GENDER AND HEALTH

Silas kuria
(BScN –Puea)

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 Learning Objectives

1. Describe the social construction of gender

2. Explain basic gender and development concepts
3. Explain the purpose of gender analysis and its application in health
4. Describe gender mainstreaming in provision of health services
5. Discuss gender issues affecting health
6. Discuss gender – based violence and their management
7. Discuss female genital mutilation and other rites of passage and
their relevance in delivery of health care

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 Learning Activity

 Sometimes I'm glad I'm a woman because…

 Sometimes I wish I were a man because…

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 What is your take on these?

 Policeman  police officer

 Manpower  work force

 Chairman  chair person

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 Basic Concepts on Gender

Mainstreamin
Analysis
g

Equality Indicators
Gende
r

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Why study gender and health

 To study the ways in which gender influences health

 Identify and address gender-based health inequalities
 To develop policies and programs that promote health for all

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 C0ncepts of gender
Definition of Gender
 Gender refers to one’s sense of being male or female and playing
masculine or feminine roles in ways defined as appropriate in one’s
culture and society
 Gender has biological construct, social construct and psychological
construct
Definition of Sex
 Sex is usually used to describe the biological or genetic determination
of maleness or femaleness.

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Difference btwn sex and gender

sex Gender

1. Does not vary 1. Varies within and between cultures

2. Biological 2. Socially constructed roles and
3. Universal responsibilities and behavior
4. Born with 3. Culture (elements related to gender
5. Generally cannot be changed( change vary within and between cultures)
is now possible with surgical 4. Learned behaviour
intervention) 5. Changes over time ( in the past few,
women became lawyers and
physicians, today its common to find
women in these professions)

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Cont.…

Gender Roles
 Gender role refers to societal expectations about what is expected of
our behavior as males or females. Example of gender roles: division
of labour, dress codes, games and sports, emotional response,
sexuality.
Gender Identity
 Gender identity refers to the degree to which we feel comfortable in
our social roles as men and women.
Gender Equality
 Means that women and men, boys and girls, enjoy the same rights,
resources, opportunities and protection
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 cont...
Gender Role Typing
• Gender role typing is the developmental learning process of how we come to think of
ourselves as a member of one sex or the other.
Self – Concept
• Self – concept is the sum of all our thoughts and feelings about ourselves
Gender Role Conflict
• Gender-role conflict is any feeling of restriction that accompanies the desire to behave
in a way that does not conform to traditional gender stereotypes.
Gender Sensitivity
• Gender sensitivity refers to the ability to acknowledge and highlight existing gender
differences, issues and inequalities and incorporate these into strategies and actions.
Gender Discrimination
 It refers to how people are treated differently because of their sexes and it’s not
based only on gender differences
Gender Inequality
 It refers to unequal treatment or perceptions of individuals wholly or partly due to
their gender(e.g unequal access to power, resources and opportunities in society). It
arises from differences in gender roles.
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Causes of gender inequalities

 Cultural beliefs
 Social economic practices
 Religion
 Lack or failure to implement gender sensitive policies
 Structural and legal barriers
 Stereotypical attitudes-from socialization
 Ignorance-lack of knowledge, gender awareness

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How to achieve gender equality

 Positively rebuilding norms, values and attitudes

 Increasing awareness and education about the costs of gender
inequality
 Transforming institutions and institutional practices
 Breaking down gendered division of labour that dictate what is
appropriate for women, men, girls and boys
 Reviewing and amending laws and policies to be equitable and
inclusive|implementing gender sensitive policies
 Women empowerment
 Equal opportunities

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Benefits of gender equity

a. Gender equality promotes agriculture and will reduce world hunger.

Women comprise of an average of 43% of the agricultural labour
force in low income countries, Yet women farmers control less land
and have restricted access to all the investments necessary to
improve agricultural productivity
b. Gender equality expands labour markets and improves
employment opportunities for all. with women now representing
40% of the global labour force and more than half the worlds
university students overall productivity will increase if their skills
and talents are fully used.
c. Gender equality in education leads to higher economic growth
d. Gender equality in health contributes to economic development
e. Gender equality reduces poverty. Gender inequality perpetuates
poverty because women face life threatening risks from early
pregnancy and lose chance for education and improved income
early in life
CONT….

 Gender awareness- understanding that there socially determined

differences between men and women based on learned behaviour
which affect the ability to access and control resources.
 Gender blindness- failure to recognize that gender is an essential
determinant of social outcomes including health.
 Gender responsive-a higher level of gender sensitivity where one is
not only able to recognize but is also empowered to address the
gender issues and hence take action to solve gender problem.
 Gender bias- this result when cultural and structural arrangements
favor men over women and vice versa
 Gender balance- participation of a more or less equal number of
women and men within an activity or organization.
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CONT….

 Gender parity- this is the numerical concept that define the

proportion of men, women, boys and girls within a particular setting.
 Empowerment- implies people both men and women taking control
over their live by setting their own agenda, gaining skills , increasing
their self-confidence, solving problems and developing self reliance.
 Affirmative action-positive action or positive discrimination involves
set of policies and practices within a government or organization
seeking to include particular groups based on their gender, race,
sexuality, creed or nationality.

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 Gender Stereotypes
Fixed and oversimplified beliefs about the ways in which men and women ought to
behave.

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 Cost of Gender Discrimination
 Gender inequalities:
 reduce program effectiveness and waste resources
 inhibit country’s growth and development
 limit opportunities and potential

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how to Fight Gender Discrimination

 Name it
 Change it
 Take legal action
 Advocate for temporary special measures or other
policies/legislation
 Advocate for new laws
 Ignore it…but it won’t go away

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 Cont’…..

 Engage men!
 Men also affected – directly and indirectly
 Gender inequality and discrimination impact society as a whole
• Very little that women can’t do based on sex
• Gender roles impact political participation… but can change
• Women are a diverse group
• ALL issues are women’s issues
• Discrimination is costly… name it and change it!

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Linking gender and health

 Gender is a major contributor to disparities in health

 Health disparity| inequity- differences in healthcare received by
different groups of people that are not only uunecesary and avoidable
but also unfair and unjust.
 Equity in health- refers to individuals achieving their highest level of
health through elimination of disparities in health and healthcare.

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Why is gender important in health?

 Women and men's experiences with health and healthcare are often
very different
 The unequal social relations between women and men do produce
inequalities in health outcomes and the access to or utilization of
health services.
 Women and girls have specific health needs which are often neglected
 Women carry a disproportional burden of informal health care
provision in household and communities (home based care of HIV)
 Women are the main frontline health providers
 Women lack access and control over financial resources
 Men have less access to sexual and reproductive health services.
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Patterns of health and illness in men
and women
 Women tend to live longer
 Women suffer considerable mortality and morbidity in relation to their
sexul and reproductive health
 Fertility regulation, pregnancy and childbirth require health services
for women
 Women and men differ in relation to the physical aspects they
occupy, the tasks and activities they perform and the people they
interact with.

