Addressing Gender Issues with Men and Couples in a Reproductive Health Service in Ecuador: A Case St - PowerPoint PPT Presentation

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Addressing Gender Issues with Men and Couples in a Reproductive Health Service in Ecuador: A Case St

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International Health and Human Rights Program ... Media campaigns stressing services for both men and women (1996) & urology services (2000) ... – PowerPoint PPT presentation

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Title: Addressing Gender Issues with Men and Couples in a Reproductive Health Service in Ecuador: A Case St


1
Addressing Gender Issues with Men and Couples in
a Reproductive Health Service in Ecuador A Case
Study in Organizational Change
  • Bonnie Shepard, Senior Program Manager
  • International Health and Human Rights Program
  • François-Xavier Bagnoud Center for Health and
    Human Rights

2
Ecuador
  • Small, but geographically and culturally diverse
  • 13 million population, 37 rural
  • 35 indigenous minorities
  • Low-income country
  • 52 earn less than US2 a day
  • Reproductive health
  • Maternal mortality 210 infant mortality 33.4
  • Fertility rate 2.87

3
Institutional context
  • APROFE IPPF affiliate in Ecuador
  • 20 clinics in 15 cities and towns
  • Mainly serves urban and peri-urban population
  • Now serves low-middle income strata
  • Withdrawal of external funders
  • Main support historically came from USAID, and
    from IPPF

4
APROFES GOALS
  • Increase sustainability by increasing numbers of
    paying users
  • Implement IPPF Vision 2000 and ICPD/Beijing
    principles
  • Comprehensive approach to health
  • Respect for reproductive rights
  • Commitment to womens empowerment and male
    involvement

5
APROFEs strategies 1990s
  • Increase numbers of paying users
  • Diversification of services (including sexual
    health)
  • Increased marketing
  • Quality of care with a gender framework
  • Male involvement
  • Serving couples, and increasing numbers of male
    users
  • Implement IPPF Vision 2000 and ICPD/Beijing
    principles
  • Train providers in gender issues
  • Quality of care training emphasizes respect and
    warmth
  • Treat the whole person through diverse services

6
Gender-related health risks
  • Male norm of multiple partners
  • Male work entails travel away from home
  • Low priority to women and girls in allocating
    food
  • Violence among men, risk-taking behavior
  • Violence against women, coerced sex
  • Mens reluctance to seek health care
  • Lack of male involvement in FP
  • Women have sole burden of housework and child
    care, less leisure than men

7
Gender-related Obstacles to Increasing of Male
Users
  • Stereotyped attitudes towards Men
  • Male Attitudes to Health Care
  • Child Care
  • Men demand higher quality of care

8
Male Involvement in APROFE
  • Male clinic 1991-1993 a failed strategy
  • under-used
  • Image of APROFE as women-only
  • resistance to vasectomies
  • Donors mainly interested in CYPs
  • sex segregation
  • Impractical surgical facilities in female
    clinic, and women invaded male clinic
  • Unnecessary Men expressed no need for it
  • Not conducive to sexual health, which mandates
    treatment of couples

9
Broader Focus for Male Involvement mid-1990s
  • From FP and CYPs to reproductive and sexual
    health, gender equity
  • Focus group study 1997
  • Men didnt want male clinic. They wanted quality
    care and friendly treatment
  • Low opinion of APROFE services felt excluded.
  • Need was established multiple partner norm, high
    risk before marriage, low acceptance of FP methods

10
Strategies for Male Involvement
  • Jan. 1998 protocol to encourage involvement of
    female users partner
  • Media campaigns stressing services for both men
    and women (1996) urology services (2000)
  • Changes in hours, appointments

11
Success in Increasing Numbers of Male Users
12
Indicator of couples served
  • 1999 to 2000 of couples served doubled in the
    4 clinics in the study
  • 2001-2002 In Guayaquil clinics, of users
    increased by 11, while of couples seen
    increased by 74.

13
Indicators in Incorporating Gender Frameworks
  • Indicators for providers
  • 1st stage Accept social construction of gender
    roles
  • 2nd stage Understand risk factors and gender
  • 3rd stage Actively promote gender equity

14
Treating the Couple and Gender Issues
  • Balancing male involvement and users rights to
    privacy
  • Need to ask users consent in private
  • Diplomacy and subterfuge needed sometimes in
    order to speak to women privately
  • Need to ask consent at each stage teamwork
    essential
  • Dealing with patterns of male domination
  • Providers encouraged women to speak
  • Some providers advocated on behalf of women to
    get men to accept treatment needs

15
Practical vs. strategic gender interests in
sexual health
  • Practical interests are short-term, solvable
  • e.g. curing an STI, providing information to help
    prevent a future STI
  • Strategic interests are root causes
    discrimination, power imbalances, and sexual
    gendered norms
  • e.g. addressing inequities in gender roles that
    put women and men at risk of STIs

16
APROFEs Achievements in Addressing Practical
Interests
  • With most couples, practical interests addressed
  • Standard approach
  • focus on treatment, not blame future, not past
  • referrals for counseling
  • Barriers
  • Highly emotional situation
  • Patterns of male domination made treatment
    impossible in some cases

17
Lessons Learned on Male Involvement with Gender
Equity
  • Personal invitation by female partner most
    effective in increasing mens clinic usage
  • Educational outreach necessary to fully address
    strategic gender interests
  • Continuous quality of care supervision and
    training needed
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