Gender Centre

Although non-communicable diseases (NCDs) are the leading cause of morbidity and mortality worldwide, the global policy response has not been commensurate with their health, economic and social burden. This study examined factors facilitating and hampering the prioritization of NCDs on the United Nations (UN) health agenda. Shiffman and Smith's (Generation of political priority for global health initiatives: a framework and case study of maternal mortality. The Lancet 370: 1370-9.) political priority framework served as a structure for analysis of a review of NCD policy documents identified through the World Health Organization's (WHO) NCD Global Action Plan 2013-20, and complemented by 11 semi-structured interviews with key informants from different sectors. The results show that a cohesive policy community exists, and leaders are present, however, actor power does not extend beyond the health sector and the role of guiding institutions and civil society have only recently gained momentum. The framing of NCDs as four risk factors and four diseases does not necessarily resonate with experts from the larger policy community, but the economic argument seems to have enabled some traction to be gained. While many policy windows have occurred, their impact has been limited by the institutional constraints of the WHO. Credible indicators and effective interventions exist, but their applicability globally, especially in low- and middle-income countries, is questionable. To be effective, the NCD movement needs to expand beyond global health experts, foster civil society and develop a broader and more inclusive global governance structure. Applying the Shiffman and Smith framework for NCDs enabled different elements of how NCDs were able to get on the UN policy agenda to be disentangled. Much work has been done to frame the challenges and solutions, but implementation processes and their applicability remain challenging globally. NCD responses need to be adapted to local contexts, focus sufficiently on both prevention and management of disease, and have a stronger global governance structure.

BACKGROUND: Addressing the uptake of research findings into policy-making is increasingly important for researchers who ultimately seek to contribute to improved health outcomes. The aims of the Swiss Programme for Research on Global Issues for Development (r4d Programme) initiated by the Swiss National Science Foundation and the Swiss Agency for Development and Cooperation are to create and disseminate knowledge that supports policy changes in the context of the 2030 Agenda for Sustainable Development. This paper reports on five r4d research projects and shows how researchers engage with various stakeholders, including policy-makers, in order to assure uptake of the research results. METHODS: Eleven in-depth interviews were conducted with principal investigators and their research partners from five r4d projects, using a semi-structured interview guide. The interviews explored the process of how stakeholders and policy-makers were engaged in the research project. RESULTS: Three key strategies were identified as fostering research uptake into policies and practices: (S1) stakeholders directly engaged with and sought evidence from researchers; (S2) stakeholders were involved in the design and throughout the implementation of the research project; and (S3) stakeholders engaged in participatory and transdisciplinary research approaches to coproduce knowledge and inform policy. In the first strategy, research evidence was directly taken up by international stakeholders as they were actively seeking new evidence on a very specific topic to up-date international guidelines. In the second strategy, examples from two r4d projects show that collaboration with stakeholders from early on in the projects increased the likelihood of translating research into policy, but that the latter was more effective in a supportive and stable policy environment. The third strategy adopted by two other r4d projects demonstrates the benefits of promoting colearning as a way to address potential power dynamics and working effectively across the local policy landscape through robust research partnerships. CONCLUSIONS: This paper provides insights into the different strategies that facilitate collaboration and communication between stakeholders, including policy-makers, and researchers. However, it remains necessary to increase our understanding of the interests and motivations of the different actors involved in the process of influencing policy, identify clear policy-influencing objectives and provide more institutional support to engage in this complex and time-intensive process.

