[Effect of gender equality on mortality from non-communicable diseases]. / Efecto de la igualdad de género en la mortalidad por enfermedades no transmisibles.

OBJECTIVE: Relate gender inequalities with the probability of mortality from non-communicable diseases (NCD), in the countries of the world from the year 2000 to 2019, to detect the progress of Target 3.4 of the Sustainable Development Goal 3, to reduce NCD by one third between the ages of 30 and 70 by 2030. METHOD: Exploratory ecological study on the association between the probability of death from NCD and the gender inequality index (GII) at the global level in 2000, 2015 and 2019. Logistic regression estimation of the risk of not being on track to meet Target 3.4 by 2019 by gender inequality. RESULTS: The mean probability of death from NCD decreased progressively in all countries. Median 2000/2015/2019: women 20.20/16.58/16; men 26.59/22.45/21.88; total 23.14/20.10/19.23. The risk of not achieving the goal in 2019 is greater in countries with a lower GII than in countries with a higher GII (OR: 2.13; 95% CI: 1.14-3.99; p=0.018), being the higher risk in women (OR: 2.64; 95% CI: 1.40-5.06; p=0.003) than in men (OR: 2.12; 95% CI: 1.44-3.98; p=0.017). CONCLUSIONS: The risk of deaths from NCD has decreased in both sexes in all countries of the world since the year 2000; but progress is slow, so the greater gender inequality in the countries, there is a greater risk of not achieving the reduction needed to comply with the agreement to reduce mortality from NCD by one third in 2030; this risk being greater in women than in men.

Efecto de la igualdad de género en la mortalidad por enfermedades no transmisibles / Effect of gender equality on mortality from non-communicable diseases

Objetivo: Relacionar las desigualdades de género con la probabilidad de mortalidad por enfermedades no transmisibles (ENT) en los países del mundo desde 2000 hasta 2019, para detectar el progreso de la Meta 3.4 del Objetivo de Desarrollo Sostenible 3, de reducir en un tercio las ENT entre los 30 y los 70 años para 2030. Método: Estudio ecológico exploratorio sobre la asociación entre la probabilidad de fallecimiento por ENT y el índice de desigualdad de género (IDG) en el mundo en 2000, 2015 y 2019. Estimación mediante regresión logística del riesgo de no estar en proceso de cumplir la Meta 3.4 en 2019 según desigualdad de género. Resultados: La probabilidad media de fallecimiento por ENT descendió progresivamente en todos los países. Medianas 2000/2015/2019: mujeres 20,20/16,58/16; hombres 26,59/22,45/21,88; total 23,14/20,10/19,23. El riesgo de no estar logrando la meta en 2019 es mayor en los países con menor IDG que en los países con mayor IDG (OR: 2,13; IC95%: 1,14-3,99; p = 0,018), siendo el riesgo mayor en las mujeres (OR: 2,64; IC95%: 1,40-5,06; p = 0,003) que en los hombres (OR: 2,12; IC95%: 1,44-3,98; p = 0,017). Conclusiones: El riesgo de fallecimiento por ENT descendió en ambos sexos en todos los países del mundo desde el año 2000, pero el progreso es lento y, a mayor desigualdad de género en los países, mayor riesgo de no estar logrando el descenso necesitado para cumplir con el acuerdo de reducir un tercio la mortalidad por ENT en 2030, siendo este riesgo mayor en las mujeres que en los hombres.(AU)