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How does gender affect health

 Access to resources and opportunities

 Decision making in the household
 Health seeking behavior
 Access to health education
 Harmful traditional practices
 Harmful behavior and social expectations

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Factors contributing to gender-
based health inequalities
 Gender stereotypes and norms
 Social and economic inequalities
 Lack of access to healthcare
 Violence and abuse
 lack/failure to implement gender sensitive policies

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Gender and reproductive health

 Gender differences in society can influence both women's and men’s

reproductive health through:
 Exposure to risk factors
 Access to and understanding of information about disease
management prevention and control.
 Subjective experience of illness and its social significance
 Attitudes towards the maintenance of ones own health and that of
other family members
 Patterns of service use
 Perception of quality of care

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Gender issues affecting
reproductive health
 Poverty
 Marriage practices
 Low social, legal and economic status
 Sexual dimensions organized on gender lines

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INTRODUCTION
 RH is a state of physical mental and social well being and not merely
the absence of disease or infirmity in all matters related to the
reproductive system and its functions and processes.
 RH is an internationally recognized right,
 Basic right of all couples and individuals to decide freely and
responsibly the number ,spacing and timing of their children and have
the information and means to do so and the right to attain the highest
standard of sexual and reproductive health..
RH RIGHTS
 Right to privacy and confidentiality
 Right to RX of STI/RTI
 Right to access of care
 Right to choice of care giver
 Right to be RX with dignity
 Right to safety
 Right to comfort
 Right to continuity of care
RH right ct
 Right to opinion
 Right to informed choice/consent
 Right to make informed decision
 No discrimination
 No coercion
 No violence
 NB-health workers should be trained on these rights so that they
can support the the woman fully, ie respectable maternity care.
RESPONSIBILITY OF HEALTH
WORKER
IN REPRODUCTIVE
Promote and protect the rights;
HEALTH
 Policies
 Education
 Laws
 Advocacy
 Documentation
 Counseling
 Implementation
GOVT ROLE
 LAWS—legal advice and changing the laws
 POLICIES—involve both gender and the youth
 EDUCATION—on human rights
 JUSTICE—women to access justice eg FIDA
 RESEARCH—comprehensive to clarify issues
 RESOURCES—include RH in the national budget
 ADVOCACY- –give RH public support
Maternal health

 Among all the people in the community, pregnant women ,new born
and children are at the greatest risk of disease and death.
REASONS
 Poverty
 Lack of health education
 Lack of transport
 Harmful beliefs
 Failure to recognize danger signs
 Delayed decision making by husband or other family member
 Failure to have an individual birth plan
 Poverty- financial power influences

1. Education attainment
 Educating girls and women improves their health and that of their
children
importance
a. reduces infant mortality
b. It leads to an increase in utilization of health services
c. Help prevent diseases
d. Delays marriage and child bearing
e. Increases use of family planning
f. Increasing decision making power
g. Participation in training and credit programs
Cont

 Despite the many advantages of educating women and girls many

girls in some Kenyan communities do not go to school or leave
school early because of the following reasons;
a. To assist in productive work
b. Lack of money to pay school fees
c. Families reluctant to invest in the girls as they will be married off
and a belief that that topics taught in school are inappropriate or
not useful or the girls will be exposed to wrong ways of living
2. Access and control to
resources
 Very few women in Kenya have a say in how to spend money even
if they helped earn it.
 A woman without money will not be able to attend antenatal care,
get medicines, or buy food needed especially during pregnancy.
 Women have little access to other resources eg machines, training
or credit programs, equipment which can make their work easier,
technical advice and supplies information.
 In some Kenyan culture a woman is not allowed to have custody of
children , inherit property, earn income or participate in public
affairs without permission of her husband, father, first born son or
in-laws (father, mother, sister and brother).
3. Decision making
 Women are not consulted when major decisions ( family planning use,
when to deliver, how many children to have, when to get married and
to who.)
4. Nutrition and health
 In many families men and boys eat first and have the biggest share
followed by girls and finally the mother.
 If the family is poor this means that the girls and the mother will not
have enough to eat.
 Under nutrition makes one weak and vulnerable to diseases and
predisposes them to complications and problems during pregnancy.
Marriage practices
1. Early marriage
 Women in Africa tend to marry at a very early age (in some areas as
early12years old) because poor families want to have dowry, to be
relieved the burden of caring and to avoid the of illegitimate birth.
 Most of these girls are married to older men which prevents from
making reproductive health decisions as they are either shy or
depended on their husbands.
 Consequences of early marriage

1. School dropouts leading to inability to read and write

2. Having many children early. This exposes mother and her children to
psychological and other problems
3. It exposes women to HIV/AIDS and other STDS. The overriding desire
to be a good wife in the eyes of the family and the husband prevents
the child wife from negotiating for safe sex, thus exposing her to the
risk of acquiring HIV/AIDS and sexually transmitted diseases
4. Inability to plan or manage families because they are also children
young or immature mothers exercise less influence and control over
their children and have less influence and control over their children
and have les ability to make decisions about their nutrition , health
care and house hold management.
cont
5. The next generation of child wives. Children whose mothers married
early tend to marry early thus creating generation of child wives
6. Marital instability. Because of the age differences and the attendant
poor communication many early marriage end in early divorce or
separation
7. Physical and sexual abuse. Out of fear of her parents and social stigma
as well as the poverty associated with being single, many child wives
are compelled to remain in a loveless and violent marriage
 2. Forced marriage

 Forced marriage is when the bride, groom or both don’t want to get
married but are pressured into it by their families.
 The pressure can be financial, emotional or actual blackmail or
threatened physical or sexual violence
 Women are not involved in decision making e.g. who to marry
them and when.
Causes of forced marriage

a. Honor- in certain cultures the honor of the family is the most

important thing to keep intact.
 This done by strategically marrying children off for the benefit of
the family and controlling women's sexuality
b. Pregnancy- t is believed that an unplanned pregnancy can be made
right if the girl is married to the father of the child.
 The reason for this lies in family honor as well as illusion for
protection
c. Poverty- being poor is one of the major causes of forced marriage .
 Whenever families are offered a large sum of money in exchange
for their daughters hand it is hard to refuse.
d. Protection- whenever a woman is raped or has sex outside marriage
in some cultures , the blame is directly onto the woman. in many
cases she is an outcast from her society with no way to make a
living or marry.
 Many parents want to protect their daughters from this fate no
matter the cost
Effects of forced marriage
a. Isolation- victims have no one to trust or talk to
b. Forced marriage victims can also be forced to live as domestic
slaves. They are kept under house arrest , suffering abuse not only
from their spouse but from extended family too
c. Women in forced marriage suffer from violence, rape forced
pregnancy and child bearing

d. Children conceived in a forced marriage environment can seriously

be affected by it either by learning that violence is acceptable or
being traumatized by witnessing it.
e. Victims of forced marriage have limited opportunities for further
personal and educational development and end up with little career
choices
3. polygamy
 women may not access resources when husbands have other wives,
they may be predisposed to harmful practices to impress the man eg
give birth to many boys.
 High chances of spreading HIV/AIDS.
4. wife inheritance
 When women are widowed a man is selected by the family to inherit
her without her consent.
5. Dowry
 Dowry is seen as a source of income.
 Physical, psychological and sexual abuse by the husband may occur
because he has paid dowry to the woman's family.
Low social, legal and economic
status

 The status of women in most African communities depends on how

many children she has.
 Desire for status makes women to continue having children even
when pregnancy and child birth carry serious health risk.
 Women do not have access to money, training, credit and other
resources and freedom to make decision for themselves and their
children.
Sexual dimensions organized on
gender lines
1. sexual partnership
 Society assumes that men cannot control
their libido and thus allows to have as many partners as they
want.
 Men unlike women are allowed to make choice of who to marry and
when to marry.
 Men are allowed to change their sexual partners frequently and as
many times as possible.
 This predisposes them to infections, eg STIs/HIV
2. Sexual art
 Women are expected to be in control of their sexuality all the time, not
to initiate sex and not to express sexual enjoyment.
 Sex is centered on pleasure and satisfaction of men and this
predisposes women to harmful practices eg female genital cut, use of
herbs to satisfy men etc.
 Incase infertility among either of the partner women are always
blamed.
3. Sexual meanings
 This is a process through which sexual thoughts , behaviors and
conditions eg virginity are interpreted and cultural meanings ascribed.
 Perception of pleasure shows the nature of the body, what is
considered erotic and when to talk about sexuality and with who.
 Men are supposed to demonstrate virility at all times (masculine
characteristics).
4. Sexual drives and enjoyment

