GENDER AND HEALTH
Item
- Title
- GENDER AND HEALTH
- extracted text
-
RF_COM_H_74_SUDHA
Engi.ndluini.I I I AH II
Dr.MaryPoonenLukose
(1887-1976)
Born on 2nd August 1887 into an
the hurdle was
in
the
form
of racial
aristocratic Christian family of central
Travancore as the daughter of a medical
discrimination. The post she applied for was
doctor Dr. T.E. Poonen gave Mary Poonen
Government turned down her application
Again her royal connections helped and given
her excellent credentials she got an appointment
more opportunities than an average Indian
woman. But even then, she had to face a lot of
trials and tribulations in her life in a male
dominated society of Nineteenth century. She
reserved only for white people and the British
as Obstetrician in the Government hospital for
had her schooling in Trivandrum and passed
women and children in 1916. She was appointed
as the ActingSurgeon General of Travancore in
the matriculation with high marks. The first
discrimination was in the form of denying
in the world.
admission to take science as a subject in the
college as women were denied admission in
science stream. She had the opportunity to do
BA History only. This was at least possible
becauseof her fathers' contacts with high class
Hindus and the Royal family. She graduated
in 1909, the first lady graduate from Madras
university. Her desire to become a doctor like
1924. She was the first woman surgeon general
She did pioneering work in the hospital to
reduce mortality and morbidity. She started
training students in midwifery as well as retrain
scientifically the local dais. She even delivered
her first child in this hospital. It was her
tremendous efforts that led to the establishment
of Nagercoil TB Sanatorium and the X-ray and
Radium Institute in Trivandrum. She was verv
her father was a big hurdle as no women
students were allowed in medical colleges in
active in the social sector of Trivandrum. She
was the first lady legislator in Travancore in
India. However, she was determined and got
her medical graduation from London
1922 till 1937.
University. She did her post graduation in
Her husband was an advocate. Mr. K.K.
Obstetrics and Gynaecology from UK and
Lukose, who later became a Judge of High Court
of Travancore. She had two children She died
further training in Paediatrics. She stayed in
London till 1916.
Finally the time had come for her to return
to India. In the meantime her father had
passed away and all their wealth had been
looted. She decided to stay back in Kerala.
Getting a job for a UK trained Indian ‘native’
Obstetrician was not easy again and this time
AMCHSSQUARTERLY
in 1976 at the age of 90
Reference:
I.
APioiieerinMediciiie-Dr.MivyPoonenl ukose.
K. Rajasekharan Nair, Samyukta July 2002.
Vol II; 2; 117-121
__
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2/4/04
Pagei of 4
Page 1 of 1
Main identity
From:
To:
Cc:
Sent:
Attach:
Subject:
‘ Anant Shan” <dranantbhan@yahoo.com>
<sochara@vsnl.com>
<phmsec@toucntelindia.net>
Friday, November 28,2003 3 38 PM
Engendering Heaith-Oct-Decf1j.2003.pdf
Newsletter
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Dear Ur. I itelma and Ur. Ravi,
Please find attached the pdf version of the first issue of the Engendering Health Newsletter.
I win send you the hard copies soon.
Warm Regards.
AHuiIi
Do you Yahoo!?
Free Pon-Un Blocker - Get it now
12/1/03
ngendering Health
1
MainArtide
♦ (jcnderiruMedicalEduauion
No. 1
October-December2003 Volume!
AX’hjcheneed
-Dr AnantBhan
GenderinMedical
Education :Whytheneed
5
*=> NewsUpdates
ResourcesSecrion
5
«=> Article
6
* (k-ndepISsuesiriDepression
o
-Dr.Ar.ivindP.
«=> Research Reports on
♦
GcnderedLens
10
AnnalsofMPH
11
BulletinBoard
12
Cou rseAnn oun cem en cs
WHOGenderPolicy
Useful Links
Its Friday night in the
undergraduate boys’hostel of
16
17
Pages from History 19
2C
e
Dr.MalaRamanathan
EditorialCom rn it tee
Dr.AmarJesani
Dr.SundariRavindran
Dr.AnantBhan
Ms.BettySusanNinan
AMCHSSQUARTERLY
as many women are about to
deliver. As they cry out in
the day when one finds the
pain, the interns on duty are
maximumhostelitesinthemess
busy playing cards, not at all
room.Thisisbecausethisisthe
concerned about the apparent
day of the week where almost
dislressthatthewomenarein;
on a religious basis, a fest of
theayahsondutykeepcursing
pornographic movies is held
the women periodically and
startingfrom Hollywood skin
ask them to hurry up, some
flicks and then graduating
remarkingthatbeingawoman
through soft porn into hard
theyshouldtoiei alepain,
porn.Thecatcallsandthesexisl
others denigratingsaying that
conunentsreachacrescendoas
if they had enjoyed during
while
intercourse, why complain
September brings with it the
aboutthis.
freshbatchofstudentsintothe
Allthethreeaboveexamples
hostelandsoon, itistimefor
are an ominous pointer to the
theanniialfreshersnight.The
gapslhatexistinthewaystiidents
juniors are made to'perforin'
aretaughtinniedicalinstitutions,
for their seniors. The most
leadingtoalackofawarenessand
popularperformanceswiththe
sensitizationaboutsocial issues.
seniors are the ones in which
The issue of the i tn pot lance of
there are simulations of the
bringing in gender issues in the
sexual act, jokes with sexual
Editedby
It is noisy in the labour ward
the medicalcollegeand this is
thenightprogresses.
Editorial
o
innuendoes,andusageof
locker
room banter. Thejuniors who
field of medical education has
been widely debated with the
AMCHSS(inlndia)havingtaken
have not used these 'creative'
up the mantle of devising a
ideashavetobearthebruntof
short course in t hesubjeclr The
moreraggingthantheir'wiser’
youngmedicalprofessionalswho
counterparts.
graduateenmassfrointhelndian
Exc.i \di uixcl 11 \i.ih
medical colleges have most of
“In
the
doctor-patient
or seniors about their personal
the time no clue about howto
relationship, thepatientisatthe
conflicts like family/societal
relate to a female patient & to
receiving end of the power
pressures to get married or if
addressherspecialhealthneeds.
equation. This is due to thefact
alreadymarried.tobearchildren.
This is especially true of many
that the patient approaches a
Marriedfemaleresidentsespecially
male graduates who sometimes
doctor when he/she is in need of
thosewithchildrenfaceproblems
justblankoutwhentheyhavea
relieffrom phystcal/emotional
in
young lady coming in with
distress.Therclieffrompatnand
sometimes, but are rarely given
specificcomplaintsJWyexperience
sufferingatthehandsofadoctor
thelibertyofaflexibleschedule
has shown that sometimes even
nalurallyevokesadifferentkindof
Manyof them gel caught in the
the ladygraduatesare no better
responseform the patient than a
cycle of overwork, fatigue and
attending night
duties
as they also struggle to be able
simple'thankyou’.Thepatientis
undernutrilion. Added loth is is
to delve into the psyche of the
gratefultothedoctorandismany
the fact that being physically
woman as exemplified in the
timeswonderstruck,thankstothe
attractive might actually be an
practice of Obstetrics and
mystification of medical science.
impedimentfortheladyphysician
Gynecology, a specialty with
manyladyconsultants.Thelady
graduates internalize the male
values of aggression to survive
professionally, whichaddstothe
problem.
Secondly the doctor legitimately
withher'popularity’with senior
probesthepatient’sbodyandmind
staff being attributed to her
to arrive at a diagnosis and this
'beauty' rather than her hard
completeexposureofone ’sperson
workand academicprowess.
to the doctor has its own
implications forequality tn the
The dehumanizing way in
doctor-patient relationship. The
which the practice of Obstetrics
Many students when they
veiyactof undressing before the
andGynecologyiscarriedoutin
join medical college come from
doctor sets up an unequal power
many teaching institutions and
backgroundsofhavingstudiedin
relation. "2lnthisunequalpower
the scant respect given io the
'samesex’institutionsandittakes
relation, the focusisonlyon the
patients in the wards/delivery
alongtimeformanytoadjustto
'cure of the malady’ with no
rooms/operationroomsgivesno
the atmosphere in the co-ed
concernforpatientswithspecial
opport iinityfomstiideiniolearn
medicalinstitutions.Whenthisis
needs. Theyoungdoctor, due to
theart of makings lady patient
the time when a feeling of
lack of exposure is prompt to
comfortable before a pelvic/
camaraderiebetweenthestudents
criticize the practices of the
gynecological
should be developed, either the
patients without understanding
which is almost an intrusion of
freshers are being ragged or are
their social, economic, and
the privacy of the individual,
beingthrustintodissection halls
culturallimitations.
especially so in the Indian
and asked to cut up cadavers
examination
Young women interns and
context.Thewaylhewomenare
reeking offormalin without any
residents are sometimes bogged
herded fortheD&Cs.MTPs, IUD
lime given for adjustment. The
down by the excessive work
insertions in almost a factory
impersonal tertiary healthcare
pressuresinlheclinicalwardsfas
production line manner with a
teaching facility encourages a
they work harder to garner the
rare word of encouragement,
feeling of superiority in the
same respect as their male
succour or empathy only serves
medical
to build up a stereotype in the
students
that
is
contemporaries) and at the
continuously reinforced and
same time, they can expect no
impressionable mind of the
perpetuated bythesystem.
sensitivity from their colleagues
student.
2 I
AMCHSSQUARTERLY
ENGI NIU.RINl.l I I Al I II
Sometimes women present
45yearsandmanytimesnoton
Added to this, being physically
with vague and psychogenic
the pre menarchal girl child and
attractivemightactuallyturnout
complaintsthataredismissedby
the postmenopausal women.
to be an impediment for the
the ‘busy’ doctor without even
Many times, the elderly women
young lady physician who might
realizing that this could be a
who come to the outpatient
bepickeduponorharassed.
pointer to the trauma (physical,
departments and wait in long
mental,se.xualorotherwise)that
queues to be examined for their
the woman might be going
agerelaledmedicalproblemssuch
through and is expressing
asosieoporosisarejust blatantly
indirectly. This is not only
prescribed analgesics such as
restrictedtothepootwomenonly
‘Nimesulide’ and shooed off
butaffectswomenfromallstrata
withoutevenapropetexamination
of society. Violence against
andexplanationaboutthereason
women has many forms- rape,
forthesymptoms.
assault, burning, incest, and
sexual
harassment
at
the
workplace etc. Young medical
graduates,whoarepredominantly
uncomfortableexaminingfemale
patientsareunabletopickttpthe
nonverbalcuesfromthesewomen
astheyareunabletoestablishthe
feeling of trust that is the
The lack of choice that the
her own health is frequently
re fleeted in thetvayshe is asked
to eat this tablet, get that test
done, and many times in the
wauhecontraceptivechoicesare
thrust on women without
explainingtheprosandconsand
the side effects of each choice.
Thisisanexampleofthe typical
top-down approach that ails our
beleaguered healthcaresystem.
Perhapstheonlyencouragtng
trendhasbeentheincreasingratio
olfemalestudentsjoiningmedical
andoftentrytoavoiddealingwith
them-thishampersthequalityof
health services (like counseling
and STD treatment) that can be
isthus,veryimportanttoaddress
this issue in the training of
medicalstudents.
colleges over the years and the
forayoffemaleresidentsforpost
Itmightbe useful tohavea
graduation into'unconventional’
Sexuality and Reproductive
subjectslikeSurgery,Orthopedics
Health(SRH)Courseformedical
etc. that were earlierconsidered
students like in the Newcastle
tobemalebastions.
Medical School, Australia where
“Thisisprobablyareflection
and the better performances that
girl candidates produce in
examinations. The shift however
becomescounteiproductivebecause
of theattrition rateamongthe
the course has been compulsory
and examinable since the first
intake ofst udents i n 1978.Th i rd
year students devote two weeks
tothestudyofsexuality.Thereare
also four additional sessions
scheduled throughout the next
women doctors after graduation
month. One nominated day per
due tofamily demands and child
week is set aside for counseling
bearing.Thereshouldbewaysand
and interactional skills. Aims of
meansofsupportto
ladydoctorsto
thiscoursehavebeendefinedas:
prevent this attrition
rate due to
family demands and facilitate
re-entry into the profession, with
continuing education and other
The focus in women’s
supportsatalaterstageaswell.”'
healthcareisontheobstetricand
There is a Iso sometimes the lack
childbearing aspects in the
of role models for women in the
reproductive age group of 15 to
field of academic medicine.
AMCHSSQUARTERLY
patients from sexual minorities
offeredtothisneglectedsegment
of the changing social mores
patienthasinmattersrelatingto
graduates are
whoarestigmatizedinsociety.lt
foundation of a ideal doctorpatientrelationship.
Medical
usually very uncomfortable with
• Students
to
acquire
appropriate diagnostic
reasoningskillsandcontem
knowledge in the area of
humansexualityandSTDs.
• Students to acquire some
importantconsultingskills.
n a
Em;i.m>i kincH i ai.th
• Students are given an
opportunity to reflect on
theirownsexualawareness,
loexaminethetratti tildes
abou thumansexiialityand
tocoinparethemwiihthose
ofotherstudents. 4
Note
This article has been written
About
based on my limited personal
Engendering Health
experiences,butitismybeliefthat
the field level realuyenunciaied
above remains the same across
ourcountry.
Engendering Health is a
References
Achutha
1. Gender&MedicalEducation;
for Health Science Studies,
CEHAT & AMCHSS; June
Sree Chitra Tirunal Institute
There is also the issueof the
paramedical workers being
lookeddownuponbythedoctors
quarterly publication of
and hence the students also
imbibetheariofijnfairtreatment
Menon
Centre
2002
for Medical Sciences and
Anant Phadke; The Private
Technology.
expected to be following each
Medical Sector in India:
Authorsareinvitedtosendin
order to the hilt and are almost
Monograph prepared from
never thought as team mates.
papercommissioned forthe
to them, especially the nurses
(mostofwhoarefemale)whoare
2.
theirarticles.views^ugges lions
onthefollowing topics:
Undue freedom of behaviour is
updated (1994) volume of
takeninmanyinstanceswiththe
‘Health Status of the Indian
nurses. Unfortunately, even the
People’;FRCH,Pune; 1994;Pg
womenphysiciansfallpreytothis
23.
MedicalEducation
RaviNarayan;Perspectivesm
•GenderandHealth
mindset, thanks to the well-
entrenched system & the trap of
3.
Medical Education; VHAI;
themalehierarchy.
2002
Thelandmarklegislationslike
the MTP Act and the PNDT Act
arenotpartofthecurriculumat
medicalcollegesandhencemost
cliniciansareconfusedaboutthe
4.
Imperatives
in
Medical
Education: The Newcastle
Approach;FacultyofMedical
& Health Sciences; The
legal implications of their
University of Newcastle;
everydaypractice.
AustraIia;1997;Pgsl 16,117.
These are just a few of the
Acknowledgements
reasons why the component of
'GenderinMed icalEducation ’has
to be considered to be a priority
issuebytheacadetniainmedical
education. The health activists
Suggestions by Dr. Thelma
•Genderand
HealthPraai.ee
Pleasesendthesameto:
Dr. MalaRamanathan
AssociateProfessor
AchuthaMenonCentrefor
Healths cienceStudies
SreeChitraTirunal Institute for
acknowledged.
Med ica IS ci encesa ndTcch no logy
Thiruvananthapuram-695011
Kerala,India
Health Care’ should also ensure
sensitized
WomenHealth
andDr.SukanyaR.aregratefully
campaign towards a ‘Right to
thatthehealthcareinpracticeat
•Genderand
Narayan,Ms. SrilakshmiDivakar
also need to stress that their
all levels be just and gender
• Genderand
Tel:00914712524234
Dr. Anant Bilan
Eniail:mala@sctimst.ac.in
Flat No. 405, Building No. A-l 1.
Planci Millennium, Aundh Camp. Pune- 411 027
Phone: 020 7404110: email: drbhan@sify.com
AMCHSSQUARTERLV
ENGI.XI >1 KIXC.I I I All II
New genital gel could empower
EWSUPDATE
BOYSDEMANDMORE
THANGIRLS,EVENBEFOREBIRTH
Swedish and American researchers have
j solved the puzzle of why baby boys are so much
\ bigger at birth than girls, their mothers eat more
during pregnancy. Women carrying maleembryos
: consume about 10 percent more calories, eight
percent more protein and have a higher intake of
carbohydrates and animal and vegetable fats. It
is widely accepted that on average newborn boys
I are heavier than newborn girls. The findings give
I us a better understanding of why that is the case.
Researchers studied the diets ol 200 women
I during theirsecond trimester of pregnancy. They
■ believe women carrying boys eat more because
' thev have a higher energy requirement, which
could be due to testosterone secreted by the foetal
testicles. Butalthough they produce bigger babies,
mothers of boys do not put on more weight than
: other women during pregnancy because the
gender of the baby had no effect on maternal
weight. These data suggest that in utero boys are
already more demanding than girls.
women against the AIDS epidemic
Proponents of the male condoms have not
comprehended the trauma of women who
would want to conceive without being infected
by the virus from their HIV positive partners
And it seems like good news when John Moore
of Cornell University in New York and his
colleagues arc enthused by their findings of a
new viral blocker that prevents the virus from
burying into human cells. The new study has
backed the belief that microbicides-chemicals
that hobble viruses - could act as shields against
HIV. This or other microbicides, applied in cream
from to the vagina or rectum could save the lives
of several women who are not able to protect
themselves by monogamy or by using condoms.
Researchers are investigating around 60
potential microbicides that thwart HIV in a
variety of ways. In the new study, researchers
used a human antibody called b 12 that binds an
HIV coat protein and stops it latching onto cells.
This antibody, unlike certain other microbicides
targets only the HIV virus and does not affect
healthy cells.
MedlndiaResearch Update.
(Medlndia Research Update - December 2002)
RESOURCESECTION
Gender and Health Advocacy Kits
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a current issue in Gender and Health in a concise and
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of fact sheets), a brief issue paper and a power point
presentation. They can be used as part of a conference
presentation, as a tool to educate policy-makers or as
the basis for a workshop or class session on Gender and
Health issues. Upcoming kits include: Gender, Health
and HIV/AIDS in the Americas; Gender, Work, and
Health; and Gender Equity in Health
You may download the whole kit free of charge. Please
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its efficacy can be evaluated. Please contact at
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Advocacy Kits with your comments and suggestions.
