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Global Health BSc 2018/19 - CDMM2 > Women, gender + health - 2.1 - 2.3 > Flashcards

Women, gender + health - 2.1 - 2.3 Flashcards

1
Q

When was reproductive health internationally recognised?

A

1994 International Conference on Population and Development in Cairo - 20 year Programme of Action which focused on individual’s needs and rights rather than on achieving demographic targets

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2
Q

What is the definition of reproductive health?

A

Complete physical, mental and social well-being in all matters relating to the reproductive system + to its functions and processes

  • Capability to reproduce
  • Freedom to decide if, when and how often to do so
  • Right of men and women to be informed and to have access to safe, effective, affordable and acceptable methods of family planning of their choice
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3
Q

Describe the global burden of maternal and newborn mortality + morbidity

A

India has highest number of maternal deaths - 1 death every 7 minutes
- Huge improvements: improved access to facility based care via vouchers, ASHA system (Accredited Social Health Activist), huge investment in infrastructure

Maternal death is also high in Africa
High in areas with fragile settings –> crisis and conflict

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4
Q

What are the 3 phases of delay?

A

Phase 1: Seeking care
Phase 2: Identifying and reaching medical facility
Phase 3: Receiving adequate + appropriate Tx

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5
Q

What are the factors affecting the phases of delay?

A

Socioeconomic/cultural factors
Accessibility of facilities
Quality of Care

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6
Q

What phases does lack of child education affect?

A

Phase 1 - evidence that higher maternal age, education and household wealth and lower parity increase use and urban residence

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7
Q

What phases does lack of female empowerment affect?

A

Phases 1, 2 + 3

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8
Q

What phase does lack of physical access to health care facilities affect?

A

Phase 2

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9
Q

What phases does poor communications and quality of care affect?

A

Phase 2 + 3

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10
Q

What does public health spending mean?

A

All government spending on health care + money from grans, social insurance and NGOs
Reduces or even eliminates direct cost of health care to an individual
If a family needs to spend > 40% of their income on healthcare - this is catastrophic

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11
Q

What are the challenges to reproductive health in LMICs?

A

Few specialists/drs/nurses, esp in rural areas
Poor diagnostic support
Limited drug options + poor drug control
Restrictive abortion laws
Poor physical infrastructure
Few existing + functional cancer screening programmes
High incidence of HIV/AIDS
High fertility rate + low CPR (Contraceptive Prevalence Rate)
Weak health systems

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12
Q

What is the obstetric transition model?

A

Stage 1 = high MMR (>1000) + TFR, very low SBA; Direct or comm. Dx causes of MD + low medicalisation of birth e.g. Tribes

Stage 2 = high MMR (999-300) + TFR, very low SBA; Direct or comm. Dx causes of MD + low medicalisation of birth e.g. Cambodia

Stage 3 = 299-50 MMR, Low TFR, Normal SBA, Direct, non-comm Dx causes of MD; Normal medicalisation of birth e.g. Brazil

Stage 4 = < 50 MMR, Low TFR, N+ SBA, Indirect causes of MD, Very high medicalisation of birth e.g. UK

Stage 5 = < 5 MMR, Low TFR, N ++ SBA, Indirect causes of MD, Very high medicalisation of birth e.g. Germany

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13
Q

Name 3 global policies/initiatives/declarations to improve maternal health

A

Alma-Ata declaration 1978 - universal coverage reforms, service delivery reforms, public policy reforms, leadership reforms, increasing stakeholder participation

Safe Motherhood Initiative 1987 - SM movement in Nairobi Kenya –> Safe Motherhood Technical Consultation Sri Lanka 1997

MDGs
- 50 countries failed to achieve the child mortality reductions by MDGs –> only 4 out of 75 countries achieved both MDG 4 + 5: Cambodia, Eritrea, Nepal and Rwanda

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14
Q

What 2 declarations focused on improving global aid effectiveness?

A 
Paris declaration (2005)
Accra declaration (2008) - strengthen and deepen implementation of the Paris declaration
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15
Q

What are the key strategic objectives towards EPMM (Ending Preventable Maternal Mortality)?

A

Address inequities - ensure UHC for comprehensive sexual, reproductive, maternal and newborn health care
Address all causes of maternal deaths - strengthen health systems
Ensure accountability to improve quality of care and equity - healthcare facility; national level: civil society, community

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16
Q

What SDGs focused on maternal health?

A

SDG 3
By 2030, reduce the global maternal mortality ratio to < 70 per 100 000 live births
By 2030, end preventable deaths of newborns and children under 5 y/o
By 2030, ensure universal access to sexual and reproductive health-care services

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17
Q

What is the definition of universal health coverage?

A

Ensuring that all people have access to needed promotive, preventive, curative and rehabilitative health services, of sufficient quality to be effective, while also ensuring that people do not suffer financial hardship when paying for these services

18
Q

What global movement supports the rights of women and girls to decide freely and for themselves whether, when and how many children they want to have?

A

Family planning 2020

Launched in London in 2012 - enable 120 million more women and girls to use contraceptives by 2020

19
Q

What is sex work?

