Interventions to combat gender-related barriers to health access

Health programmes should integrate actions to remove gender-related barriers to health.

Key legal, policy, and sociocultural entry points

Interventions to address gender inequality, harmful gender norms and gender-based violence are critical enablers for access to health care. Recommended interventions include review and reform of laws and policies as well as activities to strengthen access to justice and law enforcement.

A critical first step to building gender responsive and transformative interventions for health is conducting robust, participatory gender assessments to understand the unique cultural and structural factors in a given operating context. See the ‘Gender assessments’ page for more information.

Examples of interventions, to be informed by gender assessments and local priorities, may include:

  • Awareness-raising and sensitization programmes with young people to reduce gender inequality, raise awareness about different gender identities and reduce gender-based violence;
  • Dialogue, awareness-raising and sensitization programmes with religious leaders, traditional leaders and community members on harmful practices that violate the health and development rights of women, girls and other gender identities;
  • Law review and reform to strengthen gender equality in law and to eliminate gender-based violence and discrimination;
  • Legal literacy (“Know Your Rights”) campaigns to educate women, young girls and other vulnerable and key populations of their legal rights and avenues for redress for human rights violations;
  • Legal support services to support access to redress for discrimination and human rights violations on the basis of a person’s sex, gender, sexual orientation or gender identity; and
  • Working with law enforcers to address gender-based violence, including sexual violence, in the harassment and abuse of key populations such as sex workers and transgender persons.
Case study: Legal literacy to strengthen women’s health rights

In Nepal, a toolkit to empower women to protect their rights in healthcare settings has been rolled out, covering know your rights, how to access justice if rights are violated and how to improve transparency and accountability of health care providers.

Review of Country Progress in Addressing Legal and Policy Barriers to Universal Access to HIV services in Asia and the Pacific

COVID-19 and gender-based violence

Emerging data shows that gender-based violence has increased as a result of COVID-19 lockdowns. In France, reports of domestic violence increased by 30% and in Argentina, emergency calls about domestic violence increased by 25% after lockdown in mid-March 2020. Many other countries reported increases. UNAIDS recommends 6 key measures to address the needs of women and girls during COVID-19:

  • Address the different needs of women and girls, paying attention to the most marginalized, who experience a disproportionate impact due to existing, entrenched inequalities and gendered power dynamics.
  • Recognise and guarantee access to essential health services, including sexual and reproductive health care
  • Address increases in gender-based violence against women and girls
  • Prohibit the misuse of criminal and punitive laws e.g. through the use of COVID-19 regulations or the harsh enforcement of existing criminal laws against sex workers, lesbian and transgender women, women who use drugs
  • Prioritize adolescent girls’ and young women’s education, health and well-being, by e.g. ensuring gender-responsive approaches to remote learning, measures to keep girls in school and access to comprehensive sexuality education.
  • Value women’s work and make unpaid care work everybody’s work.

UNAIDS (2020) Six Concrete Measures to Support Women and Girls in all the Diversity in the Context of the COVID-19 Pandemic

Designing gender-responsive health programmes

There are several arguments for ensuring that health programs are gender responsive. The two key ones are a) rights-based: health programs are intrinsically mandated to contribute towards gender equality and b) for efficiency purposes: addressing gender inequalities in health risk, behavior, service uptake and care will enhance the efficiency of the program and lead to improved health impact.

A range of gender-responsive interventions have been designed and implemented across health programmes to date. While most have focused on providing services that address the gender-specific needs of women and men (e.g. for pregnant women or men who have sex with men-MSM); some have sought to factor in gender-related differences in their design (gender sensitive); and a smaller subset have sought to address and transform the causes of the inequalities (gender transformative).

Understanding different degrees of gender responsiveness

Gender unequal = perpetuates gender inequalities
Gender blind = ignores gender norms and inequalities
Gender sensitive = acknowledges but does not address gender inequalities
Gender specific = addresses specific needs of a gendered group
Gender transformative = addresses the causes of gender-based health inequalities and works to transform gender norms, roles and relations

In 2019, UNDP commissioned a review of the Global Fund-funded HIV, TB, and malaria programmes it supports to analyze the implementation of gender responsive activities, identify gaps in the response and capture key implementation successes and challenges. Led by the United Nations University (UNU), the review led to several recommendations of strategies and interventions to support the prioritization of gender-responsive programs in the context of national HIV, TB and malaria responses.

