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A focus on women in the health workforce on International Women’s Day

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Just in time for International Women’s Day 2018 the Gender Equity Hub (coordinated by Women in Global Health and The WHO Global Health Workforce Network) held a hard-hitting webinar on Gender Transformative Approaches in the Health and Social Sectors. Drawing on expert opinion from Africa, Europe and the Caribbean the speakers described a sector in crisis, and one that needs urgent reform if we are to meet the Sustainable Development Goals and other international targets.

Kate Hawkins (Director of Pamoja Communications)

08 March 2018

The health and social workforce needs gender-transformative reform

In introducing the webinar Tana Wuliji explained that the global economy is projected to create around 40 million new health and social sector jobs by 2030. However, there is a projected shortfall of 18 million health workers and the problem is particularly pronounced in low-income countries. Much of the global dialogue on women and health focuses on women’s health and does not recognise the significant contribution women make to global health. Women’s contribution to global health, where they perform about 70% of all jobs, is US$3 trillion. Half of this work is in unpaid care roles, which are finally beginning to be seen as legitimate work by international policy making bodies.

When you invest in the care economy you can boost overall employment, particularly the employment of women. With the right investments we could make a step forward on gender equity. This is the aim of the Gender Equity Hub, it is trying to accelerate this change by bringing together evidence, advocacy and a community of change-makers which can be used to accelerate gender transformative policy and practice in the health and social sector.

Women health workers face violence and sexual harassment at work

Health care is dangerous work. Shockingly, in the presentation by Sandra Massiah of Public Services International (PSI) we heard that 25% of all violence in the world of work occurs in the health sector. This occurs across all countries and occupations in the sector. Furthermore, there is a growing culture of violence and conflict in many settings and austerity measures are leading to increased inequality, which in turn leads to violent acts from third-parties.

Often there is a lack of legislation specifically on workplace violence and when it exists it is not implemented or policed (by unions and civil society). Particularly vulnerable women, for example young women and single mothers, are more frightened of reporting harassment and bullying in case they lose their employment.

She described the work of Public Services International with Lady Health Workers in Pakistan which revealed widespread sexual harassment in the field, sexual harassment by co-workers/colleagues, domestic violence, humiliation by community members, and violence from extremist groups.

Sadly, these dangers are also found in health worker education. The presentation from Varwo Sitor-Gbassie (Maternal and Child Survival Program Human Resources for Health Project) focused on Liberia. Their 2017 research aimed to increase women’s matriculation rates and reduce drop outs in pre-service health education. They found that there was very limited access to gender training in schools, there was poor access to sexual and reproductive health services, female students were not kept safe and secure, and there was sexual harassment on campus. School policies were also discriminatory. Pregnant learners were also forced to leave their studies for two years.

Fragile and conflict affected states have particular problems

Presenting on the health workforce, gender and conflict-affected and fragile states, Sally Theobald reported that there are severe challenges to recruiting health care workers (training institutions have been destroyed and staff have been killed or fled). In addition to the under-representation of women in leadership positions and the struggle to balance caring responsibilities in the home and work which are found in other settings, women in conflict settings deploy various strategies to cope. They talked of blending in so that it wasn’t so apparent that they were health care workers:

“…the rebels came, abducted the in-charge and killed a nursing aide. I managed to escape but … I ran among the community members… I would not treat my hair… they [rebels] would follow you because you look different from other people. … That is why they [rebels] did not focus on me particularly because I was exactly like the community. And I used to buy simple clothes for my baby like for the community…” (woman health care worker, Northern Uganda)

In Cambodia male health workers trained themselves to use weapons for protection, whereas female health workers found ways to escape. In Sierra Leone health workers were targeted for kidnapping to provide health services behind rebel lines; female health workers also faced the additional risk of sexual violence if kidnapped by the rebels. Despite this, women showed special resilience and courage, supported by links to families and communities.

Sandra Massiah reflected on their work in the Democratic Republic of Congo. Since 2011, nurses and other healthcare workers have faced increased violence because of the military conflict as well as suspicion and traditional views: this includes rape, molestation in addition to attacks and murder during vaccination campaigns. SOLSICO reports that between 2011 and the present, over 700 nurses were raped and 188 killed.

