Sexual Harassment, Abuse, and Discrimination in Obstetrics and Gynecology: A Systematic Review.

Importance: Unlike other surgical specialties, obstetrics and gynecology (OB-GYN) has been predominantly female for the last decade. The association of this with gender bias and sexual harassment is not known. Objective: To systematically review the prevalence of sexual harassment, bullying, abuse, and discrimination among OB-GYN clinicians and trainees and interventions aimed at reducing harassment in OB-GYN and other surgical specialties. Evidence Review: A systematic search of PubMed, Embase, and ClinicalTrials.gov was conducted to identify studies published from inception through June 13, 2023.: For the prevalence of harassment, OB-GYN clinicians and trainees on OB-GYN rotations in all subspecialties in the US or Canada were included. Personal experiences of harassment (sexual harassment, bullying, abuse, and discrimination) by other health care personnel, event reporting, burnout and exit from medicine, fear of retaliation, and related outcomes were included. Interventions across all surgical specialties in any country to decrease incidence of harassment were also evaluated. Abstracts and potentially relevant full-text articles were double screened.: Eligible studies were extracted into standard forms. Risk of bias and certainty of evidence of included research were assessed. A meta-analysis was not performed owing to heterogeneity of outcomes. Findings: A total of 10 eligible studies among 5852 participants addressed prevalence and 12 eligible studies among 2906 participants addressed interventions. The prevalence of sexual harassment (range, 250 of 907 physicians [27.6%] to 181 of 255 female gynecologic oncologists [70.9%]), workplace discrimination (range, 142 of 249 gynecologic oncologists [57.0%] to 354 of 527 gynecologic oncologists [67.2%] among women; 138 of 358 gynecologic oncologists among males [38.5%]), and bullying (131 of 248 female gynecologic oncologists [52.8%]) was frequent among OB-GYN respondents. OB-GYN trainees commonly experienced sexual harassment (253 of 366 respondents [69.1%]), which included gender harassment, unwanted sexual attention, and sexual coercion. The proportion of OB-GYN clinicians who reported their sexual harassment to anyone ranged from 21 of 250 AAGL (formerly, the American Association of Gynecologic Laparoscopists) members (8.4%) to 32 of 256 gynecologic oncologists (12.5%) compared with 32.6% of OB-GYN trainees. Mistreatment during their OB-GYN rotation was indicated by 168 of 668 medical students surveyed (25.1%). Perpetrators of harassment included physicians (30.1%), other trainees (13.1%), and operating room staff (7.7%). Various interventions were used and studied, which were associated with improved recognition of bias and reporting (eg, implementation of a video- and discussion-based mistreatment program during a surgery clerkship was associated with a decrease in medical student mistreatment reports from 14 reports in previous year to 9 reports in the first year and 4 in the second year after implementation). However, no significant decrease in the frequency of sexual harassment was found with any intervention. Conclusions and Relevance: This study found high rates of harassment behaviors within OB-GYN. Interventions to limit these behaviors were not adequately studied, were limited mostly to medical students, and typically did not specifically address sexual or other forms of harassment.

The workplace culture, mental health and wellbeing of early- and mid-career health academics: a cross-sectional analysis.

There are reports of poor working conditions for early and mid-career academics (EMCAs) in universities, however, empirical data using validated tools are scarce. We conducted an online, cross-sectional survey using validated tools to assess workplace satisfaction, exposure to workplace abuse, and mental health. Participants included employees of medical and health faculties of two of the largest Australian universities, surveyed between October 2020 and January 2021.Overall, 284 participants responded. Many reported job insecurity: half (50.7%) working on contracts with less than one remaining year. Workloads were considerable, with 89.5% of participants working overtime and 54.8% reporting burnout. Workplace abuse in the forms of bullying (46.6%), sexual harassment (25.3%), sexism (49.8%) and racism (22.5%) were commonly reported. Clinically significant symptoms of depression (28.0%), anxiety (21.7%) and suicidal ideation or self-harm (13.6%) were reported; with a higher prevalence among those working more overtime, and those exposed to workplace abuse. Priorities include providing a stable and safe workplace, increasing accountability and transparency in addressing workplace abuse, and supporting professional development.In summary, EMCAs in our study were commonly exposed to precarious employment conditions and workplace abuse. Our findings provide empirical evidence on where universities and funding bodies should direct resources and change organisational risk factors, to improve workplace culture.

