nspire Y rs

INDIAN INSTITUTE OF HEALTH MANAGEMENT RESEARCH, J AIPUR

WHOCollaborating Centre for District Health System Based on Primary Health Care
Poem
Gender Analysis
Blood camp clippings
Gender &condom promotion
HIV prevention
Central category (poem)
ijikaSrivastava
Chetna Mehrotra
eha Goel
Priya Wiliams
Pradip Kumar
Ravi Kant Shukla
Lata Suresh
Tanu Diwadi
Hem K. Bhargava
Nutan J ain
Patricia Wolf (Editor)
C\Vefcome.
To the first edition of the IIHMR Gender Health
Resource Centre's (GHRC) newsletter. The
contributors are from everywhere in IIHMR and
beyond. It includes information, resources and
many items that you might find helpful regarding
gender and health issues pertinent in India today.
If you are a researcher, trainer, teacher or just
interested in gender issues, you will find this
material a helpful tool to network with people,
find information for a project you are working
on or as material for a training design that you
might be involved in. So read on...

The GHRC Background and

Philosophy Whoare we?
The Indian Institute of Health Management
Research (IIHMR)' Gender Health Resource Centre
was established in 1998 under the name of the
Women's Health Resource Centre. Now, in 2004,
we have reactivated this centre and have changed
its name to The Gender Health Resource Centre
(GHRC) keeping in step with the ever-changing
evolution in thinking about men and women's
health concerns and how individuals,
organizations, agencies and institutions act
regarding men and women's health.
Today, in the field of gender, health and
development, efforts are to look for the ideal state
of health and development in which gender
relations are equitable. Although this requires a
special focus on women's situations, there are
instances in the health/ disease process where men
are at adisadvantage. A gender approach to health
needs to be applied to both men and women and
when either sex is identified as being at a
disadvantage or at risk, we promote the necessary
interventions that seek to improve their particular
situations.
Research
The GHRC is a component of the Indian Institute
Health Management Research (IIHMR), aresearch
and training institute. As such, GHRC is involved
in research studies that are gender-oriented such
as reproductive health for men and women, safe
motherhood, male health education, gender related
violence and many other topics. As part of IIHMR,
the GHRC has access to gender related data and
reports that are organized and utilized to facilitate
learning. The GHRC organized this data so that
others interested in the gender field can access these
data for their professional purposes.

Training and Consulting

In addition to research, the GHRC has a strong
consulting/training base by which organizations
and individuals can gain knowledge and skills by
utilizing these services offered by IIHMR's GHRC.
We conduct gender-based training and offer
consulting resources an all areas relevant to gender.
For example, the GHRC isin the process of training
100trainers inthe state of Rajasthan for the UNFPA'
IPD2 5-year project inwhich gender-based training
is an integral part of the success of this program.
Also, recently, the GHRC hosted other interested
gender health professionals from Bangladesh
interested inactivities and projects inwhich gender-
related issues playa part.
Networking and Capacity-
building
Inaddition to research and training, the GHRC acts
as an NGO networking centre in which NGOs can
come together and collaborate on projects and
activities, as well as receive capacity building
training related to their own goals and projects.
The GHRC isvery interested inworking with other
gender-related organizations who wish to join
forces inpromoting gender concepts within health-
related areas. If you are interested in promoting or
sharing your experiences and work, your
contributions are most welcome.
Our newsletter will keep you posted on our
activities at the GHRC as well as give you
information onpeople interested inwhat you might
be interested in, research about various gender
topics, and general useful information. For that
artistic side of the brain, art and poetry will be a
regular addition to our pages.
If you would like to contribute to our newsletter,
please feel free to contact us at (iihmr@iihmr.org).
Check out our newly modified website!
- Patricia Wolf
Associate Professor, IIHMR
The State of Rajasthan, UNFPAand
IIHMR'sGender Health Resource Centre Present ...
Successful Gender Sensitization
Training
InOctober and November of this year, the GHRC
has hosted aseries of gender sensitization training
programmes in collaboration with the State of
Rajasthan and UNFPA. State level training was
conducted in the month of October and these
trainers will now train other trainers as part of the
Integrated Population Project (IPD2)project launch.
All these efforts aretoeducate health workers and
doctors regarding gender and health issues with
particular focus onissues related toRCH. Thefirst
batch of trainers for thefieldwas trained fromNov
16-27. Other groups will be trained in December
and J anuary. These training programs are all part
of a 5-year state RCH project which requires
extensivetraining effortsintheareaof basic gender
sensitization as well as train-the trainer
components targeting health care workers and
doctors in thestate.
Gender and Health
During the training, attendees learn gender
concepts inthefirstpart ?f theprogramme andthen
have an opportunity in the latter part of
programme to practice the training in which they
present mock demonstrations. This method is
considered very helpful and gives everyone a
chance to practice a new skill. The entire
programme is 11days. Trainees have felt much
more comfortable with the material and look
forward to starting their first class!
Thetraining programs havebeen abigsuccess and
trainers both new and experienced have walked
away from the trainings with new perspectives,
better training techniques and some new friends
and colleagues they can call upon for help and
assistance.
The trainees enjoy the campus environment too!
The campus is aquiet place to learn, reflect, relax
and meet people inthe field of gender and health.
Examples:
A woman cannot receive needed health service because norms in her
community prevent her fromtravelling alone to aclinic
A teenage boy dies in a car accident because of trying to live up to peers'
expectation that young men should be "bold" risk-takers
A married woman contracts HIV because soci etal standards encourage her
husbands promiscuity while simultaneously prevnting her from insisting
on condom use