AMCHSSQUARTERLY
WorkshoponGender,Hecilthand
Development: AFacilitator'sGuide
(PDFFormat)
Developed by PAHO's Woman, Health and
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structure and some tools fro a workshop on
looking at health through a gender lens,
understanding men's and women's health-illness
processes and improving the equality with which
roles, responsibilities and rewards are distributed
in health promotion and care.
Download the Complete Workshop - PDF 1.41 MB
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gendertraining.htm
1
ISxGI \ I>1 RIXGl I I Al I H
Gender Issues in Depression
Asummaryandoverviewofselectedstudiesondcpression
Aetiology and Pathogenesis
Introduction
Gendeidif ferenccindepression
iso n e o ft h es t ro ngest fi nd i ngs i n
' 1 cm pe ra m e n t (Persona lit i j
(factorsajfecdngiuhogetsill)
A number of personality
Multi factorial origin of
features have been proposed as
psychiatric epidemiology. I’he
depression is well accepted. It’s a
vulnerability factors for the
Global Bu rdenofldiseases (G B D
diseasei nwhichnatureandnurcu re
development and maintenanceof
2000)estimatesthat5.8%ofmen
havetheirownrole.Thusbiological
depression. Men arc said to be
and9.5°ooKvomcnwillexperience
d i f fe re ncesi n tc ract i n gwi t lisoc i a 11 y
more autonomic, si riving for
adepressivcvpi.sodeinal 2months
constructed differences between
perfectionism and independence.
period.1
Burdeno (Depression
I ncrcased risk for women
varies by d iagnosticsub types and
men and women contribute co
More women arc said to be
gender differences in depression.
socio tropic, which is related to
interpersonaldependencyjefersto
Someofrhesefaccorsarc:
astrong need for al filiation and
Heredity
support! romothersIthasbccn
Althoughgeneticfactorsretain
has suggested that women in
issubstan t ialfonnajorde press ion,
astronginfluenceonliabilityto
dysthym ia (miId depression),
situationswhichlacksocialsupporr
depression, they do not seem to
contribucerotheincreasedriskfor
and good interpersonal relations
atypical depression and seasonal
w i n te id e p re ss i o n2 .Preponde ra nee
women by a direct mechanism.2
me nw h ope rce i vet h e i n o bsasl ow
among women is not a universal
But on the other hand generic
in decision altitude are more ar
phenomenon. It is more in
factors
circumstances where significant
vulnerability in one gender by
discrimination against women is
othermechanismslikegenetically
may influence
rhe
present and may also depend on
determined personality traits,
ge n de rd i ffe rences i n d iagnos i n ga
wh icharcr is kl'ac to rsfo id c p ress io n.
case The difference is virtually
Developmental Factors
non-existence or even absent in
environment and experiences in
t rad i 11 o n alsoci e tiesan di nsoc i a 11 y
(familial
growingtip)
homogc noussam pies’
The available evidences on
arcm o rep ro n ecod c p ress i o n wh i 1 e
risk’.
Life Events
An increased risk of onset of
depression may reasonably be
expectedwhens&vcrcevcnrsoccur
inlifcx.lomainstowhichindividu.il
attach astrongscnscofvaluca nd
commitment.lndividualswirhfew
o v c r v a I u c d go a I s a n d I a c k i n g a n
It has also been shown that
de ve I o p m e n ta Ifac ro rss u gges rt h a r
iniimatcscnscofpcrceivedchoicc
women arc at greater risk of
thcearlyrraumaticexperiencesmay
havchighcrrisksincecheyareleft
depressionandanxietyatanearly
bepartlyresponsibleforawomen’s
with few alternatives for self -
preponderance in the depression
evaluation when their main goals
facei n c reased ri s ko fde p ress ionin
rates,sincetheyareatgreaterrisk
are threatened
certain periods- pregnancy,
for certain events such as sexual
situations arc more likely in
agethanmcn.'
1 nadul di fewomen
. Both these
menopauseetc.Duringpldagealso
abuse, suffer from lack of self
women's life Events that are
d u ctoth ci n c reasedl i feex peccancy
esteem and anxiety over body
particularlyassociatedwirhahigh-
in women we have a larger
i m age. M o re o ve r wo m e n a p pea r
risk
p ro p o r t i o n o f wo m e n a m o n g t h e
more sensitive co depressogenic
co nee r n i n gawo i n e ii’sh u m i I i a t io n,
depressed.
effcccoftheseevents.
h eren t ra p me n t i n scve re on goi n g
6 I
onset,
includes
those
AMCHSSQUARTERLY
EnGI \1>I.H1\(.I I I Al I II
5In
dirt icuk iesanddearhof someone
moreprecariousthyroidstatus.
importanttoher ". Women from
addition low estrogens and high
centres with alcoholism and
aPHCwhilemcn.ipproachrefcri.il
developing countries and lower
progesterone status has been
substance abuse associated with
socio-economic condition more
postulated as possible mediating
depression. Th is often leaves die
often find themselves in some of
factor in postpartum depression,
depress!vci 11 nessun denecogn i.sed
theschelplesssituations.
premenstrual accentuation of
and under treated in women.
SocialRolesandCukuralNorms
I he
identification
of
affective instability and women’s
Depressivcsympromswercperceix'cd
vu I nerab i 11 tytodep ressan teffecrof
asm oreda ngero u si ndp ri va ter h a 11
steroidalcontraceptive.
somatic problems. 11 also put the
individuals at high risk tor
su ffe re rsi nascici a 11 yd isa d van raged
developing depression, based on
Gender Differences in Care and
pos i t i o n bya fleer i n gp ros p ec rs fo r
socio demographic variables and
Careseeking
marriage, marital breakdown,
data collected across different
Pathwaystocare.
unemployment and ultimately
countries and cultural groups,
indicate that social roles and
cukuralinfluencescontributetoa
women’s
in
preponderance
identify
variables
with
sign i fi can a nfl uenceonseve ri tvof
depression found that marital
status.childreninthehousehold,
education and the interaction of
the education with marital status
arc significant factors associated
with severe depression in women
b u tn o twi t hm e n .M a r r i edwo m en
especially with children in
householdhavemoreroledemands
and surfer from chronic family
stresst hanmen. itcanbeassumed
that higher education mightgo
along with additional female role
de m a n ds a u chastobcau tonom ic,
or having a good occupation.
Similar studies from developing
countries in addition showed
infertilitypoverty ’ anddrinkingpf
spouse strongly related
Itvariesacrosssocioeconomic
Thus a better understanding of
situations and from country to
h owde p ressed pa tien ts vi ew r h ei r
country. To rhe majority of the
sy n i ptomsi ndi f feren tscri i n gsn i a y
world’s population access to
depression rates. A recentstudy
to
compromising rhe self-esteem.
to
bekeyroi mprovediagnosricrares
specialisedpsychiatrictreatmcntis
Eveninspecialisedpsychiarric
non-existentAlargeproportionof
these diseases are treated in rhe
cl i n icsi r’sawe I lacce predf ac tsrh a t
p r i i n a ryca reset r i ngs a n d res t e nd
women present with
u pwithtraditionalpratgcitioners.In
vegetative symptoms like fatigue,
p r i m ary ca re de p ressi o n is h i gh Iy
lossol sexual interest, sleep and
prevalent and almost twice as
appetite disturbances while men
common! nwomenasinmensincc
re po r tm o repsyc h o i no torch a n ges,
wo men with dep ress ion approach
feeling of worthlessness and
prim aryca refaci I i tyfo rd e p ress io n
dec rcascdco nee n r ratio n
while men approach more of
experiencedhigherlevelofanxiery
refer ralfaci I i tyatamuchad vanced
a n d h o.s t i I i ry a n d a n ge r.
stage2. Studies have shown that
ofrencomplicarcdbycomorbiditics
detection by primary care
like substance abuse, which is
physicians were patient’s sex
increasing around the world.
(women), m a ri ra Is ta tus( w id owo r
Althoughwomenwithdepression
wido we r) a n d e m p I oy m e n r s ta tus
a rd essl i k e Iytoh avcproble msw i r h
(retired)9.
alcohol or cannabis, they arc
A challenging aspect in
more likely ro misuse sedatives
diagnosis of depression in the
and other prescription drugs.
somatization of depression
11 ormonal Influences
. Wo m e n
1 reacment of depression is
factors related to lower rate of
primary care setting is the
depression in women.
more
(presentinggsunexplainedsomatic
Substanceuseisunderrecognized
11
in women and they have lesser
ch an ce toge tco11 nsc 11 i ngo ro t h c r
higher
complaints). Community studies
treatment for this ".This can
concertrrationol monamintoxidase
have shown that more women
adversely affeer the outcome of
(depressogenic) in
presenrwithsomatiesymptomsin
t reatm cn t fo rd ep ress i o n.
Women
AMCHSSQUARTERLY
have
the brain and
1 7
MG N >1 <I\G1I I Al III
AnOverviewolGenderlssuesin
Outcome
Wbmencspeciallvitxleveloping
councriesdro|X)utfromtreatment
mo reofte nduetodec reasedaccess
and resources to care. It is also
common in Indiaamongwomen
ro discontinue treatment when
rhevgemiarriedtohiderheillness
due to the stigma. Similarly
pregnancy is another commonly
cicedreasonforstoppingdrugs.
I n the drug treatment arena,
One of the unfortunate
higherthanindustrialisedcounrrics
consequences© fdepressionishigh
andsignificantassociationbctwcen
risk for suicide, which is more
PostNatall >eprcssion( PNI ) iind
frequentinmematrhesametime
poor family relationship, low
more women attempt suicides.
socio economic factors, early
A trend analysis study done in
age
Australia on decrease in suicides
pregnancy,premenstruakyndromes.
pregnanej,
unplanned
and simple anti depressant
m i sea r r i agesa n d I ac k o f a n t i n a ca I
p res cri b i n g13 (m os tly by genera I
ca re.'l ’h is s t tidy also showed that
p racti t i one rs)s h o wedas i g n i fi cam
number©! daughters in previous
negative association that is more
deliveries as a risk factor while
pronouncedi nwomen.Thisstudy
numbersofsonsisnot. Similarly
clearly indicates the effect of
delivering a daughter has an
antidepressant treatment from a
increased chance of depression
therearelotofconflicringreports
p r i in a ry ca rese tti nga ndi is added
thanasonshowingsrronggcndci
o n e f f ec t i ve n ess o f o n e t rea t m e n t
be n e fi ts fo rwo m e n.
preference and lack of social and
ove ro t he rf o n ne nan dwo m e ne. g.
a randomized tripleblind control
trial with 1 2 weeks follow up
showed that women taking
familysupportgivcnondclivcring
Pregnancyand Depression
ababygirl.
Duringpostpartumperiodup
to85%ofwomenexperiencesomc
S e rt ral i n e( an ewe i w i d e I yuseda n t i
ki nd of mood disturbance. Some
de pressa n t wi t h I esse rs i deeffects)
ofthemexperienc&imoralisabling
had lower drop outs and better
and persistent kind of mood
response than women taking
disorder. Although postpartum
Imipraminefclassicaltricyclicanti
depression is common, patients
depressant).Butthefindmginmcn
and their caregivers ’ frequently
showed a better response to
overlook! t.
1 m i p r a m i n e a n d n o d i ffe re n ce i n
d ropo u tw i th Se r t ral i n e.
1?
Long-termCareandRehabilitation
A prospective stud}' of
postnatal depression in Goa
found similar risk factors in
addition to antenatal depression
andmaritalviolence. I husgender
bias and the limited control a
woman basoverhcrhcalth make
pregnancyastressfulexpericncefor
manywomen
Recentstudiesdncludingthe
Avon longitudinal study) has
ImplicationsforProgrammesand
looked seriously on antenatal
Policies
depression and found that self
Social! actorsinlongtermcare
reported symptom scores for
and rehabilitation are especially
de p ress io na reh i gh e ri np regn a n cy
u n f a i r to wo m e n i n reso u rce poor
(1 S'11 and 32 nd week) than in
set fin gs Aw o m a nfreq tie n dyfaces
postnatal period and that the
sexual abuse in asylums and has
distribution of total scores and
■
Redesign medical training to
make health care providers
morcgendeisensirive,andthus
faci I irate better diagnosisand
management.
fewerch oi cesfo ire h a b i 1 i ta ti o n s. 1 n
i n d i v i d u alsym p to md i d no rd i ffe r
de v e 1 o p i ngco u n t r i est h eyal soft n d
beforeand after ch i Id birth
difficulty in independent living,
its necessary to include a
menialdisordersinthcprimar}r
out of hospitals and nursing
psychological component to
care setting with special
homes.Theseissuesaddonasrisk
antenatal screening programmes.
e m ph asisonge nde rd i f I e re 11 ce
f actors fo r re currentepisodes a n d
One year follow up study in
in
relapses.
Eas t e rnTu rkey 15fou n dp re valen ce
presentation.
,4. So
■
I m prove capacity ro diagnose
depressionandothercommon
symptomatology
ami
AMCHSSQUARTERLY
ENGI NDlKINt.l I I Al I H
and
d i f fe rence i n majo rdepress ion
in Tamil Nadu. Nat Med J
treatment of common mental
and its response to anti
I ndia2002Nov-Dec-331-335.
d i sorde rs i n w o me n toa I ready
depressants. J Affect Disord
existing maternal health
2003;75(3):223-235
Integrate
diagnosis
J,
5 - BeckAT, Cogn i tivetherapyo f
these programmes closer to a
depression ofdepression: new
use, d e p re ss i v e s y m p t o m s,
complete life cycle approach.
perspectives. In: Clayton PJ
and gender in primary care
and Barrett JE, Editors,
Psychiatr Serv 2001; 52:
Treatment of depression:
1251-1253.
(e.g. I ncl udi ngam e n ta Ih ea 11 h
in
RCH
old controversies and new
programme)
Public health approach for
primarypreventioiiandaddress
risk factors manyo rw h i c h a re
6.
KB. Problematic substance
12.
women with chronic major
1983:p.265-290
depressionrespondeddifferently
Broad head j, Abas M, Life
toScrtralincand Imipraminc.
difficulties
Am] psychiatry 2000; I 5
and
1445-52
depression among women in
Stronglegislation.policies.md
urban setting in Zimbabwe.
program mestoaddressgender
13.
Psychological med 1998;28:
discrimination, gender based
stereotyping as these are the
29-38
McManus I’. Association
Barnows,LindenM,Luchet
between
factors tor depression among
prescribing and suicide in
i m po r ta nee of psych o I ogical
Australia, I 901 -2000: trend
depression in distinguishing
14.
Evansj,heron],francombl 1,
Encourageresearch.toexplore
between adjustment and
okcS.GoldingJ.C'ohortstudy
gender issues beyond sex
depressive disorders.] Affect
of depressed mood during
difference in the study of
Disord2002;72:71-78.
p reg n a n cya n deh i Id b i r t h. B MI
Patel],PereiraL,fernandesJ,
2001:323:257-260
disease ingeneral.
8.
Fernandes A M. Poverty
References:
3.
analysisBM]2OO3may 10;?20.
factor gender and severity of
women.
am idepressani
Freyberger H. The
M,
underlying signif icant risk
Hall WD. Mam A, .Mitchel!
PB. Rendle VA, Dickie IB.
violence and gender role
7.
KorcnsteinSG.ci.il.Menand
approaches, Raven, New York
events
genderspecific.
2.
Tang L. Kenneth B. Wells
programmes. Th is will bring
component
1.
RoeloffsCA,FinkA,LJntitzer
11.
1 5. InandiT.etaLRiskfaccorfor
psychological disorder in
depression in post natal first
The World Health Report
p r i m a ryca reat te n d e rs i n G o a,
year in eastern Turkey. Int I
2001, WHO Geneva; 2001.
p.29-30.
India. Br J
Epidemcol2002;31:1201-1207
Picinelli M, Wilkinsom G.
Gendetdifferencesixlepression
Psychiatry
1998;172:533-536
9.
16. PateIV.RodrigucsM,DeSouza
HortalGEetalprevalenceand
N. Gender, poverty and
detectionofdepressivedisorder
postnatal depression: A study
Hr J of Psychiatry 2000; 177:
i npr i ma ryca re A re nPr i maria,
ofmothersinGoalndia.Am]
486-492.
Apr2002;29(6):329-36
psych iatry2002:1 59:/i3-4~’.
Kaplan
and
Sadock.
Comprehensive textbook of
psych iatiy./thed.Philadelphia,
U S A:Li ppi n co tt.Wi 11 i a msand
Wilkins;2000.p. 1284-1298.
10.
NambiSK,Prasad],SinghD,
A b ra h a m V, Ku r u v i 11 aA,] aco b
KS. Explanatory modelsand
common mental disorders
among
patients
with
zl. Scheibes.PreuschhofC.Cristi
unexplainedsomaticsymptoms
C. Bagby M. A rethe regender
attendingprimary carefacility
AMCHSSQUARTERLY
Dr.AravindP.
Ml’l ISu.cknt.Aihudi.iMi noia enuJorl k-.iiih
ScicnccSmdics.SCTlMS I.Tm.indnim
email- .ir.ivindt'H tnn>t ..u .in
1 9
E X G EMJ V RIN G H E AI TH
Research Reports through Gendered Lens -
'ACCESSTOHEALTHCAREANDWOMEN'
Cun eniSiotusofServiceDeliveryintheHeallhand
Family Welfare Sector in Kerala with Particular
RererenceloRcproductiveandChildHecilthProgram
K.R.Thankappan,P.SankaraSarma,
V.MohananNairandRajappanPillai,
AMCHSS,SCTIMST
Sites: five districts from the state, two from the
north two from the south and one from the central
region.
Samplesize: A total of 5000 households (3500
rural and 1500 urban) were selected by a multistage
random sampling collected information from
selected 70 sub centers, 20 mini primary health
centers, 10 block primary health centers, 4
community health centers and 4 first referral units
from the five districts. The information included
infrastructure facilities in those institutions, drugs
and supplies, staff strength, and services provided
from those institutions.