Workplace sexual harassment: a qualitative study of the self-labelling process among employees in Denmark.

PURPOSE: To explore how employees understand work-related sexual harassment and label their experience. METHODS: This study is based on 13 semi-structured in-depth interviews with employees exposed to workplace sexual harassment. We analysed the data using a thematic approach drawing on frameworks of sensemaking in organizations. RESULTS: We identified four major themes. The first two themes, distinguishing between sexual harassment and unwanted sexual attention and labelling real life sexual harassment, outline the interviewees' definitions of the two terms "sexual harassment" and "unwanted sexual harassment" and reveal the challenges of labelling sexually harassing behaviours at work. The last two themes; making the connection and negotiating boundaries and labels, explain the sensemaking process, i.e., how the interviewees come to understand and label their experience. CONCLUSION: The analysis showed that the interviewees related sexual harassment with physical, coercive, and intentional behaviours, whereas unwanted sexual attention was seen as less severe and less intentional. The interviewees often doubted how to label their experience, and making sense of one´s experience could take years. Self-labelling is inherently a social process, and the validation and rejection of others play an important role. Finally, the #MeToo movement constituted a turning point for several interviewees' understandings of events.

Sexual harassment and implicit gender-career biases negatively impact women's life expectancy in the US: a state-level analysis, 2011-2019.

BACKGROUND: Despite some gains, women continue to have less access to work and poorer experiences in the workplace, relative to men. The purpose of this study was to examine the relationships among women's life expectancy and two work-related factors, sexual harassment and gender-career biases. METHOD: We examined the associations at the state level of analysis (and District of Columbia) in the US from 2011 to 2019 (n = 459) using archival data from various sources. Measures of the ratio of population to primary health providers, year, the percent of adults who are uninsured, the percent of residents aged 65 or older, and percent of residents who are Non-Hispanic White all served as controls. RESULTS: Results of linear regression models showed that, after accounting for the controls, sexual harassment and gender-career biases among people in the state held significant, negative associations with women's life expectancy. CONCLUSION: The study contributes to the small but growing literature showing that negative workplace experiences and bias against women in the workplace negatively impact women's health.

Perceptions of lecturers and students regarding discriminatory experiences and sexual harassment in academic medicine - results from a faculty-wide quantitative study.

BACKGROUND: Discrimination and sexual harassment are prevalent in higher education institutions and can affect students, faculty members and employees. Herein the aim was to assess the extent of discriminatory experiences and sexual harassment of students and lecturers at one of the largest teaching hospitals in Europe. We analyze whether there are differences between lecturers and students, different study programs as well as sex/gender differences. METHODS: In an interdisciplinary, iterative process, a semi-standardized questionnaire was developed and sent to N = 7095 students (S) of all study programs and N = 2528 lecturers (L) at Charité-Universitätsmedizin Berlin, Germany. The study was conducted from November 2018 to February 2019. Besides a broad range of questions on sociodemographic background allowing for diversity sensitive data analysis, they were asked if they had witnessed and/or experienced any form of discrimination or sexual harassment at the medical faculty, if yes, how often, the perceived reasons, situational factors and perpetrators. RESULTS: The response rate was 14% (n = 964) for students and 11% (n = 275) for lecturers. A proportion of 49.6% of students (L: 31%) reported that they have witnessed and/or experienced discriminatory behavior. Sexual harassment was witnessed and/or experienced by 23.6% of students (L: 19.2%). Lecturers (85.9%) were identified as the main source of discriminatory behavior by students. Directors/supervisors (47.4%) were stated as the main source of discriminatory behavior by lecturers. As the most frequent perceived reason for discriminatory experiences sex/gender (S: 71%; L: 60.3%) was reported. Women and dental students experienced more discriminatory behavior and sexual harassment. CONCLUSIONS: Discriminatory behavior is experienced by a significant number of students and lecturers, with power structures having a relevant impact. Dental students and women appear to be particularly exposed. Specific institutional measures, such as training programs for lecturers and students are necessary to raise awareness and provide resources. Furthermore, national preventive strategies should be thoroughly implemented to fight discrimination and harassment at the workplace.

