Application of a gender-based approach to conducting a community health assessment for rural women in Southern Illinois

Rural populations in the United States experience unique challenges in health and health care. The health of rural women, in particular, is influenced by their knowledge, work and family commitments, as well as environmental barriers in their communities. In rural southern Illinois, the seven southernmost counties form a region that experiences high rates of cancer and other chronic diseases. To identify, understand, and prioritize the health needs of women living in these seven counties, a comprehensive gender-based community health assessment was conducted with the goal of developing a plan to improve women's health in the region. A gender-analysis framework was adapted, and key stakeholder interviews and focus groups with community women were conducted and analyzed to identify factors affecting ill health. The gender-based analysis revealed that women play a critical role in the health of their families and their communities, and these roles can influence their personal health. The gender-based analysis also identified several gender-specific barriers and facilitators that affect women's health and their ability to engage in healthy behaviors. These results have important implications for the development of programs and policies to improve health among rural women.     

Coalition for a Healthier Community: Lessons learned and implications for future work

The Coalition for a Healthier Community (CHC) initiative was implemented to improve the health and well-being of women and girls. Underpinning CHC is a gender-based focus that uses a network of community partners working collaboratively to generate relevant behavior change and improved health outcomes. Ten programs are trying to determine whether gender-focused system approaches are cost-effective ways to address health disparities in women and girls. Programs implemented through coalitions made up of academic institutions, public health departments, community-based organizations, and local, regional, and national organizations, are addressing health issues such as domestic violence, cardiovascular disease prevention, physical activity, and healthy eating. Although these programs are ongoing, they have made significant progress. Key factors contributing to their early success include a comprehensive needs assessment, robust coalitions, the diversity of populations targeted, programs based on findings of the needs assessments, evaluations taking into consideration the effect of gender, and strong academic–community partnerships. A noteworthy impact of these programs has been their ability to shape and impact public, social, and health policies at the state and local levels. However, there have been challenges associated with the implementation of such a complex program. Lessons learned are discussed in this paper.     

Evidence from the field: Findings on issues related to planning,implementing and evaluating gender-based programs

An Initiative of the United States Department of Health and Human Services’ Office on Women's Health (OWH), Coalition for a Healthier Community (CHC), supports ten grantees across the U.S. in the implementation of gender-based health interventions targeting women and girls. A national evaluation is assessing whether gender-focused public health systems approaches are sustainable and cost effective in addressing health disparities in women and girls. To inform the evaluation, a systematic examination was conducted of literature in both the public and private sector designed to track, assess, understand, and improve women's health, public health systems approaches, and the cost-effectiveness and sustainability of gender-based programs. A two-person team assured the quality of the results following the review of abstracts and full-text articles. Of 123 articles meeting eligibility criteria (See inclusion criteria described in Section 2.2 below), only 18 met inclusion criteria specific to a focus on a systems approach, cost-effectiveness and/or sustainability. Studies assessing systems approaches suggested their effectiveness in changing perceptions and increasing knowledge within a community; increasing involvement of local decision-makers and other community leaders in women's health issues; and increasing community capacity to address women and girls’ health. Further evaluation of the cost-effectiveness and sustainability of gender-based approaches is needed.     

Gender,tribe and development: a case study of the Reang tribal community in Tripura (Northeast India)

The article critically examines the gendered impacts of state-led development among the Reang tribal community in Tripura (Northeast India) and outlines causes of gender-based inequalities that affect Reang women’s ability to engage in livelihood, achieve financial independence and participate in political affairs of the state. The article outlines two interlinked arguments. First, gender-based inequalities are not adequately addressed by the postcolonial Indian state which tends to homogenise members of tribal communities through development policies by privileging ethnicity over gender. Second, gender-based inequalities are also not adequately addressed within the Reang community highlighting complex intra-tribal dynamics wherein differential notion of inequalities among the Reangs and position of certain influential actors within the community determines which issues are addressed and which are marginalised.     

‘When does the end begin?’ Addressing gender-based violence in post-conflict societies: case studies from Zimbabwe and El Salvador

This article analyses gender-based violence in the country contexts of Zimbabwe and El Salvador, where distinct periods of conflict and turbulence led to nominal peace, but no recognisable reduction or improvement in the status of women. Women in these two societies continued to experience high levels of gender-based violence. We outline the experience and strategies of Oxfam America along with national partners in addressing gender-based violence in these post-conflict societies. The article draws from Oxfam America's experiences in El Salvador and Zimbabwe, where a campaign and advocacy approach promoted new policy responses and legislation as a result of changes in societal and political attitudes to gender-based violence. It outlines the strategies and partnerships used by the Zimbabwe and El Salvador campaigns, including community outreach, mass mobilisation, and legislative lobbying, to achieve a positive shift in national policies and practices, to prevent gender-based violence.     

