who -Why Gender Matters - Immunization Agenda 2030-此为英文文档

IMMUNIZATIONAGENDA2030

WHY

GENDER

MATTERS

Whygendermatters:immunizationagenda2030

ISBN978-92-4-003394-8(electronicversion)

ISBN978-92-4-003393-1(printversion)

©WorldHealthOrganization2021

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CONTENTS

iv

Acknowledgements v

Acronyms vi

Definitions vii

Purposeandaudience ix

Chapter1:Whydoesgendermatterforimmunization?

Whatisgendermainstreaminginimmunizationprogrammes? 6

Whatisgenderanalysis? 7

Whyconductagenderanalysis? 7

Chapter2:IA2030andgender

IA2030:Coreprinciples 13

Chapter3:Understandinggender-relatedbarrierstoimmunization

Barrier1:Poorqualityservicesandnegativehealthproviderattitudes 16

Barrier2:Loweducationlevelandhealthliteracy 17

Barrier3:Limitedautonomyindecision-makingandhouseholddynamics 17

Barrier4:Lackofaccessandcontroloverresourcesandmobility 17

Barrier5:Highprevalanceofgender-basedviolence(GBV)andharmfulpractices 18

Chapter4:Gender-responsiveapproachestoincreasingimmunizationcoverage

Acontinuumofgender-responsiveness 21

Approach1:Investingenderdataandanalysis 22

Approach2:Makecommunityengagementandsocialmobilizationgender-responsiveandtransformative 25

Approach3:Engagewithmentotransformgendernorms 28

Approach4:Empowerandcollaboratewithcivilsocietyandchangeagents 30

Approach5:Implementgender-responsiveactionsforthehealthworkforce 32

Approach6:Improvethequality,accessibilityandavailabilityofservices 33

Approach7:Integrateservicesandcollaborateacrosssectors 35

Approach8:Implementgender-responsiveimmunizationservicesinemergencysettings 37

Approach9:Applyagenderlenstoresearchandinnovation 40

Chapter5:Wayforward-commitmentandaccountability

Conclusion:Acceleratingprogressfor2030 44

References 45

Annexes

Annex1:GenderAnalysisMatrix 50

Annex2:Resourcesandtoolsforgender-responsiveprogramming 51

Annex3:Metricstoidentifygender-relatedbarrierstoimmunization 52

v

Acknowledgements

ThisdocumentwasdevelopedcollaborativelybytheWorldHealthOrganization(WHO),UnitedNationsChildren’sFund(UNICEF)andGavi,withinputfromtheGlobalPolioEradicationInitiative(GPEI),theUSCentersforDiseaseControlandPrevention,theWorldBank,theBill&MelindaGatesFoundation,theUnitedNationsEntityforGenderEqualityandtheEmpowermentofWomen(UNWomen),theInternationalFederationofRedCrossandRedCrescentSocieties,theCoreGroupandCivilSocietyHumanandInstitutionalDevelopmentProgramme–Pakistan,withSiniRamoastheleadauthorofearlydrafts.

vi

Acronyms

BCG

bacillusCalmette–Guérin

BeSD

behavioralandsocialdriversofvaccination

CTC

controlledtemperaturechain

DTP3

threedosesofdiphtheria,tetanusandpertussisvaccines

GBV

gender-basedviolence

GPEI

GlobalPolioEradicationInitiative

HepB

hepatitisB

HIV

humanimmunodeficiencyvirus

HPV

humanpapillomavirus

IA2030

ImmunizationAgenda2030

IASC

Inter-AgencyStandingCommittee

LGBTQI

lesbian,gay,bisexual,transgender,queerandintersex

NIS

nationalimmunizationstrategy

NITAG

nationalimmunizationtechnicaladvisorygroup

RITAG

regionalimmunizationtechnicaladvisorygroup

SARS

Severeacuterespiratorysyndrome

SDG

SustainableDevelopmentGoal

SRHR

sexualandreproductivehealthandrights

TT

tetanustoxoid

UHC

universalhealthcoverage

UNDP

UnitedNationsDevelopmentProgramme

UNFPA

UnitedNationsPopulationFund

UNICEF

UnitedNationsChildren’sFund

UNICEFROSA

UNICEFRegionalOfficeforSouthAsia

UNWomen

UnitedNationsEntityforGenderEqualityandtheEmpowermentofWomen

WASH

water,sanitationandhygiene

WHO

WorldHealthOrganization

vii

Sexistypicallyassignedatbirthandreferstothebiologicalcharacteristicsthatdefinepeopleasfemale,maleorintersex.