Prevalence and determinants of discrimination or harassment of women: Analysis of cross-sectional data from Bangladesh.

This study aimed to explore the prevalence and determinants of discrimination against or harassment among Bangladeshi women. The nationally representative cross-sectional data of the Multiple Indicator Cluster Survey 2019 were employed in the study. Women aged 15-49 were asked whether they felt discrimination or harassment due to seven potential reasons in the last twelve months before the survey. The outcome was a binary variable indicating whether a woman has experienced discrimination or harassment for any of the seven reasons. Responses were obtained from 64378 women and analysed through bivariate and multivariate procedures. The data had a hierarchical structure since women were nested within the clusters. A mixed-effects logistic regression model was used to analyse the data appropriately. A strong association between discrimination or harassment was seen with the functional difficulties of women. Notably, women with functional difficulties were 1.629 times more likely to experience discrimination or harassment than women without such difficulties. Other significant factors were the respondents' area, age, education, current marital status, wealth index quintile and ethnicity. The study concludes that education, marital status, functional difficulties and wealth index are the most important determinants of discrimination or harassment of women.

Prevalence and predictors of workplace sexual harassment of nurses in the Central Region of Ghana: a cross-sectional online survey.

OBJECTIVE: We investigated the prevalence and predictors of workplace sexual harassment against nurses in the Central Region of Ghana. DESIGN: A cross-sectional online survey. SETTING: Central Region of Ghana. PARTICIPANTS: A total of 1494 male and female nurses from various healthcare facilities in the Central Region participated in this survey from August to September 2021. MAIN OUTCOME MEASURES: The prevalence of sexual harassment was determined using the Sexual Experiences Questionnaires and the Workplace Violence in the Health Sector Questionnaires. We used descriptive statistics to analyse participants' characteristics and the occurrence of sexual harassment. Binary logistic regression was used to determine the predictors of sexual harassment. The survey instrument yielded a reliability value of 0.82. RESULTS: The prevalence of sexual harassment was 43.6% when behaviour-based questions were applied and 22.6% when a direct question was used. The main perpetrators of sexual harassment were male physicians (20.2%), male nurses (15.4%), male relatives of patients (15.1%) and male patients (11.6%). Unfortunately, only a few victims lodged complaints of harassment. Compared with males, female nurses were more likely to be sexually harassed (adjusted OR, aOR 1.59, 95% CI 1.23 to 2.07). Moreover, nurses with higher work experience (aOR 0.86, 95% CI 0.80 to 0.93), those married (aOR 0.54, 95% CI 0.41 to 0.72) and those working in private or mission/Christian Health Association of Ghana health facilities (aOR 0.49, 95% CI 0.36 to 0.68) were less likely to be sexually harassed. CONCLUSIONS: The prevalence of workplace sexual harassment against nurses in the Central Region of Ghana is high and may compromise quality healthcare delivery in the region. Therefore, managers of healthcare facilities and the Ghana Health Service need to institute antisexual harassment interventions, including education, training and policy, with a focus on females in general, but especially those who are not married, less experienced and those working in public health facilities.

National science foundation grant awardees' perspectives on Article X and sexual harassment in science.

