Gender and Cultural Diversity Programme

GD promotes the development of health policies, plans, programs and legislation that guarantee access to quality health care, participation in decision-making and equitable resource allocation

AHO Gender Equality Policy

This policy reflects AHO’s unwavering commitment to the principles of equity, respect for human rights, and the exercise of citizenship, in addition to its determination to actively participate in global efforts to eliminate all forms of gender discrimination. It is also an expression of the institutional resolve to increase the effectiveness and efficiency of public health practice in Africa.

The goal of this policy is to contribute to the achievement of gender equality in health status and health development through research, policies, and programs which give due attention to gender differences in health and its determinants, and actively promote equality between women and men.

Guiding principles

Gender equality in health means that women and men have equal conditions for realizing their full rights and potential to be healthy, contribute to health development, and benefit from the results. Achieving gender equality will require specific measures designed to eliminate gender inequities.

Gender equity means fairness and justice in the distribution of benefits, power, resources, and responsibilities between women and men. The concept recognizes that women and men have different needs, access to, and control over resources, and that these differences should be addressed in a manner that rectifies the imbalance between the sexes. Gender inequity in health refers to those inequalities between women and men in health status, health care, and health work participation, which are unjust, unnecessary, and avoidable. Gender equity strategies are used to eventually attain equality. Equity is the means, equality is the result.

Empowerment is about women and men taking control over their lives: being able to perceive alternatives, make choices, and fulfil those choices. It is both a process and an outcome, and it is collective and individual. Women’s empowerment is essential to achieving gender equality. Outsiders cannot empower women, only women can empower themselves. However, institutions can support empowering processes both at the individual and collective levels.

Diversity in the approach means recognizing that women—and men—do not constitute homogeneous groups. Women’s and men’s diversity with respect to age, socioeconomic status, education, ethnicity and culture, sexual orientation, ability, and geographical location must be taken into account whenever issues of gender and health are addressed.

Gender mainstreaming is “… the process of assessing the implications for women and men of any planned action, including legislation, policies, or programs, in any area and at all levels. It is a strategy for making women’s as well as men’s concerns and experiences an integral dimension in the design, implementation, monitoring, and evaluation of policies and programs in all political, economic, and social spheres, such that inequality between men and women is not perpetuated. The ultimate goal is to achieve gender equality”. A mainstreaming strategy may include affirmative initiatives directed towards either women or men.

Violence against Women in Africa: A human rights violation and a public health problem

The United Nations defines violence against women as: Any act of gender violence that results, or is likely to result, in physical, sexual, or psychological harm or suffering to women, including threats of such acts, coercion, or arbitrary deprivation of liberty, whether occurring in public or private life.

Although domestic or gender violence is globally recognized as a human rights abuse, in many countries in Africa it is still not perceived or addressed as a public health problem. But in most countries the health care system is the only institution that interacts with almost every woman at some point in her life. This makes public health organisations the best point of contact to detect and initiate the correction of gender violence.

Battered women are likely to interact with the health sector because of an increased incidence of physical and mental damage, as well as adverse reproductive health consequences, such as miscarriage or abortion. Unfortunately, most health providers have not been trained to recognise domestic violence risk or to collect information on the situation.

Studies show that health providers may see the same women multiple times for similar injuries without suspecting gender violence. Doctors have also been accused of being insensitive to the plight of female patients. The demand for health services is so great, that there is no time to talk to the patients. In the diagnostic exams, the doctor only has time to look at the medical problems. Many women will not discuss violence unless asked directly.

There are many factors that inhibit women from seeking help for abuse. The first are internal factors, such as gender beliefs and values, the fear of suffering increased aggression, or a lack of knowledge about their human rights and the laws against domestic violence. There is also the social shame of wife-beating and the desperate hope that their spouse will change.

External factors, such as the cost of medical exams and judicial proceedings, the bureaucratic process, the low quality of services, and lack of understanding, keep women silent. In addition ignorance about the process of confronting their abuser-or their economic dependence on him-stifles their initiative.

The factors that seem to catapult women into seeking help are the frequency and magnitude of the abuse or the growing realisation that her children or family are at risk.

Gender Violence in Africa

Although detailed data on the prevalence and nature of gender violence are still scarce, research shows that it is widespread throughout Africa. Reports show that gender violence causes more death and disability among women aged 15 to 44 than do cancer, malaria, traffic accidents, or war. Gender violence also differs from other types of social violence in that it is often based on the subordinate roles of women and girls within their families and communities. According to a l994 World Bank study, 50 to 70 percent of the abuse suffered by women involved their partners or former partners-and a similar figure is reported worldwide.

Physical, Psychological and Sexual Abuse

Various studies across the globe show that around 52 percent of physically abused women were also sexually abused by their partners with 95% physically abused women claiming sexual, psychological and emotional abuse as well.

Violence against Women Not Reported

Study across the world show that only 2 to 8 percent of sexual abuses against women were ever reported-compared to 62 percent of all assaults and 83 percent of all robberies. A large proportion of injuries and hospitalisations of women are also due to gender violence. They also find out that 20 percent of all reported injuries and 94 percent of hospitalized injuries to women were due to spousal violence.

Adolescent Pregnancies from Incest

Across the world, adolescents in shelters show that 95 percent of the pregnant girls 15 years old or younger are victims of incest.

The Causes of Gender Violence

A framework of factors at the individual, family, community, and societal levels causes this violence against women. Factors that increase the likelihood of abuse on the individual level include the following:

• Being abused or witnessing marital violence in the home as a child;
• Having an absent or uninvolved father;
• Alcohol or drug abuse.

