Personalism or party platform? Gender quotas and women's representation under different electoral system orientations

Underrepresentation of women in politics is a matter of great concern to social scientists, citizens, and policymakers alike. Despite effort over the past decade to ameliorate it with gender quotas of different types, scientific research provides a mixed picture on the extent to which quotas can close these gender gaps under different conditions. We approach this puzzle by focusing on the orientation of electoral systems-candidate-centered vs. platform-centered-as a context that conditions the effect of quotas on representation. Our analyses of 76 countries' electoral rules and legislatures show that contrary to expectations, it is in candidate-oriented systems that quotas facilitate stronger effect on women's representation. Even after considering proportional representation, district magnitude, human development, or labor-force participation as alternative explanations, we show that quotas foster greater increases in gender representation in candidate-oriented systems. The broader implications are that in electoral systems that tend to have larger gender gaps, quotas have a substantial contribution to equal representation.

Women's empowerment in agriculture and productivity change: The case of Bangladesh rice farms

Using productivity change as a measure of farm economic performance, we analyze the relationship between women's empowerment in agriculture and farm productivity change and its components, which include efficiency change, technological change, and scale efficiency change. A non-parametric Malmquist approach is used to measure farm specific productivity change and its decomposition. We use a bootstrap regression to analyze factors that cause differences in productivity change and its components, testing, in particular, the role women's empowerment plays. The empirical application focuses on a sample of Bangladesh rice farms over the crop cultivation period 2011 and 2014. Results suggest that improvements in women's empowerment in agriculture were associated with higher levels of productivity change, efficiency change, and technical change, while they had no impact on scale efficiency change. We find that empowering women, specifically, improving their ability to make independent choices regarding agricultural production had a statistically significant positive association with productivity change, efficiency change, and technical change. We also find that lowering the gender parity gap is positively related with improving productivity of the sample farms.

What empowerment indicators are important for food consumption for women? Evidence from 5 sub-Sahara African countries

This paper draws on data from five sub-Sahara African countries; Uganda, Rwanda, Malawi, Zambia, and Mozambique consisting of 10,041 married women who were cohabitating with a male spouse. The study aim was to investigate the relationship between women's empowerment and women's dietary diversity and consumption of different food items. Women's empowerment was measured using the indicators in the five domains of Women's Empowerment in Agriculture index (WEAI) and women's dietary diversity and food consumption was examined using the women's dietary diversity score (WDDS) measure. OLS and LPM regressions were used and analyses were confirmed using marginal effects from Poisson and logistic regressions. Results suggest that three out of the 10 WEAI indicators of empowerment showed different magnitude and direction in significant associations with improved WDDS and varied associations were found in three out of the five countries examined. In addition, the three significant empowerment indicators were associated with the consumption of different food groups in three out of the five countries examined suggesting that diverse food groups account for the association between the WEAI and WDDS. Improved autonomy, and input in production were associated with improved likelihoods of consumption of dairy products, and fruits and vegetables including vitamin A-rich produce. Empowerment in public speaking was associated with improved consumption of other fruits and vegetables including vitamin A-rich produce. The varied nature of empowerment indicators towards improving women's dietary diversity and food consumption suggests that different empowerment strategies might confer different benefits towards the consumption of different food groups. Further, findings imply that interventions that seek to empower women should tailor their strategies on existing contextual factors that impact on women.

Markers of achievement for assessing and monitoring gender equity in a UK National Institute for Health Research Biomedical Research Centre: A two-factor model

BACKGROUND

The underrepresentation of women in academic medicine at senior level and in leadership positions is well documented. Biomedical Research Centres (BRC), partnerships between leading National Health Service (NHS) organisations and universities, conduct world class translational research funded by the National Institute for Health Research (NIHR) in the UK. Since 2011 BRCs are required to demonstrate significant progress in gender equity (GE) to be eligible to apply for funding. However, the evidence base for monitoring GE specifically in BRC settings is underdeveloped. This is the first survey tool designed to rank and identify new GE markers specific to the NIHR BRCs.

METHODS

An online survey distributed to senior leadership, clinical and non-clinical researchers, trainees, administrative and other professionals affiliated to the NIHR Oxford BRC (N = 683). Participants ranked 13 markers of GE on a five point Likert scale by importance. Data were summarised using frequencies and descriptive statistics. Interrelationships between markers and underlying latent dimensions (factors) were determined by exploratory and confirmatory factor analyses.

RESULTS

The response rate was 36% (243 respondents). Respondents were more frequently female (55%, n = 133), aged 41-50 years (33%, n = 81), investigators (33%, n = 81) affiliated to the BRC for 2-7 years (39.5%, n = 96). Overall participants ranked 'BRC senior leadership roles' and 'organisational policies on gender equity', to be the most important markers of GE. 58% (n = 141) and 57% (n = 139) respectively. Female participants ranked 'organisational policies' (64.7%, n = 86/133) and 'recruitment and retention' (60.9%, n = 81/133) most highly, whereas male participants ranked 'leadership development' (52.1%, n = 50/96) and 'BRC senior leadership roles' (50%, n = 48/96) as most important. Factor analyses identified two distinct latent dimensions: "organisational markers" and "individual markers" of GE in BRCs.