Promising practices

Employers have a duty of care and states must enforce this: Sandra Massiah provided valuable insights on how the trade union movement is organising to tackle both gender inequity (on pay for example), gendered violence in the health workplace, and patriarchal norms. PSI are calling for national governments and employers to support an ILO convention and recommendation on this issue. They are also assisting affiliates in linking gender-based violence and harassment to the campaign for Gender Responsive Public Services (GRPS). By promoting and encouraging the attendance and participation of members of national women’s committees in the International Labour Conference they are supporting discussion on the issues. Public services unions have a critical role to play in discussions and policy formulation on violence in society. Furthermore, Sandra argued that tax justice is a gender issue – as it contributes to the public sector and thus the achievement of the Sustainable Development Goals. Gendered reform in the sector is reliant on this source of funding.

“Collective action by organised workers has proved to be a crucial means to mount a challenge to addressing inequality in remuneration between men and women…These struggles contribute to challenging the gendered construction of the economic and social value of productive and reproductive work that these inequalities stem from.”

Gendered approaches to health systems: As Sally Theobald argued, health systems are part of, and reflect, the broader social structures they are situated within. They are shaped by gender and other relations of power. This means that we must pay attention to systems and structures that maintain inequity in our research and policy frameworks. We also need to look at norms in households and communities as these shape the way health systems operate and how unpaid care roles are distributed.

Institutional monitoring and transformation: Emma Nofal, an Athena Swan NHS Fellow from the United Kingdom presented on how inequality is being tackled in the National Health Service. The Athena Swan Programme was developed in 2005 to encourage and recognise commitment to advancing the careers of women in science, technology, engineering, maths and medicine. Emma’s team are adapting this for use in the health sector through a pilot study in Sheffield teaching hospitals. Members who sign up to the Athena Swan charter apply for an award which is dependent on a focus on promoting and supporting gender equality for women. This research has enabled them to develop a better understanding of barriers for women in progressing, accessing training, accessing maternity leave, pay banding, and how we can make the working lives of staff better.

Supporting women’s leadership: Participants suggested that we need to encourage women’s leadership in the health and social care sector and this includes men in managerial positions pushing for change, supporting training for women, and removing the barriers that they currently face. In the union sector we need to engage men to make the necessary changes in their thinking and attitudes.This may mean initiatives to educate them about what is going wrong and how they can become allies in transformative change.

Zero tolerance for sexual harassment and violence: On the webinar there was a call for a zero-tolerance approach to sexual harassment and violence, including in the health workplace. We need to centre the victims of violence and support them when they come forward (including with psycho-social interventions). Workplace policies need to be assessed and updated and workplaces need to become safe spaces for raising issues of gendered and other forms of discrimination, this may also mean tackling bullying in the workplace more generally. Leaders in global health and in politics need to openly add their voices to calls against sexual harassment and set global standards to tackle violence in the world of health work.

Contact info@womeningh.org for more information about the Global Health Workforce Network Gender Equity Hub

Ten reasons to be cheerful

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If you work on women’s rights and gender you may be feeling a little deflated by the last twelve months. It is easy to be demoralised by the stories which rush past our Twitter feed or jump out from newspaper headlines. To cheer myself up I decided to put together a list of RinGs’ top ten accomplishments in the hope that as we head out for the holidays we can keep our chins up and our heads high. I would love it if you could share some of your gender triumphs with us in the comments below. It is nice to celebrate the positives.

Kate Hawkins (director of Pamoja communications)

21 December 2017

 

1. We have a new partner!

We are delighted that the original partners in RinGs have been joined by a new consortium, COMDIS-HSD, represented in RinGs by Helen Elsey and Rebecca King. COMDIS-HSD are working on the prevention, diagnosis and treatment of TB, malaria, HIV and communicable diseases, within primary care and community settings in Nepal, Bangladesh, Pakistan, Swaziland and Ethiopia. They got off to a flying start with an intersectionality training which was a big hit!

2. The European Commission launched guidance on gender and health systems

With Sarah Hawkes (UCL), Sally Theobald and Jo Raven provided training to the European Commission. Reflection across staff at headquarters and in their country offices led to the publication of a report to galvanise gender analysis in policy and practice.

3. The launch of the WHO Gender and Equity Hub

The Global Forum on Human Resources for Health was a great opportunity to meet with colleagues from around the world who are working on gender equity. Sarah Ssali, Rosemary Morgan, and Sally Theobald attended and went to some great panels on community health workers, how to do gender analysis, and more. The launch of the WHO Hub on Gender and Equity in the Health Workforce was warmly welcomed. Do submit evidence to their ongoing consultation if you can.

4. Kui Muraya became a film star

OK, this may be a bit of an overstatement. However, we are delighted that Kui appeared in a film about her work on gender and health system governance and leadership in Kenya, South Africa and Nigeria.