Objective: Relate gender inequalities with the probability of mortality from non-communicable diseases (NCD), in the countries of the world from the year 2000 to 2019, to detect the progress of Target 3.4 of the Sustainable Development Goal 3, to reduce NCD by one third between the ages of 30 and 70 by 2030. Method: Exploratory ecological study on the association between the probability of death from NCD and the gender inequality index (GII) at the global level in 2000, 2015 and 2019. Logistic regression estimation of the risk of not being on track to meet Target 3.4 by 2019 by gender inequality. Results: The mean probability of death from NCD decreased progressively in all countries. Median 2000/2015/2019: women 20.20/16.58/16; men 26.59/22.45/21.88; total 23.14/20.10/19.23. The risk of not achieving the goal in 2019 is greater in countries with a lower GII than in countries with a higher GII (OR: 2.13; 95% CI: 1.14–3.99; p = 0.018), being the higher risk in women (OR: 2.64; 95% CI: 1.40–5.06; p = 0.003) than in men (OR: 2.12; 95% CI: 1.44–3.98; p = 0.017). Conclusions: The risk of deaths from NCD has decreased in both sexes in all countries of the world since the year 2000; but progress is slow, so the greater gender inequality in the countries, there is a greater risk of not achieving the reduction needed to comply with the agreement to reduce mortality from NCD by one third in 2030; this risk being greater in women than in men.(AU)

Education as a dimension of human development: A Provincial-level Education Index for Ecuador.

This article deepens in the differences in educational development between the Ecuadorian provinces and in their evolution over time by estimating the Provincial-level Education Index. This index is built using the micro-databases of the two latest rounds of the Ecuador`s Living Standards Measurement Survey (2005-2006 and 2013-2014). The results show an overall increase in the educational development of the Ecuadorian provinces, as well as a slight reduction in inequality. However, differences between them continue to exist. Underlying our results, which are consistent with the provincial production structure and socioeconomic context, some public policies seem to affect the educational sector, as their impact has been evidenced during the period covered in this research.

Healthcare professionals' experiences and perceptions regarding health care of indigenous pregnant women in Ecuador.

BACKGROUND: Pregnancy is an important life experience that requires uniquely tailored approach to health care. The socio-cultural care practices of indigenous pregnant women (IPW) are passed along the maternal line with respect to identity, worldview and nature. The cultural differences between non-indigenous healthcare professionals (HPs) and IPW could present a great challenge in women's health care. This article presents an analysis from a human rights and gender perspective of this potential cultural divide that could affect the health of the IPW in an Andean region of Ecuador with the objective of describing the health challenges of IPWs as rights holders through the experiences and perceptions of HP as guarantors of rights. METHODS: We conducted 15 in-depth interviews with HPs who care for IPW in Chimborazo, Pichincha provinces of Ecuador. We utilized a semi-structured interview guide including questions about the experiences and perceptions of HPs in delivering health care to IPW. The interviews were recorded, transcribed and subjected to thematic analysis in Spanish and translated for reporting. RESULTS: We found disagreements and discrepancies in the Ecuadorian health service that led to the ignorance of indigenous cultural values. Common characteristics among the indigenous population such as illiteracy, low income and the age of pregnancy are important challenges for the health system. The gender approach highlights the enormous challenges: machismo, gender stereotypes and communication problems that IPWs face in accessing quality healthcare. CONCLUSIONS: Understanding the diverse perspectives of IPW, acknowledging their human rights particularly those related to gender, has the potential to lead to more comprehensive and respectful health care delivery in Ecuador. Further, recognizing there is a gender and power differential between the provider and the IPW can lead to improvements in the quality of health care delivery and reproductive, maternal and child health outcomes.

Governance commitment to reduce maternal mortality. A political determinant beyond the wealth of the countries.

Some countries reached, in 2015, the Millennium Development Goal of reducing maternal mortality to 96 or less maternal deaths per 100,000 live births. Others, however, did not. This paper analyses the strength of the association between maternal mortality and each of the six components of Governance-a political determinant scarcely explored in the literature-in 174 countries. It was found that the greater the governance, the lower maternal mortality, independently of a country's wealth. We used all six indicators of the World Bank's Worldwide Governance Indicators Project in 2015: government effectiveness, regulatory quality, rule of law, control of corruption, voice and accountability, and political stability and absence of violence. Findings were encouraging as maternal mortality in low-income countries with higher government effectiveness and regulatory quality was similar to that of medium-income countries with lower government effectiveness and regulatory quality. To achieve the post-2015 sustainable development goal on preventable maternal mortality-which persists despite economic development-all governance dimensions are essential and represent interdependent cornerstones.