CONCLUSIONS

A two-factor model of markers of achievement for GE with "organisational" and "individual" dimensions was identified. Implementation and sustainability of gender equity requires commitment at senior leadership and organisational policy level.

Athena SWAN and gender diversity: a UK-based retrospective cohort study

OBJECTIVES

To promote gender diversity and equity in higher education, Athena Scientific Women's Academic Network (SWAN) supports and recognises higher education institutions (HEI) in advancing the careers of women through charter commitment, awards, training and advocacy since 2005. Most evaluation studies, however, are based on qualitative assessments. This study sought to (1) examine the relationship between Athena SWAN accreditation/awards in the UK and gender diversity of leaders and senior academics using quantitative data from 2012/2013 to 2016/2017, and (2) explore the associations between Athena SWAN awards and university performance as measured by overall scores in global ranking systems.

DESIGN

Retrospective cohort study based on the UK HEIs.

SETTING

Higher education sector in the UK provided by the Higher Education Statistics Agency.

PARTICIPANTS

148 HEIs who provided employment data on female-to-male ratios (55% complete data) for each academic year between 2012/2013 and 2016/2017.

PRIMARY AND SECONDARY OUTCOME MEASURES

Gender diversity, defined as female representation rates of positions in managerial leadership (eg, heads of institutions, department heads) and professors. The Quacquarelli Symonds (QS) World University Rankings scores, an indicator of research, teaching, employability and internationalisation, were collected to measure university performance.

RESULTS

Gender diversity of managerial leaders and non-managerial professors at all levels of Athena SWAN status has improved over the 5 years. Linear mixed effects models identified that Athena SWAN awardees had lower female representation than non-awardees in managerial leadership positions (p<0.05), while the gap was narrowed among Silver awardees over time. Athena SWAN Charter members had increasingly higher female representation than those not in the Charter (p<0.05). Silver-award institutions ranked higher in QS rankings than Bronze-award institutions (β=11.80, p<0.05).

CONCLUSIONS

There are overall rising trends in gender diversity from 2012/2013 to 2016/2017. Athena SWAN members showed greater and faster growth in female representations. Silver awardees had greater university performance than Bronze awardees.

Update on Reproductive Rights and Women's Mental Health

Reproductive rights are essential to the recognition/treatment of women as full-fledged human beings/citizens. Barriers to reproductive rights pose a grave danger to women's well-being. This article explores the origins of these barriers, their nature, and their impact on mental health. The most controversial relationship is between induced abortion and mental health. Barriers, misinformation, and coercion affecting contraceptive, abortion, and pregnancy care are an ongoing danger to women's mental health and the well-being of their families. Mental health professionals are best qualified, and have an obligation, to know the facts, apply them, and provide accurate information to protect women's health.

Women's empowerment and fertility preferences in high fertility countries in Sub-Saharan Africa

BACKGROUND

Nearly all countries with fertility levels of more than five children per woman are in Sub-Saharan Africa. Prestige, insurance in old age, and replacement in case of child deaths are related to preferences for large families. In this paper, we examine the association between women's empowerment and fertility preferences of married women aged 35 years and above in four high fertility Francophone Sub-Saharan Africa (FSSA) countries, namely Burkina Faso, Mali, Niger and Chad.

METHOD

The ideal number of children among married women and their ability to have the desired number of children are used to measure fertility preferences. We used principal component analysis to construct a multidimensional empowerment index. We then estimated negative binomial and logistic regression models to examine the association between women's empowerment and fertility preferences. Data are from the most recent Demographic and Health Surveys (DHS) conducted in the countries included in the analysis.

RESULTS

Regardless of the country, more empowered women desire significantly fewer children compared with their less empowered counterparts. The first step to having fewer children is formulating programs to improve economic empowerment of women. The specific elements of women's empowerment that were important for fertility preferences included education, skills development, decision-making power, and control over household resources. In addition, familial empowerment matters more than other dimensions of empowerment in influencing women's ability to achieve the desired number of children in the FSSA countries included in the study.

CONCLUSION

Paid employment and access to and control over resources are factors which, if improved upon, could significantly reduce the ideal number of children. By taking necessary steps, mass media can be used much more adequately to reduce ideal number of children in FSSA countries. In addition, the desire for many children could also be due to their participation in income-generating activities to improve the household's socio-economic status. The findings suggests that improvement of women's ability to have the desired number of children is a big challenge to which policy makers must pay careful attention.

Country-Level Gender Equality and Adolescents' Contraceptive Use in Europe, Canada and Israel: Findings from 33 Countries

CONTEXT

Although an association between gender equality and contraceptive use has been confirmed among adult samples, few studies have explored this relationship among adolescents. An examination of whether adolescents' contraceptive use is more prevalent in countries with higher levels of gender equality is needed to fill this gap.

METHODS

Nationally representative data from 33 countries that participated in the 2013-2014 Health Behaviour in School-Aged Children study and country-level measures of gender equality-using the 2014 Global Gender Gap Index-were analyzed. Multilevel multinomial logistic regression analyses were employed to assess associations between gender equality and contraceptive use (condom only, pill only and dual methods) at last intercourse as reported by 4,071 females and 4,110 males aged 14-16.