Key entry points for integrating gender responsiveness include the early phases of the grant cycle, including the analysis, programme design and prioritization of interventions, as well as accountability mechanisms for implementation. In particular:

  • Grant design: Knowing your epidemic includes understanding gender-related risks, barriers and inequities
  • Grant planning: Prioritise interventions that address gender inequities and promote greater equity
  • Grant performance: Be accountable to promoting gender equity

Learn more about key recommendations in these phases of the grant cycle here.

Case study: Training health workers to protect women’s health rights

In South Sudan, in its role as Global Fund Principal Recipient, UNDP supports a program to train health care workers to respond to GBV and refer survivors to a range of appropriate services. The provision of co-located psycho-social and legal referral services for women are a great example of the integrated service provision necessary to address gender-based violence and HIV. In addition, the program supports a number of behavioural change communication initiatives aimed at preventing GBV and supporting the use of GBV services, using the popular medium of radio. These messages are translated into multiple languages, including those spoken by internally displaced populations, and are aimed at removing the stigma and gender inequality that drives the HIV epidemic and often prevents survivors of GBV victims from accessing key HIV-related prevention services.

In Afghanistan, UNDP, as co-Principal Recipient of Global Fund grants for TB and building resilient and sustainable health systems, is supporting six non-governmental organisations to train women to become community health nurses. Women in Afghanistan struggle to access health care, since they must be seen by a female practitioner and be accompanied by a male family member – doubling travel costs and contributing to health inequity. With an increase in the number of female nurses available, Afghan women will have expanded access to health services, especially in rural areas. However, the development benefits go beyond health, also contributing to women’s empowerment and livelihoods in a country with very high female illiteracy and few education and employment opportunities for women.

Empowering adolescent girls and young women

Interventions that aim to empower adolescent girls and young women and strengthen their socio-economic circumstances are particularly important, given their unique health risks and needs. They may include:

  • Community mobilisation and building leadership amongst AGYW and young men, to strengthen their engagement in challenging harmful gender and social norms
  • Cash transfers and social grants to meet basic survival needs, help keep girls in school and prevent AGYW from entering into transactional sex or making partner choices based on economic necessities
  • Advocacy and support for programmes to keep girls in school, to reduce early marriage, risky sexual partnerships and increase opportunities for AGYW.
Keeping girls in school

Higher education is linked to reduced HIV prevalence in later life – it helps to create educated, more independent young women who are better placed to make healthy life choices.

HIV prevalence among young women who received an additional year of schooling in Botswana was 17% after 10 years, compared to 25% among those who did not receive the additional year of schooling. A study in South Africa showed that the risk of HIV for girls who stayed in school was reduced by two thirds.

UNAIDS (2016) HIV Prevention Among Adolescent Girls and Young Women

Case study: Mobilizing young women and girls in Angola to lead the fight against HIV

UNDP, UNFPA, Ajuda de Desenvolvimento de Povo para Povo Angola (ADPP) and the Global Fund have worked with adolescent girls and young women in Angola to combat the unique challenges they face to access HIV prevention and treatment services. Efforts to increase access to HIV testing services that are free of stigma and discrimination are vital. For adolescent girls and young women this means HIV approaches must be tailored to their specific needs so that information is shared by someone they can relate to and trust. HIV testing facilities must also be made available at sites they can access and where they feel comfortable. Responding to this clarion call are women-led community groups known as Bancadas Feminanas – which translates to ‘women’s band’. Led by trained female Activistas, the groups work in local neighbourhoods, using local languages, to increase awareness of HIV and health issues and to encourage women and girls to know their HIV status. Group leaders receive training on social mobilisation and HIV, and meetings are advertised via school and church networks. The trained Activistas also promote the meetings in their own neighbourhoods and marketplaces to help reach adolescent girls who are out of school.

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