Markers of achievement for assessing and monitoring gender equity in a UK National Institute for Health Research Biomedical Research Centre: A two-factor model.

BACKGROUND: The underrepresentation of women in academic medicine at senior level and in leadership positions is well documented. Biomedical Research Centres (BRC), partnerships between leading National Health Service (NHS) organisations and universities, conduct world class translational research funded by the National Institute for Health Research (NIHR) in the UK. Since 2011 BRCs are required to demonstrate significant progress in gender equity (GE) to be eligible to apply for funding. However, the evidence base for monitoring GE specifically in BRC settings is underdeveloped. This is the first survey tool designed to rank and identify new GE markers specific to the NIHR BRCs. METHODS: An online survey distributed to senior leadership, clinical and non-clinical researchers, trainees, administrative and other professionals affiliated to the NIHR Oxford BRC (N = 683). Participants ranked 13 markers of GE on a five point Likert scale by importance. Data were summarised using frequencies and descriptive statistics. Interrelationships between markers and underlying latent dimensions (factors) were determined by exploratory and confirmatory factor analyses. RESULTS: The response rate was 36% (243 respondents). Respondents were more frequently female (55%, n = 133), aged 41-50 years (33%, n = 81), investigators (33%, n = 81) affiliated to the BRC for 2-7 years (39.5%, n = 96). Overall participants ranked 'BRC senior leadership roles' and 'organisational policies on gender equity', to be the most important markers of GE. 58% (n = 141) and 57% (n = 139) respectively. Female participants ranked 'organisational policies' (64.7%, n = 86/133) and 'recruitment and retention' (60.9%, n = 81/133) most highly, whereas male participants ranked 'leadership development' (52.1%, n = 50/96) and 'BRC senior leadership roles' (50%, n = 48/96) as most important. Factor analyses identified two distinct latent dimensions: "organisational markers" and "individual markers" of GE in BRCs. CONCLUSIONS: A two-factor model of markers of achievement for GE with "organisational" and "individual" dimensions was identified. Implementation and sustainability of gender equity requires commitment at senior leadership and organisational policy level.

A formative assessment of gender awareness and ability of staff based on the service programs of the All-China Women's Federation: The case of the "3861 My Home" program.

In order to achieve "gender mainstreaming" which is a global strategy to promote the development of women, it has in recent years been a major task for the All-China Women's Federation (ACWF) to improve the gender awareness and ability of policy makers and implementers. Thus, researchers should constantly propose and evaluate various possible attempts to improve gender awareness and the ability of individuals. There are few empirical studies on the assessment of gender awareness and the improvement of the ability of staff who have been trained and educated. Research studies focusing on the promotion of gender-sensitive awareness and ability of staff by participating in programs are even rarer. This study presents a specific case, namely the evaluation of promoting social service workers' gender awareness and ability within the implementation of the "3861 My Home" program. Based on this case, this study examines how to promote gender awareness and ability of social service workers through the implementation of the service program of Women's Federation, and also assesses the quality of the results of this implementation. Moreover, this study also contributes to the literature pertaining to assessing the development of social service workers' gender awareness and ability. In addition, the study provides an option for enhancing the gender awareness and ability of social service workers in addition to training: The participatory learning or action pertaining to gender awareness and ability based on the Women's Federation programs are able to effectively improve the gender awareness and ability of staff.

An account for barriers and strategies in fulfilling women's right to quality maternal health care: a qualitative study from rural Tanzania.