Globally, 8.4 million people are

estimated todevelop tuberculosis
(TB) each year and nearly 2
million deaths result from the
disease. Overall, 1/3 of theworld
population is currently infected
with the tuberculosis bacillus,
over 90%of them in developing
countries.
This situation warrants urgent
action to curb the epidemic. Examining the
gender dimensions of TB is important for
overcoming barriers to effective prevention,
coverage and treatment of tuberculosis.
Tuberculosis incidence and prevalence is
higher in adult males then in adult females.
The reasons for the higher male prevalence
and incidence are poorly understood and
need further research to identify associated
risk factors.
Reported incidence rates for tuberculosis may
under-represent females. Lower rates of
notification may also be a consequence of a
smaller proportion of women than men.
There aresex differences in the development
and outcome of tuberculosis. Once infected
with TB,women of reproductive agearemore
susceptible to fall sick than men of the same
ageand also to die fromit.
HIV isalso contributing tosex differentials in
risk of tuberculosis in young people. HIV
weakens the immune system, and a person
who is HIV positive and infected with TB is
more likely to develop active disease than a
person similarly infected but HIV negative.
Tuberculosis in pregnancy enhances the risk
of poor pregnancy outcome. Studies from

Mexico and India report that

pulmonary tuberculosis inthemother
increases the risk of prematurity and
lowbirth weight inneonatal two-folds
and the risk of perina tal deaths
between three and six fold.
Genital tubercul~sis frequently leads to
infertility in women in many developing
countries with far reaching consequences to
their lives and well being.
Social and economic consequences of
tuberculosis vary by gender. Because of
gender differences inthedivision of labor and
in roles and responsibilities, tuberculosis
affects men and women differently. Social
isolation because of stigma associated with
tuberculosis affects both sexes. But the
consequences may beharsher for women and
girls.
Despite early care seeking, women had a
longer delay before tuberculosis was
diagnosed because they often sought care
fromaprivate practitioner or aless qualified
professional and waited for the treatment to
take effect before going to the hospital. They
didnot gotothehospitals where TBtreatment
is available because of the distances to be
covered and the restrictions ontheir physical
mobility.
Menaremorelikely not tocomplete treatment
inspite of having a better access to TB
treatment. Theneed to earn alivelihood also
acts as a barrier to completing treatment.
Women on the hand have agreater difficulty
reaching anappropriate facility,but thosethat
do usually complete treatment.
Gender and Condom
Promotion for HIV/AIDSPrevention
Condompromotion isanimportant weapon forIndia's fight
against HIV/ AIDS.Wehave donewell inincreasing access
tocondoms, but alack of gender sensitivity canbesmelled
inthisintervention. Thewhole focus of this intervention is
on promotion of male condom and thus the realities of
anatomy dictate that the ultimate decision-makers about
condomuseareusually themenwhomust wear them. CSW,
at themost, canonly negotiate with their clients and if this
negotiation fails, which is more often than not, they are
always inadisadvantage our position. Sheeither losesthe
incomeor exposes herself totherisk.
Data always supports the above-mentioned facts. When
CSWsareaskedabout thereasons fornot wearing condoms
at thelast sexact themain reason (68%)cited was partner
objection (BSS2001). Thus it is clear that the ultimate
decision-maker was the male client. Similarly, data on
condomnegotiation with paying clients showed that if the
client refused to use a condom, 38%reported that they
refused tohave sexwith theclients, while 30%reported to
sold sex, either by charging the same amount or extra
amount. Inthisway, thelack of options isnot only putting
CSWsinadisadvantageous position but alsohampering the
effectivenessof condompromotion programme.
Femalecondoms may beacluefor many of theproblems.
Although the female condom does not eliminate the need
for sexual negotjation with clients, as they are worn and
controlledbywomen, itdoesprovidewomen withamethod
of protection that can give them more control over their
reproductive health. Itmay beparticularly useful for CSWs,
due to various socio-economic reasons may not be ableto
negotiate safesexat all.
Although costlier in comparison to latex condoms, awell-
designed cost-effectiveanalysis isnecessary beforerejecting
them. If found costeffective, addition of femalecondoms as
a weapon against HIV/ AIDS will not only provide an
additional option for CSWs, but will also add a gender
sensitivedimension tocondompromotion programme.
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f j )omest i c o/i of ence

How behavior of Health Care
Providers often contributes to
women's domestic violence
According tothe"Power and Control Framework"
Normalizing victimization: Believing that
abuse is the natural outcome when women
disobey their male partners.
Ignoring her need for safety: Failing to
recognize h~r sense of danger.
Not respecting her autonomy: punishing the
client for not taking your advice.
Blaming the victim: Asking what she did to
provoke the abuse.
Trivializing and minimizing the abuse: Not
taking the danger she feels seriously.
Violating confidentiality: Interviewing in the
front of the family.
Health workers can help empower
women to overcome abuse by an
alternative framework
Promote accesstocommunity services: Know
theresources in the community.
Help planning for future safety
Respect autonomy to make decisions.
Acknowledge the injustice.
Believeand validate her experiences.
Respect confidentiality.
Red Fagsfor providers to be alert
Thebest way touncover ahistory of abuse infemale
clients istoask about it. Nonetheless, several types
of physical injuries, health conditions, and client'
behavior should raise health care providers'
suspicion of domestic violence or sexual abuse.
When these signs, or " red flags", are present,

