Gender, poverty and the delivery of basic services, such as healthcare, education and social protection, are closely interwoven. The delivery of public services is essential for helping women and men to reach their full potential and realise their human rights. Recent investments in human capital endowments have led to significant progress in improving health and education for both women and men. Although gender differences are gradually narrowing, much remains to be done to reduce inequalities in women and men’s well-being. Many of the gaps in progress towards achieving poverty- and service-related MDGs are gender gaps, with women and girls missing out on vital services.
Women are often more dependent on basic services, such as healthcare, education, water and sanitation, because of their domestic roles. However, gender-specific biases in the way services are designed and delivered are failing women in many countries. For example, a lack of separate toilets (or any toilet facilities) in schools can deter adolescent girls from attending school.
Corruption in the provision of basic services such as health and education also has disproportionate negative consequences for women and girls. This is because women are usually the primary users of public services and may also have less access to financial resources to pay necessary bribes.
Corner, L. and Repucci, S. (2009). ‘A User’s Guide to Measuring Gender-Sensitive Basic Service Delivery’, United Nations Development Programme and United Nations Development Fund for Women, Oslo
How can gender-sensitive indicators be used to improve the relevance and quality of basic services for women? This guide offers suggestions and tools to help in developing and using appropriate indicators for various contexts. Sex-disaggregated and gender-sensitive indicators are essential for delivering gender-sensitive services that recognise the different roles, needs and situations of women and men. Indicators can also be used to challenge and inspire others to change their thinking on gender issues.
Transparency International. (2010). ‘Corruption and Gender in Service Delivery: The Unequal Impacts’, TI Working Paper 02/2010, Transparency International
This paper investigates how corruption in the provision of basic services can increase gender inequalities. Corruption in health and education provision can have disproportionate and negative consequences for women and girls. It can compromise their access to quality schools and clinics, their own social and economic empowerment, and their country’s prospects for economic and social development. Mainstreaming gender in anti-corruption work ensures that women are represented at all stages of service delivery and thus less vulnerable to corruption.
World Bank. (2012). ‘Education and health: Where do gender differences really matter?’, Chapter 3 in World Development Report 2012: Gender, Equality and Development, World Bank, Washington DC
This study notes that investments in health and education – human capital endowments – shape the ability of men and women to reach their full potential. It examines gender gaps in education and health, and progress in addressing them. It finds that great progress had been made in cases where removing a single barrier is required. However, progress has been slower either where multiple barriers need to be lifted at the same time or where a single point of entry produces bottlenecks.
Ndikumana, L. (2013). Impact of sectoral allocation of foreign aid on gender equity and human development. WIDER Working Paper, 66.
What role can foreign aid play in improving access to basic services, and in improving gender equality? The paper combines OECD-DAC spending allocations with country-level data. It finds that human development outcomes are largely dependent on pre-existing levels. In gender equality, aid appears to be effective in reducing maternal mortality as well as the gender gap in youth literacy, but its effects are at best mixed for other indicators. The results suggest that more funding to health and education has generally positive effects but specifically helps reduce gender inequality.
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Services and accountability
As one of the most direct measures of government accountability, gender-sensitive service delivery reflects a system of governance that is responsive to women. Women’s efforts to address gender inequalities in service delivery and improve the accountability of public-service providers have ranged from ‘voice’-based (demand) approaches that emphasise collective action, and representation of interests and the ability to demand change, to ‘choice’-based (supply) approaches that promote changes in the supply of responsive public services or fair market practices (UNIFEM, 2009). Although both approaches can complement each other, women (and men) do not always have a ‘choice’ when purchasing power is limited.
UNIFEM. (2009). ‘Services’, Chapter 3 in Who Answers to Women? Gender and Accountability, Progress of the World’s Women 2008/2009, UNIFEM, New York
This chapter examines gender biases in the way services are resourced and designed, and shows how women’s physical and social access to services is often constrained. Practical ways of improving accountability in service delivery include: gender-sensitive mandates that bring gender equality into the remit of every public service; incentives to reward responsive performance; sanctions for neglect of women’s needs; performance measurements and monitoring to ensure that outputs benefit women.
MacPherson, E. (2008). ‘Invisible Agents: Women in Service Delivery Reform’, IDS Bulletin, Vol. 38, No 6, pp. 38-46
Overwhelmingly it is women who access and use public services to meet household needs. New Public Management (NPM) emphasises empowering end-users as agents of accountability, and has influenced public service delivery reforms. This article argues that the generic notion of end-users of public services found in NPM-inspired reforms is mistaken. It hides the constraints women face when accessing services, which can limit their efficacy as agents of accountability. Reformers need to consider gender power relations when designing service delivery reforms.
