Collaborative Efforts for Advancing Gender Equality

Achieving gender equality remains a critical goal for efforts in global development and health, yet data to inform progress toward this goal has often been absent or unused. To advance gender measurement on reproductive, maternal, newborn, child, and adolescent health and nutrition (RMNCAH+N), Countdown to 2030, is collaborating with the Global Financing Facility (GFF) and the Monitoring and Action for Gender and Equity project (MAGE), a GFF partnership with the Johns Hopkins University (JHU).

What to Measure

Health systems often exhibit gender imbalances in leadership positions, with men disproportionately represented in high-level roles. Moreover, women bear a significant burden of unpaid work. Health services lack women-friendly attributes, including concerns related to cost, convenience, and respect. The measurement of women's health needs and outcomes is often deprioritized, neglecting issues such as maternal morbidity, infertility, and menstrual health.

There are three types of gender indicators:

  • sex disaggregated indicators,
  • sex specific indicators, and
  • gender power relations and systems level indicators.

These can be used to measure the extent to which (1) women and girls are disadvantaged compared to men, (2) women's and girls’ needs, preferences and rights are being met, and (3) health systems are catering to assess these needs. While sex-disaggregated indicators can be used to measure inequality between women and men, gender-specific indicators can also be used to assess ways in which women and girls are disadvantaged because their rights, needs, and choices are not addressed, or women's health-related experiences as care givers and care seekers are shaped by power dynamics within health systems.

For example, findings show how, in select countries, girls are disadvantaged compared to boys on birth registration (Fig. 1), women’s need for basic post-natal care (PNC) remains low or unmet, and women are less likely to be enrolled in and use health insurance compared to men (Fig. 2).

 

Fig 1. Percentage of girls vs. boys 0-4 who had their births registered

Source: Liberia 2019-20 DHS; Mali 2018 DHS; Senegal 2019 DHS

 

Fig 2. Percentage of women and men enrolled and utilizing health insurance in Cote d’Ivoire

Source: CIV national health insurance data 2021; CNAM 2020

 

While traditional measurement tools such as indices and scales are useful for tracking progress over time, they often overlook gender-specific elements and fail to capture the nuances of women's experiences within healthcare settings. It is also important to consider intersectional disadvantages, recognizing that factors such as age, wealth, and location can further exacerbate disparities in healthcare access and outcomes.

 

Enhancing Gender Measurement in Countdown Collaborations

Countdown, in collaboration with its partners, is conducting multi-country studies on maternal and newborn health (MNH), family planning and other topics. The results from the MNH study will offer valuable insights into the intersectionality of gender and RMNCAH+N indicators, help deepen understanding of gender dynamics and inform progress on reforms toward more gender equitable RMNCAH+N outcomes. By analyzing data and identifying national and regional trends, these studies will contribute to the evidence base for promoting gender-responsive MNH interventions and policies.

Content on measurement of gender equity has also been included in the Countdown annual meetings. In 2023, Dr. Anju Malhotra presented how gender equality can be promoted through Countdown’s work. In 2024, the MAGE and GFF teams also contributed a poster on Gender and Measurement of RMNCAH+N. Additionally, the MAGE and Countdown teams collaborated with the Zambia country team to demonstrate how facility data and survey data on women’s experience of experience can be used to demonstrate the significant gaps in women’s access to respectful maternal care. The Zambia case study highlighted how the provision and experience of delivery care, especially for disadvantaged women is frequently disempowering (Fig. 3), and how providers not only lack training, but face challenges due to staff shortages and limited equipment and supplies. Health facilities, especially at the primary level, are significantly short on service readiness (Fig. 4).

 

Fig 3. Women's experience of delivery care

Source: data on women’s experience of delivery care from Lusaka study in Unplanned Settlements, 2022

 

Fig 4. BEmONC Service Readiness

 

Data analysis from the case study in Zambia highlights critical actions moving forward. It is essential to ensure that healthcare facilities meet women's basic needs and rights, as women are likely to avoid facilities that fail in this regard: many lower-level facilities require significant upgrades to ensure basic service readiness, and attention must be given to staffing, training, and management improvements at both lower-level and higher-level facilities to fully address women's needs and rights. The Countdown-GFF-MAGE collaboration provides opportunity to translate data for a policy audience and leverage platforms to enhance gender analysis, data use and dissemination.

Existing Resources

Partnering with GFF and MAGE has enabled Countdown to leverage resources, expertise, and data to advance gender equality. The GFF data portal on gender equality is as a valuable repository of evidence to support the interpretation and use of data on gender equality and RMNCAH+N. GFF’s Gender and RMNCAH+N indicators emphasize the role of current gender inequalities as determinants of RMNCAH+N outcomes. Similarly MAGE offers a comprehensive library of gender tools to help integrate gender into monitoring and evaluation, data portals to facilitate research and analysis in this crucial area, and additional resources.