Module 8

Incorporating Intersectional Gender Analysis
into Research on Infectious Diseases of Poverty

A toolkit for health researchers

Incorporating an intersectional gender lens into implementation research on infectious diseases of poverty

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Implementation outcome variable: acceptability – the perception among stakeholders that an intervention is agreeable

• To what extent do women’s (frequent) lack of skills and resources (education, money, technology, employment) or autonomy affect whether or not others perceive their involvement in the intervention as acceptable?

• Does men’s and women’s work inside and outside the home affect whether or not others perceive their involvement in the intervention as acceptable?

• How do social and cultural gender norms affect whether or not the intervention is accepted by the community, e.g. do cultural beliefs about women as child bearers and mothers influence their involvement in a family planning intervention?

• How do the conditions at health facilities affect access? To what extent do health facilities provide services with appropriate conditions (such as functioning toilets, bathing areas for inpatient facilities, shelter from sun/rain in the waiting area) and confidential services? Can patients request to consult a health care provider of their choice if they prefer to?

• Who decides whether or not it is acceptable for someone to participate in an intervention? How do they decide this? Are women or other marginalized populations (transgender people, ethnic minorities, migrants, inhabitants of informal settlements, people employed in illegal occupations, etc.) excluded?

Vulnerability to disease/ illness

Gender analysis questions

Implementation outcome variable: feasibility - the extent to which an intervention can be carried out in a particular setting or organization

• To what extent are marginalized populations able to access relevant information and care related to an intervention?

• How do women’s social roles, such as childcare, infant feeding and other reproductive tasks, affect their access to and utilization of an intervention?

• How does stigma inhibit certain men, women and people with non-binary identities from accessing or using an intervention? Do interventions targeted at women, such as maternal and child health, and family planning services, exclude men?

• Who decides whether and how much household resources should be used to pay for health care services? How might this affect an intervention?

• Do women require the permission of a male partner or relative to use the intervention?

Gender power relations domain

Illustrative gender analysis questions

Implementation outcome variable: appropriateness - the perceived fit or relevance of the intervention in a particular setting or for a particular target audience or issue

• To what extent do women’s (frequent) lack of skills and resources (education, money, technology, employment) affect whether or not others perceive their involvement in the intervention as relevant?

• To what extent are the intervention activities, such as health outreach visits or clinics, organized considering men’s and women’s agricultural, economic or caretaking activities in their communities?

• Does involvement in the intervention compromise any implementer’s safety? Or bring additional tasks to certain groups that may be unpaid or unremunerated? (For example, do they rely on the labour of women volunteers who have to travel after dark?)

• How do women and men within households and communities prioritize individuals’ involvement in an intervention? For example, is the intervention more likely to be seen as relevant for men due to their role as providers or for women because of its unpaid, low-prestige status?

• Does the implementation problem and design draw on health providers’ (and others’) tacit knowledge? Does it incorporate both men’s and women’s perspectives?

• Who decides whether or not someone can participate in an intervention? And at what level, i.e. within households, communities, institutions? And how is this decided?

Gender power relations domain

Illustrative gender analysis questions

Implementation outcome variable: feasibility - the extent to which an intervention can be carried out in a particular setting or organization

• To what extent do women and men (or other marginalized categories of people) have the same access to educational and training opportunities? To what extent do family support and roles help or limit opportunities for training by gender, marital status, age or other social stratifiers? How might this affect stakeholder engagement within an intervention?

• To what extent do women (or other marginalized categories) have sufficient literacy, autonomy and access to technology to effectively use an intervention?

• To what extent is protective health equipment and gear made available and does it fit bodies that are not the male standard?

• To what extent are women more or less likely to work in frontline service delivery in poorly compensated (including volunteer) or less-supported positions than men? How does this affect who implements an intervention and how?

• How do men’s and women’s roles and responsibilities affect the use of products used within the intervention (e.g. bed nets, vaccinations)?

