Social determinants of health

Stories of positive action from around the world

Story numbers correspond to those in the Report.

Ensuring gender equity for health

13.4: Changing jurisdiction over rape cases in Pakistan

According to the Human Rights Commission of Pakistan, there is a rape every 2 hours and a gang rape every 8 hours in the country. The small but articulate women’s movement together with the human rights movement in Pakistan has been struggling for change in a political situation made increasingly complicated by the wars in Afghanistan and Iraq. Their efforts have recently borne fruit with the passing by the National Assembly and Upper House of the 2006 Protection of Women Bill, which transfers the jurisdiction over rape cases from sharia to civil courts. It also makes it easier for a woman to prove a rape allegation without being charged for adultery. Although consideration of the Bill had to be postponed earlier because of Islamist opposition, it has been signed into law. Yet, more will be needed for it to be fully implemented and endorsed. Source: WGEKN, 2007

13.5: Changing norms regarding female genital mutilation

Multi-pronged education approaches have succeeded in changing attitudes and norms regarding female genital mutilation in some cases. Examples of success include the Senegal project that is now a regional model endorsed by UNICEF. Its success involves public declaration of intent to abandon the practice, and a slow but steady human rights education programme that encourages villagers to make up their own minds about the practice.

More generally, effective programmes typically have the following features: (i) inclusion of men in interventions that attempt to change attitudes; (ii) careful selection of the right group leaders/facilitators for projects, and agreement on criteria for selection of participants; (iii) reproductive health and rights education classes that lift the taboo on talking about health problems associated with female genital mutilation; (iv) collaboration with the community to design an alternative rite of passage; and (v) education with a focus that is much wider than female genital mutilation to include rights, health, and development. Source: WGEKN, 2007

13.8: Gender mainstreaming in the Chilean Government - management improvement programme

The Management Improvement Programme in Chile works as a group incentive linked to institutional performance: all staff in a public institution receive a bonus of up to 4% of their salaries if the institution attains programme management targets that have been approved by the Ministry of Economics. The Management Improvement Programme of each institution is prepared considering a group of common areas for all institutions in the public sector. One of these areas is gender planning. The proposal is presented yearly, together with the proposed budget, to the Ministry of Economics. The incorporation of a gender planning component implies the introduction of the gender approach in the budgetary cycle. This makes it possible to integrate gender considerations in the routine and habitual procedures of public administration, permanently introducing modifications into the daily dynamics of the institutions and their standardized procedures.

Thus, public institutions need to incorporate this dimension into all their strategic products, making it possible to allocate the public budget in a way that responds better to men’s and women’s needs and contributes to the reduction of gender inequities. The implementation of this incentive mechanism constitutes an important innovation: for the first time a concept of gender equity is integrally associated with budgetary management in Chile. Source: WGEKN, 2007

13.14: Providing childcare services in India

SEWA is a trade union of poor, self-employed women. Its members expressed the need for childcare, which would allow them to work without jeopardizing their children’s safety and development. Working closely with the government, SEWA’s 100 childcare centres are managed by cooperatives of childcare providers, which have been formed with SEWA’s support. Each serves 35 children, ranging from birth to 6 years of age. They focus on the overall development of the children, including their physical and intellectual growth. The teachers hold regular meetings with the mothers, where they discuss and give suggestions for the child’s development. Children are regularly weighed and records of their growth are properly maintained. The childcare centres double as centres for childhood immunization and antenatal and postnatal care.

SEWA’s studies show important impacts of childcare provision: mothers reported income increases of over 50%, with spin-offs to, among others, child nutrition. They said that for the first time they could bring vegetables and lentils to feed their children. They also reported ‘peace of mind’, knowing that their children were well looked after while they were at work. Furthermore, older siblings, especially girls, entered school for the first time as they were released from childcare responsibilities. Also, the physical growth of young children improved significantly with the nutrition at the centres, as did their cognitive skills. All children started primary school at the age of 6 years and the majority continued until high school. Adapted, with permission of the author, from SEWA Social Security (nd).