Gender inequality and violence against women in Spain, 2006-2014: towards a civilized society / La desigualdad de género y la violencia contra las mujeres en España, 2006-2014: hacia una sociedad civilizada

Objective: Considering both the economic crisis of 2008 and the Gender Equality Law (2007), this study analyses the association between gender inequality in Spanish Autonomous Communities (AC) and intimate partner violence (IPV) from 2006 to 2014 in terms of socio-demographic characteristics. Methods: Ecological study in the 17 Spanish AC on the correlation between the reported cases by IPV and deaths and the Gender Inequality Index and its dimensions: empowerment, participation in the labour market and adolescent birth rates; and their correlation with Young People Not in Education, Employment or Training (NEET). Results: In 2006, IPV mortality rates were higher in autonomous communities with greater gender inequality than AC with more equality (4.1 vs. 2.5×106 women >14 years), as were reporting rates of IPV (OR=1.49; 95% CI: 1.47-1.50). In 2014, the IPV mortality rates in AC with greater gender inequality fell to just below the mortality rates in AC with more gender equality (2.5 vs. 2.7×106 women >14 years). Rates of IPV reports also decreased (OR=1.22; 95% CI: 1.20-1.23). Adolescent birth rates were most associated with IPV reports, which were also associated with the burden of NEET by AC (ρ2006=0.494, ρ2014=0.615). Conclusion: Gender-sensitive policies may serve as a platform for reduced mortality and reports of IPV in Spain, particularly in AC with more gender inequality. A reduction of NEET may reduce adolescent birth rates and in turn IPV rates (AU)

Objetivo: Considerando la crisis económica de 2008 y la Ley de igualdad entre hombres y mujeres (2007), se analiza la asociación entre la desigualdad de género de las comunidades autónomas (CCAA) españolas con la violencia del compañero íntimo (VCI) en 2006 y 2014, respecto a características sociodemográficas. Métodos: Estudio ecológico en las 17 CCAA sobre la asociación entre las muertes y denuncias por VCI y el Índice de Desigualdad de Género y sus dimensiones: empoderamiento, participación en el mercado laboral y tasas de fecundidad de adolescentes; y su asociación con jóvenes que ni estudian ni trabajan. Resultados: En 2006, las CCAA con mayor desigualdad de género sufrieron tasas de mortalidad por VCI superiores que las de mayor igualdad (4,1 frente a 2,5×106 mujeres >14 años), y también las denuncias fueron más (odds ratio [OR]: 1,49; intervalo de confianza del 95% [IC95%]: 1,47-1,50). En 2014, disminuyeron las tasas de mortalidad por VCI en las CCAA con mayor desigualdad de género, situándose ligeramente por debajo de las de más igualdad (2,5 frente a 2,7×106 mujeres >14 años). Las denuncias también disminuyeron (OR: 1,22; IC95%: 1,20-1,23). La fecundidad de las adolescentes es la dimensión más asociada con las denuncias por VCI, asociadas al porcentaje de jóvenes que ni estudian ni trabajan por CCAA (ρ2006=0,494, ρ2014=0,615). Conclusión: Las políticas con perspectiva de género pueden ser la base de la reducción de la mortalidad y de las denuncias por VCI en España, y aún más en las CCAA con más desigualdad de género. Reducir la cantidad de jóvenes que ni estudian ni trabajan puede disminuir la fecundidad adolescente y los índices de VCI (AU)

Gender inequality and violence against women in Spain, 2006-2014: towards a civilized society.