The global burden attributed to Neglected Tropical Diseases (NTDs) is 47.9 million Disability-Adjusted Life Years (DALYs). These diseases predominantly affect disadvantaged populations. Priority for NTDs has grown in recent years, which is observed by their inclusion in the sustainable development goals (SDGs). This study analyzed the process that allowed these diseases to be included on the global health policy agenda. This global policy analysis used the Shiffman and Smith framework to understand the determinants of global health political priority for NTDs. The framework comprises four categories: actor power, ideas, political contexts, and issue characteristics. Global documents and World Health Assembly (WHA) resolutions were examined, key-informant interviews were conducted, and academic publications were reviewed to understand the four categories that comprise the framework. A total of 37 global policy documents, 15 WHA resolutions, and 38 academic publications were examined. Twelve semi-structured interviews were conducted with individuals representing different sectors within the NTD community who have been involved in raising the priority of these diseases. This study found that several factors helped better position NTDs in the global health agenda. These include the leadership of actors that mobilized the global health community, the creation of a label combining these diseases as a group to represent a larger disease burden, the presence of mechanisms aligning the NTD community, and the agreement on ways to present the NTD burden and potential solutions. The process of building the priority of NTDs in the global health agenda shows that several determinants led to positive outcomes, but these diseases continue to have low priority at the global level which requires the implementation of actions to increase their global priority. These include sustaining the commitment of current actors and engaging new ones; increasing the attention given to diseases formerly categorized as "tool-deficient", including zoonotic NTDs; continue leveraging on policy windows and creating favorable policy moments to sustain commitment, as well as setting realistic targets. Findings from this study can help develop strategies to build the momentum and drive actions to implement the goals of the new Roadmap for NTDs in the pathway to universal health coverage (UHC) and sustainable development.

Abstract In September 2015, Member States of the United Nations ( UN ) committed to work towards a transformative policy agenda consisting of 17 ambitious Sustainable Development Goals ( SDG s) to be achieved by 2030. However, implementation progress has been slow and at the current rate the SDG agenda will fall far short on delivery of its 169 targets. In order to accelerate progress at global, national and local levels it is necessary to prioritize goals and targets. One standalone SDG that is also cross‐cutting and universal is Goal 5: Gender equality and empowerment of all women and girls. In this article we assemble evidence to make the case that decisively (and politically) placing the gender equality goal ( SDG 5 and its 9 targets) together with 54 gender indicators across all goals as the priority focus of the 2030 agenda is the most impactful way to ensure measurable achievements are made across the agenda to deliver on all 5 pillars of the global commitment: namely People, Planet, Peace, Prosperity and Partnerships.

INTRODUCTION: Since sex-based biological and gender factors influence COVID-19 mortality, we wanted to investigate the difference in mortality rates between women and men in sub-Saharan Africa (SSA). METHOD: We included 69 580 cases of COVID-19, stratified by sex (men: n=43 071; women: n=26 509) and age (0-39 years: n=41 682; 40-59 years: n=20 757; 60+ years: n=7141), from 20 member nations of the WHO African region until 1 September 2020. We computed the SSA-specific and country-specific case fatality rates (CFRs) and sex-specific CFR differences across various age groups, using a Bayesian approach. RESULTS: A total of 1656 deaths (2.4% of total cases reported) were reported, with men accounting for 70.5% of total deaths. In SSA, women had a lower CFR than men (mean [Formula: see text] = -0.9%; 95% credible intervals (CIs) -1.1% to -0.6%). The mean CFR estimates increased with age, with the sex-specific CFR differences being significant among those aged 40 years or more (40-59 age group: mean [Formula: see text] = -0.7%; 95% CI -1.1% to -0.2%; 60+ years age group: mean [Formula: see text] = -3.9%; 95% CI -5.3% to -2.4%). At the country level, 7 of the 20 SSA countries reported significantly lower CFRs among women than men overall. Moreover, corresponding to the age-specific datasets, significantly lower CFRs in women than men were observed in the 60+ years age group in seven countries and 40-59 years age group in one country. CONCLUSIONS: Sex and age are important predictors of COVID-19 mortality globally. Countries should prioritise the collection and use of sex-disaggregated data so as to design public health interventions and ensure that policies promote a gender-sensitive public health response.

Different methodological approaches for implementation research in global health focusing on how interventions are developed, implemented and evaluated are needed. In this paper, we detail the approach developed and implemented in the COmmunity HEalth System InnovatiON (COHESION) Project, a global health project aimed at strengthening health systems in Mozambique, Nepal and Peru. This project developed innovative formative research at policy, health system and community levels to gain a comprehensive understanding of the barriers, enablers, needs and lessons for the management of chronic disease using non-communicable and neglected tropical diseases as tracer conditions. After formative research, COHESION adopted a co-creation approach in the planning of interventions. The approach included two interactions with each type of stakeholder at policy, health system and community level in each country which aimed to develop interventions to improve the delivery of care of the tracer conditions. Diverse tools and methods were used in order to prioritise interventions based on support, resources and impact. Additionally, a COHESION score that assessed feasibility, sustainability and scaling up was used to select three potential interventions. Next steps for the COHESION Project are to further detail and develop the interventions propositioned through this process. Besides providing some useful tools and methods, this work also highlights the challenges and lessons learned from such an approach.

