Gender &
Reproductive Health
Gender &
Reproductive Health
|
Caridad Tharan |
|
The original idea was to convene a seminar to sensitize health professionals to gender issues in FP. However, one was confronted with the basic question, what happens after the seminar? Once people are sensitized, what effect would it have on the organization and on the programmes? Having, therefore, realized the limitation of a seminar or workshop by itself, ICOMP and Danish FPA agreed to conceptualize a three-year pilot project and proposed that it be carried out in the Philippines after consultations were undertaken. The
Pilot Project The second strategy was the provision of resources and technical assistance to partner organizations to support gender sensitive initiatives carried out at the project sites. The third strategy was the documentation of the processes undertaken throughout the project in order to keep track of changes taking place, to gain insights as the activities unfolded and to cull lessons in terms of providing gender sensitive programmes and services. The pilot project was envisioned to be carried out in a period of three years. The following sections narrate the highlights of the project. First Year The first year of the pilot project was devoted largely to laying the groundwork to pave the way for project implementation. Several activities were carried out. A baseline survey was undertaken on policies, programmes and approaches to FP by different groups such as the national government, the Department of Health, in particular the National Commission on the Role of Filipino Women (NCRFW), the Commission on Population (POPCOM) and women’s organizations. Interviews were also conducted with heads as well as service providers/clinic managers of the leading FP/MCH (Maternal and Child Health) NGOs primarily to find out their general awareness and understanding of gender concerns and sensitivity in FP and population programmes, and how they are incorporated into the organization’s programmes and activities. A planning meeting was held in October 1994, a month after the International Conference on Population and Development (ICPD) in Cairo. Planning Meeting A
planning meeting was organized mainly to arrive at a common operational
framework for gender sensitivity and gender responsiveness in FP.
Women’s
health advocates served as facilitators and presented papers on quality
of care and women-centered reproductive health framework.
During workshop sessions, the participants discussed intensively the issues, needs and concerns of their individual organizations in responding to a gender-sensitive FP programme. This involved a re-examination of the organization’s ethics/values, programme operations, programme management, following which possible interventions for a gender sensitive programme were formulated. The deliberations and exchange of information revealed the inadequacies of existing FP programmes. These are: focus is mainly on mothers and not women as a whole; that concern is largely on morbidity and mortality, not women to be healthy per se, that target orientation is still the norm, men’s responsibilities are not emphasized and service delivery standard only conforms to minimum medical standards. There is a need to expand services to include those for STDs, RTIs, HIV/AIDS and violence against women. Only minimal effort exists in terms of informing clients on their rights. Limited range of contraceptive methods is offered, mainly voluntary surgical contraception or bilateral tubal ligation. A conscious and regular users’ feedback mechanism is lacking and success indicators are too quantitative. There is no clear definition and reference to concepts such as reproductive rights, reproductive health, women’s rights, women’s health, sexual rights and sexual health. Second Year An increased momentum in the pace of activities was achieved in the second year of the pilot project. These activities can be grouped into: Experience Sharing/Workshops
The workshop exercises elicited first-hand experiences of FP workers as they tried to act out “before and after” scenarios of their organizational environment prior to institutionalizing gender sensitivity interventions in the work place. It encouraged the participants to be more sensitive to women’s needs especially as they are in the forefront of service delivery. Sharing sessions on quality of care in FP and reproductive programmes with project staff and other women’s health advocates who are implementing reproductive health programmes were convened. Sessions were also held with the health professional staff of the DOH, Rural Health Unit (RHU) discussing the elements of reproductive health, gender issues as well as the benefits of gender-sensitive counselling and how this can be applied to the present set-up of the clinic. A review of the clinic protocols was also made. Visits
to the barangay center (lowest unit of local government)
were undertaken by the project staff mainly to dialogue with predominantly
male audience on various aspects of women’s health, shared responsibility
in family life and FP and the sensitive issue of domestic violence.
Training Workshop on Gender Sensitive Counselling A major intervention in the pilot project is the development of skills in gender sensitive counselling in FP. The six-day training was one of the major activities of the project in response to the expressed need by partner organizations to increase knowledge and understanding of women’s health and gender issues. Primarily, the purpose of the training was to upgrade knowledge and skills in counselling so as to enable the service providers to respond more effectively to the needs of their clients in the clinics and in their communities. In order to broaden the understanding of gender sensitive counselling, the importance of contexualizing it within a reproductive health framework was stressed. Topics such as sexuality, reproductive health and rights, quality of care and violence against women were covered. Baseline
Generation Activity / Focus Group Discussions on
The generation of baseline data was undertaken to gather information on existing organizational set-up of partner agencies and its systems and procedures. Such information was crucial toward designing appropriate gender sensitive interventions. The selection and gathering of data included clinic guidelines, standard operating procedures, reporting forms, activity plans and projects already implemented by the partner organizations. Data-gathering activities involved observation of clinic operations and set-up; observation of clinic and community dynamics; records review; key respondents interview; and conduct of focus group discussions. Community profile was also gathered through research and analysis of secondary data; and interviews with local government employees. Third Year Following
the above activities, the partner organizations formulated action
plans for promoting gender responsiveness to their FP and health
programmes. A refresher course on Gender Sensitive Family
Planning Counselling was also organized during this period. The development
and implementation of Action Plans by Partner Organizations was carried
out during the third year.