Sex

Genderreferstothesociallyconstructedroles,norms,behaviorsthatagivensocietyconsidersappropriateforindividualsbasedonthesextheywereassignedatbirth.Genderalsoshapestherelationshipsbetweenandwithingroupsofwomenandmen.

Gender

Genderidentityreferstoeachperson’sdeeplyfeltinternalandindividualexperienceofgender,whichmayormaynotcorrespondwiththesexassignedatbirthorthegenderattributedtothembysociety.

Genderidentity

Genderequityistheprocessofbeingfairtowomenandmen.Itrecognizesthatmenandwomenhavedifferentneeds,powerandaccesstoresources,whichshouldbeidentifiedandaddressedinamannerthatrectifiestheimbalance.Addressinggenderequityleadstoequality.

Gender

equity

Genderequalityistheabsenceofdiscriminationbasedonaperson’ssexorgender.Itmeansprovidingthesameopportunitytoeachperson,includingaccesstoandcontrolofsocial,economicandpoliticalresources,withprotectionunderthelaw(suchashealthservices,educationandvotingrights).

Gender

equality

Gendernormsrefertobeliefsaboutwomen,men,boysandgirlsthroughsocialization.Gendernormschangeovertimeandindifferentcontext.Gendernormsleadtoinequalityiftheyreinforcemistreatmentofonegrouporsexovertheotherorleadtodifferencesinpowerandopportunities.

Genderrelations

Genderrelationsrefertosocialrelationsbetweenandamongwomen,men,boysandgirlsthatarebasedongendernormsandroles.Genderrelationsoftencreatehierarchiesandunequalpowerrelationsbetweenandamonggroupsofmenandwomen,disadvantagingonegroupoveranother.

Genderroles

Genderrolesrefertowhatmen,women,boysandgirlsareexpectedtodo(inthehousehold,communityandworkplace)inagivensociety.

Genderanalysis

Genderanalysisidentifies,assessesandinformsappropriateresponsestodifferentneedsandbarriers,andaskscriticalquestionstouncoverrootcausesofgender-basedinequities.

Gender

mainstreaming

Gendermainstreamingistheprocessofassessingimplicationsforwomen,men,girlsandboysofanyplannedactionincludinglegislation,policiesorprogrammesatalllevels.Itreferstoastrategyformakingwomen’sandgirls’,aswellasmen’sandboys’concernsandexperiencesanintegraldimensionofthedesign,implementation,monitoringandevaluationofpoliciesandprogrammessothatwomenandmenandgirlsandboysbenefitequallyandinequalityisnotperpetuated(1).

Intersectionalityreferstoanapproachtounderstandthecomplexinteractionofdifferentsocialmarkerstodisadvantageandoppressdifferentpeopledependingontheircharacteristicsandcontexts.Genderintersectswithage,race,ethnicity,class,socioeconomicstatus,disability,sexualorientationandgenderidentity,geographicallocationtoshapesocialinequalities.

Intersectionality

Definitions

Term

Definition

Gendernorms

viii

Intersectionalgenderanalysisisanapproachtoidentifyingandaddressingtheinteractionofdifferentsocialcategoriesandpowerhierarchiesthatresultinhealthinequity.

Intersectional

genderanalysis

LGBTQILGBTQILesbian,gay,bisexual,transgender,queer,intersexpersonsandothers.

Term

Definition

Gender-sensitive

Gender-sensitiveprogrammesshowanawarenessofgenderroles,normsandrelationswhilenotnecessarilyaddressinginequalitiesgeneratedbythem.Noremedialactionsaredeveloped.