providers should be sure to ask their clients about

possible abuse, remembering to be empathic and
respectful of client's privacy.
Domestic Violence:
Chronic, vague complaints that have no
obvious physical cause,
Injuries that do not match the explanation of
how they occurred,
A male partner who is overly attentive,
controlling, or unwilling toleavethewoman's
side,
Physical injury during pregnancy,
Late entry into prenatal care,
A history of attempted suicide or suicidal
thoughts,
Delays between injuries and seeking
treatment,
Urinary tract infection,
Chronic pelvic pain.
Sexual Abuse:
Pregnancy of unmarried girls under 14
Sexually transmitted infections inchildren or
young girls
Vaginal itching or bleeding
Abdominal or pelvic pain
Sexual problems, lack of pleasure
Vaginisms (spasms of themuscles around the
opening of the vagina)
Anxiety, depression, self-destructive behavior,
. Sleeping problems,
A history of chronic, unexplained physical
symptoms.
Your mother andyou?
Your Mother and You!
When you were 1year old, she fed and bathed you
You thanked her, by crying all night long!
When you were 2years old, she taught you to walk
Your thanked her, by running away when she called!
When you were 3years old, she made all your meals with
love -
You thanked her, by tossing your plate on the floor!
When you were 4 years old, she gave you some crayons -
You thanked her, by coloring the dining room table!
When you were 6years old, she walked you to school -
You thanked her, by screaming" I AM NOT GOING "!
When you were 7years old, she bought you a baseball -
You thanked her, by throwing it through the next-door-
neighbors-window!
When you were 10 years old, she drove you all day from
soccer to gymnasticsD& to one birthday party after another -
Youthanked her, by jumping out of the car and never looking
back!
When you were 11years old, she took you and your friends
to the movies -
You thanked her, by asking to sit in a different row!
When you were 12 years old, she wamed you not to watch
certain tv shows -
You thanked her, by waiting until she left the house!
When you were 13, she suggested a haircut -
You thanked her, by telling her she had no taste!
When you were 14, she paid for a month away at summer
camp -
You thanked her, by forgetting to write a single letter!
When you were 15, she came home from work, looking for
ahug-
You thanked her, by having your bedroom door locked!
You thanked her, by taking it every
chance you could!
When you were 17, she was expecting
an important call
You thanked her, by being on the
phone all night!
When you were 18, she cried at you
high school graduation -
You thanked her, by staying out
partying until dawn!
When you were 19, she paid for you college tution, drove
you to campus carrying your bags -
You thanked her, by saying good-bye outside the dorm, so
you wouldn't beOembarrassed in front of your friends!