Enhancing diversity, equity, and inclusion (DEI) in the scientific and healthcare workforces∗ promotes research innovation and equitable access to quality healthcare. Efforts to advance DEI within the global scientific and healthcare workforces have assumed a new urgency given the strain caused by the COVID-19 pandemic, the aging of the global population, and the persistent shortages in the healthcare workforce, particularly in low- and middle-income countries. Yet, these fields continue to struggle to promote DEI. Considering the impact of intersectionality—how multiple identities interact to create unique experiences of privilege and power—within these workforces will enhance efforts to promote DEI. This series explores the impact of intersectionality on scientific and healthcare workforce DEI and how prominent institutional and structural factors (e.g., sexism and racism), as well as their interpersonal manifestations, can create barriers for workers with multiple intersecting marginalised identities. This paper, the first in a three-part series, describes how intersecting identities interact with workplace inequities and suggests ways to incorporate intersectionality into DEI efforts within the scientific and healthcare workforces. ∗We use the phrase scientific and healthcare workforces throughout this article to broadly encompass individuals associated with the biomedical, clinical, behavioral, and population science workforce.

OBJECTIVES: To identify the differences between women and men in the probability of entrapment, frequency of injury and outcomes following a motor vehicle collision. Publishing sex-disaggregated data, understanding differential patterns and exploring the reasons for these will assist with ensuring equity of outcomes especially in respect to triage, rescue and treatment of all patients. DESIGN: We examined data from the Trauma Audit and Research Network (TARN) registry to explore sex differences in entrapment, injuries and outcomes. We explored the relationship between age, sex and trapped status using multivariate logistical regression. SETTING: TARN is a UK-based trauma registry covering England and Wales. PARTICIPANTS: We examined data for 450 357 patients submitted to TARN during the study period (2012-2019), of which 70 027 met the inclusion criteria. There were 18 175 (26%) female and 51 852 (74%) male patients. PRIMARY AND SECONDARY OUTCOME MEASURES: We report difference in entrapment status, injury and outcome between female and male patients. For trapped patients, we examined the effect of sex and age on death from any cause. RESULTS: Female patients were more frequently trapped than male patients (female patients (F) 15.8%, male patients (M) 9.4%; p<0.0001). Trapped male patients more frequently suffered head (M 1318 (27.0%), F 578 (20.1%)), face, (M 46 (0.9%), F 6 (0.2%)), thoracic (M 2721 (55.8%), F 1438 (49.9%)) and limb injuries (M 1744 (35.8%), F 778 (27.0%); all p<0.0001). Female patients had more injuries to the pelvis (F 420 (14.6%), M 475 (9.7%); p<0.0001) and spine (F 359 (12.5%), M 485 (9.9%); p=0.001). Following adjustment for the interaction between age and sex, injury severity score, Glasgow Coma Scale and the Charlson Comorbidity Index, no difference in mortality was found between female and male patients. CONCLUSIONS: There are significant differences between female and male patients in the frequency at which patients are trapped and the injuries these patients sustain. This sex-disaggregated data may help vehicle manufacturers, road safety organisations and emergency services to tailor responses with the aim of equitable outcomes by targeting equal performance of safety measures and reducing excessive risk to one sex or gender.

After analysing the concluding observations of the Committee on the Rights of Persons with Disabilities, hereafter referred to as the Committee, this paper examines how the Committee has sustained a protective, medical, and gender binary model to address the sexual and reproductive rights of persons with disabilities. To break away from this narrow approach to sexuality, I call for an understanding of sex/gender that is more fluid and shifting, recognising the ability of persons with disabilities to express and act upon desire consensually, and bringing into the discussion issues of sexual orientation and gender identity.

