Gender analysis, the examination of gender power relations in a society and the norms, expectations and roles for different genders, is receiving more attention in the public health sector, but is often considered an afterthought within the research process. Instead of being an add-on, gender analysis in health systems research should be an integral component at every phase. Health systems are not gender neutral; if the goal is to create equitable and sustainable health solutions and health promotion interventions, then gender (and how gender interacts with other social stratifiers) needs to be considered when designing effective solutions.

Applying a gender lens means examining the role of gender within the different building blocks of health systems and how we can most effectively shape health systems policies, programs and services to benefit everyone. This includes studying how gender power relations play out within a health system and ensuring that we do not perpetuate different gender inequities in our research.

Dr. Rosemary Morgan, assistant scientist in the Health Systems Program of the Department of International Health, brings her experience working on the project, “Research in Gender and Ethics (RinGs): Building Stronger Health Systems” to the Program. The project, funded by the UK Department for International Development (DFID), seeks to galvanize gender analysis within health systems research by providing resources for and building the capacity of health systems research to conduct gender analysis. In addition, Dr. Morgan has been working with students within the Johns Hopkins Bloomberg School of Public Health (JHSPH) to explore the role of gender within different areas of the health system.

Dr. Morgan advised Poonam Daryani, a recent graduate of the MPH program at JHSPH, to conduct an intersectional gender analysis of the Zika response in Brazil. Through her analysis, Poonam explored how the distribution of power based on gender interacted with other social stratifiers, such as race and class, to create different vulnerabilities to Zika infection during the epidemic.

Findings showed that the national response, with its focus on household-level vector control efforts, did not consider the complex sociocultural and economic barriers facing women in Brazil. Failure to account for differential power relations and the resulting gender inequities in Brazil may have limited the effectiveness of the national response in curbing transmission of the virus. Moreover, the inadequacies of the national response were felt largest by poor black and brown Brazilian women, who are largely concentrated in the peripheries of urban centers as well as the North and Northeast regions of the country and who experience disproportionate and compounding barriers to achieving positive health outcomes.

The gender analysis inspired Poonam to pursue the highly competitive Johns Hopkins-Pulitzer Center Fellowship for Global Health Reporting, through which Poonam traveled to the northeast of Brazil to explore the long-term consequences of Zika on those who care for and raise children with congenital Zika syndrome.

Health responses can be strengthened with a greater awareness of gender relations in a given society’s health system. Ideal responses examine and question gender inequities in order to achieve health goals and advance gender justice. It is necessary to apply a gender lens to all health issues so that we can build policies, structures and procedures at an institutional level that create a healthy society for everyone.