Gender-related Barriers Research Articles

Ensuring gender and social equity in health: an analysis of Nigeria's Social Health Insurance Scheme and Basic Health Care Provision Fund

BackgroundIt is expected that a well-functioning, pre-paid health financing system that aims to move a country towards universal health coverage (UHC) will be equitable and gender-balanced. However, this feature is not automatic; much depends on the policy environment, including legal frameworks, implementation design, and management of the health financing scheme. To move towards UHC, Nigeria is implementing two key reforms: the Basic Health Care Provision Fund (BHCPF) and Social Health Insurance Scheme (SHIS). The BHCPF was created under the 2014 National Health Act to provide a basic package of health care to all Nigerians. Here, I report on a review of policy and legal frameworks at the policy formulation stage of the reforms, with a focus on gender and equity. MethodsI used findings from Abia state gender and equity analysis conducted to identify gender-related and equity-related barriers and opportunities in the design and implementation of the BHCPF and SHIS. I undertook project monitoring of the early-stage policy formulation phase of the reforms across functional areas of governance, revenue generation, risk pooling, enrolment strategies, and health benefit package. FindingsInitial assessment results showed several service delivery barriers to gender parity in staff (men in leadership and women in service delivery positions), low level of male engagement, lack of youth-friendly health services, unavailability of gender-based violence services, and low level of knowledge and understanding of gender and equity issues among key state-level implementing institutions. But early intervention results showed that progress has been made in the inclusion of men and women in the governance of the scheme, the establishment of an equity fund to subsidise those who are too poor to pay and progressive financial contributions into the scheme based on the ability to pay, and a central pooling of risk. Furthermore, a sustainable effort towards bridging the knowledge gap of key health-care professionals and policymakers in gender and equity issues in health has been instituted by national government implementing agencies with the mainstreaming of gender issues in the BHCPF manual and followed through with trainings of community representatives and health service providers. InterpretationUHC is hinged on gender and social equity in access to health-care services. Efforts to achieve this must begin at the policy formulation stage and carry through to policy implementation. However, UHC does involve political trade-offs and the degree to which implementation practice will conform to policy directions already set out is yet to be seen. FundingUSAID through Health Policy Plus (HP+) implemented by Palladium.

Career Barriers of Chinese Self-Expatriate Women: Neither Double Jeopardy nor Ethnic Prominence.

The study explored barriers to career progression of Chinese self-initiated expatriate (SIE) women in the United Kingdom using semi-structured interviews with two matched samples of Chinese SIE and native Caucasian British women. Double jeopardy and ethnic prominence offered the theoretical backdrop. Common gender-related career hindering factors emerged in both groups. However, no barriers due to ethnicity per se emerged for the Chinese SIE women, whilst their narrations revealed that the Chinese stereotype had rather facilitated their careers in the host country. Furthermore, they did not view self-expatriation as a particularly challenging endeavor. None of the two interpretative frameworks deployed, double jeopardy and ethnic prominence, could account for the findings. The study implies that the effects of ethnicity on self-expatriation experiences and outcomes may be contingent on SIEs’ ethnic and cultural origins. In addition, the findings imply that women who self-expatriate to escape gendered opportunities in their home countries may face similar gender-related barriers in host countries.

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

ABSTRACT 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 Moderating Role Of Top Executives' Sex, Level Of Education And Knowledge On Adoption Of Mobile Health Applications By Hospitals In Kenya.

BackgroundKenya lags behind other countries in adoption of mobile health (m-health) applications. Understanding factors affecting adoption of m-health by hospitals is required to inform strategic scale up and leverage m-health for sustainable development goals. This study investigated the moderating effects of Top Executives’ (TEs) traits, namely sex, level of education and knowledge of m-health, on adoption of Patient Centered (PC) and Facility-Centered (FC) m-health applications.MethodsThis study applied the Technological, Organizational and Environmental (TOE) framework and the Diffusion of Innovation (DOI) theory to test hypotheses that TEs' traits individually or combined had no statistically significant moderating effect on adoption of PC and FC m-health applications. Primary data were collected through a self-administered questionnaire from a representative sample size of 211 TEs from level 4 to 6 hospitals. The Logit Regression Model was used to determine the significance of each predictor.ResultsMost TEs of hospitals are predominantly male (75.3%). Most TEs (65%) rated their knowledge of m-health at medium level. Most TEs reported having completed undergraduate (46%) or post-graduate (38.4%) degrees. At 5% level of significance, the study found that being a male TE (p=0.041) and having higher level of knowledge of m-health (p=0.009) were statistically significant moderators of adoption of PC m-health applications by hospitals in Kenya. However, all TEs' traits combined or individually were not statistically significant moderators of FC m-health applications. The moderating effect of TEs' traits is thus affected by the focus, level of complexity of the technology, and by the required organizational change management. For PC scale-up, there is an urgent need to integrate digital health training in the medical education curricula and in the professional development programs and to develop policy incentives that remove any gender-related barriers to adoption of m-health. However, scale up of FC m-health may require other strategies such as pre-existence of systems and infrastructure and a cohesive change management strategy.ConclusionThis study recommends a differentiated approach to introduction, scale up, and investigation of PC and FC m-health applications.