The ax erage number of antenatal visits was
found to be 8 in the total sample. The cost of an
antenatal visit was reported to be around rupees
200. There is a need to reduce the number of
antenatal visits. Institutional delivery was found
to be 98.8% for the entire sample Only
Malappuram districts reported home deliveries
(6.7%). All the other four districts had 100 percent
institutional deliveries. Female obstetricians
conducted more than 80% of deliveries in our
sample. In a poor state like Kerala over dependence
on specialists is a concern because it raises the cost
of health care. Over 95% of women preferred to
have their deliveries conducted by a female
provider. Majority of deliveries (52%) were
conducted in private sector hospitals. Since more
than two third of hospital bods in Kerala is in the
private sector this is not high as one would expect.
Barring Malappuram district home deliveries are
becoming extremely rare in Kerala Sub centers and
primary health centers are also not conducting
deliveries particularly in southern districts. This is
the reason for the overcrowding of tertiary level
maternity hospitals in government sector. In spite
of having a high proportion of institutional
deliveries the state does not have data on maternal
10F
mortality ratio. I bis could be collected from
hospitals easily provided the piivate hospitals
would also report maternal mortality to the state
health authorities
Low birth weight was found to be 13.3 "...
Medical termination of pregnanev was reported to
be very expensive in both government and prix ate
sector. Infrastructure facilities in manx' institutions
were reported to be inadequate. Many sub centres
did not have minimum facilities to accommodate
the junior public health nurse. This might be one
of the reasons for the low proportion ol house visits.
Unless inpatient facilities are prox ided in primary
health centre, the only government institution in a
Panchayath with a medical officer, people will be
pushed to private sector hospitals.
Given above are some excerpts from results of
the study. Looking through the gendered lens it can
be seen that the cost of care is increasing for women
and the reason is lack of accessibility to quality care
al government hospitals.
Poverty and Gender Dimensions of Tuberculosis in
SouthEastAsiaRegion(Sear)Counti i.
T. K.Sundari Ravi nd ran, Shin eyC. Alex and Betty
SusanNinan
Objective: The review attempted to understand
the many ways in which poverty, gender and
biology interact to create differential risks and
vulnerability to tuberculosis, differences in health
seeking behavior, utilization of tuberculosis
services, and the social and economic consequences
ol the disease across social groups and between
women and men.
Findings: Some studies mention a greater
proportion of women delaying making the first
contact with a health provider, lor reasons that
include: lack of decision making power, limited
access to cash and lack of attention paid by husband
and in laws to the women’s ill health. Women max
not delay seeking treatment anv more than men,
but may still have a longer delay to receix ing
treatment, because they seek health care from
providers who are more easily accessible and also
from providers who are more easily accessible and
AMCHSSQUARTERLY
Enc.i \l>l RINC.I I I.AI'l II
switch providers a few limes before seeking
sere ices from TB treatment services. Fearof stigma
and limited access to resources may contribute to
this pattern of health seeking. Default rates were
found less for women but reasons for default
differed between men and women. The DOTS
strategy max have to be modified to better reach
out to women and men.
SituofionalAnalysisofMTPServicesinKerolci:
CommunityPerspectives
DrA1alaKamanathan,DrJ1SSarmaandC.S.Krishna
Kumar
This studv is a component of the Abortion
Assessment Project of India that is being
coordinated bv CEHAT, Mumbai. It forms a part
of a multi-centricstudv bv six institutions, assessing
the provider perspectives on MTP services in the
country.
Objectives: to examine the community
perspectives of abortion, its legal status, and the
available abortion providing centers in kerala
Methodology: Focus group discussions. In
Kerala, this studv was conducted in two districts:
Kollam and Malappuram
Findings. Women sought health care for
reproductive health problems in both private and
the public sector. In Kollam district where public
facilities were better functioning, women preferred
them. In Malappuram this was notso an the private
sector was more often sought and utilized. Women
felt that conditions prevailing in government
hospitals were inadequate. They were not clean
and the staff had to be paid for services and
supplies that had to be used for the procedures
bought from outside and drugs were often not
available and had to be bought. The absence of a
woman doctor in the government facility also
seriouslv restricted the type of health care sought
at the facility. Women were aware of specific
abortion services in their neighbour hood. In
Kollam, abortion services were few but available
in both the public and the private sector. But in
Malappuram abortion services were almost absent
in public sector. In the public sector supplies had
to be bought and staff to be paid, it added additional
burden to the already difficult decision of abortion.
There was also stigma attached. The legal status of
abortion is also not known to many.
□
AMCHSSQUARTERLV
ANNALS OF MPH
Gender Watch
Prevalence and Correlates of Hypertension among
the Middle Aged Population
Author: ManuG. Zachariah
Batch 2000
Setting : Urban community in Trivandrum district
Gender Watch : Reported morbidity of hypertension
was found to be higher among women(25.2) compared
to men (21.5%). Obesity and being overweight was
found to be more prevalent among women compa red
to men (men 6.7, women 14.6). but prevalence of
hypertension was higher among men (56.4%) while
m women it was 52.3%. Mean Systolic blood pressure
was higher among women where as diastolic blood
pressure was higher among men. Awareness and
treatment among women differed by about 10% more
among women compared to men
The Extent and Determinants of Treatment .\nn• Compliance among Pulmonary TB Patients in
RNTCP-DOTS, Trivandrum
Author: Betty Susan Ninan
Batch : 2000
Setting: Trivandrum District
Gender Watch: For 34.5% of patients someone else
i was collecting the drugs. The reasons for sending
others were the present illness and fatigue, going for
work, stigma, shyness to be directly observed.
personal household duties and disability The
proportion of men who send others to collect the cl rugs
was 29.9% compared to 53.8% of women [p <0.0011.
For age groups 15-20 years and >60 years, the
proportion of those sending somebody to collect was
more [P<0 01]. Only 77.5% were collecting the drugs
on a thrice-weekly basis in the intensive phase. But
there were no significant difference between those
coming thrice weekly and those who were not For
only 15.5% of patients had DOT providersand among
them only 15.6% were directly observed. Following
bivariate analysis to identify associations, multiple
logistic regression identified lack ol family support,
lack of friends/relatives to collect on one's behalf,
going for work during the treatment, lower
educational status as significant correlates of noncompliance. Drug supply was 100%. Default tracing
mechanisms were minimal and not prompt Stigma
was more for younger patients especially unmarried
women.
111
E\gi \i>i rixgH i \i.th
Bulletin Board
GenderMainstreamingMedical Education
ashortcourseforMedical Educators
November! 0 "ToNovember21
BACKGROUND
Achutha Menon Centre for Health Science Studies
(AMCHSS). Sree Chitra Tirana! Institute for Medical
Sciences and Technology, Trivandrum, Kerala, has
initiated a project to mainstream gender perspectives in
sensitive and act as change agents to initiate
mainstreaming of gender in the medical curriculum
Specific Objectives
(i)
(ii)
To apply the above concepts to medical curricula.
teaching, learning, research, service delivery and
individual practice and the delivery of health services
policy
The lack of a gender perspective in medical education
has led to a failure to inquire into and act upon gender
To gam a common understanding of gender and
rights concepts
medical education.
It is medical education and training that informs
u2003
To
(iii)
develop a plan for implementing a process of
based differentials in health across different social
curricula change w ithin their own Institutions and
groups. These include potentially different health risks
eventually work towards gender mainstreaming the
and vulnerabilities, presenting symptoms, treatment
formal curricula for under graduate medical
compliance, and health outcomes The absence of a
education
gender perspective could therefore result in avoidable
morbidity, mortality and disability. It could cause
delays in diagnosis or inappropriate treatment for
certain disorders. It contributes to the implementation
of health programmes and services which do not address
the major factors associated with a health problem, or
meet population health needs, resulting in wasted
expenditures.
THE INSTITUTION
The Achutha Menon Centre for Health Science
Studies (AMCHSS). Sree Chitra Tirunal Institute for
Medical Sciences and Technology, Trivandrum, is the
course organiser. The AMCHSS is a wing of Sree Chitra
Tirunal Institute for Medical Sciences and Technologx
and is dedicated to public health training
The Centre
THE COURSE
currently offers graduate and post-graduate programs
As part of the project to mainstream gender perspectives
in public health, and specialized short courses.
in medical education, it is planned to organise a series
of workshops lor change agents drawn from among
medical educators who can influence the process of
gender mainstreaming medical education.
OBJECTIVES
COLLABORATION AND FINANCIAL SUPPORT
This project is funded by (he MacArthur
Foundation, while Wl IO-South East Asia Regional Office
is a collaborator and is providing financial support to
run the pilot training workshop for medical educators
General Objectives
from India and from the Wl IO-SpUth East Asia Region
lo create a cadre of medical educators who are gender
countries in November 2003.
12P
AMCIISSQUARTERLY
Enci XIHRIXl.l I I Al I II
includes the following persons: Dr. T.K Sundari
COLRSESTRUCTURE
The course is structured into three modules- the
concepts module', the 'application module' and the
'planning tor action module'. The training is structured
Ravindran, Dr. Amar Jesani, Dr. Mala Ramanathan,
Dr. Sukanya R„ Ms Padma Prakash, Dr. Kamaxi Hhate,
Dr. Thelma Narayan and Dr. Bhargavi Davar.
to gi\ e the participants the analvtical tools, evidence, and
skills to mobilize and sensitize others and to implement
changes in their own institutions, and in a broader way.
1.
ELIGIBILITY CRITERIA
Participants in the short course will be teachers of
Concepts Module
undergraduate medical students, having a track record
ti) Social Construction of Gender
of making changes, and interested in gender issues.
(ii) Gender as a Social Determinant of Health
Apart from medical professionals, social scientists
(iii) Gender Analysis in Health
and nursing professionals who teach undergraduate
(i\) Specific Gender and Health Issues
medical students can also apply.
Selection of participants will be done based on their
II.
Application Module
(11
interest m and ability to effect changes within their own
Gender and Cultural Stereotyping in Health
settings.
Service Settings
(ii i Rights. Ethics and Doctor-Patient Relationship
COURSE SCHEDULE
(iii) Gender Sensitive and Client Centered Health
The first course is scheduled Irom November
Service Settings
Application of Gender Analysis to Health
(iv)
Science Studies.
Information
The scheduling of subsequent courses will be
('. I Core Competencies of a Medical Graduate
announced shortly
with a Gender and Rights Perspective
Planning for Action Module
III.
(i)
FOR DETAILS
Facilitating Participatory and Experiential
Learning
details:
(iii) Planning for Projectsand Initiatives
Dr. Mala Ramanathan
FACULTY
course
faculty
is
constituted
of
a
multidisciplinary team. The team includes national and
international experts in gender and rights training and/
or with experience in mainstreaming gender in medical
curriculum.
CORE COMMITTEE
A core committee has been formed to advice on
curriculum planning and training. This core committee
AMCHSSQUARTERLY
Those who are interested to participate in the future
courses may please contact the following persons lor
till Making Change Happen within Our Settings
The
10-21, 2003 al the Achutha Menon Centre for Health
Associate Professor
Achutha Menon Centre for Health Science Studies
Sree Chilra Tirunal Institute for Medical Sciences and Technologv
Thiruvananthapurani - 695 011
Kerala, India
Tel. 1)091 -171 2524234
Email . mala@sctimst.ac.in
Dr. Anant Bhan / Ms. Betty Susan Ninan
Senior Research Assistants
AMCHSS, SCI’IMST
Thiruvananlhapuram - 695 011
Tel : 0091 471 2524249
Email: anant@sctimst.ac.in ; bsn@sctinist.ac.in
ExGI M>l KIXGl 1 I Al III
Announcing
Firunal Institute for Medical Sciences and Technology
MakingP regnancyS afer:
and is dedicated to public health training. The Centre
A SHORT-COURSE FORK EALTHM ANAGERS
currently offers post-graduate programs and specialized
short courses in public health.
BACKGROUND
Acutha Menon Centre for Health Science Studies
(AMCHSS), Sree Chitra Tirunal Institute for medical
THE COURSE
As part of this project it is planned to organise .1
series of workshops for making pregnancy safer.
sciences and Technology, Trivandrum, Kerala, has
initiated a project on research, training and advocacy
WHO WOULD BE THE 'TARGET AUDIENCE’
tor gender sensitization oi medical education and
OF THE COURSE?
capacity building of health professionals for reduction
oi maternal mortality and morbidity.
The people who are most likely to change at the
delivery interlace or act as community interface in terms
Up to now, the programs and policies that have been
ol promoting women's ability to be sale in pregnunev
dev eloped either as part of a global trend or indigenously,
with some evidence of understanding research or work
like the Child survival and safe mother hood program
m this area. People from health management institutions,
(Sate motherhood initiative) or the Reproductive and
managers in health system, trainers ol managers, trainers
Child health program or the Family welfare program have
of health care providers, members of medical associations
been developed and implemented with little or partial
like FOGSI, middle level persons from donor agencies.
success within the country. One of the reasons for this
research organizations and NGOs doing research.
limited success has been the lack ol incorporation of a
teachers of nursing schools, members of nursing
social and gender perspective in the policies or in the
associations, rural management professionals etc. are
programs that evolve as consequences of the policy. This
the ideal participants as the group should have some
is because of the overwhelming emphasis on medical
basic knowledge of health, especially on reproductive
solutions to health problems that have social, as well as
and maternal health, but need not necessarily he
individual level causes. One way to overcome this lacuna
clinicians II they are administrators ol health programs.
at the policy and programmatic level would be training
should have some kind ol work experience in health field
of health professionals both those working within the
and aware ol health issues and terminologies.
medical services delivering health care to the
communities as well as those who develop the policies
OBJECTIVES
that guide these programs to recognize this gap. This
‘To build commitment, knowledge and skills
training program aims al reducing the gap in health
(leadership, management and advocacy skills) at each
knowledge by incorporating a Public health perspective
level of the health system lor action to make pregnancy
that is gender sensitive to the understanding of maternal
safer and pregnancy related care effective’.
mortality and morbidity.
Module I : Flow big is the problem?
THE INSTITUTION
The Achutha Menon Centre for Health Science
□
Concepts and definitions
□
Magnitude ol the problem ol maternal mortality
and morbidity
Studies (AMCHSS), Sree Chitra Tirunal Institute for
Medical Sciences and Technology, Trivandrum, is the
course organiser. The AMCHSS is a wing ol Sree Chitra
□
Assessing this magnitude—qualitative and
quantitative methods
AMCHSSQUARTERIY
EXGIM>l RIM.I I I Al I II
Module II : Why and what to do
How to influence key stake
FOR DETAILS
about it.’
holders/gate keepers to improve
Those who are interested to
I.
quality of care.
participate tn the pilot course may
X.
To understand the socio
please contact the following
economic determinants of
maternal
mortality
and
II.
Module III :
Have we made a
difference!
morbidity.
Dr. Maia Ramanathan
To illustrate health system
MIS- Input, process indicators.
functioning affecting maternal
action indicators, various tools of
AMCHSS.SCTIMST
auditing
Trivandrum - 695 Oil, Kerala,
India
mortality and
morbidity
and to develop potential
Email : ntalala sctimst.ac.in
FACULTY
IV.
Associate Professor
Tel :0091 471 2524234
interventions.
III.
coordinators for details :
To review the current state
ot knowledge on common
The course faculty is constituted
practice for pregnant women-
of a multi disciplinary team. The team
Senior Research Assistant
abortion. ANC, delivery
includes national and international
AMCHSS, SCTIMST
Trivandrum 695 011
practice etc
experts in the field of gender, public
Review appropriateness of
Ms. Betty Susan Ninan
Tel: 0091 471 2524249
health, health policy training.
Email: bsnio sctimst.ac in
ELIGIBILITY CRITERIA
Dr. Anant Bhan
Senior Research Assistant
Selection Criteria:
AMCHSS, SCTIMST
Trivandrum 695 011
health care providers roles and
responsibilities, training and
accountability (front a policy
perspective).
V
Look at data on interventions
□
from other countries.
VI.
program which have tried to
To investigate methods of
Email . anant(a.sctimst.ac.in
Cell; 0091-9895116650
degree or equivalent - with prior
□
training/project work in this area.
address women's health and to
VII.
Tel: 0091 471 2524249
graduates, Post Graduate in social
work/ management, master's
To assess implementation ol
list the weakness.
Qualified medical and nursing
□
Interested tn improving quality.
□
Having responsibility in key areas.
improving quality of care.
VIII.
To review existing resources
on routine maternal care
comparing India and other
IX.
COURSE SCHEDULE
The first course is scheduled tn
places.
early 2004.
To deiine what a MIS which
subsequent courses in November
The scheduling of
promotes quality of care would
2004 and April 2005 will be
include.
announced shortly.
AMCHSSQUARTERLY
115
Exgi xm KIXGlI I \I TH
/HO GENDER POUCYJ
• the manifestations, severity and
frequency of disease, as well as
health outcomes;
© the social and cultural
conditions of ill health/ disease;
Integrating Gender Perspectives in
the Work of WHO Background and
Rationale
1. Fifty years after the WHO
Constitution was adopted, it is
increasingly well recognized that
there are differences in the factors
determining health and the burden
of ill health for women and men The
dynamics of gender in health are of
profound importance in this regard
and they have long been overlooked
2. Gender roles and unequal
gender relations interact with other
social and economic variables,
resulting in different and sometimes
inequitable patterns of exposure
to health risk, and in differential
access to and utilization of health
information, care and services
These differences, in turn have
clear impact on health outcomes.
Evidence documenting the multiple
connections between gender and
health is rapidly growing.
3. It will be the Organization's
policy to ensure that all research,
policies, programmes, projects, and
initiatives with WHO involvement
address gender issues. This action is
also in harmony with the decision,
now being implemented across the
\
L.
system 1, that integration of
gender considerations, that is
gender mainstreaming, must become
standard practice in all policies and
programme.
between women and men in staffing
are complementary policies.
