Why Does Gender Equality Matter in Public Health?

By Dr. Nafsiah Mboi, Minister of Health for the Republic of Indonesia and Chair of the Board of the Global Fund

in Voices on 07 March 2014

Why Does Gender Equality Matter in Public Health?

Gender and public health are two branches of the same tree. This is one of the first lessons I learned when I started practicing as a pediatrician in my native Indonesia. In many societies, women and young girls do not enjoy the same access to health as men, let alone the same rights or opportunities. But a society that does not cure and treat its women and young girls with love and care and with equality will never be a healthy society.

So why does gender equality matter to the Global Fund to Fight AIDS, Tuberculosis and Malaria? As we celebrate International Women’s Day this is an important question to think about. Experience and evidence show us that gender inequalities often affect the ability of women and young girls to access care and other services, and fuel the spread of disease. Gender inequalities are a strong driver of HIV, tuberculosis and malaria epidemics. Women made up 52% of all adults living with HIV globally and 57% in sub-Saharan Africa in 2013.  Approximately two-thirds of new HIV infections in adolescents aged 15 to 19 were among girls. Tuberculosis is one of five leading causes of death among women in low and middle-income countries. In Africa, an estimated 10,000 women and 200,000 of their infants die annually as a result of malaria infection during pregnancy.

The Global Fund’s new funding model will ensure the world’s health investments reach the populations that need them most, and achieve greater impact. We have an opportunity to put women and girls at the center of our health interventions. We will be thinking and re-thinking with our partners about the importance of gender analysis in all aspects of our programs – management, problem identification, provision and utilization of information and service, public policy, community empowerment.

A classic statement on the subject of gender says that we are born male and female and that we learn to be men and women. Masculinity and femininity are socially defined.  They influence private opinion, societal behavior and public policy.  We define, we impose. But the good news is that we can also change. Following gender norms and values, societies reward certain behaviors and sanction others.  Gender concerns relate to us all and influence all of us. They cannot be seen only as a woman’s issue or a man’s issue. Gender analysis is the crucial tool to help us understand the differential impact of gender norms and expectations which may increase or decrease exposure to disease and may influence the way services are delivered and received.   For example, in many parts of the world if a person is diagnosed with a sexually transmitted infection the reaction may be very different in both the health care provider and the individual receiving the diagnosis depending on the patient’s gender. The man may be proud, the woman embarrassed. The man may be treated with a wink and a mild rebuke. The woman may be altogether shunned or scolded on the grounds that if she were a “good woman” she could not have such an infection. These discrepancies in how men and women are treated are often made worse for women of key affected populations, including women living with the diseases and those who are sex workers, use drugs or are transgender.

If we want to be successful in reducing new infection and mortality due to HIV, tuberculosis and malaria, we need to make sure that every intervention we fund – be it antiretroviral treatment, harm reduction programs, TB diagnosis or social mobilization related to malaria prevention – is delivered in such a way that it reduces gender-based inequities that threaten many women. The new funding model opens a number of opportunities to strengthen gender equality and to engage women and girls more fully in the way we design and implement our grants.

Human rights is an overarching concern of the Global Fund and identifying and addressing gender equity issues in public health is a prime example of the practical application of human rights in the world of the Global Fund.  If we embrace and champion the principles of gender awareness we will be more effective as agents of change, we ourselves will be empowered anew, and that will support empowerment of our partners for their health and enjoyment of fuller lives.

In Lobamba, Swaziland Mentor Mother Thandi Mnisi (left) met Sebentile Sukati (right) when she was 17 and newly diagnosed with HIV, during her first pregnancy.  Thandi helped Sebentile through this difficult time in her life and the two became fast friends.  Now both have become mentor mothers, working in their community and at the nearby health center.  Thandi, who lost both parents and a sister to AIDS recently gave birth to her third child, Buhlebenkosi, which means ‘beauty of the lord’.  Having received health services to prevent transmission of HIV from mother to child she has strong hopes that he will be HIV-negative, and councils other HIV-positive expectant mothers to adhere to their treatment.

For more information about Global Fund photos, please e-mail: photos@theglobalfund.org.

Copyright: The Global Fund / John Rae.