Sex and Gender-Based Analysis (SGBA)

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  • Why sex and gender matter in health research, policy-making and practice 
  • What is SGBA?
  • SBGA tools (general)
  • SBGA tools (specialized)
  • Applications of SGBA: Some examples
  • Links to government programs and resources
  • Additional resources
    • General
    • Health determinants
    • International
    • Journals

Why sex and gender matter in health research, policy-making and practice

An understanding of sex- and gender-based analysis (SGBA) is crucial for engaging in effective health research, policy-making and practice. SGBA is a powerful tool for analyzing how both sex – rooted in biology – and gender – rooted in social roles shaped by environment and experience - affect our health.

Health research and practice have traditionally assumed a gender-neutral or gender-blind stance by using men as the standard for medical practice while excluding women from clinical trials and other research. More recently, and largely through the field of women’s health, we have come to develop the SGBA tools to understand and improve women’s health. SGBA is still in its formative stages but already making great strides. As Arlene Bierman writes, “In a relatively short period, sex- and gender-based analyses have contributed to an exponential growth in our knowledge about health differences between men and women.” (Sex Matters, CMAJ, 2007 177(12)) New approaches to health research, such as “intersectionality” are further enriching and honing our SGBA tools.

And now it is clear that SGBA is a vital tool for improving the health of not only women but men as well. Through using SGBA, we are learning how women and men differ – often very significantly - in patterns of illness, disease risk factors, treatments and social contexts. And when we apply this expanded knowledge to policy and practice, it leads to better health outcomes for all.

The following list is a selection of Canadian and International resources available on the Internet to aid you in understanding and using SGBA.

For more information: The CWHN databases, from which these resources are drawn, are updated regularly with new resources. For more information about SGBA, please search our databases with terms such as: “sex and gender”, “sex- and gender-based analysis”, “gender-based analysis”, “GBA”. Search our database.

 What is SGBA?

Better Science with Sex and Gender: A Primer for Health Research
By Joy Johnson, Lorraine Greaves, and Robin Repta, Women’s Health Research Network
, 2007
Aims to help researchers understand how sex and gender contribute to health, and suggests ways to incorporate this understanding into their research practices.

Serious Gaps: How the Lack of Sex/Gender-based Analysis Impairs Health
By Rosaly Correa-de-Araujo, Journal of Women's Health, December 2006, Volume 15, Number 10, pages 1116-1122

Looks critically at the need for SGBA in health research, practice and policy for improving health outcomes for women.

Gender-Based Analysis: Beyond the Red Queen Syndrome
By Karen R. Grant, Presentation at the GBA Fair, Ottawa Congress Centre, January 31, 2002

Advocates for the continuing need for gender-based analysis to assess the effects of health policies and programs on women and men.

SBGA tools (general)

Rising to the Challenge: Sex‑ and Gender‑based analysis for Health Planning, Policy and Research in Canada
By Barbara Clow, Ann Pederson, Margaret Haworth-Brockman, and Jennifer Bernier (Eds.), Atlantic Centre of Excellence for Women's Health, 2009

Provides a comprehensive overview of sex‑ and gender‑based analysis, including a discussion of core concepts and a number of case studies illustrating the application of SGBA to surveillance data, literature reviews and systematic reviews, health surveys, health policy making, health protection and health program development. A list of resources is included.

Gender Awakening Tool / Bibliography: Sex & Gender in Research
By Linda Nieuwenhoven and Ineke Klinge, Women in Science Research and Education Festival, 2007

Presents a checklist or step-by-step plan developed in Europe to assess if all relevant aspects of sex and gender have been considered in biomedical and health related research. Also contains a bibliography with references of literature on the integration of sex & gender aspects in health research.

Gender-Based Analysis in Planning
By the Prairie Women’s Health Centre of Excellence, 2005

Offers recommendations from the Centres of Excellence for Women’s Health and Working Groups of the Women’s Health Contribution Program on how to more fully integrate GBA in research, planning and decision-making.

Just the Facts Ma’am: A Woman’s Guide for Understanding Evidence about Health and Health Care
By the National Coordinating Group on Health Care Reform and Women (now Women and Health Care Reform), 2005

Provides tools for women to assess arguments and evidence about women, health and health care reforms, and to help women make their own decisions about health care and health care reforms.

Gender, Sex and Health Research Guide: A Tool for CIHR Applicantss
Canadian Institutes of Health Research

A guide to help CIHR applicants consider when and how sex and gender are implicated in proposed research projects.

The Gender and Health Collaborative Curriculum Project (GHCCP)
A self-guided learning tool for health practitioners to learn why and how to use sex-and gender-based concepts and approaches in medical practice and health research. Sponsored by the Ontario Women’s Council.

SBGA tools (specialized)

Intersectionality: Moving Women's Health Research and Policy Forward
By the Women’s Health Research Network, 2009

Explains how to apply an intersectional framework when carrying out women's health research. Shows how intersectionality can be used for studying, understanding, and responding to the ways in which sex and gender intersect with other variables and how these intersections contribute to unique experiences of health. Argues for an intersectional framework as the next step in the evolution of women’s health research and policy.

Sex, Gender and Systematic Reviews
By Madeline Boscoe, Marion Doull and Vivien E. Runnels
, in Rising to the Challenge: Sex‑ and Gender‑based analysis for Health Planning, Policy and Research in Canada, pp. 44-48, Atlantic Centre of Excellence for Women's Health, 2009
Describes the development of the Sex and Gender Appraisal Tool for systematic reviews and reports on its application with systematic reviews of cardiovascular diseases. Reinforces the conclusion that current systematic review models are not sufficiently sensitive to sex and gender and suggests opportunities to address this situation.