While the first two categories are considered environmental, both drug abuse and alcohol abuse are classified as diseases that can be treated by public health organizations. Even though gender violence can have a variety of root causes, it almost invariably results in physical damage and subsequent health problems. The best solution is early detection and treatment with the proper procedures.

Cross-Cultural Studies on violence against women

Male control of wealth and decision-making within the family is a significant relationship factor that often leads to abuse. On the community level, the physical isolation of women and lack of social support-when combined with male peer groups that encourage and support violence-also increase the likelihood of violence against women. Finally, at the societal level, rigid gender roles and a “macho” concept of physical and psychological dominance often perpetuate violence against women.

Cultural beliefs concerning violence in gender and sexual relationships are not only held at the individual level, but are re-enforced by the family, community and society level, including the media. Boys and girls are socialised to adhere to cultural norms and values: Males are encouraged to be aggressive and sexually active, while females are taught to be submissive and resist sexual activity.

The Cost of Gender Violence

Violence against women and girls causes many immediate and long-term health problems such as injuries, death, or disability; a variety of chronic physical conditions; reproductive health problems; mental health disorders; suicide; drug abuse, and risky sexual behaviour.

There is also preliminary evidence that violence against women affects the health and development of their children. Studies have shown that 63 percent of their children repeated a school year. Their children also dropped out of school four years earlier and were 100 times more likely to be hospitalised than the children of non-abused women. One-third of children who have been abused or exposed to parental violence become violent adults-and sexual abuse in childhood has been identified as a risk factor in males for sexual offenses as an adult.

Preventing Gender Violence

Gender violence is endemic in most developing countries, and both its perpetrators and its victims come from all classes, nationalities, and economic strata. While much of the research has focused on the personal characteristics of perpetrators, behaviour is also influenced by society. Laws, cultural values, social structures, and local or family relationships help determine whether a person engages in violent behaviour, and these social constructs can be changed.

Existing research shows that societies can be relatively free from domestic violence when there are supportive modes of community behaviour and an active societal recognition of women. These include:

• The empowerment of women outside the home;
• Active community participation in addressing violence;
• Solidarity and advocacy by feminist groups;
• Sanctuaries from domestic violence.

To be successful, these interventions and programs should be integrated into the community and supported at the national policy level.

Community Efforts Involving Women, Men, and Youth

Effective interventions give more visibility to the problem and challenge the social norms and values that condone and encourage violence against women.

These include:

• Using mass media and education messages along with community sanctions to deter violence by publicly identifying and shaming abusers.
• Rallies bring together organisations, civic leaders, and individuals to protest violence against women and promote awareness of the attitudes, beliefs, and behaviours that perpetuate the violence.
• Marches to demand that the perpetrators of this violence-the batterers, the rapists, the murderers-be held responsible for their actions and be made to change.
• Men can also become involved in speaking out against violence against women by helping change the social norms that perpetrate this behaviour.

Interventions focusing on the children of abused women may be an important prevention strategy not only against domestic violence, but against violence in general. They can lead to the improved mental health and physical well-being of future generations. School programmes for young children that help influence better gender relations, non-violent conflict resolution, and programs to teach parents how to raise children in a non-violent atmosphere can help heal society.

Addressing Gender Violence

AHO’s integrated model provides countries with a framework model to help each woman who is suffering from domestic abuse and eradicate the problem on a large scale. The model operates at three levels:

• At the community level creating networks;
• At the health sector level strengthening capacity to address gender violence and launching educational campaigns through the news media and other channels to cut tolerance of family violence;
• At the national level through coalitions that advocate for policies, legislation, and programs.

These are the initial detection points for women suffering from abuse. Health care providers are trained to screen women during primary and reproductive health care visits. They then apply protocols to assure quality service and data collection and are sometimes trained to collect judicial evidence.

Task Forces

These include AHO and partners, who assess the prevalence of violence by using information from the health providers, judicial system, police, and surveys. They apply the instrument developed by AHO to identify community organizations, individuals, and resources to help women address their situation.

Health workers then use the task force information to mobilise community organisations and leaders to form support and service networks. These vary by community and may include police, judicial systems, community leaders, NGOs, women’s organisations, schools, churches, and hospitals. The networks meet regularly to plan, implement, monitor, and coordinate activities that deal with the needs of victims and their families. They set up referral and information networks, training programs, and support groups.

Replication of this system at the regional and national levels should include representatives from local networks and national public programs, such as the ministries of health, women, labour, education, and welfare, as well as the courts. Networks can also advocate for policies, training, legislation, and resources to address domestic violence at the national, regional, and local levels.

AHO’s Women’s Lives Free from Violence

Gender violence is different from other social violence, in that it happens in the privacy of homes and is often inflicted by loved ones or former partners. Most of the battered victims are women who have limited access to income or power and who are not likely to consult existing health services regarding gender violence. When they do consult these services, often it is only for the physical, mental, and reproductive health problems that were caused or aggravated by their situation.

Ultimately, violence against women is usually rooted in gender-based discrimination and, therefore, any attempt to address it should be linked to efforts that empower women. Women will not be free from violence until there is equality, and equality cannot be achieved until violence and the threat of violence is eliminated from women’s lives.

Preventing and addressing violence against women entails commitment from many sectors, as well as an integrated approach. Such a commitment and effort should focus on prevention as a basic human right and take a public health approach in which the health sector, battered women, and their advocates all actively participate. Even with all of this, it is an ambitious project.