© the roles of women and men as
formal and informal health care
5. The goal of this policy is to providers.
contribute to better health for both
This analysis will include
women and men,through health
identification of wavs to overcome
research, policies and programmes
constraints so that improved health
which give due attention to gender
outcomes for women and men can
considerations and promote equity
be achieved.
and equality between women and
men
Organizational Arrangements for
Goal and Objectives
Objectives:
Implementation
© increase coverage, effectiveness
and efficiency of interventions;
7. Successful realization of this
policy will require consistent and
active participation by all staff at
Headquarters, Regional and Country
offices and collaboration and
effective linkages across Departments
and levels of WHO
© promote equity and equality
between women and
men,
throughout the life course, and
ensure that interventions do not
promote inequitable gender roles
relations,
© provide qualitative and
quantitative information on the
influence of gender on health and
health care; and
© support Member States on how
to undertake gender-responsive
planning, implementation and
evaluation of policies, programmes,
and projects
6. These objectives will be
achieved through the incorporation
of gender analysis in the work of
WHO at Headquarters, and in
Regional and Country Offices. This
analysis will examine the differences
in the relationships between women
4. WHO is also committed
and men and their roles, and how
to advancing gender equality in
these differences impact on:
its own workforce, as well as in
• protective and risk factors;
scientific and technical advisory
bodies, and among temporary
advisers and consultants. Integrating
considerations into technical pro
grammes and achieving equality
16 r
© the response of health systems
and services;
• access to resources to promote
and protect mental and physical
health, including information,
education, technology and services;
8 Senior management will take
the necessary steps to ensure the
policy is translated into action in
both technical and management
aspects of Wl 10 programmes.
9 This policv applies io all
work throughout the Organization:
research, programme planning.
i m p 1 e m e n t a t i o n, m o n i t o r i n g,
evaluation, human resource
management, and budgeting.
Effective implementation of the
policy will require senior lex cl
commitment and validation,
organizational support for activities
to advance the knowledge and skills
of staff for efficient gender analysis
in their area of work. Directors will
be expected to institutionaIi/e
mechanisms for building capacity
among their staff providing.
information, training or technical
support stall needed to assure the
policy's success.
AMCHSSQUARTERLY
ENGI NDI.RJX'gI I I Al i II
10. General guidance and
support will initially be provided by
the Gender Unit of WHO/ FCH, in
collaboration with gender focal
points in other departments/
clusters/ regional offices. However,
all programmes will be expected to
collect disaggregated data by sex,
review and reflect on the gender
aspects of their respective areas of
work, and initiate work to develop
con ten t-speci fic ma teria Is.
1’.. Regional and country offices
will be expected to develop their
own mechanisms, appropriately
staffed and resourced, and
collaborate with HQ to develop
strategies to promote the integration
of gender issues in health systems,
working mainly with Ministries of
Health, other sectors, NGOs and civil
society.
12. Ihe HQ Gender Unit will
assist and support the development
of methodologies and materials for
gender analysis, standardized
terminology to ensure coherentcommunication about gender issues,
a strategy for appropriate capacity
building across the
Organization, and mechanisms
for monitoring and evaluation The
Gender Unit will also have
responsibility for on-going collection
and dissemination of information,
such as case studies of "good
practice" in mainstreaming gender
in health, as well as contributing to
the building of an appropriate
evidence-base on gender-related
health issues in the Organization
13. The
resources
and
administrative and operational
mechanisms for implementation and
monitoring effectiveness of this
policy throughout the Organization
will be set forth in directives of the
Director General and Cabinet.
U'<'I'.ih H'Ol from WHO Gender Pohci/I
AMCHSSQUARTERLY
women. Consisting of a preamble
and 30 articles, if
constitues
discrimination against women and
sets up an agenda for national action
to end such discrimination
Notable Feature(s): Access to Division
Q web: A world wide Web
Network for exchange of knowledge,
experience and ideas on woman's
health and gender issues
resources, including those specifically
on eliminating discrimination
Contact: qwcb@kvinnofourm.sc
against women.
Areas of interest : Gender
Equality, Society and women's
health, Sexuality and Reproduction,
Adolescence, Violence and Abuse,
Trafficking.
Contact Information
for the Advancement of women
UN Division tor the Advancement of
Women
2UN Plaza, DC2-12th Floor
New York, NY 10017
In India and Africa , Women's
USA FAX; 212.963.3463
Low Status Worsens Their Risk of
Email:draw@un.org
AIDS by Barbara Crossette
International Centre for
http:/www.Chaiigeniakers.nel/librnry/
ienip/nyl022601 (fin
Research on Women (ICRW)
http://www icrw.org/
The poverty and powerlessness
of women in Africa and Asia are
combining to make them increasingly
vulnerable to research groups are
now calling a women's disease.
Despite years of international
conferences and declarations abo In
many cultures and in the most
disadvantaged societies girls and
women do not have the power to
reject unwante In many cultures and
in the most disadvantaged societies
girls and women do not have the
http://www.ierw.org/proiect^/prowid/
prowidrcgions.htm
The International Centre for
Research on Women is a private
nonprofit organization founded in
1976 and based in With and office in
India The International Centre for
Research on Women is a non-profit
organization that seeks to in women
in poverty, advance women's
equality and human rights, and
contribute to the broader economic
power to reject unwante
and social accomplishes this, in
partnership with others, through
Convention on the Elimination of
policy-oriented research, capacity
All Forms of Discrimination
binding and advocacy on women's
against women (CEDAW)
economic, health and social status in
http://www.ini.org/womeinuatch/daw/
low and middle income countries
cedaw/index.htnd
The
Convention
Elimination of All
ICRW
on
the
Forms of
bases
its
work
in
sustainable development on a
number of key principles:
Discrimination against Women
Supporting women as economic
(CEDAW), adopted in 1979 by the
Assembly, is often described as an
providers and innovators, nutures
and caregivers, communitv leaders
international bill of rights for
and ensuring women's control of
117
Eng en deringH ea lth HHHHHHHHHHHIHHI
economic resources, guaranteeing
reproductive rights, health and
around the world, including one on
from the 1992 UN Conference on
activities.
Environment (UNCED noted the
nutrition, capabilities and increasing
Contact Information.
integrative power of the concept in
political power, fostering equity and
e-mail, webmaster@ipsnews.net
linking socioeconomic and ecological
respect for the human rights and
issues to policy-making.
Women and Population
diginity of all.
Notable Feature(s): A vast
collection of research , analyis, and
hltp:/www.fao.org/waiceni/faoinfo/
sustdev/wpdirect/default him
Notable Feature (S): Special I NII-’EM
focus on "Strengthening Women's
Economic Capacity" and tools to
reporting on programmes about
News, handbooks, and reports
women in development, challenges
and opportunities, skills and legal
on best practices annd action plans
status in communties around the
environment, food issues.
world, links to policy and advacacy,
Contact Information.
tor women
I-I IV AIDS, poverty reduction,
Food and Agriculture Organization
304 East 45th Street, I5t;' floor
nutrition governance, environment,
of the U N (FAO) Sustainable
Newyork, NY 10017, USA
violence aginst women, reproductive
Development Department, Viale
Phone- 212/906-6400
health, and norms and institutions.
Dolle Tcrmc Di Caracalla,
Fax: 112/906-6705
Contact Information:
Rome 00100 Italy
Email: unitem@unclp.org
Internationla Centre for Research on
Telephone: (+39 6) 57051
Women of the world- country
Women (1CRW)
Fax: (+39 6) 570 53064
specific resource directory
1717 Massachusetts Avenue, NW
Suite 302,Washington, DC 20036,
E-mail SD-Dimensions@fao.org
http://www.un.org/
USA
for: agriculture, gender equality,
Women and Trade
htlp://ivww.unifeni undp.org/trade/
eradicate poverty.
Contact Information:
Women and Trade
United Nations Development Fund
w om en w a tch / w o r I d / index.html
contact Information:
Email womenwalch@ un.org
Shaan online: IPS e-Zine on Gender
index.him
and Human Rights
h i Ip:// www.unifem. undp.org/
Women of Uganda Network
http:/www.ipsne’ws.net/hivnids/
economic him
(WOUGNET)
http://www.wougnet.org
index shtml
The Impact of trade liberation
Shaan is an initiative of IPS, inter
reaches almost every community in
WOUGNET is a place to share
press Service News Agency (IPS), the
the World, both directly and
news, information and activities on
women related issues in Uganda.
world's
leading
provider
of
indirectly women particular, are
information on this special magazine
affected in many ways Since the
Its goal is to provide information
produced by Inter press service (IPS),
founding of the WTO in January
and communications technologies
in cooperation with the United
1995, a number of organizations are
(ICTS) tor women organisations and
Nations Development (UNIFEM),
been working on trade liberalization
individuals.
the impact of HIV/AIDS on women
and its consequences for sustainable
Notable Feature(s): Subscribe to
who are denied their human rights,
livelihoods, including women's
mailing list for exchange of news and
is told through their own voices. IPS
livelihoods. The term " sustainable
activities related to women in
is backed bv a network of journalists
livelihoods" was first used bv the
Uganda; lin global organizations and
in more than 100 countries Its clients
Brundtland Commission in our
resources
include more than 3,000 media organs
common Future (1987) to be in
education, women and business,
of thousands of civil society groups,
resource ownership and access, basic
women and health, human rights
academics, and other users.
needs and livelihood security
and other topics; useful bulletin
about
women
and
Notable Feature(s): Poverty,
especially in rural areas. This concept
board of announcements, news,
Women and HIV/A IDS, one of
has legitimization through several
conferences, research and advocacv.
several sections addressing women
major international forum. Agenda 21
18f
□
AMCHSSQUARTERLY
C.o n-) > ! - } Ci
EXGI XDI RINGH I AI.TH
Medical education in India has expanded
with 183 colleges of modem medicine (a majority
in the private sector), producing over 20 000
doctors of modern medicine per year. Although
health policy documents till early 80's talked
about the social role of medical education,
technology oriented education was what got
imparted to these several thousands of trainees.
More recently, even the lip service to this social
role of medical education has been eroded with
the 2002 health policy document not providing
any strong social or other perspective to the
creation and evolution of medical professionals.
In the last 20 years it has become more elitist
than ever due to entry of private players in the
commercialization There has been a steady
increase in the proportion of women entering
the modern medicine but at higher levels of
education only one third of the students are
women in post graduate education and in the
super specialty fields it is even less (2%)
Despite great expansion, medical education
is the least studied, documented and discussed
for its gender content or sensitivity. The numbers
of books on medical education are also few in
number. Social activists have done some work
on medical education and much of the work is
found in various committee review reports, but
none of this has found its way back to any efforts
at reform.From the initial stages, the MPH
programme at AMCHSS,SCT1MST has had a
strong component of gender in its training of
MPI I. Being a national institute in medicine and
public health, SCT1MST can contribute much in
medical education and influence change in
gender sensitization
An absence of gender sensitivity in medical
education has serious implications for the
practice of medicine and affects lives of men and
women in many ways. The medical curricula
do not quickly accommodate the changing
regulatory mechanisms into practice-viz. the
Supreme court regulation regarding sexual
harassment in the work place or the social,
ethical and legal debates surrounding the issue
of sex determination. Gender sensitization
would provide a key to making medical
education socially relevant again without
removing from it the clinical moorings.
Keeping this in mind, we are undertaking a
study to sensitize health to issues of gender by
undertaking an exercise to critique the content
and method of medical education and
developing strategies for intervention
This newsletter is also part of that effort at
gender sensitization of health professionals
within the country. We plan on bringing this out
every quarter with at least two articles relevant
to the issue of gender and health education and
related issues. We will also bring to you abstracts
of articles and policy documents published
elsewhere but are relevant to the issue at hand,
important links and contacts, abstracts of kev
projects and other activities related to or relevant
to gender. The road ahead is leasl traveled and
challenging. We have fewer fellow travelers
today down this path but we hope to convince
many more on route. I assure you that this
journey that we are embarking on towards
engendering health will be informative and
thought provoking for you. Do write in and let
us know what you would like and what vou are
not happy with and what changes you would
welcome.
Amarjesani
Publishedby Dr.D.VaraiharajanforAchuthaMenonCenireforHoalthScicnccStudios.SC I IMST.T hiruvananthapuram-695011
DesscjnodbyPro|ectandPublicationCcll,AMCHSS.SCTIMST.PrintcdatSl JosophsPross.Thiruvananthapuiuin-695014
PART IX
Dear friends,
Good morning!
Nothing gives me more pleasure on an ordinary Monday morning to meet with women and men who
are committed to women's rights!
Thank you all for coming and for sharing your talents, expertise and experiences.
Changing the world in order to improve the lives of women is not an easy task. It takes a lot:
commitment, resources, political will and maybe above all’ courage. Courage to stand up and speak
out. Although we might have our differences in what we believe is the right path to follow, it is a joint
path that we have taken and our solidarity will get us there! So, welcome to you all!
I looked into a pile of documents that Cordaid and its predecessors -Cebemo, Lenten Campaign,
Caritas Nederland and Memisa- prepared over the last 20 years or so, on the role of women in
development initiatives and on issues around gender. An interesting and rich history, or should I say,
her story, emerges. There has been true commitment over the years. But we know that commitment,
as important as it is, is not enough to change the world. We also need policies, instruments, indicators
and resources! That is where this workshop will be about.
I would like to briefly review with you Cordaid's gender policy. It is clear that there are no simple
solutions to the challenges that we have been facing in designing and implementing our policies and
practices. It’s dilemma’s that emerge from that overview. I would like to ask you to keep those
dilemma's in mind in working together the coming days. This workshop is an excellent opportunity to
move forward on some of those. I will get back to the dilemma’s later on. Let me first give you a short
overview on the debate on gender in Cordaid, to refresh our memory and also to honour the work that
has been done so far.
This overview starts from 1996, but it is clear that in the years before within the different organizations,
thoughts had been given to the role of women in society and also on how that could translate into
policies and practices working in the field of development. Within Bilance, those thoughts have been
articulated most explicit in the organizations agenda. Bilance stressed its gender goal in all its
activities: project funding, development education, lobbying and fundraising.
Its gender goals were stated as follows:
“to bring about changes in existing power relationships so that women and men gain equal
opportunities to develop themselves and just development is furthered."
Bilance aimed at making at least 50% of its funds available for activities that benefited women,
preferably by improving their position, participation and influence on decision- making.
The Bilance gender policy was translated into 4 minimum requirements for funding, amongst them:
the vision of the partner organisation in terms of awareness on gender issues,
the need for active participation of women in the organisation;
the necessity of making a situational analysis, addressing the needs and interests of women and
men separately, and:
a translation from analysis to expected results, indicated separately for men and women.
Bilance also conducted internal program evaluations around this theme, to see what learnings there
were. In 1999 the internal evaluation was aimed at elaborating a Cordaid gender policy, bringing
togehter the merging organisations: Bilance, Mensen in Nood and Memisa. I would like to share the
main conclusions of that evaluation with you.
Introduction on Cordaid's gender policy and actions
Gender Strategy Workshop 10 and 11 May 2004
Lilianne Ploumen
Quality & Strategy Department
1
PART IX
On gender policy:
The study noticed a gap between gender policy and practice. Gender policy objectives were in general
not made operational. And the other way round: there was also no mechanism for translation of
experiences in the local context in the South to policy development.
On gender instruments the conclusions were:
o Clearly defined gender instruments did not exist.
o Gender was mainly given attention in general instruments. The commitment and
capabilities of (Cordaid) staff were therefore crucial for the attention for gender.
o Use of gender instruments by Cordaid staff relates to the attention for gender in their
own organisation (Cordaid).
On monitoring and evaluation it became clear that concrete indicators to evaluate the gender policy
did not exist. There was no answer to the guestion how to measure egual opportunities for women and
men and a just development. Also, the absence of concrete objectives and indicators hampered
monitoring and evaluation of gender results. Another hampering factor was the fact that in Cordaid
much more attention was given to the approval-phase of projects than to monitoring of the
implementation and results Much more information could be obtained from reports and evaluations, if
agreements on gender were monitored, and evaluations were systematised and translated into policy.
In the dialogue with partners, there was no systematic approach with regard to gender. Methods or
frameworks for gender analysis were not available or not used.
The past years we have been working to adress these issues. And where, will you ask, does this take
us in 2004? We made progress. Of course, there were also some backlashes. Tiredness on issues of
gender has sometimes taken hold of policies and practices. And sometimes we have assumed
knowledge and commitment where there is none, also because we did not invest enough in it.
On the other hand, much of our thinking about our development strategy is very sensitive to the role of
gender relations in society.
Cordaid believes that promoting gender eguality is an important part of its development strategy that
seeks to enable all people - women and men alike - to escape poverty, to develop their talents,
express their needs and ideas, and negotiate these with the broader society.
Poverty is also a structural lack of opportunities, influence, rights, freedom and scope for personal
development. Therefore, Cordaid aims at structural poverty alleviation, which combines direct aid with
sustainable improvement of social relations and is aimed at fair distribution, economic growth,
democratisation and ecological sustainability.
Structural poverty alleviation implies a transformation in the division of wealth, influence and well
being from the rich to the poor and marginalized groups in societies. This includes a process of
change in which gender ineguality is one of the main factors at play, at all levels. If there is
transformation in gender relations towards more eguality between men and women, we can truly
speak of structural, sustainable poverty alleviation.
Gender related transformation involves men as much as women. The approach following from this
vision implies that in all 'mainstream' activities, the possible outcomes are established for their
contribution to changes of gender relations, whether it means working with men, women or mixed
groups. This agenda of change and transformation has conseguences for the practice of Cordaid and
for the monitoring and evaluation of that practice. Cordaid is operating at three distinctive levels (target
group, partner organisations and the level of Cordaid itself). At each of these levels an agenda for
change of existing unegual relations is formulated.
Introduction on Cordaid's gender policy and actions
Gender Strategy Workshop 10 and 11 May 2004
Lilianne Ploumen
Quality & Strategy Department
2
PART IX
Based upon this agenda of change, Cordaid has formulated the following two objectives:
• Achieving equal access for women and men, boys and girls to (natural) resources, and equal
access to the enjoyment of the outcomes of the use of these resources
•
Making a contribution to increasing decision-making power for women and girls in order to
remove inequality between women and men, in other words: to strengthen womens and girls
voices
Now, in 2004 we feel that these objectives need to be further elaborated. They are not sufficiently
consistent with our agenda for change This is one of the key issues that we want to work on the
coming days.
In order to achieve the two above mentioned objectives, Cordaid strives for results at partner level:
•
By 2006 80% of our partner organisations will be gender sensitive, which implies that
- they have developed a clear gender vision
- they can make gender analyses
- at least 25% of higher positions in the organization are held by women
- gender analysis is translated into concrete actions
- gender expertise is present in the organisation
- women from target groups are involved in decision making processes
•
15% of Cordaid's partners are women organisations
And at Cordaid level, learning processes are set up in relation to Cordaid themes (peace & conflict,
access to markets, urban poverty alleviation, HIV/Aids and health & care). And, of course, in our
human resources policy for example, we have set indicators regarding the number of women and men
in certain positions.
