and activities they perform and the people they interact with.
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Social Determinants of Health

Health is a socially constructed reality, a product of the physical and social environment in which we live and act. Differences in people’s health status, including those by gender, arise not only from biological differences but also as a consequence of differentials in social and economic status.
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Men & Masculinities

Masculinity has been defined in multiple ways that manhood is socially defined across historical and cultural contexts and the power differences which exist between different versions of manhood. Masculinity is thus different from being a male.
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Violence and Health

Gender-based violence, that is, violence that is directed against a woman because she is a woman or that affects women disproportionately. It includes acts that inflict physical, mental or sexual harm or suffering, threats of such acts, coercion and other deprivations of liberty. (Convention against all forms of discrimination against women-CEDAW)
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Medical Ethics, Human Rights & Gender

This presentation is on gender, human rights and medical ethics.
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Ethics, Rights and Doctor-Patient Relationship

This presentation covers topics such as morality and ethics, ethics principles, needs, rights & duties, doctor-patient relationship, patients’ rights and empowerment
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Rights, Ethics and Gender in Health Care

This presentation covers the concept of doctor patient relationship
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Contraceptive Programme Rights and Gender Perspective

This presentation shows the gender perspectives and contraceptive rights of women
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Planning for Gender-Sensitive & Client-Centered health services

The aim of this presentation is to recognize gender differences in the impact of routine healthcare. To develop check lists for health problems/conditions that integrate gender and rights perspectives [gender-sensitive & client-centered].
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Integrating gender into the curricula of health professionals: Experiences and lessons learned

Integrating gender into pre-service training curricula for health professionals is key to gender mainstreaming in health. This presentation starts with an overview of interventions from different parts of the world for gender mainstreaming pre-service curricula of health professionals. Focuses on the core competencies for integrating gender into undergraduate medical curriculum in three sites: USA, Philippines and Thailand.
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ART – SS - Hysterectomies

This is a presentation on Hysterectomies
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Medico legal documentation in a case of Burns

Presentation on Burns cases
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Child Sexual Abuse Forensic Examination

This presentation aims to understand what are the legal issues in medical examination of a child with sexual abuse. To understand what is the evidence to be collected depending on the nature of assault. To know what constitutes medical opinion & why? To know the solutions for FAQs (frequently asked questions) during medical examination of CSA.
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Medico legal documentation in a case of Poisoning

Presentation on Poisoning
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Medical examination on the Accused of a Sexual Assault

Can you force a medical examination on the Accused of a Sexual Assault? Is it relevant to document the POTENCY of the Accused?
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Medico legal documentation in a case of DYING DECLARATION

Presentation on dying declaration
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Social Determinants of Health

Health is a socially constructed reality, a product of the physical and social environment in which we live and act. Differences in people’s health status, including those by gender, arise not only from biological differences but also as a consequence of differentials in social and economic status.
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GME Phase II: Workshop for GME Faculty

The workshops was organized for the GME faculty on January 18 & 19, 2016. The main objective of the workshop was to orient the faculty to the proposed interventions, To share the finalized gender- integrated modules, to acquaint them the tools for process documentation and to develop the timeline for the intervention.
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GME Phase II: Workshop for GME Faculty

The workshops was organized for the GME faculty on January 18 & 19, 2016. The main objective of the workshop was to orient the faculty to the proposed interventions, To share the finalized gender- integrated modules, to acquaint them the tools for process documentation and to develop the timeline for the intervention.
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GME Phase II: Workshop for GME Faculty

The workshops was organized for the GME faculty on January 18 & 19, 2016. The main objective of the workshop was to orient the faculty to the proposed interventions, To share the finalized gender- integrated modules, to acquaint them the tools for process documentation and to develop the timeline for the intervention.
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Handout 1 Definitions

Health is a state of physical, mental and social well-being, not merely the absence of disease or infirmity (WHO). Women’s and men’s well-being is determined by social, political and economic factors that shape their lives, as well as by their biological condition. Biological differences between women and men – that is differences related to their sex – affect their vulnerability to illness or disease. Differences in the roles, resources and status of women compared to men interact with biology to increase or decrease this vulnerability. These gender differences also affect access to health knowledge, self-perceptions of health needs and the ability to access services. Gender inequalities in the preconditions for health and in health information and services produce inequalities in health outcomes. In order to understand and address the health needs and priorities of women and men gender analysis must be integrated into health research and the design, implementation and monitoring of health services. This handout introduces us to certain basic concepts of SEX, GENDER and gender analysis.
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Tables for sex differences