Gender Basic: Final Report
By Dr. Ineke Klinge, Centre for Gender and Diversity, School for Public Health and Primary Care (Caphri), Maastricht University, The Netherlands, 2008

Reports on The Gender Basic project that arose from the European Union gender equality policy for research. References a wide variety of SGBA tools and health research which has used SGBA in anxiety disorders, asthma, metabolic syndrome, nutrigenomics, osteoporosis, and work-related health.

Culturally Relevant Gender-based Analysis: An Issue Paper
By the Native Women’s Association of Canada, 2007

Highlights the effects of gendered discrimination against Aboriginal women, and outlines recommendations on future work that is needed to ensure that culturally relevant gender-based analysis (CRGBA) is implemented effectively.

Gender-Based Analysis of Settlement
By the Canadian Council for Refugees, 2006
Discusses the importance of gender-based analysis within the settlement sector, dealing with issues of health, education, sexuality, employment, and family relations.

Applications of SGBA: Some examples

A Profile of Women’s Health in Manitoba
By Lissa Donner, Harpa Isfeld, Margaret Haworth-Brockman, and Caitlin Forsey, Prairie Women's Health Centre of Excellence, 2008

Reports on a first-ever gender-based analysis of over 150 indicators of women's health. Provides new information on the health, health outcomes and health care use of women in Manitoba, using a broad perspective. Shows that what makes women healthy or unhealthy is not just a combination of physical and physiological conditions, but includes many other factors. Describes and explains these factors, and points to policies and programs which can lead to improvements and change.

Sex Matters: Gender Disparities in Quality and Outcomes of Care
By Arlene S. Bierman ,CMAJ, December 4, 2007, Volume 177, Number 12, pages 1520–1521

Identifies important sex and gender disparities in intensive care use and outcomes. Shows that, for example, critically ill women 50 years and older were less likely than critically ill men to be admitted to an intensive care unit (ICU) and to receive potentially life-saving interventions, and they were more likely to die in ICU or in hospital. Notes that patient-level, provider-level and system-level factors contribute to observed sex and gender disparities in quality and outcomes of care for critical illness.

Gender-based Analysis and Wait Times: New Questions, New Knowledge
By Beth E. Jackson, Ann Pederson and Madeline Boscoe for the Women and Health Care Reform Group, 2006

Looks critically at wait times issues for women in Canada, using a gender-lens and gender-based analysis. Published as an Appendix to the Final Report of the Federal Advisory on Wait Times.

The Inclusion of Women in Clinical Trials: Are We Asking the Right Questions?
By Abby Lippman for Women and Health Protection, 2006

Addresses both the narrow and the wider issues evoked in considering the inclusion of women in clinical trials, highlighting especially where gender, even more than sex, is pertinent.

The Bare Bones of Sex: Part 1 - Sex and Gender
By Anne Fausto-Sterling, Signs, 2005, Volume 30, Number 2, pages 1491-1528

Argues that the sex/gender distinction has limitations when thinking specifically about the body and biology and that new theoretical approaches must be developed to analyze the interplay between biology and culture. Considers, for example, the sex/gender differences in bone development.

Links to government programs and resources

Institute of Gender and Health: Canadian Institutes for Health Research
Canada’s national institute supporting research that addresses how sex and gender influence health.

Gender Matters: Institute of Gender and Health Strategic Plan 2009-2012
Maps a course for the strategic activities of the IGH from 2009 to 2012, through the Institute’s annual allocation of strategic funding. Explains that this money will be directed toward capacity building and supporting priority research areas, and that additional dollars will be acquired by leveraging partnerships and working collaboratively with others.

Note: Provincial, territorial and regional health programs and policies for SGBA vary across Canada. See regional government health departments for information about each region’s commitment to SGBA.

Additional resources

General

Gender-based Analysis/Gender Mainstreaming Annotated Bibliography
By the Status of Women Canada, 2002
Organized into five categories: guides/tools; policy and official documents; training; research; and, evaluation.

Health determinants

Gendering the Health Determinants Framework: Why Girls’ and Women’s Health Matters
By Cecilia Benoit, and Leah Shumka for the Women’s Health Research Network, 2009
Clarifies the concepts in the health determinants framework (HDF) and examines its usefulness in understanding the health of a unique population group — girls and women — who face disadvantage due to structural inequities.

International

Closing the Gap in a Generation: Health Equity through Action on the Social Determinants of Health
World Health Organization Commission on the Social Determinants of Health Final Report, 2008
Explains that social justice is a matter of life and death. Describes how, for example, a girl born today can expect to live for more than 80 years if she is born in some countries – but less than 45 years if she is born in others. Also shows that within countries there are dramatic differences in health that are closely linked with degrees of social disadvantage. Calls on the WHO and all governments to lead global action on the social determinants of health with the aim of achieving health equity.

CIDA’s Policy on Gender Equality
By the Canadian International Development Agency, 1999
Argues that gender equality contributes substantially to improving the well-being of women, men, girls and boys in our partner countries. Discusses how CIDA remains committed to creating, with their partners, a better world for all where inequality on any grounds, be it gender, class, race or ethnicity, is finally overcome.

Journals

Gender Medicine
The peer-reviewed journal of the Partnership for Gender-Specific Medicine at Columbia University.