Federal scientific agencies seek to make an impact on the continued prevalence of sexual harassment in the scientific academic community beyond institutional self-regulation. The National Science Foundation's Article X, released in 2018, is one of the most significant and ambitious federal policy initiatives to address sexual harassment. The present article presents the results of the first study to examine scientists' knowledge and attitudes about this important recent policy. We found, although overall knowledge about Article X was fairly low, the majority of participants responded positively to it. Crucially, impressions of the policy varied based on past experience and demographic factors. Individuals who had experienced harassment in the past year were less likely to believe the policy would help reduce sexual harassment in the sciences compared to those who had not experienced harassment (OR = 0.47, 95% CI:0.23-0.97, p = .034) and had greater odds of endorsing that the policy failed to go far enough (OR = 2.77, 95% CI:1.15-6.66, p = .023). Associations between demographic factors and views of the policy were less pronounced, but it is notable that, compared to their White counterparts, Black participants were more likely to believe the policy went too far (OR = 5.87, 95% CI:1.04-33.17, p = .045). Additionally, concerns were raised about the institutional enforcement of these policies and the existence of sufficient protections for survivors. Our work has implications for NSF's continued evaluation of the efficacy of this program as well as for other federal agencies implementing or considering similar policies.

Trends in Sexual Harassment Prevalence and Recognition During Intern Year.

This cohort study uses Internal Health Study and Sexual Experiences Questionnaire data to assess changes in sexual harassment prevalence and recognition among training physicians.

Problematic situations related to social media use and competencies to prevent them: results of a Delphi study.

A three-round Delphi method was used to study the problematic situations that adolescents may encounter when using the social media, and the competencies needed to address these situations. A panel of Finnish experts (N = 22) provided an open-ended list of problematic situations and competencies in 2020-2021. These were then evaluated and ranked according to their significance. The experts provided an information-rich list of both problematic situations and competencies. Finally, 16 problematic situations and 19 competencies were ranked in order of importance by the experts. The most important problematic situations were direct and indirect cyberbullying and sexual harassment. The most important competencies were the ability to act responsibly, knowing what kinds of activity are prohibited, and knowing whom to contact on exposure to cyberbullying or harassment. The findings can be used in developing policies, recommendations, and solutions aimed at counteracting the harmful effects of social media on wellbeing during adolescence.

The relationships of sexually harassing behaviors to organizational context factors and working men's dark personality traits.

This research examined the roles of organization contexts factors and dark personality traits in men's (N = 600) self-reports of sexually harassing behaviors toward women in the workplace. Four organization context factors (a permissive climate, a masculinized job/gender context, male/female contact, and Masculinity Contest Culture [MCC] Norms) and four dark personality traits (psychopathy, narcissism, Machiavellianism, and sadism) were examined. While only one organizational context factor, MCC Norms correlated with men's admissions of sexually harassing behaviors at work, all four dark personality traits evidenced significant correlations. In a multiple regression analysis, MCC Norms emerged again as the single organizational context predictor and psychopathy as the single personality predictor of men's admissions of sexually harassing behaviors at work. Moderation analyses showed that a masculinized job/gender context interacted with psychopathy to produce more admissions of sexually harassing behaviors. Mediation analyses showed that psychopathy, narcissism, and Machiavellianism had indirect relationships with admissions of sexually harassing behaviors through MCC Norms. Higher levels on these traits were related to higher levels of these workplace norms which, in turn, predicted more admissions of sexually harassing behavior. This research sheds new light on how both organizational contexts and enduring personal characteristics of men are related to sexual harassment in the workplace.

Joint trajectories of bullying victimization and sexual harassment victimization as predictors of adolescent alcohol use.

OBJECTIVE: The present study examined the independent and joint effects of bullying victimization and sexual harassment victimization on adolescent alcohol use over time within a community sample of adolescents. METHOD: Adolescents aged 13-15 years old at baseline (N = 800, Mage = 14.42, SD = 0.83; 57.5% female) recruited from Western New York State made five online survey reports of peer victimization and alcohol use over a 2-year period. Latent class growth analysis was used to identify trajectory classes of victimization from bullying and sexual harassment over time, and regression modeling was used to examine the associations with later alcohol use. RESULTS: Three developmental courses were identified for bullying victimization (moderate/decreasing, high/decreasing, never or low) and for sexual harassment victimization (moderate/decreasing, moderate/increasing, never or low). Adolescents in the moderate/decreasing group of bullying victimization subsequently consumed more alcoholic drinks when they drank. Belonging to the moderate/increasing group of sexual harassment was associated with increased later alcohol intoxication and number of drinks. Bullying victimization and sexual harassment victimization were concurrently correlated over time. Adolescents who followed the joint trajectory group of moderately decreasing bullying and increasing sexual harassment were more likely to report increased later alcohol intoxication and number of drinks. CONCLUSIONS: Moderate levels of bullying victimization along with increasing sexual harassment victimization are associated prospectively with greater alcohol use in adolescence. Findings highlight the importance of considering the cumulative, joint effects of multiple types of peer victimization on adolescent health outcomes. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Beyond reporting: proactive strategies for safer scientific fieldwork.

