Gender tool - WHO/Europe - World Health Organization

Gender tool - WHO/Europe - World Health Organization
European strategy for
child and adolescent
health and development
Gender tool
World Health Organization
Regional Office for Europe
Scherfigsvej 8, DK-2100 Copenhagen Ø, Denmark
Tel.: +45 39 17 17 17. Fax: +45 39 17 18 18. E-mail: [email protected]
Web site: www.euro.who.int
Gender tool
European strategy for child and adolescent
health and development
Working document
Acknowledgements
1. Introduction
The WHO Regional Office for Europe developed the tool in a consultative process with the support of
the Observatory of Women’s Health, Ministry of Health and Consumer Affairs, Madrid, Spain, and the
collaboration of the Institute of Child Health IRCCS Burlo Garofolo, Trieste, Italy. Raúl Mercer and Dalia
Szulik were the main authors.
The WHO Regional Office for Europe promotes and supports the implementation of the European strategy
for child and adolescent health and development, which the European Member States adopted at the 55th
session of the WHO Regional Committee for Europe in September 2005. The strategy gives policy-makers
a concrete means of addressing health issues to improve the health of children and adolescents.
Support and contributions were received from: Concepción Colomer and the staff from the Observatory
of Women’s Health, Ministry of Health and Consumer Affairs; Laura Cogoy and Giorgio Tamburlini from
the Institute of Child Health IRCCS Burlo Garofolo; Michael Rigby from Keele University, United Kingdom;
Richard Parish from the Royal Society for the Promotion of Health, London, United Kingdom, Mikael
Østergren and Isabel Yordi Aguirre from the WHO Regional Office for Europe; and Adepeju Olukoya and
Anayda Portela from WHO headquarters.
This tool was developed to accompany the existing assessment, information and action tools intended to
provide support to Member States in building and developing their own policies and programmes within the
framework of the strategy. It can also be used as a stand-alone document that allows policy-makers and
programme staff to assess how gender sensitive their current child and adolescent health programmes and
policies are.
Thanks to all the staff of the WHO Regional Office for Europe and participants in country workshops who
have contributed to the gender tool.
The gender tool is based on the evidence that shows how gender differences and inequality influence various
aspects of illness and health among girls and boys.
Objectives
The objectives of the gender tool are:
• to assist countries, institutions and policy-makers in the process of incorporating gender analysis into their
child and adolescent health programmes and policies; and
• to enable countries, institutions and policy-makers to identify interventions with a gender perspective that
have proven effective in protecting the health of children and adolescents and promoting their development.
© World Health Organization 2007
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However, the published material is being distributed without warranty of any kind, either express or implied. The responsibility for the
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from its use. The views expressed by authors, editors, or expert groups do not necessarily represent the decisions or the stated policy of
the World Health Organization.
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Rationale
The health of children and adolescents is determined by their environment, by the socioeconomic position of
their parents, by their access to education, by their ethnic background and by gender. Gender means the
characteristics of women and men that are socially constructed; sex refers to those that are biologically
determined. Gender defines the socially perceived roles, responsibilities, opportunities and interactions for
females and males that are influenced by familial, cultural, political, and economic determinants. The access
to resources and the roles that society imposes on women determine their health and that of their children.
Expectations related to what it means to be a boy or a girl determine the sexual behaviour of children and
adolescents, their attitudes towards risk-taking, their health behaviour and their use and access to services.
This acquired behaviour comprises gender identity and determines, together with the biological differences,
the gender roles of children.
The purpose of gender analysis is to unearth sex differences and gender inequality and inequity and how they
affect specific health problems, health services and successful responses. Inequality and inequity often create,
maintain and exacerbate exposure to risk factors that threaten health. They often affect the control over and
access to resources, including decision-making processes, that are conducive to promoting and protecting
health. Finally, these differences influence the responsibilities and types of relationships established between
health service providers and the population served, a field that has not been thoroughly explored for the early
stages of life.
Gender equality is the absence of discrimination on the basis of a person’s sex in opportunities, in the
allocation of resources and benefits or in access to services.
3
Gender equity refers to fairness and justice in the distribution of benefits and responsibilities between women
and men. The concept recognizes that women and men have different needs and power and that these
differences should be identified and addressed in a manner that rectifies the imbalance between the sexes.
Gender equity in health requires that men and women be treated equally where they have common needs
and that their differences be addressed in an equitable manner. The following factors demonstrate gender
inequity in the health of children and adolescents.
2. Conceptual framework applied to the life cycle
The conceptual framework shows how gender affects key factors influencing the development of the health
of children and adolescents throughout their lives (Fig. 1). These factors, selected from the European
strategy for child and adolescent health, might be also influenced by other social determinants that interact
with gender, such as education and economic background. Gender-related outcomes express how gender
affects these factors (gender pathways).
•
Differences in health risks and protective factors: greater risk-taking behaviour among boys means that
they tend to have a higher prevalence of hazardous use of substances and a higher prevalence of injuries
from road crashes, whereas protective factors of the role of care assigned to women by society tend to
make girls have healthier eating behaviour. In contrast, boys often engage in more health-promoting physical activity than girls.
Providing a gender scope to health and developmental problems among children and adolescents implies the
need to develop gender-based interventions. Intervention at different levels (individuals, families, communities, health services and policies) will contribute to promoting gender equity during childhood and adolescence. However, timely gender-based intervention can influence the development of gender equity in
health and development and how this can be reproduced within the social and intergenerational context.
•
Imbalance between health needs and access to resources: due to biological differences, adolescent
boys have different health needs than girls. In most countries, the sexuality of boys is overlooked when
health services are designed. Systems for funding health services and efforts to privatize health services
need to address the fact that women have fewer economic resources than men on average. Research
must be conducted to ascertain how this affects the health of children.
Fig. 1. Relationships between factors influencing health during the life course, gender pathways,
gender-related outcomes and the quality of the interventions
•
Differences in how health policies and programmes affect girls versus boys: public policies should
incorporate gender equality into socioeconomic and political analysis to avoid discriminatory bias. It is
important to evaluate how any planned action will affects boys and girls, including legislation and policies
or programmes, in any sector and at all levels, with the ultimate aim of achieving gender equity. For
example, programmes to prevent the use of tobacco have often been more successful among young boys
than among young girls because they have not addressed the gender dimensions of tobacco uptake,
advertisement, control policies, etc.
