HEALTHY MOTHER, HEALTHY BABY ACTIVITY GENDER GAPS ASSESSMENT KHATLON, TAJIKISTAN Data Collected: June-July 2021 Submission: Aug 29, 2021 This document was produced for review by the United States Agency for International Development Tajikistan Mission (USAID/Tajikistan). 1 1. SUMMARY Program Name: Healthy Mother, Healthy Baby Activity Name of Report: HMHB GENDER GAPS ASSESSMENT Name of Prime Abt Associates Implementing Partner: 72011520C00003 [Contract/Agreement] No: Name of Subcontractors: Dimagi, Changeable Khatlon Province Geographic Coverage Districts: J. Balkhi, Jaihun, A. Jomi, Khuroson, Levakant, N. Khusrav, (districts) Qabodiyon, and Yovon Reporting Period: June - July 2021 HMHB GENDER GAPS ASSESSMENT 2021 2 2. ACRONYMS COVID-19 Coronavirus-19 DC District Coordinators FGD Focus Group Discussions FTF Feed the Future GBV Gender-based Violence GOT Government of Tajikistan HLSC Healthy Lifestyle Centre HMHB Healthy Mother Healthy Baby IEC information, education, communication KII Key Informant Interviews MCH Maternal and Child Health PHC Primary Healthcare Centers SMART Specific, Measurable, Achievable, Relevant, and Time-bound THNA Tajikistan Healthy Nutrition Activity USAID U.S. Agency for International Development VIP Ventilated improved pit latrines WASH Water, Sanitation, and Hygiene PWD People with disabilities CWFA Committee on Women and Family Affairs WRC Women Recourse Centre HMHB GENDER GAPS ASSESSMENT 2021 3 TABLE OF CONTENTS 1. SUMMARY ............................................................................................................ 2 2. ACRONYMS ........................................................................................................ 3 3. ACKNOWLEDGEMENTS ................................................................................ 5 4. OBJECTIVE ........................................................................................................... 6 5. GENDER ASSESSMENT METHODOLOGY ................................................ 6 6. TAJIKISTAN HEALTH AND NUTRITION ACTIVITY ............................. 9 7. DATA ANALYSIS ............................................................................................. 11 7.1 Men and Women’s Access to Healthcare Services ........................................................11 7.2 Men and Women’s Access to Nutrition Services and Information ............................15 7.3 Men and Women’s Access to WASH ................................................................................17 7.4 Women’s Economic Empowerment ..................................................................................18 7.5 Gender Relationships and Power Dynamics ....................................................................21 7.6 Key Influencers, Sources of Information, and Media Preferences ...............................23 7.7 Focus Group Discussions .....................................................................................................26 7.8 Key Partner and Project Capacity to Deliver Gender Responsive Services .............28 8. CONCLUSIONS .............................................................................................. 28 9. RECOMMENDATIONS ................................................................................. 31 10. ANNEXES .......................................................................................................... 33 10.1 Annex I: Case Studies ............................................................................................................33 10.2 Annex II: Data Collection Questionnaire .........................................................................34 10.3 Annex III: Tables .....................................................................................................................40 10.4 Annex IV: List of Literature ..................................................................................................43 HMHB GENDER GAPS ASSESSMENT 2021 4 3. ACKNOWLEDGEMENTS The United States Agency for International Development (USAID) Healthy Mother, Healthy Baby (HMHB) Activity would like to acknowledge all who supported this 2021 Gender Gaps Assessment in Khatlon, Tajikistan. We would like to thank USAID/Tajikistan Mission for the financial support to make the assessment possible. We would like to appreciate the active partnership with the Government of Tajikistan, especially the leadership in Khatlon inclusive of District’s Department Committee of Women and Family Affairs, Heads of the Department of Religion, Regulation of Local Traditions and Ceremonies of the District’s Executive Body, Heads of Department of Work with Youth and Sport, Healthy Life Style Centres, Local jamoat’s representatives, doctors and nurses from the local District