Unpaid Family Caregiving-The Next Frontier of Gender Equity in a Postpandemic Future.

This Viewpoint discusses how the COVID-19 pandemic has spotlighted the critical role of unpaid family caregiving.

Exploring the reasons for labour market gender inequality a year into the COVID-19 pandemic: evidence from the UK cohort studies.

The COVID-19 pandemic has caused unexpected disruptions to Western countries which affected women more adversely than men. Previous studies suggest that gender differences are attributable to: women being over-represented in the most affected sectors of the economy, women's labour market disadvantage as compared to their partners, and mothers taking a bigger share childcare responsibilities following school closures. Using the data from four British nationally representative cohort studies, we test these propositions. Our findings confirm that the adverse labour market effects were still experienced by women a year into the COVID-19 pandemic and that these effects were the most severe for women who lived with a partner and children, even if they worked in critical occupations. We show that adjusting for pre-pandemic job characteristics attenuates the gaps, suggesting that women were over-represented in jobs disproportionately affected by COVID-19 pandemic. However, the remaining gaps are not further attenuated by adjusting for the partner's job and children characteristics, suggesting that the adversities experienced by women were not driven by their relative labour market position, as compared to their partners or childcare responsibilities. The residual gender differences observed in the rates of active, paid work and furlough for those who live with partner and children point to the importance of unobserved factors such as social norms, preferences, or discrimination. These effects may be long-lasting and jeopardise women's longer-term position through the loss of experience, leading to reinforcement of gender inequalities or even reversal of the progress towards gender equality.

SDG5 "Gender Equality" and the COVID-19 pandemic: A rapid assessment of health system responses in selected upper-middle and high-income countries.

Introduction: The COVID-19 pandemic disrupted healthcare and societies, exacerbating existing inequalities for women and girls across every sphere. Our study explores health system responses to gender equality goals during the COVID-19 pandemic and inclusion in future policies. Methods: We apply a qualitative comparative approach, drawing on secondary sources and expert information; the data was collected from March-July 2022. Australia, Brazil, Germany, the United Kingdom, and the USA were selected, reflecting upper-middle and high-income countries with established public health and gender policies but different types of healthcare systems and epidemiological and geo-political conditions. Three sub-goals of SDG5 were analyzed: maternity care/reproductive health, gender-based violence, and gender equality/women's leadership. Results: We found similar trends across countries. Pandemic policies strongly cut into women's health, constrained prevention and support services, and weakened reproductive rights, while essential maternity care services were kept open. Intersecting gender inequalities were reinforced, sexual violence increased and women's leadership was weak. All healthcare systems failed to protect women's health and essential public health targets. Yet there were relevant differences in the responses to increased violence and reproductive rights, ranging from some support measures in Australia to an abortion ban in the US. Conclusions: Our study highlights a need for revising pandemic policies through a feminist lens.

Improving family functioning and reducing violence in the home in North Kivu, Democratic Republic of Congo: a pilot cluster-randomised controlled trial of Safe at Home.

OBJECTIVE: To test the effectiveness of the Safe at Home programme which was developed to improve family well-being and prevent multiple forms of violence in the home. DESIGN: Waitlisted pilot cluster randomised controlled trial. SETTING: North Kivu, Democratic Republic of Congo. PARTICIPANTS: 202 heterosexual couples. INTERVENTION: The Safe at Home programme. PRIMARY AND SECONDARY OUTCOME MEASURES: The primary outcome was family functioning, with secondary outcomes of past-3 month co-occurring violence, intimate partner violence (IPV) and harsh discipline. Pathway mechanisms assessed included attitudes related to acceptance of harsh discipline, gender equitable attitudes, positive parenting skills and power sharing within the couple. RESULTS: No significant improvements in family functioning were documented for women (ß=1.49; 95% CI: -2.75 to 5.74; p=0.49) and men (ß=1.09; 95% CI: -3.13 to 4.74; p=0.69). However, women in Safe at Home reported a OR=0.15 (p=0.000), OR=0.23 (p=0.001) and OR=0.29 (p=0.013) change in co-occurring IPV and harsh discipline; physical/sexual/emotional IPV by their partner and use of physical and/or emotional harsh discipline against their child, respectively, as compared with women in the waitlisted group. Men participating in Safe at Home reported a OR=0.23 (p=0.005) change in perpetration of co-occurring violence, OR=0.26 (p=0.003) change in any form of IPV perpetration and OR=0.56 (p=0.19) change in use of harsh discipline against their child as compared with the waitlist arm. Positive changes were also noted in pathway variables around attitudes, skills and behaviours within couples. CONCLUSION: This pilot trial demonstrated the Safe at Home programme to be highly effective in preventing multiple forms of violence in the home and improving equitable attitudes and skills in couples. Future research should assess longitudinal impact and implementation at scale. TRIAL REGISTRATION NUMBER: NCT04163549.

Global evidence of gender equity in academic health research: a scoping review.