The following examples show the need to have data stratified by sex that allow the differences to be
examined and analysed to determine the reasons for these differences and how to address them (Box 1).
Box 1. Analysing the health of children and adolescents from a gender perspective: examples
of important factors
• Role of parents, such as partner support for child care
• Various behaviour-linked risk conditions, such as road crashes
• Differences in the access to and control of health-related resources, such as preventing HIV
transmission
• Considering gender perspectives in biologically determined situations, such as pregnancy
• Greater prevalence among girls than boys or vice versa, such as eating disorders
• Different outcomes (physical, mental and social) for boys and girls, such as depression and suicide
• Links to risk factors differing for boys and girls, such as youth violence and sexual violence
• Involving responses differing in boys and girls, such as use of contraceptive services
• Systems (institutional, family and community) respond differently to boys and girls, such as sexual behaviour
4
Box 2. Definitions of terms used in Fig. 1
Factors influencing health: factors influencing the health and development of children and adolescents at various stages of the life course. They were selected from the European strategy for child and
adolescent health and development with the purpose of developing interventions to improve the
situation of children and adolescents to promote equity in health between boys and girls.
Gender pathway: the expression of a sequence of events mediated through gender that can lead
towards gender equality and equity in health and development or towards inequality and inequity.
Gender-related outcome: the potential effects of the gender pathways in terms of health and development expressed as positive or negative results. Outcome may include gender-based effects on the
mother and father and effects on gender-based differences between boys and girls.
5
The tool includes some considerations related to the health of women during pregnancy and childbirth and
after birth. This is because the health and socioeconomic status of the woman and the care received
during pregnancy and at the time of birth are strong determinants of the health and survival of newborn
babies. Children’s mortality and morbidity are closely linked to poverty and to women’s ability to access
services and make decisions about their reproductive health and the care of their children. Efforts to ensure
access to quality skilled care during pregnancy and childbirth and immediately after birth for all mothers and
newborn babies are crucial for the development of infants, as stated in Improving maternal and perinatal
health: European strategic approach for making pregnancy safer.1
3. How to use the gender tool
The conceptual framework can be applied:
•
•
to identify the gender pathways (Box 2) that influence the main factors influencing health among children
and adolescents during the life course (the life-cycle table); and
to identify the main actions that health systems and other sectors can undertake to address the gender
issues identified, including defining the information needed (the health priority table).
3.1 The life-cycle table
This table may be used to identify and to illustrate the relevance of performing gender analysis of the main
factors influencing the health of children and adolescents throughout their lives. The following example shows
how this table can be filled in. It is not meant as an exhaustive list of factors influencing health and outcomes
but as a selection of relevant examples.
1 Improving maternal and perinatal health: European strategic approach for making pregnancy safer. Copenhagen, WHO Regional
Office for Europe, 2007 (http://www.euro.who.int/pregnancy/20071024_1, accessed 19 October 2007).
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7
Life-cycle table: example
Life-course stage
Life-cycle table: example
Factors influencing health
Gender pathways
Pre-conception and early
pregnancy
Planning and spacing of
pregnancy
Extent to which women have
access to safe abortion
Inequality or equality in negotiation power,
such as negotiation of condom use or
timing of pregnancy
Gender differences or equality in access
to and use of contraception
Level of education of women and men
Differences in awareness of
contraception among adolescents
Differences or equality in the value placed
on the lives of boys and girls
Extent of unwanted and unplanned
pregnancies
Extent of sexual violence
Extent of sexually transmitted infections
and HIV infection
Extent of unsafe abortions
Extent of teenage abortion
Extent of selective abortion
During pregnancy
Extent to which women
have access to high-quality
antenatal care
Women’s decision power to access antenatal care
Women’s decisions about maternal and
perinatal practices
Extent to which the partner and family
participates and provides support in
pregnancy
Extent to which health services are
gender- and culture-sensitive
Adequacy of antenatal care
Access to antenatal services
Extent of stress and postpartum
depression
Extent to which pregnancy is
free from the hazardous use
of tobacco, alcohol or drugs
Gender differences or equality in risk
behaviour
Inequality or equality in the involvement
of partners in behavioural change
Birth weight of infants and extent of
perinatal morbidity
Potential transmission of
HIV and sexually transmitted
infections
Greater risk of acquiring HIV and sexually
transmitted infections associated with
negotiation skills and knowledge among
women
Incidence of mother-to-child transmission
of sexually transmitted infections and HIV
Extent of exposure to
gender-based violence
Higher risk of gender violence during
pregnancy
Extent of mental and physical health
problems for women
Quality of care services
during childbirth
Women’s decisions about maternal and
perinatal practices
Staff sensitive to gender and cultural
issues
Women’s decisions about partner and
family involvement during childbirth
Extent of harmful practices (such as
excessive use of caesarean section,
episiotomies and forced position for
childbirth) and lack of use of beneficial
practices (such as support)
Extent of maternal distress
Success in early bonding
between the mother and
father and the baby and in
initiating breastfeeding
Women’s decisions and extent to which
women’s needs are considered
(institutional barriers)
Fathers’ involvement
Extent of maternal distress
Success in mother–child and father–child
bonding
Extent to which breastfeeding practices
are improved
Success in achieving
exclusive breastfeeding
Extent to which women’s needs (privacy,
work and others) and cultural differences
are considered
Value placed on women’s mental health
needs during the postpartum period
Partner involvement
Partner and family involvement in care at
home
Success in breastfeeding
Extent of postpartum depression
During childbirth
During the first four weeks
of life (newborn period)
Maternal postpartum care
8
Gender-related outcomes
Life-course stage
First year of life
Early childhood
(cont.)
