Bài giảng Sức khỏe toàn cầu và giới tính - Lê Hoàng Ninh

Sức Khỏe Toàn Cầu và Giới Tính 
Global Health and Gender 
 GS TS Lê Hoàng Ninh 
Giới và sức khỏe toàn cầu 
• Women Gender and 10/90 Gap 
• HIV/AIDS and Women 
• Maternal and Reproductive Health 
• Missing Women 
• Gender Based Violence 
• Research on Gender and Global Health 
Gender and 10/90 GAP 
10/90 GAP = only 10% current global funding for 
research is spent on diseases that afflict 90% of the 
world’s population 
In developing countries- 
 • Women have less access to health care and 
 gender analysis to health research is lacking. 
 • There are distinct differences in patterns of 
 health and health outcomes when gender analysis is applied 
Nguyên nhân tử vong hàng đầu ở phụ nữ 
2001 
 HIV/AIDS 1.3 million 
 Malaria 592,000 
 Maternal Conditions 509,000 
 Tuberculosis 500,000 
Source: World Health Report 2002, 
World Health Organization 
HIV/AIDS and Women 
More than 50% of those living with HIV are 
women 
 < 1% globally have access to anti-retrovirals 
In sub-Saharan Africa nearly twice as many 
 women as men are infected 
HIV/AIDS and Women 
Potential reasons 
• Biological differences of risk of acquisition 
• Economic vulnerability leading to transactional sex 
• Coerced sex/rape/marriage 
• Inability to negotiate condom use 
HIV/AIDS and Women 
Sự khác biệt nguy cơ thụ đắc 
về mặt sinh học 
 • Several studies have shown that it is easier for a woman to 
 contract HIV/AIDS from a sexual contact with an infected 
 man than it is for a man with an infected woman 
• The presence of an untreated STI increases the risk to 
 contract 10X. STIs often do not give rise to any 
 symptoms in women so they remain untreated or 
 unrecognised 
• Coerced sex increases risk of micro-lesions; more frequent 
 for women, although also important in young boys 
Gender and Global Health 
• Women Gender and 10/90 Gap 
• HIV/AIDS and Women 
• Maternal and Reproductive Health 
• Missing Women 
• Gender Based Violence 
• Research on Gender and Global Health 
Tử vong mẹ 
(Maternal Deaths) 
Reasons for Maternal Deaths in 
Low Income Countries 
Low income countries - 53% attended during delivery 
 30% receive postnatal care 
Gender and Global Health 
• Women Gender and 10/90 Gap 
• HIV/AIDS and Women 
• Maternal and Reproductive Health 
• Missing Women 
• Gender Based Violence 
• Research on Gender and Global Health 
Missing Women 
Number of Women per 1000 Men, India 
Missing Women 
60 million “missing girls” mostly in Asia 
Reasons: 
• Neglect of female children in health care, admissions to 
hospitals and feedings 
• Female infanticide/abortions/dowry deaths 
• Maternal mortality 
Missing Women – Young Adults 
• DOWRY DEATHS: 
– Bride burning - Dowry Deaths India 
– 1987 - 1,786 dowry deaths in India (frequently 
kerosene burning) 
– Maharashtra state 19% deaths women 15-44 
“accidental burns” 
– < 1% in Guatemala, Ecuador 
• HONOR KILLINGS: (1000 Pakistan – 1999) 
Gender and Global Health 
• Women Gender and 10/90 Gap 
• HIV/AIDS and Women 
• Maternal and Reproductive Health 
• Missing Women 
• Gender Based Violence 
• Research on Gender and Global Health 
Violence Against Women - 
Internationally 
Female Circumcision and Mutilation 
 >80 million women in 39 countries worldwide have 
 undergone female mutilation of the external sex organs. 