BACKGROUND: Tanzania has ratified and abides to legal treaties indicating the obligation of the state to provide essential maternal health care as a basic human right. Nevertheless, the quality of maternal health care is disproportionately low. The current study sets to understand maternal health services' delivery from the perspective of rural health workers', and to understand barriers for and better strategies for realization of the right to quality maternal health care. METHODS: Semi-structured in-depth interviews were conducted, involving 11 health workers mainly; medical attendants, enrolled nurses and Assistant Medical Officers from primary health facilities in rural Tanzania. Structured observation complemented data from interviews. Interview data were analyzed using thematic analysis guided by the conceptual framework of the right to health. RESULTS: Three themes emerged that reflected health workers' opinion towards the quality of health care services; "It's hard to respect women's preferences", "Striving to fulfill women's needs with limited resources", and "Trying to facilitate women's access to services at the face of transport and cost barriers". CONCLUSION: Health system has left health workers as frustrated right holders, as well as dis-empowered duty bearers. This was due to the unavailability of adequate material and human resources, lack of motivation and lack of supervision, which are essential for provision of quality maternal health care services. Pregnant women, users of health services, appeared to be also left as frustrated right holders, who incurred out-of-pocket costs to pay for services, which were meant to be provided free.

Good practice or positive action? Using Q methodology to identify competing views on improving gender equality in academic medicine.

OBJECTIVES: The number of women entering medicine has increased significantly, yet women are still under-represented at senior levels in academic medicine. To support the gender equality action plan at one School of Medicine, this study sought to (1) identify the range of viewpoints held by staff on how to address gender inequality and (2) identify attitudinal barriers to change. DESIGN: Q methodology. 50 potential interventions representing good practice or positive action, and addressing cultural, organisational and individual barriers to gender equality, were ranked by participants according to their perception of priority. SETTING: The School of Medicine at the University of Leeds, UK. PARTICIPANTS: Fifty-five staff members were purposively sampled to represent gender and academic pay grade. RESULTS: Principal components analysis identified six competing viewpoints on how to address gender inequality. Four viewpoints favoured positive action interventions: (1) support careers of women with childcare commitments, (2) support progression of women into leadership roles rather than focus on women with children, (3) support careers of all women rather than just those aiming for leadership, and (4) drive change via high-level financial and strategic initiatives. Two viewpoints favoured good practice with no specific focus on women by (5) recognising merit irrespective of gender and (6) improving existing career development practice. No viewpoint was strongly associated with gender, pay grade or role; however, latent class analysis identified that female staff were more likely than male to prioritise the setting of equality targets. Attitudinal barriers to the setting of targets and other positive action initiatives were identified, and it was clear that not all staff supported positive action approaches. CONCLUSIONS: The findings and the approach have utility for those involved in gender equality work in other medical and academic institutions. However, the impact of such initiatives needs to be evaluated in the longer term.

Gender inequity in Saudi Arabia and its role in public health.

In Saudi Arabia, local interpretations of Islamic laws and social norms have a negative impact on the health and well-being of women. The objective of this literature review was to discuss gender inequity in Saudi Arabia and its relation to public health. Despite the scarcity of recent statistics and information regarding gender inequity in Saudi Arabia, this review is an attempt to explore this sensitive issue in this country. Women's roles and rights in Saudi society were examined, including education, marriage, polygamy, fertility, job opportunities, car driving and identification cards. Further research to assess knowledge, attitudes and practices towards health care of Saudi men and women is recommended.

Human rights barriers for displaced persons in southern Sudan.

PURPOSE: This community-based research explores community perspectives on human rights barriers that women encounter in a postconflict setting of southern Sudan. METHODS: An ethnographic design was used to guide data collection in five focus groups with community members and during in-depth interviews with nine key informants. A constant comparison method of data analysis was used. Atlas.ti data management software facilitated the inductive coding and sorting of data. FINDINGS: Participants identified three formal and one set of informal community structures for human rights. Human rights barriers included shifting legal frameworks, doubt about human rights, weak government infrastructure, and poverty. CONCLUSIONS: The evolving government infrastructure cannot currently provide adequate human rights protection, especially for women. The nature of living in poverty without development opportunities includes human rights abuses. Good governance, protection, and human development opportunities were emphasized as priority human rights concerns. Human rights framework could serve as a powerful integrator of health and development work with community-based organizations. CLINICAL RELEVANCE: Results help nurses understand the intersection between health and human rights as well as approaches to advancing rights in a culturally attuned manner.