Factors influencing health
Gender pathways
Gender-related outcomes
Success in continued breastfeeding and initiating healthy
eating habits
Extent to which working hours are adapted
Fathers’ participation in childrearing
The extent to which women take
responsibility for childrearing
Legislation on maternity and paternity
leave
Differences in the value placed on the
health of boys versus girls
Breastfeeding continues or is interrupted
Growth and development differs between
boys and girls or differences are reduced
Fathers develop positive or negative
attitudes and practices towards fatherhood, which influences the health and
development of the mother, the child and
the father himself
Mental health of the mother and father are
affected positively or negatively, which
influences the mental health of the child
Infants are healthy or
unhealthy
Balance or imbalance in exposure to
hazards between boys and girls
Gender differences or equality in the
incidence of injuries, other diseases and
effects of immunization
Extent of access to
immunization
Level of education of mothers
Cost of immunization in relation to
mothers’ and fathers’ access to resources
Immunization gaps or good coverage
Differences or similarities between boys
and girls in coverage
Extent of stimulation through
play, communication and
social interaction
Discriminatory or equal access to leisure
activities
Development of or reduction in
gender-based stereotypes through leisure
activities
Extent to which there is early
socialization of positive (such as empathic
and caretaker roles) and negative (such
as excessively risky and violent)
behaviour among boys and positive
(such as being physically active) and
negative (such as eating disorders and
image problems) behaviour among girls
Extent to which
developmental problems and
learning disabilities are
detected and treated
Gender differences or equality in
expectations concerning developmental
capabilities and skills
Gender differences or equality in the
detection and treatment of developmental
problems (such as autism and
developmental disability) and learning
disabilities
Exposure to child abuse and
neglect
Differences or equality between boys and
girls in whether and how adults expose
them to sexual and physical abuse and
neglect
Gender differences or equality in the detection of child abuse and action by the
health system to prevent and stop it
Extent to which the
environment is safe
Extent to which exposure to accidents differs between boys and girls
Gender differences or equality in rates of
accidents
Health of the infant secondary to maternal
depression (adequacy of feeding and
bonding)
9
Life-cycle table: example
Life-course stage
Late childhood
Adolescence
10
Factors influencing health
(cont.)
Gender pathways
Gender-related outcomes
Extent to which lifestyles, diet Discrimination or equality in ability to and
and physical activity develop encouragement to participate in physical
in healthy directions
activity and sports
Discrimination or equality in exposure to
risky behaviour
Differences or equality in eating habits
Extent to which the incidence of
accidents differs between boys and girls
Building of body image and behaviours
based on stereotyped or genderequality models
Differences or equality in the incidence
of eating disorders
Prevention, early detection
and management of mental
health problems
Gender differences in the detection and
treatment of depression, learning difficulty
and behavioural problems
Gender norms and values conditioning
behaviour
Prevalence of aggressive conduct
generally greater among boys
Prevalence of hyperactivity syndrome
generally greater in boys
Prevalence of diagnosed depression
generally greater among girls
Exposure to exploitation and
hazardous child labour
Differences or equality in risk, vulnerability
and health impact between boys and girls
Differences or equality between boys and
girls in disabilities and opportunities to
develop
Diet and physical activity
Discrimination or equality in ability to and
encouragement to participate in physical
activity and sports
Gender differences or equality in relation
to body mass index and self-perception of
weight
Gender differences or equality in eating
habits
Extent to which boys have a higher
incidence than do girls of sports
accidents and road crashes (cars and
motorbikes)
Extent to which girls have more problems
than do boys linked to the development of
body image
Extent to which risky
behaviour (tobacco, alcohol
or other substance misuse
and unsafe sex) is prevented
Gender-based patterns in risk-taking
behaviour and protective factors
Gender bias or equality within health
services, mass-media campaigns and
policies
Gender differences or equality in
hazardous use of substances
Gender differences or equality in suicide
rates
Gender differences or equality in
(diagnosed) depression rates
Extent of gender-based violence and
sexual exploitation, early marriage and
adolescent pregnancy
Initiation to sexual life
Discrimination or equality in access to
sexual and reproductive health services
(especially male adolescents)
Unequal or equal position of female
adolescents in negotiation of sexual
relations and contraception use
Discrimination against or equal treatment
of adolescents with sexual orientation
other than strictly heterosexual
Extent of unsafe sex among male and
female adolescents
Gender-based differences or equality in
vulnerability to sexually transmitted
infections and HIV transmission and the
desirability of pregnancy
Other health outcomes as a consequence
of discrimination or equal treatment (such
as effects on mental health)
Extent to which accidents
are prevented
Development of high-risk and protective
behaviour based on gender-based
stereotypes or on gender equality
Gender-based differences or equality in
the proportion of accidents linked to other
risks (such as alcohol consumption and
weapon use)
Gender-based differences or equality in
the prevalence of aggressive behaviour
Gender-based differences or equality in
the prevalence of preventive behaviour
3.2 The health priority table: gender-sensitive actions for selected health priorities
Once the gender issues have been identified, gender-sensitive actions are to be defined. This table follows
the eight priority areas identified by the European strategy for child and adolescent health and development
and the main factors influencing health for each area defined in the action tool. It offers a diverse set of
examples on how to mainstream the gender perspective into designing, planning and implementing actions
to promote health and development among children and adolescents. It is a flexible tool, and its usefulness,
reading and interpretation has neither a unidirectional nor a linear sequence. Each country, programme or
decision-maker can establish priorities based on:
•
•
•
•
age group (life course)
health problem
levels of intervention
what is relevant.
