Let’s talk about sex and gender
The term “gender” is sometimes used interchangeably with “sex,” but for those of us creating health innovations and working to increase equity, we must parse words. “Sex” refers to a biological distinction: male versus female. When we talk about “gender,” we’re talking about a person’s identity and how the world and their environment interact with them based on that identity. Unlike sex, gender isn’t binary, and gender equity isn’t exclusively about equity for women—although public health programs designed to increase equity for women are a big part of the conversation.
Why gender matters
When we develop solutions to health challenges, we consider the role that gender plays in the lives of those we are trying to serve. Gender norms, social roles, and community expectations for men, women, and other gender identities are learned and ingrained in society, and can look different in different cultures.
But how does a gender perspective support real-world improvements in health for people and communities?
Samuel Oduor Wangowe carries his son Carl on his shoulders. Samuel lost another young son to malaria and has dedicated his career to educating others about the disease. He hopes his Carl will one day receive a malaria vaccine. Photo: PATH/Jordan Gantz.
1. Who’s calling the shots?
Traditionally, people in many places would say that raising children—feeding them, taking care of them when sick, preventing injuries—is “a woman’s job.” But, a mother’s lower status in the home can lower her capacity to do what is best for her children.
In reality, fathers often (and sometimes mothers-in-law) decide who will get the money for transportation and take time away from work to take the child to the health center. When parents decide together to prioritize immunization, the child health dividends are huge. Men can be change leaders in child health, by supporting mothers day to day and leading the call for immunization in their communities.
Together with other immunization leaders, we’ve drafted a report on looking at gender to advance immunization equity. In this report, we’ve listed concrete recommendations for targeting fathers, not just mothers, for immunization information and other actions that can lead to change. Because shifting “women’s work” to “parents’ work” will make all the difference to the health of the family.
Health care workers in Tanzania are using digital tools to improve care. Photo: PATH/Trevor Snapp.
2. Who counts and who’s counting?
Digital health is a game changer for primary health care. But like all game changers, you can only win if you’re at the table. Looking at routine health data by age and sex can tell you a lot about who faces specific disease risks, who is accessing testing services, and who is sticking to treatment. This information can provide signposts for gender inequities and barriers to health care. For example, it can tell you if men are having more difficulty adhering to tuberculosis treatment than women, or if new HIV infection patterns are different for adolescent females compared to males.
In addition to the data itself, the tools we use to collect data matter. Tools that make it easier for health care workers to enter data using mobile devices can improve the speed and accuracy of collecting and analyzing this vital information.
In many countries, women have less access to mobile device technology and less data training in general than men. As we work to expand access to these tools, we must be aware of any potential gender biases in terms of who gets trained and who has the opportunity to lead these exciting developments. We will only get the best information when we ensure equal input into the design and use of digital health technologies.
Closing the digital divide is not only the right thing to do, it’s the smart thing to do.
3. Power in her hands
In some communities and cultures (in every country in the world), prevailing gender norms mean that many women (including adolescent females and young women) do not have a say in when, with whom, or under what circumstances they have sex. This basic power imbalance contributes to their high HIV vulnerability. It is difficult for younger women to ask their partner to use a condom, and this and other challenges have fueled higher HIV infections in young women compared to men.
Pre-exposure prophylaxis (PrEP) is a combination of drugs that is highly effective in preventing HIV when taken properly. It’s a powerful tool that both men and women can use on their own, without having to negotiate with their partner.
In Kenya, where PATH and partners are implementing HIV prevention and empowerment activities for adolescent girls and young women through the DREAMS project, health care providers are directly linked to DREAMS groups. This allows providers to help young women with a variety of health needs, including access to PrEP.
PATH has also been working with partners toward the development of a microarray patch for PrEP that offers multiple benefits by delivering HIV prevention and contraceptive drugs. In Kenya, South Africa, and Uganda, we’re engaging directly with women and health care workers for their input into this innovative product design.
Providing HIV prevention options that can work for everyone, including women, is an important part of reducing gender inequities.
Gender equity in programming
These are just a few examples of the ways that we promote gender equity in our work at PATH; this list of three is by no means all. We’re engaged in a continuous effort across the organization—and in our partnerships—to use a gender perspective as we create equitable solutions to drive better health for everyone.
Editor's note: The MAPs for PrEP project and DREAMS activities (through the Afya Ziwani project) are made possible by the generous support of the American people through the United States Agency for International Development (USAID) through the United States President’s Emergency Plan for AIDS Relief (PEPFAR), under the terms of Cooperative Agreement #AID-OAA-A-17-00015 (MAPs for PrEP) and Contract #AID-615-C-17-00002 (Afya Ziwani). The contents are the responsibility of PATH and do not necessarily reflect the views of USAID, PEPFAR, or the United States government.