This paper shows sex differences in different parameters by background characteristics, Bihar, 2005-06. First table shows the neonatal, infant, and under-five mortality rates for the 10-year period. Second table shows percentage of children age 12-23 months who received specific vaccines at any time before the survey (according to a vaccination card or the mother’s report). Third table shows the percentage of children under age five years classified as malnourished according to three anthropometric indices of nutritional status: height-for-age, weight-for-height, and weight-for-age.
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Handout on Intersectionality

Social justice is based on the idea that all members of society have an equal access to the various features, benefits and opportunities of that society regardless of their position or station in life . However, in reality we know that people face ‘discrimination.’ Discrimination refers to the process by which members of a socially defined group are treated differently (especially unfairly) because of their membership of that group. This unfair treatment arises from socially derived beliefs each group holds about the other and patterns of dominance and oppression, viewed as expressions of a struggle for power and privilege.
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Power Walk Tool

The main objective of Power Walk Tool is to explain the concept of Intersectionality and to explain the various axis of power. The Power Walk is a very strong tool in explaining the concept of Intersectionality. Since the participants are expected to enter into the roles of various characters, they are able to experience various privileges as well as disadvantages based on Gender, Caste, Class and Community.
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Handout 1: Gender and Health Analysis Tool

Gender Analysis of a Health Problem: the impact of different characteristics of gender on men and women’s health
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Handout 1: Gender as a Social Determinant of Health

This is a handout for spider web exercise.
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Case studies- Sexuality

This paper consist a series of case studies on sexuality. These cases were discussed with the participants in the workshop and their views were analysed.
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Handout on Sexuality

This handout consist of the WHO's working definitions of sexuality and of sexual health.
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Case study 1

This case study contains questions for group discussion like what will happen to men and women if men start sharing housework and childcare? And what will happen in family and to man-woman relationship if men and women share equal income and property?
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Case Study 2

This case study contains questions for group discussion like what will happen to men and women if men start sharing housework and childcare? And what will happen in family and man-woman relationship if men and women share equal and to man ncome and property?
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Case Study 3

This case study contains questions for group discussion like what will happen to men and women if men start sharing housework and childcare? And what will happen in family and man-woman relationship if men and women share equal and to man ncome and property?
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Gender-Based Violence Against Women and the Role of Health Care Providers: Case Studies

This paper includes several case studies on gender-based violence against women and highlights the role of health care providers in such cases.
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Violence Against Women: Health Care Worker Intervention

Violence against women is a global public health problem of epidemic proportion, reruiring urgent action. Health-care providers are in a unique position to address the health and psychosocial needs of women who have experienced violence, provided certain minimum requirements are met.
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Violence Against Women: Guidelines for Health Sector Response

WHO's new clinical and policy guidelines on the health sector response to partner and sexual violence against women emphasize the urgent need to integrate these issues into clinical training to health care providers.
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Violence Against Women: Health Impact

In this infographic violence against women and its impact on their health has been presented.
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Violence Against Women: Prevalence

1 in 3 women throughout the world will experience physical and/or sexual violence by a partner or sexual violence by a non-partner.
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Universal Declaration of Human Rights

The Universal Declaration of Human Rights (UDHR) is a declaration adopted by the United Nations General Assembly. The Universal Declaration of Human Rights is a common standard of achievement for all peoples and all nations, to the end that every individual and every organ of society, keeping this Declaration constantly in mind, shall strive by teaching and education to promote respect for these rights and freedoms and by progressive measures, national and international, to secure their universal and effective recognition and observance, both among the peoples of Member States themselves and among the peoples of territories under their jurisdiction.
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People like You Never Agree to Get It’: An Indian Family Planning Clinic

This paper is a transcript of audiotaped interaction between patients and family planning providers at an urban hospital in India. Providers included a female physician, an assistant female physician, 2 male junior doctors, and an ayah (helper). Striking is the irritable, impatient, non-empathic tone of the senior physician's interactions with both clients and assisting staff. Clients are repeatedly addressed with a Hindi term, "Rani," used by parents for their daughters. Several young mothers were exhorted to obtain immediate sexual sterilization, despite a lack of health indicators, and with no regard to their personal feelings on this issue or obstacles to the hospitalization required (e.g., a lack of alternate child care). In one instance, the physician expressed the seemingly delusional belief that a patient was purposively trying to cheat her out of her government incentive by declining immediate sterilization. Clients are told to "shut up," and shouted at for complaining about the long wait or asking too many questions. This clinic was observed by the author as part of field work for a dissertation on reproductive choice in South Asia.
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The Patients' Rights Charter-South Africa