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Health priority table: example
Gender-sensitive actions for selected health priorities
Priorities
1. Health of mothers and neonates
Gender pathways
Information needed
Health system actions
Intersectoral actions
Preventing preterm delivery,
intrauterine growth retardation
and congenital anomalies
Extent to which negotiation power is equal
Level of education of the mother and the father
Extent to which the partner and family participate, provide
support and take responsibility
Extent to which health services are gender- and culturesensitive
Extent of sexual violence
Prevalence of low-birth-weight infants
Percentage of partners or families participating in antenatal
care visits
Quality perceived by women and men during antenatal
care
Prevalence of alcohol and tobacco consumption in
both parents
Providing adequate provision and equitable access to antenatal care services for
both parents, including advice on nutrition, counselling on tobacco and alcohol
use during pregnancy and screening for HIV and sexually transmitted infections
Training health care teams for pregnant women in gender-sensitive issues such
as violence and empowerment
Promoting the participation of the partner or family and support network
Using gender-sensitive guidelines in antenatal care
Improving and implementing legislation to support working women during
pregnancy
Revising and adjusting legislation to allow pregnancy to be terminated in
selected cases
Promoting information, education and communication activities for pregnant
women and partners on healthy motherhood, preventing congenital anomalies
and birth planning
Promoting women’s empowerment
Ensuring adequate referral systems for victims for violence
Educating girls and women
Ensuring skilled attendants at
childbirth for all women and the
right place of birth in high-risk
cases
Extent of autonomous decision-making of the woman in the
use of medical procedures during the perinatal period
Extent to which childbirth is medicalized
Extent to which the family provides appropriate care and
support
Percentage of deliveries attended by qualified professionals
Quality perceived by women and their families during
childbirth
Using gender-sensitive evidence-based clinical guidelines and antenatal care
during childbirth
Implementing an appropriate referral system for high-risk pregnancies and
deliveries
Promoting legal frameworks that empower women on decisions about childbirth
Educating girls and women
Providing essential care to all
newborn babies
Extent to which the demands of the woman immediately
after childbirth (mental health, privacy and health care) are
acknowledged as a relevant issue for the health of the
newborn baby
Existence of barriers to or factors promoting early
mother-to-baby bonding
Prevalence of practices recommended for neonatal care
Percentage of newborn babies exclusively breastfed at
hospital discharge
Percentage of newborn babies kept with mothers during
the hospital stay
Ensuring that professionals are trained in providing evidence-based and
humanized, gender-sensitive care for the baby and family
Promoting the participation of men in caring for the newborn baby
Promoting early mother-infant bonding
Providing mother- and baby-friendly environments
Ensuring the child’s right to identity and the construction of citizenship
Adopting legislation on maternity and paternity leave
Managing preterm and
low-birth-weight infants
Extent of early bonding
Fathers’ involvement in child care
Differences or equality in the value assigned to the lives of
girls and boys
Prevalence of early support (partner or family) during the
hospital stay
Promoting the father’s involvement in care of low-birth-weight newborn babies,
such as involving fathers in Kangaroo mother care practices
Providing parent education for caring for newborn babies after discharge from a
health facility
Establishing community networks for following up high-risk infants
Ensuring appropriate monitoring
and evaluation of maternal and
newborn health services
Value placed on the health of mothers and newborn babies
Gender perspective in information systems (such as
qualitative information on empowerment, participation,
equity and indicators of satisfaction with care) stratified by
sex
Performing gender analysis of maternal and newborn services by considering
indicators of socioeconomic status, geographical locations, ethnic group, etc.
Building capacity among health care providers on how gender affects the quality
of services
Promoting systems to evaluate gender equity that take into account multiple
information sources (education, socioeconomic status, ethnic group and
geographical location), stratified by sex
Ensuring adequate nutrition among
pregnant women and mothers
Value assigned to women’s health
Extent of men’s support for healthy nutrition among
pregnant women
Socially determined models of body image of pregnant
women
Women’s access to resources
Prevalence of micronutrient deficiencies among pregnant
women stratified by economic condition, family status and
ethnic group
Prevalence of supplementation programmes of
micronutrients relevant to pregnancy (iron and folate)
Qualitative information about the impact of cultural and
ethnic differences on eating habits
Continuing gender-sensitive education of health care teams and the population
in nutrition
Counselling on nutrition in antenatal visits that include the partner
Training health care providers on the specific cultural needs of migrants and
various ethnic groups
Training health care providers on specific cultural needs for pregnant women
among migrants or ethnic minority groups
Enacting legislation to promote folic acid supplementation
Promoting access to supplementation programmes with micronutrients (iron and
folate)
Reflecting cultural diversity in healthy eating programmes
Protecting, promoting and
supporting exclusive breastfeeding
Women’s ability to decide feeding practices and receive
adequate support in all cases
Extent to which institutional resources and regulations take
into account women’s needs (such as privacy and
employment)
Partner involvement in supporting breastfeeding
Norms and values in communities and families related to
breastfeeding
Prevalence of breastfeeding by age groups, socioeconomic
background and ethnic group
Prevalence of exclusive breastfeeding by age group,
socioeconomic background and ethnic group
Qualitative information on partners and family support for
breastfeeding
Training health professionals in counselling related to breastfeeding and gender
issues
Acting to address men’s support for breastfeeding
Emphasizing more strongly the beneficial effects of breastfeeding for the mother
and the child versus benefits for the child only
Implementing the Baby-Friendly Hospital Initiative with a gender perspective
Improving and applying legislation to protect working mothers who breastfeed
Promoting information campaigns on breastfeeding
Promoting paternity leave
Preventing malnutrition and
micronutrient deficiencies
Gender differences in patterns of distribution of food and
resources within families
Prevalence of malnutrition and deficiency of micronutrients
stratified by sex and ethnic group
Providing food supplementation and advice about culture- and gender-sensitive
nutrition
Involving men in healthy nutrition
Empowering women in decision-making processes
Providing access to food fortification programmes with micronutrients (iron,
folate and iodine)
Preventing overweight and obesity
Unequal or equal access to information and opportunities for
physical activity
Extent of gender-based stereotypes about physical activity
Differences or equality in the priority placed on preventing
obesity among boys versus girls
Prevalence of overweight and obesity stratified by sex, age,
socioeconomic background and ethnic group
Data on diet and physical activity by sex and age
Promoting gender-sensitive healthy eating habits and physical activity
Providing gender-sensitive services for obese and overweight boys and girls
Supporting schools in gender-sensitive screening and programmes for overweight
and obesity
Implementing programmes that promote equal opportunities for physical activity
among boys and girls
Regulating aspects of information in the mass media about adolescent eating
habits with a gender perspective
Implementing gender-sensitive nutrition programmes in schools
Promoting oral and dental health
Differences or equality in the use of family resources for
dental care among boys versus girls
Prevalence of dental health problems stratified by sex and
socioeconomic level
Patterns of access to dental health care stratified by sex and
educational level
Promoting access to oral and dental health care services with a gender
perspective
Implementing campaigns for oral and dental health promotion with a gender
perspective
Promoting oral health education with a gender perspective in the education
system
2. Nutrition
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Health priority table: example
(cont.)