We also developed instruments:
In 2003 we have developed the gender thermometer. It looks totally different from any thermometer
that you have ever seen! And it was intended to be like that: we want to challenge people to use the
instrument and to make measurement more fun.
Up till now, we have not yet used the instrument throughout the organization. The Latin America
department has experimented with the instrument and the Africa department is developing qualitative
criteria, because the thermometer as such does not provide these. At this time we have the
quantitative gender criteria that I mentioned a few minutes ago, but we feel that there should be more
to it. The qualitative criteria should be directly linked to our agenda for change and our objectives
regarding our gender policy. We need to articulate this agenda of change, sharpen our objectives and
criteria, to make the tool even more useful to all of us.
And here we face the dilemma’s that I mentioned earlier. Those dilemma's mainly address the earlier
mentioned gap between policy and practice and our quest for instruments to help us bridge that gap.
There is the issue of mainstreaming. Mainstreaming is also called: “male streaming", or “away
streaming”. It means that we put in a lot of energy to mainstream gender in general policies, at
the same time knowing that it will be difficult to follow that up, and not to fall into the trap of
instrumentalization. Mainstreaming endangers our perspective of thinking in terms of unequal
power relations and unequal opportunities between women and men. We need that
perspective to work effectively on the role of women at all levels of society. We also need that
perspective to keep paying attention to the suffering of many women, due to those unequal
power relationships.
And do not get me wrong: I am not victimizing women, but I would also not want us to think too
easy about the harmful effects on women of some traditional beliefs and practices, religious
fundamentalisms and paternalistic societal mechanisms. Aids Response, one of our partners
Introduction on Cordaid's gender policy and actions
Gender Strategy Workshop 10 and 11 May 2004
Lilianne Ploumen
Quality & Strategy Department
3
PART IX
here presents, puts is rightly as it states that “does not only deal with the traditional patriarchal
setting of the church, but also with the traditional matriarchal setting of non professional health
care for sick and dying.
We feel that contextualizing policies and practices is a key element to effective development
initiatives. Now, how can that work for gender policies and practices? How can we translate the
realities of local contexts and the demands of you, our partners, into our gender instruments. We need
more insight into the effects of those instruments and the prerequisites for use. For example: in
emergency aid as well as in other interventions, womens needs should be addressed from their
perspective. Now, how does that work? How can we operationalize those needs? I know that work has
been done on that, building on experiences that we have in more structural interventions. Still, it is not
common practice to tailor emergency interventions also to the needs of women. How can we assist
each other in designing those mechanisms and instruments?
As a large organization, working on 5 themes, in 40 countries, with 1000 organizations, we have
wonderful opportunities for learning. How can we capitalize on those opportunities: how do we
upgrade strategies and spread learning experiences. We know that toolkits, instruments and checklists
are useful, but we also know that those alone are not sufficient. We need better insight in what works
and what doesn’t work in certain contexts and we need to clarify what our role can be in facilitating
those joint learning processes. Recently, in a different setting, we have had positive experiences with
peer reviews, could that be one of the ways that we can improve our joint learning processes? Huairou
Committee, one of the international grass roots women networks (also present here today) might
serve as a good example of peer learning. They have been very well able to mobilise and enhance
grass roots women knowledge and strategies and ultimately link these strategies to the global
debates....
And finally: what can our identity, being a non governmental catholic agency, add to our agenda for
change? How can we harmonize the realities of women that we work with and for into our agenda and
how can we best voice their concerns in the international community that we are part of. How can we
work together with women in the Netherlands and elsewhere? And also: how can we play an effective
role in advocating for womens rights in our catholic community. With Cairo and Beijing +10 coming up,
we have an opportunity to reflect on our role and views.
Well, I think that should be enough food for thought for the coming days! My colleagues, Marjolijn
Wilmink, Helen Beyersbergen and Lucia Helsloot, have put together an excellent agenda for this
meeting. I would like to thank them for their input to this process. Their energy revitalises our thinking!
I am convinced that the coming days will reaffirm our commitment to womens rights.
Lilianne Ploumen
Introduction on Cordaid’s gender policy and actions
Gender Strategy Workshop 10 and 11 May 2004
Lilianne Ploumen
Quality & Strategy Department
4
PART IV-N
Women’s Voice Malawi
Case Study
Introduction
Women’s Voice is a local non-profit organization which is devoted to the promotion and protection
of justice and welfare of women and children,s rights through:
• Training
» Civic education
»
Action oriented research
• Forums for dialogue and
«
Advocacy and lobbying.
The organization has the following objectives:
• To educate women and children their legal and human rights.
o To advocate for gender equality
o To collect and disseminate information on women and children’s rights
» To carry out research on problems faced by women and children in all areas.
o To urge Government to amend and repeal all laws that are repressive and discriminate
against women and to urge government to ratify and incorporate into Laws of Malawi all
International Instruments on women and children's rights.
Level of interaction
The level of interaction is both at local as well as National. At local level, most of Women's Voice
activities are community based. At National level the organization is actively involved in issues of
policy advocacy in issues mainly concerning women.
Size
Women’s Voice is a national organization with Community offices and projects in 4 districts of
Malawi. The organization has 16 paid up staff, 9 Board Members and 430 Community based
volunteers.
Summary of Experiences
As the name suggests, most of the programmes and activities were women focused, the
member'sof staff were all women. The organization was following a Women in Development
(WID) approach where all the strategies were women focused and the organization was there to
address the problems of women and nothing else.
Actual Case Study
The organization ever since its inception, it was using a WID approach and through out this
period, the projects were somehow meeting resistance from men in society and somehow it was
very difficult to make headway and register impact. Women were empowered but they could go
no where with their empowerment because men were very hostile and could not open up to
accommodate the changes in their women because they were not part of the change and
transition..
Later in 2000, through donor demand for a more gendered approach and of course through our
experiences in the field, Women’s Voice decided to adopt a new strategic direction and decided
to move from a WID approach to a GAD approach where all the projects and decisions were to
benefit both men and women and in the long run reduce the disparities rather than advancing it.
PART 1V-N
With this need for a new direction, Women’s Voice went through a gender Audit through the
Tanzanian Gender Networking programme (TGNP) with the funding from Southern Africa AIDS
Training Programme.
With this transition Women’s Voice moved completely from WID to GAD, in so doing, it meant
that all projects were to benefit both men and women. Community volunteers were both men and
women unlike before. With this approach, Women's Voice activities started gaining an
overwhelming support from the catchment area as well as from the chiefs.
Women’s Voice started treating men as colleagues and partners in development. All in all
Women’s Voice adopted the following as a strategy to ensure that Gender is mainstreamed in all
its programming:
-$■ Decided to reshape the mainstream rather than adding activities to accommodate
men
0 Strongly focused on equality than women as a target
Focused on broad policy and made changes
0 Moved beyond responding to Gender differences and decided to increase attention to
reduce disparities
Focus
Changes in the organization helped Women’s Voice to work in a more gender aware manner
and experience gained at the community level..
As the organization was changing in terms of area intervention, the number of staff (human
Resource) was also increasing to meet the demands out there.
The staff was also developing in their expertise and hence was able to analyze situations and
able to adopt what is relevant and what will help Women's Voice if the organization was to
make impact.
One of the issues analyzed was the gender disparities which was their and the resistance
which the organization was meeting out in the field.
With the Gender Audit which the organization did, this helped the organization to identify and
examine the impact of external and internal factors on gender issues in its programming.
This helped Women’s Voice to promote gender equality objectives in its internal operations
and in its programming.
That is when Women’s Voice then mainstreamed gender in its programming as much as
possible in such a way that all its projects moved beyond responding to gender differences
and decided to increase attention to reduce disparities, this assured that projects will benefit
men and women.
At personnel level, the organization looked at recruitment as a starting point. Before the
organization went through this transition, women occupied almost all the posts, but this is not
the same anymore. Now 40% of the staff are men.
All the Programme staff have gone for a gender mainstreaming course to ensure that all
programme staff speak the same language and wear gender lens in planning, implementation
and monitoring of all projects
Two donors played a very big role in this kind of positive transition from a women focus to a
more gendered approach and these are CORDAID and SAT.
PART IV-N
CORDAID in its institutional Assessment of the organization made strong recommendations
that Women’s Voice has to consider Gender strongly in its programming. CORDAID reporting
guidelines also emphasized for organizations to strongly report from a gender perspective
and as much as possible provide gender disaggregated data for project beneficiaries.
SAT programme has also helped the organization a lot.
SAT has offered trainings in Gender mainstreaming to all programme staff at Women's Voice
and it has also helped the organization to change in broad policies by helping it to undergo
the situation analysis from a gender perspective. It also helped the organization examine the
extent to which gender equality has been mainstreamed in various facets of the organization
like at:
V Organizational policies
0 Strategies and activities
v Existing Gender expertise in the organization
Personnel policies
0 Information management
0 Decision making in the organization
Culture of the organization.
Working Group Urban Liveability
o
o
o
o
o
o
o
o
o
o
o
Mrs. Helen Yamo, Femmes Africa Solidarite Switzerland
Mrs. Aleli Marcelino, Philippines
Mrs Safia Abdi, Cordaid Regional Office Kenya
Mrs. Sri Husnaini Sofjan, AWAS
Mrs Anna Schilizzi, Cordaid
Mr. Marc v.d. Linden, Cordaid
Mrs. Josta ten Broeke, Cordaid
Mrs. Nele Odeur, Cordaid (May 10, 2004 only)
Mrs. Marloe Dresens, Cordaid
Mr. Adriaan Fokker, Cordaid
Mrs. Margriet Nieuwenhuis, Cordaid
Working Group HIV/AIDS
o
o
o
o
o
o
o
o
o
o
o
Mrs. Makoko Chirwa, Women's Voice Malawi
Ms. Loretta Joseph, AIDSResponse South Africa
Mrs. Esther Mwaura-Muiru, Groots Kenya
Mrs. Joanna Kerr, AWID USA
Mr. Piet van Gils, Cordaid
Mrs. Lieke de Winther, Cordaid
Mrs. Carla de Wit, Cordaid
Mrs. Lucia Helsloot, Cordaid
Mrs. Anneke v.d. Meij, Cordaid
Mrs. Barbara Berger, Cordaid
(Mr. Nico Keijzer, Cordaid)
Working Group Health and Care
o
o
o
o
o
o
o
o
o
o
Mrs. Angela Dwamena-Aboagye, ARK Foundation Ghana
Mrs. Radium D. Bhattacharya, GAP-SRCDE, India
Mrs. Thelma Narayan, Community Health Cell India
Mrs. Annemiek van Voorst, Voorstrategie, the Netherlands
Mrs. Stephany Kersten, Cordaid
Mrs. Rens Rutten, Cordaid
Mr. Bert Ruitenbeek, Cordaid
Mrs. Margriet de Kruif, Cordaid
Mr. Remco v.d. Veen, Cordaid
Mr. Frans Wierema, Cordaid
04-05-2004
G:\K&S\Management AssistenttGenderworkshopWerdeling in werkgroepen.doc
Pagina 1 van 2
Working Group Peace and Conflict and Human Rights
o
o
o
o
o
o
o
o
o
o
o
o
Mrs. Emma Lindsay, Femmes Africa Solidarity Switzerland
Mrs. S. Sawitri, LKTS Indonesia
Mrs. Ira Febriana, Indonesia
Mrs. Leonor Esguerra, Corporation Mujeres que Crean, Colombia
Mrs. Aline Batarseh, Women’s Studies Centre, Israel
Mrs. Maria Teresa Rodriguez, Fundacion Guatamala
Mr. Laurens den Dulk, Cordaid
Mrs. Astrid Frey, Cordaid
Mrs. Jeanne Abdulla, Cordaid
Mrs. Elly Reinierse, Cordaid
Mrs. Lia van Broekhoven, Cordaid
Mrs. Dorine Plantenga (only May 11, 2004)
Working Group Access to Markets
o
o
o
o
o
o
o
o
o
o
Mrs. Lawrencia K. Wonnia, SEND Ghana
Mrs Merecedes Canalda, ADOPEN Dominican Republic
Mrs. Sandy Schilen, Groots International USA
Mrs. Manuela Janssen, Cordaid
Mrs. Martine Benschop, Cordaid
Mrs. Edith Boekraad, Cordaid
Mrs. Hetty Burgman, Cordaid
Mrs. Inge Barmentlo, Cordaid
Mr. Ben Krommendijk, Cordaid
Mr. Tony Fernandes, Cordaid
Working Group Emergency Relief & Linkage
o
o
o
o
o
o
o
o
Ms. Christiana Thorpe, FAWE Sierra Leone
Mrs. Francoise Bigirimana, Burundi
Mrs. Nicole Spijkerman, Cordaid Maluku, Indonesia
Mrs. Jan Peterson, Huairou Committee USA
Mrs. Greet Robbe, Cordaid
Mrs. Sasja Kamil, Cordaid
Mrs. Marloe Geurts, Cordaid
Mr. Marcel Krabbendam, Cordaid (May 10 afternoon, May 11, morning)
Mrs. Monika Haekel
04-05-2004
G:\K&S\Management Assistent\Genderworkshop\Verdeling in werkgroepen.doc
Pagina 2 van 2
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ADOPEM
Dominican Association for
Woman’s Development
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■
..
Affiliated to
Women’s World Banking
(WWB)
“
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ADOPEM
GEOGRAPHICAL
LOCATION
x
HALF-CLOSE OF
THE DOMINICAN REPUBLIC
Population
:
8.7 Millions
Territory
:
48,511 Km2
Currency
:
Peso
Change
:
US$ 1 = RD$ 45
Economically
Active Population (PEA)
:
3.6 Millions of People
Unemployment rate
:
15%
Inflation
:
:
:
:
7.70 %
4.38 %
9.00 %
30.00 %
2000
2001
2002
2003
ADOPEM
Mission
To improve women’s living conditions and their family,
in the Dominican Republic incorporating to the formal
sector through financial and developing services that
work for most
“Changing the way world Work”
ADOPE1
ADOPEM
□ In the Dominican Republic as much of the places in the world women’s
don’t have many opportunities to access credit, education, participation.
□ Women are 52% of the all population in the DR
□ Women have 26% more participation in micro business that men in the DR
□ Statistical 100 pesos that get to women’s hands impact directly into a
family, food, education and held, only 20 pesos if that money get to
mans hands
ADOPEM IMPA CT IN SER VICES FOR WOMEN
□ Important Information:
o Born in 1982
o 2% of the PEA
o More than 50,000 loans a year
o More than a financial service
o Won different prizes
ADOPEM
CORDAH)
( OATRIBIIIOA
~
...p
■ ■ •
CORDAID PAR TICIPA TION
Date of Disbursement
Amount
Rate (Interest)
Term
Payment of Interest
Payment of Capital
Dec. 4, 2001
NLG612,500.00
US$ 254,692.11
8% plus inflation
2001 - 2005
Every six months
4 payments every six months
(30 months after the first disbursement)
POSITIVE:
o More than 750 women with loans
o Best time to receive the money
o Good term, in domestic currency, not foreign exchange risk
NEGATIVE:
o Difficulties to get new facilities
o Difficulties to renegotiate the terms because inflation
—
ADOPEM
,'g>
Domi Estela Perez
□ Lives in a rural zone
□ She has 5 sons
□ Initiates her business by the
necessity to be in her house, because
her younger daughter with 13 years old
become pregnant
□ Got abuse by her first husband
□ Initiates selling vegetables
□ Knows ADOPEM and install her
own grocery store
□ Began with a loan of RD$1,000
(US$30) in 1998 and actually she has a
loan ofRD$12,000 (US$360)
ADOPEM
Fiorentina AngelesReyes
■ Fiorentina is 43 years old and lives
with her husband who is 71 years
old and two of her three children
and her grandson.
■ Fiorentina has three businesses:
1. Lunch business: sells 15 to 20
lunches each day to a nearby
factory. Also sells to walk-in
customers. Operates out of her
kitchen.
2. Grocery Store: Sells home made
fruit juices, daily food stuffs.
Store is located in front of her
house.
3. Rental Property: currently has 7
rooms and 1 wooden house rented
as accommodation; 1 store front.
All located in family compound.
^.°==^
■ She has been borrowing from
ADOPEM since 1997 and has
invested the money in property.
ADOPEM
Elorentina; GrowtEin Rental Itfcome Per Months
' <s»
i RD$
Lives in Builds
Wooden Cement
House
House;
Rents Out
Wooden
House
Builds 2
Rooms
for Rent
Builds 2
Rooms
for Rent
Improves Builds 2 Builds 1 Room for
Rent;
own
Rooms
for Rent;
house
1 Storefront for
Rent
Closes
~ Veranda
to Inaice'
Grocery
Store
ADOPEM
FlorenSna; Most Recent Edition.
Store frorrt plus accmm^odatiqn above_
Fiorentina: Growth in Property Value
“When I feel that I
cannot work,
when I am old, I
will have my rent
with which I can
buy food and not
be hungry. ”
1999
2003
ADOPEi
Bethania’s-Fiye Businesses
1. Organizing ROSCAs (SANEs): E.g. Bethania organizes 5 participants. Each
contributes RDS100 every day for 60 days, equivalent to RD$6,000 each or
RD$30,000 total. The payout is RD$5,000 every 10 days. As the ROSCA
organizer, Bethania is entitled to the first payout of RD$5,000 without
contributing any money.
2. Selling Clothes: Bethania buys RD$5,000 worth of merchandise every two weeks,
sells it for RDS8,000, giving an estimated ROI of 40% per month.
3. Lending Money: Bethania lends small amounts of money e.g. RDS500 to
RD$2,000 for short terms (2 weeks) to people that she knows. She charges 20%
every 2 weeks.
4. Deposit Collecting: Bethania minds money for some local shopkeepers. For
example, a shopkeeper comes to Bethania’s house each day and gives her
RDS200 to guard. He does this each day for 60 days, equivalent to RD$12,000
total. At the end of 60 days she gives him back RD$10,000 and keeps RD$2,000
as a fee.
ChihlMinfling-Jlethaniamindsaneiphbor’schikLforRDSl.OOOamonth.
^
ADOPEM
WE HA VE A GREA T COMMITMENT
TO THE DOMINICAN WOM'MEN’S
PARTICIPATION
Jig
; ADOPEM
ITDG GENDER WORK
BACKGROUND
The political, social and economic, legal and cultural influences on pastoral society have in many
ways affected the gender balance in a negative sense for women. Despite being managers of
homesteads pastoral women do not have access to the traditional forms of regenerative wealth.