Holland, J., Ruedin, L., Scott-Villiers, P., & Sheppard, H. (2012). Tackling the Governance of Socially Inclusive Service Delivery. Public Management Review, 14(2), 181-196.
This article draws on case study research in Nepal to examine social accountability processes that work on both sides of the supply–demand divide. It considers their likely contribution to socially inclusive service delivery and to challenging deeper institutional norms that sustain social exclusion. The evidence supports a theory of change which integrates both supply and demand. It also suggests that contextual interventions have a more sustained impact when they tackle the institutions that underpin accountability relations.
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For further discussion and resources on service delivery, see the Service Delivery topic guide.
Although life expectancy is higher for women than men in most countries, women’s longer lives are not necessarily healthy lives. Gender differences in health result partly from unequal access to information and basic healthcare. Broader failures in the coverage and quality of service delivery – water and sanitation, education, employment, electricity – can also impact negatively on girls and women’s health. Other gender-related constraints which reinforce health inequalities include the low value attached to girls’ and women’s wellbeing and limited powers of decision-making over resources at the household and community level. Gender-based violence can also have a severe impact on victims’ physical and mental health.
WHO. (2009). ‘Women and Health: Today’s Evidence Tomorrow’s Agenda’, WHO, Geneva
What are women’s health needs? What is their contribution to the overall health of societies? This report takes stock of the health of women around the world and draws attention to the consequences and costs of failing to address health issues at appropriate points in women’s lives. Addressing women’s health is a necessary and effective approach to strengthening health systems overall – action that will benefit everyone. Consequently, there is an urgent need for more coherent political and institutional leadership, visibility and resources for women’s health.
Bulletin of the World Health Organization (2013). Special theme: women’s health beyond reproduction – a new agenda. Bull World Health Organ vol.91 n.9 Genebra Sep. 2013
This themed issue looks at women’s health and access to healthcare beyond reproductive health issues. The issue provides primary research on specific diseases, ageing, and risk factors, and policy lessons and perspectives. It acknowledges that heath systems are generally not responsive to women’s needs and women do not have access to a full range of healthcare. It recommends a Universal Health Coverage approach, which is client-responsive and holistic.
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Masculinity and participation of males in gender-sensitive health services
Social constructions of gender, notions of masculinity, and power hierarchies between men can also leave certain groups of men vulnerable to health problems. In many countries, higher rates of male mortality are linked to socially-acceptable ‘male’ behaviour that increases men’s health risks, for example, smoking, heavy drinking, and engaging in risky activities. Men also tend to be less likely to access health services, preferring to treat themselves for infections, which can have direct heath implications for the well-being of women and children. Health programmes that seek to engage men and boys have shown promising results – changing attitudes and behaviour. However, most of these health interventions are small in scale and short in duration (Barker et al. 2007).
Barker, G., Ricardo, C. and Nascimento, M. (2007). ‘Engaging Men and Boys in Changing Genderbased Inequity in Health: Evidence from Programme Interventions’, WHO / Promudo, Geneva
How do social constructions of masculinity affect health equity? What kinds of interventions can produce behavioural change in men and boys? This review assesses the effectiveness of programmes seeking to engage men and boys in achieving gender equality and equity in health. Gender norms influence how men interact with their partners, family and children on a wide range of health issues. Programmes that include gender-transformative elements, and those that are integrated with wider community outreach or mobilisation initiatives, are more effective in producing behavioural change.
Odimegwu, C., Pallikadavath, S., & Adedini, S. (2013). The cost of being a man: social and health consequences of Igbo masculinity. Culture, health & sexuality, 15(2), 219-234.
What are men’s approaches to health and health care? This mixed-methods study in Nigeria shows that that there are social and health costs associated with adherence to masculine ideologies (many sexual partners; non-use of condoms) and a strong association between masculine ideologies and men’s health, risk-taking and health-seeking behaviours. Failure to meet ideals of masculinity results in shame, ridicule and street jokes. According to participants, health consequences include a higher prevalence of and risk for STIs, including HIV, high blood pressure, suicide and substance abuse, low sperm count, early ejaculation, wet dreams and herpes. There seems to be an emerging general shift toward non-traditional gender-role beliefs and practices, especially in the urban areas and among those who have more education. Men under-utilise reproductive health services, which need to respond to masculine ideologies.
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For further information and resources on gender and GBV, see the ‘Gender-based violence’ chapter of this guide. For more information on gender and HIV/AIDS, see the section on HIV/AIDS in the ‘Sexual and Reproductive Health and Rights’ chapter of this guide.
