NURSING MATTERS

Nursing Matters fact sheets provide quick reference information and

international perspectives from the nursing profession on current health and
social issues.

Mainstreaming a Gender Perspective

into the Health Services
The concept of gender refers to womens and mens roles and relationships
that are shaped not by biology but by social, economic, political and cultural
factors1.

Why take a gender perspective?

Worldwide, women experience inequality far more markedly than men,
especially in sharing wealth, employment opportunities, participation in public
life and access to services such as health and education. A gender
perspective acknowledges the importance of both sexes in contributing to
development and promotes the equitable distribution of resources,
opportunities and benefits. A gender perspective:

Recognises different gender roles.

Stresses the need for both men and women to have access to and
control over resources and decision-making processes.
Acknowledges that men and women have different experiences
and needs.
Gives equal weight to the knowledge, values and experiences of
men and women.
Ensures that both men and women are involved in identifying their
needs and priorities.
Integrates gender awareness and competence into mainstream
development.

What does mainstreaming the gender perspective mean?

The United Nations Social and Economic Council (ECOSOC) defined
mainstreaming as:
... the process of assessing the implications for women and men of
any planned action, including legislation, policies or programmes, in
any area and at all levels.
It is a strategy for making womens as well as mens concerns and
experiences an integral dimension of the design, implementation,
monitoring, and evaluation of polices in all political, economic, and
societal spheres so that women and men benefit equally, and
inequality is not perpetuated2.
A major outcome of taking this approach is that gender equality will not be
treated merely as a womens issue. It is a central societal concern requiring
acknowledgement that the different health experiences and health care needs
of women and men need to be translated into health policy and planning3,4.
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Mainstreaming gender in health care delivery

Experience of the Commonwealth Secretariat in introducing a Gender
Management System to governments and health services in member
countries indicates that two critical elements need to be in place for success:
1. Sensitisation and training in gender concepts. Poor awareness or
gender blindness is often at the root of bias and prioritisation of male
interests by policy makers, planners and health service managers.
2. Political commitment at the highest government level5.
In her paper for the meeting on Women and Health: Mainstreaming the
Gender Perspective Into the Health Sector6, Doyal identified a number of
questions for health policy makers and planners to use in clarifying their
understanding of gender issues that may be operating. The questions include:

Do gender differences in daily life expose man and women to

different kinds of health risks? For example how do sex and gender
differences affect susceptibility to infectious diseases, including
STDs and HIV/AIDS? Are male and female health care providers
differently affected by violence in their daily work?
How are gender differences in the utilisation of the services to be
explained? For example do the hours when clinics are open make it
difficult for women to attend? Do lack of mobility and other social
constraints discourage women from seeking services?
Can any differences be observed in the quality of care women and
men currently receive? For example socialisation and attitudes of
many doctors and nurses may deprive women of having the capacity
to give informed consent or refuse treatment.
Who currently controls access to health related resources, and do
allocation criteria take account of the different needs of women and
men? For example are women sufficiently represented as policy and
decision-makers in the health sector so that their voice is heard
when it comes to decisions about allocation of resources and health
care priorities?
Do gender relations in the health service affect the experience of
users? For example does the limited degree of control over
decisionmaking that many nurses (most of whom are female)
experience with respect to their work make a difference to the quality
of the service they provide?

Policy makers and planners carrying out health sector reform need to ask a
further series of questions to ascertain that reforms are indeed improving
womens position with respect to men and not further aggravating it. It may be
useful to examine the following areas:

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What would be the impact of health sector reforms on the functioning

of males and females who work in health care bureaucracies? For
example how will reform affect promotion and professional and other
aspects of personal development? Will reform remove existing
barriers such as civil service rules, rigid hierarchical structures and
seniority patterns that often discriminate against women?
Will de-centralisation of health care improve access or create even
more barriers for vulnerable groups? For example will the resources
be transferred to the periphery in a sufficiently equitable way so that
poorer areas have the funds to meet the health needs of vulnerable
groups such as poor women7?
Will womens health needs be met in a mixed form of health services
requiring funds from sources other than public funds? For example
how will user fees affect women who tend to be poorer, have less
access to paid work, and therefore less disposable income?

Implications for nursing

Putting gender issues into the policy and planning process
There is a relative absence of women, and more specifically nurses, in most of
the arena of health policy formulation, programme design, planning,
implementation and evaluation. Experience indicates that success in reaching
more equitable participation for women is more likely if there is a national or
regional policy framework that makes gender equality one of its goals.
National nurses associations (NNAs)8 can be effective in promoting this
approach through:

Advocacy work at all health service levels, with legislators and other
influential leaders. However, NNAs first must develop a clear
position on gender mainstreaming, and identify strategies that will
work in their political, legal and social structures.
Using their relations with the media to promote a gender sensitive
approach to health care.
Forming partnerships with other groups who share common interests
(for example womens and development groups) to promote the
concept to the public.
Promoting access of nurses to appropriate programmes that will
enable them to acquire the competencies and confidence required
for active participation in health policy and planning activities.

Capacity Building
As well as increasing gender awareness through gender sensitivity training
for both sexes, the United Nations Development Programme (UNDP)
recommends that three skill areas be developed for both managerial and
operational success in gender mainstreaming activities.

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1. Analytic skills to identify and understand the differences, inequalities and

impact of gender in the political, social and economic aspects of a country,
region or community.
2. Advocacy and communication skills to advocate successfully for the
consideration of gender perspectives.
3. Decision-making skills to be able to contribute to key decision-making
processes9.
For further information, please contact: icn@icn.ch
The International Council of Nurses (ICN) is a federation of more than 130
national nurses associations representing the millions of nurses worldwide.
Operated by nurses and leading nursing internationally, ICN works to ensure
quality nursing care for all and sound health policies globally.
FAA/2000

References
1

NGO Forum for Health and Committee on the Status for Women (Geneva). Health
for All Means Women and Men: A Gender Perspective. Report of a meeting held
in Geneva, 28 October, 199
2
United Nations. Substantive Session of 1997, Agenda item 4. E/1997/L.30, para.
4, Geneva, 1997
3
International Council of Nurses. ICN on Womens Health. Nursing Matters, 1999
4
International Council of Nurses. ICN on Mens Health. Nursing Matters, 1999.
5
United Nations & Commonwealth Secretariat. Women and Health: Mainstreaming
the Gender Perspective Into the Health Sector. Report of the Expert Group
Meeting. EGM/HEALTH/1998/Report. New York, UN, 1998.
6
Doyal, Lesley. A Draft Framework for Designing National Health Policies With a
Gender Perspective. Paper prepared for the Expert Group Meeting, Women and
Health: Mainstreaming the Gender Perspective Into the Health Sector, Tunisia,
October, 1998.
7
International Council of Nurses. ICN on Poverty and Health: Breaking the Link
Nursing Matters, 1999
8
Haselgrave, M. The role of NGOs in Promoting a Gender Approach to Health Care,
Paper prepared for the Expert Group Meeting, Women and Health:
Mainstreaming the Gender Perspective Into the Health Sector, Tunisia,
October, 1998.
9
United Nations Development Programme. Gender in Development at the web site
http://www.undp.org/gender/
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