 This includes men and women knowledge of body's sexual and

reproductive capacities and the ability to obtain physical and
emotional pleasure in form of fantasy, sexual encounters or self
stimulation.
 It involves formation of sexual identities , social conditioned sex drives
and perception of pleasure.
Barriers to womens access to health

 Lack of resources – influences access to available health services

 High opportunity costs of women's labor time for instance , facilities
may be distant and wasting time is a deterent for women having to
manage household and other responsibilities
 Transportation may not be available and or womens mobility may be
affected
 Family members may not allow women to attend clinics
 Stigma
 Low literacy rates and reduced access to information
 Being excluded from decision making on health actions and
expenditure
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Gender role expectations and
how they limit life options
 Social- this refers to different perceptions of men's and women's
social roles ;
 the man is seen as the head of the house hold and chief bread
winner, while `the woman is seen as a nurturer and care giver.
 Political- these are the differences in which women and men
assume power and share power and authority.
 Men are more involved in national and higher level politics while
women are more involved at the local level in activities linked to
their domestic roles.
cont
 Educational- these are differences in the educational opportunities
and expectations of girls and boys.
 Family resources are directed to boys rather than girls education, and
girls are streamed into less challenging academic tasks.
 Economic- these are the differences in men's and women's access to
lucrative careers and control over financial and other productive
resources , such as credit, loans and land ownership.
Social construction of gender

 Refers to how a society values and allocates duties, roles and

responsibilities to men and women.
 It points to how gender roles,r/ships and stereotypes are constructed
and reinforced in a society
 Social construction of gender can be through
 myths and popular culture
 Systems and institutions – religious,schools ,law…..
 Culture and societies perpetuate gender roles and stereotypes
through folklore( songs, stories, games, proverbs, rhymes etc).
 Some of the meanings/messages may contribute to gender
discrimination.
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Cont.…..

 Socialization of gender- meaning dependent on socio-cultural

location, the time, and place not stable or fixed. Meaning need to be
congruent with sex assigned at birth
 Its through socialization process that gender that gender is socially
constructed
 Begins at birth or even before naming is done
 Primary socialization- occurs in the home setting. Involves parents,
other children and relatives.
 Secondary socialization- occurs in institutions and involves different
agents

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Social construction of gender
through institutions and systems
 Institutions and systems may create and maintain gender stereotypes
.
 At the same time the functioning of institutions and systems may
create a more gender equitable society.
Gender development concepts
It focuses on social, economic and cultural forces that determine how
women and men benefit from the control of resources and participate
in activities differently.

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Gender Based Division of
Labour
 Every society assigns different tasks to women and men. This is known as the gender
based division of labour.
 Work in the society is basically divided into three categories.
1) Productive work
2) Reproductive work
3) Community work
A. PRODUCTIVE
The production of goods and services for income, trade, or
subsistence; tasks that contribute economically to the
household and community includes
I. wage earning
II. crop and livestock production
III. handcraft production,
IV. Marketing
V. Fishing
VI. manufacturing and construction.
When people are asked what they do, the response is most often related to productive
work
 B. Reproductive

 Reproductive work involves the care and maintenance of the household and its members,
including bearing and caring for children, food preparation, water and fuel collection,
shopping, housekeeping and family health care.
 Although reproductive work is crucial to human survival, it is seldom considered ‘real
work’ or counted in national accounts and labour statistics
The care and maintenance of human life within the household includes
I. childcare
II. food preparation
III. collection of water and firewood
IV. cleaning and maintaining shelter
V. health care.
c. community
 Community work involves the collective organization of social events and services,
ceremonies and celebrations and community improvement activities, as well as
participation in groups and organizations and political activities.
 Within community work, a further distinction is often made between community
managing roles and community political roles.
 Maintenance and improvement of the community as a whole includes
I. Building schools or clinics
II. planning celebrations
III. judging disputes
IV. making laws
V. advocating for community needs such as access to water.
Much of this work is deemed voluntary
ct Gender division of labor
 Both men and women do productive work but women mainly are
responsible for reproductive work while women and men are both
involved in community work.
 Men tend to have more public and high status tasks, such as chairing
boards and leading ceremonies.
 Productive work is recognized and valued , while reproductive work
(performed primarily inside the house ) is not. Women are often
overburdened because they are expected to engage in productive,
reproductive and community work
Practical gender needs

 These are the needs of women and men that are related to the
responsibilities and tasks associated with traditional gender roles
or immediate necessity.
 Responding to practical needs can improve quality of life, but it
does not challenge gender divisions of men's and women's
positions in society.
 Practical needs generally involve issues of access or conditions.
 Conditions refer to the material in the environment in which men
and women live .
 Strategic gender interests/needs

 These are interests concerning the positions of women and men in

relation to each other in a given society.
 Strategic interests may involve decision making power or control
over resources e.g land,education,credit facilities.
 Addressing strategic gender interests helps women and men to
achieve greater equality to change existing gender roles and
stereotypes.
 Gender interests generally involve issues of position, control and
power
cont
 In order to implement effective and sustainable programs it is often
necessary to consider strategic issues of power, control and status
because they serve as obstacles to the attainment of reproductive
health
 Addressing strategic issues enables us to get at the underlying
structures that cause the problems.
 Meeting a strategic gender need might not have immediate results but
will work towards a sustainable redistribution of roles,respo,resources
and power btn women and men.
The distinction between practical and strategic gender need

PGN are needs p’ple id’ in their socially acceptable roles in the society.
The needs affect the flow of power and don’t challenge the subordinate
position of women nor the division of labor/power, although arising from
them.
Are a response to perceived immediate necessity identified within a
specific context. They are practical in nature and often concerned with
inadequacies in living conditions such as water provision, healthcare and
employment
Strategic gender needs

 Needs that women identify because of their subordinate position to

men in their society. Vary according to particular contexts
 Relate to gender divisions of labor ,power and control and may
include such issues as landrights,domestic violence,equal wages and
womens control over their bodies.Meeting these needs help women
achieve greater equality
 SGN challenges the division of labor,power and control.
How to address gender needs

 Through:
 Education
 Empowerment
 Promoting gender responsive policies
 Ensuring equal acces to employment regardless of gender

66
Gender analysis
 It is a systematic way of exploring the current and potential roles and
responsibilities of men and women and their access to and control
over resources and benefits with a particular setting.
Reasons for gender analysis
a. Helps to ensure that both women and men participate in and
benefit from development
b. Looks for root causes of gender inequality and enables us to
address them.
c. Helps us to look at equity of impact
d. It focuses on transforming attitudes and practices to bring about
change
e. It helps to ensure that traditional power imbalances do not work
against women and men advancement
f. It enhances effectiveness of reproductive health activities
g. It ensures long term sustainability by addressing underlying
obstacles to development.
Can also be defined as

 Gender analysis is the process of examining roles and responsibilities or any other
situation in regard to women and men; boys and girls, for policy and program
development and implementation
1. Harvard analytical framework
2. women’s empowerment framework
3. capacity assessment and perception tool. (CAP)
Gender analysis models
1. Harvard analytical framework
 It uses three diagnostic tools to develop description and analysis of
gender roles and relations in the community
 A fourth component applies to gender analysis to a needs
assessment , proposal, project, evaluation or other activity
 It was developed in Harvard institute in USA.
 It is based on the understanding that women and men are affected by development
activities differently.
 The framework emphasizes the role on data and information because provision of data
makes women and men to be more visible in projects.
 It uses tools like activity profile, access and control profile
Activity Profile

 The activity profile identifies all relevant productive and reproductive tasks of the
community and addresses the question ‘who does what?’ In each case, men’s and
women’s work is shown.
 The activity profile is captured by the use of the daily activity profile tool.
 Daily Activity Profile Tool
 It is also called the 24 hour daily calendar. It describes how women or girls and men
and boys spend a typical day from the time they wake up until the time they go to
sleep.
Cont’
The Access and Control Profile

 Identifies resources and benefits associated with the roles delineated in the activity
profile.
 Besides physical resources and benefits, such as land and capital, these can include
access to time and education, political power and outside income.
 2.Women's empowerment framework

 This model emphasizes on women participation and women's issues

at every stage of the development cycle, with overall goal of
overcoming women's inequality.
 The framework consist of a five level scale of increasing equality
and empowerment
These are listed from highest to lowest.

