Gender, GBV and Health
Dr. Sam Thenya, Group CEO-The Nairobi
5th GTZ Health Sector Network Meeting
Mombasa 25th Feb 2010
Gender based violence is an umbrella term for
any harmful act that is perpetuated against a
person’s will and that is based on socially
ascribed (gender) differences between male
GBV results in physical, sexual or
psychological harm. It includes threats to
carry out such acts, coercion or arbitrary
deprivation of liberty, whether occurring in
public or in private life.
All over the world GBV has a greater impact on
women and girls than men and boys. The term GBV is
used interchangeably with the term Violence Against
Women (VAW). GBV highlights the relationship of
female subordinate status in society and their
increased vulnerability to violence.
CONCEPTS OF GENDER
• Social differences between males and females that
• …though deeply rooted in every culture, are
changeable over time
• …have wide variations both within and between
• Determines the roles, responsibilities, opportunities,
privileges, expectations, and limitations for males and
for females in any culture.
Human rights issue
• Acts of GBV violate a number of women’s human
rights principles enshrined in international human
rights instruments. These include, amongst others
-the right to life, liberty and security of the person;
-the right to the highest standard of physical and
-the right to freedom from torture or cruel, inhuman, or
degrading treatment or punishment;
-the right to freedom of opinion and expression, to
education, to social security and to personal
Power is the ability to influence or control. It
includes access to decision- making processes.
In most communities, cultures and societies, the
gender roles assigned to women have less visibility
and thus less power attributed to them.
This lack of power and status make women
vulnerable to acts of violence.
Violence encompasses, but is not limited to, the
• socio-economic and
• psychological violence occurring within the
Consent = agreement
Informed consent means making an informed choice
(ie. an individual is aware of all his/her options and is
able to make a decision without coercion) freely and
voluntarily by people in an equal power relationship.
i.e. Reproductive health rights and the number and
spacing of children.
Children (people under 18) and individuals who are
mentally challenged, are deemed unable to give
informed consent for acts such as FGM, marriage,
sexual relationships etc..
This is a process that involves ensuring gender
perspectives and attention to the goal of gender
equality are central to all activities such as policy
development, research, advocacy/ dialogue,
legislation, resource allocation, planning ,
implementation and monitoring of programs or
This is a globally accepted strategy for promoting
gender equality which is not an end in itself but
means to achieving gender equality.
Refers to policy pronouncements on action to be
A policy or Programme of taking steps to increase the
representation of certain designed groups seeking to
redress discrimination or bias through active
measures in education and employment. It is usually
achieved through discrimination against other groups.
A process through which men, women, boys and girls
acquire knowledge, skills and attitudes to critically
analyze their situation and take appropriate action to
change the status quo of the underprivileged and
other marginalized groups in society.
The process of ensuring that planning and
programming is appropriate for and takes into
account the female and male differences and
This identifies, analyzes and informs action. It
addresses inequalities that arise from the
different roles of men and women; the
unequal power relations between them; and
other contextual factors like: ethnicity, sexual
orientation, employment, citizenship, etc.
Is the understanding that there are socially
determined differences between men and
women based on learned behavior, which
affect ability to access and control resources
This is failure to recognize that gender is an
essential determinant of social outcomes. It
therefore impacts on project planning and
Refers to unequal or preferential treatment of
individuals or groups on the basis of their
gender that results in reduced access to/ or
control of resources and opportunities .
Refers to the equal treatment of women and
men, girls and boys so that they can enjoy the
benefits of development including equal
access to and control of opportunities and
Refers to the practice of fairness and justice
in the distribution of benefits, access to and
control of resources, responsibilities, power,
opportunities and services.
Arise from the four components cited above.
Since men and women have different gender
roles, do different types of work, have different
degrees of access to services and resources,
and experience unequal
Refers to capacity of individual or group to
initiate action and determine outcomes which
change existing social, political and economic
systems and norms, to equalize gender
It means ‘Rule of father’ and refers to the
current male dominated social relations,
ownership and control of power at many
levels in society. It is thought to be the root
cause of the existing system of gender
Gender and Health Care
Gender refers to the social – cultural attributes associated with being
man or woman, boy or girl. Societies have different roles,
responsibilities and expectations for men and women.
These gender roles exert various degrees of constraints, the more
rigid the gender role in a society, the sharper the gender division of
labour and the lower the status accorded to women.
