Health is one of the most critical parts of the Sustainable Development Goals (SDGs) to which all governments and agencies across the globe have committed to achieving by 2030. Women and girls are an important part of health programmes and services, as they are not just consumers of services but also a part of service delivery. When we look at health programmes, they have been built on universal principles and frameworks, with the aim of reaching maximum individuals. But sometimes health programmes are more focused on reproduction and maternal health, including service delivery, while working with women and girls, and forget to include them as individuals or acknowledge their agency. This critical aspect should be an integral part of ideating, planning, policy-making, programming and implementation.
It is important to look at some of these nuances that are related to gender norms and addressing them while creating intervention programmes on women and girls’ health needs so that most benefits can reach women and girls from the most marginalized communities.
Gender is a key determinant of health inequities. Gender influences the relationships between people, and the distribution of power in those relationships, thus impacting health-seeking behaviours of individuals. It also intersects with socio-economic status, marital status, age, ethnicity, disability, sexual orientation, etc. One can see its manifestation when married adolescent girls find it difficult to negotiate safer sex or pregnancy with their partners and/or have no access to information and services for contraception. This makes them vulnerable.
Gender discrimination is based on gender norms, which are ideas about how women and men should be and act. It governs the behaviours of individuals while accessing health-related services and information. Internalised early in life, gender norms can establish a life-cycle of gender socialisation and stereotyping. Gender norms thus influence the health and well-being of women and girls across three domains:
- How women and girls themselves and their families view their health needs.
- How much agency and decision-making women exercise over their bodies and the choices they make.
- What challenges they face in accessing health-related information and services.
An example of gender norms is seen in the importance given to the notion of virginity for girls; virginity is directly related to the perceptions of purity, family honour, and marriageability of a girl. Fears over sexual violence, abuse or harassment exist and are seen as risks to this purity. Therefore, to preserve this purity, adolescent girls are married off before the age of 18 years or just as soon as they turn 18. A UNICEF report shows that while child marriage rates halved in 2018, this still meant that nearly 1.5 million girls got married before the age of 18. And for these adolescent girls, who are married off early, there is a huge taboo in accessing information on sexual and reproductive health services. The taboos extend to adolescent girls and women attempting to express desire and negotiating with their partners, including for sexual and/or reproductive choices. The norms and taboos make adolescent girls and women more vulnerable to risky sexual behaviours, unprotected sex and unwanted/unplanned pregnancy, and/or unsafe abortions. This, in turn, influences their health-seeking behaviour and also has a long-term impact on their health.
In terms of family planning, despite the above taboo, statistics show that there is almost an overall dependence on women. According to the National Family Health 4, the male versus female ratio for sterilization in stood at 1:52, with “female sterilisation being the most popular contraceptive method”. This directly impacts the health and agency of many women.
Similar situations come up time and again in a woman’s life, which impact her health. These situations limit her choices, access to contraception, when and if she would want to have a children, how many children she would want and even her ability to say yes or no to sex with her partner.
In rural areas, FLWs are the key service providers and their training is critical for the kind of information that is shared with the communities where they work. It is important to address the FLWs’ own biases and prejudices regarding adolescent girls accessing sexual and reproductive health information and services. It is also important to build their capacities on how to promote a healthy dialogue on issues related to sexual and reproductive health and identifying violence with young people in communities where they work.
Gender norms also do not prioritise women’s and girls health needs but see them merely in their reproductive role to give birth to a healthy next generation. India has very strong laws on sex selection and also relatively progressive laws on abortion. Yet, women and girls find it extremely difficult to make an informed choice, and/or access quality services in a non-judgmental manner. Son preference is high and has resulted in a lower child sex ratio during the past few decades. According to the 2011 census, the current sex ratio is 940 women per 1000 men.
This mindset continues to see control over women’s choice to abortion being affected and/or limited by her marital family’s choice. Their decisions are mostly determined and influenced by what their husband’s family wants.
Laws, services and policies alone will not create this change; the need is to change the mindset of people, of how they view the health of women and girls, the choices women have and make and the agency they have. It is important to change and challenge norms by working towards and making the health needs of women and girls a priority.
Featured image used for representational purpose only. Image source: Pixabay