OBJECTIVES: To chart the global literature on gender equity in academic health research. DESIGN: Scoping review. PARTICIPANTS: Quantitative studies were eligible if they examined gender equity within academic institutions including health researchers. PRIMARY AND SECONDARY OUTCOME MEASURES: Outcomes related to equity across gender and other social identities in academia: (1) faculty workforce: representation of all genders in university/faculty departments, academic rank or position and salary; (2) service: teaching obligations and administrative/non-teaching activities; (3) recruitment and hiring data: number of applicants by gender, interviews and new hires for various rank; (4) promotion: opportunities for promotion and time to progress through academic ranks; (5) academic leadership: type of leadership positions, opportunities for leadership promotion or training, opportunities to supervise/mentor and support for leadership bids; (6) scholarly output or productivity: number/type of publications and presentations, position of authorship, number/value of grants or awards and intellectual property ownership; (7) contextual factors of universities; (8) infrastructure; (9) knowledge and technology translation activities; (10) availability of maternity/paternity/parental/family leave; (11) collaboration activities/opportunities for collaboration; (12) qualitative considerations: perceptions around promotion, finances and support. RESULTS: Literature search yielded 94 798 citations; 4753 full-text articles were screened, and 562 studies were included. Most studies originated from North America (462/562, 82.2%). Few studies (27/562, 4.8%) reported race and fewer reported sex/gender (which were used interchangeably in most studies) other than male/female (11/562, 2.0%). Only one study provided data on religion. No other PROGRESS-PLUS variables were reported. A total of 2996 outcomes were reported, with most studies examining academic output (371/562, 66.0%). CONCLUSIONS: Reviewed literature suggest a lack in analytic approaches that consider genders beyond the binary categories of man and woman, additional social identities (race, religion, social capital and disability) and an intersectionality lens examining the interconnection of multiple social identities in understanding discrimination and disadvantage. All of these are necessary to tailor strategies that promote gender equity. TRIAL REGISTRATION NUMBER: Open Science Framework: https://osf.io/8wk7e/.

Gender Inequalities in Publications about COVID-19 in Spain: Authorship and Sex-Disaggregated Data.

Gender inequalities in biomedical literature have been widely reported in authorship as well as the scarcity of results that are stratified by sex in the studies. We conducted a bibliometric review of articles on COVID-19 published in the main Spanish medical journals between April 2020 and May 2021. The purpose of this study was to analyse differences in authorship order and composition by sex and their evolution over time, as well as the frequency of sex-disaggregated empirical results and its relationship with the author sex in articles on COVID-19 in the main Spanish biomedical journals. We identified 914 articles and 4921 authors, 57.5% men and 42.5% women. Women accounted for 36.7% of first authors and for 33.7% of last authors. Monthly variation in authorship over the course of the pandemic indicates that women were always less likely to publish as first authors. Only 1.0% of the articles broke down empirical results by sex. Disaggregation of results by sex was significantly more frequent when women were first authors and when women were the majority in the authorship. It is important to make gender inequalities visible in scientific dissemination and to promote gender-sensitive research, which can help to reduce gender bias in clinical studies as well as to design public policies for post-pandemic recovery that are more gender-equitable.

Nursing Students' Perception about Gender Inequalities Presented on Social Networks: A Qualitative Study.

During the COVID-19 pandemic, gender inequalities in nurses have been exacerbated through the images shown on social networks. This study aimed to explore and describe nursing students' experiences and perceptions about gender inequalities in nurses during the COVID-19 pandemic. A descriptive qualitative study was carried out in two universities in 264 undergraduate nursing students. The photovoice method was used to guide the study. Results: Two main categories and four subcategories were described from the data: "gender-related stereotypes", with "male leadership in a female profession" and "sexualization of female nurses" and "women's vulnerability in the pandemic" with "the gender gap in the face of increased risk of contagion " and "women's emotional fragility". Over the years, care has been considered a female task, and nursing continues to be thought of in this way. The nurse has been discriminated against, poorly considered as a professional, and, as a woman, subjected to gender roles.

A health impact assessment of gender inequities associated with psychological distress during COVID19 in Australia's most locked down state-Victoria.

BACKGROUND: Since March 2020, when the COVID19 pandemic hit Australia, Victoria has been in lockdown six times for 264 days, making it the world's longest cumulative locked-down city. This Health Impact Assessment evaluated gender disparities, especially women's mental health, represented by increased levels of psychological distress during the lockdowns. METHODS: A desk-based, retrospective Health Impact Assessment was undertaken to explore the health impacts of the lockdown public health directive with an equity focus, on the Victorian population, through reviewing available qualitative and quantitative published studies and grey literature. RESULTS: Findings from the assessment suggest the lockdown policies generated and perpetuated avoidable inequities harming mental health demonstrated through increased psychological distress, particularly for women, through psychosocial determinants. CONCLUSION: Ongoing research is needed to elucidate these inequities further. Governments implementing policies to suppress and mitigate COVID19 need to consider how to reduce harmful consequences of these strategies to avoid further generating inequities towards vulnerable groups within the population and increasing inequalities in the broader society.