5. Our Health Policy and Planning supplement

We just can’t stop tweeting about these journal articles! It takes years to get a supplement published so when it finally arrives it brings a great deal of joy. Check out this collection which explains how gender intersects with other axes of inequity within specific contexts to shape experiences of health and health seeking within households, communities and health systems.

6. The World Health Summit

With our esteemed partners, Women in Global Health, we took part in a panel at the World Health Summit in Berlin on gender equality within the global health workforce. We were represented by Sally, Sreytouch, and Linda Waldman. A lot of discussion focused on the need to support individual women as well as addressing broader social, political and power dynamics that act as barriers, and for the need to take action at all levels – institutional, political and individual – to promote gender equity in the global health workforce.

7. Sreytouch Vong became a Heroine of Health

Sreytouch was named a Heroine of Health by Women in Global Health. ‘These women are working tirelessly to improve global health with dedication and passion to champion better healthcare for all.’  Much deserved! Check out her brief on women’s leadership in the Cambodian health system on the Building Back Better website.

8. Rosemary and Kui were published in the Lancet

Rosemary and Kui are authors of the widely read commentary on the ways that women are missing out on receiving medicine and public health awards. Thanks to the Lancet for publishing this work. We are glad to see that they have launched a call for papers on women in science, medicine and global health. Do send in your research!

9. New brief on intersectionality

Rebecca Wolfe, Sassy Molyneux and Rosemary worked with their colleagues to put together an excellent brief on the main tenets of intersectionality analysis, its value to health systems research, and how it relates to notions of everyday resilience.

10.   An extension to our work

We are thankful to the UK Department for International Development for providing another two years’ worth of financing to RinGs so that we can continue to develop our work. Much appreciated. We have lots of ideas about how to keep gender at the top of the health systems research agenda as we move forward together in solidarity.

supplement of gender and health systems research

NEW SUPPLEMENT Leaving no one behind: the role of gender analysis in strengthening health systems

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We are delighted to announce the publication of our journal supplement on gender and health systems research!

RinGs

14 December 2017

This supplement brings a gender lens to bear on the health system, uncovering new learning which can help us to build more equitable and people-centred research, policy, and practice globally and in different low- and middle-income countries. The papers cover a range of health issues and health systems areas and use a range of methods. The findings demonstrate that gender intersects with other axes of inequity within specific contexts to shape experiences of health and health seeking within households, communities and health systems. The supplement is an important step in drawing together emerging evidence on gender and health systems and encouraging others to adopt a similar lens.

For additional information about this supplement read Kate Hawkins’ blog on the Health Policy and Planning website, or listen to this podcast where authors Sally Theobald and Kui Muraya discuss why they think gender analysis is important within health systems research.

To view the supplement visit Health Policy and Planning.

 

Articles in the supplement

Editorial (Sally Theobald et al): The importance of gender analysis in research for health systems strengthening

Original article (Sophie Witter et al): Minding the gaps: health financing, universal health coverage and gender

Original article (Rosemary Morgan et al): Gender dynamics affecting maternal health and health care access and use in Uganda

Original article (Tumaini Nyamhanga et al): Prevention Of Mother To Child Transmission Of Hiv In Tanzania: Assessing Gender Mainstreaming On Paper

Original article (Kelly Muraya et al): “If it’s issues to do with nutrition…I can decide…”: Gendered decision-making in joining community-based child nutrition interventions within rural coastal Kenya

Original article (Fiona Samuels et al): Psychosocial support for adolescent girls in post-conflict settings: beyond a health systems approach

Original article (Sophie Witter et al): The gendered health workforce:  mixed methods analysis from four fragile and post-conflict contexts

2017 Global Forum on Human Resources for Health

Gender trends at the 2017 Global Forum on Human Resources for Health

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A few weeks have passed since the 2017 Global Forum on Human Resources for Health which has given some space to reflect on what we heard about gender at the event.

By Kate Hawkins, Sally Theobald, Roopa Dhatt, Sarah Ssali, Rosemary Morgan, Kerry Scott, Kelly Thompson, and Rosie Steege

07 December 2017

Overall the prognosis is very positive: there was a strong contingent of ‘gender champions’ at the event, issues like women’s leadership were at the heart of one of the main framings of the conference, ‘decent work’, and the launch of the World Health Organization Hub on Gender and Equity created a buzz about this work and represents a promising step forward for the field.