Rights to safe motherhood and newborn health: ethical issues.

Worldwide, one woman dies every minute as a result of being pregnant. This statistic highlights the denial of women's rights to safe motherhood in many parts of the world, particularly in low-resource countries where 98% all maternal deaths occur. The majority of pregnant women die because they deliver unattended by a properly trained birth professional. According to the 1948 Universal Declaration of Human Rights, every woman has the right to a standard of living adequate for the health and well-being of herself and her family, including medical care. The principle of moral philosophy supporting women's rights to safe motherhood may be difficult to implement. Philanthropy is diverted by other competing needs, such as HIV prevention and treatment, or provision of urgent food supplies. Equity is denied because women's health is too often set as a low priority. Utilitarianism advocates that safe motherhood is an investment of societal shared interest.

[Female circumcision--a new issue for gynecologists practicing in the E.U. countries?]. / Obrzezanie kobiet--nowy problem w praktyce lekarza ginekologa w krajach Unii Europejskiej?

An increasing number of immigrants from countries practicing female genital mutilation (FGM) has begun to concern Europe as well. The aim of this article is to present recent medical data about FGM which, in the age of globalisation and migration of people, may become essential for gynaecologists working in Poland, but also those practising abroad.

On enrolling more female students in science and engineering.

Many people hold this truth to be self-evident that universities should enroll more female students in science and engineering; the main question then being how. Typical arguments include possible benefits to women, possible benefits to the economy, and the unfairness of the current female under-representation. However, when clearly stated and scrutinized these arguments in fact lead to the conclusion that there should be more women in scientific disciplines in higher education in the sense that we should expect more women (which various kinds of discrimination may prevent), not that we should actively enroll more women. Outreach programs towards high school students may therefore be logically incompatible with the arguments supposed to justify them. They should purport to allow women to graduate in a field congruent with her abilities and desires, rather than try to draw as many of them to scientific disciplines as possible: one cannot try to 'recruit' as many female students as possible while claiming to help them choose more freely.

Understanding the impact of a microfinance-based intervention on women's empowerment and the reduction of intimate partner violence in South Africa.

OBJECTIVES: We sought to obtain evidence about the scope of women's empowerment and the mechanisms underlying the significant reduction in intimate partner violence documented by the Intervention With Microfinance for AIDS and Gender Equity (IMAGE) cluster-randomized trial in rural South Africa. METHODS: The IMAGE intervention combined a microfinance program with participatory training on understanding HIV infection, gender norms, domestic violence, and sexuality. Outcome measures included past year's experience of intimate partner violence and 9 indicators of women's empowerment. Qualitative data about changes occurring within intimate relationships, loan groups, and the community were also collected. RESULTS: After 2 years, the risk of past-year physical or sexual violence by an intimate partner was reduced by more than half (adjusted risk ratio=0.45; 95% confidence interval=0.23, 0.91). Improvements in all 9 indicators of empowerment were observed. Reductions in violence resulted from a range of responses enabling women to challenge the acceptability of violence, expect and receive better treatment from partners, leave abusive relationships, and raise public awareness about intimate partner violence. CONCLUSIONS: Our findings, both qualitative and quantitative, indicate that economic and social empowerment of women can contribute to reductions in intimate partner violence.

Women's empowerment and health: the role of institutions of power in Pakistan.

Women's right to health has been reiterated many times. However, there are social and cultural barriers in developing countries that hinder their empowerment. Women's low status, deprivation of education and lack of control over their own lives and bodies have a negative impact on their health status and that of their families. This paper discusses women's empowerment and health within the framework of the 4 institutions of power in a society-family, community, health care systems and the state--with special reference to the situation in Pakistan. It concludes that to improve women's health status, concerted efforts are needed by all these institutions of power to work towards gender equality and the greater empowerment of women.

