Somporn Rungreangkulkij, RN, Ph.

D
WHO CC Research and Training on Gender
and Womens Health
Khon Kaen University, Thailand
 Discussion
What are indonesian society,
especially potianak believe or
expect to women and men
1.Roles in a family, workplace,
community
2.Norms,
3.Place
 GROUP 1
ROLES IN
FAMILY/WORKPLACE/COMMUNITY/
NORM /PLACE

MAN WOMAN
 GROUP 2
ROLES IN
FAMILY/WORKPLACE/COMMUNITY/
NORM /PLACE

MAN WOMAN
 GROUP 3
ROLES IN
FAMILY/WORKPLACE/COMMUNITY/
NORM /PLACE

MAN WOMAN
 GROUP 4
ROLES IN
FAMILY/WORKPLACE/COMMUNITY/
NORM /PLACE

MAN WOMAN
 GROUP 5
ROLES IN
FAMILY/WORKPLACE/COMMUNITY/
NORM /PLACE

MAN WOMAN
 GROUP 6
ROLES IN
FAMILY/WORKPLACE/COMMUNITY/
NORM /PLACE

MAN WOMAN
 GROUP 7
ROLES IN
FAMILY/WORKPLACE/COMMUNITY/
NORM /PLACE

MAN WOMAN
Greeting from Thailand
Greetings from Khon Kaen

Cassia fistula

Cassia bakeriana
Craib
Khon Kaen University
Scope of presentation

How gender is matter to health

Examples of gender sensitive interven

 Presentation Sharing

Example of gender sensitive research

: a case study of depression and

suicide
Example of gender sensitive research

: a case study of gender specific for

alcohol abuse

Developing an empowering feminist

counseling training manual for OSCC
staf
 Situation of Health problems in
Thailand
Health Female Male Year
problems/diseases
Life expectancy at 78.8 71.9 2010-
birth (in years) 2015
MMR (per 100,000 live 10.7 n.a. 2009
births)
Cardiovascular: 876 774 2007
per100,000
Diabetes: per100,000 991 530 2007
Hypertension: 1,184 778 2007
per100,000
Cancer: per100,000 559 474 2007
Use of tobacco (aged 2.4% ; 42.9% ; 2001;
15 yrs +) 1.7% 6.1% 2011
Use of alcohol (aged 9.8% ; 55.9% ; 2001;
15 yrs +) 10.9% 3.4% 2011
 Social determinants of Health

the conditions in which people are born,

grow, work, live, and age, and the wider
set of forces and systems shaping the
conditions of daily life. These forces and
systems include economic policies and
systems, development agendas, social
norms, social policies and political
systems.

http://www.who.int/social_determinants/
en/
Social determinants of Health:gender

Gender is an important social factor with

profound efects on health outcomes and
should be considered in public health work.

http://www.who.int/social_determinants/
en/
Sex and gender

Sex : Biological and physiological

characteristics that define men and

women.

Gender: socially constructed roles,

behaviors, activities, and attributes that
a given society considers appropriate for
men and women.
Examples for sex
characteristics
Women menstruate while men do not
Men have testicles why women do not
Women have developed breasts that are
usually capable of lactating, while men have not
Men generally have more massive bones than
women
 Examples for gender
characteristics
Women earn significantly less money than
men for similar work.
Men are expected to be decisive, take risk,
competitiveness, breadwinner,
independence etc.
Women are expected to do housework,
caring for children and other family
members, nurturance, emotional
expressiveness, maintain interpersonal
 Sex and Gender
SEX GENDER
Fixed and Unchangeable Dynamic and fluid
Determined at birth Constructed over
lifetime
Universal Can be culture
(with variations determined by specific
genes)

Biologically defined Socially constructed

Usually two distinct
categories
(male and female)
 Gender is
Relational women and men do not isolation.

Hierarchical- diferences established between

women and men often attribute greater
importance and value to masculine
characteristics.

Historical gender norms are nurtured by factors

that change over time and space because they can
be modified

Contextually specific-because gender relations

vary depending on ethnicity, culture, age, sexual
orientation, religion and other factors.

Institutionally structured-social relations are

supported by values. Legislation, religion, etc.
Example of gender sensitive
research: a case study of
depression
 KKU Depression Screening
Tool: Gender sensitive

14 items; likert scale 0-3

Cut point for men: 5 sensitivity 92

(95%CI 85-100)
specificity 63 (95%CI 59-67)

Cut point for women: 6 sensitivity 92

(95%CI 86-98)
specificity 63 (95%CI 59-67)
 Objectives
1. To explain experiences of in
men and women patients with depressive dis
based on a gender perspective.
2. To explain explanatory model of men and wom
patients with depressive disorder.
 Participants
21 men and 21 women patients
with depressive disorder were
recruited from out-patient clinics at a
psychiatric hospital and a university
hospital in Khon Kaen province.