clinics, and active community members. HMHB also recognizes the lead consultant, Ms. Shahlo Shoeva, for technical expertise in tool development, data collection, analysis and report writing. We would also like to provide recognition to the Abt Associate gender expert, Ms. Abigail Donner, and Abt’s editors, Ms. Leah Quin and Ms. Rachel Peniston. Last, with deep gratitude, we would like to thank the HMHB in-country Tajik team, especially the District Coordinators, who assisted with data collection. HMHB GENDER GAPS ASSESSMENT 2021 5 4. OBJECTIVE Gender equality and women’s empowerment are fundamental components of human rights that are key to effective and sustainable development outcomes. For societies to thrive, women and girls must have equitable and safe access to resources including education, healthcare, capital, technology, land, and markets. They must also have equal access to opportunities that will enable them to become business owners, peace builders, and leaders. Equality between women, girls, men, and boys improves the quality of life for everyone. Gender equality is not just a woman’s issue; it is also inextricably linked to public health. If women and girls are not valued, cared for, or given equal access to health, overall health objectives cannot be met. The objective of this assessment is to evaluate the gender-related components of the Healthy Mother, Healthy Baby (HMHB) Activity, identify gaps, and provide recommendations on mainstreaming gender throughout the activity in alignment with the USAID Gender Equality and Women’s Empowerment Policy (2020). Abt Associates conducted this gender analysis on the HMHB Activity and documented findings in this report, in which gaps were identified and recommendations provided. The report analyzes qualitative data pertaining to Abt Associate’s gender dimensions and areas of operation, with a focus on health, nutrition, economic empowerment, and water, sanitation, and hygiene (WASH) sectors. The findings will help ensure alignment with the six USAID Gender Analysis Domains: 1. Access, 2. Knowledge, Beliefs and Perception, 3. Practices and Participation, 4. Time and Space, 5. Legal Rights and Status, and 6. Power and Decision Making and the USAID Gender Equality and Women’s Empowerment Policy throughout the course of implementation of HMHB. 5. GENDER ASSESSMENT METHODOLOGY Assessment Methodology The assessment encompassed qualitative and quantitative data collection methods such as Focus Group Discussions (FGD) among implementing partners and other key actors in four target districts. It also covered Key Informant Interviews (KII) in another four target districts. Respondents were asked questions about the community as a whole and not asked about their personal opinions (for example, instead of asking “do you personally think women are equal to men”, respondents were asked “does your community believe that women are equal to men?”). As such, respondents answered based on their perceptions of other people in their community and how they think as a whole, rather than expressing their only on their own personal beliefs. Furthermore, four Case Studies were captured to highlight specific perspectives of two women and two men from the HMHB target districts. HMHB GENDER GAPS ASSESSMENT 2021 6 Table 1. Number of FGD Participants per District District Total Number of female Number of participants male participants Khuroson 8 4 4 J. Balkhi 10 6 4 Yovon 7 4 3 Qabodiyon 6 3 3 Total 31 17 14 Table 2. Number of KII Participants per District District Total Number of female Number of male participants participants Jomi 2 0 2 Levakant 8 2 6 Nosiri Khisrav 6 5 1 Jaihun 5 2 3 Total 21 9 12 Implementing partners and community members from four districts held FGDs—J. Balkhi, Khuroson, Yovon, and Qabodiyon with 31 respondents. Researchers conducted seven interviews with 21 key informants in A. Jomi, Levakant, Nosiri Khisrav, and Jaihun districts. Key informants refer to individuals who had insight into the health care sector, including nutrition services, economic empowerment, WASH, and other domains in their targeted communities. The key informants included: • Implementing partners • Local community leaders • Community members (both men and women) • District officials aware of the Activity • Health providers • Women committee members • Religious committee members • Youth committees engaged in project planning and implementation These activities took place in locations that protected the confidentiality and safety of participants. Researchers conducted the assessment within the community (i.e., household, health facilities, and jamoat offices (municipality office, each district has their such offices) and followed necessary precautions to prevent COVID-19 spread. We asked all respondents