1.2 Developing a Gender-Sensitive Approach to Improving Reproductive Health Services

Our health is affected by many different conditions, often called the determinants of health. The determinants may be biological (sex, genes), social (gender, education, family roles, community support), economic (poverty), environmental (pollution, workplace environment), and related to lifestyle (eating patterns, smoking, sexual behaviors). These determinants of health rarely operate in isolation from each other. Rather, they may reinforce or impact the others in a variety of ways.

Health providers, program managers, policy makers, and donors are increasingly aware that gender is a critical element in the design, management, and implementation of reproductive health programs, and ultimately, in the success and impact of these programs. Reproductive health services that meet both men’s and women’s needs will encourage increased use of those services and promote sound reproductive decisions.

In Bangladesh like many countries, traditional male and female roles deter couples from discussing sexual matters, and may even encourage risky sexual behavior. Ultimately, they contribute to poor reproductive health for both men and women. For example, when women play subservient roles and men have the authority to make critical decisions without consulting their wives, there may be little or no discussion of sexual activity, fertility, contraceptive use, and limited access to health information and services, finances, transportation and other resources. Or, when traditional attitudes and expectations about masculinity prevail, men may be encouraged to have multiple sex partners and expose them—and their partners—to risks of disease.

A "gender perspective" prompts attention to these destructive patterns and ways to build constructive relationships between women and men.

1.1 Introduction to FPAB

Family Planning Association of Bangladesh is a national non- government organization having affiliation with IPPF. It was established in 1953 under the leadership of Dr. Humaira Sayeed, a professor of Dhaka Medical College. Since then the Association has been working with commitment to address the needs of un-served, under-served and marginalized poorest of the poor through primary and reproductive health care. It introduced an innovative approach of direct house to house motivation through full time field workers which was later adopted and replicated as a ‘model’, by the government.

FPAB emerged as the leading NGO in the field of reproductive health and family planning sector in Bangladesh. By the year 2000 total number of service recipients of the Association reached 1.5 million of which 63% was family Planning users and 37% received other sexual and reproductive health service. Currently FPAB has branches in 20 greater districts with special work units in 11 new districts. It is running 38 static clinics. In order to bring the services to the door steps of the clients FPAB runs several hundred mobile service unit through out the country.

In response to the needs and demands due to the shift in program paradigm, deprived from dimension set in International Conference on Population and Development (ICPD) and Fourth World Conference on Women (FWCW), globally and in Health and Population Sector Strategy, nationally FPAB developed its 5 year Strategic Plan in 2000 covering 200 1-2005.

In its strategic plan 2001-2005 FPAB commits to meet the major challenges of IPPF and also to address the priority areas and issues identified in HNPSP, the five year health and nutrition program launched by Bangladesh Government.

Gender policy in health services

Gender is one of the most important factors to consider in designing, managing, and delivering reproductive health services. It also encompasses the fundamental human rights. Health is one of the important most basic human rights recognized, proclaimed and ratified by all state constitutions and various UN/International charters, gender should be specially emphasized as one of the most crucial cross-cutting issue in he overall aspects of health.

Yet gender may also be the least understood characteristic in terms of how women’s and men’s health needs differ and how those differences can best be addressed.

In many countries, gender significantly influences a person’s ability to access health services. Differences in influence or power relations between women and men may, for example, determine whether women can purchase or use a contraceptive, and therefore, how vulnerable they might be to an unintended pregnancy or to a sexually transmitted infection. Or, attitudes towards "masculinity" may result in some men continuing sexual practices that affect their own health and endanger the health and lives of their families. Awareness of such conditions and the adoption of appropriate responses can help women and men to improve their health and advance in life, and can enrich the quality of life in their communities.

The roles that women and men play should guide the ways in which health service providers/clinic staffs assess their clients’ needs and provide care. It can be also shown with FPAB, a pioneering NGO in Bangladesh with reproductive health services, as an example how awareness of gender issues can improve the design, management, and delivery of health services, and takes FPAB step by step through the process of assessing the influence of gender on organizational management and yields positive changes in the aspect of FPAB’s overall performance.