Gender gaps in education have reduced considerably at all levels since the establishment of MDGs 2 and 3 on education and gender equality, and the Dakar World Education Forum (2000), when countries committed to eliminating gender disparities in primary and secondary education by 2005. Gender parity in primary education has been achieved globally – equal numbers of girls and boys are enrolled.
This global statistic masks regional and demographic inequalities, and girls continue to face barriers to schooling. Gender disparities persist in many parts of the world, due to deep-seated inequalities. Getting all girls into school will involve designing strategies to tackle household and community-level barriers, such as the direct costs (school fees, clothing, books etc.) and the indirect costs of schooling (such as loss of potential income). The traditional division of household labour often places girls at a disadvantage in terms of ‘opportunity costs’. Early marriage, the low status of women, and patriarchal norms often reduce the priority given to girls’ education. At a school level, barriers to gender equality include harassment in schools, lack of genderresponsive school infrastructure (particularly sanitation facilities), curriculum content, and poor quality learning processes. Girls are often pushed into nonprofessional courses, and overlooked by teachers in classroom discussions.
While progress has been made in closing the gender gap at primary school level, the situation is worse for adolescent girls in secondary school. Gender disparities increase through secondary and tertiary education, with the gap actually widening in Sub-Saharan Africa between 2000 and 2011. Although education for adolescent girls is important for reducing early pregnancies, lowering the risk of HIV/AIDS, and helping girls to meet their learning and developmental needs, relatively few programmes have been specifically designed for adolescent girls. The evidence suggests that adolescent girls require a range of educational opportunities, both formal and nonformal (Lloyd, 2009).
Further research should investigate educational quality and relevance at all levels, particularly aspects that may be beneficial to girls. These include curricular content and promoting opportunities for studying non-traditional subjects at secondary and tertiary level.
Lloyd, C. (2009). ‘New Lessons: The Power of Educating Adolescent Girls’, Population Council, New York
How can education for adolescent girls be improved? This report draws on research on over 300 past and current programmes and projects. It provides new evidence on how proven practices, such as curricula relevant for adolescent girls, scholarships, and the recruitment and training of female teachers, can increase the number of adolescent girls attending school. It also outlines three developmental and learning phases during adolescence, with associated learning goals and preferred educational pathways for girls.
Dunne, M. (2009). ‘Gender as an Entry Point for Addressing Social Exclusion and Multiple Disparities in Education’, Technical Paper, UNGEI Global Advisory Committee Technical Meeting, 27 May, New York
This paper proposes that multiple disparities in education might be best addressed by working through gender. It provides an exploration of the gender disparities, pointing out links to the social and educational exclusion of marginalised groups. The discussion is structured around three main themes: identities, power and processes, and methodologies.
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UNESCO. (2014). 2013/4 Education for All Global Monitoring Report: Teaching and learning: Achieving quality for all. UNESCO Publishing.
The Education for All consortium promotes quality of schooling, and secondary schooling, rather than simple access. It has a set of goals parallel to and overlapping with the MDGs. This annual update shows that in low income countries more girls than boys are out of school, but in middle and high income countries more boys are out of school especially at higher levels of education. The worst-performing countries for gender parity are in Sub-Saharan Africa. It also highlights that there are still very many children not attending school at all.
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Unterhalter E., North, A., Arnot, M., Lloyd, C., Moletsane, L., Murphy-Graham, E., Parkes, J., & Saito, M. (2014). Interventions to enhance girls’ education and gender equality: Final Report. Education Rigorous Literature Review. EPPI-Centre, Social Science Research Unit, Institute of Education, University of London.
What is the evidence on the kind of interventions which lead to expansion and improvement in girls’ education, and does this deepen gender equality? 169 studies were reviewed. The paper shows that the effectiveness of resource interventions depends on careful targeting of educationally under-resourced families, and thoughtful design of programmes to focus on girls most at risk. The evidence shows that good teachers are highly important. Effective interventions are associated with a ‘quality mix’, that is, a combination of a number of different approaches to enhancing gender equality. Interventions concerned with shifting gender norms and enhancing inclusion are under researched and under resourced.
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Women and men are affected by different risks and vulnerabilities. Gender-specific vulnerabilities often intersect with other forms of social exclusion. A gender lens is important when designing and implementing social protection programmes in order to tackle these complex and multiple vulnerabilities, some of which are specific to gender and others exacerbated by gender inequalities. Interventions need to be designed to harness opportunities for positive change – for women and men –and minimise negative consequences. Gender-sensitive social protection programmes are also thought to be more effective in reducing the intergenerational transmission of poverty (Barrientos and Scott, 2008). For example, cash transfers targeted at women are more likely to focus on children’s needs – improving children’s health, nutritional status and school attendance – although they may also reinforce women’s traditional caring roles (Holmes and Jones, 2010).