 Control: equal control over in decision-making over factors of production.

 Participation: equal participation in decision-making processes related to
policymaking, planning and administration.
 Conscientization: attaining equal understanding of gender roles and a gender
division of labour that is fair and agreeable.
 Access; equal access to the factors of production by removing discriminatory
provisions in the laws.
 Welfare: having equal access to material welfare (food, income, medical care).
 The framework also identifies three levels of recognition of women’s issues in project
objectives:
 Negative level: ignores women’s issues.
 Neutral level: recognizes women’s issues and ensures only that women’s positions are
not further undermined.
 Positive level: focuses on improving the position of women.
cont
3. Change, accessibility and perception tool (CAP)
 The CAP is gender analysis tool designed to guide the development of
gender sensitive IEC(information, education and communication)
activities and ensure that there is gender equity and equality.
 The CAP is a simple tool consisting of three broad components and
associated questions designed to promote dialogue or gender issues
 The CAP components are
a. Change
b. Accessibility /control
c. Perception
 Other tools include the gender analysis matrix and gender and
development framework.
Change Component

 Guides users to analyse the desired behaviour

change. This is because for every project, the
goal is to achieve a change in behaviour.
 For example, a campaign on promoting
condom use among the youth will have a goal
to decrease STI/HIV infection and also
prevent unwanted pregnancies.
Access and Control Component

 This component examines the access and control

issues that affect the ability of men and women to
participate in and benefit from the communication
messages and services.
 For example looking at access, the user may wish
to find out who has access to family planning
clinic and who makes the decisions on family
planning.
Perception Component

Guides users on how the communication

activities in the messages are perceived by
men and women.
This is important because the perceptions
will be different for each group. ( using
auditory channel) observing channels of
communication
Gender mainstreaming
 It is a process that ensures that gender inequalities between women
and men, boys and girls are addressed in the Design, Planning,
Implementation, Monitoring and Evaluation of programs that the
beneficial outcomes are shared equitably by all men, women, boys
and girls.
 In gender main streaming all gender biases are removed and every
one plans with concern of women , men, boys and girls in mind and
how the intended activity affects them differently.
 There is no disparity , a deliberate trade-off is made to bring about
gender equity
 Mainstreaming addresses both practical gender needs and strategic
interests
 Gender mainstreaming is therefore based on outcome of gender
analysis
Summary Gender Mainstreaming

 Gender mainstreaming is a process of making the

concerns of women, men, boys and girls an integral
part of the design, implementation, monitoring and
evaluation of programmes (Ministry of Gender,
children and social services, 2008).
 Gender mainstreaming is a strategy that ensures
that inequalities between men, women, boys and
girls are addressed by the projects that are run.
 The ultimate goal of gender mainstreaming is to
achieve gender equality.
Purposes of gender
mainstreaming
a. Equal career opportunities for women and men
b. Fair distribution of unpaid and paid work among women and men,
wages and salaries that women live independently
c. Equality of women and men with regard to political representation and
participation
d. Enhancement of gender roles and standards for women and men,
elimination of restricting standards
e. Same personal freedoms for women and men and protection against
all forms of aggressions
Importance of gender mainstreaming

1. It contributes to more efficient and sustainable development

since the strategic needs of men and women are taken into
consideration.
2. It allows for equal participation of both men and women in
development of projects
3. Allows all persons that is men, women, boys and girls benefit
from programmes in an equal and fair way
4. When programmes are gender mainstreamed, they respond to
the specific needs of both men and women in an equal and fair
way
CONT.
5. It strongly focus on the needs of the most vulnerable people in
the society, both men and women for example Gender
mainstreaming in a RH project will ensure that vulnerable women
such as those living in conflict areas have access to basic RH
services such as family planning, maternal and new-born care
services.
6.GM makes full use of resources by involving women, men,
boys and girls 7. In the context of Reproductive health, gender
mainstreaming is necessary to achieve long term change in gender
relations that will promote the RH well-being of men and women
8. It takes into account the diversity among men and women.
These could be social differences (gender) and also the biological
differences (sex).
9. It leads to enhanced equality between men and women in
respect to their rights, opportunities and the value attributed to
their roles in the society
Requirements for Gender Mainstreaming

 According the ministry of gender, children and social

services (2008), effective gender mainstreaming can
occur if the following are in place:
 A clear gender policy in an organization or a project
 Practical coordination of all gender mainstreaming
initiatives
 A clear guide on gender mainstreaming and best practices
 Training and capacity building of the persons involved
CONT.

 Awareness creation and advocacy on gender mainstreaming

 Partnerships and networking for persons and institutions
 Research and information dissemination on gender issues
 Sex disaggregated data (how many men, women, boys and
girls are affected by the specific gender issue of interest)
 Resources mobilization
 Monitoring, evaluation and reporting mechanisms are in
place
Limitations of Gender Mainstreaming

 Lack of appropriate tools, methods and

techniques for the implementation of gender
mainstreaming.
 Lack of training for the actors involved result in
non-implementation of procedural changes
needed.
 Lack of resources to mainstream gender.
 Lack of clear policies on gender mainstreaming.
 Lack of data disaggregated by sex for example,
in the project area.
Gender based violence
 This refers to acts of violence with power inequalities that result in or
are likely to result in physical , sexual or mental harm or suffering ,
including threats of such acts , coercion or arbitrary deprivation of
liberty whether occurring in private or public life.
Types of gender violence
a. Sexual violence e.g. rape, incest, sexual harassment, defilement,
female genital mutilation (FGM) .
b. physical violence e.g. domestic violence. Husband/ wife beating,
heavy workload, cutting, starvation, forced pregnancy, deliberate
infection of STIs and HIV
c. Psychological violence e.g. early marriage, abuse, distribution of
resources., divorce, public insults, denied rights to associate with
other women, denied chance to work, polygamy.
cont
d. cultural- women denied certain foods, wife inheritance, women not
involved in decision making, preparing girls for sexual practices to please
men, men allowed to have extra marital relationships, early marriages
e. social- inequality (education, household chores, acquisition of loans,
labeling of girls in case of pregnancy
f. Economic violence
 women running families with limited resources
 Women not allowed to work
 Joint accounts with the man as signatory
 Discriminatory land ownership laws
f. Political violence- inequality in the political arena
g. Violence on women by women-
 Mistreatment of house helps
 At workplace
 Fight over men
 Domestic violence- it is physical , psychological, or economical abuse of a
woman by her partner or ex-partner or by a person with the family or
Effects and consequences of violence
to individuals , family or community

a. Separation/ divorce
b. Deaths
c. Physical injury
d. Psychological torture
e. Delinquency
f. prostitution
Effects of gender based violence to
individual
1. Prevents people from exercising and enjoying their fundamental
rights and freedom
2. Affects their quality of life politically, economically, socially,
physically, and emotionally
3. It is an obstacle to achievement of equality, development and
individuals advancement
4. Un realization of the full potentials of the victims
5. Lack of full participation in development and other societal
activities
6. Can lead to drug abuse and low quality health
7. Can lead to fear, low self esteem, sexual dysfunction depression
and even suicide.
Factors associated with gender based violence

 They can be grouped into:-

a. Society̧
 Norms granting men control over female behavior ̧
 Acceptance of violence as a way to resolve conflict
 Notion of masculinity linked to dominance,honor and aggression
 Rigid gender roles
b. community