FINANCIAL INCLUSION AND GENDER BARRIERS FOR RURAL WOMEN

This paper tries to examine the gendered nature of barriers faced by rural women which intersects financial inclusion worldwide. Although financial inclusion for rural women has been linked with poverty eradication and economic empowerment, the delivery of financial products and services to rural women has been at a disadvantageous position. Some of the barriers women experience in accessing financial resources are embedded in the patriarchal bias of the society. Gender related barriers are those barriers that are specific to women which arise due to discrimination and societal norms. Gender related barriers that inhibit women's ability to access to financial services and block women empowerment should be considered carefully while preparing these programs. A feminist analysis was done to understand the causes of gender related barriers and measures adopted worldwide to devise innovative strategies. Gender-transformative approaches to financial inclusion go beyond focussing on access to financial services to challenging the existing gender inequalities that impede women’s financial inclusion and economic empowerment.

PROTOCOL: Policies and interventions to remove gender-related barriers to girls' school participation and learning in low- and middle-income countries: A systematic review of the evidence.

PROTOCOL: Policies and interventions to remove gender-related barriers to girls' school participation and learning in low- and middle-income countries: A systematic review of the evidence.

PROTOCOL: The effects of empowerment-based nutrition interventions on the nutritional status of adolescent girls in low- and middle-income countries.

PROTOCOL: The effects of empowerment-based nutrition interventions on the nutritional status of adolescent girls in low- and middle-income countries.

“You Take Medications, You Live Normally”: The Role of Antiretroviral Therapy in Mitigating Men’s Perceived Threats of HIV in Côte d’Ivoire

Men diagnosed with HIV face gender-related barriers to initiating and adhering to antiretroviral therapy (ART). This qualitative study (73 in-depth interviews; 28 focus group discussions), conducted with men in three urban sites in Côte d'Ivoire in 2016, examined perceptions of ART, including benefits and challenges, to explore how ART mitigates HIV's threats to men's sexuality, economic success, family roles, social status, and health. Participants perceived that adhering to ART would reduce risk of transmitting HIV to others, minimize job loss and lost productivity, and help maintain men's roles as decision makers and providers. ART adherence was thought to help reduce the threat of HIV-related stigma, despite concerns about unintentional disclosure. While ART was perceived to improve health directly, it restricted men's schedules. Side effects were also a major challenge. Social and behavior change approaches building on these insights may improve male engagement across the HIV care continuum.

Technology adoption and gender-inclusive entrepreneurship education and training

PurposeDrawing on social feminist theory, this paper aims to close gaps between knowledge about gender-related barriers to information, communication and technology (ICT) adoption and the provision of entrepreneurship education and training (EET) programs.Design/methodology/approachEmpirical findings are drawn from 21 semi-structured interviews (22 informants) possessing differing training expertise regarding digital technology among women entrepreneurs. An open-coding technique was adopted where descriptive codes were first assigned to meaningful statements. Interpretive and pattern codes were then assigned to indicate common themes and patterns, which were reduced to higher-order categories to inform the research questions.FindingsThe findings specify and validate further gender influences in the digital economy. Digital skills are identified, and strategies to close gender barriers to ICT adoption with EET are described. The findings are discussed in reference to a large-scale, Canadian ICT adoption program.Research limitations/implicationsPerceptual data may be idiosyncratic to the sample. The work did not control for type of technology. Gender influences may differ by type of technology.Practical implicationsFindings can be used to construct gender-inclusive ICT supports and inform ICT adoption policies. This includes program eligibility and evaluation criteria to measure the socio-economic impacts.Originality/valueThe study is among the first to examine the intersection between knowledge about gender-related barriers to ICT adoption and EET. The findings can be adopted to ICT support programs targeted at small business owners and entrepreneurs.

