Bài giảng Sức khỏe toàn cầu và giới tính global health and gender – Lê Hoàng Ninh

Sức Khỏe Toàn Cầu và Giới Tính Global Health and Gender GS TS Lê Hoàng Ninh Giới và sức khỏe toàn cầu • 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 • 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 • 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 • 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 • 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 • 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” 1. Circumcision (type I - sunna) cutting of the hood of the clitoris (least severe) - least practiced 2. Excision (type II - reduction) removal of clitoris and labia minora 3. 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 Cycle Major Problems causing undernutrition and missing women Priority Action Infancy-childhood Male Preference Cultural consciousness about infanticide; nutritional and health needs of female children A Life Cycle Approach Period of the Life Cycle Major Problems causing undernutrition and missing women Priority Action Adolescence Early Reproductive Role Delay early marriage; Teach family planning; Female literacy; Nutritional supplementation Female literacy and health: 1 additional year schooling = 3.4% reduction in mortality A Life Cycle Approach Period of the Life Cycle Major Problems 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 Cycle Major Problems causing undernutrition and missing women Priority Action Later Years Marginalization and Dependency Public policy change for female land ownership; Social services for elder abuse Gender and Global Health • 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 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 BURDEN OF BLINDNESS IN MEN AND WOMEN 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 • Gender Task Force – senior level managers report gender mainstreaming to Director General