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use (in health systems) of various tools to highlight gender inequalities and Women and men also use health care differently, with the former consulting
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GENDER INEQUITY in health refers to those inequalities between women and men in health status, health care, and health work participation, which are unjust,
Gender and equity in health sector reform programmes - Oxford
inequalities of access to health care and in women's and men's different positioning as users and pro evidence on gender inequality in health care access
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In India, sex preference is mainly manifested in the form of excessive mortality of female child The poor health status of female relatively to males is found to be
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there is reasoned evidence of inequalities in health care based on patient gender His re action aligns with that of health professionals' and researchers'
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Genderandequityinhealthsectorreform
programmes:areviewHILARYSTANDING
SectorReformProgramme,LiverpoolSchool
ofTropicalMedicine,Liverpool,UK countriesinthe inequalities ducers highlightingsixmain siveness.ItThissuggests
Introduction
pact ofsuchreformsonthepoorestsectionsoftheir populations.Ofparticularconcernhavebeentheim
plications ofcostrecoveryforthepoor.Other importantdimensions ofvulnerability,notablySimilarly,otherimportantaspects
ofhealthsector employment,havenotbeenconsideredfromthe viewpoint oftheirpossibleimpactonthegender composition oftheworkforce.Thisdiscussionseeks
toaddresssomeoftheempirical andwomen'shealth.]Itspremise isthatgenderisa significantindicator ofinequalityanddisadvantage 2 etc.,it foundintheliteratureonhealthcare: •women'shealthneeds, •genderinequality. theimplicationsforwomen ofdifferencesinthe proachhighlightsthespecifichealthneeds ofwomen exclusively) ofthebiologyofreproduction.Two theimbalanceofneed.Theotherstressesthecost-Downloaded from https://academic.oup.com/heapol/article/12/1/1/610536 by guest on 06 July 2023
2HilaryStanding
tions),both incomparisontoothertypesofinterven tionand asameanstoimprovethehealthofinfants inparticular.Women'shealthandnutritionhavebecomeanin
creasingfocus ofinternationalconcern,whichiswell exemplified inarecentWorldBankpublication (1994).Thisstanceisthenpart ofthewidertheme of'investinginwomen'toreducetheburdenof seen asthemosteffectiveconduittoimproving of children.Agenderinequalityapproach
tohealthisconcerned withtherole ofgenderrelationsintheproduction tiontoaccessandutilization ofservices.Itisthus theways inwhichhealthmayalsobeasiteofgender conflict. One ofthemostimportantfeaturesofagender approach isitsemphasisontheneedtoexamine resourceallocation withinhouseholds,ratherthan treatingthehousehold asthemostminimumfocus fecttheextent oftheinformalcareburdencarried predominantlybywomen.Gender
isanimportantpointertovulnerabilityintwo resources,includinghealthcare,and tobemoreInterms
ofabsolutevulnerability,therefore,being femalecanbeone ofthemostimportantpredispos ingfactors.Vulnerability isalsorelative.Urban womenandgirlsgenerallyhavebetteraccess tohealth access ofwomenandgirlstohouseholdresourcesfor healthexpenditure inbothruralandurbanareashas beenfound inmanyinstancestobelessthanthatof ofhealthservices areimportantlyinfluenced byculturalandideological titioners,lack offreedomtoactwithoutpermission fromhusbandsorseniorkinandlowvaluation ofthe healthneeds ofwomenandgirlscomparedtothatSegall1995).
Agenderapproachalsohighlightstheways
inwhich womenandmenarepositioneddifferently inrela criticalaspectstothis inthecontextofHSR.First, womengenerallycarrymore ofthecareburdenin adults.Thehouseholddivision oflabouralsotends treatment(Leslieetal.1988;Leslie1992). aregenderdifferentiated intermsoftheirdivisions importanthealthcareproducers aswellasconsumers, buttheytendtobeconcentrated inparticularsegmentsBloom1991;HoldenandLittlewood1991).
tions inrelationtoHSR.Fromawomen'shealth needspoint ofview,thequestionishowfarHSRFirst,howfardoestheproposed
contentreflectthese needs?Second,whatisthelikelihood oftheiraccep tanceandimplementation inresourcepoorcountries? fromawomen'shealthpoint ofview.Doescost recoveryhaveamoreadverseimpactonwomen's capacitytoutilizeservicesthanonthat ofmen, leadingtoaneglect oftheirspecifichealthneeds? aboutboththeconsumptionandtheproduction of balances ingenderrelations?Forexample,interms itworsenorimprovethem, orcreatenochanges?Inthecontext
ofwomen'srolesashealthcareDownloaded from https://academic.oup.com/heapol/article/12/1/1/610536 by guest on 06 July 2023