The Patients’ Rights Charter of South Africa is a charter of the National Department of Health that promotes and protects your rights as a patient in the health care sector. The charter has been around since 1999 and tells you what your rights and responsibilities are as a patient when you go for treatment and medication at health facilities. During apartheid people may have been treated badly at hospitals and clinics. The Patients’ Rights Charter reminds us to be respectful towards one another as nurses, doctors and patients at hospitals and clinics.
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Case Study: Sadhavis, Sexuality and Societal Morality

This is a case study on Sadhavis, Sexuality and Societal Morality
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Case Studies- Abortion

This paper contains a few case studies on abortion. It also discusses issues like sexual and reproductive health rights of women
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Quiz- Abortion

This paper contains set of questions on abortion and sexual and reproductive health rights of women.
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India & the Sex Selection Conundrum

The decline in child sex ratio (0-6 years) from 945 in 1991 to 927 in 2001 and further to 914 females per 1,000 males in 2011 — the lowest since independence — is cause for alarm, but also occasion for serious policy re-think. Over the last two decades, the rate of decline appears to have slowed but what began as an urban phenomenon has spread to rural areas. This is despite legal provisions, incentive-based schemes, and media messages. Indians across the country, bridging class and caste divides, are deliberately ensuring that girls are simply not born. This artificial alteration of our demographic landscape has implications for not only gender justice and equality but also social violence, human development and democracy.
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Don't Trash This Law, the Fault Lies in Non-Implementation

There can be little quarrel with the argument that India requires a comprehensive policy to prevent sex selection as put forward by National Advisory Council members Farah Naqvi and A.K. Shiva Kumar in The Hindu (“India & the sex selection conundrum,” January 24, 2012). That the use of sex selection technologies to abort female foetuses is linked to the increasing devaluation and disempowerment of women is well known.
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Case Studies- Abortion.

This paper contains a few case studies on abortion. It also discusses issues like sexual and reproductive health rights of women.
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Power Walk Tool: Intersectionality

The main objective of Power Walk Tool is to explain the concept of Intersectionality and to explain the various axis of power. The Power Walk is a very strong tool in explaining the concept of Intersectionality. Since the participants are expected to enter into the roles of various characters, they are able to experience various privileges as well as disadvantages based on Gender, Caste, Class and Community.
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WHO Principles and Recommendations

The box below gives the WHO recommendations on the provision of rights-based contraceptive services based on the nine key human rights principles and standards
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Handout 1: Instructions for group work

This handout is made for group work. All the participants are divided in groups. Each group will be working on one of the following situations, and developing a checklist for examining and advising the patient.
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Handout: Integrating gender competencies in the medical curriculum

A list of some gender competencies (i.e. specific learning objectives for including a gender perspective) that could be expected as the outcome of gender mainstreaming are given below. a) Select a topic/area in your curriculum that could benefit from a gender perspective b) Select one competency each in knowledge, behaviour and skills from the examples given below (or any other, as you wish) c) In the grid provided, • Describe how a given topic will be dealt with so that each of the specific learning objectives will be achieved • Describe how you will evaluate the student to assess whether the specific learning objective has been achieved, giving specific examples
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“Gender Competencies” as listed by WHO

A gender-competent physician will: • Demonstrate an understanding of basic gender concepts: gender power relations, gender roles, access and control, manifestations of gender bias, gender equity and equality and of gender as one of the many social determinants of health. • Be able to explain sex and gender differences in normal development, health and illness (psychopathology and pathophysiology) as they apply to prevention and management of health problems. • Effectively communicate with patients, demonstrating awareness of the doctor–patient power differential and gender and cultural differences. This will be demonstrated, for example, through use of language by the provider in a way that minimizes power imbalances, validates patient experiences and minimizes gender stereotypes. • Perform sex and age appropriate and culturally sensitive physical examination • Discuss the impact of gender-based societal and cultural roles and beliefs on health and healthcare of patients. • Discuss the impact of gender-based societal and cultural roles and beliefs on the health and well-being of care providers. • Identify and assist victims of gender-based violence and abuse. • Assess and counsel patients for sex and gender-appropriate reduction of risk, including life-style changes and genetic testing. • Assess and critically evaluate new information through a “gender lens”: identifying gender biases and gaps; and adopt best practices that incorporate knowledge of sex and gender differences in health and disease. • Demonstrate understanding of the differential impact by gender of health care systems (e.g. the way they are organized and financed) on populations and individuals receiving health care.
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