I N T E R N A T I O N A L B A N K F O R WORLD BANK R E C O N S T R U C T I O N A N D D E V E L O P M E N T 1 April 2006 No. 88 A regular series of notes highlighting recent lessons emerging from the operational and analytical program of the World Bank’s Latin America and Caribbean Region MAINSTREAMING GENDER IN THE HEALTH SECTOR: PREVENTION OF GENDER-BASED VIOLENCE AND MALE INVOLVEMENT IN REPRODUCTIVE HEALTH Myra Betron and Lucía Fort Background Over the past decade, the prevention of gender-based violence 1 and male involvement in reproductive health have come to be viewed as key to advancing the fight against poverty. Research and experience have demon- strated that both issues are crucial to the objectives of gender equality, the reduction of maternal mortality and mitigating the spread of HIV/AIDS, among other impor- tant development indicators. In fact, a 1993 World Bank study showed that the global health burden from gender- based violence, domestic violence and rape in particular is comparable to other diseases and risk factors already recognized in the global agenda, including obstructed labor, HIV, maternal sepsis and tuberculosis (See Figure 1). Studies have also shown the nega- tive economic impact of gen- der-based vio- lence. For ex- ample, in Nicara- gua in 1995, the estimated value of lost produc- tivity from both paid work and unpaid work, as well as the fore- gone value of lifetime earnings for women who died as a result of violence was es- timated to be US$ 32.7 million or 1.6 percent of GDP (Morrison and Orlando in WHO, 2004). Men’s role in improving their own health and that of their families and the importance of addressing the gender inequities underlying poor reproductive health also cannot be denied. Family planning and reproductive health issues have traditionally been seen as concerns for women, and reproductive health programs traditionally focus on women. Although common sense dictates that men play an important role when it comes to reproductive health, Ministries of Health in developing countries almost always have special maternal health or women’s health divisions, implicitly reinforcing the notion that reproductive health concerns only women. Recent findings, displayed in Box 1, underscore the fact that men not only have their own reproductive health concerns but significantly affect the reproductive health of women. Men often decide whether women will receive medical care, as dem- onstrated by anec- dotal evidence from various technical as- sistance activities of the World Bank’s Latin America and the Caribbean Region’s (LCR) Poverty and Gender Group. Sexual and Reproduc- tive Health (SRH) practitioners and scholars have recently began to recognize Public Disclosure Authorized Public Disclosure Authorized Public Disclosure Authorized Public Disclosure Authorized Public Disclosure Authorized Public Disclosure Authorized Public Disclosure Authorized Public Disclosure Authorized 36077