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Pillars of our Work in Health Promotion

  • Gender and Health

  • Prevention of Violence against Women

  • Sexual and Reproductive Health

Gender and Health

Gender and health still matters.

As leaders in health promotion and primary prevention of health, WHISE builds upon and uses the evidence base on social determinants of health (in accordance with the World Health Organisation) and understand in our planning and our practice that unequal power, status across genders are a root cause for the inequalities faced by women and girls –across their lives.

In their charter for the 2019 Federal Election, the Australian Women’s Health Network laid the clear foundations for a focus on women and their health:

Health outcomes and experiences for women (and men) continue to be profoundly shaped by sex (biological) and gender (social) and often reflect broader gender inequalities in society. Gender inequality and the imbalance of power in relationships impacts on social, emotional, economic and health outcomes for women.
- (Australian Women’s Health Network, 2019)

Intersectionality

The concept of intersectionality is about being attentive to the way in which “systems of inequality interlock to create conditions for either health equity or health inequalities” (Lopez & Gadsden, December 5, 2016). Taking an intersectional lens on health from a women’s perspective, “helps us understand that every (woman’s) experience is fundamentally different that the experience of others, based on their unique identify and structural positions within systems of inequality and structural impediments” (Lopez & Gadsen, 2016).

An intersectional approach… starts with diversity instead of commonality. Such an understanding may be arrived at by bringing the voices and experiences of marginalized women to the centre of analysis, rather than positioning them at the margins to be defined by their ‘difference from’ the universalized centre. - (A Murdolo and R Quiazon in Chen, 2017)

Gender inequality in the workplace

As of November 2018, Australia’s national gender pay gap stands at 14.1%, with women in full-time work earning on average $239.80 less per week than men (Workplace Gender Equality Agency, 2018). Over the last 20 years, the gender pay gap has ranged between 14.9 in 2004 and 18.5 in 2014. The pay gap starts from the time women enter the workforce. Contributing factors include: hiring and pay discrimination, female-dominated sectors attracting lower wages, women’s disproportionate share of unpaid caring and domestic work, limited workplace flexibility to accommodate women’s non-work responsibilities, and women’s greater time out of the workforce impacting career progression (Workplace Gender Equality Agency, 2018). The gender pay gap, combined with women’s higher likelihood of part-time work, impacts on their lifetime economic security and health.

Gender inequality in income

ABS census data from 2016 demonstrated clear gender inequality in the proportion of women and men who earn below the minimum weekly wage (that is, $0 -$649 pw) across the SMR. In our region, the proportion of women earning below the minimum weekly wage was consistently higher than men. There were six LGAs in which the proportion of women earning below the minimum weekly wage exceeded the state average.

Unpaid Work

According to ABS figures, “employed women did more hours of unpaid domestic work such as housework, grocery shopping, gardening and repairs than employed men. In 2016, over half of employed men did nil or less than five hours per week of unpaid domestic work (60%) compared with a third of employed women (36%). Men were also less likely than women to do 15 hours or more per week of unpaid domestic work (8% of men and 27% of women). This pattern applied across all hours of paid work, even for those working more than 49 hours per week” (ABS 2016).

Throughout the SMR, similar findings are observed. As can be seen from the chart below, females bear the burden of unpaid domestic work across all ten LGA’s, highlighting the gendered nature of caring/domestic responsibilities.

Gender inequality in leadership

Gender disparities are consistently seen across Australian workplaces, such as the disparity between men and women in leadership roles. This perpetuates existing stereotypes about the role of women, both at work and in wider society, and exacerbates gender pay inequality (WHV, 20196). While women in leadership does not provide a solution for gender inequality, women’s increased representation contributes to gender equality, which is a key determinant for women’s health.

Prevention of Violence against Women

The link between gender inequality and health outcomes is clearly demonstrated in the prevalence of violence against women.