Health care on the other hand connotes the attention given to the
well being of person weather physically, socially, mentally and
Different valuation for different roles means that women and men
everywhere do not have equal access to the material and emotional
resources needed to sustain health. Underlying causes of women
health problems such as domestic violence or examining their living
and working conditions have been ignored.
There is considerable evidence of gender differences in access to
health care, affetced by medical knowledge and Literacy levels .
Processes of pregnancy and childbearing for instance have been
turned into medical events with control taken away from women
Effects of Gender Roles in Health Sector
Women remain economically dependent on men and/or
men have control over family resources making it difficult
for women to pay for health care or transportation costs
to health care facilities.
Social- cultural believes/ norms deny women the right to
travel alone or be in the company of men outside their
immediate family or making the decision to access health
facilities. FGM viewed as an essential for marriage.
Domestic/household chores which lead to opportunity
costs of medical treatment to be greater example during
harvesting attending to health care concerns would be
unacceptable burden on the household considering that
women provide the highest number of farm labourers.
Discriminatory legislations examples policies restricting
reproductive rights, maternity leave and/or sick leaves.
Gender Based Violence (GBV) in
relation to Health Care
Gender based violence is an umbrella term for any harmful act that is
perpetuated against a person’s will and that is based on socially
ascribed (gender) differences between male and female. The term
GBV is used interchangeably with the term Violence Agaisnt Women
Gender violence is a human rights violation that has serious health
implications example effects of domestic violence. Sadly it’s used as
a weapon of war or dispute resolution.
Gender roles render women vulnerable to Gender based violence a
profound human rights and public health problem. It is a leading
cause of injury and death of women in Kenya and is also a major
cause of HIV/AIDS; fear of violence prevents women from insisting
on safe sex.
Dimensions of Gender Based violence
Socio – economic
The factors that promote GBV form the basis of the form
they take. They are promulgated by the agents of the
society who include custodian of culture, media, religious
leaders, discriminatory legislations, economic
dependency, myths among others.
The Demographic and Health Survey, 2003 reports that that half (53%)
of all women in their 30’s and 49.4% in their 40’s have experienced
violence since age 15.
15% of married women in Kenya report having experienced marital
One out of every four girls and young women report loosing their
virginity through forces.
Police statistics for 2006 show a 35% increase in child rape cases since
Women comprise 52% of Kenya’s population. Approximately half of the
poor in Kenay are women in rural areas. Women also make 67% of the
Women and girls education levels are low hence denying them better
economic opportunities and empowerment.
Generally, the statistics of sexual violence more or less represent the
rate of spread of HIV/AIDS. GBV is no longer just a human rights issue
but a national health issue which threatens to set back the multibillion
gains which Kenya has made in fighting HIV/AIDS.
Case Study: Gender Based Violence
Nairobi Women’s Hospital/ Gender Violence Recovery Centre Experience)
The Nairobi Women’s hospital was set up in March 2001 with the aim of
providing holistic care to the women and children though men also benefit
from the health services. The hospital specializes in Obstetrics and
Gynecology, but is also competent to handle all other general medical
As a way of giving back to the society NWH established GVRC as a non-
profit and non partisan charitable trust of the hospital who main mandate is
to provide free specialized medical treatment and psychosocial support to
the survivors of GBV; the only such facility in East and Central Africa and a
one stop medical centre for women and children.
The hospital provides gynecology services in the out patient department as a
primary health care service, breast clinic managed by a consultant surgeon
and is a leading example in provision of emergency health care to sexually
violated persons within the recommended first 72 hours.
Gender Based Violence Expereince
Since inception the hospital has received over 14,000 GBV Survivors;
90% of the cases are of Sexual violence (Rape, Defilement &
9% are Domestic violence cases
1% Physical violence
49% were children
45% were women
6% were men
The youngest GBV survivor was 1 ½ months old baby, the oldest
106 yrs, both complained of sexual violation.
NWH/GVRC figures intensified during the post election violence. For
the period 27th December 2007 to 26th March 2008, 612 GBV
survivors were treated at the hospital, 229 children and 383 adults.
