For four decades, Management Sciences for Health has promoted gender equality in development in more than 135 countries. Through MSH’s health systems strengthening framework, it is helping governments realize their obligation to fulfill the right to health and the Millennium Development Goals (MDGs). We apply gender-sensitive strategies throughout our programs and recognize that improved health outcomes are dependent on equal realization of dignity and human rights for all.
In many parts of the world women and men do not have equal access to health care services and resources. The US Global Health Initiative, along with major international policy makers and institutions acknowledge that gender inequity affects the overall health of women because of their biological vulnerabilities, their lack of access to information and resources and finally their inability to make independent decisions about their own health or their families and communities.
MSH works at the policy, individual, community, and institutional levels to promote equity and equality, which constitute the following:
- Gender equity is the process of being fair to women and men by compensating for historical and social disadvantages that prevent them from operating on a level playing field.
- Gender equality permits women and men equal enjoyment of human rights, socially valued goods, opportunities, and resources.
Therefore equity is the means, while equality is the result of equitable policies, programs, institutions, and distribution of resources.
MSH´s Focus on Women and Girls
Throughout the world, but particularly in developing countries, women and girls constitute the poorest and most vulnerable segments of the population. Widespread inequalities in education, lack of personal, political, and socioeconomic power, and gender-based violence lead to higher mortality and morbidity rates among women and girls. These facts demonstrate why health programs must address the needs of women and girls from a gender perspective:
- The World Bank estimates that, in virtually every low-income country girls comprise two-thirds of children with no access to schools.
- UNDP figures show that, only 1 in 4 members of Parliaments and Legislatures worldwide are women, and women worldwide hold less than 20% of ministerial positions.
- Over half of married women in Africa and Southeast Asia have no say regarding decisions related to their health. Furthermore, in this day of HIV/AIDs ,UNICEF and UNFPA reports indicate that at least two thirds do not have the ability to negotiate safe sex and illegal abortions takes the lives of many women in these countries.
- The majority of women in the world today cannot get bank loans or legally own property. They are self-employed or contribute to family work with little or no pay. Women and girls’ economic vulnerability increases their likelihood of turning to sex work to survive.
- Globally, according to UNDP, 35-70% of women are beaten, raped, or otherwise abused in their lifetime. Women and girls predominantly experience sexual violence, trafficking, domestic and intimate partner violence, harmful traditional practices (often ‘accepted cultural practices’ such as female genital mutilation, incest, dowry murder and honor killings), and crimes against women in situations of armed conflict, including forced pregnancy and slavery.
To counteract gender inequities, MSH advocates for the empowerment of women and girls as an essential step toward overcoming their exploitation and suffering. MSH believes women play a crucial role in ensuring the health of their communities so we work to build the capacity of women as leaders and managers, health providers and community health workers.
40 Years improving the Lives of Women and Girls
Over the last 40 years, MSH has enabled more accessible and efficient care for women and entire communities by integrating services and building the capacity of women as leaders, managers, technical experts, clinicians, and community health workers. The result is that women not only enjoy better health, but they are also empowered to improve the health and well-being of their families and neighbors.
Starting from the design, implementation, and evaluation of our programs, gender is addressed to determine gaps and identify opportunities where interventions can be implemented to meet the specific needs of women. The process of using a gender analysis identifies gender norms which should be reinforced, accommodated, and/or transformed to maximize health impact. We apply our expertise to strengthen the core components of effective health systems: leadership, governance & management, health service delivery, human resources, pharmaceutical & laboratory management, health care financing, and health information.
These core components indicated above work together to improve the health of women and girls. For example, in 2006 in Afghanistan, the Community-based Healthcare Project doubled the number of births attended by skilled health providers to 4,000 that year. Additionally the use of modern contraceptives increased from 16% to 26%, while more than 800 midwives educated 8,500 women in health-oriented basic literacy.
In Tanzania, nearly 4,000 licensed dispensers are owned by trained women who have been socially and economically empowered. This model is now being replicated in Uganda.
In Egypt, the worldwide Leadership, Management and Sustainability Program contributed to the decline in maternal mortality from 85 to 50 per 100,000 women. Similarly, the Local Initiatives Program in Bangladesh strengthened the management skills of health providers, resulting in 38,000 female volunteers who provide family planning services to their communities. This model is being replicated in India. As the leading partner of the Basic Support for Institutionalizing Child Survival Program, MSH has also developed strategies at the district, national, and global levels to deliver efficient health services to women and reduce preventable infant and childhood morbidity and mortality in more than 20 countries.
MSH advances gender equitable solutions for health issues that disproportionately affect women and girls, and strengthens understanding of approaches that promote their full potential, creating and expanding opportunities for them.
Reinforcing Positive Gender Norms and Male Involvement
MSH encourages women and men to work in creative, culturally sensitive, and effective ways within the communities we serve to promote gender equality. Through gender analysis and assessments, the roles, rights, and responsibilities of women and men are analyzed to identify and address obstacles, opportunities, and choices available to them both socially and within the health sector.
Moreover MSH encourages positive attitudes that lead to healthy practices through the use of community mobilization, effective behavior change, and communication strategies that engage influential leaders to support gender equity. In Guyana, the ministries of Health, Education, and Culture, Youth, and Sport work together to offer a youth life-skills training curriculum that includes positive gender roles, and the Ministry of Health engages men to play an active role in mother and child health, reproductive health, and family planning programs. As a result, the demand for family planning has increased and men have become supportive of optimal infant feeding practices. Furthermore, since the prevention of mother-to-child transmission (PMTCT) of HIV services is integrated into primary health care, couple counseling and testing for HIV, along with disclosure rates, increased.
Effectively Addressing Gender-Based Sexual Violence
While Sexual and Gender-Based Violence (SGBV) is in itself an epidemic, it is also one of the key HIV driving factors in countries with a generalized HIV epidemic. UNFPA also estimates that one third of the pregnancies in developing countries are unplanned. Both scenarios are intrinsically related to the inability of women to negotiate safe sex due to fear of psychological, physical, or sexual violence.
To address sexual and gender-based violence, MSH often collaborates with nongovernmental organizations, governmental agencies, and community groups working on gender issues. In addition to changing harmful gender norms and behaviors through a variety of effective communication approaches, health care providers are trained to identify survivors of violence within reproductive health, PMTCT, and triage services to make sure victims receive care and support.
Healthcare providers trained on gender and SGBV understand the relationship between gender and reproductive and sexual health to improve health outcomes. Such interventions lead to:
- higher rates of contraceptive use
- fewer adolescent pregnancies
- increased knowledge of HIV prevention
- increased male and female condom use
- lower STIs rates
- increased knowledge of sexually transmitted infections
- improved client-provider interactions
MSH Endorses International Accords and Commitments
MSH is guided by and promotes international commitments, such as:
- the 1994 International Conference on Population and Development (ICPD) in Cairo and its holistic framework for reproductive health and development, which links gender equity, human rights, and health, and the subsequent ICPD plus 15, which reaffirmed the commitment;
- Fourth World Conference on Women, Beijing Declaration 1995; and
- the Convention on Eliminating all Forms of Discrimination against Women (CEDAW), 1979
- the Millennium Development Goals (MDGs), which provide the latest guidance on addressing gender issues in health programs. Goal 3 specifically seeks to promote gender equality and empower women. MSH´s programs are aligned with the US President’s Global Health Initiative, specifically the Gender Supplemental Guidance on Women and Girls, and the Gender Equality Principle.