Interventions to counter gender discrimination

Figure 3Governments and PSE institutions must take action if they are to produce the robust workforces able to respond to the health needs of the populations they serve. To effectively counter gender discrimination, interventions must be 1) gender-transformative and 2) multilevel and comprehensive.

Gender-transformative interventions
Gender-transformative interventions actively strive to examine, question, and change rigid gender norms and imbalances of power as a means of reaching health as well as gender-equity objectives (Interagency Gender Working Group 2012). Gender norms, power imbalances, and stereotypes must be targeted. These include norms that women can be approached sexually, regardless of the setting, or beliefs related to female employees’ commitment or competence. Institutions must end impunity for perpetrators of sexual harassment and strengthen legal protections for women, who also need access to information on their legal rights. Schools and workplaces must also be restructured to reflect the value of caregiving for both male and female employees (Williams 1989). This is necessary so that women are not economically or socially penalized or disadvantaged for caregiving. Measures that redistribute resources can also change imbalances of power or level the playing field (Ridgeway and Correll 2000, 115). These include affirmative action3 as well as policies that allocate resources equally to men and women (e.g., equal funding of women’s sports programs).

Intervention bundles
Multilevel interventions are needed to target the complex individual, family, organizational, structural, and societal contributors to the gender discrimination, inequality, and violence that disrupt the health worker pipeline. Comprehensive family-friendly “bundles” of interventions are key to equalizing opportunities for women and men. They signal that the institution values the ability of both male and female faculty, staff, and students to have a career and a family without professional setbacks. CapacityPlus’s systematic review (Ng, Newman, and Pacqué-Margolis 2012) identified a range of available interventions but focused on sets of interventions that when implemented as “basic bundles” have the potential to counter gender discrimination and inequalities. The systematic review did not find evaluative evidence on the interventions’ effectiveness that would enable comparisons between institutions or settings with different income levels, but examples from a variety of resource settings are available. Interventions are recommended as bundles based on their gender-transformative potential, as rated according to the criteria developed for the systematic review (see Figure 3).

Although some institutions may not have the resources to implement all interventions identified in the systematic review, these “basic bundles” provide a foundation on which institutions can build even more comprehensive gender-transformative interventions.

Figure 4Establishing a sexual harassment policy and grievance procedure appears to be feasible across resource settings, as Ng, Newman, and Pacqué-Margolis (2012) identified numerous African and American universities that had implemented the two practices. However, a lack of awareness of and training on the procedures was a common reason for the practices failing to be used as intended, which is why the third component of the bundle, education and awareness-raising, is so important to ensuring the success of the “basic bundle.” Developing a strategic plan for implementing the policy is one way to address this issue. Workshops, trainings, videos, websites, and other platforms can be relatively low-cost ways to raise awareness among institutional communities. Content for such training is available in an eLearning course produced by CapacityPlus’s HRH Global Resource Center, Foundations of Gender Equality in the Health Workforce (Newman et al. 2012; a French version is also available). Institutions would need to supplement this content with information on their own policies and procedures. Developing a plan and associated budget for regular trainings and other awareness-raising events may also help promote understanding and use of sexual harassment policies and grievance procedures.

The interventions in the “basic bundles” to counter pregnancy and family responsibilities discrimination signal the legitimacy of being both a parent and a student/employee. Yet few institutions have implemented these “basic bundles” in their entirety. Among the 53 educational institutions and projects reviewed by Ng, Newman, and Pacqué-Margolis (2012), only the University of California and the University of Michigan, both in the US, offer the “basic bundle” for faculty. Funding information at most institutions is not publicly or readily available, but the University of California, for example, combines university funding with external grants from private foundations and the government to offer benefits and services such as child care. In other settings, practices included in these “basic bundles” have been documented as feasible, with institutions in South Africa, Tanzania, and other countries offering child care.

However, institutions considering implementing the “basic bundles” should keep in mind that creating a culture supportive of these practices is as important as offering them. Some students and faculty are hesitant to take a flexible schedule or time off for pregnancy or domestic responsibilities because they worry that colleagues would view them as uncommitted. In addition, some cannot afford child care, even when subsidized by the university. Institutions are therefore encouraged to design multilevel strategies that not only incorporate the “basic bundles” of practices but also promote enabling environments, making the “basic bundles” culturally as well as financially and logistically feasible.

Figure 5Gender centers and equal employment opportunity units, institutional structures that are created to advocate for, coordinate, oversee, implement, and evaluate such multilevel strategies, have worked to:

  • Develop gender policies
  • Engage in awareness-raising and information-sharing
  • Serve advocacy and accountability functions
  • Conduct gender sensitization workshops or sexual harassment training
  • Conduct research and university assessments
  • Provide financial assistance to female students
  • Offer mentoring and faculty career and leadership programs to women.

A key difference between the two structures is that equal employment opportunity units are often backed by and therefore help operationalize national equal opportunity laws, whereas gender centers are not necessarily backed by law.

3 Affirmative action refers to measures to ensure that groups that have been excluded in the past receive equal educational and employment opportunities to enter all fields.

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