Community research on older women in the Dominican Republic

This article looks at action research into the interests and needs of older women in 11 urban communities in Santo Domingo, Dominican Republic. Since 1993, Aquelarre has been working in Santo Domingo with the goal of ending child abuse and violence against women in the home, promote good health among women, and the well-being of older women. In order to achieve these goals, an action research was conducted. Individual interviews with 70 older women, focus group sessions with 120 women, and interviews with key community members were carried out to elicit information on older women's interest and needs. The research was able to identify the major concerns among women, which are health, economic issues, education and family. Practical solutions to these problems were then developed. Throughout the research, it was noted that there was a tendency for participants to focus on the needs of their loved ones, rather than their own needs and problems.     

Help,harm or hinder? Non-governmental service providers’ perspectives on families and gender-based violence against women with intellectual disabilities in South Africa

Through in-depth interviews with service providers from non-governmental organisations (n = 58), this article describes the intricacy of familial relationships for women with intellectual disabilities in South Africa who experience gender-based violence. The findings suggest that families navigate social stigma, limited resources and isolation, whilst trying to be vigilant against gender-based violence and disability-related violence, and respond to it as it happens. However, family members are also simultaneously implicated in violence perpetration. We suggest that a social relational model of disability could help account for these crucial intra-familial dynamics.     

Exploring the role of gender norms in nutrition and sexual health promotion in a piloted school-based intervention: The Philadelphia Ujima™ experience

Perceptions of masculinity and femininity influence behaviors and can be identified in young children and adolescents (Brannon, 2004). Thus, adolescents’ engagement in health risk or promoting behaviors is influenced by perceptions of masculinity and femininity and the differences in expectations, norms and responsibilities for girls and boys (WHO, 2007). Girls and boys have different needs, and gender-based interventions that consider similarities as well as differences are needed. A gender-based nutrition and sexual health promotion program was developed and piloted by the Philadelphia Ujima Coalition in a high school setting. To explore the gender differences in adolescents’ perceptions of the influence of gender norms on weight, nutrition, physical activity, and sexual health and the implication of these differences in future gender-integrated health promotion programming for youth, a content analysis of student and facilitator debriefing forms were implemented for the participating schools. The content analysis was used to identify central themes, concepts gained, and overall impact of the intervention sessions. Overall, gender norms influence healthy eating practices and activity through influencing perceptions of body type in adolescents. Gender norms also influence sexual activity and decision making through influencing perceptions of beauty, masculinity, femininity, pressures and popular concepts related to sexual activity. Thus, interventions that address gender may more effectively promote health and wellness in adolescents.     

Exploring gender and elder abuse from the perspective of professionals

We conducted an online survey of professionals working in two Canadian provinces to learn about their knowledge of elder abuse from a gender-based perspective. A total of 169 professionals (90% women) completed a survey in either French or English. Five topic areas emerged from the analysis: the influence of gender on the risk of abuse; types of abuse detected; knowledge gaps; capacity to respond to gender-based abuse; and awareness of resources. To gain further insight into these results, we conducted three focus groups with a total of 24 professionals. Professionals held relatively little recognition of, or knowledge about, gender related to elder abuse. Our results indicate the need to develop educational and awareness raising opportunities for professionals who work with abused older adults in both French and English to identify and respond to the unique needs of older women and men.     

Implementing a gender policy in ACORD: strategies,constraints, and challenges

ACORD, a consortium of 11 nongovernmental organizations from Europe, Asia, and North America devoted to poverty alleviation in Africa, formally adopted a gender policy in 1990 aimed at reducing gender-based inequities in communities where ACORD works. A 1994-96 survey of field programs indicated that the greatest gains for women had been recorded in the areas of welfare, access to resources, conscientization (awareness of and will to alter gender inequalities), and, to a lesser extent, participation; minimal progress was noted in shifting the prevailing gender-based imbalance of power and control in public or private spheres. The research identified several programming and organizational strategies that have promoted positive outcomes for women: gender-awareness training for staff and community members, working with mixed groups, working with women-only groups, promotion of female leadership, gender-aware participatory planning and evaluation, spreading responsibility throughout the organization for implementing the gender policy, recruitment and promotion of women staff, networks for women staff, and direct field involvement in research. Also identified were internal and external factors that weakened policy implementation: a lack of clarity as to its aims, culture-based resistance, confusion regarding responsibilities and procedures, weak accountability mechanisms, lack of gender impact indicators, training inadequacies, underrepresentation of women staff, and inadequate resources. As a result of the review process, ACORD has given gender issues centrality in its current 5-year strategic plan.     

