I’ve never had an “Ahaa” moment when viewing gender issues as an important aspect to health outcomes, until 2014 after I joined a clinical medicine training college, based in the southern coast of Tanzania (Mtwara).
When I began my studies, I uncovered shocking data on the teenage pregnancy and school dropouts of young people. In the Mtwara region, specifically from 2015-2017, there were hundreds of school dropouts from secondary and primary schools due to teenage pregnancy. During early adolescence, when a girl gets pregnant they are not allowed to go back to school in Tanzania finding themselves with a child to support and no qualification to gain a good job. During hospital rotation, is where I have met adolescent girls and young women suffering serious complications from unsafe abortions and some others even ending up losing their lives.
Adolescent boys and those known as young fathers, are praised as being “man enough” and more masculine, as an age-old cultural/tribal perception partly still proven by boys and men intentionally having more kids by different or multiple partners and welcome being a young father because they are seen as a man and a legend. These societal gender dynamics in sexual and reproductive health and rights (SRHR) have contributed to a number of poor health outcomes in Tanzania like high maternal mortality rate, high neonatal mortality rate, poor nutrition for children under five, due to poor motherhood skills, and a high rate of HIV/AIDS transmission. As of today, there are reportedly more than 8000 school dropouts in Tanzania each year due to teenage pregnancy, this dynamic affects more girls and women than boys and men and contributes to a higher gender disparity gap.
In 2019, I worked with a group of young mothers between 18-25 years who were kicked out of school due to teenage pregnancy and started working as commercial sex workers, inevitably earning less than a dollar per day. Considering the fact that commercial sex work is not recognized in Tanzania, once a girl or woman becomes pregnant and is not allowed to go back to school this stigma adds an excessive amount of social discrimination.
Furthermore, a typical group of 25 young pregnant mothers are not a homogenous group, some of them may have multiple overlapping forms of vulnerabilities such as the following:
Gender is a social construct for what is attributed to be socially acceptable otherwise right or wrong based on gender roles for a man or woman; and this concept is not a women-only construct. Oftentimes, gender issues are seen as women-only issues and this is incorrect, as gender issues affect men and everyone as well.
Our societies’ cultures have been very much attached to a patriarchal system that favors men more than women in many aspects including gender roles and needs assessments, gender resource mobilization including issues of access, and control over resources. These issues have pivotal impacts on the power dynamics between men and women that trickle down to decision making capabilities even on sensitive issues like access to health care services. For instance, in Mtwara and most Tanzania communities, a man is the final decision maker on whether their girlfriend or wife should use a family planning method or not.
During a recent scenario in one of our programs, a man asked to use a knife to forcefully remove an implant from his wife’s arm. Eventually, the impact of family planning affects everyone not just women, to further emphasize having unplanned pregnancies affects both of the caregivers/parents proving gender issues are not just women issues but societal issues that men, women, and everyone need to be involved in together.
In 2023, Young and Alive Initiative are working in partnership with USAID, and IREX through the youth excel project, we are implementing a gender transformative program for adolescent boys and young men in the southern highlands of Tanzania. The reason we focused on men this time is because men and boys have often been overlooked in discussions around SRHR and gender.
We are leveraging a gender transformative tool that covers a wide range of topics such as family planning, mental health, and gender with the aim of promoting social behavior change (SBC) by encouraging responsible sexual and reproductive health behaviors among adolescent boys and young men. We have recently learned how to undergo intersectional rapid gender assessments (IRGPA) before conducting any project in any community. The IRGPA helps us understand common issues such as gender roles, responsibilities and time use, capacities, and assets and resource distribution in given communities before we implement our programs.
We also make it a point to involve communities in brainstorming gender exercises. One of my favorites is a gender box game that brings everyone to reach an “AHAA ” point just as I found myself during my studies. This exercise involves communities doing their own gender analysis by looking at daily gender role dynamics or distribution amongst themselves. At the end of the exercise, participants continue to analyze further to detect how common occurrences of gender role dynamics impacts resource distribution and power imbalances during decision making for sensitive issues like whether to use family planning or not.
I want to encourage organizations and partners working in the health sector to provide spaces for individuals in their organizations to learn about gender-based issues. I have recently learned most of the institutions would have discussions on current gender policies, but these are not being lived by individuals outside of corporate or traditional working spaces. Someone can present themself as gender sensitive at work, but at home very patriarchy and oppressive. I am calling for individuals to commit time, understanding, and efforts to learn about gender issues and “walk the talk.” I charge all organizations and institutions to learn how to conduct gender audit assessments and utilize it to train their team members on areas of impactful improvements. Gender issues are issues to learn and uncover everyday.