The evidence to date suggests that gender has been unevenly integrated into social protection approaches. While some programmes are designed explicitly with a primary objective of empowering women, others only include women as a target beneficiary group, and some programmes ignore gender dimensions altogether (Holmes and Jones, 2010).
Although targeting based on sex will help ensure that women receive benefits, it is important that the design and implementation of social protection programmes responds more broadly to different gender-specific risks and vulnerabilities. Such responses might involve improving access to social protection in the labour market and extending social insurance to the informal sector, where women are disproportionately represented. Formalising the informal can help increase the likelihood of reaching poor women. Assisting women in informal social protection, like caring for relatives, by strengthening informal household and community level protection mechanisms is also important. However, this should not increase the burden of work for women. Another strategy is to combine interventions, such as childcare and conditional transfers to benefit women. Gender specific indicators are also needed to assess programmes’ gender differentiated impact (Luttrell and Moser, 2004).
Sweetman, C. (2011). ‘Introduction: Special Issue on Social Protection’, Gender and Development, vol. 19, no. 2, pp. 169-177
This journal issue examines how social protection has been understood and implemented by the state, NGOs, and community organisations, and the impact of different initiatives on gender equality and women’s rights. It highlights the need for more women’s participation in the planning of social protection interventions, and for greater focus on transformative programmes that address structural barriers faced by women.
Holmes, R. and Jones, N. (2010). ‘Rethinking Social Protection Using a Gender Lens’, ODI Working Paper no. 320, Overseas Development Institute (ODI), London
To what extent is social protection programming reinforcing women’s traditional roles and responsibilities, or helping to transform gender relations in economic and social spheres? How can policy and programme design and evaluations better address gender-specific risks and vulnerability? This paper synthesises multi-country research, finding that the integration of gender into social protection approaches has so far been uneven at best. However, all the programmes studied had both intended and unintended effects on women and gender relations. Attention to dynamics within the household can help to maximise positive programme impacts and reduce potentially negative ones. Relatively simple design changes and investment in more strategic implementation practices are needed.
Barrientos, A. and Scott, J. (2008). ‘Social Transfers and Growth: A Review’, Working Paper 51, Brooks World Poverty Institute, Manchester
What effects may social transfers be expected to have on household-level growth in developing countries? This analysis of the available evidence finds very little to support concerns that social transfers have a negative impact on growth. Instead, there is some evidence to indicate that welldesigned and well-implemented social transfers can facilitate micro-level growth by increasing the ability of poor households to invest in their productive capacity. Policymakers need to incorporate growth objectives into social transfer programmes to help build packages of interventions that promote sustainable, long-term improvements in well-being.
Luttrell, C. and Moser, C. (2004). ‘Gender and Social Protection’, Overseas Development Institute, London
This paper discusses the role of gender issues in social protection policies, programmes and strategies. Vulnerabilities to risk vary significantly by gender and shocks affect men and women differently. These differences need to be taken into account when developing social protection policies and programmes.
Kabeer, N. (2008). ‘Mainstreaming Gender in Social Protection for the Informal Economy’, Commonwealth Secretariat, London
This book reviews women’s need for social protection, to protect their livelihoods, encourage decent working conditions and enable collective action. Women are over-represented in the informal and precarious sector, and structural inequalities prevent them from overcoming these barriers by themselves. Children also need to be protected from entering the labour market.
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Holmes, R. and Jones, N. (2013). Gender and Social Protection in the Developing World: Beyond Mothers and Safety Nets. London: Zed Books.
This book illustrates the progress made in the social protection sector in incorporating objectives of voice and agency, and also highlights the significant challenges that remain in moving the social protection poverty agenda beyond a focus on income and ‘traditional’ gender equality goals. Drawing on empirical evidence from poor households and communities in Africa, Asia and Latin America, this book provides insight into the effects of a range of social protection instruments. It concludes that with relatively simple changes to design and with investment in implementation capacity, social protection can contribute to transforming gender relations at the individual, intrahousehold and community levels.
Antonopoulos, R. (2013). From Safety Nets to Economic Empowerment: Is There Space to Promote Gender Equality in the Evolution of Social Protection? (Public Policy Brief 128). Levy Economics Institute.
How can gender equality be integrated into social protection programming? This paper provides a background and overview of social protection, and describes how strategies are evolving from one-off safety nets or risk prevention, to interventions designed to tackle the causes of vulnerability. A gender-sensitive social protection system views women as active agents rather than passive recipients. The paper particularly reviews Conditional Cash Transfers and Employment Guarantee Programmes.
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Further discussion and resources can be found in the Social Protection topic guide.