A gender-based approach to developing a healthy lifestyle and healthy weight intervention for diverse Utah women

Utah women from some cultural minority groups have higher overweight/obesity rates than the overall population. We utilized a gender-based mixed methods approach to learn about the underlying social, cultural and gender issues that contribute to the increased obesity risk among these women and to inform intervention development. A literature review and analysis of Utah's Behavioral Risk Factor Surveillance System data informed the development of a focus group guide. Focus groups were conducted with five groups of women: African immigrants from Burundi and Rwanda, African Americans, American Indians/Alaskan Natives, Hispanics/Latinas, and Pacific Islanders. Six common themes emerged: (1) health is multidimensional and interventions must address health in this manner; (2) limited resources and time influence health behaviors; (3) norms about healthy weight vary, with certain communities showing more preference to heavier women; (4) women and men have important but different influences on healthy lifestyle practices within households; (5) women have an influential role on the health of families; and (6) opportunities exist within each group to improve health. Seeking insights from these five groups of women helped to identify common and distinct cultural and gender themes related to obesity, which can be used to help elucidate core obesity determinants.     

Gendered Economic,Social, and Cultural Challenges to HIV/AIDS Prevention and Intervention for Chinese Women

ABSTRACT

China is experiencing the most rapidly expanding HIV prevalence in the world, with the percentage of Chinese women living with HIV/AIDS also increasing significantly. Chinese women's risk of HIV infection is heavily influenced by patriarchal cultural beliefs, Confucian doctrines, and rapid social and economic changes in China. Chinese women generally have a low level of awareness of HIV/AIDS. With inherent inferior social status and economic disadvantage, their vulnerability to HIV infection is heightened by adverse impacts of massive rural-to-urban migration, explosion of the commercial sex industry, and prevalence of gender-based violence. In order to target HIV/AIDS prevention and treatment programs for Chinese women, their specific needs and gendered obstacles must be addressed and tackled. These include strategies that aim to fight against poverty, improve education, enhance HIV/AIDS awareness, facilitate new life-skills acquisition and behavior change, make available woman-centered services for testing and treatment of HIV, and eradicate gender-based discrimination and violence. There is also an urgent need to further develop various public health infrastructure in China, especially in remote and rural areas. The pool of gender experts in China should also be expanded to conduct a thorough gender analysis and design a national response to address the evolving HIV/AIDS epidemic in Chinese women.     

Supporting families with a mentally ill parent: European perspectives on interagency cooperation

This paper reports on the findings of a cross-country comparison of cooperation between services for community mental health and child protection in 11 states. The authors consider the implications of the findings for English practice. When children have a parent with mental health problems, they have needs over and above those of other children. Often these needs are met by the family, but this is not always possible. There are increasing numbers of these children, and they feature disproportionately in the case loads of child welfare professionals, health visitors and social workers. The cross-country comparisons demonstrate the ways in which differences in structures, resources, expectations and attitudes affect professional responses and the experiences of families. The findings provide information on several levels. A comparison of commonalities and differences highlights the problems that are shared across countries, and alternative ways of responding to them at ground level are discussed. The factors that facilitate a good outcome are analysed in relation to English practice and service structures. The research findings are relevant for British social welfare strategies, and the paper highlights the implications of the findings for policy and practice. Copyright © 2001 John Wiley & Sons, Ltd.     

Gender-based health interventions in the United States: An overview of the coalition for healthier community initiative

Health disparities by gender constitute an important yet often overlooked aspect of health around the globe. Within the United States, there is both a paucity of research as well as planned programs that take into account how socio-cultural roles and expectations for men and women may differentially affect symptoms, access to care, and treatment. Viewing women's health exclusively as a function of sex (i.e., biological) differences represents a narrow understanding that does not fully explain gaps in health disparities between men and women. In September 2010, the U.S. Department of Health and Human Services (DHHS) launched a national initiative entitled the Coalition for a Healthier Community (CHC) to employ a gender-based framework in several urban, suburban and rural communities across the nation. The Office on Women's Health (OWH) within the DHHS funded 10 coalitions to ultimately improve the health of women and girls utilizing a gender-based approach. This article provides an overview of the initiative and the focus of the special issue.     