Data were collected by in-depth

interviews and were tape recorded.

Data were analyzed using content

analysis.
 Meaning of depression

Trapped within
Thoughts Sufering

Wanting to lean on Nobody understood

something

Personal weakness
Causes of
depression

Decreasing male gender Unequal relationship

roles
Family issues
Perceived failure at work (husbands and
childrens behaviors)
Stress due to financial
situation Tired from multiple
roles
 Depressive
Symptoms
Symptoms Men Women
Loss of interest 18 19
Insomnia 18 11
Preoccupy 17 11
Feeling irritate 8 9
Poor appetite 4 7
Feeling down 3 6
 Symptom
management
Symptoms Men Women
Pushing 6 1
Themselves
Employing 4 8
Buddhist
Alcohol drinking 8 0
Music/TV 2 2
Sleeping pill 2 10
 Perceptions of
Treatment
Men Women

Getting Medicine gave

treatment, me back my life
getting accepted
Shame to
Dont want to be receive
seen as a patient psychiatric
treatment

No recovery
Future research

Gender specific
intervention

Gender sensitive psycho-

education
Example of gender sensitive
research: a case study of
suicide
Significance of
study
Every year, almost one million people die from
suicide; a global mortality rate of 16 per
100,000,
or one death every 40 seconds (WHO, 2011).

Suicide is complex with, psychological, social,

biological, cultural and environment factors
involved.
Suicide rates per 100,000 Thailand,
1997-2010
 Contents

Suicide rates per 100,000 , sex,

Thailand, 2001-2010
Year 200 2002 2003 2004 2005 2006 2007 2008 2009 2010
1
Total 7.74 7.84 7.13 6.87 6.34 5.77 5.97 5.98 5.97 5.9
Male 9.9 12.0 11.0 10.5 9.9 9.46 9.46 9.31 9.34 9.29
Femal 1.8 3.8 3.3 3.3 2.9 2.47 2.54 2.72 2.56 2.62
e
 Objective of the qualitative
study
To describe the meaning of suicide and the
conditions that lead to suicide behaviors
among men and women.
 Key informants: 33 persons (15
women and
18 men) who have attempted suicide.
Data collection: In-depth interviews
with
tape recording.
Data analysis: content analysis
Findings: meanings
Men and women described the word
suicide in a similar way.

Three common themes have emerged:

Living in the dark
No points of living
Too painful to live
 Given up my life for
Additional
you
meanings for
women For
Reincarnation
 Conditions Women Men
Alcohol problem 4 12
Drunk and abusive husband 7 0
Failure as a leader of the family 0 6
Marital afairs 4 4
Upsetting words/and behaviors 2 4
of the family members
Being a burden for the family 0 2
Love isnt fulfilled 2 0
 Gender has an impact on suicide
behavior for both men and women but in
different dimensions. Women suffer from
unequal relationships in the male
dominated society. For men, being under
pressure to maintain a mans role, family
financial problems, and drinking lead to
suicidal behavior.
 This finding calls for gender specific
intervention for suicidal prevention. Health
policy and strategies should include gender
mainstreaming in order to promote gender
equality and gender role flexibility.

Policies and strategies related to control

alcohol producing, selling and drinking should
be able to be a real practice in a community.
Example of Gender sensitive
intervention for suicidal
prevention in alcohol users
Significance of the
study
Mental disorders (particularly
depression and alcohol use
disorders) are a major risk factor
for suicide.
(WHO, 2011)
Significance of the
study
Individuals with alcohol
dependence have a 60- 120
times greater suicide risk
than the non-mental ill
population (Sher, 2006).
Significance of the
study
Individuals with alcohol dependence
who committed suicide are
characterized by major depressive
episodes, stressful life events,
especially interpersonal difficulties,
poor social support, living alone, high
aggression/impulsivity, severe
alcoholism, serious medical illness.
(Sher, 2006)
Thais attitudes toward drinking
Social pressure: peer, being a man
Socialization
Ritual events such as, wedding, funeral,
cultural events
Health: relief muscle pain
Increase appetite
Stress reduction
 Brief intervention
Motivational enhancement
therapy
CBT
Case management
Self Help Group
 Objective

To presents an example of gender

sensitive psychosocial
intervention

for alcohol users.

 master prepared
work at a substance abuse
clinic
gender sensitivity course
training
Brief intervention training
 Men Women
Being abused by a husband (11)
Feeling inadequate
from being a Chronic stress from family
breadwinner (5) financial and adult childrens
behaviors (3)
Wife ask for divorce (2)
Feeling inadequate Sex worker (4)
from being a man Stress from not being a good
(dominated by a mother) mother (1)
(1)
Please a husband (1)
 Discuss about how male gender-role

rigidity related to drinking problems.

