Empowering Women and Girls: The Impact of Gender Equality on Public Health
This article first appeared on The Lancet Global Health Blog on August 8, 2014. It is republished with kind permission from the editor.
Several news stories in recent months have illustrated gender inequalities on a global scale. Social media campaigns like #YesAllWomen and #BringBackOurGirls have helped to raise awareness of injustices and encourage female empowerment. What has gone mostly unspoken in these discussions, however, are the ways in which these social inequalities affect public health.
Dr. Nafsiah Mboi, Indonesia's minister of health and chair of the Global Fund to Fight AIDS, Tuberculosis and Malaria's board, has said that "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."
Many in the global health community are working to weave a focus on women and girls more tightly into the framework of global public health efforts. The Global Fund, for its part, is committed to addressing the social, legal, cultural, and biological issues that underpin gender inequality and contribute to poor health outcomes. As the world's largest public health financier, it has been supporting programmes to address the health needs of women and girls, including investing in more than 10 percent of the total foreign aid for maternal and child health every year since 2005. It is also supporting half of all women receiving antiretroviral treatments for HIV/AIDS in Africa. In addition, at its March board meeting, the Global Fund launched a new Gender Equality Strategy Action Plan, placing increased priority on addressing gender inequalities and strengthening efforts to protect women and girls' rights to health care.
Reaching women and girls is critical to achieving impact. HIV/AIDS is the leading cause of death worldwide for women aged 15-44 years. Globally, adolescent girls and young women aged 15-24 years are twice as likely to be at risk of HIV infection than boys and young men in the same age group. Among adult women ages 20 to 59 in low-income countries, tuberculosis is one of the five leading causes of death. And, in Africa, an estimated 10,000 women and 200,000 of their infants die annually as a result of malaria infection during pregnancy.
Gender inequalities are a strong driver of HIV/AIDS, tuberculosis, and malaria. Women and girls tend to have unequal power in sexual relationships, economic decision-making, and access to health information and services, all of which greatly influence their vulnerability to disease. Traditional power dynamics among couples may undermine a woman's ability to receive antenatal care, including services to prevent mother-to-child transmission services (PMTCT) when an expectant mother is HIV-positive. Gender politics can prevent a woman from accessing insecticide-treated nets to prevent malaria, or from taking malaria-stricken children to health services without a partner's permission. Transgender women, sex workers, and women who use drugs are also particularly marginalised, and face challenges in access to health care. The action plan is designed to address these harmful gender norms and scale up services to reduce gender-related vulnerabilities to infection.
The Global Fund action plan is also strengthened by the 2013 rollout of the new funding model, in which country coordinating mechanisms (CCMs)—the group of government, civil society, and health partners that identify a country's needs, apply to the Global Fund for financing, and provide implementation oversight—is charged with integrating gender issues into their health plans. Under the new funding model, a country's CCM is required to: establish greater gender balance among its membership; provide analysis of gender inequalities and related disease response; produce evidence-informed programming with sex- and age-disaggregated data that demonstrates investment for impact; and respond to the needs of most-at-risk populations of women, specifically female sex workers, transgender women, and drug users.
The Global Fund is also working to empower civil society organisations, including organisations of women who are living with or are directly affected by the three diseases, by conducting comprehensive training on gender issues, identifying capacity gaps, and providing technical assistance. The Global Fund has already trained more than 100 women in 33 countries on the strategy—with further training planned—to help enhance the involvement of civil society and gender advocacy in Global Fund-funded health programmes and community systems.
The gender equality plan is already having an impact. For example, during its 2013 grant review process, Cambodia expressed a willingness to expand HIV interventions addressing the vulnerabilities and specific needs of women and girls. To that end, the Global Fund's grant approval committee recommended that the country set aside a certain percentage of money for programmes directed at this population. To help ensure measureable results, conducting a gender assessment of the national HIV responses has also been built into the grant as a requirement for future funding. Together, the Global Fund, Cambodia's ministry of health, and partners are accelerating efforts addressing gender-related challenges in HIV responses.
Gender-focused health strategies can act as a catalyst for global change in the health and social welfare of women and girls. As former secretary of state Hillary Clinton said at the 2012 Global Health Summit, "improving women's health has dividends for entire societies." We must, as the Global Fund's Dr. Mboi suggests, consider health and gender holistically, helping women and girls achieve a better quality of life and increasing our impact in the fight against HIV/AIDS, tuberculosis, and malaria.blog comments powered by Disqus