Gender ender Issues in Maternal and Child Health - A Manual for

84 Pages·2012·11 MB·English

GGeennddeerr IIssssuueess iinn MMaatteerrnnaall
aanndd CChhiilldd HHeeaalltthh
A Manual for Grassroot Level Workers
Anganwadi
Anganwadi
helper JMC (Jan Mangal
worker
ANM (Sahayika)
Couple)
ASHA
Sahayika
Ministry of Health and Family Welfare, Rajasthan
Ward Ward
Ward Sarpanch Up-Sarpanch Teacher
Panch Panch
Panch
Gender Issues in Maternal
and Child Health
A Manual for Grassroot Level Workers
Ministry of Health and Family Welfare, Rajasthan
Contents
Gender - An Introduction 9
Chapter 1: Gender diff erences found everywhere and all the time 13
1. Gender discrimination starts from birth itself
2. Equal right to play and learn for boys and girls
3. Starting points of gender bias
4. The gender bias aff ects both girls and boys
Chapter 2: Ante Natal Care (ANC) 21
5. Gender issues that infl uence the utilization of ANC services
6. Lack of information and superstition hindering utilization of ANC services
7. Not giving priority to the health needs of the woman
8. Being gender sensitive does not depend on being a man or a woman, but on their
approach and attitude.
Chapter 3: Maternal and Child Health and Nutrition day (MCHN day) 29
9. Gender issues in the organization of MCHN day
10. Need for privacy and confi dentiality in maternal and child health services
11. Building capacity of the adolescent girls on Reproductive health
12. Importance of communication with the clients to remove gender bias and myths.
Chapter 4: Delivery 37
13. Preparations for delivery
14. Gender inequity and delay in decision regarding the selection of place of delivery
15. Poor transport access increases the vulnerability of the woman
16. Small eff orts that can enhance clientʼs dignity&comfort
Chapter 5: Newborn care 45
17. Newborn deprived of breast feeding based on gender biased practices and
superstitions
18. Both male and female babies have equal rights and needs for motherʼs milk
19. Male involvement in newborn care
20. Gender discrimination in care for sick newborn
Chapter 6: Post natal care 53
21. Avoidable maternal death
22. Need for sensitivity to motherʼs needs during post natal period
23. Eff ect of domestic violence on motherʼs health during post natal period
24. eff ort to reduce diffi culties for lactating mothers
Chapter 7: Immunization 61
25. Gender discrimination in immunization
26. Systemic and gender issues that aff ect the immunization services
27. Gender stereotyping leading to discrimination for immunization
28. The wheel of protection is broken when even one child misses immunization
Chapter 8: Gender issues in family planning 69
29. Pressure on adolescent couple to become parents soon after marriage
30. Struggle of woman to break the resistance for adopting spacing method
31. Reluctance of husband for adopting family planning puts pressure on women
32. Role of Gram Panchayat in promoting vasectomy
Chapter 9: Gender based violence 77
33. Gender discrimination begins even before birth
34. Munni gets courage to take step against sex determination
35. Sexual harassment takes away womanʼs freedom
36. Domestic violence takes away womanʼs dignity
Chapter 10: Role of Gram Panchayat in improving Maternal and Child health Services 85
37. Gender sensitivity of the Sarpanch facilitates service provision
38. Capacity building of Garm Panchayat members for participation in health activities
39. Sensitizing Gram Panchayat to provide services with equity and dignity
40. Role of Gram Panchayat in making the health centre safe for women and children
Preface
NIPI Secretariat feels privileged to release this gender manual primer for grassroots level
workers in the maternal and child health sector. This manual is a primer, that can help grassroots
level service providers to understand the linkage between the gender biased attitudes, beliefs,
and practices found in the community that aff ect maternal child health service provision in
an equitable manner and utilization by all women without discrimination.
This manual is developed based entirely on communitiesʼ gender realities from Rajasthan,
identifi ed through fi eld visits in several blocks of Bharatpur, observation of several MCHN
days, in depth interviews with the community members, focus group discussions with the
ASHA, ANM, Anganwadi workers, adolescent married and unmarried males and females,
consultations with the Sarpanches drawn from all regions of Rajasthan and other community
members.
For easy learning this manual uses cartoon format and provides opportunities for self learning
and refl ection. The manual is divided into ten chapters. The introductory chapter and chapter
one explain the gender concept in simple conversation form between ANM, ASHA and
AWW. At the end of the chapter, a one page explanation on “what is gender” is provided
for clarifi ication before moving on to other chapters. From chapters 2-8 diverse aspects of
Maternal and child health and gender issues are highlighted. Chapter 9 deals with a very
important issue of gender based violence, which has serious health implications for women
and children. Chapter 10 deals with the role of Panchayat in improving maternal and child
health, which has the overall mandate to improve maternal child health in the villages. At the
end each chapter a one page explanation is given to help the health workers understand the
specifi c gender issues in each story along with key points for refl ection and self action.
This manual is expected to help all grassroots level health workers to identify and take action
for:
(cid:2) Improving privacy, safety and confi dentiality of information of women when they
attend MCHN days or when they come for institutional delivery
(cid:2) Removing those gender biases that deprive the newborn boy or girl from their rights
to be breastfed soon after birth and continued exclusively until six months of age
(cid:2) Addressing those discriminatory practices or beliefs which deprive lactating mothers
of adequate rest, nutritious food and hard work for the few weeks after delivery
(cid:2) Educating families on the need for immunizing every single boy and girl child to
avoid the risk of infection and disease in the community
(cid:2) Reducing the reluctance of the male members to participate in newborn care
activities
(cid:2) Communicating eff ectively with the adolescent couples and families on the
importance of postponing the fi rst child
(cid:2) Strengthening the Village Health and Sanitation Committee by increased
involvement of the Gram Panchayat in the MCHN days
(cid:2) Increasing the involvement of the Gram Panchayat to ensure: all deliveries are
institutional deliveries in the village; all the newborn boys and girls and children are
immunized; male sterilization increased; transport for delivery organized, especially
in remote areas; and maternal and child health priorities are placed in the village
development plan.