Gender champions

The week began with a moving and stirring event which was organised by Women in Global Health to enable health care workers to tell stories about their careers. Unsurprisingly, given most of the speakers were women, many of these stories uncovered the gendered realities of work on the frontline of health systems. This included having to deliver services in very insecure settings where the risk of ambush was high, being shot at, and being assaulted. Personal stories help us understand deep rooted power structures in the health system and how they can be transformed. The issue of gendered violence, raised here, was returned to later in the conference as a key concern. The voices of health care workers and their ability to speak truth to power are important mechanisms for honouring their service and pushing their concerns up the political agenda.

Many of the most passionate advocates at the conference were young people who were active in their own side sessions and integrated into the main sessions of the conference. Their side sessions included conversations about women in leadership, ideas of equity, and the role of nurses in health decision making. Their Call for Action included strong content on gender in which they:

“Call for attaining equal gender representation and female empowerment within the health workforce, and strongly urge all relevant stakeholders to make concrete commitments in order to minimize gender inequalities, add a gender perspective to all strategic decisions, and actively enable the fuller participation of women.”

Decent work

Decent work was one of the main themes of the Forum and as such it was unsurprising that many of the gender sessions focused on this topic. Many speakers queried whether it was possible to carve out a decent work agenda if we don’t focus on gender. The topics raised included visibility, compensation, and accountability frameworks to ensure gender equity at work. Speakers pointed out that despite making up the majority of the health workforce women are under-valued, under-paid and make up less than 10% of the health leadership.

The issue of decent work was also raised in relation to women’s unpaid care in the household and community health workers (who are sometimes volunteers and if paid are paid poorly). It was noted that because unpaid care is seen as women’s work community health workers have limited opportunities for progression and are employed precariously.

Overall, addressing ‘decent work’ was linked with addressing the currently indecent gender and power relationships within the health system – creating policies that are supportive, work environments that are enabling, and training structures that reflect women’s inputs and boost their possibilities. This is only possible with larger societal change which aims to alter the harmful norms and structures that underpin discrimination against women.

Gender and Equity Hub

Undoubtedly discussions about gender and health workers were given tremendous energy and vibrancy by the launch of the WHO Gender and Equity Hub on the first day of the Forum. This enabled likeminded delegates to come together to share evidence and experience which helped shape their interventions over the rest of the week. It was also a great opportunity to build a movement of solidarity across different stakeholders in the health system. It is warmly welcomed.

While the Hub puts in place plans for a thorough mapping of stakeholders, initiatives, and evidence the meeting enabled us to identify some key themes that participants felt were crucial. Unsurprisingly equal pay, education and training, a decent working environment and equal leadership were prioritised. But also preventing discrimination (in particular violence and harassment in the workplace), social protection, and transforming our systems of unpaid care. There was also a focus on intersectionality – how different women’s experience are shaped by race, ethnicity, age, sexuality etc. – and how this must inform our strategies moving forward. This may require more contextually nuanced methods of gathering data (led by marginalised women themselves) and interventions that consider people of different genders as a heterogenous group with differing experiences, needs, and desires.

As has been mentioned elsewhere, in conversations at the conference there was also an acknowledgement that gender is a men’s issue. For example, in the Gender and Equity Hub meeting there were discussions about the importance of not placing all the responsibility for creating gender equitable workplaces on women (e.g. assuming that increasing the number of female leaders will automatically achieve great gains, etc.) but recognizing that everyone perpetuates patriarchy and men must also be part of systemic change.

Moving forward

The Forum’s focus on transforming policies and guidelines is laudable. However, sometimes there is a tension between gender equitable human resources for health policy/law and social realities. For example, in India the Community Health Worker programme aims to create safe spaces for ASHAs to share issues of violence they are dealing with. Yet the likelihood of this happening in such an under-resourced environment, without adequate support, is very low. Similarly, ASHAs are taught about the legal rights of those subject to domestic violence, but accessing justice or the financial resources to leave a violent situation is not very realistic in Indian villages. In the future we may need to consider how health systems can reconcile or maximize the benefit of gender-equitable policy in light of challenging ground realities and the slow pace of social change. The health sectors relationship with other areas of the state, for example the criminal justice system, needs further exploration and strengthening.

With the momentum of health sector reform primarily being pushed by the Universal Health Coverage agenda we may need to better consider how a gender lens might alter the implementation and accountability mechanisms that are being proposed for this area.

Finally, while the Forum was a great space to share emerging evidence on issues related to gender and human resources for health there are still large gaps in our knowledge – notably on community health workers, migration, and the changes that occur when men enter previously woman-dominated professions within the health workforce. Building the research base in a manner that captures and boosts the voices and concerns of health workers is key to remedying this.