One in three Australian women will experience physical violence and one in five women over the age of 15 will experience sexual violence at some stage in their lifetime. Violence against women includes psychological, economic, emotional, physical and sexual violence and is the leading preventable contributor to death, disability and illness in Victorian women aged 15 – 44 years. It compounds existing socioeconomic disadvantage that may result in homelessness, and has significant effects on the mental health of those affected.

Family Violence and Pregnancy

Gender disparities are consistently seen across Australian workplaces, such as the disparity between men and women in leadership roles. This perpetuates existing stereotypes about the role of women, both at work and in wider society, and exacerbates gender pay inequality (WHV, 20196). While women in leadership does not provide a solution for gender inequality, women’s increased representation contributes to gender equality, which is a key determinant for women’s health.

Family Violence and Children

In the VicHealth report ‘Violence against women in Australia ‘An overview of research and approaches to primary prevention’ (2017), it was reported that “there are 128,500 women in Australia who have experienced violence by a current cohabiting partner and had children in their care during the violence; for 74,300 (58%) of these women, the children in their care witnessed (heard or saw) the violence”.  Moreover, the report revealed that “there are 733,900 women in Australia who have experienced violence by a previous cohabiting partner and had children in their care during the violence; for 568,700 (77%) of these women, the children in their care witnessed (heard or saw) the violence” (Victorian Health Promotion Foundation, 2017).

Perceptions of safety

There is a low sense of safety in the region. Evidence from research into perceptions of safety show that females have lower rates in regard to perceptions of safety compared to men across our region. From 2011 to 2015, the rate of perceptions of safety fell across our region for women.  While men’s perception of safety also fell from 2011 to 2015, the rates were still considerably higher than that of females revealing that men’s perception of safety was significantly higher than that of females in both 2011 and 2015.

Females across Casey, Frankston and Greater Dandenong express more significant concerns about safety.  Six out of the 10 municipalities within the region scored below the state average of in both 2011 and 2015. In contrast, females in the municipalities of Bayside (71.8%), Port Phillip (71.9%), Mornington Peninsula (67.8%) and Stonnington (69%) scored higher when answering the same question.

Stalking and Harassment in the SMR

Across the SMR, stalking and harassment offences have increased since 2014 in a number of LGA’s.  As can be seen from the chart below Kingston, Port Phillip and Stonnington have seen increased rates of stalking and harassment in the last five year period.  Port Phillip and Kingston, in particular, have seen a significant rise with an increase of 33.85% and 34.6% respectively.

Attitudes to violence against women

The high rates of violence against women and sexual offences within the SMR reveal concerning attitudes and experiences.  While limited information and data is found regarding attitudes to violence against women within the SMR specifically, the National Community Attitudes towards Violence against Women Survey, or NCAS (2017) provides some relevant data and insights.

Amongst some of its encouraging results, the survey reveals that:

  • Most Australians have accurate knowledge of violence against women and do not endorse this violence.
  • Most Australians support gender equality and are more likely to support gender equality in 2017 than they were in 2013 and 2009.
  • Australians are more likely to understand that violence against women involves more than just physical violence in 2017 than they were in 2013 and 2009.
  • Australians are less likely to hold attitudes supportive of violence against women in 2017 than they were in 2013 and 2009.
  • There has been improvement in knowledge and attitudes related to 27 of the 36 questions asked in 2013 and again in 2017.
  • There has been improvement in knowledge and attitudes related to all but two of the 11 questions asked in the 1995 NCAS and again in 2017.

Despite these encouraging results, there continues to be concerning attitudes, including:

  • A decline in the number of Australians who understand that men are more likely than women to perpetrate domestic violence.
  • A concerning proportion of Australians believe that gender inequality is exaggerated or no longer a problem.
  • Among attitudes condoning violence against women, the highest level of agreement was with the idea that women use claims of violence to gain tactical advantage in their relationships with men.
  • 1 in 5 Australians would not be bothered if a male friend told a sexist joke about women.

