Gender Initiatives

In a country where the male-female morbidity ratio is blatantly skewed and maternal mortality is as high as 437/10,000 live births (1994-95), it is imperative to inculcate an awareness of the need to achieve gender parity in the sphere of health. Over 50 per cent of Indian women suffer from anaemia, and 12 to 15 per cent of deaths among rural women are in the child-bearing age.

Men have greater access to quality health care, and the fact that most service providers at the PHC and higher levels are men acts as an additional deterrent. To make matters worse, the culture of silence in which Indian women are bred inhibits them from voicing their needs—a majority do not even know where to seek help or what to ask for.

In its attempts at gender-sensitization, DANLEP has, first and foremost, tried to spread the message that gender-sensitive health care does not pertain merely to the reproductive health of women. Health providers, as well as the community, must understand that unlike sex, which refers to a biological difference, gender refers to the socially and culturally determined identity of the sexes. It must be understood that gender disparities arise from educational and social biases and are thus reversible.

DANLEP has made sustained efforts to empower women, which means enabling them to make informed choices (after, of course, giving them options to choose from), as well as empowering them to exercise greater control over resources and decision making. It was with this aim in mind that women's issues were incorporated in all of DANLEP's activities from the start of the programme in 1986.

Workshops on gender have been a major tool in all 3 states. The first was held at Ootacamund in 1995, followed by a series of workshops at Puri, Durg and other places. These workshops helped women articulate their perceptions and needs, and helped them to take measures to improve their lot.

In 1996, a Gender Core Team was set up to formulate DANLEP's gender policy, the goals of which included:

• Increasing women's access to health care.
• Addressing their health needs for their entire lifetime.
• Promoting women-centred health research.
• Redesigning health information and services, as well as training of health workers, to make it more gender-sensitive.
• Developing and implementing gender-specific IEC programmes.

This was followed by a series of initiatives, including attempts to sensitize policy-makers, NGOs and members of the local administration.

A major component of the activities in all 3 states has been the provision of training on gender issues to health workers at all levels. Some examples are the pilot project undertaken in Tamil Nadu in 1998-99, and a similar programme for the trainers of nurses in Behrampur in 1996. In Orissa and Madhya Pradesh, attempts have also been made to broad-base the campaign by mobilizing women's groups at the grass-roots level. The involvement of cadres from other programmes and agencies (e.g., ICDS and NYK) has benefited the cause in Madhya Pradesh.

The wheels have been set rolling and certain lessons have emerged in the process. Experience has shown that the process of gender-sensitisation and training must be a continuous one, and should encompass not only health workers and women, but men, administrators and NGOs as well. The state has to formulate a clear policy and play a more active role. Finally, there is a need to co-ordinate efforts at all levels.

Tamil Nadu Experience

Madhya Pradesh Experience

Orissa Experience