 

For further information on the Gender and Equity Hub please contact info@womeningh.org

Acknowledgements: This blog draws on the notes recorded by Twitter users during the Forum, we are extremely grateful for their diligent engagement and rapporteuring skills. You can read a roundup of all commentary here. The photo that accompanies this blog is of Edith Thaulo head nurse of Tisungane Clinic at Zomba. It was taken by Travis Lupick.

Photo of woman with child by Eduardo Arraes.

An online learning resource on gender and health for the European Commission

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We supported a new open access online learning resource on Gender and Health Systems, drawing on case studies developed in the Building Back Better project. This collaborative process helped to galvanise gender analysis in policy and practice.

Sally Theobald and Joanna Raven

20 November 2017

 

We recently had the opportunity to work with the European Commission – a major funder of health systems strengthening initiatives globally – to help expand the resources that they have on gender and health. We worked with Dr. Maryse Simonet of the EC’s DEVCO B4 team, EC central health staff, and those from country offices to develop resources to inspire and support further action on gender equity. We considered a range of health responses to promote gender equity which EC delegates could operationalise within their health systems strengthening projects. This led to the development of a new open access online learning resource.

The online learning resource defines key gender concepts and links to relevant open access tools, resources, and frameworks which can be applied to support gender analysis in different contexts and across different health systems issues. The health systems approach and frameworks provide opportunities to institutionalize gender equality in a sustainable manner and to enhance policy synergies amongst the four pillars of the EU second gender action plan:

  • Ensuring girls’ and women’s physical and psychological integrity
  • Promoting the social and economic rights/empowerment of girls and women
  • Strengthening girls’ and women’s voice and participation
  • Shifting the institutional culture to more effectively deliver on EU commitments

The online learning resource is supported by case studies, which explore how gender influences rates of risk exposure to common drivers of ill-health, patterns of health-care seeking for women and men, analysing and assessing the implications for health systems and global health institutions.

The resource draws from our Building Back Better work, illustrating how gender analysis can be applied in fragile and conflict affected settings. Additional case studies present health systems challenges from a gender perspective in Zimbabwe and Guinea Bissau.

It was an interesting process to collaboratively develop these case studies. We worked with health specialists and gender focal persons, in various EU delegations and people in charge of health development projects, mostly in low-income settings.  We also had inputs from EC delegates from Nigeria and Tunisia to enable discussion on the extent to which challenges (and solutions) identified were context specific or had a wider applicability. A seminar was held with delegates to discuss the case studies and resources which triggered a range of reflections and critical questions: on strategies and approaches to ensure gender analysis also include a focus on men and boys; the importance and challenges of fostering intersectoral collaboration to promote gender equity in interventions such as those addressing gender-based violence; the challenges of fast paced change and multiple players in conflict affected contexts; and the importance of gender indicators,  collecting and using sex disaggregated data and gender analysis to resist the “evaporation” of a gender focus in policy and practice at all levels of the health system.

The tool is now available as an open access resource for anybody to use.  You can also watch the video to find out more!

We would like to congratulate the European Commission for developing a gender action plan and making strides to ensure that gender is part of their core work.  We were very happy to be part of the process and learned a lot through it, and we hope you find the online learning resource helpful. We also hope that the French version, in the making (thanks to the EC), will trigger exchange and broaden involvement.

The Learning Resource – Gender and Health Systems – can be downloaded from this link.

Photo of woman with child by Eduardo Arraes.

We’re editing a new book on women’s leadership in global health

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There is a growing interest in women’s role in global health leadership. We know that women are the majority of people working to improve health outcomes in communities, health facilities, non-governmental organizations, and multilateral organizations. So why is it that when it comes to leadership positions we have a governance system that privileges men and what can we do to redress the balance?

Kate Hawkins

06 September 2017

 

We are delighted to announce that together with Women in Global Health, with the support of Springer, we will be publishing a book that explores women’s leadership in global health.

This ground-breaking collection will explore the leadership roles that women currently play in global health, teasing out the routes that women have taken to leadership, the challenges that they have faced, and what has facilitated their journey. It will bring to the fore the stories of women on the frontlines of this struggle from around the world, highlighting and complimenting these stories with theoretical and analytical explorations of the structures and systems that help or hinder the process. Empirical studies in this volume will demonstrate how women’s leadership is thwarted or supported from a range of different contexts, positions, and starting points.

The authors come from various academic and professional disciplines and have been purposefully selected to show the range of types of leadership in global health. The book will form a rallying call to arms to redress gender inequality and celebrate the many ways in which women are taking the lead in supporting the health of their communities internationally. This book will be a must read for those working in global health or studying the topic. It will also be a feminist primer that aims to support other women in their efforts to succeed in a highly unfair and unequal world.