Gender-responsive

Gender-responsiveprogrammesorpoliciesareoneswheregendernorms,rolesandinequalitieshavebeenconsideredandmeasureshavebeentakentoactivelyaddressthem.Theygobeyondgendersensitivity,andincludegender-specificandgender-transformativeactions.

Gender-specific

Gender-specificprogrammesintentionallytargetaspecificgroupofwomenormenforaspecificpurpose,butdon’tchallengegenderrolesandnorms.

Gender-

transformative

Gender-transformativeapproachesarethosethatattempttoredefineandchangeexistinggenderroles,norms,attitudesandpractices.Theseinterventionstackletherootcausesofgenderinequalityandreshapeunequalpowerrelations.

Gender-based

violence(GBV)

Gender-basedviolence(GBV)isviolencedirectedagainstapersonbecauseoftheirgenderandisrootedingenderinequality.MostGBVisdirectedatwomenandgirlsatthehandsofmen;however,mencanexperiencegender-basedviolencetoo.TransgenderpopulationsalsoexperienceuniquegenderedGBV.GBVincludes,forexample,physical,sexual,emotionalandeconomicviolence.

Caregiver

Caregiverisapersonwhoregularlyorintermittentlycaresforaninfantorchild,forexamplemothers,fathers,grandparentsandsiblings.

Empowerment

Empowermentistheexpansionofpeople’scapacitytomakeandactondecisionsaffectingallaspectsoflife-includingdecisionsrelatedtohealth-byproactivelyaddressingsocioeconomicandotherpowerinequalitiesinacontextinwhichthiscapacityorchoicewaspreviouslydenied.Programmaticinterventionsoftenfocusspecificallyonempoweringwomenbecauseofgenderinequality.

ix

Purposeandaudience

Genderequalityisafundamentalhumanrightandapowerfuldriverforbetterhealthoutcomesglobally.

Immunizationinterventionswillonlysucceedinexpandingcoverageandwideningreachwhengenderroles,normsandrelationsareunderstood,analysedandsystematicallyaccountedforaspartofimmunizationserviceplanninganddelivery.

ThisdocumentexplainstheneedformainstreamingofgenderacrossthecoreprinciplesandstrategicprioritiesofImmunizationAgenda2030(IA2030).Itspurposeistwofold:

(i)toimproveawarenessandunderstandingofhowgender-relatedbarrierscanaffectimmunizationprogrammeperformance;and

(ii)toprovidepractical“howto”concepts,toolsandmethods,andactionsthatcanbeusedtoeffectivelyintegrateagenderperspectiveintoimmunizationprogrammes.

Thetargetaudienceiseveryoneengagedinsupporting,managingorimplementingimmunizationprogrammes–managersandserviceproviders,aswellasthestaffofministriesofhealthandothersectors(e.g.ministriesofeducation,ministriesofgender,ministriesoffinance),civilsociety,internationalorganizationsanddonorpartnersinvolvedinrealizingtheIA2030visionofaworldwhereeveryone,ateveryagefullybenefitsfromvaccinesforgoodhealthandwell-being.

Genderisarelationaltermusedtodescribesociallydetermineddifferencesbetweenwomenandmen,girls’andboys’roles,attitudes,behaviourandvaluesasperceivedinagivensocietalcontext.Sexisabiologicaldifference.

GenderisNOTsynonymous

withjustwomenandgirlsand

NOTjustforactionorthe

benefitofwomenandgirlsonly.

Women,men,girlsandboys

allmustbeinvolvedto

advancegenderequalityand

societaltransformation.

Notallwomenandgirlsarethesame,asinequalities,

needsandbarriersdifferacrosscaste,ethnicities,age,

location,wealthquintile,literacylevels,maritalstatus,

specialneeds(suchasdisability)andconflictconditions.

Gendermainstreamingisaboutaddressinggenderissuesacrossallsections,sectorsandlevelsinanyplannedactionincludinglegislation,policiesandprogrammes.

Gendermainstreamingshouldconsidertheneedsofallwomenandmen,girlsandboysequally.

Source:Gendertoolkit:integratinggenderinprogrammingforeverychildinSouthAsia.UNICEFROSA(2018).