502 were complaints of sexual violence and 110 Domestic and
Physical violence. Most of the sexual violence was perpetrated by
gangs of young men ranging from 2 to 11 men per act. Over 2,500
people were treated through medical camps held in different crisis
centre countrywide and over 150,000 people received psychosocial
Gender Based Violence Interventions
Gender based violence interventions in healthcare are attempts or
efforts to promote good health behaviour or to prevent bad health
behaviour. These interventions reduce or end suffering.
Types of interventions.
Comprehensive medical examination and treatment including;
Provision of post exposure prophylaxis (PEP) – Postinor, Euvax,
Laboratory tests (Pregnancy, HIV/AIDs, High Vaginal swab,
Hepatitis, Urinalysis, Liver function, Pregnancy),
Continuous supply of variety of prescriptions & palliative care for
Reproductive health care including family planning options
Professional counseling of survivors of GBV and their families
(Individuals and support groups)
Distribution of aid materials such as clothes, food, sanitary towels
Training and capacity building of health workers in other health
facilities, police, prosecutors, magistrates, community based
organizations among others on impact of GBV in the society and how
to handle GBV survivors. (Medical and Psychosocial aspects).
Referrals for accommodation (Shelter homes) and legal aid services.
This is done through partnerships/networks with other like minded
organizations such as FIDA Kenya, WRAP, Goal Kenya, CLAN, The
CRADLE and COVAW.
Increase GBV survivors’ access to justice by providing testimonies
and/or evidence in court in favour of the survivors and enactment of
favourable legislations example Sexual opffences Act, Children’s Act
and upcoming Gender Bills(Domestic Violence (Family Protection)
Bill, Marriage Bill, Matrimonial Property Bill and Equal Opportunities
Bill), domestication of human rights instruments.
Community awareness programmes (Community trainings and
media coverage) to enhance awareness of the nature, manifestation,
dynamics and impact of GBV & HIV/AIDS with the aim of influencing
public opinion and perceptions on GBV and enroll public to fight GBV
and HIV/AIDS (reduce levels of GBV). Includes Legal awareness.
There is need to expand medical services to reach the people at the
grassroots level. Includes expansion of personnel and infrustracture.
Need to enhance community awareness on nature, manifestation,
dynamics and impact of GBV & HIV/AIDs with the aim of influencing
public opinion and perceptions on GBV and HIV/AIDS.
Need for counseling to also target possible perpetrators to stop the
inhuman acts and also benefit service providers who are vulnerable
to burn out.
Need to enhance networks to reach out for emergency response
example contacts for emergency evacuations to reach survivors of
humanitarian crisis, media alerts etc. (hotline responses)
Need for adequate supply of prescriptions of certain medical
conditions example diabetes, cancer, high blood pressure, physically
challenged among others.
Political will is inadequate in Kenya.
Outcomes in relation to Health and Human rights
Gender Based Interventions bring out collective results including;
Improvement of the physical and psychological health.
Increased appreciation of self-worth (Self esteem) achieved through
counseling.- (Human rights component).
Legislation reforms which include enactment of;
The children’s act No. 8 of 2001
The Sexual Offences Act, 2006 and the establishment of a task force to
ensure implementation of the Act,
National Action Plan for the eradication of Female Genital Mutilation.
HIV/AIDS Prevention and Control Act 2006 whose objective is to provide
measures for the prevention, management and control of HIV and AIDS.
National Policy on Gender Equality and Development, 2000 and
Sessional Paper No. 2 of 2006 on Gender equality and Development.
Adolescent and Reproductive Health and Development Policy, 2003
National framework on GBV (Multisectoral intervention to prevent and
respond to GBV).
Millennium Development Goals achievements.
It is very important that all people working in humanitarian organizations,
public service, health sectors, religious organizations among others to have
a comprehensive understanding of gender, health and human rights, the
three must not be addressed separately. GBV is part and parcel of health
care services and should be in all training institutions and where possible all
service providers be subjected to regular refresher courses on Gender and
It is also important to have a fair grasp of relevant legislations including,
Human rights instruments, the Children’s Act No. 2 of 2001, the Sexual
Offences Act, 2006 and HIV/AIDS Act, 2006.
Basic counseling and psychological support skills are crucial for any health
care giver or service provider including those working in humanitarian
organizations. Listening is a therapeutic. All health systems must listen to the
There is also need to lobby development partners to highlight gender
concerns as one of the conditions of funding in any projects. This will enable
gender to be visible in development plans, policies and legislations
Lobby for state obligation over human rights.
Supporting survivors and
families to heal.