RESULTS

Increasing gender equality was positively associated with contraceptive use among both males and females. For every 0.1-point increase on the equality scale, the likelihood of condom use at last intercourse rose (odds ratio, 2.1 for females), as did the likelihood of pill use (6.5 and 9.6, respectively, for males and females) and dual method use (2.1 and 5.6, respectively). Associations with pill use and dual use remained significant after national wealth and income inequality were controlled for. Overall, associations were stronger for females than for males.

CONCLUSIONS

More research is needed to identify potential causal pathways and mechanisms through which gender equality and adolescents' contraceptive use may influence one another.

Assessing the performance of the least developed countries in terms of the Millennium Development Goals

This article presents a proposal for assessing the progress of least developed countries towards the achievement of the Millennium Development Goals over the period 2000-2015. Composite indices are built to perform spatial and temporal benchmarking relying on the P2 Distance method. The results are contrasted with other indices developed under a multi-criterion approach with a double reference point. The main findings are that all the countries have improved their situation and country disparities have been reduced. Cambodia and Ethiopia have registered the best trends and South Sudan and Timor-Leste show the worse performance. Considering the position in the 2015 ranking, Rwanda and Bhutan performed the best, while Somalia and Chad rank in the last position. Having now reached the end of the Millennium Development Goals period, the gap with respect to the world average indicates that much work remains to be done in the 2030 Agenda for Sustainable Development.

Composite measures of women's empowerment and their association with maternal mortality in low-income countries

BACKGROUND

Maternal mortality has declined significantly since 1990. While better access to emergency obstetrical care is partially responsible, women's empowerment might also be a contributing factor. Gender equality composite measures generally include various dimensions of women's advancement, including educational parity, formal employment, and political participation. In this paper, we compare several composite measures to assess which, if any, are associated with maternal mortality ratios (MMRs) in low-income countries, after controlling for other macro-level and direct determinants.

METHODS

Using data from 44 low-income countries (half in Africa), we assessed the correlation of three composite measures - the Gender Gap Index, the Gender Equity Index (GEI), and the Social Institutions and Gender Index (SIGI) - with MMRs. We also examined two recognized contributors to reduce maternal mortality (skilled birth attendance (SBA) and total fertility rate (TFR)) as well as several economic and political variables (such as the Corruption Index) to see which tracked most closely with MMRs. We examined the countries altogether, and disaggregated by region. We then performed multivariate analysis to determine which measures were predictive.

RESULTS

Two gender measures (GEI and SIGI) and GDP per capita were significantly correlated with MMRs for all countries. For African countries, the SIGI, TFR, and Corruption Index were significant, whereas the GEI, SBA, and TFR were significant in non-African countries. After controlling for all measures, SBA emerged as a predictor of log MMR for non-African countries (β = -0.04, P = 0.01). However, for African countries, only the Corruption Index was a predictor (β = -0.04, P = 0.04). No gender measure was significant.

CONCLUSIONS

In African countries, corruption is undermining the quality of maternal care, the availability of critical drugs and equipment, and pregnant women's motivation to deliver in a hospital setting. Improving gender equality and SBA rates is unlikely to reduce MMR in Africa unless corruption is addressed. In other regions, increasing SBA rates can be expected to lower MMRs.

Examining the mechanisms by which women's status and empowerment affect skilled birth attendant use in Senegal: a structural equation modeling approach

BACKGROUND

Despite the reduction in maternal deaths globally, maternal mortality rates remain unacceptably high, particularly in some regions of the world. In sub-Saharan Africa, maternal mortality rates have even increased recently, with 201,000 deaths in 2015 as compared to 179,000 in 2013. Use of a skilled birth attendant (SBA) at delivery has remained low, despite evidence of the effectiveness of SBAs in reducing maternal deaths. Women's empowerment is increasingly recognized as a key determinant of maternal health care-seeking and outcomes, yet empirical examinations of the linkages between women's empowerment and delivery care use are particularly limited, especially from sub-Saharan Africa.

METHODS

Using data from the 2010 Senegal Demographic and Health Survey (n = 7451), in this study we employed structural equation modeling (SEM) to investigate the complex and multidimensional pathways by which three women's empowerment domains (household decision-making, attitudes towards violence, and sex negotiation) directly and indirectly affect SBA use.

RESULTS

Although variations were observed across measures, many of the women's status and empowerment measures were positively related to SBA use. Notably, women's education demonstrated a substantial indirect effect: higher education was related to older age at first marriage, which was associated with higher levels of empowerment and SBA use. In addition to age at first marriage, gender-role attitudes (e.g., progressive attitudes towards violence and sex negotiation) were significant mediators in the relationship between education and SBA use. However, household decision-making was not significantly associated with SBA use.

CONCLUSIONS

Findings indicate significant effects of women's education, early marriage, and some dimensions of women's empowerment on SBA use. SEM was particularly useful in examining the complex and multidimensional constructs of women's empowerments and their effects. This study informs policy recommendations and programmatic efforts to reduce maternal mortality in sub-Saharan Africa by strengthening support for women's access to higher education, delaying marriage and childbearing among girls and young women, and supporting more equitable gender norms.

