Assess the potential impact of recommendations (2)

Recommendations for transformation

Developing recommendations using the core concepts not only helps us to avoid negative unintended effects, it also actively promotes the creation of policies and programs that address health and other inequities. Equity in health and well-being requires that we understand and pay attention to the range of human experiences in order to create policies and programs that are responsive to the needs of all people. There are many conceptual approaches to designing and evaluating policies and programs for equity, such as human rights, cultural competence, and anti-oppression. But we are going to focus on gender equity for two reasons: because “gender relations of power … are among the most influential of the social determinants of health” and, because “taking action to improve gender equity in health and to address women’s rights to health is one of the most direct and potent ways to reduce health inequities and ensure effective use of health resources.[1]

Developing recommendations, programs and policies can be challenging. The first step is recognizing the differences between policies and programs that empower women and men and those that don’t. Empowerment involves ensuring that people have the skills, knowledge and opportunities to realize their own potential, to make their own choices, and to be able to participate fully in social, political and economic life. Gender equity is only possible when both women and men have similar types and amounts of power. As a result, interventions that seek to empower women are more likely to lead to gender equity.

This framework was conceptualized by Ann Pederson and builds on a substantial body of research as well as analytical and advocacy work [2]

As we create or evaluate recommendations for gender equity, we need to appreciate that a particular policy or program may not fall neatly into one of these five categories. For example, an innovative approach to smoking cessation among pregnant women, called TRIPS (Tobacco Related Interaction Patterns), has both responsive and transformative elements. The program is designed to help women understand that their efforts to reduce or stop smoking are “influenced by routines and habits shared with others in [the] household” (Borttoff, et al., p.2). For example, couples may share smoking, enjoying their time together as well as the tobacco itself. When a woman becomes pregnant, her partner may support her efforts to quit smoking or may resist losing the closeness of shared routines and habits. Similarly, when a woman smokes but her partner does not, she may be subjected to intense pressure to quit once she becomes pregnant. The TRIPS program is gender responsive in that it involves developing tailored strategies to support pregnant women to become and stay smoke-free. It also has transformative elements in that it recognizes – and tries to address – the reality that pregnant women who smoke may be disempowered in their relationships, in society, or in both (Borttoff, et al., p.9). [3]

Sources: [1] Sen, G. & Östlin, P. (2007). Unequal, unfair, Ineffective and Inefficient, Gender Inequity in Health: Why it exists and how we can change it, Final Report of the Women and Gender Equity knowledge Network to the WHO Commission on Social Determinants of Health, http://www.who.int/social_determinants/resources/csdh_media/wgekn_final_report_07.pdf; [2] The diagram “A Framework for Transformative Recommendations”, has been developed as an aid to recognizing the characteristics of different types of policies and programs. Five categories of intervention are identified in the diagram, ranging from those that disempower women to those that have the potential to transform gender relations of power. The defining features of each category are described and concrete examples are provided. This framework builds on a substantial body of research, analysis and advocacy, including: Interagency Gender Working Group. (n.d.). Gender Integration Continuum. http://www.igwg.org/igwg_media/Training/FG_GendrIntegrContinuum.pdf
WHO. ( 2010). Gender, women and primary health care renewal: a discussion paper. http://whqlibdoc.who.int/publications/2010/9789241564038_eng.pdf; Dey de Pryck, J. (2010). Addressing Gender for Inclusive Development, Global Conference on Agricultural Research for Development, http://www.prgaprogram.org/GCARD/JennieDeydePryck.pdf; Interagency Gender Working Group. (2004). How to Integrate Gender into HIV/AIDS Programs: Using Lessons Learned from USAID and Partner Organizations, http://www.prb.org/igwg_media/HowToIntegrGendrHIV.pdf; Gupta, G.R., Whelan, D. & Allendor, K. (2003). Integrating Gender into HIV/AIDS Programmes, http://www.who.int/gender/hiv_aids/hivaids1103.pdf; Kabeer, N. (1995). Reversed Realities: Gender Hierarchies in Development Thought. New Delhi: Kali for Women; [3] Greaves, L., Cormier, R., Devries, K., Bottorff, J., Johnson, J., Kirkland, S., and Aboussafy, D. (2003). Expecting to Quit: A Best Practices Review of Smoking Cessation Interventions for Pregnant and Postpartum Girls and Women. Vancouver: British Columbia Centre of Excellence for Women’s Health, http://www.bccewh.bc.ca/publications-resources/documents/Expecting_to_Quit.pdf; Lumley J, Chamberlain C,Dowswell T,Oliver S,Oakley L,Watson L. (2009). Interventions for promoting smoking cessation during pregnancy. Cochrane Database of Systematic Reviews. 3 http://www.first5sandiego.org/files/Item%202%20-%202%20Interventions%20for%20Smoking%20Cessation.pdf; Bottorff, J. L., Carey, J., Poole, N., Greaves, L. & Urquhart, C. (2008). Couples and Smoking: What you need to know when you are pregnant, http://www.facet.ubc.ca/

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