性別主流化與友善醫療環境的建構：國外經驗與本土推動實例的探討

Gender Mainstreaming and the Construction of Gender Friendly Medical Environment: A Review of Research and Discussion about the Implementation

游美惠(Mei-Hui You)

性別主流化 ； 性別與醫療 ； 性別與健康照護 ； 性別友善醫療環境 ； Gender Mainstreaming ； Gender and Medicine ； Gender and Health Care ； Gender Friendly Medical Environment

思與言：人文與社會科學期刊

57卷1期（2019 / 03 / 01）

231 - 271

繁體中文

本文將探討透過國家推動性別主流化的政策，在健康照護體系之中，如何藉由醫療環境的改善，更積極達成性別平等目標，同時也應兼顧差異，促成性別友善與社會正義，讓弱勢者能享有更友善與便利的醫療服務，使醫療資源能為全民有尊嚴的共享。研究者引介相關「做性別」與「交織性」等性別理論概念並整理、探討國外性別主流化於醫療現場的實踐經驗相關文獻，希望能轉化理論與他國經驗成為論述資源，做為臺灣推動相關性別主流化工作的基礎。本文聚焦在性別友善的醫療環境之營造上，包含硬體空間與友善態度等工作面向之加強，運用政策的推動力量，加強醫院治理和醫療人員的性別敏感度，逐步加強整體的性別友善程度並落實醫療體系的性別主流化。

This research aims at the construction of gender friendly medical environment and the promotion gender equity in healthcare. According to previous literature, attempts to mainstream gender into healthcare often turn out to be simplified reports of sex differences without taking account of the conditions of intersectionality. The article thus deals with the gender friendly medical environment construction and healthcare service delivery in terms of theoretical concepts, ＂doing gender＂ and ＂intersectionality＂. It is stressed that the expression of ＂gender friendly＂ will vary as it intersects with other factors. The healthcare workers/professions must have knowledge and insight into the meaning of gender for spatial arrangement and gender sensitive social interactions. Gender awareness is necessary to overcome gender bias and to reach equity in health. Furthermore, the policy-making is also explored in this paper. The researcher focuses on two cases implemented in Taiwan to explore the possibilities of putting gender mainstreaming into practice in health care policy. The research finally provides related international trends to justify the importance of constructing gender friendly environment and promoting gender equity through the implementation of gender mainstreaming policy. Hopefully, change will occur in healthcare system with the recognition that gender indeed matters.

