Building fairer and more inclusive societies requires reversing the root causes of gender inequality. Access to social security is an important step in this regard, as it promotes the economic empowerment of women. Importantly, social security systems must be designed and delivered in a gender-sensitive way.
The recently concluded 2020 ISSA Good Practice Award for the Americas, attracting more than 130 entries, as well as other ISSA activities, highlight measures to address gender inequalities by social security institutions across the region. Innovations in both programme design and implementation approaches allow social security institutions to better take into account the needs and circumstances of women, and work towards removing gender-specific access barriers.
This article focusses on three types of measures that have emerged as specifically important in the good practices of social security institutions in the region:
- Building capacities for gender sensitivity in social security
- Improving maternity care services in rural areas
- Removing barriers to access through automated digital services
Gender-sensitive social security approaches
The recent ISSA Webinar on gender equality in social security called attention to a serious need to propose and support gender-sensitive policies on health, social security and labour in order to address the roots of gender inequality.
In this regard, the experiences of the Mutual for Safety CChC (Mutual de Seguridad CChC) and of the Catholic Workers' Circle of the Uruguay Mutual Fund (Círculo Católico de Obreros del Uruguay Mutualista) illustrated how social security institutions are applying a gender perspective to the implementation of programmes and services.
The Catholic Workers' Circle of the Uruguay Mutual Fund developed a transversal approach to embed a gender perspective in all services by building the capacity of staff, from customer services clerks to senior management. Within the institution, an Bipartite Commission on Health and Social Security serves as a multidisciplinary team that coordinates, promotes and fosters work on reducing inequalities. More specifically, the commission provides services to women and children to address systemic gender-based violence that affects them the most, including the provision of housing for female victims of human trafficking. Free psychosocial services are provided to women, adolescents and children who are victims of sexual abuse, and the institution actively shares preventive information on these problems with the public.
This multi-disciplinary approach is in line with a national strategy in Uruguay to enhance gender considerations within the care sector by coordinating social security, social services and employment measures. This National Integrated Care System offers a dedicated forum to design and evaluate policies from a gender perspective. It opens the discussion for topics such as non-remunerated work in the care economy and helps create an understanding on the obstacles that arise from normative gender role expectations that cause a lower participation of women in the labour market, lower pay or unpaid care work.
In Chile, the Mutual for Safety CChC recognizes gender differences – both social and biological – to calibrate their responses to risks and injuries at work. The gender pay gap exists in all sectors of the economy and the labour market mirrors gender roles at home, with more women in the care economy and more men in construction, mining and sports. To adapt to this situation, prevention approaches are made more gender-sensitive by taking into consideration the susceptibility of insured persons to certain types of injury or sickness rather than simply using standard protocols. For example, more women than men are prone to sickness when exposed to certain agricultural chemical agents. Recognizing this difference helps understand the higher propensity of women to fall sick when performing such jobs, which in turn provides vital information to make the necessary adjustments in the workplace.
In addition to the example of Uruguay outlined above, staff training is also an important factor in working towards gender-sensitive service delivery systems for other institutions in the region. In Argentina, the Mutual Association for the Protection of Families (Asociación Mutual de Protección Familiar – AMPF) conducts a yearly campaign on 8 March, which coincides with the International Women’s Day, to train their staff on gender equality. In Mexico, the Mexican Social Security Institute (Instituto Mexicano del Seguro Social – IMSS) addresses obstetric violence through regular workshops to train staff to provide more sensitive, compassionate and dignified maternity care to patients.
Table A summarizes examples of measures by social security institutions from the region, and assesses their impact compared to the previous situation.
| Institution | Previously | Now |
|---|---|---|
| Uruguay, Catholic Workers’ Circle of the Uruguay Mutual Fund A comprehensive approach to gender-based and generational violence in health services |
Need to improve care and service to victims of gender-based violence; need to involve other social security stakeholders; need to sensitize and train staff to deliver more comprehensive care and attention to this vulnerable group. | Improved quality of care services to insured persons and victims of gender-based violence; regular trainings to build staff awareness and capacity to manage gender-related issues; increased access by decentralizing services and decision-making to field offices. |
| Argentina, Mutual Association for the Protection of Families Workshop on 8 March, International Women’s Day |
Need for in-depth analysis of service differences provided to male and female members in order to improve overall costumer experience. | Workshops to raise awareness on gender inequalities and services provided to members especially in old age; increased interest and more awareness on the topic among staff. |
| Mexico, Mexican Social Security Institute (IMSS) and the Mexican National Union of Social Security Workers (SNTSS) Customer service training to enhance the services for pregnant women |
Need to improve customer service for pregnant women. | The program “Greet, Listen, Respond” was specifically designed to improve the maternity care experience (prenatal, birth and postnatal) for pregnant women. |
A focus on reducing maternal mortality and improving care services
In recent years, significant progress has been achieved in reducing the maternal mortality ratio in Latin America and the Caribbean from 88 per 100,000 live births in 2005 to 74 in 2017. However, disparities remain within national boundaries, especially with regard to the lack of access of rural populations to high-quality healthcare. In this context, strategies to design and implement specific operational measures to meet the needs of population groups facing difficulties to access certain social security benefits can be effective.