Gender-sensitive actions for selected health priorities
Priorities
3. Communicable diseases
Gender pathways
Information needed
Health system actions
Intersectoral actions
Providing immunization for
vaccine-preventable diseases
Effect of women’s level of education and socioeconomic
background on immunization
Fathers’ involvement in immunization of children
Coverage of immunization programmes stratified by sex
Coverage of immunization programmes stratified by level
of education and the socioeconomic background of the
mothers
Implementing immunization programmes targeting mothers with low education
and socioeconomic status
Involving fathers in immunizing their children
Empowering women in decision-making processes within the family
Ensuring legal mechanisms for equal access to vaccines free of user charges
Managing the most common
infectious diseases of childhood
Women’s level of education and socioeconomic background
Fathers’ involvement in the care of children
Decision-making power on health issues within families
Providing child-care services that address gender barriers to accessing services
Training health care providers to identify gender barriers
Involving men in child care
Empowering women to access resources
Implementing campaigns targeting men on the responsibility for the care of their
children
Controlling HIV and sexually
transmitted infections
Extent to which male adolescents are more likely to use intravenous drugs
Extent to which girls lack power to negotiate condom use
Differences or equality in the early and timely detection of
sexually transmitted infections
Extent to which social pressure is applied to boys or girls for
sexual debut
Extent to which girls are exposure to more sexual abuse
than boys
Extent of sexual exploitation of girls and boys
Gender differences in access to information on the
prevention of sexually transmitted infection and HIV
transmission
Information on infectious diseases of childhood stratified by
sex and age and socioeconomic background
Qualitative information about the role of fathers and mothers
in prevention and care decisions for boys and girls
Prevalence of sexually transmitted infection and HIV
infection stratified by sex and age
Prevalence of intravenous drug use stratified by sex and
age
Access to harm reduction programmes stratified by sex and
age
Condom use
Qualitative studies on the perception of condom use
negotiation among boys and girls
Access to services and counselling stratified by sex
Initiation of sexual activity stratified by sex
Numbers of victims of violence, abuse and sexual
exploitation stratified by sex and age
Promoting access to gender-sensitive information and counselling services
Providing treatment for preventing the mother-to-child transmission of HIV
Empowering professional teams on the gender dimensions of sexual and
reproductive health
Integrating the gender dimension and respecting sexual diversity as a quality
issue for health care delivery for adolescents
Developing, strengthening or instituting gender-sensitive harm reduction
programmes for vulnerable populations
Including gender-sensitive prevention of sexually transmitted infections and
HIV in school curricula
Providing condoms through various civil society organizations
Implementing legal frameworks that respect diversity in sexual orientation and
gender identity and promote sexual and reproductive rights
Controlling tuberculosis
Extent of gender gradients in the prevalence of tuberculosis
linked to HIV and AIDS and poverty
Gender differences or equality in risk behaviour and stigma
Differences or equality in community and family support for
males and females with tuberculosis
Role of women in the home care of people with tuberculosis
Incidence and prevalence of tuberculosis by sex,
socioeconomic status and comorbidity
Numbers of young men and women seeking care
Prevalence of tuberculosis among young women and men in
prisons
Gender-sensitive awareness-raising among health professionals
Gender-sensitive health services addressing the needs of vulnerable groups:
groups in poverty and ethnic minorities
Integrating the prevention of tuberculosis into programmes oriented to empower
vulnerable populations
Preventing and reducing the
morbidity and mortality arising
from poor water supply and
inadequate sanitation
Differences or equality in access to water and basic
sanitation and recreational areas for boys and girls
Links between gender differences or equality in general
access to resources and access to clean water and
adequate sanitation
Role of women in ensuring the use of clean water
Prevalence of morbidity and mortality linked to deficiencies
in access to water and basic sanitation, stratified by sex
Training health professionals in issues related to the environment and health of
children and adolescents with a gender perspective
Advocating for clean water and sanitation as a poverty alleviation issue
Addressing gender roles in water and sanitation programmes
Preventing and reducing
respiratory diseases due to indoor
and outdoor air pollution
Extent to which young girls have higher exposure to harmful
air pollution during household activities (such as solid fuel
for cooking, etc.)
Impact on the health of children of gender differences or
equality in parents’ exposure
Prevalence of asthma, poisoning, acute respiratory infection
and allergies stratified by sex and age
Prevalence of secondary exposure to cigarette smoke at
home and public places stratified by sex
Training health professionals in children’s and adolescents’ environment and
health with gender perspective
Informing and advocating on the dangers of indoor air pollution
Educating caregivers, health care providers and school personnel on ways to
prevent and reduce children’s and adolescents’ exposure to indoor air pollution
with a gender perspective.
Prevalence of illnesses produced by exposure to hazardous
chemicals and physical and biological agents stratified by
sex
Training health professionals in environmental health among children and
adolescents with a gender perspective
Raising awareness on gender-based health effects due to differences in exposure
and/or susceptibility
Consider sex-specific exposure patterns and susceptibility to air pollutants in the
development of risk reduction programmes
School dropout stratified by sex and age
Prevalence of child labour stratified by sex and age
Prevalence of trafficking and sexual exploitation stratified by
sex
Training health professionals in health problems related to exploitation and labour
among children and adolescents
Developing protective legislative frameworks for eradicating all types of child
labour and exploitation
Ensuring the enrolment of boys and girls in the education system
Generating greater social awareness of the risks of child labour and exploitation
4. Physical environment
Differences or equality in occupational exposure in farms
Reducing the risk of diseases and
and factories, such as gender differences or equality in
disabilities arising from exposure
to chemical, physical and biological exposure to ultraviolet radiation during work
agents
Preventing child exploitation and
hazardous child labour
14
Extent of sexual exploitation of boys and girls
Extent of gender-based stereotypes based on the male role
as provider and the female limited to domestic domains
Extent to which boys work in hazardous environments (such
as construction work or mechanical work)
15
Health priority table: example
(cont.)
