Investing in the Power of Nurses

Women make up 70% of the total health and social care workforce. In the nursing and midwifery profession, that percentage is even higher. Despite this, however, women hold only 25% of health system leadership roles.

Addressing gender-related barriers to leadership in nursing is critical to ensuring universal access to quality health services and achieving Sustainable Development Goal 3.

Investing in the Power of Nurse Leadership: What Will It Take? is a new report launched by Nursing Now in collaboration with IntraHealth and Johnson and Johnson.

Drawing on surveys and interviews with over 2,500 nurses and nurse-leaders, the report offers essential new insights into the lived experiences of nurses worldwide.

At the Women Deliver 2019 Conference, Girls’ Globe spoke to Barbara Stilwell, Executive Director of Nursing Now.

She told us: “This moment in time is a moment for nurses. And I don’t think it will come again for a long time.”

The research found that there are a ‘constellation of barriers’ preventing female nurses in particular from progressing into leadership roles.

Key recommendations to address these barriers include:

1. Change the perception of the nursing as a ‘soft science’ and elevate the status and profile of nursing in the health sector.

2. Address occupational sex segregation and eliminate the perception of nursing as ‘women’s work.’

3. Eliminate employer discrimination on the basis of gender or child-bearing status.

4. Build nurses’ self-confidence and sense of preparedness to assume leadership positions.

5. Ensure workplace environments that are safe and responsive to work/life balance and allow for employee flexibility to fulfil both formal work and unpaid care responsibilities.

6. Ensure opportunities for nurses to access funding for leadership development, higher education, or other professional development.

7. Foster increased access to professional networks and mentoring schemes for nurses.

It’s clear that major changes are required to strengthen leadership and equality in the global nursing workforce. This report reflects the voices of nurses – it’s time for the rest of the world to listen.

This blog post was created by Girls’ Globe powered by Johnson & Johnson.

Health Care Workers Matter for Gender Based Violence

It was 10:30 pm on a Monday night.

After a long day at work, I was preparing to go to bed. I usually read before I go to sleep and I’d been trying to finish one book for ages but other things kept coming up. I hoped and prayed tonight would be the night, but the universe had other plans – as always.

My cell phone beeped: “Doctor, it’s an emergency.’’ 

I flung myself out of the bed and tried to reach the hospital as quickly as I could. The patient was a married 27-year-old woman who had sustained major injuries after accidentally burning herself while cooking.

“60 percentage burn,” I deduced, after taking the patient’s history and a physical assessment. But somewhere inside, I knew this wasn’t an accident and I felt sure there was more to the story.

I started with the patient’s family members. Unsurprisingly, upon enquiry they maintained their stance and kept trying to convince me that their daughter-in-law burned herself while preparing the meal for the family. I decided to talk in confidence with the victim, but she was hesitant to break her silence too.

One day, over the course of providing her with routine care, the woman broke down into tears and alleged that her in-laws had set her on fire for dowry.

In a country like Nepal, speaking out about gender-based violence (GBV) is exceptionally difficult because of the shame, stigma and pressure from families and communities preventing victims from reporting abuse and seeking appropriate services.

Victims are often afraid of disclosing or reporting violence because of the consequences they fear will follow.

In turn, silence can aggravate the situation for survivors, leaving them with prolonged mental and physical suffering.

Nepal has a very high incidence of gender-based violence. And while everyone – regardless of gender – can be affected, women remain the main victims. It is difficult to understand the gravity of GBV in Nepal as many of these cases go unreported due to the silence maintained by victims and perpetrators.

GBV remains one of the most rigorous challenges to women’s health and well-being. It can take many different forms, like physical, sexual, emotional or psychological. The causes of gender based violence are multi-dimensional, and include social, political, economic, cultural and religious factors.

Dealing with survivors of GBV can be a very challenging and sensitive task; starting from acknowledging and identifying the violence to asking relevant questions, without being too intrusive or judgmental at all.

