Table 6 Gender Framework (power relation and drivers of inequality)
Content | In households/communities | In health services/facilities/system |
|---|---|---|
Who has what? | -Husbands, fathers and elders typically have control over resources in households, including income women have earned -Married women often cannot access household resources, influencing their ability to independently follow hospital and health worker advice | -There are fewer female than male medical practitioners (physicians) employed in (especially rural) health facilities, contributing to some discomfort in women accessing those facilities for themselves and their children. - Most CHWs are female; some fathers are dismissive of their advice |
Who does what? | -Women/mothers have multiple domestic tasks in the home, including childcare. Some (especially in urban areas) also earn an income. Traditionally young lactating mothers feed themselves last in a household. -Especially young mothers may have to hand over child’s care to others in the household after discharge | -Hospitals and health centres are seen as a women’s domain; men generally do not feel comfortable staying in facilities with their children, even if their wife is earning -Some CHWs are not welcome in homes, particularly where they are seen by men to be undermining their relationship with their wives |
How are values defined? | - Men generally seen as heads of households and main breadwinners, and women as child carers - Young women’s views/knowledge on child health etc. generally less valued than men’s and elders; women sometimes blamed for a child’s condition for failing in her ascribed roles - Boys sometimes seen to have greater potential as breadwinners and future support for the family than girls, and so prioritized over girls in access to food, medicine & treatment | -Linked to the way in which values are defined in households/ communities, caring roles in the health professions are possibly seen as more appropriate and feasible than clinical leadership positions - Positions which can be isolated or need other family members to accompany the job holder (like postings to rural facilities) can be considered more appropriate for men than women |
Who made the decisions? | -Husbands and household elders typically made decisions on division of labor in household in relation to children, and on food, medicine and treatment seeking decisions | -Husbands and household elders can influence women’s ability to access medical practitioners and CHWs -There may be greater eagerness or pressure on mothers to get out of hospitals and back to homes where boys are left at home, and where girls are admitted |
How is power negotiated and changed | -Especially in urban areas, more women are earning an income exposing them to different types of interactions with men and giving some greater decision-making power over treatment-seeking - Women reported that they were rarely able challenge gender based decision-making norms regarding childcare and treatment because doing so is considered unacceptable socially and culturally. | -Some providers introducing initiatives aimed at easing discomfort of women and their husbands in attending facilities -Some women are interacting with CHWs in empowerment programmes aimed at supporting greater equity, and less abuse, in homes |