Gender-sensitive actions for selected health priorities
Priorities
5. Adolescent health
Gender pathways
Information needed
Health system actions
Intersectoral actions
Promoting the health and
well-being of adolescents
Gender differences or equality in health and risk behaviour
Effect of gender roles on the access of boys and girls to
education and job opportunities
Differences or equality in how families distribute resources
on the education of boys versus girls
Extent to which the development of opportunities for
participation and leadership is conditioned by gender
Studies of self-perception and well-being among
adolescents stratified by sex and ethnicity
Coverage of education and employment of young people
stratified by sex
Absenteeism and school dropout stratified by sex, age and
level of education
Population of institutionalized adolescents stratified by sex
Promoting the development of youth-friendly and -responsive services from the
perspectives of gender and the right to satisfy basic human needs
Promoting public health policies and campaigns addressing the specific health
needs of boys and girls
Training health care professionals in gender-sensitive health promotion
Promoting the participation of young boys and girls in developing gender-sensitive
services
Providing opportunities for developing gender-sensitive life skills in school
programmes
Disseminating gender-specific and -sensitive health messages in the mass
media
Promoting peer-to-peer services
Preventing unwanted pregnancies
among adolescents and ensuring
appropriate support for adolescent
mothers
Extent of gender and culturally sensitive reproductive health
services for young people
Inequality or equality in access to information and resources
for preventing unwanted pregnancies
Inequality or equality in negotiation power on condom use
Extent of programmes for pregnant teenagers in the
education system
Prevalence of adolescent pregnancy stratified by the age
of both partners
Contraception use stratified by method and sex
Access to reproductive health services stratified by sex
and age
Coverage of sex education activities stratified by sex and
level of education
Implementing reproductive health policies addressing gender differences and
inequality
Facilitating access to gender specific programmes, information, resources and
contraceptive services for adolescents
Providing counselling for pregnant girls and their partners in unplanned pregnancy
Training health teams in aspects of sexual and reproductive health from
perspectives of gender and the right to satisfy basic human needs
Promoting social support networks for adolescent mothers and their partners
Promoting sex education in schools
Promoting collaboration among sectors to ensure contraception services
Promoting programmes conducive to keep pregnant girls in the education
system
Promoting culturally sensitive services and programmes for migrant populations
and ethnic minorities
Preventing and managing HIV
infection and sexually transmitted
infections among adolescents
Extent to which male adolescents are more likely to use
intravenous drugs
Extent of differences between boys and girls in the
possibility of negotiating condom use
Extent to which social pressure is applied to boys about
starting to become sexually active
Extent to which girls are more exposed to sexual abuse, rape
and exploitation
Extent to which pregnancy is a situation of greater
vulnerability linked to less protection
Differences or equality in access to information on preventing
sexually transmitted infections and HIV transmission
Extent to which women are more likely to contract HIV
infection and other sexually transmitted infections during
sexual activities with an infected partner
Information stratified by sex and age on the prevalence of
sexually transmitted infection and HIV infection and alcohol
and other substance use (cannabis, heroin and ecstasy)
Qualitative studies on the perceptions of negotiating condom
use among males and females
Access to counselling services
Initiation of sexual activity stratified by sex
Victims of violence, sexual exploitation and abuse stratified
by sex and age
Qualitative studies on homosexuality in adolescence
Developing gender-specific campaigns on risk behaviour related to HIV infection
and sexually transmitted infections
Promoting access to confidential information and counselling activities and
prevention and testing in HIV and sexually transmitted infections
Providing treatment for preventing the mother-to-child transmission of HIV
Training health professionals on gender-sensitive sexual and reproductive health
Gender-sensitive harm reduction programmes
Providing legal frameworks for sexual and reproductive rights that include
access to information services for adolescents
Introducing aspects of preventing sexually transmitted infection and HIV infection
in the school curricula
Providing information through institutions (schools, churches, community-based
organisations, etc.)
Providing condoms through various organizations to ensure equal access
among girls and boys
Ensuring appropriate management
and support for adolescents with
chronic diseases and disabilities
Extent of stigma and gender-based discriminatory attitudes
towards people with disabilities
Extent to which disabled girls are more highly exposed to
abuse
Extent to which stigma is attached to women when disability
affects their reproductive capability
Information on disability and discrimination stratified by sex
Access to programmes and services for young disabled
people stratified by sex
Prevalence and incidence of chronic illness and disabilities
stratified by sex
Providing gender-sensitive health services for young people with disabilities
Empowering health professionals in issues of inclusive development, emphasizing
gender and disability
Integrating gender and health issues into social policies addressing the needs
of young people with disabilities
Preventing hazardous use of
substances
Extent to which boys are more likely to engage in hazardous
use of substances
Extent to which the prevalence of smoking among girls is
increasing or decreasing
Extent to which substances are used that are linked to
gender-based stereotypes (greater autonomy among
women and greater virility among men)
Prevalence of hazardous use of substances stratified by
type and sex
Knowledge of risk and protective factors stratified by sex
Access to services stratified by sex
Developing gender-specific prevention programmes on hazardous use of
substances
Providing appropriate services for care of adolescent consumers of alcohol,
tobacco and other substances, including harm reduction
Providing gender training for health care providers to identify and address risk
factors and vulnerability among adolescents
Developing legal frameworks for preventing the consumption of tobacco and
alcohol
Developing mass-media campaigns for reducing the consumption of alcohol and
tobacco
Preventing overweight and obesity
See table on nutrition
See table on nutrition
See table on nutrition
See table on nutrition
Preventing bullying and violent
behaviour among adolescents
Gender differences or equality in risk and protective factors
Extent to which adolescents with sexual orientation other
than strictly heterosexual or with nontraditional gender
identity are at greater risk
Extent to which power relationships between boys and girls
and between adolescents of the same sex are imbalanced
Extent to which there are violent masculine stereotypes
Extent to which knowledge of patterns of girls’ violent
behaviour is lacking
Prevalence of bullying in school settings stratified by sex
Qualitative information on experiences among girls and boys
on violent situations and peer pressure
Providing gender-sensitive psychological services for adolescents
Developing gender-sensitive programmes that promote nonviolent dialogue and
conflict resolution in the education system
Implementing gender-sensitive prevention campaigns
Preventing and managing eating
disorders
Gender differences or equality in social pressure to have the
ideal body image
Extent to which detecting eating disorders among boys or
girls is difficult
Prevalence of eating disorders stratified by sex
Qualitative information on risk and protective factors
Training professionals in the early detection and treatment of eating disorders with
a gender approach
Developing gender-sensitive support programmes for boys and girls with eating
disorders
Promoting realistic female and male body images through the mass media
16
17
Health priority table: example
(cont.)
Gender-sensitive actions for selected health priorities
Priorities2
6. Injuries and violence
2
Gender pathways
Information needed
Health system actions
Intersectoral actions
Preventing home-related
unintentional injuries
Differences or equality in exposure to domestic accidents
based on different gender roles
Information on home accidents stratified by age, sex,
ethnicity and socioeconomic background
Promoting gender-sensitive education of parents on reducing hazards
Empowering health teams with a gender perspective for detecting possible
hazards at home
Implementing gender-sensitive prevention campaigns
Preventing road crash injuries
Extent of gender dimensions of driving habits and
pedestrian attitudes
Extent to which gender roles influence how people drive and
how pedestrians behave
Extent to which masculine role models are linked to risky
behaviour and fearlessness
Extent to which gender-based stereotypes push boys to
avoid protective behaviour and affect how conflicts are
resolved
Information on road crashes stratified by sex, age, cause
and location
Information on road crashes linked to hazardous use of
alcohol, drugs and other substances, stratified by sex and
age
Self-perception of risky behaviour stratified by sex
Self-perception of protective and self-care behaviour
stratified by sex
Considering gender differences in the consequences of temporary or permanent
disability resulting from accidents
Including information on habits and gender-based stereotypes in school
consultations with adolescents
Implementing public campaigns that consider gender differences in behaviour
Promoting school programmes on road safety that address gender-based
stereotypes and various types of behaviour
Designing interventions that challenge gender roles
Preventing drowning (in pools, etc.)