\u2018To be honest, women do everything\u2019: understanding roles of men and women in net care and repair in Southern Tanzania

BackgroundIn Tanzania, the roles of men and women are classified based on the local cultural context. While men are usually the breadwinners, women are traditionally responsible for most domestic chores. Particularly for malaria prevention, studies in Africa have revealed women as being responsible for daily up-keep of the net. Using social role theory, this study explored the role of men and women in net care and repair and gender-related motivation and barriers to net care and repair in Tanzania.MethodsThe study was conducted in the two villages of Ruangwa district in Lindi Region. The study applied qualitative approaches and carried out in-depth interviews and focus group discussions with men, women, women with children under the age of five, and village key informants.ResultsMosquito nets were valued by all participants as a protection measure against mosquitoes. Study findings indicate that net care and repair falls under a woman’s daily household responsibilities. While men were said to assist in stitching damaged nets, washing dirty bed nets was regarded inappropriate for men and not traditionally accepted. Motivation for net care and repair was reported to come from both men and women; for a woman keeping the net clean defined a caring and responsible woman, while men indirectly promoted net washing when complaining about nets being dirty. Women reported that men could do everything that women do regarding net care and repair, but that it does not fit into societal norms.ConclusionWith increased globalization in Tanzania, more women are becoming part of the workforce, which may limit their full commitment to net care and repair activities, leading to increased net damage, malaria incidences and higher costs for malaria treatment. The National Malaria Control Programme should consider incorporating research-informed gender-transformative messages into their behaviour change communication on mosquito nets and work closely with trusted Community Health Workers to inform communities about the importance of sharing responsibilities in net care and repair. It is acknowledged that changing people’s behaviour and practices is a long process, which will require a deep cultural and political shift.

Reaching substantive female representation among decision-makers: A qualitative research study of gender-related experiences from the health sector in Mozambique.

BackgroundAchieving significant female representation in government at decision-making levels has been identified as a key step towards achieving gender equality. In 2015, women held 39.6% of parliamentary seats in Mozambique, which is above the benchmark of 30% that has been suggested as the turning point for minority representation to move from token status to having a sizable impact. We undertook a study to identify gender-related barriers and facilitators to improving women-centered policies in the health sector.MethodsWe conducted in-depth interviews with 39 individuals (32 women, 7 men) involved at a senior level in policy making or implementation of woman-centric policies within the Mozambique Ministry of Health and affiliated institutions. We used a semi-structured interview guide that included questions on difficulties and facilitating factors encountered in the policy making process, and the perceived role of gender in this process. We used both deductive and inductive analysis approaches, starting with a set of pre-identified themes and expanding this to include themes that emerged during coding.ResultsOur data suggest two main findings: (1) the women who participated in our study generally do not report feeling discrimination in the workplace and (2) senior health sector perceive women to be more personally attuned to women-centric issues than men. Within our specific sample, we found little to suggest that gender discrimination is a problem professionally for female decision-makers in Mozambique. However, these findings should be contextualized using an intersectional lens with recognition of the important difference between descriptive versus substantive female representation, and whether “percentage of women” is truly the best metric for gaging commitment to gender equality at the policy making level.ConclusionsMozambique’s longstanding significant representation of women may have led to creating an environment that leads to positive experiences for female decision-makers in the government. However, while the current level of female representation should be celebrated, it does not negate the need for continued focus on female representation in decision-making positions.

A Bayesian Approach to Understanding Sex Differences in Tuberculosis Disease Burden.

Globally, men have a higher epidemiologic burden of tuberculosis (incidence, prevalence, mortality) than women do, possibly due to differences in disease incidence, treatment initiation, self-cure, and/or untreated-tuberculosis mortality rates. Using a simple, sex-stratified compartmental model, we employed a Bayesian approach to explore which factors most likely explain men’s higher burden. We applied the model to smear-positive pulmonary tuberculosis in Vietnam (2006–2007) and Malawi (2013–2014). Posterior estimates were consistent with sex-specific prevalence and notifications in both countries. Results supported higher incidence in men and showed that both sexes faced longer durations of untreated disease than estimated by self-reports. Prior untreated disease durations were revised upward 8- to 24-fold, to 2.2 (95% credible interval: 1.7, 2.9) years for men in Vietnam and 2.8 (1.8, 4.1) years for men in Malawi, approximately a year longer than for women in each country. Results imply that substantial sex differences in tuberculosis burden are almost solely attributable to men’s disadvantages in disease incidence and untreated disease duration. The latter, for which self-reports provide a poor proxy, implies inadequate coverage of case-finding strategies. These results highlight an urgent need for better understanding of gender-related barriers faced by men and support the systematic targeting of men for screening.