Like me, a wide range of health professionals are likely to come into contact with individuals who have experienced GBV. Health workers are in a unique position to help and heal the survivors of GBV, provided they have the knowledge to recognize the signs. Most of the time, health professionals are likely to be the first point of contact for GBV victims.

But are we, as health workers, equipped with the necessary skills to deal with GBV?

While staff and facilities play a key role in health delivery systems for GBV victims, their efforts will have limited impact unless there are specific policies on the issue of GBV to guide the integration of the response to GBV into health care.

One important approach is to specify the role of health care professionals, and to provide guidance and tools. For instance, the World Health Organization has developed guidelines for in-service training of health care providers on intimate partner and sexual violence against women, specifically. The guidelines are based on systematic reviews of evidence, and cover:

• identification and clinical care for intimate partner violence
• clinical care for sexual assault
• training relating to intimate partner violence and sexual assault against women
• policy and programmatic approaches to delivering services
• mandatory reporting of intimate partner violence

The guidelines aim to raise awareness of violence against women among health-care providers and policy-makers, so that they better understand the need for an appropriate health-sector response. They provide standards that can form the basis for national guidelines, and for integrating these issues into health-care provider education.

Sensitizing staff and building their skills on how to recognize and respond to GBV is crucial. Ensuring that services follow human rights-based and gender specific approaches, and are guided at all times by the preferences, rights and dignity of the victim, is important.

Providing adequate infrastructure to ensure the patient’s privacy, safety and confidentiality is also essential. This can be done by providing a private room for consultations, requiring that consultations are held without presence of a partner, putting in place a system for keeping records confidential or giving instructions to staff on explaining legal limits of confidentiality, if any.

Not only are health workers the ones to fix a fracture or heal a burn injury, they can also play the role of advocate by speaking up against injustice in the course of providing routine care.

Health professionals can also assist victims by making them aware of the counselling and legal services available, which is often a part of the recovery process. Gaining the trust of victims is important in this scenario. Community health care workers and midwives, who are often the most trusted members of societies, can use their power to reach women and vulnerable groups to encourage them to break their silence, and to make informed decisions about their bodies and lives.

The role of health professionals goes beyond simply treating and healing a survivor of gender bases violence – we can empower them, too.

Health Heroes on the Front Lines

The ability to see a doctor, nurse, or other trained health provider when we need to is hugely important. We may not think about it much when we are healthy, but sometimes, a visit with a health provider could mean the difference between life or death.

Unfortunately, millions of people in rural areas and low-income communities live far away from their nearest hospital, clinic, or health center, and don’t have adequate transportation or resources to reach them during an emergency. In fact, about half of the world’s population cannot access health care when they need it.

Consider those living in areas affected by natural disasters, emergencies, or armed conflict. Frontline health workers typically live in or near the communities they serve. If a community is affected by drought, the health workers are affected too. If ongoing conflict causes people to flee their homes and communities, doctors and nurses will likely flee with their families as well (if they can). Those left behind may have no one to provide them medical care or to help them stay healthy.

CARE trains, works with and relies on frontline health workers (FHWs) to deliver health services every day in a variety of low-resource settings. These include doctors, nurses and other health workers with varying degrees of formal and informal training. We know that their jobs are difficult, even in the best circumstances. Now imagine what life is like as a FHW in an area affected by crisis or armed conflict.

Let us introduce you to some of the people doing this work:

Mary is a midwife working in the Imvepi refugee settlement in Uganda. She has a three-year-old son.

Photo credit: Jennifer Bose/CARE

Uganda has become one of the largest refugee hosting countries in the world. At the height of the crisis, more than 3,000-7,000 people from South Sudan would arrive every day in the search of refuge. Of the 1.2 million refugees in Uganda, 900,000 are South Sudanese and 86% are women and children in real danger of sexual and physical violence, with many reporting incidents of violence on their journey. Imvepi refugee settlement hosts more than 110,000 refugees.

CARE has established five centers in Imvepi where refugee women and girls can seek assistance and sexual violence survivors can be provided with psychosocial support and health services. Mary works in one of these centers.

