Gender, according to the World Health Organization (WHO), comprises the socially constructed characteristics of women, men, girls, and boys, including norms, behaviors, and associated roles with being a woman, man, girl or boy and interactions with each other.
Gender can change over time and varies from place to place and in fact, in many countries today includes a third gender — people who are non-binary. The fact that gender can vary from time to time and place to place means that we all need to re-learn what we know about gender on a regular basis.
The WHO created a 5-Level Gender Responsive Assessment Scale that can be used as criteria for assessing programs and policies. This scale serves as a guideline for nations, organizations and individuals striving to integrate gender equity.
It is critical to highlight that this scale is a reference to help improve programs and policies all over the world. It is not pointing fingers, casting blame, or assigning shame at programs that are not yet gender equitable. It is designed to assist all of us in making progress towards achieving gender equity in our programs and policies.
You can take the WHO Gender Assessment Quiz to learn where your work falls on the scale, and what you can do to move gender integration forward as a champion.
Level 1: Gender Unequal
Gender unequal programs and policies are biased against one gender, making it more advantageous to belong to the favored gender, which is most often male.
Example of a Gender Unequal Program
A campaign to improve death registration in a country that doesn’t specifically detail the importance of registering deaths of women and people who are gender diverse will end up attracting increased registration of men’s deaths due to gender norms around patrilineal inheritance.
Example of a Gender Unequal Policy
Countries, such as Afghanistan, Bhutan, and Kenya, with policies that require both mother and father to be present to register the birth of their child in the CRVS system.
Level 2: Gender Neutral
Gender neutral programs and policies ignore gender customs, responsibilities, and relations, while often supporting traditional gender-based roles that favor males. Gender-neutral policies treat everyone the same in the spirit of fairness, ignoring the differences in opportunities and resource allocation based on gender.
Example of a Gender Neutral Program
A training program on how to collect cause of death and mortality data using ICD-11 which does not include discussion of gender-based violence in the module on external cause code for injuries, which incorporates the intent, mechanism, and object of the deceased in a single code.
Example of a Gender Neutral Policy
A policy that mandates verbal autopsy (VA) to ascertain the cause of a death based on an interview with next of kin or other caregivers where no medical certification is available that does not provide guidance on how to safely and effectively take verbal autopsies in cases of gender-based and intimate partner violence.
Level 3: Gender Sensitive
Gender sensitive programs and policies consider different gender norms, roles, and relations, but do not consider the consequences of the existing inequalities between genders. These programs and policies acknowledge that there is a problem without providing solutions.
Example of a Gender Sensitive Program
A tobacco cessation media campaign that targets pregnant women, without acknowledging the secondhand smoke pregnant women are exposed to from the men in their families.
Example of a Gender Sensitive Policy
Countries such as Indonesia and Bangladesh that have policies of implementing high taxes on cigarettes, have shown that having a smoker in the household diverts household income from food to tobacco, putting women and children at greater risk of chronic malnutrition and death.
Level 4: Gender Specific
Gender specific programs and policies purposely target and benefit a group of women or men, or in countries where it is legal, people who are non-binary, based on their needs, gender norms, roles and relations.
Examples of a Gender Specific Program
The ICD-11 has redefined gender identity-related health, replacing outdated diagnostic categories with “gender incongruence of adolescence and adulthood” and “gender incongruence of childhood” respectively. Gender incongruence has been moved out of the “mental and behavioral disorders” chapter and into the new “conditions related to sexual health” chapter. This reflects current knowledge that trans-related and gender diverse identities are not conditions of mental ill-health, and that classifying them as such can cause enormous stigma.
Examples of a Gender Specific Policy
Situating transgender health within inclusive and comprehensive national health policies for universal health coverage can bolster attention and help muster the resources necessary to provide gender-affirming health care and public health services.
Level 5: Gender Transformative
Very few programs or policies are gender transformative. Gender transformative policies consider and address the differences in gender roles and norms, identifying the root causes, while simultaneously looking for ways to change them based on the specific needs of each gender.
Examples of a Gender Transformative Program
Given the strong link between child marriage, adolescent pregnancy, and high rates of maternal and infant mortality, the Ministry of Health (MoH) and Ghana Health Service (GHS) set up multiple transformative programs in alignment with the 1998 Children’s Act. These include:
- provision of comprehensive sex education in schools,
- community sensitization on sexual and reproductive health for both boys and girls,
- engagement with traditional authorities to consider the needs of adolescents,
- engagement with parents on sexual reproductive health of adolescents
- revision of the service policy for reproductive health services to include sexually active teens,
- training of service providers to be more receptive and adolescent friendly,
- scaling up of abortion care service as prescribed by law, and
- regular review of the national adolescent health strategy.
Examples of a Gender Transformative Policy
Child marriage is illegal in Ghana. Both the 1992 Constitution and the 1998 Children’s Act set the legal age for marriage at 18 for both girls and boys. Research points to a range of harmful economic, social, and health effects for women and men in LMICs who married early, including lower educational attainment, poorer reproductive health knowledge, and a higher chance of exceeding desired fertility.