 Poverty, low socioeconomic status,

 unemployment
 Associating with peers who condone violence
 Isolation of women and family
Role of the community in preventing
gender based violence
 Ensure that all victims have a safe place to return
 Expand services
 Seek and use survivor input
 Increase the cultural and linguistic competence of community
programs
 Expand availability of culturally competent and culturally specific
services
 Develop new leadership
 Protect privacy and confidentiality
cont
 Inform policy makers
 Build partnerships with community groups
 Increase organizational capacity
 Eliminate the economic crisis that often follows victimization
 Implement policies and programs that support both safety and
self sufficiency
 Promote the safe pursuit of child support whenever possible and
consider exemptions from paternity and child support
requirements in cases which risks to the custodial parent or child
cannot be overcome.
cont
 Increase the availability of job training programs and educational
opportunities
 Enhance the safety and economic security of at risk families and
survivors of abuse
 Engage the media , community members and educators
 Ensure availability of services to those who seek help
 Form community partnerships
 Create campaigns with grass roots organizing component
cont
 Target education and awareness campaigns to young people and men
 evaluate public education efforts rigorously
 Do not reward men for aggressive behavior
 Recognize men who are already working to create more equal
relationships and more peaceful communities
 Relook at the societal socialization process
c. family

 marital conflict
 Male control of wealth and decision making in the family
d. Individual perpetrator
 Witnessing marital violence as a child
 ̧Absent or rejecting father
 Being abused as a child
 Alcohol use
Effects of Gender Based Violence
 Gender based violence typically has physical, psychological, and social
effects.
a. Physical effects
 injury
 disability
 chronic health problems (irritable bowel syndrome, gastrointestinal
disorders, various chronic pain
 syndromes, hypertension, etc.)
 sexual and reproductive health problems (contracting sexually
transmitted diseases, spread of HIV/AIDS, high
 risk pregnancies, etc.)
 death
b. Psychosocial effects
 Psychological
 Effects can be both direct/ indirect
 Direct to individual:
 anxiety
 fear
 mistrust of others
 inability to concentrate
 Loneliness
 post traumatic stress disorder
 Depression
 suicide, etc. ̧
Direct effects to family and dependants:

 divorce, or broken families;

 jeopardized family’s economic and emotional development
 babies born with health disorders as a result of violence
experienced by the mother during
 pregnancy (i.e. premature birth or low birth weight);
 increased likelihood of violence against children growing up in
households where there is domestic violence;
cont
 collateral effects on children who witness violence at home
(emotional and behavioral
 disturbances, e.g. withdrawal, low self esteem, nightmares, self
blame, aggression against peers, family members, and property;
increased risk of growing up to be either a perpetrator or a victim of
violence)
Indirect effects
 psychosomatic illnesses
 withdrawal
 alcohol or drug use
 Compromised ability of survivor to care for her children (e.g. child
malnutrition and neglect due to
 constraining effect of violence on women’s livelihood strategies
and their bargaining position in marriage)
 Ambivalent or negative attitudes of a rape survivor towards the
resulting child.
The impact of violence on the
perpetrators:
 sanctioning by community, facing arrest and imprisonment;
 legal restrictions on seeing their families, divorce, or the break up of
their families;
 feeling of alienation from their families;
 minimizing the significance of violence for which they are responsible;
deflecting the responsibility for violence onto their partner and failure
to associate it with their relationship;
 increased tension in the home
The impact of violence on society

 burden on health and judicial systems

 hindrance to economic stability and growth through women’s lost
productivity
 hindrance to women’s participation in the development processes
and lessening of their contribution to social and economic
development.
 constrained ability of women to respond to rapid social, political, or
economic change.
 breakdown of trust in social relationships
 weakened support networks on which people’s survival strategies
depend.
 strained and fragmented networks that are of vital importance in
strengthening the capabilities of communities in times of stress and
upheaval
Female genital mutilation
 FGM constitutes of all procedures which involves partial or total
removal of the female genital organs or other injury to the female
genital organs whether for cultural or any other non therapeutic
reasons.
Types of FGM
Type l- Clitoridectomy
Type ll- Excisim (excision)
Type lll- infibulation
Type lv- unclassified
 cont
Type I — Partial or total removal of the clitoris and/or the prepuce
(clitoridectomy).
 Type I mutilation has the following subdivisions
 Type Ia, removal of the clitoral hood or prepuce only;
 Type Ib, removal of the clitoris with the prepuce.
Type II — Partial or total removal of the clitoris and the labia minora.
the following are subdivisions are subdivisions of type type ll
mutilation.
 Type IIa, removal of the labia minora only;
 Type IIb, partial or total removal of the clitoris and the labia
minora;
 Type IIc, partial or total removal of the clitoris, the labia minora
and the labia majora.
cont
Type III — Narrowing of the vaginal orifice with creation of a covering
seal by cutting and appositioning the labia minora and/or the labia
majora, with or without excision of the clitoris (infibulations). it is
important to distinguish between variations in infibulations, the
following subdivisions are proposed:
 Type IIIa, removal and apposition of the labia minora;
 Type IIIb, removal and apposition of the labia majora.
Type IV — All other harmful procedures to the female genitalia for
non-medical purposes, for example: pricking, piercing, incising,
scraping and cauterization.
summary

TYPE 1 – this the excision(removal) of the clitorial hood with or without

removal of all or part of the clitoris.
TYPE 2 – is the excision of the clitoris together with part or all of the
labia minora (the inner vaginal lips)
Type 3 – is the excision of part or all of the external genitalia (clitoris,
labia minora and majora) and stitching or narrowing of the vaginal
opening, leaving a very small opening abt size of a match stick to allow for
the flow of urine and menstrual blood.
Complications of FGM
 Short term physical complications
a. Severe pain
b. Injury to adjacent tissue of urethra, vagina, perineum or rectum
c. Hemorrhage
d. Shock
e. Acute urine retention
f. Infection
g. Failure to heal
h. death
Long term physical
complications
a. Difficulties in passing urine
b. Recurrent urinary tract infections
c. Pelvic infarctions
d. Infertility
e. Keloid scar
f. Abscess
g. Cysts and abscesses of the vulva
h. Clitoral neuroma
i. Difficulties in menstrual flow
j. Calculus formation in the vagina
k. Vesico- vaginal fistula (VVF)
l. Recto vaginal fistula (RVF)
m. problems in child birth
n. Failure to heal
Psychosocial consequences

a. Fear, submission, inhibition and suppression of feelings

b. Reported pain during sexual intercourse and menstruation
c. Emotional pain following the personal experience
d. Feeling of betrayal, bitterness and anger
e. For some girls and women the experiences are comparable to rape
f. Reported disturbances in eating and sleeping habits and in mood
and cognition
g. Girls who have not been excised may be socially stigmatized,
rejected by their communities and unable marry locally which also
causes psychological trauma
Sexual complications of female
genital mutilation
 Various forms and degrees of sexual dysfunction
 Painful sexual intercourse (dyspareunnia) because of scarring,
narrowing of the vaginal opening.
 Vaginisms may result from injury of the vulva area and repeated
sexual acts.
Management of girls and women
with FGM complications
Assessment to identify physical complications due to FGM
1.