There is also gross underrepresentation of women in management committees and decision
making positions that have resulted in the creation of policies that fail to address their needs and
concerns as women are currently unlikely to be elected to positions of management committees.
Therefore, Community decisions on resource management are always made by men, despite the
fact that the burden of family labor and responsibilities is predominantly borne by women and girl
child.
The structurally weak, inadequately resourced and poorly coordinated women institutions - with
limited capacities to assume roles of community leadership has made women groups
unrecognized by state institutions. The groups also lack strategic integration into local, district and
national level policy making processes. Other elected women still find it difficult to speak out their
grievances in front of their husbands and fathers while others find it more difficult to put their
argument forward to outsiders. As a result they rarely gain the opportunity to effectively influence
decisions or engage in implementation.
In Marsabit, Turkana and Samburu ITDG-EA, through its Rural Livelihood projects, continues to
witness and document the marginalization of pastoral women under the current socio-cultural,
political and economic setup. In particular, ITDG-EA acknowledges that over generations,
societies have assigned roles, access and ownership of resources on gender lines. This has led to
impoverishment and marginalization of women as opposed to men.
To change the status quo, ITDG-EA recognized that promoting the positive role of women in
development is a pre-requisite to sustainable development. It identified gender sensitization and
economic empowerment as an urgent matter at community level. The other pastoral sectors that
needed to be addressed in respect to gender issues were energy, agriculture, water and
sanitation, shelter, environment and income generating activities.
Hence, ITDG-EA with funding from CORDAID thus embarked on streamlining,gender awareness
in its pastoralist project in Northern Kenya. The various interventions were designed to build
capacity of the women, empower them with knowledge so that they are able to engage in
decision-making processes that affect their livelihoods, increase their skills in income generating
activities and natural resource management.
The following case studies therefore highlight ITDG-EA specific experiences in Nothern Kenya:
The Bubisa Women Group
Introduction
Bubisa is located in northern Kenya about 600 kilometers north of Nairobi and 150 kilometers
from the Kenya /Ethiopia border. It is a dry season watering point for pastoralists in this area,
which with time has become a settlement especially for pastoralists dropouts and in particular
women headed households dependent on relief agencies for their livelihood security. The
settlement has a very high proportion of female-headed pastoralist drop out households in a
community that is very paternalistic in terms of resource control and decision-making.
In recent periods changing weather patterns, increased conflict over water and pasture as well as
interventions associated with modern development such as construction of boreholes, schools
and health facilities have necessitated the establishment of permanent settlements, interfering
with the pastoralist way of life. In addition most relief based interventions targeting the pastoralists
have brought about a change in food taste with most of the settled communities preferring maize
based meals and thus creating a dependence on externally sourced food stuffs. This has resulted
in an increasing number of dropouts from the nomadic way of life. This has consequently resulted
in increased poverty of the communities and especially for pastoralist dropouts in the settled
areas.
Women Group Profile
Bubisa Women group is a women initiative to pool together resources and skills to tackle the high
levels of poverty affecting most of the members of the group. Out in the dry patched land of
northern Kenya towards the border with Ethiopia survival is the norm as the inhabitants of the
area try to eke out a living from the hostile environment. Traditionally, residents of this area are
nomadic pastoralists moving from place to place in a systematic pattern governed by seasonal
changes of the weather in search of pasture and water for their livestock. In addition other
problems facing the community in this area include low literacy levels, low school enrolment,
some negative cultural practices e.g. Female Genital Mutilation, girl marriage and traditionally
accepted multiple sexual partners enhancing the spread of HIV Aids and other sexually
transmitted diseases.
To improve their welfare, women from this area came together and registered a women self help
group in 1996 with the overall objective of cushioning their members from the devastating effects
of poverty prevalent in the area as well as empowering them to take control over decisions that
affect their lives. The group is based in Bubisa location of Maikona division of Marsabit District in
northern Kenya. It is made up of 17 members aged between 25-45 years, 8 of who are household
heads fending for themselves and their children with little or no resources at all.
Most of these women have been rendered poor as a result of cattle rustling due to banditry
activities and diseases that affect their livestock. They are pastoralist dropouts who have adopted
other coping strategies towards improving their livelihoods and that of their children. The age-old
traditional livestock lending culture in the community, which provided support for the poor and
women headed households has been eroded with time. Even for men headed households,
women still tend to suffer more during difficult times as most of them are left at home with the
children to take care of while husbands move away with livestock in search of pasture and water
for the livestock particularly during prolonged drought.
Activities
The group since its formation has been involved in various activities for the benefit of their
members. To date the group has undertaken the following activities:
Environmental Conservation through Rehabilitation of Degraded sites
Process
Of the group's activities, the most ingenious initiative by the women group so far has been the
environmental conservation work. This involved the construction of a stone wall to protect the
centre from strong winds and enable natural re-vegetation of the degraded site. Groundwork
included the creation of good will among the stakeholders - Bubisa Water User Association
(WUA), EMC, local leaders and Bubisa women's group. To ensure that implementation was
participatory, the expected roles of the various stakeholders were defined through consultative
forums. During the consultative meetings, the community members demonstrated knowledge of
the project and the urgent need to have it started.
A total of 45 members, 10 men and 35 women were involved in the process. Both men and
Women were responsible for piling of stones, loading and offloading of stones. Women also
contributed food, water and milk. ITDG-EA provided funds for barbed wire and cement for
foundation while the community raised funds for cedar posts.
Work commenced with the collection of stones from a nearby area with the full support of the
area chief and clan elders. Two Dhabelas (the Yaa elders), the Marsabit project team and the
Marsabit District Trade Officer collected the foundation stones. A hired tractor ferried stones while
between 12 and 13 women were on the construction site on a day-to-day basis playing various
roles - loading/unloading of the tractor with stones, making tea or doing actual construction of the
wall.
The construction of a stonewall is an activity that Gabra women cherish, following their
experience in the construction of enclosures for camel calves, structures traditionally called
mona. By the end of the year, a total of 1,730-metre perimeter wall was complete, with less than
500 metres of the intended enclosure remaining.
Results and Impacts
The community reported some positive impact following the construction of the enclosure so far
covered. The wall acted as a windbreak, reducing the impact of wind erosion at the centre.
Despite the prevailing stressful environment associated with pro-longed drought, there was
evidence of natural regeneration on the inside of the enclosure. This part had accumulated
manure, seeds and patches of green vegetation that had not been disturbed by livestock. Despite
all the odds the wall was finally completed by the end of the year.
Lessons Learnt
Such community efforts need to have some short-term benefits to encourage them to continue
with the work, which may take many generations for the full benefits to be realised. In Bubisa
after two years the community is already benefiting from reduced effects of sandstorms and
greening of their environment, which has given them a vision of what their area could look like in
a few years time with sustained efforts in environmental conservation. It is hoped that efforts like
those of Bubisa Women group would spur other community groups and development agencies to
undertake environmental work to mitigate against the imminent environmental degradation
resulting from infrastructural development activities.
Energy Conservation through Energy Saving Mud Stoves
There is recognition of the central role of women in household energy and the different energy
needs and contributions. The Technology that has been developed for energy conservation is
commercial oriented and by far specialized in male dominated activities. ITDG-EA recognized the
need for fuel saving technologies and A 5-days training workshop on fuel-efficient stoves was
held at Bubisa centre with a focus on mud stoves (jiko sanifu types) as a response to the
communities' needs.
A total of 19 participants drawn from Torbi women's group (3), Thagado women's group (3), Yaa
Galbo (1) and Bubisa women's group (12) benefited from this training. The Energy Programme of
ITDG-EA facilitated training in collaboration with two members from the Ministry of Agriculture,
Marsabit. Bubisa women’s group banda was used for accommodation. The women’s group also
provided catering services to participants empowering the group for effective contribution to
livelihood.
Technology Transfer (PTT) approach was used during the training. Participants shared their
experience on the problems of energy at household level and narrated the various options they
used to address wood scarcity. Participants constructed five demonstration stoves within kitchens
of Bubisa participants during the training session with minimal supervision from the facilitators,
suggesting that the technology offered was simple for trainees to adopt.
Results and Impacts
A follow-up conducted by the project team observed an increase in the adoption of the new
technology beyond the group members. Totals of 6 and 8 stoves had been made and were in use
at Bubisa and Torbi centres by the end of the reporting period. The women reported increased
use of one load head from 3 to 5 days per household.
As a result of the adoption of the energy saving technology by women groups in Bubisa, there
has been a reduction in the amount of fuel wood used. Trees have also regenerated drastically
due to reduced demand for wood.
Through this technology women in Bubisa can now cook food faster and in a cleaner environment
due to reduced smoke emission.
Kubi Bagassa Women’s Group
Introduction
Kubi Bagassa Water Users Association (WUA) was formed in 1997 with the objective of
managing day-to-day operations of the borehole, including determining user fees and recruitment
of a pump attendant. A general meeting was held following which officials, who were all men,
were elected to manage the borehole. Since then, the borehole has experienced a number of
breakdowns, which the WUA has had difficulties to address due to management and financial
factors, despite daily collections from water users. The users pay KShs 1.00 for an animal
watered and for a 20-litre Jerry can of water drawn. On average, therefore, the management
collected between KShs 700 and 800 per day.
Frequent breakdown and shortage of diesel forced women to travel to the neighbouring Dirib
Gombo borehole (3 km away) and Dirib Gombo shallow wells (8 km away) for water for domestic
use. Animals were also forced to water in the same sources.
The financial and management problems faced by the committee composed of men were:
■
•
•
Unavailability of diesel to run the engine.
Lack of accountability of monies collected.
Frequent breakdown of the genset due to poor and/or failing to service it. The pump
attendant lacked technical skills and was hardly paid.
•
■
*
Lack of a forum for the committee to deliberate on borehole matters; the executive had no
knowledge of its obligations and roles;
Poor record keeping; the committee kept no record of transactions at the borehole including
daily collections, and the purchase of fuel and spare parts.
Poor maintenance/improper management of the borehole.
The Process of Change
Early September 2000, a meeting was convened to address the management of the borehole.
After lengthy deliberations, women expressed interest in sharing the management of the
borehole. Consequently, they were allowed to collect and manage the sale of drinking water,
charging KShs 1.00 per Jerry can. The women formed a group to undertake the management of
their collections. Men were left to handle collections from watering animals.
The new resolution became operational immediately. That month, the women’s group collected
KShs 6,360. In early October, the borehole ceased functioning from lack of fuel. The men, in
charge of purchasing fuel, had no money to do so and could not account for the disposition of
funds collected the previous month. The women's group invested KShs 3,000 in the purchase of
diesel and cautioned men against interfering with their collections. They then took on the
responsibility of collecting for watering of animals. The women turned down the request put
forward by men that they be responsible for purchasing diesel. Instead they undertook purchasing
and supervision of use of the fuel. That was when the committee composed of men decided to
pass over full control of the borehole to the women's group in October 2000.
Results
The women’s group has a total of 53 members. Since the women’s group took over the
management of the borehole, they have opened an account with Kenya Commercial Bank,
Marsabit branch. By December they had deposited over Kshs 4,000 in their account. The bank
has handed over the certificate of registration of the borehole management to the women’s group.
Cases of engine breakdown have reduced and access to water by the community improved.
A major achievement was that the DC chose to celebrate the World Water Day at Kubi Bagassa.
This showed support of the administration to this group.
They recently acquired a new genset from UNICEF.
The women’s group in conjunction with ITDG-EA, the Department of Culture and Social Services
and the Water department is revising user by-laws. The group also approached ITDG-EA for
leadership and micro-enterprise business training, which was done. The training was facilitated
by ITDG-EA in collaboration with the Department of Water.
Challenges
The new management faces the following challenges:
Threats and intimidation from the local administration, particularly the area chief and councilor;
Inadequate capacity to effectively address management issues, particularly because for a long
time, men have benefited from capacity building workshops. As indicated above, this gap is being
addressed by on-going training facilitated by ITDG-EA.
The challenges have been summarized as below:
'Our main problem here in Kubi Bagssa is neither lack of enough, funds to bdy diesel nor less
committed water users but is simply the extension of our male hegemony right .from the
Manyattas to the water points." Says Mrs. Lokho, a community wdnien leader.'-'Afei^niilhg to'tei1,
their husbands, in cahoots with the area chief, have formed a habit of running away with all water
revenues every tim'e. they become water'cashlers.' “They have never appreciated iour efforfs to
maintain the Manyattas with sufficient water by keeping the borehole running as.'thisjs; our, only
source of water,” she explains. "Every time they, hear the sound of the engine; 6dr meh. would
come running to displace women from the water points accusing us'of collaborating wjth' s'ofrie:
foreigners to deny them access to their rightful property. They would keep the engine running for
as long as they could keep their eyes awake, and as-long as there is ..enough diesel. When the
Idiesel runs out or the'engine breaks- down they would simply disappear-with.Mlc.ori^ctiq
Manyattas leaving us to. struggle looking for funds, besides footing miles away. in' desperate
search for water. After all, the goats and the camels can do without water for a couple of-days
unlike the daily domestic water requirements that stops at the .woman " The women leader
[explains
..."
.
?
'The problem started when-the local community voted, opt The male ;,dominated<ar;^.;.'<^nupt
management committee in favour of the local women group that.had be.eh-i^eratip§^i^"afea'
for quite some. time. “It was a' miracle that the water user's 'group considered
our role was simply to pay and draw water. We were grossly "un'derffepresented -in i-wateh
management committee and the few who were considered were mere spectators as they could
not speak in. front of their husbands", The. women deader-explains Acpordwg.,to hB; there were
meitherrecords nor. accounts for the water .users group before tney-took over the borTa'rJas'men
used to stuff coins into .their pockets just, to show off to their suitors how riche' they are. ; ’ i ; i ’'
'However, things worsened when the local;administrator physically,-ejectedthe. wometTfromthe
borehole replacing them with his relative whotiad no idea on how to-, operate the.machihe. |ri the
process the young man pressed the wrong button thereby blowing off the-mortar, the switchboard
and the water pumps resutting.rtp.a-loss worth.kshs. 700rQ,00, We are not £ure if hetwas instructed
to do so, says the local women leader, butthe way all-men havedisappeared,l< „ . . .
lhere -is quite telling
’“t
Initially, women used .to borrow fuel from a local petrol station -arid'pay biablft^^
collections but this time round they have been shot on the foot, as they can’t raise Over Kshs
700,000 to.repair the machine:. ..
The consequences have however, been .disastrous,; over 400 women who ywa^^Mg served by'
this borehole now .walk over 10 kilometers in search of water from a nearby borehole which is
also unreliable due to its frequent breakdown.- -.They wake up :at.J^te..nighb risking theirslwesifrom
wild ianirnalp; trying^, to beat the usually long^ueue:'The 10-fitre con^rW^ >-drawing
;water is- barely sufficient enough- to sustain,fhe. hQusehold-needs’^Woth^rsjagB^t^i^fe^Wi
between watering the:lactating and young animals,-and providing drinking water.fer their childreri:
and the old.
The two nurseries and vegetable gardens they had started two years ago had^genejto.waste;.;
Women have no time to rest and majorities are.cbntfacting'pneumbnia-'dbeitomprn^gj^l^sdTl^e!
women .leader , painfully narrates how one of their members who recently gave, birtt '
wash her baby for four days, leave alone getting bath hersef due to'lack of-wi'
husbands prefer watering the lactating animals and the sick ones to attending t<
There are many horrible experiences our members have gone through since the.
down. She concludes.
S'!
The local chief and his men have extended their chauvinism further by diswu-ra'glngp^ppfeifrgni
paying up their debts. Even the chief himself owes the borehole over kshs '5,000 dfynpaidv/ater
bills. But despite this huge bill the chief, is still, spreading rumours among local community that.the
machine requires a lorry of coins to enable its repair, which is far much expensive fpr iftte
community to. contribute. As the women insubordination persists;'! poof women-saiKdb^ Bagasa
continue to suffer.
■ ..Hy-
-Similarly, a IQO.OOCMitre tank,.constructed, oy ALRiv'iP that has.been serving dne cgtn y ij
cracking and total degeher&fibn. if,it, remains'dry iwith'out wzatefehth^nekKf^irf^i^j,,.^,.^
are also afraidof .vandalism'.jpf -.the;-.machinealtogether if- nci attended- jo soon.er..<ap/th;ay.',ls;ho
watchman at the site. Hence a Kshs. 2 million water project risk total collapse for lack of 600,0.00
to repair the machine
.- ...
.........
- -■
'
I..'.-:; ■■ •'
However, according the Urinbrglla Group chairman, the Area District
warning letter to.the chief-instructing .him to .keep off the borehole'or else-risk- siSm-'dlsciplinary
action from his office. This was confirmed during the. recent'aWb^S;rnp^j^-Sh^:lti®-;E)^j
firmly instructed the vzomen the loc^l. community’ to. report' to:him•if'-.the;'dht?f;:ifr’mA<s"'hahi<'-'
However; when the women approached the ministry df water .for assiste-;*'*-- '
lackof funds for purchase of spare parts but .are'wiiling to provide trahspoft-'fedili'
i
■
Kubi Bagasa was the first bprehoiejn-its.kind to be mariaged-by local wpmeg-.ip®e'w/
It has been a showcase both at the local, district and regional on the importance' of Women’s
involvement in watqr,management, Its cpjlaps§.shay..strike,a big.bio'^.npt,p' '
ja,group..but-also to the wider womep fratqrpity;who9haye ’beeJf^trampaigning>'fdr wdi ‘
management and- -the -Ones; who have "been fightjng-insubqrdinatiprfiSind.!
whole pastoral cbmmuriity. Mr. Ortd, Group umbrella chairman concludes!'' '
District Water Umbrella Association
•
Environmental conservation in which they have provided protection for young shoots of ASAL
adapted trees species from browsing animals like camels and goats through erection of a
wall enclosure using readily available stones. This work has been very successful and has
even been featured in the Baobab1 development magazine as an example of an ingenious
community response to environmental degradation.
•
Energy conservation through use of appropriate energy conservation techniques. Two group
members after participating in a workshop on construction of energy saving mudstoves have
trained other community members on the same resulting in increased use of the fuel saving
stoves and a resultant reduction in pressure for firewood on the environment.