Violence against women in Mexico: conceptualization and program application.

Violence against women has been a problem in human cultures for centuries. This is still the case both in developed and in developing countries, but it is in developing countries where the problem is aggravated as the result of cultural norms that are tolerant of men exerting power over women and girls as a commonly accepted practice. This power is often put into practice through physical and psychological acts of violence. In Mexico, as in many other countries, there is a legal framework that protects women from such acts, yet in the case of Mexico it has not yet been translated into actual improvements in their lives. We present an overview of advances in legal remedies regarding violence towards females internationally and in Mexico. The fact that these advances per se do not lead to changes in social norms that tolerate violence against females is emphasized. Also presented is the experience of the Mexican Institute for Research on Family and Population (IMIFAP) with the design and implementation of programs that promote protective factors and changes in behaviors in such a way that violence is effectively prevented. These programs focus on the development of psychosocial skills and knowledge through participatory workshops that promote self reflection, and they are developed and evaluated before being then applied on a large scale in poverty-stricken communities. These workshops lead to more egalitarian relationships between genders. IMIFAP's programs address not only violence but also other areas are integrated such that the enablement of psychosocial skills is applied in the broader socio-cultural context, leading to healthier and economically more productive lives. These programs are derived from the Framework for Enabling Agentic Empowerment (FENAE), which enables choice and the development of agentic empowerment through integrating skills, knowledge, and the context in which people live.

United Nations measures to stop violence against women.

This article consists of a brief overview of the involvement by the United Nations (UN) and nongovernmental organizations (NGOs) in worldwide efforts to expose and prevent violence against women. It begins with a depiction of the types of gender-based violence in contemporary society. Then follows a short history of the institutions and mechanisms created by the UN and civil society to prevent domestic and public violence against women. It concludes with a sketch of ongoing UN/NGO efforts to build on the momentum of the last decade, and suggests the challenges this presents to each and all of us in the new millennium.

Constructions of gender in Vietnam: in pursuit of the 'Three Criteria'.

Vietnam has advanced far beyond most other developing countries and, indeed, surpasses many developed countries in adopting a legal framework based on gender equality, and in creating institutions and programmes to support women's advancement. Inegalitarian gender norms have also persisted, however. The Vietnam Women's Union promotes women's educational, political and economic advancement but simultaneously exhorts women to pay attention to their Confucian role of maintaining family hierarchy and harmony. This paper presents findings from qualitative research examining gender relations at the grassroots level in central Vietnam. It argues that the Vietnam Women's Union could support women more effectively by promoting greater diversity in gender norms and by initiating a public discussion to address the pressures women face in trying to achieve ideals that are often experienced as contradictory and unattainable.

Barriers to and facilitators for female participation in an HIV prevention project in rural Ethiopia: findings from a qualitative evaluation.

Ethiopian women face complex social and cultural factors that influence their probability of HIV infection. HIV prevention efforts among this population are particularly important; however, female participation in a rural, HIV prevention project has been minimal. This programme evaluation investigated barriers and facilitators influencing women's ability to participate in project activities. Evaluation data were collected through nine focus groups and 20 semi-structured interviews, which were conducted between October and November 2003. The main themes found to negatively influence women's decisions to participate in this HIV prevention activity included: domestic workloads, lack of education and awareness, and cultural norms that have discouraged discussions about HIV and sexuality. Domestic chores, which are labour intensive and limit time and energy, were found to be the primary barrier to participation among women. Respondents also indicated that female illiteracy and limited educational attainment occur within a social context that traditionally supports education for men but discourages formal knowledge among women, including HIV prevention. Lack of education and inability to freely discuss sexuality denies women access to health information, potentially exposing women to adverse consequences such as HIV infection. Identified facilitators of participation included a radio serial drama and the one female peer educator associated with the project.