Gender mainstreaming for health managers: a practical approach / Handout 3.0 - Understanding access to and control over resources - Sahara's story
Handout 3.0. Understanding access to and control over resources –
Sahara’s story
Sahara is a young woman who, after participating in a school health campaign on breast cancer, performs monthly
breast self-examinations. Now married, she lives in a joint household with many other sisters-in-law who are older than
her. As the youngest sister-in-law and newest member of the household, Sahara has yet to develop relationships with
her husband’s family, who could potentially be a source of social support for her in the transition to married life, joint
living and a new place of residence.
During a monthly breast self-examination, Sahara noticed swelling in her breast and detected a lump in her underarm
area. She remembered that these were signs to look out for from the school health campaign and decided that she
should go to the health clinic for a clinical breast examination to rule out breast cancer or pursue treatment options.
The household has a car and driver, a rare luxury in her small township. Sahara does not have a driver’s permit,
as women from her community are not allowed to drive.
To use the car, Sahara must explain the reasons to the eldest sister-in-law, who will then ask her mother-in-law for
permission on Sahara’s behalf and raise any issues about Sahara’s health - including stigmatizing questions about the
causes of breast lumps and what this may or not imply about Sahara’s character. If her mother-in-law approves, she will
go to see Sahara’s husband to determine whether he is aware of Sahara’s health issues (combined with any commentary
of what it may mean with respect to cultural interpretations of breast issues), that Sahara wants to use the car and
whether he is available to drive her to the clinic. The mother-in-law finally consults the head of the household, Sahara’s
father-in-law, to inform him that Sahara needs to use the car – maybe even the driver – to seek his approval. As it would
be considered inappropriate for Sahara to go to the health clinic in the car alone with the male driver, a decision will be
made as to who will accompany Sahara. In the meantime, Sahara has been worried about the lump she found.
Breast cancer notes
Breast cancer is the most common type of cancer among women younger than 60 years globally and is the leading
cause of death among women 20 – 59 years of age in high-income countries. Although breast cancer is thought to be
more common in high-income countries, the incidence is increasing in low- and middle-income countries, where
a combined burden of breast and cervical cancer takes a toll on women’s health.
Although breast self-examinations do not reduce breast cancer mortality, increasing breast awareness among women
through such a practice can lead to early detection. Studies have shown that women who report practising breast
self-examination tend to have their tumours diagnosed at an earlier stage than those who do not practise breast selfexamination. Early detection can enhance treatment effectiveness. Although breast self-examination may lead to early
diagnosis, the practice does not constitute a reliable screening modality and should not be considered as a replacement
for clinical breast examinations or mammography.
Annual clinical breast examinations (administered by trained health workers) and/or mammography are recommended
for women older than 50 years as important screening components of cancer prevention strategies. The choice of
method depends on the economic setting of the health system in question, although mammography is the preferred
screening method. While the evidence on clinical breast examination is less conclusive, sufficient evidence indicates
that screening by mammography reduces mortality from breast cancer among women aged 50 – 69 years.
Discussion questions
1. Does Sahara have access to the car and driver (or transportation – a health-related resource)?
2. Does Sahara have control over this resource?
3. How do gender norms, roles and relations in Sahara’s household affect her access to and control over other healthrelated resources?
References
1. Breast cancer: prevention and control. Geneva, World Health Organization, 2010
(http://www.who.int/cancer/detection/breastcancer/en/index.html, accessed 15 January 2010).
2. Early detection. Geneva, World Health Organization, 2007 (Cancer control: knowledge into action: WHO guide for
effective programmes; module 3; http://www.who.int/cancer/modules/en/index.html, accessed 15 January 2010).
3. National Cancer Control Programme. Manuals for training in cancer control: manual for health professionals.
New Delhi, Directorate General of Health Services, Ministry of Health and Family Welfare, Government of India, 2005.
4. Thomas DB et al. Randomized trial of breast self-examination in Shanghai: final results. Journal of the National Cancer
Institute, 2002, 94:1445–1457.
5. Women and health: today’s evidence, tomorrow’s agenda. Geneva, World Health Organization, 2009
(http://www.who.int/gender/women_health_report/en/index.html, accessed 15 January 2010).
This tool/document is part of the larger WHO Gender Mainstreaming Manual for Health Managers: a practical approach.
All modifications or uses should reference this source.