NIPI Secretariat wishes each and every grassroots level health worker happy reading and
success in their eff orts
Antony Cameron Lalitha Iyer
Director Advisor, Gender
NIPI Secretariat NIPI Secretariat
How to read this book and understand?
(cid:3) We are grateful to all the grassroots level workers for discussing and providing inputs
based on which this manual has been developed.
(cid:3) This manual can be used by a grassroots level worker for self learning; Also can be used
in training contexts to get an understanding of gender issues and how they aff ect service
provision as well as utilization.
(cid:3) In order to help you to understand how ʻgender ʻ plays a role in your day-to-day life , the
fi rst chapter starts with an introduction to gender.
(cid:3) The manual coveys gender concepts and issues through sharing of experiences of
ASHA who participated in a gender training, with her colleagues- ANM and Anganwadi
worker.
(cid:3) The manual is divided into ten chapters and each chapter has four separate stories.
(cid:3) In the beginning of each story, the conversation between ASHA, ANM and Anganwadi
worker gives an introduction to the issues taken up in the story given below.
(cid:3) These stories are given in the form of cartoons, to make it interesting.
(cid:3) In order to help you to refl ect and discuss, at the end of each story, a few bullets are given
which highlights the issues taken up in the story or related issues.
(cid:3) At the end of each chapter (after four stories), a brief analysis of the stories along with
certain tips are given for you to refl ect and to remember.
(cid:3) In these tips, certain practical issues are given as ʻfacts to rememberʼ which will help you
in your day to day work.
(cid:3) ʻDo it yourselfʼ and ʻplease refl ectʻ are aspects that will help you to do self learning and
refl ection.
(cid:3) Please read this manual, share it with your colleagues, family members, friends, neighbors
and community members.
(cid:3) In case you have any comments, suggestions regarding the manual do send them to the
address given in the inside page of the back cover for action.
Gender - An Introduction
Asha, I heard that you went for some training
You must have heard that people often talk about
to Jaipur. What did you learn there? gender bias; in the training I understood how that
impacts our work and life. We have no understanding
of this and ignore it as a routine aspect of life.
Sub-health
centre
Tell us the key Teacher asked us to think
Changes have happened; girls are allowed
issues that you
about the changes in recent
to go to school and work outside. Big
learned.
years in the way we live,
streets, buses, TV and many other things;
clothe, eat and what impact
even to that extent that we have our own
it has had on men and
mobiles.
women.
What is the point of these
This is the sad issue. Changes have
changes? Our fate is to
happened and yet women have
work at home and outside
to still struggle a lot on several
and yet get abused. I can
fronts.
relate as to how the
woman’s vulnerability is
enhanced and she is
made to feel helpless
due to many pressures.
9
I am experiencing this
The teacher said that these biases are
struggle from my childhood. Being a girl, do
social biases. Nature has created both
this or do not do that. No opportunity to go out
boys and girls equal except for the sexual
or to learn to be street smart.
organs. But based on the social beliefs and
practices separate expectations and roles
have been created for males and females.
Gender roles and
expectations keep
changing according to
time, location, and
situation; but sex is
natural and remains
constant.
Yes, but this impacts the In addition, if the woman happened to
Yes, this is the reason
lives of women more belong to a disadvantaged community
for different status for
seriously since she is or minority or disabled, then do not
men and women that puts
already disadvantaged even ask about her situation.
pressure on both.
due to less access to
information, support
and resources.
In the training the teacher told us Surely; those
Oh, you did the teacher tell
that such gender inequities start even are the
you the effect of these
before the birth. Often we women stories I am
gender biases on our work
practice these biases ourselves. The going to share
of providing maternal and
bias is so deep rooted that we fail to with you.
child health services?
recognize them.
10
What is gender?
The name of the book is gender issues “behave like girl, sit quietly at home; it is
in maternal and child health. First let us not good to jump around like a boy”. In
understand the meaning of ʻgenderʼ issues. several cases the diff erences start even
All of us know that there are biological before birth where due to ʻsonʼ preference,
diff erences between men and women pre natal diagnostic test is done and the
from the time of birth, such as girls being girl is eliminated.
born with vagina and boys with penis.
The other biological diff erences women The above expectations regarding roles
experience include getting periods, and behaviors have placed women at
becoming pregnant and breastfeeding lower status than men resulting in women
the babies. These are natural diff erences facing a number of discriminations and
between men and women and remain the biases in their daily lives, including poor
same all over the world. access to education, information, early
marriage, young girls forced to marry
ʻGenderʼ is the sociological diff erences older men, dowry and domestic violence
between men and women which are
created by the society and which decides
the role of a man or woman. For example,
the primary role of a man is that he goes
out and earns, make decisions at home
and keep control over the family. The
primary role of a woman is to look after
the household, cook and keep the house
clean, look after the children etc.
ʻGenderʼ based expectations also decide
how a man or woman should behave. For
example, women should not talk loudly,
men should not cry, men should have
authority over women, and men should
establish their ʻmanlyʼ status in the family
etc. This kind of gender construct and
diff erences in the roles and expected
behaviors, starts very early in our lives. For
example, when a boy cries, often he is told,
“why are you crying like a girl”? ; Incase a
girl plays ʻgilli dandaʼ cricket (games that
usually boys play) often they are told,
11