•
Income generating activities is one of the major activities of the women giving them access to
resources directly under their control as well as providing services to the community.
•
The group has engaged an adult literacy teacher to provide literacy classes to their members
and other community members.
•
The group through drama and poetry is involved in raising community awareness on negative
cultural practices as well as HIV/AIDS.
Results and Impacts
Environmental Conservation
The community has benefited from reduced sandstorms and women can now cook outside the
manyattas even during the day.
Lessons Learnt
Such community efforts need to have some short-term benefits to encourage them to continue
with the work which may take many generations for the full benefits to be realised. In Bubisa after
two years the community is already benefiting from reduced effects of sandstorms and greening
of their environment, which has given them a vision of what their area could look like in .a few
years time with sustained efforts in environmental conservation. It is hoped that efforts like those
of Bubisa Women group would spur other community groups and development agencies to
undertake environmental work to mitigate against the imminent environmental degradation
resulting from infrastructural development activities.
1 A publication of the Arid Lands Information Network December 2001 vol 33.
PART IV-0
ITDG Kenya
Case Study
BACKGROUND
The political, social and economic, legal and cultural influences on pastoral society have in many
ways affected the gender balance in a negative sense for women. Despite being managers of
homesteads pastoral women do not have access to the traditional forms of regenerative wealth.
There is also gross underrepresentation of women in management committees and decision
making positions that have resulted in the creation of policies that fail to address their needs and
concerns as women are currently unlikely to be elected to positions of management committees.
Therefore, Community decisions on resource management are always made by men, despite the
fact that the burden of family labor and responsibilities is predominantly borne by women and girl
child.
The structurally weak, inadequately resourced and poorly coordinated women institutions - with
limited capacities to assume roles of community leadership has made women groups
unrecognized by state institutions. The groups also lack strategic integration into local, district and
national level policy making processes. Other elected women still find it difficult to speak out their
grievances in front of their husbands and fathers while others find it more difficult to put their
argument forward to outsiders. As a result they rarely gain the opportunity to effectively influence
decisions or engage in implementation.
In Marsabit, Turkana and Samburu ITDG-EA, through its Rural Livelihood projects, continues to
witness and document the marginalization of pastoral women under the current socio-cultural,
political and economic setup. In particular, ITDG-EA acknowledges that over generations,
societies have assignedxoles, access and ownership of resources on gender lines. This has led to
impoverishment and marginalization of women as opposed to men. '
To change the status quo, ITDG-EA recognized that promoting the positive role of women in
development is a pre-requisite to sustainable development. It identified gender sensitization and
economic empowerment as an urgent matter at community level. The other pastoral sectors that
needed to be addressed in respect to gender issues were energy, agriculture, water and
sanitation, shelter, environment and income_generating activities.
Hence, ITDG-EA with funding from CORDAID thus embarked on streamlining gender awareness
in its pastoralist project in Northern Kenya. The various interventions were designed to build
capacity of the women, empower them with knowledge so that they are able to engage in
decision-making processes that affect their livelihoods, increase their skills in income generating
activities and natural resource management.
The following case studies therefore highlight ITDG-EA specific experiences in Nothern Kenya:
PART IV-0
The Bubisa Women Group
Introduction
Bubisa is located in northern Kenya about 600 kilometers north of Nairobi and 150 kilometers
from the Kenya /Ethiopia border. It is a dry season watering point for pastoralists in this area,
which with time has become a settlement especially for pastoralists dropouts and in particular
women headed households dependent on relief agencies for their livelihood security. The
settlement has a very high proportion of female-headed pastoralist drop out households in a
community that is very paternalistic in terms of resource control and decision-making.
In recent periods changing weather patterns, increased conflict over water and pasture as well as
interventions associated with modern development such as construction of boreholes, schools
and health facilities have necessitated the establishment of permanent settlements, interfering
with the pastoralist way of life. In addition most relief based interventions targeting the pastoralists
have brought about a change in food taste with most of the settled communities preferring maize
based meals and thus creating a dependence on externally sourced food stuffs. This has resulted
in an increasing number of dropouts from the nomadic way of life. This has consequently resulted
in increased poverty of the communities and especially for pastoralist dropouts in the settled
areas.
Women Group Profile
Bubisa Women group is a women initiative to pool together resources and skills to tackle the high
levels of poverty affecting most of the members of the group. Out in the dry patched land of
northern Kenya towards the border with Ethiopia survival is the norm as the inhabitants of the
area try to eke out a living from the hostile environment. Traditionally, residents of this area are
nomadic pastoralists moving from place to place in a systematic pattern governed by seasonal
changes of the weather in search of pasture and water for their livestock. In addition other
problems facing the community in this area include low literacy levels, low school enrolment,
some negative cultural practices e.g. Female Genital Mutilation, girl marriage and traditionally
accepted multiple sexual partners enhancing the spread of HIV Aids and other sexually
transmitted diseases.
To improve their welfare, women from this area came together and registered a women self help
group in 1996 with the overall objective of cushioning their members from the devastating effects
of poverty prevalent in the area as well as empowering them to take control over decisions that
affect their lives. The group is based in Bubisa location of Maikona division of Marsabit District in
northern Kenya. It is made up of 17 members aged between 25-45 years, 8 of who are household
heads fending for themselves and their children with little or no resources at all.
Most of these women have been rendered poor as a result of cattle rustling due to banditry
activities and diseases that affect their livestock. They are pastoralist dropouts who have adopted
other coping strategies towards improving their livelihoods and that of their children. The age-old
traditional livestock lending culture in the community, which provided support for the poor and
women headed households has been eroded with time. Even for men headed households,
women still tend to suffer more during difficult times as most of them are left at home with the
children to take care of while husbands move away with livestock in search of pasture and water
for the livestock particularly during prolonged drought.
Activities
PART IV-0
The group since its formation has been involved in various activities for the benefit of their
members. To date the group has undertaken the following activities:
Environmental Conservation through Rehabilitation of Degraded sites
Process
Of the group's activities, the most ingenious initiative by the women group so far has been the
environmental conservation work. This involved the construction of a stone wall to protect the
centre from strong winds and enable natural re-vegetation of the degraded site. Groundwork
included the creation of good will among the stakeholders - Bubisa Water User Association
(WUA), EMC, local leaders and Bubisa women's group. To ensure that implementation was
participatory, the expected roles of the various stakeholders were defined through consultative
forums. During the consultative meetings, the community members demonstrated knowledge of
the project and the urgent need to have it started
A total of 45 members, 10 men and 35 women were involved in the process. Both men and
Women were responsible for piling of stones, loading and offloading of stones. Women also
contributed food, water and milk. ITDG-EA provided funds for barbed wire and cement for
foundation while the community raised funds for cedar posts
Work commenced with the collection of stones from a nearby area with the full support of the
area chief and clan elders. Two Dhabelas (the Yaa elders), the Marsabit project team and the
Marsabit District Trade Officer collected the foundation stones. A hired tractor ferried stones while
between 12 and 13 women were on the construction site on a day-to-day basis playing various
roles - loadmg/unloading of the tractor with stones, making tea or doing actual construction of the
wall.
The construction of a stonewall is an activity that Gabra women cherish, following their
experience in the construction of enclosures for camel calves, structures traditionally called
mona. By the end of the year, a total of 1,730-metre perimeter wall was complete, with less than
500 metres of the intended enclosure remaining.
Results and Impacts
The community reported some positive impact following the construction of the enclosure so far
covered. The wall acted as a windbreak, reducing the impact of wind erosion at the centre.
Despite the prevailing stressful environment associated with pro-longed drought, there was
evidence of natural regeneration on the inside of the enclosure. This part had accumulated
manure, seeds and patches of green vegetation that had not been disturbed by livestock. Despite
all the odds the wall was finally completed by the end of the year.
Lessons Learnt
Such community efforts need to have some short-term benefits to encourage them to continue
with the work, which may take many generations for the full benefits to be realised. In Bubisa
after two years the community is already benefiting from reduced effects of sandstorms and
greening of their environment, which has given them a vision of what their area could look like in
a few years time with sustained efforts in environmental conservation. It is hoped that efforts like
those of Bubisa Women group would spur other community groups and development agencies to
undertake environmental work to mitigate against the imminent environmental degradation
resulting from infrastructural development activities.
Energy Conservation through Energy Saving Mud Stoves
PART IV-0
There is recognition of the central role of women in household energy and the different energy
needs and contributions. The Technology that has been developed for energy conservation is
commercial oriented and by far specialized in male dominated activities. ITDG-EA recognized the
need for fuel saving technologies and A 5-days training workshop on fuel-efficient stoves was
held at Bubisa centre with a focus on mud stoves (jiko sanifu types) as a response to the
communities' needs.
A total of 19 participants drawn from Torbi women’s group (3), Thagado women’s group (3), Yaa
Galbo (1) and Bubisa women's group (12) benefited from this training. The Energy Programme of
ITDG-EA facilitated training in collaboration with two members from the Ministry of Agriculture,
Marsabit. Bubisa women’s group banda was used for accommodation. The women’s group also
provided catering services to participants empowering the group for effective contribution to
livelihood
Technology Transfer (PTT) approach was used during the training. Participants shared their
experience on the problems of energy at household level and narrated the various options they
used to address wood scarcity. Participants constructed five demonstration stoves within kitchens
of Bubisa participants during the training session with minimal supervision from the facilitators,
suggesting that the technology offered was simple for trainees to adopt.
Results and Impacts
A follow-up conducted by the project team observed an increase in the adoption of the new
technology beyond the group members. Totals of 6 and 8 stoves had been made and were in use
at Bubisa and Torbi centres by the end of the reporting period. The women reported increased
use of one load head from 3 to 5 days per household.
As a result of the adoption of the energy saving technology by women groups in Bubisa, there
has been a reduction in the amount of fuel wood used. Trees have also regenerated drastically
due to reduced demand for wood.
Through this technology women in Bubisa can now cook food faster and in a cleaner environment
due to reduced smoke emission.
Kubi Bagassa Women’s Group
Introduction
Kubi Bagassa Water Users Association (WUA) was formed in 1997 with the objective of
managing day-to-day operations of the borehole, including determining user fees and recruitment
of a pump attendant. A general meeting was held following which officials, who were all men,
were elected to manage the borehole. Since then, the borehole has experienced a number of
breakdowns, which the WUA has had difficulties to address due to management and financial
factors, despite daily collections from water users. The users pay KShs 1.00 for an animal
watered and for a 20-litre Jerry can of water drawn. On average, therefore, the management
collected between KShs 700 and 800 per day.
Frequent breakdown and shortage of diesel forced women to travel to the neighbouring Dirib
Gombo borehole (3 km away) and Dirib Gombo shallow wells (8 km away) for water for domestic
use. Animals were also forced to water in the same sources.
The financial and management problems faced by the committee composed of men were:
■
•
Unavailability of diesel to run the engine.
Lack of accountability of monies collected.
PART 1V-0
•
•
■
■
Frequent breakdown of the genset due to poor and/or failing to service it. The pump
attendant lacked technical skills and was hardly paid.
Lack of a forum for the committee to deliberate on borehole matters; the executive had no
knowledge of its obligations and roles;
Poor record keeping; the committee kept no record of transactions at the borehole including
daily collections, and the purchase of fuel and spare parts.
Poor maintenance/improper management of the borehole.
The Process of Change
Early September 2000, a meeting was convened to address the management of the borehole.
After lengthy deliberations, women expressed interest in sharing the management of the
borehole. Consequently, they were allowed to collect and manage the sale of drinking water,
charging KShs 1.00 per Jerry can. The women formed a group to undertake the management of
their collections. Men were left to handle collections from watering animals.
The new resolution became operational immediately. That month, the women’s group collected
KShs 6,360. In early October, the borehole ceased functioning from lack of fuel. The men, in
charge of purchasing fuel, had no money to do so and could not account for the disposition of
funds collected the previous month. The women's group invested KShs 3,000 in the purchase of
diesel and cautioned men against interfering with their collections. They then took on the
responsibility of collecting for watering of animals. The women turned down the request put
forward by men that they be responsible for purchasing diesel. Instead they undertook purchasing
and supervision of use of the fuel. That was when the committee composed of men decided to
pass over full control of the borehole to the women's group in October 2000.
Results
The women’s group has a total of 53 members. Since the women's group took over the
management of the borehole, they have opened an account with Kenya Commercial Bank,
Marsabit branch. By December they had deposited over Kshs 4,000 in their account. The bank
has handed over the certificate of registration of the borehole management to the women's group.
Cases of engine breakdown have reduced and access to water by the community improved.
A major achievement was that the DC chose to celebrate the World Water Day at Kubi Bagassa.
This showed support of the administration to this group.
They recently acquired a new genset from UNICEF.
The women’s group in conjunction with ITDG-EA, the Department of Culture and Social Services
and the Water department is revising user by-laws. The group also approached ITDG-EA for
leadership and micro-enterprise business training, which was done. The training was facilitated
by ITDG-EA in collaboration with the Department of Water.
Challenges
The new management faces the following challenges:
Threats and intimidation from the local administration, particularly the area chief and councilor;
Inadequate capacity to effectively address management issues, particularly because for a long
time, men have benefited from capacity building workshops. As indicated above, this gap is being
addressed by on-going training facilitated by ITDG-EA.
The challenges have been summarized as below:
PART IV-0
The Agony of Women Water Users in Kubi Bagasa.
..
.
y
'
'Our main problem here in Kubi Bagasa ib-neither lack of ipnough. funds to buy diesel nor less
committed water users but is simply'the ektensibh of • our male hegemony right from the
Manyattas to the water points.” Says Mrs. Lokho, a community.women .leader. According to her;
their husbands, in cahoots with the area chief, have formed a habit of running away with all water
revenues every time they become water cashiers. "They hdve never appreciated our efforts to
maintain the Manyattas with sufficient water by, keeping the borehole running as this is our only
source of water," she explains. “Every time they hear the sound of the engine, our men would
come running to displace women from the water points accusing us Of/collaborating .With)ispiT!6
foreigners to deny them access to their rightful property. They would keep the engine running for
as long as they could keep their eyes awake and as long as there is enough diesel,. When the
diesel runs out or the engine breaks down they would simply disappear with all collections to the
Manyattas leaving us to struggle looking for funds besides footing miles away in desperate
search for water. After all, the goats and the camels can do without water for a'couple of days'
unlike the daily domestic water requirements that stops at the woman." The women leader
explains.
■
■
The problem started when the local community voted put the male dominated and corrupt)
management committee in favour of the local women group that had been operating in the area:
for quite some time. “It was a miracle that the wafer users group considered us for this work as
our role was simply to pay and draw water. We were grossly underrepresented in water
management committee and the few. who were considered were mere spectators as they could
not speak in front of their husbands?. The women leader explains. According io her.there Were
neither records nor accounts for the. water users group before they took over the bofeho.le as men'
used to stuff coins into their pockets just tb.show off to their suitors how richer they are'.
-T '
- V im-jh • m ■'< ',/'/<?
yyy
However, things worsened when the local administrator physically ejected the: women from the
borehole replacing .them with his relative who had ho. idea on: how to operate, the ^machine: In the
process the young man pressed-the wrong, button thereby blowing .off f he mortar; the.swifchboard
and the water pumps resulting to a loss worth kshs 70.0,000 We are not sure if he was instructed
to do so, says the local .women leader, but the-way all men have disappeared leaving us stranded
here is quite telling.
Initially, women used to borrow, fuel from a local petrol station .and pay back the money after daily
collections but this time round they have been shot on the,. foot;Vas-they.can’t raise over Kshs
700,000 to repair the machine. ■■■../';
.:
y.y,
. <■"..■
The consequences have however, been disastrous,-over 400 women,who were being served by
this borehole now. walk over: 10 kilometers in search of water from a"ni^^;Bdi^hql^j^ig^!yis|
also unreliable due to its-frequent breakdown. They wake up at. late night risking: their lives from.
wild animals trying to beat- the:usually long queue.,The 10-litre container they use in drawing
water is barely sufficient.eno.ugh;tp sustajn the-, household needst Mothers >arejat pain to choose
PART IV-O
between watering the lactating dnd young .ahi'mhlsf'and providi,hg':drihking^ater:'fortfieir children
and the old.
< . wo.; ■
,
"■?’
The two nurseries and vegetable gardens they had started two .years., ago, had .gone to waste.
Women have no time to rest and majorities are contracting pneumonia due to morning ;colds. The
women leader painfully narrates how one of their., members, who recently gave ’birth sbuld..not
wash her baby for four days leave alone getting .bath; herself due .todack'pf watpfi;Tqher; their
husbands prefer watering the lactating animals'and the sick ones to attending to their sick wives.
There are many horrible experiences our members have gone through since the machine broke
down. She concludes.
The local chief and his men have extended their chauvinism further by discouraging people from
paying up their debts. Even the chief.himself owes the borehole over kshs 5,000 of unpaid water
bills. But despite this huge bill the chief ;is;still.spreading;fijmours among focal community that the
machine requires a lorry of coins to enable its repair, which is. far: much expensive for the
community to contnbute. As the women insubordination persists, poor women in Kubi Bagasa
continue to suffer
'
, '
\
’
r
' ' ' .
,'c wy.’ 'V '
'.
Similarly, a 100,000-litre tank constructed by ALRjtfiP that.has bsen serving the community risk
cracking and total degeneration if it remains dry without water for the next few months-.-Women
are also afraid of vandalism, of the machine altogether, if .not 'attended to sooner’ as ithey ;is ijid
watchman at the site. Hence a Kshs . 2 million water project risk total;collapse,for lack-qf -SOp',000
to repair the machine.
. . T
- '
/J
. -
■'?. ..
.
.... '
'cmTwf
- ■'
However, according the Umbrella Group.chairman, the:Area;Pistricf:.Gommissipner-has Written :a
warning letter to the chief instructing him to keep off the borehp'e or else risk stern disciplinary
action from his office. This was confirmed during the recent awareness-meeting-when-.the DC
firmly instructed the women the local community to report to him • if the-chief comes back;
However, when the women approached the ministry of water for assistance the ministry decried
lack of funds.for purchase of spare parts but-are willing to provide transport facilities if required
Kubi Bagasa was the first borehole in its.kind to be managed by local women in the whole district.