The editors are Kate Hawkins, Rosemary Morgan, Roopa Dhatt, and Mehr Manzoor.

For more information watch this space! If you have any questions, just drop us a line.

community-health-worker-in-kenya

Women in the changing world of community health work

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This blog explores gender and community health workers in the context of the theme of International Women’s Day: “Women in the changing world of work”.

Lynda Keeru

17 March 2017

During US President Obama’s visit to Kenya in July 2015, he warned that nations would not succeed if they continued treating women as “second class” citizens.

Around the world, there is a tradition of repressing women, and treating them differently and not giving them the same opportunities, husbands beating their wives and girl children not being sent to school. Progressive development policies demand that girls get an education. Evidence shows that societies that give daughters similar opportunities as their sons are more likely to progress faster, and when they become mothers are more likely to bring up educated children, Obama said.

We marked International Women’s Day last week with the theme: “Women in the changing world of work.” Many organizations used the day as a launching pad to speak about their initiatives especially around the work they do to ‘empower’ women. The question though is whether women are actually getting empowered and supported to live to their fullest potential? As a participant at REACHOUT’s 7th consortium meeting in Nairobi, celebrating and acknowledging the day alongside fellow women, evidence showed that perhaps, there is very little empowerment that has occurred, especially for female Community Health Workers (CHWs).

Roles within the health workforce are highly gendered and health systems rely on a foundation of health workers that are often female, informal, poorly remunerated and poorly supported. Globally, it is estimated around 70% of CHWs are female and those unpaid are most likely to be female. In many contexts, the job is on a voluntary basis. According to the World Bank, there is a significant gender gap in earnings and wages, even after controlling for industry and occupation. UNHLP Report on Women’s Economic Empowerment reports that the unexplained gender pay gap reveals gender discrimination.

Women continue to volunteer and persevere amidst these harrowing challenges because they best ‘know where the shoe pinches’. Of particular interest is the fact that, much as the majority of CHWs are women and know exactly what happens on the ground, they are rarely incorporated into decision making committees at village and community levels.  As aforementioned, female CHWs face a myriad of challenges as they execute their duties. In the course of their home visits, they are accused by their husbands of extramarital affairs that sometimes culminate in gender based violence. On occasion, they are accused of disregarding their household chores as they carry out their CHW roles. There are other barriers including poor terrain and transport barriers, insecurity including rape cases in some instances, among others that they have to deal with and overcome in their daily service.

Women are the chief caretakers of their families and are natural researchers. CHWs have untapped insights around gender, equity, power struggles and this should be tapped to build more responsive health systems. When any of their family members are unwell, they suffer incredibly. Not all get remuneration in their roles as CHWs, some are motivated by the fact that healthier children and families mean a burden less off their shoulders.

Strong gender mainstreaming is required where both men and women share in the execution of CHW tasks. We need to create awareness among the CHWs of their rights, and how inequity affects health. This will tackle harmful gender norms and behaviours in their communities. Women should be given a seat at the table to identify their issues, get solutions to them, and get involved in decision making.  We need to include this vital interface cadre in debates and efforts to support women’s leadership in health.

Women’s career progress needs to be fostered and gender parity in leadership positions addressed. The voice of the woman needs to be strengthened and heard collectively. When women are given greater opportunities to participate in the economy, the benefits extend far beyond individual girls and women but also to societies and economies as a whole.

 

This blog was originally posted on the REACHOUT Consortium website

International Women’s Day, women’s health and gender: Four things to consider as health practitioners and researchers

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This blog explores the relationship between women’s health and gender inequity, identifying key points for health practitioners and researchers to consider.

Rosemary Morgan, Kui Muraya, Kate Hawkins, Sassy Molyneux, Linda Waldman

08 March 2017

This International Women’s Day, March 8 2017, we consider the relationship between women’s health and gender inequity and identify key points for health practitioners and researchers to consider.

1.    International Women’s Day is about gender inequity

Each year, International Women’s Day focuses the world’s attention on gender inequities. This year the theme is ‘Women in the Changing World of Work’. When it comes to health we have a long way to go:

2.    Focusing on women’s health is not the same thing as focusing on gender, although both are important

Gender is often used synonymously with women and girls; a focus on women’s health, however, is not a focus on gender. Women’s health research is concerned with the role that biological sex differences play in shaping health conditions and morbidities for women. While it typically focuses on conditions and morbidities associated with women’s reproductive role, it also examines sex differences related to communicable and non-communicable diseases.