Ambivalent sexism and egalitarian ideology in perception of psychological abuse and (in)vulnerability to violence / Sexismo ambivalente e ideología igualitaria en la percepción del maltrato psicológico y la (in)vulnerabilidad a la violencia

Abstract

Psychological violence against women in intimate relations is one of the most widespread and hidden ways of limiting their human rights. Nowadays different ideologies, including sexism and feminism, can contribute to (dis)regard this phenomenon. This study focuses on the relationship between ambivalent sexism (in its hostile and benevolent dimensions) and feminism (in the egalitarian ideology dimension) with the identification of psychological violence and the perception of invulnerability to the intimate partner violence in women. The mediator role of the myths about gender-based violence in these relationships is analysed. Participants were 91 women, with heterogeneous socio-demographic characteristics. Results showed benevolent sexism as a risk factor and egalitarian feminism ideology as a protector factor in the process of the perception of psychological violence. The egalitarian feminism ideology also appears as the main predictor of the perception of invulnerability to abuse. This relationship is mediated by the degree of adhesion to the myths about gender-based violence. These findings reinforce the importance of the attitudinal and ideological factors in the perception of gender-based violence.     

"Circumcision", culture,and health-care provision in Tower Hamlets,London

Tower Hamlets (London, England) has a sizable Somali community whose members maintain close links with their families in Africa. The London Black Women's Health Action Project (LBWAP) was established in Tower Hamlets, in 1982, to address the health needs of Somali women, especially those related to female circumcision. The major focus in the UK has been on protecting girls from undergoing this practice, with little attention to the needs of women who have already been circumcised. Of 200 Somali women interviewed by LBWAP, 61% had been infibulated in their native country by people with no medical training. Among the long-term health consequences were dysmenorrhea, recurrent urinary problems, urethral damage, and painful intercourse. Although deinfibulation can be obtained, both health care professionals and circumcised women tend to be unaware of this service. LBWAP has proposed a study to assess the expressed health care needs of circumcised Somali women and match these desires with actual health care provision. To raise the consciousness of British health care professionals, parallels between female circumcision and the indiscriminate, unnecessary use of episiotomy are being made.     

(In)credible Violence: An Analysis of Post-Alvarado Domestic Violence Asylum Cases in the United States

ABSTRACT

Every year, women from around the world apply for asylum in the United States to escape an abusive partner. In this article I find that domestic violence applicants may not be interpreted as viable truth tellers since they are missing specific markers of credibility, including legitimacy of fear, coherence and corroboration, and proof of no culpability. I link these questions of credibility to broader US discourses about gender-based violence and racialized conceptions of victimhood, which show a preference for credentialed knowledge over women’s experiences and employ assumptions about autonomous, linear decision-making. I argue that the deployment of these discourses represents a tactic of exclusion, likely motivated by fears of immigration. Asylum adjudication practices (including credibility determinations) must address these issues in order to secure the health and well-being of women fleeing abusive partners in their countries of origin.     

The mental health problems of mothers experiencing the child protection system: identifying needs and appropriate responses

This article presents the findings of a small pilot study which examined the needs of 13 mothers with severe mental health problems whose children were involved in the child protection system. The use of the diagnosis of ‘personality disorder’ in relation to this group of women is discussed and the finding that all these women had experience of domestic violence is considered in the context of other research findings. The extent to which child protection social workers and mental health professionals worked together on these cases was explored and only limited evidence of good communication and collaboration was found. The need for effective inter‐professional and inter‐agency coordination is argued, but differing conceptions of maternal mental health problems and their relationship to children's needs may make for difficulties in professional communication and decision‐making. The article seeks to identify the differing approaches to maternal mental health problems which appear to be developing out of different groups of research studies and argues that practitioners need to be explicit in identifying their perspectives on the associated issues of maternal mental health problems and child protection. Copyright © 1999 John Wiley & Sons, Ltd.     

Conducting a Hispanic Health Needs Assessment in rural Kansas: Building the foundation for community action

Healthy People 2020 states ethnic health disparities are a priority for the US. Although considerable national statistics document ethnic-related health disparities, information specific to rural areas is scarce and does not provide direction for implementing chronic disease prevention programming. Therefore, the purpose of our project was to use the Hispanic Health Needs Assessment (HHNA), a tool designed by the National Alliance for Hispanic Health (NAHH), in culturally diverse, rural Southwest Kansas. Our focus areas included: access to healthcare, heart disease, diabetes, overweight, nutrition, and physical activity.MethodsThe assessment followed six steps: (1) developing the assessment team, (2) data gathering using community member surveys, existing statistics and community leader interviews, (3) assembling the findings, (4) formulating recommendations for action at individual, institutional, community and policy levels, (5) sharing findings and program planning, and (6) sharing findings with NAHH. We identified several challenges collecting health related data in rural communities, but overall, the HHNA was a comprehensive and useful tool for guiding a community level health assessment.ConclusionThis process has provided our community partners with locally relevant statistics regarding the current status of health, health behaviors, and perceived community needs to inform resource allocation, program planning and applications for new funding initiatives.