A

Female, male and transgender adults + young people who receive money or goods in exchange for sexual services, either regularly or occasionally - UNAIDS, 2002

20
Q

Why is it important to define sex work?

A

As there is a high burden of ID (HIV, STI) but not uniform
Epidemiology - understanding variation in disease distribution
Programmatically (public health)

21
Q

What is the socio-ecological model of risk for HIV?

A

Individual -> interpersonal -> social -> structural

Factors at multiple levels - from the microscopic to the societal contribute to HIV infections

22
Q

What are the characteristics of direct sex work?

A

Location - brothels, windows, bars, street
Known to police
More easily accessible to interventions/health promotion
Easier to survey
Condoms more regularly used
Disadvantages - police harassment/violence, brothel owners

23
Q

What are the characteristics of indirect sex work?

A 
Locations: massage parlours, home-based, market vendors, phone-based
Not known to police
Often more 'tolerated' socially
Opportunistic
Hidden from interventions
Hard to survey
Sex often opportunistic
24
Q

Using the Zimbabwe case study, what changes were seen in the nature of sex work which led to change in the epidemic using the socio-ecological model?

A

Zimbabwe’s HIV epidemic - prevalence peaks at 29% in 1997 which declined to 15% in 2015
Zimbabwe had an economic crisis in 2009 which in addition to social change, led to lack of basics and change in sex work market, SW changed tactics and rise in transactional sex

Moved from bar-based to home-based

25
Q

What did the Manicaland HIV/STD prevention study cohort survey show (1998-2011)?

A

Consistent declines in HIV in both men and women
Decrease in commercial sex among women but fluctuates in men
Declines in regular bar visits among men and women engaged in commercial sex

26
Q

What does the overall synthesis of studies show?

A

Decline in paid sex
Bar visitation among men + FSW has declined: 33% of bar-based FSW reported most recent encounter was negotiatied in a bar vs., 45% of those encounters were negotiated at home
FSW who meet sexual partners in bars have a higher volume of clients and higher HIV prevalence

27
Q

Where does sex work appear to have moved to?

A

From predominantly bar-based to within the community

28
Q

What do studies among the sex worker population need to account for?

A

The growing proportion of activity that is more covert

Interventions need to be adapted appropriately to changing circumstances, populations and definitions

29
Q

What is the definition of sex?

A

Biological differences e.g. male vs female vs intersex - attributes of sex include menstruation, testes

30
Q

What is the definition of gender?

A

The roles, behaviours, activities, attributes and opportunities that derive from what society considers is appropriate for our sex

The relations between sexes + how power is distributed within and between sexes

31
Q

What is the concept of masculinity and how does this affect HIV transmission?

A

Attributes, roles and behaviours associated with men or boys. Masculinity affects male and female access and adherence to ART (Skovdal et al, 2011)

In Nepal, world’s first country to recognise ‘third gender’ on census forms

32
Q

What is the definition of equity?

A

The absence of avoidable or remediable differences among groups of people

33
Q

What is the definition of health inequalities?

A

Disadvantage through distribution of health determinants, access to resources to improve and maintain health or health outcomes

34
Q

What is the definition of health inequities?

A

Improve health inequalities PLUS disadvantage through failure to overcome structural barriers to being treated fairly or civil rights

35
Q

What is the difference between equity and equality?

A

Equality refers to opportunities

Equity refers to outcomes

36
Q

How do gender relations operate at different levels? What mechanisms influence behaviour?

A

Structural interventions: Macro level; structural drivers
Proximate determinants of risk
HIV transmission

37
Q

What are the proximate determinants?

A

Behaviour:
Access to info and services - men diagnosed at lower CD4 counts and more likely to initiate ART at WHO stage 4 disease than women –> Hegemonic (=ruling or dominant in a political/social setting) masculinity (Connell, 1995)
Partner selection - age mixing
Partner change
Unprotected sex - HIV is 2x higher in young women (15-24) vs young men (2010) Zimbabwe; condom use

38
Q

What factors are included in the macro level?

A 
Criminal Justice
Laws rights
Culture and religion
Media
GDP economics
Corporate + tax policy
Politics - colonial rule in S Africa
39
Q

What methods have been used to address gender inequality?

A

Inclusion of women in RCTs 1980s
WHO Violence and Health (feminists argued the case for inclusion of domestic violence) 1993
MDG3 + SDG5 2000s

40
Q

What did the cash transfer programme for schooling in Malawi show?

A

It showed that education and keeping girls in school had a greater effect on prevalence of HIV and HSV2 than cash transfers
64% reduction in HIV risk
76% reduction in HSV2 risk

41
Q

What are the limitations of SDG5?

A

Gender has become synonymous with women’s or men’s health focusing on limited roles
Fail to explicitly challenge power and hierarchy relationships
Fail to address intersectionalities
Nothing on masculinities

42
Q

What does intersectionality refer to?

A

Gender inequalities are pervasive and persistent, intersect with other social identities and based on inequalities of power
Agentic empowerment constrained without structural power reform

Global Health BSc 2018/19 - CDMM2 (5 decks)

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