2. Managing immediate and short term complications

3. Managing long term complications
4. Managing girls and women with psychosocial and sexual
complication of FGM
 Identification of the problem by history taking
 Counseling to help her identify the real problem and accept it
 Referral for more specialized care if needed
cont
5. Use of appropriate family planning methods in the presence of
FGM
6. Opening up of type III FGM
7. Management of women with complication due to FGM during
pregnancy
 Assessing problem associated with FGM
 Identify complications due to FGM during pregnancy
 Manage according to type of FGM.
Cont
8. Management of obstetric complication due to FGM during labour and
delivery .
 Assessment
 Identify complications due to FGM during labour and delivery e.g
infibulations. Open it and stitch each side separately so that the raw
areas do not come together.
 Manage according to the type of FGM
cont
9. Management of women with FGM during post partum period
 Identify the problems
10. Immediate care
 Hemorrhage suture
 Neonatal asphyxia resuscitate
11. Post partum follow up.
 Postpartum care
 Information, counseling and support
Strategies for prevention of FGM
Community involvement
 Integrate education and counseling against FGM into health care
service provision activities at community level.
 Involve and collaborate with influential leaders and other key
individuals and groups within the community as change agents
against FGM.
 Visiting individual people or groups in the community as appropriate
 Establishing focus groups discussions on FGM
 Assist the people to think through the practice of FGM and its gender
and human rights dimensions
 Identify and mobilize resources in the community that could be used
in the prevention program
 Suggest strategies for changing practices eg culturally acceptable
alternative rite of passage and teaching women problem solving skills
 Supporting individuals and families to cope with the problems of FGM
and with adjusting to change
Involvement of political and
government leaders
 Identification of influential people both locally and nationally
 Make contacts with relevant people and organize seminars or
workshops
 Lobby influential people in all relevant forums
 Advocacy in order to win support from the leaders
 Identify providers values, attitudes and biases towards FGM.
RAPE
 Rape is having sex with a woman or a girl without her consent or
with her consent if obtained under threat , force or intimidation of
any kind , fear of bodily harm or misrepresentation as the nature
to the act or by a person impersonating her husband.
 If the girl is less than 16 years she is deemed incapable of
consenting to sex in law and therefore sex with her is considered
rape even with her consent.
 Technically in law the rape of a girl below 16 years is termed as
defilement.
 For the act to be considered as rape or defilement , there must
penetration of the vagina or penis.
Classification of rape
 exchange rape - rape occurring as the result of bargaining or
solidarity-displaying among men
 punitive rape - rape used to punish or discipline
 theft rape - rape that happens when a woman or man is
abducted, in most cases to be used as a slave or a prostitute
 ceremonial rape - rape involving defloration rituals
cont
 acquaintance rape- is a non-domestic rape committed by someone
who knows the victim
 Gang rape- occurs when a group of people participate in the rape of
a single victim.
 Spousal rape- Also known as marital rape, wife rape, husband rape,
partner rape or intimate partner sexual assault (IPSA), is rape between
a married or de facto couple. Research reveals that victims of
marital/partner rape suffer longer lasting trauma than victims of
stranger rape.[
cont
 Incest is sexual activity between family members or close relatives.
This typically includes sexual activity between people in a
consanguineous relationship (blood relations), and sometimes those
related by affinity, stepfamily, those related by adoption or marriage,
or members of the same clan or lineage.
 Prison rape- this is rape among prison inmates
 Serial rape- is rape committed by a person over a relatively long
period of time and committed on a number of victims
 Payback rape- also called "punishment rape" or "revenge rape. The
rape is meant to humiliate the father or brothers, as punishment for
their prior behavior towards the perpetrators. Payback rape is
sometimes connected to tribal fighting
cont
 War rape- these are rapes committed by soldiers, other combatants
or civilians during armed conflict or war, or during military occupation.
It also covers the situation where girls and women are forced into
prostitution or sexual slavery by an occupying power
 Rape by deception- occurs when the perpetrator gains the victim's
agreement through fraud
 Corrective rape- is targeted rape against non-heterosexuals as a
punishment for violating gender roles especially lesbians
 Custodial rape- is rape perpetrated by a person employed by the
state in a supervisory or custodial position, such as a police officer,
public servant or jail or hospital employee. It includes the rape of
children in institutional care such as orphanages.
cont

 exchange rape - rape occurring as the result of bargaining or

solidarity-displaying among men
 punitive rape - rape used to punish or discipline
 theft rape - rape that happens when a woman or man is abducted,
in most cases to be used as a slave or a prostitute
 ceremonial rape - rape involving defloration rituals
 status rape - rape resulting from differences in hierarchy or social
class
Attempted rape
 If someone tries to rape a girl or woman but fails then this is still
an offence called attempted rape and it is punishable by life
imprisonment.
 In attempted rape there is no penetration
Penetration
 This is the partial or complete insertion of the penis into the
vagina.
Sexual violence
 Sexual violence is the use of physical sexual contact or erotic non
contact sexual exposure by one person to another against his or
her will.
 This may include acts such as rape (sex against a persons will),
kissing, touching the private parts of a person (such as the penis
or vagina), oral sex (placing the penis inside the buttocks
opening), dry intercourse(the rubbing of a penis against another
persons body) and performing such acts with an animal.
 however the defines each of these activities differently.
Steps in post rape management
Medical management ;

a. history taking and examination of the girl should be done

immediately in a safe and trusting environment. Before
undertaking the physical examination, the victim should be
explained about the procedures and why they are necessary. She
should be given a chance to ask questions
 Patients will be asked for a brief history regarding:
 Time and place of the assault
 Who put what where
 If contraception or condoms were used.
b. Physical examination
 A thorough general and genital examination will be performed to
look for any injuries and to collect evidence for forensic evaluation
cont

 Pregnancy prevention by giving emergency pills

 HIV prevention – give post exposure prophylaxis
 Management of physical injuries
 STI prevention
 Hepatitis B prevention
 Tetanus toxoid prevention
c. Laboratory tests
 Several laboratory tests will be done for forensic purposes, STIs
and pregnancy. Some of these tests are:
i. Urinalysis- urine specimen is taken and microscopy to determine
presence of spermatozoa and evidence of infection done.
 Establish presence of epithelial cells.
 Pregnancy test is also done on urine
ii. Blood- tests done on blood include HIV test, hemoglobin level, liver
function tests and VDRL.
iii. High vaginal swab- check for evidence of spermatozoa
d. legal/forensic issues

 Documentation of examination findings

 Specimen collection
 Reporting procedures
Psychosocial issues related to gender that
lead to increase in rape cases
a. Evolution- from the evolutionary perspective, the goal of sexual
behavior is to maximize the likelihood of passing ones genes. This goal
involves maximizing the chances that one will have an offspring who
themselves will survive to reproduce.
b. Alcohol use has been linked to physical aggression and this more
prevalent in men than in women. Alcohol may interfere with cognitive
processes, in particular social cognition.
c. Attitudes and gender schemas- cultural myths about violence,
gender scripts and roles, sexual scripts and roles and male entitlement
are represented at individual level as attitudes and schemas
d. Sex and power- violence against women is widely believed to be
motivated by needs to dominate women
SEXUALITY (SEXUAL
HEALTH/ADOLESCENT/YOUTH HEALTH

 Sexuality is about who you are attracted to sexually and

romantically.
 Attraction to the opposite sex heterosexual (Male to female)
 Attractionto same sex (Male to male-homosexual/gay or female to
female lesbian)
 Adolescence is a journey from the world of the child to the world of
the adult. Early adolescence 10-13 years, mid adole 10-15 years,
late adole 16-19 years
 Youths (Young adults 20-24 years they are increasingly expected to
make decisions on career, marriage and other adult responsibilities
ADOLESCENCE/YOUTH FRIENDLY
SERVICES
 Definition Broad Based Health and related services provided to
young people to meet their individual health needs in a manner and
environment to attract interest and sustain their motivation to utilize
such services.
 WHO describes A/YFS as: ‘Services that are accessible, acceptable
and appropriate for youth/adolescents. They are in the right place at
the right price (free where necessary) and delivered in the right style
to be acceptable to young people. They are effective, safe and
affordable. They meet the individual needs of young people who
return when they need to and recommend these services to friends.”
Group Assignments