Rape Survivors' Experiences With the Legal and Medical Systems

This study used a naturalistic quasi-experimental design to examine whether rape survivors who had the assistance of rape victim advocates had more positive experiences with the legal and medical systems compared to those who did not work with advocates. Eighty-one survivors were interviewed in two urban hospitals about what services they received from legal and medical system personnel and how they were treated during these interactions. Survivors who had the assistance of an advocate were significantly more likely to have police reports taken and were less likely to be treated negatively by police officers. These women also reported less distress after their contact with the legal system. Similarly, survivors who worked with an advocate during their emergency department care received more medical services, including emergency contraception and sexually transmitted disease prophylaxis, reported significantly fewer negative interpersonal interactions with medical system personnel, and reported less distress from their medical contact experiences.

Markers of achievement for assessing and monitoring gender equity in translational research organisations: a rationale and study protocol

INTRODUCTION

Translational research organisations (TROs) are a core component of the UK's expanding research base. Equity of career opportunity is key to ensuring a diverse and internationally competitive workforce. The UK now requires TROs to demonstrate how they are supporting gender equity. Yet, the evidence base for documenting such efforts is sparse. This study is designed to inform the acceleration of women's advancement and leadership in two of the UK's leading TROs--the National Institute for Health Research (NIHR) Biomedical Research Centres (BRCs) in Oxford and London--through the development, application and dissemination of a conceptual framework and measurement tool.

METHODS AND ANALYSIS

A cross-sectional retrospective evaluation. A conceptual framework with markers of achievement and corresponding candidate metrics has been specifically designed for this study based on an adapted balanced scorecard approach. It will be refined with an online stakeholder consultation and semistructured interviews to test the face validity and explore practices and mechanisms that influence gender equity in the given settings. Data will be collected via the relevant administrative databases. A comparison of two funding periods (2007-2012 and 2012-2017) will be carried out.

ETHICS AND DISSEMINATION

The University of Oxford Clinical Trials and Research Governance Team and the Research and Development Governance Team of Guy's and St Thomas' National Health Service (NHS) Foundation Trust reviewed the study and deemed it exempt from full ethics review. The results of the study will be used to inform prospective planning and monitoring within the participating NIHR BRCs with a view to accelerating women's advancement and leadership. Both the results of the study and its methodology will be further disseminated to academics and practitioners through the networks of collaborating TROs, relevant conferences and articles in peer-reviewed journals.

INTER-GENERATIONAL RELATIONSHIPS BETWEEN WOMEN'S FERTILITY, ASPIRATIONS FOR THEIR CHILDREN'S EDUCATION AND SCHOOL COMPLETION IN THE PHILIPPINES

Women's education is associated with positive social and health outcomes for women and their families, as well as greater opportunities and decision-making power for women. An extensive literature documents ways in which broader, societal changes have facilitated roles for women beyond reproduction, yet there is minimal exploration at the family level. This study used inter-generational cohort data from the Philippines to examine mothers' aspirations for their children's education, and how these aspirations predict children's subsequent educational attainment. Mothers' education, household wealth and a locally developed measure of women's status were positively associated with higher educational aspirations for children; however, only mothers with the highest fertility were less likely to desire their children to attend college or higher. Mothers' fertility and aspirations both significantly and independently predicted children's school completion. Together, these findings indicate that increased opportunities for Filipina women beyond childbearing may not only positively benefit these women themselves, but also future generations.

Representations of the subject 'woman' and the politics of abortion: an analysis of South African newspaper articles from 1978 to 2005

A key element in cultural and gender power relations surrounding abortion is how women who undergo an abortion are represented in public talk. We analyse how women were named and positioned, and the attendant constructions of abortion, in South African newspaper articles on abortion from 1978 to 2005, a period during which there were radical political and legislative shifts. The name 'woman' was the most frequently used (70% of articles) followed by 'girl/teenager/child' (25%), 'mother' (25%), 'patient' (11%) and 'minor' (6%). The subject positionings enabled by these names were dynamic and complex and were interwoven with the localised, historical politics of abortion. The 'innocent mother' and the bifurcated 'patient' (woman/foetus) positionings were invoked in earlier epochs to promote abortion under medical conditions. The 'dangerous mother' and woman as 'patient' positionings were used more frequently under liberal abortion legislation to oppose and to advocate for abortion, respectively. The positioning of the 'girl/teenager/child' as dependent and vulnerable was used in contradictory ways, both to oppose abortion and to argue for a liberalisation of restrictive legislation, depending on the attendant construction of abortion. The neutral naming of 'woman' was, at times, linked to the liberal imaginary of 'choice'.

Analyzing the glass ceiling effect among radiologic technologists

BACKGROUND

The literature has suggested that advancement within politics, academia and the health professions is influenced by gender. Purpose The authors conducted a survey to determine whether advancement was equal by gender in the radiologic science disciplines of nuclear medicine technology, radiation therapy and radiography.

METHODS

The survey was mailed to 900 subjects, 300 from each discipline. The discipline groups were further stratified by initial year of American Registry of Radiologic Technology certification; the authors selected 100 subjects from each discipline who initially were certified in 1978, 100 in 1988 and 100 in 1998.

RESULTS

Approximately 33% of those selected responded. The findings of the study provided no evidence that men are promoted differentially than women. Women perceived that men were paid more for the same work. It appears that gender bias is pervasive outside of promotion decisions and, indeed, that some illegal actions (eg, sexual harassment, inappropriate gender-related interview questions) take place in radiologic science clinical settings.

