Promoting equity in maternal, newborn and child health - how does gender factor in? Perceptions of public servants in the Ethiopian health sector.

Background: Advancing gender equality and health equity are concurrent priorities of the Ethiopian health sector. While gender is regarded as an important determinant of health, there is a paucity of literature that considers the interface between how these two priorities are pursued.Objective: This article explores how government stakeholders understand gender issues (gender barriers and roles) in the promotion of maternal, newborn and child health equity in Ethiopia.Methods: Adopting an exploratory qualitative case study design, we conducted semi-structured interviews with 17 purposively-selected stakeholders working in leadership positions with the Federal Ministry of Health and Federal Ministry of Women and Children Affairs as part of a larger study regarding the promotion of health equity in maternal, newborn and child health. A post hoc content and thematic sub-analysis was done to explore how participants raised gender issues in conversations about health equity.Results: Efforts to address gender inequalities were synonymous with the promotion of a women's health agenda, which was largely oriented towards promoting health service use. Men were predominant decision makers with regards to women's health and health care seeking in both public and private spheres. Participants reported persisting gender-related barriers to health stemming from traditional gender roles, and noted the increased inclusion of women in the health workforce since the introduction of the Health Extension Program.Conclusions: The framing of gender as a women's health issue, advanced through patriarchal structures, does little to elevate the status of women, or promote power differentials that contribute to health inequity. Encouraging leadership roles for women as health decision makers and redressing certain gender-based norms, attitudes, practices and discrimination are possible ways forward in re-orienting gender equality efforts to align with the promotion of health equity.

The Intersection of Gender-Based Violence and Risky Sexual Behaviour among University Students in Ethiopia: A Qualitative Study.

Women who experience gender-based violence (GBV) are at risk for adverse sexual health outcomes, as they may be unable to fully negotiate sexual encounters. This may be especially true for females at universities in Ethiopia, where women are the minority and patriarchal norms prevail. This study explored students' experiences and faculty's perceptions of GBV and sexual risk behaviours at two Ethiopian universities. Individual interviews were conducted with male and female students, and focus group discussions were held with students and faculty/staff. Qualitative thematic analysis was used to explore the relationship between GBV and sexual risk and identify intervention points. Data revealed that female students at both universities are regularly exposed to GBV, which in combination with risky sexual behaviours may threaten their health. Participants (n = 126) reported a belief that women who violate traditional gender norms are more prone to violence. Substance use was reported to contribute to risky behaviours, particularly for women. Participants reported male students sometimes encourage female intoxication in order to achieve sexual encounters, resulting in coercive situations. Sexual health and GBV-related services are provided on campus, but participants highlighted ways they can be improved. In order for females to safely pursue higher education in Ethiopia, campus-based interventions focused on the intersection of GBV and sexual risk are greatly needed.

"We are responsible for the violence, and prevention is up to us": a qualitative study of perceived risk factors for gender-based violence among Ethiopian university students.

BACKGROUND: There is a high prevalence of gender-based violence (GBV) victimization among young Ethiopian women, including in universities, where female enrollment is low but growing. Understanding factors contributing to GBV in this context and students' perspectives on gender, relationships, and interpersonal violence is essential to creating effective interventions to prevent GBV and support female students' rights and wellbeing. METHODS: In-depth interviews (IDIs) and focus group discussions (FGDs) were held with male and female students (male IDI n = 36, female IDI n = 34, male FGD n = 18, female FGD n = 19) and faculty and staff (FGD n = 19) at two Ethiopian universities. Audio recordings were transcribed and translated into English. Transcripts were coded thematically to identify key factors contributing to GBV and provide narratives of students' experiences. RESULTS: GBV against female students was a salient issue, including narrative accounts of harassment, intimidation, and physical and sexual violence on the university campuses and the towns in which they are located. Reported risks for GBV included receiving academic support from male peers, exercising agency in relationship decision-making, having a negative self-concept, belief in stereotypical gender expectations, and engaging in transactional sex and/or substance use. While students recognized these risk factors, they also suggested GBV may be the result of females' "improper" behavior, attire, use of males for personal gain, or personal failure to prevent violence. CONCLUSIONS: GBV is a serious issue in these two Ethiopian universities, creating a tenuous learning environment for female students. Programs are needed to address areas of vulnerability and negative attitudes toward female students in order to decrease female victimization.