Challenges facing establishment of

A/YFS
Assignment :group 1
Approaches for delivery of adolescent
youth friendly services
 The targeted approach services are designed and planned
for youth alone and are offered in settings that meet only
the needs of the youth and do not include other groups.
Such services may be clinical, non-clinical, or a
combination of both.
 Integrated approaches refers to a situation where young
people receive services as part of the general public, but
special arrangements are made to make the services more
acceptable to them.
Minimum Conditions (characteristics) for A/YFS

 Affordability and accessibility

 Safe and basic range of services
 Privacy and confidentiality
 Provider competence/attitude
 Quality and consistency
 Reliability and sustainability
 Inbuilt monitoring and evaluation system
 ONE STOP SHOP all services in one building
Models for Youth Friendly Services with
Recommended Essential Service Package
There are three models
1) Clinic-based model, group 2
2) Youth centre model, group 3
3) School-based peer youth programs.
group 4
N/B group assignments:- State the
recommended essential services
package for each model
Role of service provider in A/YFS

 Service provider should ensure the following:-

 Privacy and Confidentiality Honoured
 Respect for Young People
 Peer Counsellors Available
 Adequate Time for Client and Provider Interaction
 Young Men and Women Welcome and Served
 Necessary Referral Mechanisms Available
 Youth involvement
Youth group involvement in A/YFS
MALE PARTICIPATION IN
REPRODUCTIVE HEALTH
ROLE OF MEN IN RH - group 5
Supporting women to
-ANC,PNC
-Deliver in hospital/HF
- overcome food taboo
-improved nutrition during pregnancy
BARRIERS OF MALE PARTICIPATION
IN RH individual barriers - group 6
 Personality
 Socialization
 Ego
Family barriers
 Taboos made against male interaction with small children
 Cultural norms about family planning being a woman's problem
 Lack of role models for involved fathering
 Cultural assumption that anything domestic is women's work
Community/peer barriers

 Fear of being viewed as not a man enough by peer if caught doing

house work or child care.
 Family planning services are geared towards women's needs and are
not welcoming to men e.g. MCH/FP.
 Traditional Male/Female roles reinforced in mass media
National program/ policy barriers

 Separation laws are not favorable to male or joint custody of children

 No legal paternity leave
 Inadequate family life education in school to help change gender
stereotypes
 Hospital /clinic regulations not supportive of father involvement in
birth and postpartum` care
 Lack of specific interventions to address them
Strategies and approaches
 Advocacy
 Create enabling environment , policies, and appropriate legislature
eg paternity leave and allowance
 Role models in male participation in family level, community level,
individual level and use them as change agents.
 Male friendly reproductive health services . Ensuring privacy from
reception to service provision site.
 Reorientation of of service providers to be gender sensitive
 National planning for resources in all programmes to be shared
equitably by both men and women.
 SEXUAL OFFENCE ACT

 Definition:- An Act of Parliament to make provision about sexual

offences, their definition, prevention and the protection of all persons
from harm from unlawful sexual acts, and for connected purposes
 “genital organs” includes the whole or part of male or female
genital organs and for purposes of this Act includes the anus
 “indecent act” means an unlawful intentional act which causes—
any contact between any part of the body of a person with the genital
organs, breasts or buttocks of another, but does not include an act
that causes penetration; or exposure or display of any pornographic
material to any person against his or her will;
 “penetration” means the partial or complete insertion of the genital
organs of a person into the genital organs of another person;
149
 Sexual Offence Act

RAPE
 A person commits the offence termed rape if—he or she intentionally
and unlawfully commits an act which causes penetration with his or
her genital organs; the other person does not consent to the
penetration; or the consent is obtained by force or by means of
threats or intimidation of any kind.
 A person guilty of an offence under this section is liable upon
conviction to imprisonment for a term which shall not be less than ten
years but which may be enhanced to imprisonment for life.

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 Sexual Offence Act

ATTEMPTED RAPE
 Any person who attempts to unlawfully and intentionally commit an act which causes
penetration with his or her genital organs is guilty of the offence of attempted rape and is
liable upon conviction for imprisonment for a term which shall not be less than five years
but which may be enhanced to imprisonment for life.
SEXUAL ASSAULT
 Any person who unlawfully—penetrates the genital organs of another person with—any
part of the body of another or that person; or an object manipulated by another or that
person except where such penetration is carried out for proper and professional hygienic
or medical purposes;
 manipulates any part of his or her body or the body of another person so as to cause
penetration of the genital organ into or by any part of the other person’s body, is guilty of
an offence termed sexual assault.
 A person guilty of an offence under this section is liable upon conviction to imprisonment
for a term of not less than ten years but which may be enhanced to imprisonment for life.
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 Sexual Offence Act
COMPELLED OR INDUCED INDECENT ACTS
 A person who intentionally and unlawfully compels, induces or causes another person
to engage in an indecent act with—the person compelling, inducing or causing the
other person to engage in the act; is guilty of an offence and is liable upon conviction
to imprisonment for a term which shall not be less than five years.
DEFILEMENT
• A person who commits an act which causes penetration with a child is guilty of an
offence termed defilement.
 A person who commits an offence of defilement with a child aged eleven years or
less shall upon conviction be sentenced to imprisonment for life.
 A person who commits an offence of defilement with a child between the age of
twelve and fifteen years is liable upon conviction to imprisonment for a term of not
less than twenty years.
 A person who commits an offence of defilement with a child between the age of
sixteen and eighteen years is liable upon conviction to imprisonment for a term of
not less than fifteen years.

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 Sexual Offence Act
ATTEMPTED DEFILEMENT
 A person who attempts to commit an act which would cause
penetration with a child is guilty of an offence termed attempted
defilement.
 A person who commits an offence of attempted defilement with a child
is liable upon conviction to imprisonment for a term of not less than ten
years.
GANG RAPE
 Any person who commits the offence of rape or defilement under this
Act in association with another or others, or any person who, with
common intention, is in the company of another or others who commit
the offence of rape or defilement is guilty of an offence termed gang
rape and is liable upon conviction to imprisonment for a term of not less
than fifteen years but which may be enhanced to imprisonment for life.

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 Sexual Offence Act
INDECENT ACT WITH CHILD OR ADULT
 Any person who commits an indecent act with a child is guilty of the offence of committing
an indecent act with a child and is liable upon conviction to imprisonment for a term of not
less than ten years.
INDECENT ACT WITH ADULT
 Any person who commits an indecent act with an adult is guilty of an offence and liable to
imprisonment for a term not exceeding five years or a fine not exceeding fifty thousand
shillings or to both.
PROMOTION OF SEXUAL OFFENCES WITH A CHILD
 A person including a juristic person who—manufactures or distributes any article that
promotes or is intended to promote a sexual offence with a child; or who supplies or
displays to a child any article which is intended to be used in the performance of a sexual
act with the intention of encouraging or enabling that child to perform such sexual act,
 is guilty of an offence and is liable upon conviction to imprisonment for a term of not less
than five years and where the accused person is a juristic person to a fine of not less than
five hundred thousand shillings.

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 Sexual Offence Act

CHILD SEX TOURISM

 A person including a juristic person who— makes or organizes any
travel arrangements for or on behalf of any other person, whether
that other person is resident within or outside the borders of Kenya,
with the intention of facilitating the commission of any sexual offence
against a child, irrespective of whether that offence is committed;
 is guilty of an offence of promoting child sex tourism and is liable
upon conviction to imprisonment for a term of not less than ten years
and where the accused person is a juristic person to a fine of not less
than two million shillings.