While focusing on women and girls is important, “it does not necessarily address the determinants of gender inequality that perpetuate women’s and girl’s vulnerability and marginalization.” Gender is the social construction of behaviors and roles considered appropriate by society for men, women, and other genders. A focus on gender in relation to women’s health would therefore explore the structural, socio-cultural, or relational dynamics that influence health and health-seeking behavior, and how differences in power relations lead to differential vulnerabilities, risks, exposures and outcomes in health. In RinGs we are also concerned with intersectionality and the ways in which different axes of inequity (based on race, sexuality, (dis)ability etc.) constitute people’s gendered experience of health.

3.    Most leading causes of women’s mortality relate to gender inequities

Many of the leading causes of women’s mortality worldwide are issues which directly relate to gender inequities. In high-income countries, heart disease remains a leading cause of women’s mortality. A lack of research on women’s heart disease and a bias towards signs and symptoms of heart disease which typically present in men, are some of the reasons why the heart disease death rates have declined for men but not for women.

Leading causes of maternal mortality in low- and middle-income countries are those related to pregnancy and childbirth, with 99% of all maternal deaths occurring in these regions. Women’s lack of access to skilled birth attendants is often the result of inequitable gender norms which, as Paruzzolo et al. state, “tend to privilege the well-being of men and boys at the expense of women and girls, leading to women’s lack of economic options and lack of autonomy”. We can also see this trend in high-income countries  world, where funding cuts to sexual and reproductive health services has led to a doubling of the maternal mortality rate in Texas in the United States.

4.    To improve women’s health we need to transform inequitable gender norms and roles

Unless the underlying dynamics which reinforce and perpetuate gender inequities are challenged and changed, it will be difficult to improve women’s health in the long term. Interventions and approaches are needed which transform inequitable gender norms and roles.

According to IGWG, gender transformative approaches explicitly engage women and men “to examine, question, and change rigid gender norms and imbalance of power as a means of reaching health as well as gender equity objectives.” Tools and guidance exist to help practitioners to incorporate a transformative lens into their health interventions and research. This will also require concerted and sustained advocacy for change. Many of the changes that are needed will require powerful groups to cede power and resources for change. This is rarely a straightforward and easy process.

This International Women’s Day we encourage you to think about the role of gender inequity in relation to women’s health, and about how we, as health practitioners and researchers, can incorporate gender transformative approaches into our work to create lasting change.

 

*Research in Gender and Ethics (RinGs): Building Stronger Health Systems is a cross-Research Programme Consortia (RPC) bringing together Future Health Systems, ReBUILD and RESYST in a partnership to galvanise gender and ethics analysis in health systems.

Reflections from the UCL gender and health launch

Reflections from the UCL gender and health launch

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This blog discusses three key take home messages from the launch of the UCL Center for Gender and Health.

Eleanor MacPherson, Liverpool School of Tropical Medicine

02 March 2017

Photo of Eleanor MacPherson

 

Two years ago, when my son was two years old we met one of his friends from nursery in the park. They ran around together chasing each other. My son took a corner too sharply and fell scraping his knee and burst into tears. His two-year-old friend strode over, pointed at my son’s tears and told him to stop crying because “boys don’t cry.” As a feminist trying to bring my children up sheltered from damaging socially constructed stereotypes it was a stark reminder that we still need radical and disruptive changes to our society.

I was reminded again of this when I attended the launch of the UCL Centre for Gender and Health on Thursday 16th February. Two of the central themes that shaped the discussions during the launch were the need to disrupt and challenge the status quo to come up with new ways of being and doing.

For me it was very invigorating to be engaged and involved in these discussions and there were three key insights I gained from the day:

  • Psychological and economic violence is deeply damaging: Rachel Jewkes’s excellent presentation highlighted the deep damage that psychological and economic violence can do to women. She voiced the strong message that these forms of violence are not “Intimate Partner Violence-lite” but something that needs to be taken seriously and included in our policy interventions.
  • It is vital to work with men on gender transformative interventions: Benno de Keijzer’s presentation began by reminding us how masculine ideals do real harm to men’s health. The presentation of statistics on car accidents, suicide rates, and alcohol abuse really brought this home and reminded me again that gender stereotypes are not only bad for women they are also deadly for men. His work in Mexico provided fascinating insights and examples of gender transformative interventions with men. So often gender transformative approaches have focused narrowly on women and it was refreshing to see different ways that these can be successfully taken forward.
  • Gender isn’t binary and LGBTI people’s needs matter: It was really refreshing to hear a discussion from Maureen Fordham on gender and disasters. She reminded us that that gender isn’t a binary concept (that we need to go beyond the categories of male and female to include people of other genders) and that the rights and needs of LGBTI communities are deeply and frequently invisiblised in disaster responses. Her point that to even mention these groups exist can silence discussion in many health-related fora was a stark reminder of how far we still need to go.

