By Alvin Cloyd Dakis, RN
The Philippines is known to be one of the countries in the world that is gender-fair according to the Global Gender Gap report by the World Economic Forum (WEF). In 2018, the Philippines rose to eighth besting the other entire Southeast Asian nation. In the Asia-Pacific region, only New Zealand (7th) and the Philippines (8th) were included in the top list. The Global Gender Gap looks into four categories: labor force participation, educational attainment, political empowerment, and health and survival.
Though the World Economic Forum noted that the country has managed to close about 80 percent of its total gender gap, the highest ever recorded so far, this does not mean that the country has managed to address gender gaps in health care. No country according to the WEF has achieved a full parity, meaning a total closure of the gap between men and women in accessing health services, living better and longer lives, and increasing survival from diseases. The Philippines only ranked 42 in this sub-index.
But beyond the numbers lies several gender issues that still linger within the system. One that remains to be unaddressed and that continues to affect the effective delivery of health services to the people. That is Gender Stereotyping.
Stereotyping is a form of mental modelling where an individual shape an image of another person based on certain criteria. This process was a product of a long history of repeated characterization and association to a specific behavior, impression, or physicality. Stereotyping can be based in many criteria – including one’s gender. A person who responds to stereotypes often result to biases. Gender Bias is a human response, both mental and physical, to any form of gender stereotype.
Gender stereotypes in reproductive and sexual health
In the implementation of the family planning program, most of the recipients of information and counseling are women. This is because traditionally, women are assumed to be the care takers of their children. Women’s spouses are often left behind during patients’/mothers’ classes and therefore would know less about planning for their families. In cases of disagreements with their spouses, women would return their chosen FP supply/service or if not discontinue using it because their husbands made a different choice.
The Supreme Court ruled that under the Responsible Parenthood and Reproductive Health Act, spouses should consensually agree to get a family planning service or product. According to the high courts, married women cannot make the sole decision when it comes to their reproductive rights because according to the Family Code of the Philippines, married women and men are considered one and the same person and therefore would need to have the consent of the other in availing FP services.
So when these couples wouldn’t come up with a consensual decision, what will happen to the FP users? Women who have decided to space their children will have to retreat and abandon their decision to continue with the FP service or product of their choice because their spouses refused to. This is apparent in the country’s Contraceptive Prevalence Rate (CPR) where it remains to be stagnated and still a huge Unmet Need for Modern Family Planning Method (UN4MFP) despite a lot of innovative health policies being introduced and implemented.
Breastfeeding mothers are also often subject to ridicule if they are breastfeeding in the public, often times told to cover their breasts while feeding their children. It is not unique in the Philippines though, but this issue has been present in a country where it boasts of a more gender-fair society. The Milk Code of the Philippines and the more recent Breastfeeding Promotion Acts does not guarantee women to equal protection from being discriminated or stigmatized from feeding their newborns in public places.
Another glaring stereotype found in the implementation of the Responsible Parenthood and Reproductive Health Act (RPRH Law) is the stereotype against adolescents. Young adolescent girls and boys aged 18 years and below are not allowed to access any Family Planning services nor products except for information and counseling. According to the Supreme Court, adolescents should secure a consent from their parents should they wish to avail of FP services.
For the Supreme Court, they do not believe that young people are capable of making judicious decisions about their bodies and that they still need parental guidance in accessing such services despite fact that young people are engaging in early sex. Young Adult Fertility Survey of 2013 revealed that there was an increase of early sexual initiation among young males and females, the highest were among those who are in-school. This already proves that young people are engaging in sexual activities and information & counseling might only respond to only less than half of the intended goals – to reduce untimely and unwanted pregnancies and to lessen new cases of HIV and other sexually transmitted infections.
The RPRH Law and the Supreme Court’s bias against young people, limited their capacity to protect themselves from untimely and unwanted pregnancies and from contracting sexually transmissible infections. Perhaps a more shocking increase in teen pregnancies and STIs from the young population would shake them up?
An emerging issue in the health sector is the people with different sexual orientation and gender identities getting services. Many health professionals such as doctors and nurses do not know how to interact with patients and clients who are members of the Lesbian, Gay, Bisexual, and Transgender (LGBT) community. They are given dubious looks whenever they seek for medical help. They were treated with judgment and with side comments about their sexuality by the very people they thought could help them. They were robbed of their sexual health and reproductive rights.
Many frontline health providers need to be sensitized on handling clients/patients with sexual and reproductive health concerns regardless of their sexual orientation, gender identity, and gender expression. They need to be re-oriented of their sworn obligation, and to put their personal judgment of others way behind them when they are dealing with the afflicted, the ill, and those who are physically and emotionally unstable. Health institutions must ensure that all their staff, both frontline and support, are trained to be gender and culturally-sensitive.
Other gender issues in the workplace
It is not just the issue on gender stereotyping that needs to be addressed in the health system. Educating staff on the awareness of sexual harassment in the workplace needs to be continuously provided and that the Committee on Decorum and Investigation must be trained to handle this sensitive issue. There are some sexual harassment complaints filed by staff against their supervisors and managers and the Anti-Sexual Harassment Law specifically delineated how each case should be handled.
Health institutions especially hospitals should be able to address the reproductive needs of their staff by ensuring that programs are in place – well-functional, maintained, and sustained. Programs such as early childhood centers so that staff with young children can be assisted; specific spaces for victims of violence against women and their children (VAWC) and other gender-based violence (GBV) can be addressed by well-trained and competent personnel; and making hospitals more structurally-sound and sensitive to the needs of patients regardless of gender and those population with specific practical gender needs. Examples of gender-sensitive structures would be counselling rooms for VAWC and GBV clients, separate wards for male and female adolescent patients, early childhood centers, lactation stations, ramps and bar handles for differentlyabled clients, and an all-gender or gender-inclusive toilets for everyone.
Developing a gender-sensitive health care system
The health care system is a complicated system but it does not mean we cannot make it more gender-sensitive and even gender-transformative over time. Regular training of the workforce to become gender-sensitive should be sought but apart from it, there should be a functional system to monitor the performance indicators set by the institution.
Every programs and projects implemented including its funds must be subjected to gender analysis to ensure that gender is mainstreamed in its components. For government health agencies, the PCW recommends the use of the Harmonized Gender and Development Guidelines (HGDG) for programs and projects and the Enhanced Gender Mainstreaming Evaluation Framework (GMEF) to evaluate the institution in four criteria: People, Policy, Enabling Mechanism, and Programs, Projects, and Activities. And for private health agencies, they may use the Moser Gender Planning Framework and other gender analysis tools. They may also adopt the HGDG and GMEF tools and customize it to fit their needs.
And finally, the most key ingredient in transforming health institutions to become gender-sensitive is the efficient and dedicated leadership and governance. A strong and committed leadership ensures that the system is functional and that it follows the standards set by the regulating agencies. The Philippine Commission on Women (PCW) is the agency assigned to develop standards, indicators, and provide agencies technical assistance on gender and development (GAD). Health leaders should coordinate with the PCW to update them on the standards on GAD and other necessary tools they may use to aid them in making gender-sensitive policies.
The road to a more gender-sensitive health system is narrow and difficult to traverse but there are ways for us to move forward. I will discuss the other components in details in the future write-ups.