In Mexico, for instance, the introduction of free specialist obstetric, maternity and high-risk post-natal care in rural areas has resulted in lower maternal mortality rates. This effect has been especially visible among indigenous women, a group that is traditionally underserved in the region. Such approaches are proving to be an effective intervention for intra-gender reductions in inequalities related to ethnic origin, income level and place of residence. The programme also focuses on improving the referral system and coordination between hospitals, so that risk pregnancies can be monitored and the risk of emergency interventions is minimized. After 12 years of programme implementation, the number of deaths related to maternity complications fell from 113 per 100,000 pregnancies in 2007 to 28 in 2019.
The Social Health Insurance Institute (Seguro Social de Salud – EsSalud) in Peru introduced a booklet with a checklist for pre-natal check-ups that helped standardize maternity care services across the various health service providers. The booklet also contains general information on maternal health care for pregnant women to take home and is available in Spanish, Quechua and Aymara. By replacing paper records with an software application shared by hospitals and EsSalud’s planning and quality office, the integration of patients’ data reduced the administrative burden of higher-level supervisory staff and improved services, including the monitoring of high-risk pregnant women.
Table B provides further information on these measures, and compares the current situation with the previously identified shortcomings.
| Institution | Previously | Now |
|---|---|---|
| Mexico, Mexican Social Security Institute (IMSS) Specialist care for pregnant women at high risk or with complications or obstetric emergencies affiliated to IMSS-BIENESTAR in second- and third-tier hospitals of the IMSS |
High maternity mortality rates in rural areas. | Free prenatal and postnatal care, including surgical emergencies deriving from complications during pregnancy and birth, available at second- and third-tier hospitals for insured women under the IMSS-Bienestar programme. |
| Peru, Social Health Insurance Institute (EsSalud) The process of managing pregnancy and post-pregnancy in the Juliaca healthcare network |
Lack of effective and standardized monitoring processes of potentially at high-risk pregnant women; need of integrating processes of various departments and across hospitals for improved quality assurance. | Introduction of a more dynamic administrative process that closely monitors women at higher risk of complications during pregnancy using an Excel-based app that is integrated with the database of the Office for Planning and Quality. A booklet with a checklist enabled standardized prenatal check-ups using IT tools. Information booklets on maternal health were also provided to insured women in Spanish, Quechua and Aymara. |
Removing access barriers: online processing of benefit claims for maternity and new-born benefits
In the current context of social distancing measures due to the COVID-19 pandemic, in-person administrative procedures have been transformed into online processes. The need to reduce face-to-face transactions has resulted in an important shift to e-services, including the adoption of telemedicine. Maternity-related benefits are no exception to this trend.
This new era of service has accelerated the move towards integrated and interoperable databases to enable automatic checks and screenings of eligibility to benefits, and ultimately improves access to services. Table C includes examples for such measures. In Peru, for instance, the No-Red-Tape Breastfeeding benefit of EsSalud is now paid automatically through local banks because the records of the National Identity and Marital Status Register are now linked with the database of EsSalud.
| Institution | Previously | Now |
|---|---|---|
| Mexico, Mexican Social Security Institute (IMSS) Processing of maternity and COVID-19 leave via digital platforms |
In-person visits to a medical unit were required to request an extension of maternity leave. | Online process to extend maternity leave, to minimize the need to leave home and thereby reduce exposure to public spaces and potential infection with the coronavirus. |
| Peru, Social Health Insurance Institute (EsSalud) No-Red-Tape Breastfeeding Benefit: Supporting new-born care through a timely financial benefit |
In-person procedure at the National Identity and Marital Status Register to fill in a form 30 to 60 days after childbirth. | The breastfeeding cash benefit is confirmed automatically within 72 hours after childbirth thanks to the national Online Live Birth Registration System. The benefit is paid at specific bank locations. |
Concluding message
As this article on recent good practices in the Americas demonstrates, gender-sensitive approaches by social security institutions can make a significant contribution to enhancing gender equality. Social security institutions in the Americas are recognizing the need to protect women and to respond to their needs.
Improving gender-sensitive service delivery and removing barriers to access to social security are necessary and important steps. However, addressing the root causes of gender inequalities requires comprehensive and multi-sectoral action. Many challenges must be overcome, such as the gender pay gap, recognition of unpaid work, accounting for forgone income during care time for children and other family members, and the equality of benefit levels between men and women, especially in old age pensions.
While many of these issues go beyond the mandate of social security institutions, they can take a leadership role in a multi-sectoral approach leveraging on their operational capacity. The awareness campaigns, workshops on gender inequalities and measures to enhance access to maternity benefits are steps in the right direction on the long road to gender equality.