By Mallah Tabott
When I was in graduate school, one of my professors repeatedly reminded us that “everything is gendered”. Even though I struggled to fully understand how at the time, the work we do at the International Planned Parenthood Federation (IPPF) has been a rude awakening as to the gendered nature of healthcare in general and specifically SRHR service delivery.
As a global healthcare provider and leading advocate of sexual reproductive health and rights (SRHR) for all, it is important that we continuously reflect on how and whether our services are reinforcing harmful gender norms, ignoring them, or addressing the root causes of gender inequality in the communities in which we work. How can we, through our services, create an environment that is equitable and doesn’t discriminate against people based on their gender?
I recently attended a workshop organised by the WISH programme at IPPF, which gave us the opportunity to reflect around some these questions alongside colleagues from IPPF Member Associations in Africa. Is there equal status for all genders in the law? Are there laws that penalize individuals based on gender (e.g., laws criminalizing abortion, same sex relationships etc)? Do we hold unconscious bias? Are our healthcare providers trained on these nuances? Are adolescent boys and young men, including other non-conforming populations included in our services? Are our policies inadvertently reinforcing negative health-seeking behaviours. What roles are we playing as service providers, as programme managers, and even as institutions in addressing or reinforcing harmful gender norms via our service delivery?
Through my reflections, I seek to raise and hopefully respond to some of these questions to the benefit of myself and others working to provide access to SRHR services. What are signs that the services we render may be gender-blind, and what can we do about this?
Your organization lacks a gender policy
A first step in tackling gender inequality begins with an honest conversation with yourself as an organization about your understanding of gender and its application. This analysis involves identifying gender gaps and biases in your practices, programming, and services, understanding the internal and external bottlenecks hindering gender-transformative programming and subsequently repositioning yourself to implement more gender-transformative programmes through a gender policy. This is called a self-assessment, as is key to you understanding where you are as an organization.
Understanding the ways in which gender norms and power imbalances influence access to and control over SRHR information and services is crucial and a gender assessment and policy can help identify and address the root causes of SRHR inequities.
Your gender policy should cover all the areas where gaps have been identified, including but not limited to programming, staffing, and hiring, communication, services, advocacy, partnerships etc, and should be accompanied by an implementation plan. This is a first step in your organizational journey of gender transformative programming and provision of inclusive quality SRHR services. This first step should aim to embed gender equality and non-discrimination within the organisational structure and values.
Your service providers lack skill and confidence in providing sexual and gender-based violence (SGBV) services
Many structural barriers and harmful societal norms stand in the way of people seeking health services, especially those related to sexual violence and abuse. From unfavourable laws around rape and abortion, to stigma, discrimination, and shame which survivors and victims are forced to endure, when people succeed in jumping all these bottlenecks and make it to your clinic door, the last challenge they should face is a service provider ill equipped to solve their problems.
Given the regular interactions individuals have with health services, health providers are most likely the first point of contact a survivor would have, following a traumatic incident. This further highlights the important role of the health system within our communities and societies and why the lack of, or insufficient training for providers is a missed opportunity to contribute to a more equitable world. It is therefore critical to ensure that health providers are equipped with basic skills to offer first line support (at a minimum) to people who seek services, including referrals pathways to recognised specialised services.
Service providers who are not trained in gender-sensitive and trauma-informed care may provide services in a manner that reinforces gender norms and power imbalances. They should also be trained on how to provide services in a non-judgemental and empowering manner.
Your data collection tools are unsophisticated
We’ve done this for a long time – collecting “gender disaggregated data”. However, if we were to look closely, we would probably acknowledge that this data is binary, basic and blind. Men and women, boys and girls, age, and occupation, you name it. Clinic Management Information Systems (CMIS) must be designed to collect an expansive list of disaggregated data including on disability, gender identity, HIV status, sexual orientation, socio-economic status (class), race, education etc. Non-binary people, trans, intersex, and people from other genders should not be excluded in our data collection tools and practices. At the same time, data policies and systems should ensure confidentiality, safety, and security of client information.
However, there is a tendency to get trapped in data collection for the sake of data collection, as opposed to using it to inform how we run our programmes and improve how and to whom we deliver SRHR services to. We must truly Integrate gender in our data collection tools to help us ensure that we have a clear idea not just of who is seeking our services but how we should be improving our services for everyone – not just those we are biased towards.
Collecting sophisticated gender disaggregated data is also a first step in ensuring that health providers are not restricting or altering services based on user’s age, gender, or marital status e.g., parental consent for HIV testing.
You work in silos
As an organization, you do not work with a network of organizations working on gender-related issues in the country and community. From LGBT to SGBV, disability, sex workers, youth groups, women’s groups etc. There is also no referral system for vulnerable individuals in need of additional protection or safeguarding in cases where services are unavailable. Engaging with communities and building partnerships with local organizations can help ensure that SRHR services are responsible to the needs and priorities of those you serve.
Begin by assessing your partnership needs as an organization and then proactively reaching out to relevant network groups, organizations, and other healthcare facilities to create entry points for more inclusive SRHR service delivery. Your partnership assessment should be informed by the desire to do things differently, to challenge harmful gender norms which structurally exclude others, and to close the gaps in high quality SRHR services for all.
When your SRHR services are gender blind, it means they are not taking into account the different experiences and needs of individuals based on their gender. People face multiple and layered barriers when seeking and accessing SRHR services, from individual to community and structural barriers, and at IPPF we are on a journey of continuously learning and improving how we provide gender-transformative services. Walking away from gender-blind service delivery means working with women, men, trans persons, girls, boys, people with diverse gender identities and from all different backgrounds through an intersectional approach. This means providers treat all clients equally regardless of gender, age, class, disability, gender identity, ethnic background or sexuality.
To make services truly gender transformative, it is important to address and challenge power imbalances and gender norms that often drive unequal access to and control over SRHR information and services.
And before we leave, do not forget to monitor, and evaluate. Regular monitoring and evaluation of SRHR services is crucial for ensuring that they are indeed gender transformative and for making necessary improvements over time.
Mallah Tabot is the Lead, SRHR Programming and Innovation at the IPPF Africa Regional Office (IPPFARO).