OBJECTIVE: Considering both the economic crisis of 2008 and the Gender Equality Law (2007), this study analyses the association between gender inequality in Spanish Autonomous Communities (AC) and intimate partner violence (IPV) from 2006 to 2014 in terms of socio-demographic characteristics. METHODS: Ecological study in the 17 Spanish AC on the correlation between the reported cases by IPV and deaths and the Gender Inequality Index and its dimensions: empowerment, participation in the labour market and adolescent birth rates; and their correlation with Young People Not in Education, Employment or Training (NEET). RESULTS: In 2006, IPV mortality rates were higher in autonomous communities with greater gender inequality than AC with more equality (4.1 vs. 2.5×106 women >14 years), as were reporting rates of IPV (OR=1.49; 95% CI: 1.47-1.50). In 2014, the IPV mortality rates in AC with greater gender inequality fell to just below the mortality rates in AC with more gender equality (2.5 vs. 2.7×106 women >14 years). Rates of IPV reports also decreased (OR=1.22; 95% CI: 1.20-1.23). Adolescent birth rates were most associated with IPV reports, which were also associated with the burden of NEET by AC (ρ2006=0.494, ρ2014=0.615). CONCLUSION: Gender-sensitive policies may serve as a platform for reduced mortality and reports of IPV in Spain, particularly in AC with more gender inequality. A reduction of NEET may reduce adolescent birth rates and in turn IPV rates.

Tiempos de equidad de género: descripción de las desigualdades entre comunidades autónomas, España 2006-2014 / Times of gender equity: a description of the inequalities between autonomous communities, Spain 2006–2014

Objetivo: La equidad de género es un determinante estructural de las desigualdades en salud. Por ello, se pretende visibilizar su evolución en las comunidades autónomas (CC.AA.) desde 2006, previamente a la promulgación de la Ley de Igualdad (2007) y la crisis económica (2008), hasta 2014. Método: Estudio ecológico sobre la equidad de género en las 17 CC.AA. en 2006-2011-2014. Cálculo de: 1) índice de equidad de género modificado (IEGM) de las CC.AA. (0=equidad, ±1=inequidad); 2) convergencia interregional y temporal en equidad de género. Resultados: El IEGM de las CC.AA.2014 toma valores negativos próximos a 0 (inequidad desfavorable a las mujeres). No hay convergencia interregional en la equidad de género, pues aumenta la dispersión (2006: 0,1503; 2011: 0,2280; 2014: 0,4964). Tampoco existe convergencia temporal, al no evolucionar mejor las CC.AA. menos equitativas. La brecha de género en actividad económica sigue desfavorable a las mujeres. En 2006-2011 disminuye en todas las CC.AA., y en 2014 aumenta en seis CCAA. La brecha de género en educación tiene valores positivos próximos a 0 (desfavorable a los hombres) en 2006-2011-2014, y en empoderamiento es desfavorable a las mujeres, siendo la dimensión que más pesa en la equidad de género. Se mantiene la dispersión entre CC.AA. en 2006-2014 en actividad económica y educación, y aumenta en empoderamiento. Conclusiones: El contexto de equidad de género alcanzado en las CC.AA. españolas en 2006 se ha perdido durante la crisis económica, al aumentar la desigualdad en la equidad de género entre CC.AA. en 2014. La inequidad de género sigue siendo desfavorable a las mujeres (AU)

Objective: Gender equity (GE) is a structural determinant of health inequalities. In this light, our objective is to show the evolution of gender equity in the Spanish autonomous communities since 2006, prior to the enactment of the Equality Act (2007) and the economic crisis (2008), until 2014. Method: Ecological study of gender equity in the 17 Spanish autonomous communities from 2006-2011-2014. We have calculated: 1) modified gender equity index (MGEI) for the autonomous communities (0=equity, ±1=inequity); 2) interregional and temporal convergences in gender equity. Results: The MGEI in the autonomous communities in 2014 has negative values close to 0 (inequity towards women). There is no interregional convergence due to the dispersion increase (2006: 0.1503; 2011: 0.2280; 2014: 0.4964), and no temporal convergence due to the lack of progress of the autonomous communities with poor gender equity. The gender gap in economic activity continues to be unfavourable to women, decreasing in all communities between 2006 and 2011 but increasing in six communities in 2014. The gender gap in education from 2006-2011-2014 has positive values close to 0 (unfavourable to men), while the gender gap in empowerment is unfavourable to women, representing the most significant gender equity disparity. Inter-community dispersion of economic activity and education did not change between 2006 and 2014, while inter-community dispersion of empowerment increased. Conclusions: The level of gender equity achieved in the Spanish autonomous communities in 2006 was lost during the economic crisis, as gender equity disparities between the communities had increased by 2014. Gender inequity continues to be unfavourable to women (AU)