BACKGROUND: Evidence supports the use of pricing interventions in achieving healthier behaviour at population level. The public acceptability of this strategy continues to be debated throughout Europe, Australasia and USA. We examined public attitudes towards, and beliefs about the acceptability of pricing policies to change health-related behaviours in the UK. The study explores what underlies ideas of acceptability, and in particular those values and beliefs that potentially compete with the evidence presented by policy-makers. METHODS: Twelve focus group discussions were held in the London area using a common protocol with visual and textual stimuli. Over 300,000 words of verbatim transcript were inductively coded and analyzed, and themes extracted using a constant comparative method. RESULTS: Attitudes towards pricing policies to change three behaviours (smoking, and excessive consumption of alcohol and food) to improve health outcomes, were unfavourable and acceptability was low. Three sets of beliefs appeared to underpin these attitudes: (i) pricing makes no difference to behaviour; (ii) government raises prices to generate income, not to achieve healthier behaviour and (iii) government is not trustworthy. These beliefs were evident in discussions of all types of health-related behaviour. CONCLUSIONS: The low acceptability of pricing interventions to achieve healthier behaviours in populations was linked among these responders to a set of beliefs indicating low trust in government. Acceptability might be increased if evidence regarding effectiveness came from trusted sources seen as independent of government and was supported by public involvement and hypothecated taxation.

Abstract Recent events have focused attention on the perceived widening of the economic divide between urban and rural areas, and on the continued rise of national income inequality. We demonstrate that, in fact, the average income gap between urban (metropolitan) and rural (nonmetropolitan) households has not risen over the past 40 years, and makes virtually no contribution to national income inequality. Rising national inequality is driven by rising inequality within both urban and rural America, not by an urban/rural divergence. As is well known, the growing dispersion of household money income is partly driven by rising wage inequality, particularly in urban areas. Less well recognized is the role played by other income sources. We show that a decline in the progressivity of the distribution of social security payments and cash transfers, and an increase in the regressivity of the distribution of retirement incomes, have jointly made a comparably large contribution to rising income inequality. At the same time, the share of income from self‐employment has declined, particularly in rural America, and because self‐employment income is very unequally distributed, its diminution has retarded the growth of rural inequality. In 2014–15, however, rural inequality increased, cutting the urban/rural inequality gap in half.

Malawi's Option B+ program is based on a 'test and treat' strategy that places all HIV-positive pregnant and lactating women on lifelong antiretroviral therapy. The steep increase in patient load placed severe pressure on a health system that has struggled for decades with inadequate supply of health care workers (HCWs) and poor infrastructure. We set out to explore health system barriers to Option B+ by asking HCWs in Malawi about their experiences treating pregnant and lactating women. We observed and conducted semi-structured interviews (SSIs) with 34 HCWs including nine expert clients (ECs) at 14 health facilities across Malawi, then coded and analyzed the data. We found that HCWs implementing Option B+ are so overburdened in Malawi that it reduces their ability to provide quality care to patients, who receive less counseling than they should, wait longer than is reasonable, and have very little privacy. Interventions that increase the number of HCWs and upgrade infrastructure to protect the privacy of HIV-infected pregnant and lactating women and their husbands could increase retention, but facilities will need to be improved to support men who accompany their partners on clinic visits.

Conventional stories about conflicts often miss the role of everyday practices in escalating and de-escalating violence and how intersecting social dynamics of gender, ethnicity, age, and religion shape these practices. In this article, we introduce the Special Section on Gender and the Micro-Dynamics of Violent Conflicts. Situating the section within the scholarship on gender and violent conflict, we discuss the opportunities and paradoxes opened up by the adoption of a micro-level approach. We present theoretical and methodological reflections that emerge from the findings of the contributions and that arose in the process of implementing the research project on which these articles draw. We also reflect on the practical implications of our research. Specifically, we discuss conundrums of violent conflict research regarding two key feminist concepts – namely, gender and intersectionality – and explore (explanatory) arguments about the complex intersectional relationships between gender and violent conflict.

