1. Module: Gender Dimensions of Family Planning and Reproductive Health REVIVING EVIDENCE–BASED FAMILY PLANNING IN MEDICAL EDUCATION AND TRAINING IN THE PHILIPPINES

2. Training Objectives Locate gender in the overall reproductive health framework of the Department of Health Explain the gender concepts and how it affects the reproductive health of men and women Apply gender concepts in family planning

3. Overview Session 1: Definitions Session 2: DOH Integrated RH Framework Session 3: Rights-Based Approach to RH and FP

4. Reproductive Health A state of complete physical, mental and social well-being and not merely the absence of disease or infirmity in all matters relating to the reproductive system and to its function and processes. (Source: ICPD, para 7.2, SPFA para 94, Beijing+5 Review Document 2000 p.25 )

5. 10 elements of RH MCHN PMAC Fertility Management Infertility/ Sexual Disorders STI/ HIV/ AIDS SRH Sexual Health ARH Men’s Responsibilities / RH VAWC Cancers of the Repro. Tract

6. Reproductive Health Care Encompasses all services including appropriate and relevant information provided to address the reproductive health needs of men and women. According to the DOH, the following are included in RH Care/ Services: Family planning services, counseling and information Prenatal, postnatal and delivery care including nutrition and health care for infants and children Treatment for reproductive tract infections including STIs/HIV/AIDS Management of abortion-related complications Prevention and appropriate treatment for infertility IEC on human sexuality, reproductive health, responsible parenthood Male involvement Violence against women and children Adolescent reproductive health Management and treatment of reproductive cancers

8. What is a rights-based approach? A recognition that reproductive health is part of human rights

9. 13 Sexual & Reproductive Health Rights The Right to Life The Right to Liberty and Security of the Person The Right to Equality, and to be Free from all Forms of Discrimination The Right to Privacy The Right to Freedom of Thought The Right to Information and Education The Right to Choose Whether or Not to Marry and to Found and Plan a Family The Right to Decide Whether or When to Have Children The Right to Health Care and Health Protection The Right to the Benefits of Scientific Progress The Right to Freedom of Assembly and Political Participation The Right to Be Free From Torture and Ill-Treatment The Right to Development Taken from a presentation on sexual and reproductive rights by Reproductive Rights Resource Group (3RG-Philippines)

10. Sex and Gender Sessions Session 1: Gender & Sex Session 2: Gender Analysis Session 3: Integrating Gender and FP/RH

11. Exercise: Sex and Gender(metacards) Because I am a (woman/man), I can…. ____ ____ If I were a (man/woman), I could…. ____ ____

12. Sex & Gender

13. Sex & Gender

14. Gender refers to “the economic, social, political and cultural attributes and opportunities associated with being male and female.” (DAC Guidelines for Gender Equality and Women’s Empowerment in Development Co-operation. OECD: Paris. 1998).

15. Note… Gender Roles are NOT inborn; not biologically determined; But what is biological can be socially constructed to justify certain roles, responsibilities and activities (e.g., gender division of labor) and the values given to such roles (e.g., female labor is usually considered cheap, low-skilled) Gender influences the ways women and men are involved in different types of work, take up roles and obligations, acquire traits and behavioral patterns, are allocated opportunities and benefits and decision-making in private and public spheres.

16. Gender and Health Gender differences and disadvantages in the field of health are manifested in the way: health and disease are distributed in a population health is promoted, disease is prevented and controlled, patients are cared for, models are adapted for structuring health social security systems

17. Socialization of Gender Exercise: “Magpakalalaki Ka!; Kababae mong tao!”

18. Gender Socialization Exercise KABABAE MONG TAO! MAGPAKALALAKI KA! Question: Anoangkailanganninyonggawin/dapatmaging, paramatawag kayo o mapatunayanna kayo ay isanglalaki/o babae? (Magsalitabilangisanganak, ama o ina, asawa, kapatid, lolo/lola, tiyo/tiya, at iba pa).

19. Gender Socialization Exercise Who are the major influencers of actions both inside and outside the box? Who or what institutions ensure that a person acts like a man or a woman?

20. SWS Survery: Trait of a “Real” Man? Responsible: 36 % Mabait: 9 % May paninindigan: 7 % Mapagmahal: 6 % Matapat: 5 % Hindi pabaya sa pamilya: 5 % Masipag: 5 % Word of honor: 3 % Maalaga: 3 % May takot sa diyos: 3 %

23. Gender Socialization The process through which the individual learns and accepts roles is called socialization. Socialization works by encouraging wanted and discouraging unwanted behavior. Gender socialization refers to the learning of behavior and attitudes considered appropriate for a given sex. Boys learn to be boys and girls learn to be girls. This "learning" happens by way of many different agents of socialization. (Henslin, 1999)

24. Stereotyping and Gender Biases: Exercise Statements: “Agree” “Disagree” “Neutral” Ok lang pagmahabaangbuhoknanglalaki, pero ang babae na nagpapakalbo ay masagwangtingnan. Angbabaengnakadamitat kumilosngsexy pagnarape ay kasalananniya. Hindi nausongayonangnagpapaupongbabaesa bus. Kasalananngbabaekapagtaon-taonsiyangnangaganak. Ok lang kung magkaroonngkabitanglalakipero kung angbabae ay may ibanglalaki, hindikatangap-tangap. Pagsumipolangmgalalakesababae, ibigsabihin appreciate nilaangkagandahanngbabae. Angamaanghaligingtahanan at angina ay angilaw. Under the sayaanglalakekapagsiya ay naglalaba, nagluluto at namamalengke. Badinganglalakekapag pink angkanyangsuot. Yung lalake na masyadongmalinissakatawanaybading. Karamihanngmga STIs ay nanpapalaganapngmgababae na ‘GRO’.