SUMMARY

CHAPTER1

2

Chapter1:

Whydoesgendermatterfor

immunization?

Globalstudieshavenotfoundmajorsex-baseddiscrepanciesinimmunizationcoverage:girlsandboyshavethesamelikelihoodofbeingvaccinatedinmostlow-andmiddle-incomecountries.Afewexceptionsexistatthesubnationallevelwithinsocioeconomicallyandgeographicallymarginalizedgroups–boyshavebeenfoundtobemoreimmunizedinsomeinstances,andgirlsinothers(2).However,attentiontogender-relatedissuesinimmunizationprogrammesgoesbeyondfocusingoncoveragediscrepanciesbetweengirlsandboys.Therearemultiplewaysinwhichgenderroles,normsandrelationsinfluencewhogetssick,whohasaccessandcontroloverresources,who’svoiceisheard,andwho’shealthneedsaremet,includingforimmunization.

Genderimpactsimmunizationbothonthedemandside,throughpeople’shealthseekingbehaviours,andthesupplysideprovisionofhealthservices.Toincreaseimmunizationcoverage,andinparticulartosustainablyreach“zero-dose”childrenandmissedcommunities,itisnecessarytounderstandandaddressthemanywaysinwhichgenderinteractswithadditionalsocioeconomic,geographicandculturalfactorstoinfluenceaccess,uptakeanddeliveryofvaccines.Thesefactorsincludeage,race/ethnicity,religion,maritalstatus,education,wealth,sexualorientationandgenderidentity,HIVstatus,disabilityandmigrationstatus.Fig.1providessomeexamplesofthemostcommongender-relatedbarrierstoimmunization.ThesebarriersarediscussedinmoredepthinChapter3.

Immunizationhasbeenshowntobeaoneofthebestinvestmentsagovernmentcanmake.Thereturnoninvestmentforimmunizationishigherthanforeducationandinfrastructureprojectscombined(3).Eachdollarinvestedisestimatedtogeneratea26-foldreturnbasedonsavingsfromhealth-carecostsandlostwagesandproductivityduetoillness(4).Investmentsinwomen’shealthhavealsobeenshowntoyieldbroadereconomicgrowth(5).Combininggender-focusedinitiativeswithimmunizationsetsusonapathtomaximizeourreturnoninvestmentinvaccines.

IMPORTANTNOTE

Thisdocumentisprimarilyaboutthegenderinequalitiesthatexistbetweenmenandwomen.Addressingthebarrierstoimmunizationfacedbyotherswhoaregenderdiverse/non-conformingisalsoimportant.Whilenotspecificallyaddressedinthisdocument,manyoftheprinciplesandtoolscanalsobeadaptedforthesegroups.

3

Figure1.Commongender-relatedbarrierstoimmunization

DEMANDSIDE(HEALTHSEEKINGBEHAVIOURS)

Insomesettings,health

needsofboysare

prioritizedovergirls’due

tosonpreference.

Womenareconsideredtheprimarycaregiversforchildrenbuttheymaynotbeabletocontrolhouseholdresourcesneededtoutilizehealthservicesfortheirchildrenorthemselves.

Womeninsomeareasmaynotbeallowedtotravelaloneduetosociocultural/gendernormsandsecurityreasons.

Disempoweringgenderrolesandexcesshouseworkburdenofwomenmayresultinatrade-offbetweenchildhealthcareandtheneedtoperformthetasksforthehousehold.

StigmatizationofreceivingtheHPVvaccineandlimitedinformationonSRHRcanhindergirls’accesstoservices.

Women’slowereducationandliteracylevelsaswellaslackofaccesstohealthinformationcanleadtolowermotivationtovaccinatetheirchild.

SUPPLYSIDE(PROVISIONOFSERVICES)

Governmentpoliciesandstrategiesdonotconsidergenderinequalitiesinimmunizationplanningandimplementation.

Insomesettings,onlyfemalevaccinatorscanaccesshouseholdstointeractwithmothersanddelivervaccinestochildren.

Communitiesmayimposetraditionalgendernormswhichhinderwomen’sandgirls’fullparticipationinhealthservices.