It has been a showcase both at.-the local, district and regional.on. the importance of women’s
involvement in water management., its collapse shall strike a big;blow not only, umbrella groupbi.it
also to the wider women fraternity, who have been campaigning for women inclusion in water
management and the ones who have been-fighting insubordination and Stigmatization'in the
whole pastoral g>mmuriiity.->Mr.761tb,:'Gfou^'QiTi^la chairrnan concfudes
PART IV-O
District Water Umbrella Association
•
Environmental conservation in which they have provided protection for young shoots of ASAL
adapted trees species from browsing animals like camels and goats through erection of a
wall enclosure using readily available stones. This work has been very successful and has
even been featured in the Baobab1 development magazine as an example of an ingenious
community response to environmental degradation.
•
Energy conservation through use of appropriate energy conservation techniques. Two group
members after participating in a workshop on construction of energy saving mudstoves have
trained other community members on the same resulting in increased use of the fuel saving
stoves and a resultant reduction in pressure for firewood on the environment.
•
Income generating activities is one of the major activities of the women giving them access to
resources directly under their control as well as providing services to the community.
»
The group has engaged an adult literacy teacher to provide literacy classes to their members
and other community members.
•
The group through drama and poetry is involved in raising community awareness on negative
cultural practices as well as HIV/AIDS.
Results and Impacts
Environmental Conservation
The community has benefited from reduced sandstorms and women can now cook outside the
manyattas even during the day.
Lessons Learnt
Such community efforts need to have some short-term benefits to encourage them to continue
with the work which may take many generations for the full benefits to be realised. In Bubisa after
two years the community is already benefiting from reduced effects of sandstorms and greening
of their environment, which has given them a vision of what their area could look like in a few
years time with sustained efforts in environmental conservation. It is hoped that efforts like those
of Bubisa Women group would spur other community groups and development agencies to
undertake environmental work to mitigate against the imminent environmental degradation
resulting from infrastructural development activities.
A publication of the Arid Lands Information Network December 2001 vol 33.
How advanced is your city in terms of gender equality?
Is your administration ahead or behind in implement
ing these measures?
What remains to be done to achieve women’s full
and equal participation and their access to services
and resources?
Judge your city’s performance - and what you still
need to do...
To how many of the following items can you answer
YES?
Evaluate your municipality!
In
(your city’s name)
Political Structures, Mechanisms and Resources_______________
National laws on women’s rights and gender equality
YES
NO
YES
NO
___________________
National laws on gender quotas or parity at the municipal level______________
Affirmative action policies in municipal political parties
Parity in committees, commissions and para-municipal enterprises
Network of elected women representatives
Council-adopted policy on gender equality (developed through public consultation
and carried out via annual municipal plan of action)
Public consultation policies with mechanisms to encourage women’s participation
Policies and commitments to fight violence against women and to increase their safety
Gender perspective in all programs (including annual municipal budget
and sectoral budgets)
Support of national and international municipal associations (training, networking, etc.)
Administrative Structures, Mechanisms and Resources
Gender Equality/Women’s Office (with adequate human resources and budget),
within central administration, in charge of gender mainstreaming
Annual gender equality action plan (with specific goals, indicators and budget)
Training in gender mainstreaming (for elected officials and staff, men and women)
Access to gender-disaggregated data on all urban issues
_Gender impact assessment of urban policies, programs and service delivery
Equal opportunity program for hiring (with specific targets for different types of jobs)
Information service in boroughs and neighbourhoods/districts
Process to handle citizen requests and complaints from women and men
Participation and Partnership Structures and Mechanisms
YES
Women’s advisory council, commission or committee within council to monitor
implementation of gender equality policy
Thematic council commissions (with public hearings)
Public consultation process in boroughs, neighbourhoods or districts
Public consultation process with specific mechanisms to encourage
women’s participation
Women’s advisory councils in the boroughs, neighbourhoods or districts
.City-wide civic education campaigns
Projects and activities improving women's access to services and resources
(e.g., walking safety audits, local-to-local Dialogues between men and women
elected officials and women’s groups)
Permanent partnership committees on specific issues (safety, transportation, housing)
bringing together women’s groups, community organizations and other public
stakeholders, men and women
Regular city-wide public assemblies, as well as at the borough, neighbourhood
and district level
TOTAL
Results of your City’s Evaluation
How many of these 27 optimal gender-equality and
good-governance measures are already in place in
your municipality?
nf you checked YES to between 0 and 7 items,
you need to get cracking and study what other
cities are doing.
You’re on the right road if YES was your answer to
between 8 and 16 items. Keep up the good work.
YES was your answer to between 17 and 27 items?
Congratulations! But please don’t rest on your laurels.
If you think your city would make a good case study,
please fill out the online questionnaire at the City
of Montreal’s Femmes et ville site at:
www.montreal.qc.ca/femmesetville
Thank you for your contribution!
NO
This questionnaire is taken from:
A City Tailored to Women
The Role of Municipal Governments
in Achieving Gender Equality
2004 edition
To obtain a copy or to consult this document
online (as of May 15, 2004), visit:
www.icmd-cidm.ca or
www.ville.montreal.qc.ca/femmesetville
Femmes et ville
MontrtaJ'2>
Cer>) > \ 9
Cordaid
Dear al!,
We are very happy that you are coming all the way to Holland in order to participate in Cordaid's
Gender Workshop. We think that it would be nice if you have the opportuntiy to see and taste
something of our country during your stay. Therefore we love to invite you for a tour through the
"smallest village of Holland" on Sunday May 9, 2004. The "smallest village of Holland" is
"Madurodam", for more than 50 years Holland's smallest city. The canal houses of Amsterdam, the
Alkmaar cheese market and parts of the Delta Works, all replicated in minute detail on a 1:25 scale.
All is set in beautiful gardens (see also www.madurodam.nl). See the airplanes on the new
Amsterdam Airport Schiphol. Watch windmills turn, ships sail and modern trains traverse the city on
the world's largest miniature railway.
My collegue, Mrs Birgit Deuss, and myself will pick you up at your hotel on Sunday May 9, 2004 at
13.00 hrs (Delta Hotel) /13.30 hrs. (Sebel Hotel). From there on we will take the tram (a real Dutch
way of transport) to "Madurodam" (10 minutes). We will be back at the Hotel around 17.30 hrs.
Anybody interested in coming with us, is requested to gather in the lobby of the Hotel at the times
mentioned above.
Hope to see you Sunday (May 9, 2004)1
Yours sincerely,
Cordaid
Helen Beijersbergen
Management Assistant
Quality Assurance and Strategy Department
Email: hbh@cordaid.nl
Telephone: ++ 31 (0)70-3136316
03-05-2004
Document4
Pagina 1 van 1
Helen Beyersbergen
From:
Sent:
To:
Cc:
Subject:
Helen Beyersbergen
maandag 26 april 2004 11:42
Women's Voice Malawi, Mrs. Makoko Chirwa; ADOPEN, Mrs. Mercedes Canalda de
Beras-Goico; ADOPEN, Mrs. Mercedes Canalda de Beras-Goico II; ADOPEN, Mrs.
Mercedes Canalda de Beras-Goico III; ARK Foundation, Mrs. Angela Dwamena-Aboagye;
AWID, Mrs. Johanna Kerr; Community Health Cell, Mrs. Thelma Narayan; Cordaid
Malaku, Mrs. Nicole Spijkerman III; Cordaid Maluku, Mrs. Nicole Spijkerman; Cordaid
Maluku, Mrs. Nicole Spijkerman II; Cordaid Nairobi, Mrs. Safia Abdi; Veldkantoor Nairobi;
Corporacibn Mujeres que Crean, Mrs. Leonor Esquerra; FAWE, Ms. Christiana Thorpe;
FAWE, Ms. Christiana Thorpe; Femmes Africa Solidarite, Mrs. Bineta Diop; Francoise
Bigirimana; GAP-ISRCDE, Dr. Ms. Radium D Bhattacharya; GAP-SRCDE, Dr. Ms.
Radium D. Bhattacharya; Huairou Committee, Mrs. Jan Peterson; LKTS, Mrs. S. Sawitri;
LKTS, Mrs. S. Sawitri II; Mrs. Aleli Marcelino; Mrs. Ira Febriana; Mrs. Ira Febriana II;
Response, Mrs. Loretta Joseph; SEND Ghana, Ms. Lawrencia Wonnia; SEND Ghana,
Ms. Lawrencia Wonnia II; Women's Studies Center, Mrs. Aline Batarseh
Marjolijn Wilmink
Cordaid Gender Workshop Logistics during the week-end
Dear all,
^This is just to inform you that Marjolijn Wilmink will be visiting the hotel your will stay during your visit in the
Netherlands with regard to the Cordaid Gender Workshop on May 10-11 2004. She will visit your hotel in order for you
to present to her any questions you have with regards to the workshop or the logistics.
Marjolijn will be visiting the Sebel Hotel on Sunday evening May 9, 2004 at 19.00 hrs. She will visit the Delta Hotel at
20.00 hrs.
For emergency situation only, Marjolijn is available in the week-end at the following telephone number: 070-3927753.
Yours sincerely,
Cordaid
Helen Beijersbergen
Management Assistant
Quality Assurance and Strategy Department
Email: hbh@cordaid.nl
Telephone: ++ 31 (0)70-3136316
Cordaid J
Dear all,
As promised I still would sent you some details on the hotel- and conference location of the Cordaid
Gender Workshop on May 10-11, 2004.
You are situated in either the Delta Hotel, or the Sebel Hotel. Both are in the Hague, nearby Cordaid's
office.
The addresses are:
Delta Hotel
Anna Paulownastraat 8
2518 BE The Hague
Tel.: ++ 31 (0)70-3624999
Fax.: ++ 31 (0)70-344440
Email: dhdh@xs4all.nl
Sebel Hotel
Zoutmanstraat 40
2518 GR The Hague
Tel: ++ 31 (0)70-3459200
Fax.: ++ 31 (0)70-3455855
Email: info@hotelsebel.nl
www.hotelsebel.nl
Enclosed you will find an overview of which participants stay in the Delta Hotel and which in the Sebel
Hotel.
Upon arrival at "Amsterdam Schiphol Airport" you have to travel by train to the Hague. You will find
"the Schiphol Railway Station" on the Schiphol area, just follow the signs to the Schiphol Railway
Station. Buy a ticket from Schiphol Railway Station to "The Hague Hollands Spoor Station". This train
leaves about every 10 minutes and will cost you about € 6,40. Ofcourse Cordaid will reimburse these
costs. The trip to the Hague will take you about 20 minutes. Upon arrival at "The Hague Hollands
Spoor" you either go to the Delta Hotel or the Sebel Hotel.
For the Delta Hotel you take tram 8 from "the Hague Hollands Spoor". You can buy a ticket with the
tram driver. This will cost you about € 2,50. You get of at the tram stop 'Mauritskade/Alexanderstraat'.
Then you walk into the direction of the "Piet Heinplein". This will take you about 4 to 5 minutes.
For the Sebel Hotel you take tram 17 (direction "Statenkwartier") from "the Hague Hollands Spoor”.
You can buy a ticket with the tram driver. This will cost you about
€ 2,50. You get of at the tramstop "Elandstraat" and walk into the Zoutmanstraat (the tram goes in
there as well).
You will find the Sebel Hotel on your left hand side (no. 40).
Ofcourse you can also take a taxi from "The Hague Hollands Spoor" to your hotel. Taxis are available
in front of the "The Hague Hollands Spoor Railway Station". Ask the taxi driver to take you to one of
the addresses as written above. This will cost you about € 15,-.
Cordaid will pay for your return ticket, local transport, visa costs, accommodation for a maximum of 5
nights, food and beverages. Cordaid will NOT pay for:
- fees and additional DSAs
- international telephone calls
- over 3 beverages per day at your hotel
The Conference location
The Conference location for the Gender Workshop on May 10 and May 11, 2004 is "Concordia
Theatherzalen". This is nearby Cordaid's office, just a 5-minute-walk. On Monday morning May 10,
2004, we will gather at Cordaid's office in order to walk together to the "Concordia Theatherzalen". To
03-05-2004
Documents
Pagina 1 van 2
Cordaid )
be sure, here is the address of "Concordia": Hoge Zand 42, 2512 EM The Hague, tel.: ++ 31 (0)703022680, Fax: ++ 31 (0)70-3022681. Email: info@theater-concordia.nl
The workshop will start at 09.00 hrs, so we request you to be at Cordaid's office at 08.45 hrs. The
address ofCordaid is: Lutherse Burgwal 10, the Hague.
Tel.: ++ 31 (0)70-3136300, Fax.: ++ 31 (0)70-3136301, Email: hbh@cordaid.nl. One of our people will
be picking you up at 08.30 hrs. at the hotel in order to bring you, by foot or by tram, to Cordaid's office.
To be sure: you can also take a tram to Cordaid. Ask the people at the hotel which tram you should
take to go to the "Grote Markt". Get off at the "Grote Markt" stop, from there it is one minute walk to
the "Lutherse Burgwal". As said, Cordaid is located at no. 10. Enclosed you will find a full description
on how to get to Cordaid's office.
On May 10, 2004, the workshop ends at 18.00 hrs. Afterwards you will be invited to have dinner.
On May 11, 2004 the workshop will start again at 09.00 hrs, and therefore we again request you to be
at Cordaid's office at 08.45 hrs. At 12.30 hrs there is a lunch, after which you will all go to the Cordaid
office on foot. The workshop ends at 17.00 hrs at Cordaid's office.
I hope this information is sufficient. If you have any questions, please do not hesitate to contact me.
Yours sincerely,
Cordaid
Helen Beijersbergen
Management Assistant
Quality Assurance and Strategy Department
Email: hbh@cordaid.nl
Telephone: ++31 (0)70-3136316
Overview Delta and
Sebel Hotel...
Cordaid
jtebeschrijving engc
03-05-2004
Documents
Pagina 2 van 2
Name
Mrs Helen Yamo
Mrs. Emma Lindsay
Mrs. Angela Dwamena-Aboagye
Ms. Lawrencia Womie
Ms. Christiana Thorpe
Ms. Francoise Bigirimana
Mrs. Makoko Chirwa
Ms. Loretta Joseph
Aleli Marcelino
Mrs. Radium Bhattacharya
Mrs.-Thelma Narayan
Mrs. S. Sawitri
Ms. Ira Febriana
Ms. Nicole Spijkerman ’
Mrs; Leonor Esquerra
Mrs. Mercedes Canalda
Mrs. Aline Batarseh
Mrs. Safia Abdi
Mrs. Jan Peterson
Mrs. Esther Mwaura-Muirif
Mrs. Sri Husnaini Sofjan
Mrs. Maria Teresa Rodigruez
Mfs^Sandy Schilen
Mrs. Joanna Kerr
Mrs? Hettie Walters
Organisation
FAS
FAS
ARK Foundation
SEND
FAWE
Women's Voice Malawi
Response
Sarilaya
GAP
CHC
LKTS
Cordaid Molukken ■.
Corporadon Mujeres que Grean
ADOPEN ’
Women's Studies Centre
Cordaid Kenya
Huairou Commission
HC Groots Kenya
HC AWAS
HC Fundacion Guatemala
HC Groots International
; AWID
(AC
Delta Hotel
Sebel Hotel
Conf. Participation Arrival
day
received?
May 9
Switzerland
yes
May 10
Switzerland
yes
May 10
Ghana
yes
May 8
Ghana
yes
May 7
Sierra Leone
yes
May 9
Burundi
yes
May 9
yes
May 8
yes
May 9
Philippines
yes
May 9
yes
May 9
yes
India
May 9
yes
Indonesia
May 9
yes
Indonesia
May 9
Molucs
yes
May 9
Colombia
yes
May 9
Dominican Republic yes
May 7
Israel
yes
May 9
yes
Kenya
May 9
USA
yes
May 9
Kenya
yes
May 9
yes
?
May 9
Guatemala
yes
May 9
USA
yes
May 8
USA
yes
May 9
Nederland
yes
Country
Departure
time
day
08 30
May 12
May 12
May 15
14.20
06.10
15.00
06 00
May 13
07.10
May 12
07 30
18.00
8.00
May 16
May 15
?
?
14.50
May
14
10.00
14.25
10.40
May 14
afternoon May 14
May 12
12.00
06.35
May 14
12.00
06.35
May 14
morning
evening May 12
May 15
May 11
19.50
May 12
09.35
?
May 11
18.00
15.30
14.45
May 14
10.45
20.00
May 14
13.40
May 14
14.45
May 13
morning
15 30
14.45
May 14
May 11
18.00
12.00
May 11
_______
time
16 30
Public transport
The best way to get to Cordaid is by public transport. Take the bus (25, 123, 126 or 130) or
the tram (2 or 6) from Den Haag Centraal Station (CS) and get off at the Grote Markt stop.
From Den Haag Hollands Spoor (HS) take tram 10 to the Grote Markt stop. From here it is a
one minute walk to the Lutherse Burgwal. Cordaid is located at No. 10.
On foot
From Den Haag Centraal Station (CS)
The Lutherse Burgwal is a quarter of an hour’s walk. At the station, take the side exit on
platform 1. Cross the Rijnstraat at the tram tracks and go down the Turfmarkt. Keep straight
on past a big white building (het Ministerie van VROM). Turn right at the Spui and take the
first street on the left, the Gedempte Grach. This joins up with the Gedempte Burgwal. The
fifth street on the right is the Lutherse Burgwal. Cordaid is located on the left at No. 10.
From Den Haag Hollands Spoor (HS)
The Lutherse Burgwal is a quarter of an hour’s walk. From the station, you walk straight into
the Stationsweg. After the bridge, this joins up with the Wagenstraat. Then take the second
street on the left, the Stille Veerkade. Turn right at the T-junction into the Paviljoensgracht.
This joins up with the Lutherse Burgwal. Cordaid is located on the right at No. 10.
By car
Cordaid’s advice is to use public transport. Parking facilities in the vicinity of the
Lutherse Burgwal are extremely limited.
From Rotterdam, take the A13 and at the Ypenburg junction, follow the signs for Den
HaagA/oorburg. From Amsterdam, take the A4 and take the A12 from Utrecht. From all
directions: at the Prins Clausplein junction, follow the sign for Den Haag and turn onto the
Utrechtse baan. Take Exit No. 2 in the direction of Den Haag Centrum (parking). Then turn
left immediately, cross the Prins Bernard- viaduct and keep straight on. Cross the Spui. Turn
right at the T-junction. This is the Paviljoensgracht which joins up with the Lutherse Burgwal.
Cordaid is located on the right at No. 10.
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