Measuring Gender Equality in Education: Lessons from Trends in 43 Countries

Measuring Gender Equality in Education: Lessons from Trends in 43 Countries

Gender-Related Barriers to Service Access and uptake in nutrition programmes

Background
 Approximately 17 million children under five years suffer from Severe Acute Malnutrition (SAM). Although the most frequent barriers to service access in Community Management of Acute Malnutrition (CMAM) programmes have already been identified, there has been no analysis of the relationship between gender-related barriers and access to treatment.
 Approach
 The main objective is to review the key gender barriers to service access and uptake of treatment in CMAM programmes based on evidence gathered from coverage assessments carried out in Sub-Saharan Africa and Asia. A retrospective review of twenty-five coverage assessments was undertaken in 2013.
 Main findings
 Gender-related barriers were detected in 24 of the 25 coverage assessments. The main barriers detected were related to traditional gender roles: Women busy with duties (27.8%) followed by men control household expenditures and decision-making in the family (16.7%) and women sick (15.3%).
 Principal conclusions
 
 Gender-related barriers are present in the majority of the nutrition programs, so if the aim is universal coverage, gender should be considered during the coverage assessment
 Initiatives contributing to gender equality would contribute to overcoming coverage barriers in CMAM programmes
 The traditional use of the CMAM model considered gender with regards to the impact that the intervention could have on gender relations. However gender is now shown to also be a key factor contributing to poor nutrition.
 Further research and assessments should include Gender Based Violence as a single barrier, or as a component of other barriers

A Systematic Review of the Role of Gender in Securing and Maintaining Employment Among Youth and Young Adults with Disabilities.

Purpose There is a critical need for gender-specific vocational supports for young adults with disabilities as they transition to employment. We conducted a systematic review to explore the role of gender in securing and maintaining employment. Methods Systematic searches of seven databases identified 48 studies meeting our inclusion criteria. Using a narrative synthesis approach, these studies were analyzed in terms of the characteristics of the participants, methodology, results, and quality of the evidence. Results Among the 48 studies, 112,473 participants (56% male), mean age (of the total sample) was 21, represented across ten countries. Twenty-one studies reported that young men with disabilities had better employment outcomes than women with disabilities. Eight studies showed that females with disabilities had better employment outcomes than males. Five studies reported that there were no gender differences in employment outcomes for youth with various disabilities. With regards to maintaining employment, men with disabilities often work more hours and have better wages compared to women with disabilities. There are several gender-related barriers and facilitators to maintaining employment including social supports and gender role expectations. Conclusions Our findings highlight that there is a critical need for gender-specific vocational supports for young adults with disabilities.

Factors affecting access to primary health care services in Pakistan: a gender-based analysis

ABSTRACTThis article explores access to primary health care (PHC) services and associated factors in Pakistan. Data were collected from 302 respondents. The findings revealed that women accessed PHC services more than men due to their greater health needs. However, a large proportion of both genders did not access any PHC services. Besides general weaknesses, gender-related barriers were found in basic health unit locations, distance, transport, staff availability, income, service hours, and service organisation, confirming gender issues in access to PHC services. Policymakers are recommended to take measures to improve access to PHC services through the formulation of gender-responsive policies and strategies.

Reaching vulnerable populations: lessons from the Global Fund to Fight AIDS, Tuberculosis and Malaria.