CONCLUSION

It is hoped that this study will set a baseline for future research on whether there is a glass ceiling effect in radiologic clinical practice and stimulate discussion of the importance of equal opportunity regardless of gender.

Gender-based violence in India: long-term trends

This article examines long-term trends in Indian society regarding domestic violence between husband and wife, and attitudes to such violence. This article analyzes crime data and uses data from several Indian household surveys: "Work Attitudes and Spending" surveys (1992 to 2007); "World Values Survey" (1990, 1995, 2001, and 2006); and "Demographic and Health Surveys" (1992-1993, 1998-2000, and 2005). Several trends are apparent- some changes suggest that Indian women are becoming more liberated, but others imply worsening conditions for Indian women, such as more violence against women. This increase in violence may be temporary, as India is in transition to a more modern society: There is evidence that some gender-based violence is a male response to increasingly "modern" attitudes among Indian women.

Women's autonomy and support for wife beating: findings from a population-based survey in Jordan

The aim of this study is to examine attitudes among married women toward wife beating and to investigate the hypothesis that female individual empowerment is associated with such attitudes within a broader context of societal patriarchy in Jordan. The study uses data from a cross-sectional survey of a representative sample of married women (n = 5,390) conducted in 2002. Associations between acceptance of wife beating and several women's empowerment variables, including decision-making power, as well as other risk factors were assessed, using odds ratios from binary logistic regression models. The key finding is that the vast majority (87.5%) of Jordanian women believe that wife beating is justified in at least one hypothetical scenario, and justification is negatively associated with empowerment variables and some demographic, geographic, and socioeconomic factors.

Economic violence to women and girls: is it receiving the necessary attention?

Most studies on gender-based violence (GBV) have focused on its physical, sexual, and psychological manifestations. This paper seeks to draw attention to the types of economic violence experienced by women, and describes its consequences on health and development. Economic violence experienced included limited access to funds and credit; controlling access to health care, employment, education, including agricultural resources; excluding from financial decision making; and discriminatory traditional laws on inheritance, property rights, and use of communal land. At work women experienced receiving unequal remuneration for work done equal in value to the men's, were overworked and underpaid, and used for unpaid work outside the contractual agreement. Some experienced fraud and theft from some men, illegal confiscation of goods for sale, and unlawful closing down of worksites. At home, some were barred from working by partners; while other men totally abandoned family maintenance to the women. Unfortunately, economic violence results in deepening poverty and compromises educational attainment and developmental opportunities for women. It leads to physical violence, promotes sexual exploitation and the risk of contracting HIV infection, maternal morbidity and mortality, and trafficking of women and girls. Economic abuse may continue even after the woman has left the abusive relationship. There is need for further large-scale studies on economic violence to women. Multi-strategy interventions that promote equity between women and men, provide economic opportunities for women, inform them of their rights, reach out to men and change societal beliefs and attitudes that permit exploitative behavior are urgently required.

Women's access to health care in Ghana: effects of education, residence, lineage and self-determination

Women's physical and psychological access to health care was analyzed using the 2003 Ghana Demographic and Health Survey (GDHS), a nationally representative study for monitoring population and health in Ghana. Female respondents from the 2133 cases in the couple's data set were used in this study. Women's level of education was positively related to physical but not to psychological access to health care. Residing in an urban area was positively related to both types of access. Matriliny consistently showed positive effects on physical access. In addition to these demographic factors, both physical and psychological access were positively related to women's self-determination, i.e., women's right and ability to make real choices about their lives including their health, fertility, sexuality, childcare and all areas where women are denied autonomy and dignity in their identities as women. Self-determination factors both mediated the effects of background factors on access and added explanatory power to the models.

The limits of behaviour change theory: condom use and contexts of HIV risk in the Kolkata sex industry

This paper uses ethnographic data from a sex workers' HIV project in India to consider the appropriateness of individual, social/group and structural theories of health behaviour when applied to HIV-prevention initiatives. Existing theories are critiqued for their modernist representation of behaviour as determined by individual rational decision-making processes or by external structural forces, with inadequate recognition being given to the roles that human agency, subjective meaning and local context play in everyday actions. Analysis of sex workers' accounts of their sexual practices suggests that existing theories of health behaviour can only partially account for sexual behaviour change retrospectively and that they have limited predictive value with respect to the outcomes of individual sexual encounters. Our data show that these outcomes were, in fact, highly context dependent, while possibilities for action were ultimately strongly constrained by structural forces. Findings suggest that interventions need to adopt an integrated, structurally-oriented approach for promoting safer sexual practices in sex work settings. Recognising that no one model of health behaviour is likely to be adequate in explaining or predicting behaviour change encourages responsiveness to local people's agency, recognises the different (health- and non-health-related) registers of risk with which people operate and encourages flexibility according to local contingencies and contexts.

The impact of migration on HIV prevention for women: constructing a conceptual framework

There are an estimated 40.5 million people currently living with HIV globally, 17.5 million of whom are women, according to the AIDS Epidemic update: December 2005, conducted by UNAIDS and the World Health Organization (WHO) 2005. Women are vulnerable to HIV for biologic as well as social reasons. In the past, the HIV prevention theorists have not considered the context of women's lives: factors at the individual, relationship, and community levels, as well as structural factors (both policy and cultural) impact on HIV prevention for women. This is particularly true for migrant women, who may be especially vulnerable to HIV infection during their time of transition. Throughout this article I explore the international literature for both the historical context of HIV prevention for women and the impact of migration on HIV risk for women. The literature review provides a basis for the development of a conceptual framework of the socioecologic factors affecting HIV prevention for migrant women. I call for consideration of the broad context of women's experience when developing interventions for this population.