The overall and long-term objective of the project is to improve the status of women through the provision of gender sensitive family planning services within a reproductive health framework. Whether the status of women has improved can only be determined at a later point in time when one goes back to the women served by the RHU and the women in the community where PRRM works and assess how empowered the women are in terms of their ability to control their bodies, their fertility, their lives and to make autonomous decisions as individual, human beings. However, there are levels of empowerment, that is, from access to conscientisation, participation and control and to a certain degree, one can discern a state of women being empowered, in particular, the women at RHU and PRRM. Monitoring visits as well as in-depth interviews conducted indicate that, to a large extent, awareness and understanding of gender and gender issues in family planning and other reproductive health and related population programmes have developed among the programme heads, managers and implementors/service providers. Gender consciousness has been internalized and change can be seen in their relationships within the family and advocacy for gender equality, shared responsibility for child-rearing and care and household tasks. Change can also be discerned in the quality of care and service towards clients, especially women who come for family planning service. Prior to this, women (the clients) were just “numbers” to be attended to because they come in queue; family planning counselling was “work” or that injectables were given with hardly any explanation. Obvious changes in the quality of care and service are discernible where nurses and midwives are concerned. They now feel for the women they serve and regard them as human beings, equal to men, with rights, dignity and, therefore, deserved to be treated sensitively, to be listened to and to be given quality of care despite or in spite of constraints, such as time and the sheer number of clients compared to the number of clinic staff. It is also now understood by the service providers that fertility regulation is a shared responsibility between men and women: men have to be reached out to. There are mothers’ classes and there are also fathers’ clubs. There are gender sensitivity trainings for women and for men and for the youth as well. The Family Council provides a mechanism, a forum for all members of the community young mothers, middle-aged women and men, widows/widowers, and others to share common concerns, to seek advice and counsel, to organize informal talks, film shows and to discuss community issues and problems. New programmes and services have been added by RHU such as seminars and workshops on gender and reproductive health for men, youth and marginalized groups, such as women in the sex industry. Physical layout of the family planning room has been changed for greater privacy. Other laboratory tests such as those for reproductive tract infections have been added. Existing programmes such as Mothers’ Class have been enhanced to include topics on sexuality, reproductive rights and violence against women. Popular education materials such as comics and film shows are now being utilized to educate the community on topics of sexuality and reproductive health needs and other concerns such as rape, incest, etc. Networking between RHU and women’s organizations and other NGOs has been initiated, mainly to refer cases of violence against women. The following quotations indicate the change in the personal and professional lives of the health workers who went through the process of gender sensitization. To sum it up, “gender” has now become part and parcel of our being, it is “there wherever we are and whatever we do.” (Gender is now integrated and mainstreamed.) “I have become more resolute and more confident in myself. There has really been a great change in me.” (Confidence in one’s role as a health provider and counsellor.) “My husband now shares in household work. Also, I do not have to encounter forced sex with him.” (A step towards gender equality; gaining respect for one’s personhood/ womanhood, gaining control over one’s own body.) “I
have become very sensitive towards oppression of women and violence
against women.” (Developing empathy and sense of empowerment.)
“I treat my sons and daughters equally now.” (Consciousness of gender equality.) “I have become a better person after my gender sensitization and training. Before, I never had any patience with the prostitute clients. I would scream at them or even insult them. Now, I sit beside them and speak to them.” (Developing client – centred services; better interpersonal communication.) “Now, I do not simply advise or give counsel. I think through very hard and thoroughly. I want my client to leave the clinic feeling satisfied and without any doubts at all.” (Enhancing quality of care.) When interviewed, the PRRM Project Manager summed his views and experiences as. “Women in the village (Gugo) have started speaking out, expressing what they feel and what they think in a forum (Family Council) which is theirs and which they can control. That is a good sign. And if you can see also the kind of confidence that has been achieved, that now they could freely relate to other people, to strangers who come and visit them, that is one achievement also." “With the setting up of the Family Council, the men have become involved, their awareness and consciousness of gender relations have been raised.” As remarked by one elderly man, “Now I realize what we mean by gender relations - I have not treated my wife well at all and that explains her unhappiness.” “It is difficult for me to measure the impact of the project on the lives of the women in the community. For example, how do you measure the joy of a widowed mother who can now express her loneliness openly in the group or the gladness of having a resource centre in the village where women, men and youth can come together.” “The culture of silence among rural women has been broken down. The rural women can speak about the success of their co-operative and of their livelihood projects and health programmes but on personal enlightenment, personal consciousness, personal accomplishments, I think that is more difficult but they (the women of Gugo) were able to do that.” Lessons Learnt The main learning arising from the pilot project is that efforts on gender sensitization can yield concrete results if various stakeholders attach value to it, internalize the process in their personal lives as well as their working environment, leading to changes in programmes and services that are sensitive and responsive, mainly to the needs of women in the community and of men as well. Several lessons have been learnt in terms of strategy, approach and process of promoting gender responsiveness of family planning and health programmes. These include the following: l Gender sensitization is a slow, difficult and at times painful process but it is extremely important to transform existing family planning/health programmes into one that: (1) is people-centred, and sensitive to the situation, needs and concerns of poor, marginalized women; (2) seeks to empower women by gaining greater knowledge and understanding of their bodies, and enables them to make decisions to regulate their fertility; (3) encourages and enables men to be responsible for fertility regulation, safe sexual behaviour, child- rearing and care. Gender sensitization involves challenging one’s self, one’s long-held and sacrosanct beliefs in women’s and men’s social roles and status within the family, the community and the society at large. It entails changing a mind-set, that is, from the narrow confines of family planning to the broader concerns for women’s reproductive health, reproductive choice and rights, men’s responsibility in fertility regulation and sexual health, increased quality of care, issues of domestic violence and its effect on women’s reproductive health. Gender sensitization means re-examining the organization’s approaches, structures and processes in conceptualizing programmes, in planning, implementing, monitoring and evaluation.
|