It is all too easy to become hopeless and despondent at what needs to change in society but spending the day surrounded by academic and practitioners who do want to challenge and disrupt the status quo was incredibly inspiring and gives me hope for my children’s future.

gender buttons

Gender and the Fourth Global Symposium on Health Systems Research: Five things that stood out

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This blog discusses five things that stood out in relation to gender at the Fourth Global Symposium on Health Systems Research.

Rosemary Morgan and Kate Hawkins

13 December 2016

As people with a profound interest in gender and health systems, it was a pleasure to attend the recent Global Symposium on Health Systems Research in Vancouver last month. Here are some of the things that stood out for us from the conference.

1. A stream dedicated to equity, rights, gender, and ethics, substantially increased the focus on gender

This year the conference had a dedicated stream focused on equity, rights, gender, and ethics, which substantially increased the focus on gender within the conference. Our analysis showed that gender was mentioned 73 times in the program, as compared to 29 in Cape Town. In addition, we found that 11 sessions included gender, as compared to three in Cape Town. We were also delighted to see gender being a key focal point within the Emerging Voices programme – with gender being a main theme in the online discussions prior to the conference as well as the project itself. Having a dedicated stream on this issue increased attention on gender should become a permanent feature in future symposia. However, when we do a quick search through the Vancouver Statement that came at the end of the symposium, we don’t see gender mentioned once (although intersectionality is included). This is despite a rapporteur team working diligently to ensure that all the sessions were captured. It makes us wonder how these statements are formulated and how particular issues in our world become prominent.

Number of sessions which included gender

2. A focus on intersectionality

Intersectionality emerged as a key theme within the conference. The Thursday morning plenary discussed intersectionality as a research approach to understanding and promoting resilience and responsiveness in health systems. Intersectionality was analysed in a couple of Global Health TV interviews with TK Sundari Ravindran and Sally Theobald. Intersectionality was also highlighted in a paper by Sheikh et al. just before the conference titled “Privilege and inclusivity in shaping Global Health agendas”. Despite this focus, there is still the danger that intersectionality gets compressed to the ‘diversity’ agenda, rather than tackling the root causes of white supremacy, patriarchy, and heteronormativity etc. (E.g. kyriarchy).

3. Only a few unfortunate manels

Prior to the conference, Women in Global Health published their Event Organizer’s Checklist, which highlights the importance of having gender diverse panels. We were happy to see that there were only a few unfortunate manels at the conference, and when these did occur, they were quickly called out on Twitter. We even saw explanations being made on Twitter as to why a particular panel only appeared to be a ‘manel’ – as the female presenters were coming on next. Participants were also actively asking on Twitter how we might be able to avoid the trap of the #allmalepanel? As one participant rightly said, “Men lose too, because the focus shifts from their content to gender imbalance”. Throughout the conference people were invited to write down on flipchart what the best part of the symposium has been for them – we were heartened to see that one participant wrote “gender equality”.

4. Increased informal networking creating a ‘gender buzz’

This year we saw a number of gender networking events and activities during the conference. From a gender networking meet and greet hosted by Women in Global Health and RinGs, to badges proclaiming “I’m here for the gender analysis”. Karina Gould, the Parliamentary Secretary to the Minister of International Development even proclaimed that Canada is pursuing a feminist and rights-based agenda to health. As a result, throughout the conference there was a sense that feminist members of Health Systems Global didn’t feel as alienated as in previous years.

5. Recognition of how power plays out in health systems research and beyond

Within health systems research we continue to see an increased recognition of how power plays out. Within some of the Thematic Working Group (TWG) discussions, for example, there was a push that the TWGs attend to and respond to a lack of representation in their make-up and agenda. A board member explicitly stating during the conference the need to decolonialize our work supported this. Discussions were also held in the Teaching Health Policy and Systems Research TWG about how power and privilege manifests within health systems teaching. In the weeks leading up to the conference the Emerging Voices posted a blog about visa headaches and inequalities in attending global health conferences. There continues to remain a need for more people to be vocal about these issues, especially if the organizers in Liverpool for #HSR2018 are to have a chance to react and adapt for the future.

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