Gender and Malaria: Discussion Paper

"Making the investment case for programming that addresses the specific vulnerabilities and needs of both males and females who are affected by or at risk of malaria."

This discussion paper from the United Nations Development Programme (UNDP) summarises the existing evidence base on malaria, "demonstrating the ways in which gender impacts ...risks and effects (including those that intersect with HIV), and highlighting existing data and implementation gaps." Written for the UNDP "in its role in supporting governments to implement and operationalise the [Sustainable Development Goals] SDG agenda", the evidence and recommendations are intended "for practitioners preparing concept notes for Global Fund resources. As such, this paper has been designed to be used in conjunction with UNDP’s 2015 ‘Checklist on Integrating Gender into the Processes and Mechanisms of the Global Fund to Fight HIV, TB and Malaria’". 

As indicated in the Executive summary, while all genders and ages are vulnerable to malaria, "[W]omen have less access to information about how to protect themselves from malaria than men, due to lower literacy rates. Women’s traditional household roles, such as cooking the evening meal outdoors or waking up before sunrise to prepare the household for the day, may also put them at greater risk of malaria infection. Additionally, women may be less likely to sleep under long-lasting insecticidal nets (LLINs) due to cultural and social pressures." Males working outdoors may also be more susceptible during peak mosquito season. Thus, as stated in the discussion paper, it is important to tailor interventions materials and information to different groups and to consider social and cultural norms which impact women's and men's ability to access prevention and treatment services, depending on gender-specific economic necessity. "[T]he economic effect is greater for female family members, who face increased pressures to provide food and medicines, as well as a rise in care-giving responsibilities." 

In a study of gender-differentiated access to information it was found that language barriers are higher for women due to illiteracy. In a study of dress norms, it was found that men were more vulnerable because of more exposed skin in hot weather. Division of labour, as mentioned earlier, can cause higher vulnerability depending on hours spent outdoors, as well as the need to arise early for household chores when mosquitoes are more active.

Social norms that impede health seeking behaviours, for example, harassment from spouses about the expense of medical services, likelihood of being alone with a male doctor, restricted mobility among women, gender-driven superstitions, and lack of time for following prescribes treatments, can exacerbate the effects of malaria along the lines of gender. Pregnancy, bringing with it increased biological susceptibility, as stated in the discussion paper, should be a particular focus for prevention, diagnosis, and treatment. The document describes medical evidence of the increased risk in women who are young, poor, pregnant and HIV-positive. "The World Health Organization (WHO) recommends providing IPTp [Intermittent preventive treatment in pregnancy] and LLIN [long lasting insecticidal nets] to pregnant women through antenatal clinics (ANCs): IPTp at every ANC visit in the second and third trimester, and LLINs at the first ANC visit, as early as possible." However, lack of access to treatment is a major cause of continued health problems and mother and infant deaths.

As indicated in the paper, gaps in research and in programmatic data must be filled to support understanding of the impact of gender norms and gender inequities. Recommendation include the following:

"1. Develop a gender assessment tool tailored to malaria.

2. Develop a compendium of good practices in gender-sensitive malaria service provision.

3. Improve capacity for gender analysis and programming.

4. Require sex-disaggregated data and develop gender specific indicators."