Quantifying the effects of the COVID-19 pandemic on gender equality on health, social, and economic indicators: a comprehensive review of data from March, 2020, to September, 2021.

BACKGROUND: Gender is emerging as a significant factor in the social, economic, and health effects of COVID-19. However, most existing studies have focused on its direct impact on health. Here, we aimed to explore the indirect effects of COVID-19 on gender disparities globally. METHODS: We reviewed publicly available datasets with information on indicators related to vaccine hesitancy and uptake, health care services, economic and work-related concerns, education, and safety at home and in the community. We used mixed effects regression, Gaussian process regression, and bootstrapping to synthesise all data sources. We accounted for uncertainty in the underlying data and modelling process. We then used mixed effects logistic regression to explore gender gaps globally and by region. FINDINGS: Between March, 2020, and September, 2021, women were more likely to report employment loss (26·0% [95% uncertainty interval 23·8-28·8, by September, 2021) than men (20·4% [18·2-22·9], by September, 2021), as well as forgoing work to care for others (ratio of women to men: 1·8 by March, 2020, and 2·4 by September, 2021). Women and girls were 1·21 times (1·20-1·21) more likely than men and boys to report dropping out of school for reasons other than school closures. Women were also 1·23 (1·22-1·23) times more likely than men to report that gender-based violence had increased during the pandemic. By September 2021, women and men did not differ significantly in vaccine hesitancy or uptake. INTERPRETATION: The most significant gender gaps identified in our study show intensified levels of pre-existing widespread inequalities between women and men during the COVID-19 pandemic. Political and social leaders should prioritise policies that enable and encourage women to participate in the labour force and continue their education, thereby equipping and enabling them with greater ability to overcome the barriers they face. FUNDING: The Bill & Melinda Gates Foundation.

Gender equality in the 21st century: Overcoming barriers to women's leadership in global health.

PURPOSE: The purpose of this manuscript is to provide an overview of the significant role that women play in providing global health care, barriers encountered to achieving gender equality in global health leadership, and to propose key recommendations for advancing gender equality in global health decision-making through the integration of gender mainstreaming, gender-based analysis, and gender transformative leadership (GTL) approaches. METHOD: Data were evaluated to determine the participation rate of women in global health care and social sector roles in comparison to men. Gender equality data from the United Nations, World Health Organization, Organization for Economic Co-operation and Development, International Labour Organization, and other resources were analyzed to assess the impact of the coronavirus disease 2019 pandemic on gender equality with an emphasis on women in global health leadership positions, the health care and social sector, and gender equality measures for girls and women throughout the world. The literature was examined to identify persistent barriers to gender equality in global health leadership positions. Additionally, a review of the literature was conducted to identify key strategies and recommendations for achieving gender equality in global health decision-making; integrating gender mainstreaming; conducting gender-based analysis; and adopting GTL programs, incentives, and policies to advance gender equality in global health organizations. FINDINGS: Women represent 70% of the health and social care sector global workforce but only 25% of senior global health leadership roles. Since 2018, there has been a lack of meaningful change in the gender equality policy arenas at global health organizations that has led to significant increases in women serving in global leadership decision-making senior positions. During the pandemic in 2020, there were nearly 100 open vacancies-one-quarter of CEO and board chair positions-at global health organizations, but none were filled by women. Women disproportionately provide caregiving and unpaid care work, and the pandemic has increased this burden with women spending 15 hours a week more on domestic labor than men. A lack of uniform, state-sponsored paid parental leave and support for childcare, eldercare, and caregiving, which is overwhelmingly assumed by women, serve as major barriers to gender parity in global health leadership and the career advancement of women. CONCLUSION: The pandemic has adversely impacted women in global health care and social sector roles. During the pandemic, there has been a widening of the gender pay gap, a lack of gains for women in global health leadership positions, an increase in caregiving responsibilities for women, and more women and girls have been pushed back into extreme poverty than men and boys. Globally, there is still resistance to women serving in senior leadership roles, and social and cultural norms, gender stereotypes, and restrictions on women's rights are deeply intertwined with barriers that reinforce gender inequality in global health leadership. To ensure comprehensive human rights and that equitable workforce opportunities are available, the concept of gender equality must be expanded within the global health community to consistently include not only women and girls and men and boys, but also persons who identify as nonbinary and gender nonconforming. Efforts to eliminate remnants of systemic and structural gender discrimination must also incorporate gender mainstreaming, gender-based analysis, and gender transformative approaches to achieve gender equality throughout global health systems and organizations.

Women in pediatric radiology: a call for gender equity.

Pediatric radiology is the only specialty in radiology that is near evenly distributed among genders. Yet the top leadership positions in the field are still mostly occupied by men. In this article we review some of the history of women in pediatric radiology and discuss how to improve women's participation in the highest positions of our subspecialty.