When you were 20, she asked her whether you are seeing
anyone -
You thanked her, by saying, "It's none of your business"!
When you were 21, she suggested certain careers for your
future -
You thanked her, by saying, "I don't want to be like you"!
When you were 22, she hugged you at your college
graduation -
You thanked her, by asking whether she could pay for atrip
to Europe!
When you were 23, she gave you fumiture for your first
apartment -
You thanked her, by telling your friends it was ugly!
When you were 24, she met you fiancee and asked your
plans for the future -
You thanked her, by glaring and growling, "Muuuhh-ther,
please!"
When you were 25, she helped to pay for your wedding,
and she cried and told you how deeply she loved you -
You thanked her, by saying you were "Really busy right
now"!
When you were 50, she fell ill and needed you to take care
of her-
You thanked her, by reading about the burden parents
become to their children!
And then, one day, she quietly died. And everything you
never did came crashing down like thunder on YOUR
HEART!!!
IF SHE'S STILL AROUND, NEVER FORGET TO LOVE
HER MORE THAN EVER .....
AND IF SHE'S NOT, REMEMBER HER UNCONDI
TIONAL LOVE AND PASS IT ON .....
Because you have only one I;t1other in your life time!!!

Blood Donation Camp - GHRC In the Community
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blood and wh.:lt arc thl"' bent,nls of blood donahon etc.
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'He' inevit ably and s inc e ages - a mas t er of s t r at agem,
'He" u nfailingly and s inc e ages - an objec t of
op p r obr iu m.
'She' r egr et fu lly and s inc e ages - a p let hor a of
c onc es s z ons ,
'She' u nfor t u nat ely and s inc e ages - a s t at u e of
endu r anc e.
'He' s imu lt aneou s ly, flagellat ed and glor ified,
'He' exp lic it ly, blamed and c at egor iz ed .
'She' endu r ingly, ident ified and denied,
'She' exc lu s ively, is olat ed and os t r ac iz ed.
Wides p r ead global c laims for s exu al r ight s ,
Eac h s p ec ies fight ing it s own fight
Sexu al or ient at ion, a c au s e for dis p ar it y,
Qu es t ion: what is t he c ent r al c at egor y ?
Gender bias is t he gr eat es t p ollu t er ,
St at is t ic s - Mor e t han nu mber , an indic at or .
We ar e all living in a dis eas ed s oc iet y,
An individu al is killing t he whole c ommu nit y.
Priya Williams
yender
2?...efer st o womenJs and menJs r o{es and
r es p ons i6ifit ies t hat ar e s oc ia{Eydet ennined.
yender is r e{at ed t o how we ar ep er c eived and
e:{p ec t ed t o t hinl(and ac t as women and men
6ec au s e of t he way s oc iet y is or ganiz e~ not
6ec au s e of ou r 6iofogic a{ differ enc es .
yender fquafity
.9L6s enc eof dis c r iminat ion on t he 6as is of a
p er s onJs s e~ in op p or t u nit ies and t he
a{foc at ion of r es ou r c es or 6enefit s or in ac c es s
t o s er vic es .