Fieldwork is crucial for science but poses heightened risks of gender-based harassment and assault. Current practices prioritize post-incident reporting, despite the demonstrated potential of preventive approaches. We recommend proactive practices, training strategies, and systemic policy changes to build safe and inclusive fieldwork settings from the outset.

Bystanders' thresholds for intervention in Black vs. White women's sexual harassment.

Black women's sexual harassment is often overlooked and dismissed relative to White women's harassment. In three pre-registered experiments, we test whether this neglect extends to bystander intervention in sexual harassment. Participants observed an ostensibly live job interview between a man manager and a Black or White woman job candidate. The manager's questions were pre-programmed to grow increasingly harassing, and participants were asked to intervene if/when they found the interview inappropriate. A meta-analysis of the three studies (N = 1487), revealed that bystanders did not differ in their threshold for intervention when sexual harassment targeted the Black vs. White woman. Despite evidence for the relative neglect of Black women in responses to sexual harassment, these data suggest that bystanders may respond similarly for Black and White women.

Musculoskeletal pain among medical residents: role of workplace safety climate and sexual harassment.

BACKGROUND: Workplace factors are important predictors of occurrence of musculoskeletal pain among different occupational populations. In healthcare, a psychologically unsafe work environment can negatively affect the emotional, physical and psychological well-being of physicians. This study aimed to examine the relationship between workplace violence, sexual harassment and musculoskeletal pain among Egyptian physicians in their years of residency. METHODS: We distributed an online self-administered questionnaire to 101 residents working in various healthcare sectors in Egypt. It included sections on demographic data, working conditions, widespread pain index (WPI), pain interference short-form, workplace violence and harassment questionnaire, psychosocial safety climate questionnaire (PSC) and sexual harassment climate questionnaire. RESULTS: All residents had at least one painful site on the WPI (range 1-11). The mean WPI was 3.5 ± 2.4, and 39.6% satisfied the criteria of having widespread pain by having at least 4 pain sites. Widespread pain index showed a weak statistically significant negative correlation with workplace PSC score (rho = - 0.272, p = 0.006), and a statistically significant weak positive correlation with the calculated total abuse index (rho = 0.305, p = 0.002). Workplace violence and abuse, as measured by a calculated abuse index was the only significant predictors of widespread pain among residents. CONCLUSION: WPV was found to be a predictor of musculoskeletal pain among medical residents. Healthcare organizations need to address WPV by employing preventive strategies to minimize its hazardous effects and ensure a safe working environment for physicians.

Invasion of privacy or structural violence? Harassment against women in public transport environments: A systematic review.