Femaleprovidersandvaccinatorscanfacegenderdiscriminationandthreatsintheirwork,leadingtohighturnoverandlimitedprovisionofhealthservices.

Healthfacilitiesemphasizeattendancebywomen(mothers)andarenotfavourabletofathersorothermalefamilymembers.

Lowqualityofservicemaydiscouragewomenfromattending.

[Source:AdaptedfromImmunizationandgender:apracticalguidetointegrateagenderlens.UNICEFROSA(2019)]

Gender-relatedbarriersandgenderinequalitycanpreventpeople,bothmaleandfemale,fromgettingvaccinated.Theseoperateatmultiplelevelsfromtheindividualandhouseholdtocommunityandhealthsystems.Thesegender-relatedissuesareunderpinnedbypowerrelations,leadingtodifferentopportunities,limitations,challenges,needsandvulnerabilities,especiallyforwomenandgirls.Thegoalofgenderequalityisnotforwomenandmenandgirlsandboystobecomethesame,buttoensurethateveryonehasthesamechancesandopportunitiestoaccessandbenefitfromimmunizationservices.

Byapplyingknowledgeaboutgenderandtakingactiontodesigngender-responsiveinterventionsitispossibletoimplementmoreeffectiveimmunizationprogrammesandincreasecoverageforall.

4

•Sensitizecommunityonthevalueofimmunization

•Increasecommunity-basedoutreachservices

•Strengthenmother’s/fathers’caregroups

•Increasewomen’sdecision-makinginpublic

•Promotegenderequalitythroughsocialandbehaviouralchangecommunication

•Incomegeneratingactivitiesforwomenbasedoncontext

•Lifeskills,literacyprogrammes

•Parentingcoursetopromotepositivefatherhood

•Integrategenderandaddressspecificbarriersofwomenandgirlsintohealthnationalactionplansandtraining

•Developgender-responsiveservicedeliveryguidelines&tools

Inputs

•Womenlack

decision-makingpowerandresourcestoaccessandutilizehealthservices•Women’slowliteracylevel

•Genderrolesandnorms:mothersbeingmaincaretakers–time,poverty,lowvalueofgirls

•Lackofmen’s

involvementincare

StructuralCauses

•Women’slackofvoice

•Genderandsocialnorms:womenshouldstayathomeandundertakecarework

•Women’slimitedmobility

•Lackofsupportivemeasuresinthecommunitytoaccesshealthservices

•Lackoflaws,policies,dataandtrainingongenderissuesinhealthsector

•Lackofaccountability

•Lackofguidanceonengagingmeninchildrearingandhealthcare

Anotherwaytoviewthepathwaytoachievethisvision(whichissharedbyIA2030)isthroughtheframeworkdescribedinFigure2.Thisframeworkexploresgenderbarriersandapproachesacrossdifferentsocio-ecologicallevelsofhousehold,community,healthfacility,andlawsandpolicies.

Figure2.Frameworkofgender-barriersandapproachestoachieveIA2030goals

Fullyimmunizedgirlsandboys

Goal

HealthFacility

Household

•Womenandgirlsfreelyaccesshealth&immunizationservices•Womengainresourcesandincrease

decision-makingpower•Womenhavestrongercapacitytonegotiatehealthcare

•Men’sincreased

participation

Community

•Communityprioritizeneedsofmothersandchildren

•Womenandgirlscaneasilyaccesshealthservices

•Women’sparticipationandvoicesincreaseindecision-makingbodies

Laws&Policies

Outcomes

•Gender-sensitivehealthpoliciesandlawsprotectwomen’sandgirls’rights

•Increasemen’sparticipationinfatherhoodandcaregiving

Healthservicesare:

•accessibleforall

•highqualityandresponsive

•efficientandskilled

•needs-basedandtrusted

•non-discriminatory

•promotegenderequity

•Gendertrainingandguidelinesforhealthproviders

•Incentives,skillsandprotection(referral)forfemaleproviders

•Promotegenderequityinclinicalgovernanceandallocationofresourcesbasedonneedsofwomenandmen

•Gender-blindattitudesofhealthworkersandserviceprovisionwithoutneedsmet

•Lackoffemaleproviders

•Healthfacilitiesaimtoreachonlywomenandnotmen

•Femalehealthworkersfacethreatsinthecommunities

[Source:AdaptedfromImmunizationandgender:apracticalguidetointegrateagenderlens.UNICEFROSA(2019)]

5

Box1Beyondimmunization:Didyouknow?