Further, almost two in five (37%) young Australians agree that women make up or exaggerate claims of violence to secure advantage in custody battles, with young men (49%) nearly twice as likely to agree than young women (26%). The proportion agreeing with this statement has dropped by 15 percentage points since 2013Attitudes toward violence against women and gender equality among people from non-English speaking countries.

Sexual and Reproductive Health

Reproductive Access and Rights

Through a mapping of SRH services in the region in 2018, WHISE found that women lacked information and access to contraception.  A rise in pregnancy testing was found by a number of organisations providing this service. Twenty-five per cent of respondents identified an increase in pregnancy testing over the previous year.

Have you identified an increase or decrease in the following needs from your clients of the past year?

It was also found that the most ‘popular’ form of contraception from organisations providing this service was condoms. Out of those organisations that provide contraception, 82.5% provided condoms in contrast to other forms of contraception.  This statistic may explain the rise in pregnancy testing sought, particularly when rates for Implanon insertion remained low.

Contraceptive Implant

Within the SMR, we can see that uptake rates for the contraceptive Implant are consistently low. Data from the Women’s Health Atlas reveal that several LGA’s are below the state average, while the LGA’s of Cardinia, Casey, Frankston, and Bayside, to a lesser degree, have higher rates of contraceptive implant use.

Contraceptive IUD

Intra Uterine Device (IUD) insertion is variable throughout the SMR. Greater Dandenong has the lowest rate in the SMR, as the chart below reveals.  We can see that this has been the case from 2016 to 2018.  Interestingly, the uptake of the contraceptive IUD across the SMR has also steadily been increasing from 2016 to 2018.

Low uptake of Long Acting Reversible Contraception (LARC) remains a significant barrier to women’s SRH.  While condoms remain a very popular form of contraception, rises in pregnancy testing indicate challenges in relation to the types of contraception women might have access to.

Service Provision

WHISE has identified a number of issues of unmet service provision or requiring attention. It was found that 59% of organisations who responded to WHISE 2018 Service Mapping research stated that they were unable to appropriately provide SRH services for specific unmet needs.  Some of their concerns included:

  • Their inability to provide culturally appropriate SRH information
  • A lack of female GPs, or women’s health clinics
  • Long waiting lists for IUD insertion
  • A lack of easily accessible youth friendly sexual health practitioners

These practitioners and service providers further outlined various reasons for their inability to adequately respond to specific needs in their service provision.  These included:

  • Inadequate or no funding for certain aspects of SRH
  • Inability to adequately refer clients to more specialised services
  • Lack of consistently available health practitioners
  • Lack of appropriately qualified and experienced health practitioners

STI rates: shifting attitudes

Throughout Australia, high levels of STIs continue to occur.  There is often misinformation or misunderstanding about the impact or health consequences of STIs

Throughout the SMR, high rates of STIs were identified, in line with national trends.  In particular, high rates of Chlamydia, Gonorrhoea, and Hepatitis B were found present amongst a number of municipalities in the SMR. In addition, high rates of HIV were found amongst a large proportion of males in other municipalities.

Cervical Screening Participation

Low participation in cervical screening (formerly known as Pap Screening) is found in Cardinia, Casey, Frankston and Greater Dandenong.  These four municipalities are below the state average of 60% participation with Frankston having only 54% participation rate.

In December 2017, a five-yearly Cervical Screening Test replaced the two-yearly Pap test. The new Cervical Screening Test is more effective than a Pap test previously undertaken every two years (Department of Health, 2018).  It will be interesting to see whether this impacts on screening rates

HPV Vaccination

Several LGAs have low HPV immunisation rates for 14 year-old females. The vaccine has been shown to reduce cervical cancer and remains an important aspect of SRH.  Despite this, several LGAs within the SMR have lower rates of HPV vaccination.  Cardinia, Casey, and Greater Dandenong reveal a lower coverage, particularly in relation to Dose 3 of the vaccination. It is important for all three doses to be administered as this ensures full protection against HPV-related cancers