She has a busy schedule. At the women’s center, she identifies pregnant refugees who need maternal health services, screens for possible complications, and advises them on antenatal care. She refers any serious medical cases to nearby health clinics and balances a large case load. “Usually in a day I see around 80-100 people, many of them are pregnant mothers,” she explained. “I make sure to highlight the importance of hospital deliveries, as most of them have never seen a doctor before. But it is challenging.”

Because of the scale of Imvepi (about 150 square kilometers), Mary also makes home visits. She provides education on different topics – from family planning to gender-based violence to malnutrition and HIV.

“[Intimate partner violence] is a reoccurring problem in many families. I mostly hear of cases where food shortages lead to physical violence. Many families decide to sell the food rations they receive, ending up with little to no food left for themselves and extreme tensions at home.” Mary said. “I screen such women to see if they are in need of immediate help or referrals.”

Khawla is also a midwife, providing family planning services in Aleppo, Syria. She lives with her husband and children.

Photo Credit: CARE/SRD

Conflict has been ongoing in Syria for over seven years, and civilians are bearing the brunt of the suffering, destruction, and disregard for human life. An estimated 13.5 million people require humanitarian assistance, including 4.9 million trapped in besieged and hard-to-reach areas, where they are exposed to grave protection threats.

Working through partners, CARE supports 10 primary healthcare centers and 10 mobile clinics in northern Syria to provide vulnerable Syrian households with access to sexual and reproductive health and primary health education and services.

Khawla’s home and the health center often do not have electricity. She spends most of her time talking to women about their reproductive health and contraception. While most of Khawla’s work happens during daylight hours at the health center, sometimes she gets emergency calls from women late at night. “This is what scares me – having to go out during evening or night hours due to the security and conflict conditions in Syria,” Khalwa explains. The nearest hospital is 15 kilometers away.

Mary, Khawla, and other frontline health workers make personal sacrifices every day to deliver life-saving health care and emergency assistance to those in need under difficult circumstances. They experience and witness incredible suffering and choose to run towards the need when many would run away.

At CARE, we want to say thank you to all health heroes, wherever you are. We appreciate you, and your commitment to helping others.

Meet more of CARE’s frontline health heroes in our World Humanitarian Day publication: A Day in the Life of Seven Aid Workers.

Improving Medical Response to Violence in Fragile Settings

His full name is Dr. Jean Jose Nzau Mvuezolo, but everyone calls him Jimmy.He is kind, friendly, and easygoing – the type of person you cannot help but like right away. Jimmy is from the Democratic Republic of Congo (DRC), but now he lives in the US, where he works as deputy director for CARE’s SAFPAC team (SAFPAC stands for ‘supporting access to family planning and post-abortion care’).

SAFPAC currently supports sexual and reproductive health projects in 13 countries, but most activities are focused in three fragile states: DRC, Chad, and Mali. Jimmy agreed to talk with me about the work CARE is doing to train health providers (doctors and community health workers) to respond to cases of sexual violence, which tend to increase in times of crisis, stretching already overburdened and under-resourced health and social service systems.

Sexual violence happens everywhere. But in places like these, where the government is weak and social structures are destroyed, it is easy to commit all sorts of human rights violations,” Jimmy explained.  

What kind of training do the providers need so they can help sexual violence survivors?” I asked, expecting him to list off a bunch of medical and data management procedures I would not fully understand.

Basically,” he responded, “they need to understand the concept and accept reality.

I asked what he meant…

It turns out, some doctors in DRC, Chad, and Mali aren’t much different from powerful men anywhere.

In countries and communities all around the world, women are considered less valuable than men, and men are able to use their higher status to take advantage of women and girls.

Many of the doctors Jimmy talked to were also professors at local medical schools, and saw no problem sleeping with their young students or nurses. The concept of gaining consent was foreign to them, and some thought it was okay to repeatedly approach a woman for sex even after she said no.

They did not see how it would be possible for a woman to be raped by her husband or a sex worker to be raped by anyone, because once one is married or has engaged in sex for pay, they can be assumed to be available for sex at all times. If a woman was assaulted, they immediately wanted to know what she might have done to put herself in that dangerous situation.