Women Radiologists in the United States: Results from the American College of Radiology's 2003 Survey

PURPOSE

To retrospectively evaluate data from the 2003 American College of Radiology (ACR) survey of diagnostic radiologists with regard to characteristics of women radiologists, their professional activities, and the practices in which they work.

MATERIALS AND METHODS

The authors analyzed nonindividually identified data from the ACR's 2003 Survey of Radiologists, a stratified random sample survey that guaranteed respondents confidentiality. A cover letter assured respondents that no individually identifiable information would be disseminated; to further enhance confidentiality, survey operations were conducted by a contractor rather than by the ACR itself. There was a 63% response rate, with a total of 1924 responses. Responses were weighted to make them representative of all radiologists in the United States. Two-tailed z tests of percentages and means and multiple regression analysis were used to compare information for women radiologists with that for men radiologists.

RESULTS

Twenty-four percent of radiologists in training (residents and fellows) and 18% of posttraining, professionally active radiologists were women. Forty-one percent of posttraining, professionally active women were younger than 45 years in comparison with 29% of men (P = .004). Women radiologists were more likely to have fellowship training than men (69% vs 60%, P = .007), although they were less likely than men to have a subspecialty certificate (16% vs 27%, P < .001). Thirty-nine percent of women and 16% of men worked part-time (P < .001). Women were more concentrated in academia (22% vs 14%, P = .009) and breast imaging (27% vs 6%, P < .001) than their male peers but were underrepresented in interventional radiology (2% vs 13%, P < .001) and neuroradiology (3% vs 10%, P < .001). In situations where radiologists are likely to be practice owners, fewer women than men were owners (75% vs 91%) (P = .011). Women reported the same level of enjoyment of radiology as did men.

CONCLUSION

Women radiologists differ from men in regard to age, fellowship training, full- versus part-time employment, academic versus nonacademic practice, subspecialty practice, and practice ownership.

Domestic violence in Israel: changing attitudes

For many years, knowledge of the prevalence of violence against women in Israel was marginalized in such a way that it never figured in public discourse. Elite groups of academics and feminist activists with a Western background, together with human rights groups, delivered subversive messages that gradually infiltrated into larger circles and ultimately changed public policies. The issue is now central in public affairs. This article discusses the extent of violence against women in Israel and suggests explanations for the shift from denial to greater public awareness.

Women and HIV/AIDS in the kingdom of Swaziland: culture and risks

In Swaziland, a polygamous society in Southern Africa, the prevalence of the human immune virus/acquired immune deficiency syndrome (HIV/AIDS) is continuing to proliferate at an alarming rate. In 1992 the prevalence rate was 3.9%. However in 12 years, by 2004, the prevalence rate had reached 42.6%. This article explores some of the traditional cultural practices and experiences that increase Swazi women's vulnerability to HIV/AIDS. The traditional cultural practices fall into four categories: (1) socialization and the roles of women, (2) the minority status of women, (3) the practice of a dowry, and (4) the wife as an inheritance. The women's experiences include the Swazi men's beliefs in the virginity cure myth, the women's extreme poverty, and the Swazi men who are migrant workers in neighboring states. This article concludes with recommendations for public policy and for future research within the context of Swazi culture.

International Sexual Harassment

This paper on international sexual harassment begins with a presentation of the definitions, models, and consequences of sexual harassment. Following this discussion, a description is given of a nine-country research program that examined reactions to academic sexual harassment. A brief review of incidence studies and international laws related to sexual harassment are also included.

Female sex work in Yangon, Myanmar

BACKGROUND

Myanmar (Burma), with an upper estimate of 400,000 people living with HIV/AIDS, faces a dangerous and potentially devastating epidemic. Female sex workers in the country are one of the most affected populations, with high prevalence rates of both HIV and sexually transmitted infections (STIs).

METHODS

A qualitative study was undertaken in Yangon at the end of 2002 to investigate the social and demographic features contributing to the transmission of HIV among female sex workers in urban Myanmar. Twenty-seven key informants from the government, non-government organisations (NGOs), international non-government organisations (INGOs), private sector and the United Nations system agencies and 25 women currently working in the sex trade were interviewed.

RESULTS

The sex trade in Yangon is rapidly growing and is characterised by a high degree of complexity. The number of female sex workers is estimated to be between 5,000 and 10,000 and there are approximately 100 brothels operating in various townships around the city. Nearly one-third of the women in the study reported previous imprisonment for offences related to sex work as well as fear of harassment, sexual exploitation, violence and gang rape. Almost half reported using condoms with clients at all times. Contradicting views exist as to the level of awareness about STIs and HIV among Yangon sex workers, with the majority never having been tested for HIV. Only one-quarter of women were regular patients of the limited number of STI clinics operated by INGOs.

CONCLUSIONS

Female sex workers in Myanmar remain a highly marginalised group almost inaccessible due to a variety of legal, political, cultural and social factors and are particularly vulnerable to HIV and STIs. It is important to encourage partnerships between INGOs by promoting service coordination and information sharing to increase the availability of services for sex workers and to build political support for an unpopular cause.

