Gender, Health, and Reproductive Rights

Research and data

The WHO Multi-Country Study on Women's Health and Domestic Violence against Women is a key research initiative to investigate the prevalence, causes and consequences of physical and sexual violence, emotional abuse, and other coercive and/or controlling behaviors by an intimate male partner or ex-partner. This policy- and action-oriented study was carried out in ten countries in collaboration with local institutions, women's organizations and national ministries in order to obtain reliable, standardized estimates of the prevalence of violence against women, identify risk and protective factors in different settings, classify health consequences and women's coping strategies, and create more responsive policies and programs. 

The first multi-country report on the Study was published at the end of 2004. Ethical and safety guidelines for the research were also produced and pay special attention to the need to provide support services both for women in abusive situations and for field workers; see Putting Women First: Ethical and Safety Recommendations for Research on Domestic Violence Against Women (2001).  Research protocols, questionnaires, manuals and standardized data entry systems to facilitate cross-national comparisons can be obtained from the Department of Gender and Women's Health (address in Appendix, p. 28 below).

The Sexual Violence Research Initiative, initiated by WHO with support from the Global Health Forum, builds on the experience of the Multi-Country Study described above to improve knowledge and understanding of all forms of sexual violence, develop in-country research capacity, raise awareness of sexual violence as a public health problem, and strengthen the support base for research and action. The Initiative addresses rape and other forms of sexual coercion by intimate partners, relatives or friends, acquaintances, and strangers and encompasses sexual violence directed against children, young adolescents and vulnerable men as well as women. This project is still in its early stages; contact the Department of Gender and Women's for further information. A wealth of earlier information can be found in WHO's Annotated Bibliography on Violence Against Women: A Health and Human Rights Concern (1999).

Violence and vulnerability to risks such as unwanted pregnancies and STIs often go together. In October 2002, researchers, activists and policy makers met in Geneva to discuss the relationship between sexual violence and HIV/AIDS. The resulting publication, Violence Against Women and HIV/AIDS: Setting the Research Agenda (2001), reviews current research, identifies information gaps, and recommends research questions and methodological approaches to investigating topics such as partner violence and HIV risk, adolescents and forced sex, childhood sexual abuse, sexual trafficking, rape and post-exposure prophylaxis, and the implications of violence against women for voluntary counseling, testing and disclosure of positive HIV status.

Guidelines for providers

The centerpiece of WHO's work in gender and reproductive health from a health system perspective is the comprehensive training manual, Transforming Health Systems: Gender and Rights in Reproductive Health. A Training Manual for Health Managers (2001). Available in hard copy or on CD-ROM, the manual provides health managers, planners, policy makers and others with the analytical tools and practical skills to promote gender equity and reproductive rights within the health system. The manual consists of separate modules, each of which can be downloaded from the RHR website. 

• A Gender module examines how biological and social factors affect men's and women's health, health-seeking behavior and access to services.  
  
• A Social Determinants module locates gender inequities in the context of other differentiating social and economic factors, while the Rights module stresses the fundamental legal obligation of non-discrimination. 
  
• An Evidence module treats various aspects of monitoring, evaluation, and the use of data for planning and policy-making. 
  
• A Policy module demonstrates how to design equitable gender policies.  
  
• A Health Systems module examines how the organization and functioning of health systems affects women and men differently and shows how to create more gender-sensitive services. 

Case studies, exercises and practical materials illustrate how to incorporate gender awareness into needs assessment and services relating to safe pregnancy, STIs and HIV, sexual violence, and other sexual and reproductive health concerns. Transforming Health Systems has been adopted in regional centers in Argentina, Australia, China, Kenya and South Africa, among other settings, and is currently being adapted for use in Central Asia and the Middle East.

In collaboration with the WHO's Department of Injuries and Violence Prevention, the Department of Gender and Women's Health began an initiative in 2001 to strengthen the health sector response to sexual violence against all individuals (women, men and children). Guidelines for Medico-legal Care for Victims of Sexual Violence (2004) sets standards for the provision of health care and forensic services to victims of sexual violence and offers health care workers the knowledge and skills necessary for providing informed and humane treatment and follow-up care.  An extensive annex includes a bibliography, a sample sexual violence examination record, a report on medical issues and sexual violence, and guidance on health worker education and training. See Related material on the clinical management of rape survivors in emergency situations are described in National Policies and Strategic Plans (p. 26 below).

Integrating Gender into HIV/AIDS Programmes (2003) offers a succinct background and rationale for incorporating gender issues in HIV prevention and treatment.  In considering the impact of gender on the HIV/AIDS pandemic, the report discusses the role of gender and sexuality in determining vulnerability, sociocultural factors and norms of masculinity and femininity, economic factors of poverty and dependency, and the special vulnerabilities of adolescents and youth. Guidelines for integrating gender into HIV/AIDS programming and policies begin with the principle "do no harm" and progress through discussions of gender sensitive programs, "transformative interventions" and "interventions that empower." Technical approaches and structural elements for gender integration are reviewed.

Policies and strategic plans

Violence Against Women: A Priority Health Issue (1996) addresses policy makers, program managers and providers on the nature and scope of the problem and the health consequences of violence against women in families, of rape and sexual assault, and of violence against women in situations of armed conflict and displacement. Additional chapters include information on human rights documents relating to violence, what health workers can do, and what WHO and NGOs are doing. For more information see Summary of International and Regional Human Rights Texts Relevant to the Prevention and Redress of Violence Against Women (1999), Advancing Safe Motherhood through Human Rights (2001) and Considerations for Formulating Reproductive Health Laws (2000).  All of these texts offer useful tools for advocacy and action.

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