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Medical Education with a Gender Sensitive Lens

Rituparna Dutta | 14 Jan 2015

The WHO’s states that the enjoyment of the highest attainable standard of health is one of the fundamental rights of every human being without distinction of race, religion, political belief, economic or social condition. During the mid-late 1990’s gender and social role became variables of social analysis that explain recurring social, institutional and structural disadvantage to women. It became clear that, unless structural adjustment and health service reform and social service development programmes addressed gender inequity at all levels, they would continue to be ineffective. The outcome has been that ‘mainstreaming of a gender perspective’ has become an integral part not only in UN and WHO development programmes but throughout the entire UN system and into government, non-government and other social institutions worldwide. In 2002, the World Health organization adopted a gender policy committing itself to promoting gender equality and equity in health and to redressing health inequities that are a consequence of gender roles and unequal gender-relations in society.

 

Though there is widespread acceptance of gender equality, but when it comes to healthcare, we see an inequality in health status between men and women, and women’s unequal treatment in health care. In fact, in most medical, health and prevention issues related to women’s health, the central issue is male-female power relations, and not merely the lack of health services, medical technology or/and information. Women’s experiences and realities, clearly testify the concerns that require urgent, systematic and global intervention and change. Gender analysis is crucial to distinguish between biological causes and social explanations for the health differentials between men and women, and to understand that these gaps are outcomes of the unequal social relations between men and women, and not merely due to consequences of biology. Gender analysis will transform the biomedical and gender bias currently imbedded in medical education and research, so as to better serve the health needs of women.

 

Women’s health needs are often regarded to be restricted only to reproduction. The gender bias is reflected clearly, such that, within medicine, women’s health is relegated to only obstetrics and gynaecology; and within public health, all women’s health needs are expected to be met by maternal and child health programs. This is because women are primary seen as mothers and wives, rather than human beings having health needs. Thus, women’s non-reproductive health is either invisible or not emphasised. For instance, despite women having been part of the labour force for so long, their occupational health have often been ignored. Not only is women’s health defined by their reproductive role, it is often misunderstood because women are always viewed as a homogenous group. In reality, women’s health or illness, pertaining to reproduction or not, are differentially experienced according to social class, race/ethnicity and so forth. For instance, while among older women, breast cancer is more common among the rich, cervical cancer tends to affect more poor women than the affluent. Research has shown that black women, within each income level, are more likely to suffer from hypertension than white women.

 

Depression is found to be a major occupational illness among housewives because women are brought up to express their problems in the form of depression. In reproductive health, such as contraceptive use and family planning, women lack decision-making power to negotiate about sex, childbearing and contraception as husbands assume sexual access and control. While a husband can, and often does, refuse to use contraceptives despite his persistent sexual demands, women find themselves caught in their conflicting roles as solely responsible for family planning, and at the same time are expected to be sexually available to their husbands. In some developing countries, ill women still need their husbands’ approval before they can go out to seek medical treatment or health care. Or, when they do arrive at the hospital, there are numerous medical procedures that require their husbands’ signatures. Thus, it is clear that gender roles and male-female power relations rather than biology that underpin women’s health and well-being.

 

Mainstreaming a gender perspective into medical curricula therefore means integrating gender concepts, or making gender concepts more ‘mainstream’, common or everyday within medical education and practice. The purpose is to identify all points at which gender roles limit access to and equity in improved health and social development in the social, structural and institutional context of individuals. Practically it means acknowledging where difference is important throughout the entire curriculum and teaching process, in clinical practice and in policy development, and providing balance where needed.

 

The integration of gender competence or ‘a gender mainstreaming programme’ is aimed at addressing the imbalance between the male oriented medicine that is taught and practised in medical school and the coherent ‘gender competent’ strategies that are needed for modern clinical practice in health care settings internationally. Health care personnel are uniquely placed to address issues related to gender and gender inequalities, sexuality, violence, and many culturally defined norms that increase vulnerability to human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) and adversely affect the health of women in many societies. Integrating gender into the curricula for health professionals with a focus on gender based violence and discrimination will ensure that these issues will be addressed in health policies and programmes.

 

Indeed, integrating the gender perspective into the medical curriculum by incorporating the principles and practice of women’s health speciality is a good beginning. Yet such a transformation will involve drastic ideological changes and not mere reforms in the curriculum.

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