Migration and relationship power among Mexican women

Our study drew on original data collected in Durham, NC, and four sending communities in Mexico to examine differences in women's relationship power that are associated with migration and residence in the United States. We analyzed the personal, relationship, and social resources that condition the association between migration and women's power and the usefulness of the Relationship Control Scale (RCS) for capturing these effects. We found support for perspectives that emphasize that migration may simultaneously mitigate and reinforce gender inequities. Relative to their nonmigrant peers, Mexican women in the United States average higher emotional consonance with their partners, but lower relationship control and sexual negotiation power. Methodologically, we found that the RCS is internally valid and useful for measuring the impact of resources on women's power. However, the scale appears to combine diverse dimensions of relationship power that were differentially related to migration in our study.

Gender, caste, and economic inequalities and marital violence in rural South India

We conducted a survey to examine the relationships among gender, caste, and economic inequalities and marital violence among women in rural South India. Thirty-four percent of 397 women reported having ever been hit, forced to have sex by their husbands, or both. Women belonging to lower caste, poorer households, having greater economic autonomy, and whose husbands consumed alcohol were more likely to report violence. In multivariate analyses, indicators of women's economic autonomy and husbands' alcohol consumption were significantly associated with violence, independent of caste and economic status, which highlights the need to address the links between gender inequalities and marital violence.

Tracking gender-based human rights violations in postwar Kosovo

Four years have passed since the institution of the cease-fire in Yugoslavia, and questions remain as to how Kosovar women are faring in the country's postwar reconstruction. Reports, albeit fragmented, suggest that violence against women began to increase in 1998 and 1999. This trend continued through 2001, even while rates of other major crimes decreased. Despite considerable local efforts to address the conditions of women, there remains a lack of systematic data documenting the scope and frequency of violent acts committed against women. A centralized surveillance system focused on tracking human rights abuses needs to be established to address this critical need for empirically based reports and to ultimately guide reform efforts.

Sexuality and women's rights in armed conflict in Sri Lanka

The discourse of human rights in armed conflict situations is well adapted to respond to violence and violation, invoking internationally agreed principles of civil and political rights. However, in areas where the subject or domain of rights discourse is contested or controversial, human rights advocates appear less prepared to promote and defend such rights. Sexuality is one such domain. This paper explores the complex sexual choices women in Sri Lanka have had to negotiate, particularly widows and sex workers, within a context of ethnic conflict, militarisation and war. It argues that sexuality cannot be defined exclusively in terms of violation, even in a context dominated by violence, and that the sexual ordering of society may be subverted in such conditions. Newly widowed women and sex workers have had to negotiate self-determination as well as take responsibility for earning income and heading households, in spite of contrary community pressures. For women, political and economic rights are closely linked with the ability to determine their sexual and reproductive choices. The challenge to women's and human rights advocates is how to articulate sexual autonomy as a necessary right on a par with others, and strategise to secure this right during armed conflict and postwar reconstruction.

"Yes" to abortion but "no" to sexual rights: the paradoxical reality of married women in rural Tamil Nadu, India

This study in rural Tamil Nadu, India, explored the reasons why many married women in India undergo induced abortions rather than use reversible contraception to space or limit births in terms of women's sexual and reproductive rights within marriage, and in the context of gender relations between couples more generally. It is based on in-depth interviews with two generations of ever-married women, some of whom had had abortions and others who had not, from 98 rural hamlets. The respondents were 66 women and 44 of their husbands. Non-consensual sex, sexual violence and women's inability to refuse their husband's sexual demands appeared to underlie the need for abortion in both younger and older women. Many men seemed to believe that sex within marriage was their right, and that women had no say in the matter. The findings raise questions about the presumed association between legal abortion and the enjoyment of reproductive and sexual rights. A large number of women who had abortions in this study were denied their sexual rights but were permitted, even forced, to terminate their pregnancies for reasons unrelated to their right to choose abortion. The study brings home the need for activism to promote women's sexual rights and a campaign against sexual violence in marriage.

The impact of household delivery of family planning services on women's status in Bangladesh

CONTEXT

Qualitative studies assessing the impact of the household delivery of family planning services on women's social status have yielded contradictory findings. Given the resumption of these services in Bangladesh in 2003, it is important to reevaluate the social impact of the doorstep program using quantitative techniques.

METHODS

Longitudinal and cross-sectional data from 3,783 women using doorstep services in two rural districts of Bangladesh are used in ordinary least-squares and logistic regression analyses to assess the effect of doorstep services on changes in women's status between 1988 and 1993.

RESULTS

In analyses controlling for background characteristics, women's status in 1988, previous service use and visit selection bias, household outreach is associated with increases in women's status between 1988 and 1993. However, this effect is largely attributable to the impact of doorstep services on women's ability to regulate their fertility rather than to the home visits themselves.

CONCLUSION

The decision of the Bangladesh Ministry of Health and Family Welfare to resume household family planning services should not be detrimental to women's status, and may be associated with gender benefits to female clients served by the program.

To shatter the glass ceiling in healthcare management: who supports affirmative action and why?

