Monitoring gender equity in mental health in a low-, middle-, and high-income country in the Americas.

OBJECTIVE: Gender disparities in mental health highlight the need to include gender equity measures when planning, implementing, and evaluating mental health programs at national, state or provincial, and municipal levels. This study aimed to identify, select, and assess the feasibility of comparing gender-sensitive mental health indicators in a low- (Peru), middle- (Colombia), and high- (Canada) income country. METHODS: The indicators were selected by a multidisciplinary group of experts who used criteria and a framework proposed by the World Health Organization. Data from national, population-based databases from each country were used to measure the indicators. RESULTS: Seven indicators (12-month prevalence of the following: depression, psychological distress, generalized anxiety disorder, suicide attempts, alcohol dependence, mental health service use, and psychological impairment) were feasible for measurement in at least two countries. Only five indicators were comparable between two countries, and only one was comparable among all countries (suicide attempts). The indicators that showed the greatest inequities between men and women were depression, anxiety, suicide attempts, use of mental health services, and alcohol dependence. Female-to-male ratios for prevalence of mental illness ranged from .1 to 2.3, and ratios for service use ranged from 1.3 to 1.9. Significant trends were found when the indicators were considered by age, education, marital status, and income. CONCLUSIONS: Some of these indicators can be used to identify populations most vulnerable to gender inequities in mental health. The results from this study may provide useful information to program planners who aim to implement, improve, and monitor national mental health strategies that reduce gender inequities under different national conditions.

Monitoring gender equity in health using gender-sensitive indicators: a cross-national study.

BACKGROUND: As gender is known to be a major determinant of health, monitoring gender equity in health systems remains a vital public health priority. Focusing on a low-income (Peru), middle-income (Colombia), and high-income (Canada) country in the Americas, this study aimed to (1) identify and select gender-sensitive health indicators and (2) assess the feasibility of measuring and comparing gender-sensitive health indicators among countries. METHODS: Gender-sensitive health indicators were selected by a multidisciplinary group of experts from each country. The most recent gender-sensitive health measures corresponding to selected indicators were identified through electronic databases (CINAHL, PsycINFO, MEDLINE, Embase, LILACS, LIPECS, Latindex, and BIREME) and expert consultation. Data from population-based studies were analyzed when indicator information was unavailable from reports. RESULTS: Twelve of the 17 selected gender-sensitive health indicators were feasible to measure in at least two countries, and 9 of these were comparable among all countries. Indicators that were available were not stratified or adjusted by age, education, marital status, or wealth. The largest between-country difference was maternal mortality, and the largest gender inequity was mortality from homicides. CONCLUSIONS: This study shows that gender inequities in health exist in all countries, regardless of income level. Economic development seemed to confer advantages in the availability of such indicators; however, this finding was not consistent and needs to be further explored. Future initiatives should include identifying health system factors and risk factors associated with disparities as well as assessing the cost-effectiveness of including the routine monitoring of gender inequities in health.

Examining gender equity in health policies in a low- (Peru), middle- (Colombia), and high- (Canada) income country in the Americas.

Gender inequities in health prevail in most countries despite ongoing attempts to eliminate them. Assessment of gender-sensitive health policies can be used to identify country specific progress as well as gaps and issues that need to be addressed to meet health equity goals. This study selected and measured the existence of gender-sensitive health policies in a low- (Peru), middle- (Colombia), and high (Canada)-income country in the Americas. Investigators selected 10 of 20 gender-sensitive health policy indicators and found eight to be feasible to measure in all three countries, although the wording and scope varied. The results from this study inform policy makers and program planners who aim to develop, improve, implement, and monitor national gender-sensitive health policies. Future studies should assess the implementation of policy indicators within countries and assess their performance in increasing gender equity.

Portuguese-speaking women voice their opinions: using their words to teach about wife abuse.

BACKGROUND: This study examined Portuguese-speaking women's definitions of wife abuse and beliefs about appropriate responses to abuse. The goals were to determine the breadth of definitions and to examine cultural stereotyping. This information was sought in an effort to design education strategies in the Portuguese-speaking community. METHODS: One-on-one semistructured interviews were conducted with 163 Portuguese-speaking women living in Toronto, Canada. The participants' open-ended answers were first coded using Qualitative Software Research NUDIST and then narrowed and grouped. Responses were then tagged by group label to generate descriptive statistics using Statistical Package for Social Sciences. RESULTS: Participants defined wife abuse broadly with respect to kind, prevalence, and severity. Six themes for abuse emerged: physical, psychological, sexual, financial, patriarchal, and infidelity. Participants provided various responses to what women should do and actually do in response to abuse. Most participants believed that Portuguese-speaking women should leave their husbands and/or seek help for the abuse, but that they actually remain quiet about the abuse and take very little action. Their responses and explanations demonstrate that they hold stereotypes about their culture. CONCLUSIONS: The range of definitions reported by participants suggests that a continuum of wife abuse, using Portuguese-speaking women's own words, can be created to educate them about how abusive acts are linked and used to maintain control over women. The differences that emerged with respect to appropriate responses to abuse suggest that it may be important to challenge Portuguese-speaking women about the cultural stereotypes that they hold to help them see patriarchy as widespread rather than particular to their culture.

Menopause in highland Guatemala Mayan women.

OBJECTIVES: To explore any feelings and symptoms surrounding menopause among Mayan women in three ethnolinguistic groups in highland Guatemala and compare these with previous reports from Mexico. METHODS: This was a qualitative exploratory study of the experiences around menopause of eight middle aged women and one local key informant in each of three villages in western highland Guatemala (n=27). Individual interviews were conducted in women with irregular menses or whose menses has ceased in the last 3 years. Field notes were kept and then an analysis undertaken by the author. RESULTS: Twenty-four Mayan women, aged 38-55, and three Mayan key informants (all women over age 50) were interviewed. Most women reported some symptoms, including hot flashes, night sweats, changes in libido, irritability, moodiness, abdominal cramps and menstrual clots occurring at some stage during the last 3 years. Although women reported symptoms, they mostly accepted them with equanimity; and rejoiced at the cessation of their periods. CONCLUSIONS: Highland Guatemalan Mayan women reported symptoms that were not reported in Mayan women in Yucatan, Mexico in the years surrounding menopause. The reasons for this disparity are unclear but may reflect differences in body weight and diet. Despite these symptoms, Mayan women looked forward to menopause and their newfound freedom and status. Symptoms in women in the years around menopause must be interpreted in geographical, nutritional, biological, psychological and cultural context.