‘Sexual harassment’ was believed, by some of the men Jimmy spoke to, to be a Western idea and something that did not exist in Africa.

Now imagine coming to one of these health providers as a rape victim – distressed, hurting, and in need of care. I shudder to think about how such a visit could make an already bad situation so much worse.

So Jimmy and the other CARE facilitators start every training they do with a discussion of power dynamics, and what true consent looks like. Participants are asked to critically reflect on their own attitudes and behaviors toward women in their lives, and how they would feel if someone else treated their mothers, wives, or daughters the same way.

Jimmy described the process as “helping them to understand themselves.” They also talk about the laws in their own countries that prohibit violence and harassment of women, to demonstrate that gender-based violence is not actually a western idea.

Only after several days of reflection and value clarification exercises do the trainings move on to the clinical skills needed for treatment of sexual violence, which are, Jimmy says, “the easy part.

These doctors already know how to provide family planning and post-abortion care [from SAFPAC], so it’s not hard to teach them the rest. They should also know where to refer patients for psychosocial support and how to collect evidence for prosecution so the perpetrator can be held accountable.

So far, Jimmy and his team have offered these trainings to doctors in 152 health facilities and to more than 1000 community health workers. In the future, he hopes to strengthen the referral links between clinical services and law enforcement, and between clinical services and local organizations providing support to victims of gender-based violence.

Jimmy is resolute in his commitment. “We will keep fighting. We have no choice.

For more on CARE’s SAFPAC project, visit our project page. For more on how you can support CARE’s efforts to fight gender-based violence, visit careaction.org.

Keeping Girls In Sport When Everything Changes

The ubiquitous #LikeaGirl phenomenon took on new meaning with the release of a study in the Journal of Adolescent Health, which reported that English girls start to leave sports around puberty and the onset of breast development. It seems that the vast popularity of Run Like a Girl branding may be onto something in the collective consciousness of girlhood as the prospect of running like a woman–in a woman’s body–seems to deter many girls from sport.

The New York Times coverage of the study makes the case that this decrease in sport participation isn’t inevitable, and other research points to ways that parents, schools, and even girls themselves can continue to find empowerment through girls’ involvement in sport. These suggestions emerge from the literature:

  1. Normalize puberty. My research on girls’ experiences of early puberty, published in the Journal of Early Adolescence and Qualitative Health Research, found that girls with families and friends who talk so openly about puberty that it becomes pedantic do not become self-conscious or intimidated by the changes in their bodies. When girls are prepared for puberty through education and communication, they feel they can continue in activities they know and enjoy.
  2. School girls to be body smart. Girls in the recent UK study said that they want to learn what to expect from puberty in all-girl discussions with a teacher, more than apps, websites, or a 1:1 chat with a nurse. As many sport programs take place at school, incorporating a regular, open, teacher-moderated group into the curriculum teaches girls that their active bodies have a place at school and the school is committed to protecting their mind-body integrity.
  3. Create a positive peer culture. A 2015 study of African-American and White girls in the Journal of Early Adolescence reported that bullying and peer messaging mediates the relationship between a girl and her body. When a girl is harassed about puberty, her propensity toward depression increases. School-based wellness groups for girls can go a long way to creating a culture in which they go through puberty and continue to participate in sport without negative peer consequences.
  4. Build competence and foster joy. The rewards of sport don’t just come from winning a game or breaking the tape, though these triumphs no doubt open the endorphin flood gate, as Brandi Chastain showed us all. But research shows that perfectionistic concern about sport predicts burnout after 3 months in adolescents. When girls experience joy and competence in sport, they are more motivated, which may be particularly true when the body’s shape, size, coordination, and equilibrium are rapidly changing during puberty. A one-dimensional sport experience singularly defined by performance-based outcomes can risk alienating girls from the rewards of the experience of running, kicking, throwing, and moving through the world of their own power.
  5. Run (or drive) like a woman. When girls see their mothers and other influential women engaged in sport, they learn to be agents, not objects, and they witness embodied power in their role models. You don’t have to run marathons, and you don’t have to be a runner. But, teaching girls that self-efficacy comes from intellectual, physical, and emotional engagement with the world could be one of the most feminist acts of motherhood. A 2014 study found that maternal modeling of sport had a positive relationship with daughters’ self-efficacy, though the authors also reported that moms’ “logistic support” of girls’ participation in sport also had a positive association with girls’ self-esteem, self-efficacy, and intention to participate. So even if you don’t pin on a bib number or shlep yourself to yoga to be a good role model, take heart. All those miles that you log in the driver’s seat to get your girls to their activities matter enormously.

