Gender in Health Systems Research: Some progress but more to do

The three dedicated gender panels (Gender Rights Equity and Access; Gender and rights-oriented health systems research; New frontiers in advancing gender analysis in health systems research) provided a forum for lively and engaged discussions about gender and how it relates to people-centred health systems.  In addition, gender in relation to health systems research was also showcased at the Symposium through a photo competition sponsored by RinGs (Research in Gender and Ethics). The aim of the competition was to capture the everyday stories of how gender plays out within health systems around the world and the winning photo, along with the honourable mentions, were showcased during the conference. The winning photo and honourable mentions can be viewed here.

Despite this, we also felt that gender could have been mainstreamed throughout the conference and discussed in the Cape Town Statement(the statement produced at the end of the conference). Here are some of the themes that we thought were important when thinking about how gender was discussed at the conference, some of which were highlighted within the three gender panels:

Moving beyond just seeing gender as heterosexual women  

In theory, gender studies is about understanding how power relations shape the lives of women, men, boys, girls and people of other genders. However, within health systems research gender has often been equated to heterosexual women and the barriers they face in accessing services. It was therefore great to see a presentation by Albert Dube on the barriers men in Malawi faced in accessing health services. In the same panel Alexandra Muller’s excellent presentation discussed the barriers to health service access that LGBTI people face in South Africa. During her presentation and in the discussion afterwards she described how poorly sexual and gender minorities were received and treated in health care settings in South Africa.  When thinking about gender it is therefore important to move beyond just thinking about women, and instead expand this to include men as well as people of other genders, as it is the relationship between these different groups which shapes lived experiences, including experiences related to health.

Sexual and Reproductive Health Rights is not just for pregnant women

During the conference particularly outside of the gender panels, women were predominately discussed in relation to their gendered roles (as mothers or carers). While maternal health is extremely important, particularly as maternal deaths are one of the leading causes of death of women of reproductive age, it is important to think about women’s overall health, including all aspects of sexual and reproductive health and rights within a woman’s life cycle. During her panel, Sofia Gruskin, as well as the rest of the panel discussing sexual and reproductive health rights, emphasized the need to ensure that provision of services are much broader than simply maternal health. Discussion following the presentations included an engaged dialogue on how the millennium development goals (MDGs) focus on reducing maternal mortality has often left little space and funding for taking a wider rights-based approach to sexual and reproductive health. The discussion ended with a reflection on the need to incorporate more rights-based approaches in the post-MDG agenda, as, according to Marge Berer, one can’t have sexual, reproductive, or maternal health, without first having sexual, reproductive, and maternal rights. It is therefore important to recognize that women’s health is more than just maternal health, and that integrated services, which incorporate a rights-based approach, are needed to women’s health is to be fully recognized.

Ensuring intersectionality is taken seriously

When thinking about gender relations, it is important to think about how intersectionality affects every day lived experiences. According to Parthasarathi Ganguly, an intersectional approach assesses how multiple systems of disenfranchisement intersect to produce health inequalities – such as gender, age, education, ethnicity, disability, or income. For example, the experience of an older highly educated woman from a high income group will be very different to that of a younger lower educated woman from a low income group. The new frontiers panel showcased how intersectionality could be researched in different contexts. For instance, one presentation showed how poor women in India were reluctant to access formal health facilities, while another showed how young men’s social marginalisation in Malawi could place them at an increased risk of HIV. Intersectionality can also be applied to the research process in relation to how it shapes how data is collected within the field. For example, the panel also included a presentation from Dorcas Kamuya about the challenges that field workers in costal Kenya faced gaining consent in relation to different groups and how complex power relations shaped this process. For many, gender analysis often means collecting, analysing and disaggregating data in relation to men and women; however, gender analysis must expand beyond this and go a step further, incorporating multiple systems of disenfranchisement and analysing how this affects lived experiences.

Overall, during the symposium we felt there was some interesting and engaging debate about gender and how it shaped different aspects of people-centred health systems. However, we hope to see in Vancouver gender more mainstreamed throughout the conference, including further focus on gender in the plenaries and new innovations in the conference sessions. We hope that this includes increased incorporation of gender analysis within overall health systems research, expanding beyond the common notion of gender equating to a women-only approach and the narrow focus on maternal health, as well as including intersectional approaches within the collection, analysis, and disaggregation of data.  If a people-centred approach to health systems is to be truly people-centred, it must recognize the lived experiences of different groups and how this shapes health and health inequalities.

To find our more about RinGs visit our webpage.