ANALYSIS: Building a Gender Strategy for the Afghanistan Ministry of Public Health

Recent media reports have focused on the stalled progress for women in Afghanistan and the shift in the international community's focus as they take steps towards an eventual military withdrawl. Although there's much work to be done, it's important to note that there has been tangible improvement for women in Afghanistan. A decade ago, women weren't allowed to go out in public alone. Girls weren't allowed to attend school – now 57 percent of girls are in school. And gender issues are now being integrated into government policy.

At an International Gender Working Group (IGWG) Plenary in honor of 2011 International Women's Day hosted by PATH in Washington DC, Karen Hardee, a senior fellow at PRB and president of Hardee Associates, presented her involvement towards developing the National Gender Strategy for the Afghanistan Ministry of Public Health for 2011-2015. Much international development program and policy advocacy calls for attention to “gender,” but what does the term mean? “Gender isn't just about women,” said Hardee, but is defined as the social roles that men and women play because of the way society is organized. But these roles aren't set in stone; they can change over time.

Funded by USAID, the Health Services Support Project worked with the Afghan government to create a plan to integrate gender considerations into all public health programs and policies, focusing mostly on mental health and gender-based violence. Interestingly, the impetus of the process stemmed the initiative of a male official in the Ministry of Public Health who requested assistance to write a plan to integrate gender into the Ministry's policies and programs. Having participated in WHO-sponsored gender training workshops in the past, he understood the importance of mainstreaming gender awareness for both men and women. It's a great example of the tangible effects of the work being done on gender by NGOs and international donors.

Of course, creating policies does not automatically ensure smooth implementation. On paper, Afghanistan is very supportive of gender issues: its constitution calls for gender equality, it has ratified the Convention on the Elimination of All forms of Discrimination Against Women (CEDAW), it enacted a law on the elimination of violence against women in 2009, etc. How these policies are implemented and affect the lives of ordinary Afghans across the country is the real issue. Now that gender issues have been integrated into the Ministry of Public Health, its time for the hard work of creating the operational plan. Considering the weakness of the central government in many rural areas, this could be a challenge. Another challenge in creating an environment that supports gender equality is the fact that health is more conducive to these issues than others. For example, integrating gender into land reform is much more difficult due to the deeply engrained social and political hierarchies of land tenure and rights.

Following Karen Hardee's presentation, Ashley Frost, senior policy adviser at PRB, presented key findings from our recent Women and Girls 2011 Data Sheet. Here are a few examples:

* Skilled attendance at birth remains lowest in Africa and Asia. In some regions, such as sub-Saharan Africa and South Central Asia, less than half the women giving birth are attended by doctors, nurses, or midwives. In many countries, wealthier women are far more likely to give birth with the assistance of a trained medical provider than women from poor households.
* Early marriage, before the age of 18, is practiced in many parts of the world. In nine countries, at least half of women ages 20-24 have been married by age 18. And, in the poorest regions of the world, the proportion is more than 35 percent, with levels ranging from 45 percent in South Central Asia to nearly 40 percent in sub-Saharan Africa, to 25 percent in Latin America and the Caribbean.
* In many countries, both women and men believe that wife beating is acceptable, and it is not unusual for women to condone the violence more than men.
* In many cultures, parents have a preference for sons due to prevailing cultural beliefs. As a result, the practice of sex-selective abortion has become widespread in a number of countries. Without sex-selective abortion, the natural sex ratio is 1.05 (about 105 boys born for every 100 girls). However, in countries where sex-selective abortion takes place, the birth ratios are much higher than 1.05, meaning a disproportionate number of boys are born. The United Nations projects that highly skewed sex ratios in most countries will decline in the coming decades. Only India is projected to remain steady at 1.08 during this time.