BACKGROUND: Despite being neglected for several decades, and in many countries, public transport environments have transformed into a reflection of social disparities and inequalities. Among these issues, harassment-a pervasive and worldwide gendered dynamic-has been demonstrated to negatively impact women's behavioral trends, daily opportunities, and health impacts, as well as safety and security outcomes. AIM: This systematic review aimed to examine a set of studies analyzing harassment against women in public transport environments, with a focus on key issues such as its prevalence, impact on transport dynamics, preventive strategies, and policing avenues documented in the scientific literature. METHOD: A total of 575 indexed articles were filtered using the PRISMA methodology, resulting in a final selection of 28 original articles directly addressing the issue up to December 2023. Search strategies were developed and implemented across WOS, Scopus, NCBI, Google Scholar, and APA databases. RESULTS: Besides high frequency, widespread underreporting, and adverse effects on women's safety, this review has identified correlations between harassment and travel behavioral adaptations. Furthermore, it reveals a noticeable disparity between the existing measures and those perceived as more effective by potential victims. These findings underscore the pressing need to listen to and promote the inclusion of women in decision-making regarding transport affairs. CONCLUSION: The findings of this systematic review suggest that, despite a slightly limited body of research, the impact of transport harassment on women's health and welfare is consistently supported in the literature. In addition to being largely explained by existing inequalities rooted in social determinants, transit harassment further exacerbates gender gaps, gaining prospective importance for transport settings.

Sexual harassment and patterns of symptoms and functional abilities in a psychiatric sample of adolescents.

PURPOSE: To investigate how commonly adolescent psychiatric outpatients with symptoms of depression and anxiety report having been subjected to sexual harassment, and to explore how symptoms and functional abilities differ between adolescent psychiatric outpatients with symptoms of depression and anxiety who do report and those who do not report having been subjected to sexual harassment. METHODS: Swedish adolescent psychiatric outpatients with symptoms of depression or anxiety (n = 324; 66 boys and 258 girls, aged 12-19 years, M = 15.6, SD = 1.7) answered the PROMIS paediatric measures. Logistic regression analyses were performed to assess differences between the respondents classified as 'Sexually harassed' and 'Not sexually harassed' based on these self-report questionnaires. RESULTS: About 60% of the adolescents reported having been subjected to sexual harassment, and reported higher levels of suicidal ideation, disturbed sleep, fatigue, anxiety, depression, anger, and pain interference, as well as lower functional ability in terms of school problems, alcohol consumption, and poor family relationships. Logistic regression analyses showed that the strongest associations were with suicidal ideation, disturbed sleep, anger, and alcohol consumption. CONCLUSIONS: About 60% of the adolescents in the studied psychiatric cohort reported having been subjected to sexual harassment. Reported experiences were high in all three subtypes, with the most reports on having been subjected to verbal harassment. Clinicians should ask about experiences of sexual harassment and give information about the consequences of sexual violence and treatment options. Alcohol consumption should be addressed and tested for. Structured assessment of suicidality should always be done.

Sexual harassment exposure among junior high school students in Norway: prevalence and associated factors.

Background: Sexual harassment is common in most countries and cultures. Less is known about sexual harassment, its risk factors, and psychosocial outcomes among young adolescents. The aim of the study was to examine the 12-month prevalence of sexual harassment exposure, and sociodemographic and psychosocial factors associated with exposure among junior high school students in Norway. Methods: A comprehensive cross-sectional study was completed by 83,297 Norwegian adolescents in junior high school in 2021. Data on exposure to sexual harassment were used in combination with sociodemographic measures and psychosocial outcomes: depressive symptoms, loneliness, self-esteem, and well-being. Group differences were analyzed with Chi Square tests, and sociodemographic risk factors were analyzed with logistic regression. Psychosocial outcomes were assessed with multivariate and univariate ANOVAs, and dose-response relationships were assessed with linear regression. Results: Among the adolescents, 32.6% had experienced sexual harassment during the past year. Girls had higher odds of exposure (OR: 1.90, 95% CI: 1.84-1.96), whereas adolescents whose parents had higher education had lower odds (OR: 0.95, 95% CI: 0.90-0.99). Exposure was associated with higher levels of depressive symptoms (partial η2 [ES] = 0.11) and loneliness (ES = 0.07), and with lower self-esteem (ES = 0.06) and well-being (ES = 0.06). Among exposed adolescents, more frequent exposure was associated with poorer outcomes. Conclusion: Exposure to sexual harassment affects one third of junior high school students in Norway. Those who are exposed have poorer psychosocial outcomes, and there is a dose-response relationship between exposure and outcomes. Awareness of sexual harassment among young adolescents, and interventions to prevent and reduce it, are needed.