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 Sexual Offence Act

CHILD PORNOGRAPHY
 Any person including a juristic person who—knowingly displays, shows, exposes or
exhibits obscene images, words or sounds by means of print, audio-visual or any other
media to a child with intention of encouraging or enabling a child to engage in sexual
acts;
 is guilty of an offence of child pornography and upon conviction is liable to
imprisonment for a term of not less than six years or to a fine of not less than five
hundred thousand shillings
EXPLOITATION OF PROSTITUTION
 Any person who—intentionally causes or incites another person to become a
prostitute; and intentionally controls any of the activities of another person relating to
that person’s prostitution, and does so for or in expectation of gain for him or herself
or a third person,
 is guilty of an offence and is liable upon conviction to imprisonment for a term of not
less than five years or to a fine of five hundred thousand shillings or to both.
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 Sexual Offence Act

PROSTITUTION OF PERSONS WITH MENTAL DISABILITIES

 A person who, in relation to a person with mental disability, for
financial or other reward, favour or compensation to such person with
mental disability or to any other person is guilty of the offence of
being involved in the prostitution of a person with disabilities and
shall, upon conviction, be liable to imprisonment for a term of not less
than ten years
INCEST BY MALE PERSONS
 Any male person who commits an indecent act or an act which
causes penetration with a female person who is to his knowledge his
daughter, granddaughter, sister, mother, niece, aunt or grandmother
is guilty of an offence termed incest and is liable to imprisonment for
a term of not less than ten years
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 Sexual Offence Act

INCEST BY FEMALE PERSONS

 The provisions of section 20 shall apply mutatis mutandis with respect to any
female person who commits an indecent act or act which causes penetration
with a male person who is to her knowledge her son, father, grandson
grandfather, brother, nephew or uncle.
SEXUAL HARASSMENT
 Any person, who being in a position of authority, or holding a public office, who
persistently makes any sexual advances or requests which he or she knows, or
has reasonable grounds to know, are unwelcome, is guilty of the offence of
sexual harassment and shall be liable to imprisonment for a term of not less
than three years or to a fine of not less than one hundred thousand shillings or
to both.

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 Sexual Offence Act

Deliberate Transmission Of HIV Or Any Other Life Threatening Sexually

Transmitted Disease
 Any person who, having actual knowledge that he or she is infected with HIV or any
other life threatening STI intentionally, knowingly and willfully does anything or permits
the doing of anything which he or she knows or ought to reasonably know infect
another person shall be guilty of an offence, whether or not he or she is married to that
other person, and shall be liable upon conviction to imprisonment for a term of not less
fifteen years but which may be for life.
Cultural And Religious Sexual Offences
 Any person who for cultural or religious reasons forces another person to engage in a
sexual act or any act that amounts to an offence under this Act is guilty of an offence
and is liable upon conviction to imprisonment for a term of not less than ten years.

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 CHILDREN’S ACT

 An Act of Parliament to make provision for parental

responsibility, fostering, adoption, custody, maintenance,
guardianship, care and protection of children; to make
provision for the administration of children’s institutions; to
give effect to the principles of the Convention on the Rights
of the Child and the African Charter on the Rights and Welfare
of the Child and for connected purposes
 “child abuse” includes physical, sexual, psychological and mental
injury to a child
 “early marriage” means marriage or cohabitation with a child or
any arrangement made for such marriage or cohabitation

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 Children’s Right

Survival and best interests of the child

 Every child shall have an inherent right to life and it shall be the
responsibility of the Government and the family to ensure the survival
and development of the child.
Non-discrimination
 No child shall be subjected to discrimination on the ground of origin,
sex, religion, creed, custom, language, opinion, conscience, colour,
birth, social, political, economic or other status, race, disability, tribe,
residence or local connection
Right to parental care
 A child shall have a right to live with and to be cared for by his
parents.
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 Children’s Right

Right to education
 Every child shall be entitled to education the provision of which shall be the
responsibility of the Government and the parents
Right to religious education
 Every child shall have a right to religious education subject to appropriate
parental guidance
Right to health care
 Every child shall have a right to health and medical care the provision of which
shall be the responsibility of the parents and the Government.
Protection from child labour and armed conflict
 Every child shall be protected from economic exploitation and any work that is
likely to be hazardous or to interfere with the child’s education, or to be harmful
to the child’s health or physical, mental, spiritual, moral or social development.
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 Children’s Right

Name and nationality

 Every child shall have a right to a name and nationality and where a child is deprived of
his identity the Government shall provide appropriate assistance and protection, with a
view to establishing his identity.
Disabled child
 A disabled child shall have the right to be treated with dignity, and to be accorded
appropriate medical treatment, special care, education and training free of charge or at
a reduced cost whenever possible.
Protection from abuse
 A child shall be entitled to protection from physical and psychological abuse, neglect
and any other form of exploitation including sale, trafficking or abduction by any person.

163
 Children’s Right

Protection from harmful cultural rites

 No person shall subject a child to female circumcision, early marriage or other
cultural rites, customs or traditional practices that are likely to negatively affect
the child’s life, health, social welfare, dignity or physical or psychological
development
Protection from sexual exploitation
 A child shall be protected from sexual exploitation and use in prostitution,
inducement or coercion to engage in any sexual activity, and exposure to
obscene materials.
Protection from drugs
 Every child shall be entitled to protection from the use of hallucinogens,
narcotics, alcohol, tobacco products or psychotropic drugs and any other drugs
that may be declared harmful by the Minister responsible for health and from
being involved in their production, trafficking or distribution.
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 Children’s Right

Leisure and recreation

 A child shall be entitled to leisure, play and participation in cultural
and artistic activities.
Torture and deprivation of liberty
 No child shall be subjected to torture, cruel treatment or punishment,
unlawful arrest or deprivation of liberty
Right to privacy
 Every child shall have the right to privacy subject to parental
guidance.

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 Duties and Responsibilities of a
Child
 work for the cohesion of the family
 respect his parents, superiors and elders at all times and assist them
in case of need
 serve his national community by placing his physical and intellectual
abilities at its service
 preserve and strengthen social and national solidarity
 preserve and strengthen the positive cultural values of his community
in his relations with other members of that community

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 CHILD SEXUAL ABUSE

 Child sexual abuse is the exploitation of a child or adolescent for the

sexual gratification of another person.

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 SEXUALLY ABUSIVE BEHAVIORS

 Fondling

 Sodomy

 Oral-genital stimulation

 Verbal stimulation

 Exhibitionism

 Child prostitution

 Child pornography

 Sexual Intercourse
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 Warning signs of sexual abuse in children

 Trouble walking or sitting.

 Displays knowledge or interest in sexual acts inappropriate to his /her age.
 Makes strong efforts to avoid a specific person, without an obvious reason.
 Doesn’t want to change clothes in front of others or participate in physical activities.
 An STD/HIV/AIDs or pregnancy, especially under the age of 14.
 Runs away from home if the perpetrator is from home.

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 GENDER ISSUES AFFECTING
HEALTH/HEALTH DELIVERY SERVICES
Discuss and make notes on how gender issues affect health/health delivery
services in Kenya (20 marks)
NB. Presentations and Discussions to be done in the class- room on Thursday and
Friday
 Traditional and Cultural factors group 1
 Religious factors group 2
 Poverty and succession issues group 3
 Socio – economical factors group 4
 Marriage practices group 5
 Legal aspects/status group 6
 Sexual dimensions organized on gender lines group 7
 Education level group 8
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 Effects of Early Marriages

 Difficult labour/ child birth difficulties

 Large family size
 Hinders personal development e.g. education
 Abuse in marriage in case the spouse is older
 Marital instability
 Increased chances of acquiring STIs and Fistula
 Increased infant mortality

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 Reasons for Polygamous Marriage

 Barrenness
 Need for children of certain sex
 Show of power/wealth
 Pressure from relatives to marry from a certain community
 Lust for sexual intercourse

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 Effects of Gender Issues on RH
 Physical Consequences  Social Consequences
 Unwanted pregnancies  Added health care costs
 Serious injuries  Other added costs e.g. legal
 fees, police etc.
Injuries during pregnancies
 Decreased productivity and
 Contraction to STIs/ HIV
employment
 Injury to children
 Homicide
 Psychological Consequences
 Mental health problems (PTSD)
 Suicide

173