Extent to which gender-based stereotypes push boys to
avoid protective behaviour
Extent of gender-based stereotypes surrounding physical
activity
Mortality from drowning stratified by sex, age and place of
occurrence
Qualitative and quantitative information about swimming,
family habits and physical activity among boys and girls
Information on links between drowning and alcohol
consumption stratified by sex and socioeconomic
background
Gathering information on habits and gender-based stereotypes and risks for
adolescents and how they affect health
Addressing gender-based stereotypes on risk behaviour among adolescents in
schools
Reducing the incidence and
consequences of intrafamilial
violence
Extent to which gender-based stereotypes are perpetuated
within families
Extent to which girls are more highly exposed to intrafamilial
violence
Extent to which boys are more highly exposed to violent
family behaviour due to masculine role models
Extent of differences in whether and how parents’
gender-based violence affects boys versus girls
Incidence of intrafamilial violence stratified by sex and ethnic
and socioeconomic background
Qualitative information on the circle of violence in families
with a gender perspective
Ensuring that health professionals incorporate methods of assessing intrafamilial
violence that are gender specific
Ensuring a gender-based approach in managing children and adolescents
affected by the consequences of intrafamilial gender-based violence
Providing psychological support for children and adolescents whose mothers
suffer from gender-based violence
Building capacity among health providers to identify gender-based violence in
children’s families
Promoting gender-sensitive awareness campaigns on intrafamilial violence in
schools and community centres
Developing gender-sensitive community-based programmes that provide
opportunities for positive youth socialization
Ensure that social and judiciary services are gender sensitive
Preventing child abuse and neglect
Extent to which girls are exposed to sexual abuse more
often than boys
Gender differences or equality in parents’ violence
Extent to which boys lack attention as possible victims of
neglect and abuse
Differences or equality in the effects of abuse on the future
sexuality and reproductive health of boys and girls
Gender differences or equality in exposure to neglect
Incidence of child abuse and neglect by sex and age and
socioeconomic background
Information by the sex and socioeconomic background of
the perpetrator
Data on neglected children stratified by sex
Ensuring that the health services addressing child abuse and neglect cases are
gender sensitive
Ensuring home visiting for all mothers and newborn babies and follow-up for
those that have special needs or are at high risk
Promoting bonding after childbirth
Involving the father during pregnancy, childbirth and care of the child
Promoting specific gender-sensitive child protection and psychosocial support
programmes for children and adolescents in situations of high vulnerability
(conflict, marginal communities, etc.).
Setting up campaigns for preventing intrafamilial gender violence
Preventing child trafficking and
sexual exploitation
Extent to which girls are exposed to sexual exploitation
more often than boys
Extent to which boys lack attention as possible victims of
child trafficking and sexual exploitation
Gender discrimination or equality and extent of
empowerment promoting or retarding trafficking and sexual
exploitation
Information on trafficking from the judicial system stratified
by sex
Information on sexual exploitation stratified by age and sex
Qualitative information on risk and protective factors
stratified by sex and socioeconomic background
Training health workers and emergency services to identify the victims of
trafficking and sexual exploitation
Developing gender-sensitive protocols of conduct within the health services to
address trafficking and sexual exploitation
Enacting gender-sensitive legislation on child abuse and neglect, paedophilia,
child trafficking and exploitation
Strengthening social services to address trafficking and sexual exploitation in
a gender-sensitive way
Implementing gender-sensitive public campaigns addressing vulnerable
populations
The table on adolescence reported prevention of bullying and violent behaviour among children and adolescents.
18
19
Health priority table: example
(cont.)
Gender-sensitive actions for selected health priorities
Priorities
7. Psychosocial development and mental health
Promoting the psychosocial
development and mental well-being
of children and adolescents
Gender pathways
Development of gender-based stereotypes or equality
associated with various childrearing and socialization
practices
Extent to which there are gender-based discrimination and
negligence situations in the early stages of life
Gender differences or equality in suicide and attempted
suicide among adolescents
Extent of prejudice and stigma towards the behaviour of
children who do not respond to gender-based expectations
Gender differences or equality in responses to contexts of
deprivation, risk and violence and unfortunate life events
Extent to which gender-based stereotypes prevent boys
from seeking help in case of depression
Extent of gender bias in health services addressing the
mental health needs of adolescents
Information needed
Health system actions
Intersectoral actions
Information on psychosocial development and mental
health problems stratified by age, sex and socioeconomic
background
Suicide among adolescents stratified by age and sex
Depression among adolescents stratified by age and sex
Qualitative information on gender-based stereotypes
Qualitative information on gender identity
Promoting gender-sensitive childrearing guidelines
Building capacity among health professionals to deal with gender differences in
mental health among children and adolescents
Training professionals in gender-specific aspects of psychosocial development
and mental health problems (including diversity according to sexual orientation)
Gender-sensitive suicide prevention campaigns
Preventing child neglect and its consequences
Promoting gender-sensitive joint work with the education community
Gender-sensitive campaigns for promoting the rights of children and adolescents
Promoting the inclusive development (equal conditions and opportunities from
the early stages of life) without discriminating by sexual orientation or gender
Promoting sensitivity to issues related to gender and children and adolescents
in the mass media
Implementing gender-sensitive empowerment activities during childhood and
adolescence
Incidence of mortality and morbidity rates of chronic
diseases by sex, age and socioeconomic background
Access to health services by sex, age and socioeconomic
background
Information on abuse and neglect stratified by sex, age and
type of disability
Health-related quality of life indicators stratified by sex, age
and socioeconomic background
Providing gender-sensitive care of children and adolescents with chronic diseases
and disabilities, adequately equipped and with specifically trained professionals
Ensuring equal access for boys and girls to care for chronic diseases
Acknowledging and addressing the role of women as informal caregivers for
children and adolescents with disabilities
Integrating the health, education and employment sectors for an inclusive and
gender-sensitive approach to children and adolescents with disabilities
Promoting community and family participation in the approach to children and
adolescents with chronic diseases and disabilities that takes gender differences
into consideration
8. Management and care of children with chronic diseases and disabilities
Ensuring early detection, diagnosis
and management of mild mental
retardation and developmental
disability
20
Gender differences or equality in access to care for chronic
diseases and disabilities
Extent to which stigma and discrimination are linked to
gender and disability issues
Extent to which girls with disabilities are exposed to abuse
and neglect
Extent of gender roles and stereotypes that pose different
forms of interaction for children and adolescents with
disabilities
Role of women as informal caregivers
21
Background documents to support the use of the gender tool
General documents
European strategy for child and adolescent health and development. Copenhagen, WHO Regional Office
for Europe, 2005 (http://www.euro.who.int/childhealtdev/strategy/20060919_1, accessed 19 October
2007).
