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The Women’s Health Project is assisting in creating a greater understanding of gender- sensitive issues in the health fraternity, reports Barbara Ludman
What has gender to do with health? Everything, if you’re a woman living in a rural area in a province with few resources.
Everything, if you’re married to a man who won’t discuss sexual issues with you – like birth control, or a local prevalence of HIV or syphilis.
Wits University’s Women’s Health Project has been tackling the connection between gender and health care in three provinces for the past year-and-a-half in its Transformation of Reproductive Health Services Project. Staff are writing a manual so portions of their project can be replicated in other provinces.
“We don’t think every province would want to do the entire study,” says Women’s Health Project deputy director Makhosazana Xaba, co-designer of the project. “But each would be interested in something.
“Northern Province is keen on our manual Health Workers for Change and wants to use it as part of its ongoing in-service training for health workers. In the Northern Cape, they want to use our time flow and workload studies.”
As part of the “situational analysis”, a team went to each clinic and looked at what each staff member did with her time, the way patients were treated. The team also studied the general organisation of the clinics, such as whether women could have their children vaccinated and receive help in family planning on the same day.
The project, funded in the Northern Cape and North-West by the United Nations Population Fund and in Northern Province by Britain’s Overseas Development Agency, also included an examination of nursing education and facilitators were trained to run workshops on “gender sensitivity” with clinic staff and nursing students.
In the Women’s Health Project annual report, it’s noted that “it was clear that the concept of gender is not easy to grasp initially for most health workers”.
After project workshops, “They came to a broad understanding of gender and made suggestions for change that were predominantly about redressing the balance of numbers rather than the balance of power.”
Explains Xaba: “We would say `So how would you start addressing gender in the nursing curriculum?’ and they would say `More men must sit on the curriculum committee’ or `We need to have more men as nurses’. They believed men have more power to change things, and so they did not address the deeper issues of how to deal with inequality between men and women.”
But nurses and students who participated in workshops identified some crucial problems in their training: a fragmented approach to women’s health and a style of learning that does not encourage critical thinking and decision-making.
In addition to running workshops and interviewing senior managers, the Women’s Health Project studied completed questionnaires from 1 500 primary health care workers and checked out more than 350 clinics.
An explanation from Dr Sharon Fonn – project co-designer with Xaba – on the importance of “gender sensitivity” gives the project a certain poignant urgency: “In the treatment of sexually transmitted diseases, patients are asked to inform their partners that they may also have STDs and bring them in for treatment …
“A gender-sensitive health care service will always ascertain whether a couple can discuss sex, sexuality and sexual health within their relationship. When a couple cannot discuss sexual health problems, they will not ask the woman to inform her partner …
“Instead, they may notify him through an anonymous letter or a male health worker may be asked to visit him.”
ENDS