Puberty is life-changing by definition, but hiding from sport is not an inevitable outcome of menarche and breast growth. Teenage sports bras aren’t made for less-endowed women, after all. If we talk to girls, empower a positive peer and school culture, move our own feet, and keep driving them to practice, daughters–and their parents–will exit adolescence with greater strength and grit.

This post was originally posted at Mothers Running Rampant and was reposted with permission from the author, Kristina Pinto. Dr. Kristina Pinto is a Health and Wellness Counselor in the Boston area who specializes in girls’ and women’s psychological well-being. She can be reached at k.pinto@metrowestneuropsych.com

One Mother’s Response: What is integrated care for mothers and newborns?

Eleven months ago (today!) the most life-changing event took place in my life – I became a mother. The process of becoming a mother requires a support network that stretches beyond family and friends to a health care system that sees to all the needs of the expecting and new mother and baby.

The Global Maternal Newborn Health Conference is taking place in Mexico City this week, placing priority on the goals established to address the urgent needs of women and newborns around the world. Today’s theme is Benefitting Mothers and Newborns Through Integrated Care – and presenters will tackle this issue in various ways. So I decided to define what integrated care has meant to me as a new mother.

What does integrated care mean during pregnancy?

Acknowledging and addressing a woman’s needs, beyond the growth and health of her fetus, is necessary to make sure that her health and well-being is prioritized. Becoming a mother is most often an overwhelming experience, and women (and their partners) need not only care, but education, information and at times psychological support. Integrated care during pregnancy means meeting each woman in her situation, and forming her support thereafter.

In Sweden, throughout pregnancy, women create a relationship with their midwives, who see to their needs from day one. A midwife has the responsibility to understand the woman’s life situation – ranging from her relationships, any experience of violence or sexual assault, to her general health, eating habits and more. In Sweden, midwives are the cornerstone of integrated care for mothers and babies.

What is integrated care during childbirth?

Preparing for birth is an important part of pregnancy, and may sometimes take a bigger part of women’s preparations, than preparing for the new life that awaits with a baby. Having the option to choose how to give birth and who should be assisting her birth is an essential part of integrated care during childbirth. At the same time, one must be aware and open to the fact that childbirth does not always go as planned – as the case was for me. Integrated care means having a woman-centered approach, listening to and respecting her wishes and making sure that she has the options to make informed decisions in what may become a stressful situation. It also means making sure that necessary interventions and emergency obstetric care are readily available.

What is integrated care in the first weeks and months with a baby?

At this time, more than ever, integrated care is essential. Caring for a mother and her newborn requires both a woman-centered and baby-centered approach. During the first critical hours, days and weeks, a new mother needs support to strengthen her bond with her newborn, to support breastfeeding and her ability to care for her new baby in her home.

Evaluating possible postpartum depression and monitoring eventual childbirth injuries is a necessary part of integrating care for mothers. In Sweden I have had the possibility to follow up with the midwife who assisted my birth, to talk about my experience and evaluate decisions that were made. I have also had access to a support line to speak to midwives and lactation experts on any issues or questions that we have encountered.

Integrating care for mothers and newborns is an essential part of making sure that all women and babies access the support they need. No matter life circumstances, all women and their babies need access to essential maternal and newborn health care – and no one should be left behind.

Follow the hashtag #GlobalMNH and @GirlsGlobe on Twitter, Instagram and Periscope for live coverage from the Global Maternal Newborn Health Conference, and stay tuned on girlsglobe.org.