 2 million annually undergo circumcision 
Violence Against Women - 
Internationally 
Definitions: 3 types of “female mutilation” 
1. Circumcision (type I - sunna) cutting of the hood of the clitoris 
(least severe) - least practiced 
2. Excision (type II - reduction) removal of clitoris and labia minora 
3. Infibulation (Type III - “pharaonic circumcision”) cutting of 
clitoris, labia minora and medial part of labia. Two sides of the 
vulva are sewn with catgut and a small opening is left for menses 
 Age: few days old (Ethiopia), 7 years (Egypt, Central Africa), 
 Adolescence (Nigeria, Tanzania) 
 Documented Female Circumcision 
Violence Against Women-Internationally 
Health Sequelae of Female Circumcision 
83% women will have a medical complication 
Immediate: 
 hemorrhage (within 10 days) 
 urethral damage or other adjacent organs, tetanus, infection, urinary retention from pain 
Long term: 
 chronic infections, scarring, pelvic infections, dysmenorrhea, dyspareunia (painful 
intercourse), difficulty with urination 
Effects on Childbirth: 
 need for de-infibulation 
 delayed labor-increased mortality 
 fistulas 
Unknown Effects: 
 ?HIV transmission, sexuality, psychological trauma 
A Life Cycle Approach 
Period of the Life 
Cycle 
Major Problems 
causing 
undernutrition and 
missing women 
Priority Action 
Infancy-childhood 
Male Preference Cultural 
consciousness about 
infanticide; 
nutritional and health 
needs of female 
children 
A Life Cycle Approach 
Period of the Life 
Cycle 
Major Problems 
causing 
undernutrition and 
missing women 
Priority Action 
Adolescence 
Early Reproductive 
Role 
Delay early marriage; 
Teach family planning; 
Female literacy; 
Nutritional 
supplementation 
Female literacy and health: 
1 additional year schooling = 3.4% reduction in mortality 
A Life Cycle Approach 
Period of the Life 
Cycle 
Major Problems 
causing 
undernutrition and 
missing women 
Priority Action 
Reproductive Years 
Multiple roles for the 
family 
Reduction of women’s 
workload; 
Economic independence 
 Frequency cycling, 
depleting with 
pregnancies 
Family planning; 
Iron supplementation 
A Life Cycle Approach 
Period of the Life 
Cycle 
Major Problems 
causing 
undernutrition and 
missing women 
Priority Action 
Later Years 
Marginalization and 
Dependency 
Public policy change for 
female land ownership; 
Social services for elder 
abuse 
Gender and Global Health 
• Women Gender and 10/90 Gap 
• HIV/AIDS and Women 
• Maternal and Reproductive Health 
• Missing Women 
• Gender Based Violence 
• Research on Gender and Global Health 
Gender “Mainstreaming” 
 Mainstream gender issues and awareness into 
 programs at WHO, UN, World Bank, 
 public health initiatives 
 Mainstream gender issues into research 
www.who.int/gender/en 
www.globalforumhealth.org 
Source: Abou-Gareeb, Lewallen, Bassett and Coutright. Gender and blindness: a meta-analysis of population based prevalence surveys. 
Opthalmic Epidemiology 2001; 8:39-56 
Source: Abou-Gareeb, Lewallen, Bassett and Coutright. Gender and blindness: 
 a meta-analysis of population based prevalence surveys. 
 Opthalmic Epidemiology 2001;8:39-56 
BURDEN OF BLINDNESS IN MEN AND WOMEN 
 Higher prevalence of blindness 
among women:Why? 
• Do the greater life spans of women account for the 
 greater burden of degenerative blindness? 
 - But more women are blind at all older ages. Must be 
 another explanation. 
• Is there differential mortality among blind 
 men/women? 
- Available evidence does not seem to suggest this. 
Higher prevalence of blindness among 
women: Why? 
• Studies show that women have a higher biological predisposition 
 to cataract than men, and a socio-cultural predisposition to 
 trachoma (i.e. through child care activities, household 
 environment etc). 
• Differential use of eye-care services due to differences 
 in gender roles and behaviors. 
• Studies have found distinct differences between men and women 
 in surgical coverage across age groups – access to cataract 
 surgery/trachoma 
 Gender Mainstreaming at 
World Health Organization 
• Gender and Women’s Health Department at WHO 
• Gender Team at WHO - 
 promote awareness into programs at WHO and 
 public health work 
• Gender Task Force – 
 senior level managers report gender 
 mainstreaming to Director General