European strategy for child and adolescent health and development: information tool. Copenhagen, WHO
Regional Office for Europe, 2005 (http://www.euro.who.int/childhealtdev/strategy/20060919_1, accessed
19 October 2007).
European strategy for child and adolescent health and development: assessment tool. Copenhagen, WHO
Regional Office for Europe, 2005 (http://www.euro.who.int/childhealtdev/strategy/20060919_1, accessed
19 October 2007).
<European strategy for child and adolescent health and development: action tool. Copenhagen, WHO
Regional Office for Europe, 2005 (http://www.euro.who.int/childhealtdev/strategy/20060919_1, accessed
19 October 2007).
Strategy for integrating gender analysis and actions into the work of WHO. Geneva, World Health Organization, 2007 (http://www.euro.who.int/document/gem/final_strat_sep07.pdf, accessed 19 October 2007).
Improving maternal and perinatal health: European strategic approach for making pregnancy safer. Copenhagen, WHO Regional Office for Europe, 2007 (http://www.euro.who.int/pregnancy/20071024_1, accessed
19 October 2007).
Sweeting H. Reversals of fortune? Sex differences in health in childhood and adolescence. Social Science
and Medicine, 1995, 40:77–90.
Green L. An unhealthy neglect? Examining the relationship between child health and gender in research
and policy. Critical Social Policy, 2006, 26:450–466.
Tajer D. Pagando “a la americana”. Invisibilidad de género en el Informe de la OMS 2000 y propuesta para
un informe alterno género sensible [Paying “American style”. Invisibility of gender in the 2000 WHO report
and proposal for an alternative gender-sensitive report]. In: ¿Equidad? El problema de la equidad financiera en salud [Equity? The problem of financial equity in health]. Bogota, Plataforma Interamericana de
derechos humanos, democracia y desarrollo Observatorio Universitarios de Política social y Calidad de
vida, ALAMES, 2001.
Gender and life cycle
Fikree FF, Pasha O. Role of gender in health disparity: the South Asian context. British Medical Journal,
2004, 328:823–826.
Empowerment throughout life [web site]. New York, United Nations Population Fund, 2007
(http://www.unfpa.org/gender/empowerment4.htm, accessed 19 October 2007).
22
Health of mothers and neonates
Healthy mothers and children: the role of gender equality and women’s empowerment in the reduction of
maternal and child mortality. Washington, DC, Pan American Health Organization, 2005
(http://www.paho.org/Project.asp?SEL=TP&LNG=ENG&ID=127&PRGRP=docs_gen, accessed 19 October 2007).
“En-gendering” the Millennium Development Goals (MDGs) on health. Geneva, World Health Organization,
2003 (http://www.who.int/gender/documents/mdgdoc/en, accessed 19 October 2007).
Nutrition
Oniang’o R, Mukudi E. Nutrition and gender. In: Nutrition: a foundation for development. Why practitioners
in development should integrate nutrition. New York, United Nations Administrative Committee on Coordination, Sub-Committee on Nutrition and International Food Policy Research Institute, 2002
(http://www.ifpri.org/PUBS/books/intnut.htm, accessed 19 October 2007).
Communicable diseases
Sexual and reproductive health needs of women and adolescent girls living with HIV: research report on
qualitative findings from Brazil, Ethiopia and the Ukraine. New York, EngenderHealth and United Nations
Population Fund, 2006
(http://www.unfpa.org/publications/detail.cfm?ID=300&filterListType=1, accessed 19 October 2007).
Global Coalition on Women and AIDS. Keeping the promise: an agenda for action on women and AIDS.
Geneva, UNAIDS, 2006 (http://womenandaids.unaids.org, accessed 19 October 2007).
Bhana D et al. Young children, HIV/AIDS and gender: a summary review. The Hague, Bernard van Leer
Foundation, 2006 (http://www.bernardvanleer.org/publications, accessed 19 October 2007).
Hartigan P. Communicable diseases, gender and equity and health. Cambridge, MA, Harvard Centre for
Population and Development Studies, 1999 (Working Paper/ Series Number 99.08; http://www.globalhealth.harvard.edu/hcpds/wpweb/gender/hartigan.html, accessed 19 October 2007).
Physical environment
Sims J, Butter ME. Gender equity and environmental health. Cambridge, MA, Harvard Center for Population and Development Studies, 2000 (Working Paper Series, Vol. 10, no. 6; http://www.globalhealth.harvard.edu/hcpds/wpweb/6%20Sims-Butter%20web.htm, accessed 19 October 2007).
Adolescent health
Children having children: state of the world’s mothers 2004. Westport, CT, Save the Children, USA, 2004
(http://www.savethechildren.org/campaigns/state-of-the-worlds-mothers-report/2004/state-of-the-worldsmothers.html, accessed 19 October 2007).
Young people's health in context: selected key findings from the Health Behaviour in School-aged Children
study. Copenhagen, WHO Regional Office for Europe, 2004
(http://www.euro.who.int/mediacentre/PR/2004/20040603_1, accessed 19 October 2007).
23
Injuries and violence
Gender and road traffic injuries. Geneva, World Health Organization, 2002
(http://www.who.int/gender/other_health/en, accessed 19 October 2007).
The elimination of all forms of discrimination and violence against the girl child: report of the Expert Group
meeting. New York, United Nations Division for the Advancement of Women, Department of Economic and
Social Affairs, 2006 (http://www.un.org/womenwatch/daw/egm/elim-disc-viol-girlchild/
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Mental health
The health of Canada’s children: a CICH profile. Gender differences. Ottawa, Canadian Institute for Child
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Gender and mental health. Geneva, World Health Organization, 2002
(http://www.who.int/gender/documents/en, accessed
24
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