Since its inception in 2002--in partnership with civil society, donors, governments, people affected by the target diseases and the private sector --the Global Fund to Fight AIDS, Tuberculosis and Malaria has supported and championed country ownership of programmes that, together, have saved over 20 million lives. (1) While substantial progress has been made, attempts to achieve target 3.3 of the sustainable development goals--i.e. to end epidemics of acquired immunodeficiency syndrome (AIDS), malaria, neglected tropical diseases and tuberculosis by 2030--are being hampered because services are failing to reach vulnerable and excluded populations. This failure reflects the many deep-seated gender-related, human-rights-related, cultural, financial, political and social barriers that such populations face. Approaches that address the differences between diseases and between affected communities--while strengthening health systems--need to be developed, especially as countries become less reliant on donor funds. The Global Fund has a responsibility to use its resources to achieve the greatest possible impact while ensuring the rights of those it serves are respected and promoted. This paper discusses how, in order to achieve these goals, the Global Fund has changed its approaches since 2002 and developed a new strategy for 2017-2022. Defining vulnerability Decades of efforts to fight AIDS, malaria and tuberculosis have shown that a business-as-usual approach leaves many of the most vulnerable people behind. The Global Fund has always emphasized the need to reach key and vulnerable populations but initially provided little guidance on how to define and identify them. Country-level efforts supported by the Global Fund between 2002 and 2012 were often directed towards general population groups and, perhaps, failed to focus adequately on those who were most vulnerable. (2) From 2013, the Global Fund began to develop context-based definitions that enabled countries to identify key and vulnerable populations for each targeted disease and for each epidemiological context (Box 1). Box 1. Definitions of key and vulnerable populations In 2016, the Global Fund to Fight AIDS, Tuberculosis and Malaria3 defined key and vulnerable populations as follows: Key populations: Epidemiologlcally, the group faces increased risk, vulnerability and/or burden to at least one of the three diseases--due to biological, socioeconomic and structural factors. Access to relevant services is significantly lower for the group than for the rest of the population. Dedicated efforts and strategic investments are required to expand coverage, equity and accessibility. The group faces frequent human rights violations, systematic disenfranchisement, social and economic marginalization and/or criminalization, increasing vulnerability and risk and reducing access to services. Vulnerable populations: People whose situations or contexts make them especially vulnerable, or who experience inequality, prejudice, marginalization and limits on their social, economic, cultural and other rights. Encouraging investments Since 2013, the Global Fund has also updated its policies and procedures to enhance the effectiveness and scale of programmes targeted at vulnerable groups. The Global Fund considers community voices to be a critical component of grant design. While the Global Fund has always required countries to establish country coordinating mechanisms that included community representation, the associated guidelines were revised in 2013 to ensure that women and key populations had a voice. Since then, any country funding requests have had to be based on a broad nationwide dialogue that included all vulnerable groups. The participation of key and vulnerable populations was bolstered by the Global Fund's special initiative on community, human rights and gender. This provided communications outreach to community and civil society groups, dedicated technical support and long-term capacity building--with a particular focus on key and vulnerable populations. …

Women Who Lead: Successes and Challenges of Five Health Leaders

Women make up approximately 75% of the health workforce and yet their representation at higher levels of health leadership is limited. Untapped potential of women in health undermines the contribution they could make to effective leadership for health systems strengthening. Lived experiences of women leaders can help understand how to unlock this potential by identifying the challenges, highlighting enablers, and sharing successful strategies used to become effective health leaders. This article uses phenomenological inquiry to understand the subjective experiences of five influential women in their paths to health leadership. Interviews were conducted with these women and key messages were identified. A grounding theme—defined as the essential element for the subjective experience of leading as a woman in the health system—was revealed to be the women's “drive for equity.” This drive motivated them to pursue a career in health and to break through perceived gender-related barriers. Three figural themes around how to practice effective health leadership to promote equity were identified: (1) challenging status quos and norms; (2) leading by listening and leveraging others' expertise to build a common vision for health; and (3) having social support early on to develop confidence and credibility. Stories from the individual women's experiences are presented. Finally, three recommendations are made for system-level mechanisms that could contribute to expanding the number of women leaders in health.

Postpartum Depression and Access to Mental Healthcare among Migrant South Asian Women in Canada: A Literature Review

Although there has been an increase in research on postpartum depression (PPD) among migrant Asian women, there is particularly limited attention given to migrant South Asian women. This is a significant limitation considering the rapidly changing demographics in Canada. Migrant South Asian women face a plethora of unique challenges, which affects their mental health and further prevents them from receiving adequate and equitable mental healthcare services. For migrant South Asian women, many of these stressors are especially amalgamated in the vulnerable postpartum period, resulting in variances of postpartum mood disorders such as postpartum blues, non-psychotic postpartum depression, and in more severe cases, postpartum psychosis. While cultural values and rituals may be protective in curbing PPD symptoms in some instances, in other cases, however, they exacerbate and perhaps even worsen PPD. The objective of this literature review is to provide a basic understanding of postpartum depression among the migrant South Asian community in Canada. It aims to answer questions pertaining to the types of postpartum mood disorders that women can potentially suffer from, its risk factors, its prevalence among migrant women, as well as the socio-cultural and gender-related barriers to attaining access to mental healthcare services and treatments for PPD in Canada. Around 40 documents were examined, summarized and synthesized for this literature review. These included scholarly journal articles, non-scholarly articles, health-related websites, position papers, and medical journals.

Disparities in Substance Abuse Treatment Utilization Among Women with Intellectual Disability.

Despite concerns about health disparities among women with intellectual disabilities, little is known about substance abuse treatment access in this population. Using standardized performance measures, treatment initiation and engagement were examined retrospectively for women aged 18 to 64 (N=3,752), men with (N=5,732) and women without intellectual disability (N=493,446). Logistic regression models of utilization were conducted. Women in the sample were less likely than men in the sample or women without intellectual disability to utilize treatment, suggesting both gender-related and disability-related barriers. Policy and practice implications for improving the health and welfare of women with intellectual disabilities are discussed.