A discourse analysis of gender in the public health curriculum in sub-Saharan Africa

Abstract

Gender inequalities are still widely pervasive and deeply institutionalised, particularly in Africa, where the burden of disease is highly gendered. The public health sector has been slow in responding to and addressing gender as a determinant of health. The purpose of this inquiry was to gain a deeper insight into the different ways in which gender was represented in the public health curriculum in sub-Saharan Africa. A qualitative inquiry was undertaken on gender in the curriculum in nine autonomous schools of public health in sub-Saharan Africa. Official curriculum documents were analysed and in-depth interviews were held with fourteen staff members of two schools that served as case studies. A content analysis of the data was carried out, followed by discourse analysis. A poststructuralist theoretical framework was used as the ‘lens’ for interpreting the findings. Most of the official curricula were ‘layered’, with gender not appearing on the surface. Gender was represented mainly as an implicit discourse and appeared explicitly in only one core course and a few elective modules. The overwhelmingly dominant discourse in the official curricula was the ‘woman’ discourse, with a strong emphasis on the reproductive and maternal roles of women, while discourses on men, sexuality and power relations seemed to be marginalised. Gender discourses that emerged from the in-depth interviews with participants were lodged in biological, social and academic discourses on gender. The dominant discourses revolved around sexual difference and role differences based on sex. Participants drew on societal discourses (family, culture and religion), academic discourses and their lived experiences to explain their understandings of gender. Their narratives on the teaching of gender showed that gender was not taught or received a low priority and that it was insufficiently addressed in the public health curriculum. Barriers to teaching gender were: lack of knowledge, resources and commitment; resistance; and competing priorities. From this study it emerged that curriculum and the production of gender knowledge are sites of struggle that result in multiple understandings of gender that are manifest in dominant and marginalised discourses. Prevailing institutional power relations mirror dominant societal and political discourses that have a fundamental effect on curriculum decisions and resource allocations. This interplay between dominant discourses and power relations, underpinned by a strong biomedical paradigm, could explain the positioning of gender as an implicit representation in the curriculum, with a more explicit focus on gender in the elective modules than in the compulsory or core courses. Being implicitly represented, gender does not compete with other priorities for additional resources. It is recommended that the public health curriculum be reconceptualised by: accommodating multiple understandings of gender; questioning constructed dominant gender discourses; considering broader, varied and complex social, cultural, economic, historical and political contexts in which gender is constructed and experienced; and moving from curriculum technicalities to understanding the curriculum as a process and not a product.