25. Stereotyping and Gender Biases Gender Stereotypes: are qualities, attitudes, behaviors that are arbitrarily attributed to any particular sex. In line with these stereotypes, men are socialized to lead and dominate while women are socialized to follow and care for others. Lead to biases and double standards

26. Stereotyping RH Clients and Gender Biases among Service Providers Exercise – In meta cards…

27. Question 1: Which situation would be most difficult for you if you were that person? You are 16, currently 2nd place in your class, pregnant You are gay but in a party got a girl pregnant and the girl wants to marry you You are working in an entertainment establishment but regularly go out with customers who pay bar fines and pay you extra for sex. Now you have abdominal pains, foul smelling greenish to yellowish vaginal discharge and intensive itchiness You are pregnant with your 8th child. Your 7th child was born 14 months ago Your wife is pregnant with another man’s baby. You are a woman who wants an abortion You just learned you are HIV positive. You are a 32-year old married women with five children with multiple bruises on your thigh and upper arm

28. Question 2: Which situation would be most difficult for you to counsel or treat？ You are 16, currently 2nd place in your class, pregnant You are gay but in a party got a girl pregnant and the girl wants to marry you You are working in an entertainment establishment but regularly go out with customers who pay bar fines and pay you extra for sex. Now you have abdominal pains, foul smelling greenish to yellowish vaginal discharge and intensive itchiness You are pregnant with your 8th child. Your 7th child was born 14 months ago Your wife is pregnant with another man’s baby. You are a woman who wants an abortion You just learned you are HIV positive. You are a 32-year old married women with five children with multiple bruises on your thigh and upper arm

29. Exercise, continued What were the differences between your choice of scenario for the personal (first round choice) and for the professional (second round choice)? What if you were the client, and fit into one of those descriptions What would you fear when you go to the clinic? What would you want from the health worker? What could the clinic do to help you the most?

30. Manifestations of Gender Biases

31. Gender Roles Productive: Comprises the work done by both women and men for payment in cash or kind. Reproductive: Comprises the childbearing/rearing responsibilities and domestic tasks required to guarantee the maintenance and well-being of household members. It includes not only biological reproduction but also the care and maintenance of the persons who comprise the household. Community Management Role: Comprises activities undertaken at the community level to contribute to the development or political organization of the community. It is usually voluntary, unpaid work. Women do community work that is maintenance in nature while men are usually policy-makers.

32. Gender Roles Studies In the 2000 Pilot Time Use Survey (TUS) conducted by the National Statistics Office (NSO) for Batangas and Quezon City, results showed that for both areas, the number of hours spent by women on housework and child family care was higher than men, be it during weekdays or weekends. In fact, hours spent by women for housework was, on the average, twice as much as by men. This situation would of course mean less hours available to women to do other things such as engaging in economic activities.

34. Economic participation - 80% for men versus 50% for women in 2006

36. Gender Analysis: Access and Control of Resources Access – ability to use a resource Control – ability to define and make decisions about the use of a resource Resources: Internal, economic, political, social, information/education, time Power and Decision-making

37. Access and Control Diagram (from WHO Training Curriculum, Gender and Rights in Reproductive Health) ACCESS AND CONTROL OVER Internal Resources Economic and Social Resources Political Resources Information/ Education Time POWER AND DECISION-MAKING

38. Gender-responsive and Rights-Based Differences in RH and FP Results in: differential risks and vulnerabilities to infections and health conditions; different perceptions of health needs and appropriate forms of treatment; differential access to health services; different consequences or outcomes from disease; and, differing social consequences as a result of ill health.

39. Gender and rights may influence health status in the following ways: exposure, risk or vulnerability nature, severity and frequency of health problems ways in which symptoms are perceived health seeking behavior access to health services ability to follow advised treatment long term social and health consequences.

40. To end… Without fully appreciating the implications and impact of gender roles and relations, health practitioners will fail in their treatment of certain groups and individuals, and health planners will inadequately serve the total population.

41. FOR EVERY WOMAN For every woman who is tired of acting weak when she knows she is strong, There is a man who is tired appearing strong when he feels vulnerable For every woman who is tired of acting dumb, There is a man burdened with the constant expectation of knowing everything.

42. For every woman who is tired of being called an emotional female, There is a man who is denied the full right to weep and be gentle. For every woman who feels tied down by her children, There is a man who is denied the full pleasure of shared parenthood.

43. For every woman who is denied meaningful employment and equal pay, There is a man who must bear the full financial responsibility for another human being. For every woman who has been taught the intricacies of an automobile, There is a man who was not taught.the satisfaction of cooking

44. For every woman who takes a step towards her own liberation There is a man who finds the way to freedom has been made a little easier. Nancy Smith

45. Thank You!