Empowerment and reconstruct about
traditional men role
Teaching personal relationship and

communication skills for men patients.

 Assistance in seeking
employment
Providing information about
Domestic Violence Victim
Protection ACT (2007)
A living arrangement plan
 Encourage to receive
counseling
Teaching on efective
communication and stress
management
Discussion about tradition
 Pre Post Remark
Dependent * Dependence (2) Use to drink less or
Men (8) * Harmful (3) stop drinking but
Risky (1) back to drink from
Low risk (1) stress and cultural
Abstinent (1) events in the villages
Dependent * Dependence (3) Use to drink less or
Women (16) * Harmful (2) stop drinking but
Risky (1) back to drink from
Low risk (5) stress and cultural
Abstinent (5) events in the villages
Harmful * Risky (1) Use to stop drinking
Women (2) Low risk (1) but back to drink due
to stress from
husband
Risky Abstinent (2) 60
 Gender mainstreaming policies
need to be translated into
healthcare practice and local
governments.
Local administrative level
should pay attention on gender
based violent, especially in a
Thai Regulations against Alcohol
Consumption should enforce into
local level to alter attitudes and
popular values and to create a
consciousness among the public
to have them take interest in
social problems.
Developing an empowering feminist
counseling training manual for OSCC
staf
 Situation of VAW in Thailand

Number of abused women in 2004

was 3,585 and increase to 8,172 in
2007

The national survey in 2009

revealed that married women
aged 15-19 years sufered
violence perpetrated by their
husbands twice as much as
women from older age groups.
One Stop Crisis Center
(OSCC)
The MOPH established the OSCC since 2002.

The OSCC aims to provide a comprehensive

service (medical, social and legal assistance)
for women victims of violence.
In 2004, the MOPH expanded OSCCs to every
province.
There are 10,612 hospitals within diferent
hospital levels.
Women received service from OSCCs
increasing from 19/day in 2004 to 52/day in
2007
In 2010, there was approximately 3
women/hour who received service from
 Information related to
clients

48.76% of women who came to OSCC age

25-45 yrs.

Most abusers were their husbands.

The most factor was couple relationship

(afaire,
jealousy, and quarrel).

The common violence was physical and

sexual violence.
Developing an empowering feminist
counseling training manual for OSCC
staf
Objectives of the
training manual
1. Develop a manual for trainers who work at
OSCCs

2. Built the capacities of counselors of OSCCs

as trainers

3. To provide practical and hands on training

by using experiential learning model.

4. Respond to the needs of OSCC counselors

so that they can apply knowledge and
experience in their service setting.
Process of Developing the
Training Manual
1. Capacity building the experienced OSCC stafs
(nurses, psychologists, and social workers) on
feminist counseling and being an experiential
learning trainer.
2. Inviting the qualify OSCC trainers to participate in
the developing training manual.
3. Writing the training manual, asked feedback from
the OSCC trainers, and refined the manual.
4. The OSCC trainers selected confidential topics.
5. The OSCC rehearsed the training topics and
received feedback.
6. Refined the manual.
7. Pilot the training manual.
8. Manual evaluation using Kirkpatrick model
 Empowering feminist
counseling training manual for
OSCC staf
Understanding social

Experien
tial Understandi
learning ng self
Counseling skills identity
/Self-
awareness
Core
content
Dominant and partnership
model

Gender system

Sexuality

Empowerment counseling

Mindfulness training
 Time table
Day 7-8 8-9 9-12 12- 13- 13.30 17 18- 19-20
/ 13 13.3 19
tim 0
e
1 Introduction Relax Power and Meditatio
ation deep n
techn listening
2 Gender ique Sexuality & Watching
system deep movie
listening
Yoga Breakfas Lunc Dinne
3 t Social h Identity & r Meditatio
construction Reflection n
and GBV skill
4 Empowering Listening, Social
feminist reflection, and legal
counseling & question assistanc
e

5 Problem Summarize
solving and
 Preliminary results
There are 16/ 24 qualify trainers.

92% of the trainees were satisfied with the

training
model at the most level.

89 % of the trainees were satisfied with

the training model at the most level.

15 workshops were conducted including 287

participants.
The participants were satisfied with the
workshop
over all at 4.37 ( rating scale 1-5)
The participants rated ability of the trainers
 Why is gender important?