We examined the findings of a recent national survey of healthcare executives that showed 90% of women but only 53% of men favoured efforts to increase the proportion of women in senior healthcare management positions. Using the theories of relative deprivation and social identity, we tested hypotheses to suggest the background, work characteristics and attitudes about existing discriminatory practices in their own organizations that correlate with respondents' views about affirmative action for women. Some support is evidenced for the two theories and explanations are suggested to account for apparent anomalies.

Women's autonomy and child survival: a comparison of Muslims and non-Muslims in four Asian countries

In this article, I evaluate the hypothesis that higher infant and child mortality among Muslim populations is related to the lower autonomy of Muslim women using data from 15 pairs of Muslim and non-Muslim communities in India, Malaysia, the Philippines, and Thailand. Women's autonomy in various spheres is not consistently lower in Muslim than in non-Muslim settings. Both across and within communities, the association between women's autonomy and mortality is weak, and measures of autonomy or socioeconomic status are generally of limited import for understanding the Muslim disadvantage in children's survival.

A Population-Based Assessment of Women's Mental Health and Attitudes toward Women's Human Rights in Afghanistan

OBJECTIVE

To assess the health status of Afghan women and attitudes of these women and their male relatives during the period of Taliban rule toward women's rights and community development needs in Afghanistan.

METHODS

In household residences in two regions in Afghanistan (one Taliban controlled and the other not under the Taliban) and a refugee camp and repatriation center in Pakistan, structured interviews were conducted among a random sample of women and men exposed to Taliban policy and women living in a non-Taliban controlled area (724 Afghan women and 553 male relatives).

RESULTS

Major depression was far more prevalent among women exposed to Taliban policies (73%-78%) than among women living in a non-Taliban controlled area (28%). Sixty-five percent of women living in a Taliban-controlled area and 73% of women in Pakistan exposed to Taliban policies expressed suicidal ideation at the time of the study, compared with 18% of those in a non-Taliban controlled area. More than 90% of both women and men expressed support for equal work and educational opportunities, free expression, protection of women's rights, participation of women in government, and the inclusion of women's human rights concerns in peace talks. A majority of both women and men believed that guaranteeing civil and political rights (69%) and meeting basic needs (90%) were important for the health and development of their communities.

CONCLUSIONS

In Afghanistan under the Taliban, policies restricting women's rights were not the product of years of tradition or of social and economic deprivation. Instead, they were man-made policies as easily and swiftly revoked as they were instituted. Depression rates among women in Afghanistan, especially in Taliban-controlled areas, were extraordinarily high. Current efforts to rebuild Afghanistan must address these high rates of depression and other mental health problems to ensure women's full participation in development.

Maternal mortality and associated near-misses among emergency intrapartum obstetric referrals in Mulago Hospital, Kampala, Uganda

BACKGROUND

Many maternal deaths (as well as related severe morbidity) are of women who do not attend antenatal care in a given health unit but are referred there when they develop life-threatening obstetric complications.

OBJECTIVE

To determine the reproductive characteristics of emergency obstetric referrals, and determine the contribution of emergency obstetric referrals to severe acute maternal morbidity (near-misses) and maternal mortality.

STUDY DESIGN

Descriptive cross-sectional study.

SETTING

Mulago hospital, the National Referral hospital, Kampala, Uganda, from 1st March to August 30th 2000.

SUBJECTS

Nine hundred and eighty three consecutive women admitted as emergency obstetric referrals in labour or puerperium.

INTERVENTIONS

Subjects were followed from time of admission to discharge (or death). They were interviewed (or examined) to obtain data on socio-demographic characteristics, reproductive history, obstetric outcome of the index pregnancy, obstetric complications and cause of death. Their records were reviewed to determine evidence of severe acute morbidity from acute organ/system dysfunction, using the definition by Mantel et al. These data were analysed using the Epilnfo computer programme in terms of means, frequencies and percentages.

MAIN OUTCOME MEASURES

Socio-demographic characteristics, obstetric complications, cause of deaths, cause and type of near miss mortality and case fatality rates.

RESULTS

Of the 983 referrals, over 100 were near-misses and 17 died. Using the definition of Mantel et al of near-misses enabled identification of six times as many near-misses as maternal deaths. The commonest causes of death were postpartum haemorrhage and eclampsia. Low status was highly associated with both maternal deaths and near misses.

CONCLUSION

In developing countries, with poor obstetric services, emergency transfers in labour are very common. These women, who are of low status, contribute significantly to maternal mortality and morbidity.

Declining sex differences in mortality from lung cancer in high-income nations

After decades of widening, the difference in mortality from lung cancer between men and women has begun to narrow in recent years. Recognizing that the increase in smoking among women relative to men is the proximate cause of the changing sex difference in rates of lung cancer, I analyzed two approaches to identify the more distant sources of the changes. A gender-equality argument suggests that the difference is related to the more general equalization of women's and men's work and family roles, which also encourages the adoption of harmful behaviors such as smoking by women. An alternative explanation suggests that the convergence in mortality from lung cancer among men and women is the byproduct of a lag in the adoption, diffusion, and abatement of smoking by women. Using mortality data on 21 nations from 1955 to 1996, an analysis of logged rates of men's and women's lung cancer mortality and the logged ratio of the rates demonstrated little relationship between the sex difference and gender equality. However, I found a strong and consistent relationship between the sex difference and the stage of diffusion of the use of cigarettes.