• What are the challenges different groups of women and men might face in adhering to long-term treatment (e.g. for tuberculosis, HIV or diabetes)? Are they appropriately supported, or stigmatised within health systems and community-based structures?

• How do women and men within households and communities prioritise individuals’ access to medical technologies or commodities used within an intervention, e.g. are boys or girls more likely be prioritised for oral rehydration therapy (ORT)?

• How do social norms and notions of masculinity and femininity influence men’s and women’s decisions to use the protective equipment required in an intervention?

• To what extent does regulation stand in the way of making services used within the intervention more widely accessible for women or marginalized groups, e.g. medical abortion, family planning?

• What is the effectiveness of regulatory mechanisms to ensure that medical products for women or other marginalized groups are not misused, e.g. oxytocin to augment labour?

Gender power relations domain

Illustrative gender analysis questions

Implementation outcome variable: fidelity - the degree to which an intervention was implemented as it was designed in an original protocol, plan or policy.

• To what extent have those in leadership positions received training in gender sensitivity or gender mainstreaming? To what extent does this training emphasis the need to proactively think about gender and power relations and how they may shape an intervention and exacerbate or minimize harm?

• How might participation in an intervention affect health workers’ relationships within the home? Will participation in an intervention compromise their safety?

• To what extent are there differences by gender and other social markers in participation, decision-making and planning of interventions?

• Are health providers who are women or men recognized differently within an intervention? Do they have different needs? To what extent are providers who are women expected to provide more emotional support, or do more caring work than male providers? Are providers who are men expected to work in more dangerous contexts or travel longer distances?

• Has gender been mainstreamed into an intervention design and, if so, how and with what impact?

Gender power relations domain

Illustrative gender analysis questions

Implementation outcome variable: implementation cost - the incremental cost of the delivery strategy. The total cost of implementation also includes the costs of the intervention itself.

• Do implementers who are men or women receive the same level of pay? Do male and female volunteers receive similar incentives?

• Do performance-based incentives mean the same thing for health workers who are men and women across and within cadres? How might this affect an intervention?

• Are services or goods that would increase men’s or women’s involvement in the intervention included in the budget?

• Are opportunity costs appropriately documented from different perspectives in cost calculations, e.g. the opportunity costs of seeking care/accessing an intervention (and not being able to participate in paid/unpaid work)? From an implementers’ perspective, how might costs of participating affect women and men differently?

• What are the social norms around negotiating for the prices of goods and services? Does having a negotiator who is a man or woman affect the cost?

• Who decides what to spend money on? How might this affect what is included within the budget?

Gender power relations domain

Illustrative gender analysis questions

Implementation outcome variable: coverage - the degree to which the population that is eligible to benefit from an intervention actually receives it.

• To what extent do user fees or the removal of user fees have an impact on women and other marginalized groups?

• Has disaggregated information on out-of-pocket expenditures on health for different groups been obtained? Does an intervention incur more out-of-pocket expenditures for men or women? And what is the impact of this on individuals and households?

• Who has access to the skills, devices and technology that transmits and processes health information? How do they use this information?

• How might men’s or women’s responsibilities both inside and outside the home affect their ability to participate in the intervention?

• Are health workers in public facilities more likely to respond to certain groups of clients based on perceived ability to pay, gender etc.? How might this affect an intervention?

• Are those with decision-making power included within the intervention? How might their lack of inclusion affect ability to access the target population?

Gender power relations domain

Illustrative gender analysis questions

Implementation outcome variable: sustainability - the extent to which an intervention is maintained or institutionalized in a given setting.

• Who is more likely to have higher literacy levels and access to social capital, enabling them to participate more effectively in health committees and other forms of health/intervention planning?

• To what extent are there differences by gender and other social markers in participation, decision-making and planning of interventions?

• Does an intervention encourage the participation of men in women’s and children’s health? If yes, how and on what terms? Does it rely on women’s unpaid labour?