1. Helps to understand how the experiences of

males and females are influenced by diferences
such as age, class, religion, culture, location

2. Highlights hierarchical relation, unequal roles

and relations between and among males and
females

3. Highlights the unequal value given to womens

work.

4. Highlights womens unequal access to power

and decision-making, resources etc, (males
superior and female subordinate).
 Concluding thoughts on gender
Diferent roles per se are not the cause of inequality;

it is the value placed on those roles that lead to inequality.

- In most societies, a higher value is ascribed to masculine

roles. These may also lead to gender stereotypes.

Gender norms, roles and relations afect women and men

diferently.

- Norms and roles that undervalue women often lead to:

domestic violence

decreased access to important resources to protect their

health.

- Many societal norms encourage men and boys to engage

in high-risk behaviors that harm both themselves and others.
 Conclusion

In order to reach health equity, gender should

integrate in health service, policy and research.

There is a need to include gender mainstream

in nursing education
 Gender sensitive research to
study depression in Thailand

Chirawatkul, S. et al. 2008. Perceptions and

dealing with depression among 4 villagers of
Isan Region. Journal of Mental Health of
Thailand, 16(1): 229-241.
Chirawatkul, S. et al. 2008. Integation of gender
issues related to depressive disorders into the
National and regional health policy in
Thailand. Health Policy and Planning Journal
(Thailand), 11 (1-4): 57-69.
Arunpongpaisal, S. & Rungreangkulkij, S. 2010.
Revision of the KKU-DI, Depression test for
gender sensitivity. J. Psychiatric Association
Thailand, 55(2): 177-89.
 Gender sensitive research to
study depression in Thailand
Rungreangkulkij, S. 2010. gender
diference: Sociodemographic risk factors
of depression. J. Psychiatric Association
Thailand, 55(4): 337-46.
Rungreangkulkij, S. et al. 2012. Sex or
gender leading to a high risk of
depressive disorder in women. J.
Psychiatric Association Thailand, 57(1):
61-74.
Rungreangkulkij, S. et al. 2012. Depressive
disorder: gender analysis of depression.
Journal of Nursing science & Health,
35(4): 21-30.
 Thank you for your attention

Contact Address: Asso. Prof. Somporn Rungreangkulkij, RN

Email: somrun@kku.ac.th
Center for Research and Training on Gender and Womens H
Faculy of Nursing
Khon Kaen University, Thailand
79
Gender sensitivity

Health professionals are

competent to perceive existing
gender issues and to incorporate
these into their decisions and
actions.
 Living in the dark

I have no ways out. Nobody wants to die..If it is a

sickness, we still dont want to die. When youre
sick, you would want to get better. I dont know
where the exit is. There is really no way out. It is
just too much for me to endure. Its very
overwhelming. I cant even describe.
 Living in the dark

It was like living in the dark.

I couldnt think of anything but death.

 No points of living
The informants in this group, either men or
women, were the leader of the family. When
there are some economical changes that affect
their income, they feel less valued by their
family. They feel that there is no point of living.
 No points of living

I remember thinking what the points of living. There is

no meaning in life. There is nothing in life. Nobody
take care of me. Nobody cares to see how I eat or live.
Nobody is interested in me. Id better be gone.
 Too painful to live

The informants described the suffering

from circumstantial thinking. It pushed
them to attempt suicide in order to escape
the suffering as following
 Too painful to live

A 36 years old divorced with uncertain income

man described

Its very suffering when there is no way out. I dont

know how to get out of this. I wanted to get rid of
the suffering, not really getting rid of my life.
The theme given up my life for you comes
from women informants. They have dedicated
their life for the husband and children. When
their loved ones do not show that they care
for her, she wants to express her love for
them. She can give up her life to demonstrate
her love.
I was upset that my youngest child was always in troubles.
He took our television to a pawnshop. He stole the money. I
didnt know what to do. I was disappointed. I cried in my
sleep. One day I was going to the bathroom. I saw a piece of
cloth hanging in the bathroom. I then decided that I was
going to show that I can die for him. If I died, he would
have seen that Ive given up my life for him. I thought this
will teach him a lesson. My son will see my death with his
own eyes. He will see why I give up my life. He will learn.

(A 47 married woman day laborer with high school education)

A 20 years old hill tribe woman laborer talked about how her husband
got stressed out from economical problems. He drank alcohol. He often
physically abused her. However, she could not return to her family.
Traditionally, once she is married, she is considered an outsider.

I was living with him. We fought every day.

I took an overdose. I wanted to die. When I reborn,

I will not have to meet him (husband) again.