Achievinggenderequalityandwomen’sandgirls’empowermentisoneoftheSustainableDevelopmentGoals(SDGs)–Goal5.Itisalsoadrivingforceforadvancingallothergoals,includingSDG3onhealthandwell-being.ApplyingagenderlenstoincreaseimmunizationcoveragecontributestoSDG5andSDG3inparticular.

MoreontheSDGsandgender:

■UnitedNations:Achievegenderequalityandempowerallwomenandgirls

/topics/genderequalityandwomensempowerment

■UNWomen,ProgressontheSustainableDevelopmentGoals:Thegendersnapshot2021

/en/digital-library/publications/2021/09/progress-on-the-sustainable-

development-goals-the-gender-snapshot-2021

■EqualMeasures2030,GenderAdvocatesDataHub

/data-hub/

SDG5:Achievegenderequalityandempowerall

Target5.1

Endallformsof

discriminationagainstall

womenandgirlseverywhere.

Target5.2

Eliminateallformsofviolence

againstallwomenandgirlsinthe

publicandprivatespheres,

includingtraffickingandsexual

andothertypesofexploitation.

Target5.3

Eliminateallharmfulpractices,

suchaschild,earlyandforced

marriageandfemalegenital

mutilation.

Target5.4

Recognizeandvalueunpaidcare

anddomesticworkthroughthe

provisionofpublicservices,

infrastructureandsocialprotection

policiesandthepromotionofshared

responsibilitywihtinthehousehold

andthefamilyasnationally

appropriate.

Target5.5

Ensurewomen’sfullandeffective

participationandequal

opportunitiesforleadershipatall

levelsofdecisionmakingin

political,economicandpubliclife.

Target5.6

Ensureuniversalaccesstosexual

andreproductivehealthand

reproductiverightsasagreedin

accordancewiththeProgramme

ofActionoftheInternational

ConferenceonPopulationand

DevelopmentandtheBeijing

PlatformforActionandthe

outcomedocumentsoftheir

reviewconferences.

Target5.7

Undertakereformstogivewomen

equalrightstoeconomic

resources,aswellasaccessto

ownershipandcontroloverlandand

otherformsofproperty,financial

services,inheritanceandnatural

resources,inaccordancewith

nationallaws.

Target5.8

Enhancetheuseofenabling

technology,inparticular

informationandcommunications

technology,topromotethe

empowermentofwomen.

Target5.9

Adoptandstrengthensound

policiesandenforceable

legislationforthepromotionof

genderequalityandthe

empowermentofallwomenand

girlsatalllevels.

6

Gendermainstreamingisaprocessandastrategyforreachinggenderequality.Thismeansassessingtheimplicationsforwomenandmenofanyplannedaction,includinglegislation,policiesandprogrammes,inallareasandatalllevels.Asastrategyitinvolvesintegratingtheconcernsandexperiencesofwomen,aswellasmen,intothedesign,implementation,monitoringandevaluationofimmunizationpolicies,budgetsandprogrammeswithaviewtopromotingequalityandnotperpetuatinginequality.

Gendermainstreamingisundertakenatthreelevels–(i)policy,(ii)institution/organizationand(iii)programme/project–andisbasedonsevenprinciplesofgendermainstreaming(seebox).

Whatisgendermainstreaminginimmunizationprogrammes?

GendermainstreamingisNOTthegoalitself,but

ratheraPROCESSoraSTRATEGYforachievingthe

goalofgenderequality.

Mainstreaminggenderequalityisaboutmorethanjustunderstandingdifferentneedsofdiversewomen,men,girlsandboys.Itisalsoaboutunderstandingthewaysinwhichthedifferen