1. Kuhlmann, Ellen,成令方（譯）,蔡昌成（譯）(2011)。健康照護與政策之性別主流化。科技、醫療與社會，12，251-272。
   連結：
2. 彭渰雯,李秉叡(2007)。比利時的性別主流化。臺灣國際研究季刊，3(4)，111-134。
   連結：
3. 楊婉瑩(2004)。婦權會到性別平等委員會的轉變：一個國家女性主義的比較觀點分析。政治科學論叢，21，117-148。
   連結：
4. 衛漢庭,陳牧宏,顧文瑋(2015)。建構多元性別友善的醫療服務。護理雜誌，62(1)，22-28。
   連結：
5. 〈LGBT 同志友善醫療手冊〉。臺北市衛生局社區心理衛生中心，網址：http://mental.health.gov.tw/WebForm/External/DownloadFileList.aspx?Type=01。點閱日期：2017 年 11 月 16 日。
6. 〈醫療領域的性別主流化〉。臺灣女人連線，網址：http://twl.ngo.org.tw/category/1/article/1906。點閱日期：2018 年 1 月 22 日。
7. 性別平等政策綱領。行政院 106 年 1 月 3 日院臺性平字第 1050183619號函修正。
8. 〈營造婦女友善醫療環境〉。高雄市政府衛生局，網址：http://khd.kcg.gov.tw/Main.aspx?sn=479。點閱日期：2017 年 11 月 16 日。
9. Bloom, Gerald,Standing, Hilary(2008).Introduction - Future Health Systems: Why Future? Why Now?.Social Science& Medicine,66,2067-2075.
10. Daly, Mary(2005).Gender Mainstreaming in Theory and Practice.Social Politic,12(3),433-450.
11. Davis, Karen(2003).The Body and Doing Gender: The Relations between Doctors and Nurses in Hospital Work.Sociology of Health and Illness,25(7),720-742.
12. Dull, Diana,West, Candace(2002).Accounting for Cosmetic Surgery: The Accomplishment of Gender.Doing Gender, Doing Difference: Inequality, Power, and Institutional Change,New York:
13. Gwatkin, Davidson R.,Bhuiya, Abbas,Victora, Cesar G.(2004).Making Health Systems More Equitable.The Lancet,364,1273-1280.
14. Kuhlmann, Ellen(Ed.),Annandale, Ellen(Ed.)(2010).The Palgrave Handbook of Gender and Healthcare.New York:Palgrave Macmillan.
15. Kulmann, Ellen(Ed.),Annandale, Ellen(Ed.)(2010).The Palgrave Handbook of Gender and Healthcare.New York:Palgrave Macmillan.
16. Payne, Sarah(2011).Beijing Fifteen Years On: The Persistence of Barriers to Gender Mainstreaming in Health Policy.Social Politics,18(4),515-542.
17. Rees, Teresa(2005).Reflections on the Uneven Development of Gender Mainstreaming in Europe.International Feminism Journal of Politics,7(4),555-574.
18. Rees, Teresa(1998).Mainstreaming Equality in the European Union: Educational, Training and Labour Market Policies.New York:Routledge.
19. Sen, Gita(Ed.),George, Asha(Ed.),Ostlin, Piroska(Ed.)(2002).Engendering International Health: The Challenge of Equity.Cambridge, MA:MIT Press.
20. Sen, Gita, George Asha & Ostlin Piroska (2007). Unequal, Unfair, Inefficient: Gender Inequity in Health. Why It Exists and How We Can Change It, Final Report to the Who Commission on Social Determinants of Health. Retrieved March 6, 2009, from World Health Organization, Website: www.who.int/social_determinants/resources/csdh_media/wgekn_ final_ report_07.pdf
21. Siddiqi, Sameen,Masud., Tayyeb I,Nishtar, Sania,Peters, David H,Sabri, Belgacem,Mohamud, Khalif Bile,Jama, Mohamed A(2009).Framework for Assessing Governance of the Health System in Developing Countries: Gateway to Good Governance.Health Policy,90(1),13-25.
22. Squires, Judith(2005).Is Mainstreaming Transformative? Theorizing Mainstreaming in the Context of Diversity and Deliberation.Social Politics,12(3),366-388.
23. True, Jacqui,Mintrom, Michael(2001).Transnational Networks and Policy Diffusion: The Case of Gender Mainstreaming.International Studies Quarterly,45(1),27-57.
24. Ucsnik, Lucia(2006).Gender Mainstreaming in Hospital Organization.Linz. Austria: Vienna:Federal Ministry of Health and Women, General Management.
25. United Nations (2010). Commission on the Status of Women National Level Review of Implementation Member States Responses. Retrieved March 23, 2010, from United Nations, Website: http://www.un.org/documents/ga/ docs/52/plenary/a52-3.htm
26. United Nations ECOSOC(2010).United Nations ECOSOC (2010). Commission on the Status of Women Declaration and Platform for Action, the Outcomes of the Twenty-third Special Session of the General Assembly and Its Contribution to Shaping a Gender Realization of the Millennium Development Goals. New York: Economic and Social Council United Nations..
27. Verdonk, Petra,Benschop, Yvonne,de Haes, Hanneke,Mans, Linda,Lagro-Janssen, Toine(2009).Should You Turn This into a Complete Gender Matters?: Gender Mainstreaming in Medical Education.Gender and Education,21(6),703-719.
28. Walby, Sylvia(2005).Gender Mainstreaming: Productive Tensions in Theory and Practice.Social Politics,12(3),321-343.
29. West, Candace,Zimmerman, Don H.(2002).Doing Gender.Doing Gender, Doing Difference: Inequality, Power, and Institutional Change,New York:
30. Woodward, Alison E.(2008).Too Late for Gender Mainstreaming? Taking Stock in Brussels.Journal of European Social Policy,18(3),289-302.
31. 王志嘉(2013)。營造醫療場域具性別敏感度的環境。家庭醫學與基層醫療，28(12)，328-333。
32. 江盛(2014)。性別主流化的醫療觀點。臺灣醫學，18(3)，325-332。
33. 李佳燕(2008)。婦女親善醫療環境。性別平等教育季刊，43，31-34。
34. 林靜儀(2010)。醫療領域的性別主流化。臺灣醫界，53(3)，139-141。
35. 高雄市政府衛生局健康管理科，網址：http://khd.kcg.gov.tw/Main.aspx?sn=338。點閱日期：2017 年 11 月 16 日。
36. 黃淑玲（編）(2017).性別主流化─臺灣見與國際比較.臺北:五南.
37. 楊幸真（編）(2012).性別與護理.臺北:華杏.