[Times of gender equity: a description of the inequalities between autonomous communities, Spain 2006-2014]. / Tiempos de equidad de género: descripción de las desigualdades entre comunidades autónomas, España 2006-2014.

OBJECTIVE: Gender equity (GE) is a structural determinant of health inequalities. In this light, our objective is to show the evolution of gender equity in the Spanish autonomous communities since 2006, prior to the enactment of the Equality Act (2007) and the economic crisis (2008), until 2014. METHOD: Ecological study of gender equity in the 17 Spanish autonomous communities from 2006-2011-2014. We have calculated: 1) modified gender equity index (MGEI) for the autonomous communities (0=equity, ±1=inequity); 2) interregional and temporal convergences in gender equity. RESULTS: The MGEI in the autonomous communities in 2014 has negative values close to 0 (inequity towards women). There is no interregional convergence due to the dispersion increase (2006: 0.1503; 2011: 0.2280; 2014: 0.4964), and no temporal convergence due to the lack of progress of the autonomous communities with poor gender equity. The gender gap in economic activity continues to be unfavourable to women, decreasing in all communities between 2006 and 2011 but increasing in six communities in 2014. The gender gap in education from 2006-2011-2014 has positive values close to 0 (unfavourable to men), while the gender gap in empowerment is unfavourable to women, representing the most significant gender equity disparity. Inter-community dispersion of economic activity and education did not change between 2006 and 2014, while inter-community dispersion of empowerment increased. CONCLUSIONS: The level of gender equity achieved in the Spanish autonomous communities in 2006 was lost during the economic crisis, as gender equity disparities between the communities had increased by 2014. Gender inequity continues to be unfavourable to women.

Looking twice at the gender equity index for public health impact.

BACKGROUND: It has been shown that gender equity has a positive impact on the everyday activities of people (decision making, income allocation, application and observance of norms/rules) which affect their health. Gender equity is also a crucial determinant of health inequalities at national level; thus, monitoring is important for surveillance of women's and men's health as well as for future health policy initiatives. The Gender Equity Index (GEI) was designed to show inequity solely towards women. Given that the value under scrutiny is equity, in this paper a modified version of the GEI is proposed, the MGEI, which highlights the inequities affecting both sexes. METHODS: Rather than calculating gender gaps by means of a quotient of proportions, gaps in the MGEI are expressed in absolute terms (differences in proportions). The Spearman's rank coefficient, calculated from country rankings obtained according to both indexes, was used to evaluate the level of concordance between both classifications. To compare the degree of sensitivity and obtain the inequity by the two methods, the variation coefficient of the GEI and MGEI values was calculated. RESULTS: Country rankings according to GEI and MGEI values showed a high correlation (rank coef. = 0.95). The MGEI presented greater dispersion (43.8%) than the GEI (19.27%). Inequity towards men was identified in the education gap (rank coef. = 0.36) when using the MGEI. According to this method, many countries shared the same absolute value for education but with opposite signs, for example Azerbaijan (-0.022) and Belgium (0.022), reflecting inequity towards women and men, respectively. This also occurred in the empowerment gap with the technical and professional job component (Brunei:-0.120 vs. Australia, Canada Iceland and the U.S.A.: 0.120). CONCLUSION: The MGEI identifies and highlights the different areas of inequities between gender groups. It thus overcomes the shortcomings of the GEI related to the aim for which this latter was created, namely measuring gender equity, and is therefore of great use to policy makers who wish to understand and monitor the results of specific equity policies and to determine the length of time for which these policies should be maintained in order to correct long-standing structural discrimination against women.