In Ratanakiri province, home to a large share of Cambodia's indigenous minorities, land commercialization involving large-scale land transfers and in-migration has led to shrinking access to land for indigenous households. Drawing on qualitative interviews and a household survey conducted in Ratanakiri, this paper explores the links between social reproduction and agrarian production in the current phase of agrarian transition through the lens of everyday gendered experiences. It argues that while wage labour is becoming an essential component of agrarian livelihoods for land-poor indigenous households, gendered hierarchies mediate access to local wage labour opportunities due to the incompatibilities between care work and paid labour. This paper contributes to the literature by exposing locally-specific processes through which gender-differentiated impacts are produced under multiple modes of dispossession. It also illuminates the links between dispossession and social reproduction and the tensions between capitalist accumulation and care activities in agrarian trajectories following land commercialization.

Despite a growing consensus on the importance of integrating sex and gender in health research, research across disciplines continues to be conducted and reported without a gender focus. Research ethics committees (RECs) can play a particularly powerful role in identifying the gender gaps at an early stage of the development of research protocols. Their role is missing in the dialogue related to improving gender awareness and analysis in health research. A scoping review was conducted to examine the extent to which RECs discuss and consider the inclusion and analysis of sex and gender in health research and to examine the literature regarding the gender balance of RECs. The limited literature around gender and research ethics reveals the power and potential of RECs to ensure that gender dimensions are thoughtfully included in health research, and sheds light on the gaps that exist. These include an under-representation of women on RECs, a lack of awareness of the importance of gender-related aspects in health research and a paucity of gender-related training to RECs. Guidelines such as the Sex and Gender Equity in Research guidelines are required for RECs to strengthen the ways in which health research is gendered from conception of a research protocol to its publication.

Chronic conditions are an increasing problem in Low- and Middle-Income Countries (LMICs) yet, the challenges faced by low-income populations with these conditions in such countries are not well understood. Based on in-depth interviews with people affected by chronic conditions and their family members, this paper describes the experience of patients suffering from diabetes or hypertension in rural communities of Mozambique, Nepal, and Peru. We analysed our data using the concepts of disruption and adaptive strategies, finding that despite being very different countries, the implications in daily lives, interpersonal relationships, and family dynamics are similar, and that oftentimes such impact is defined along gender lines. We show that adjustments to living with a chronic disease are not always easy, particularly when they imply changes and reconfiguration of roles and responsibilities for which neither the individual nor their families are prepared. The study adds to the literature on the disruptive effects of chronic conditions and stresses the importance of contextualising disruptive experiences among disadvantaged populations within weak health systems. Our findings highlight the relevance of understanding the challenges of developing adaptive solutions to chronic care in resource-scarce contexts.

The launch of two landmark publications1Kruk ME Gage AD Arsenault C et al.High-quality health systems in the Sustainable Development Goals era: time for a revolution.Lancet Glob Health. 2018; 6: e1196-e1252Summary Full Text Full Text PDF PubMed Scopus (1007) Google Scholar, 2National Academies of Sciences, Engineering, and MedicineCrossing the global quality chasm: improving health care worldwide. The National Academies Press, Washington, DC2018Google Scholar on the quality of care in the world's poorest populations, including The Lancet Global Health Commission on high-quality health systems in the Sustainable Development Goals era (September, 2018),1Kruk ME Gage AD Arsenault C et al.High-quality health systems in the Sustainable Development Goals era: time for a revolution.Lancet Glob Health. 2018; 6: e1196-e1252Summary Full Text Full Text PDF PubMed Scopus (1007) Google Scholar is a welcome addition to the ongoing discourse on improving the quality of care that these populations receive. The authors of these reports rightly highlight that the push for universal health coverage in low-income and middle-income countries, as well as the setting of disease-specific targets, will not achieve their desired impact on health outcomes without a focus on improving quality. As such, improving quality of care is essential to meet the health-related targets of the Sustainable Development Goals.1Kruk ME Gage AD Arsenault C et al.High-quality health systems in the Sustainable Development Goals era: time for a revolution.Lancet Glob Health. 2018; 6: e1196-e1252Summary Full Text Full Text PDF PubMed Scopus (1007) Google Scholar With a focus on populational needs, Margaret Kruk and colleagues1Kruk ME Gage AD Arsenault C et al.High-quality health systems in the Sustainable Development Goals era: time for a revolution.Lancet Glob Health. 2018; 6: e1196-e1252Summary Full Text Full Text PDF PubMed Scopus (1007) Google Scholar align themselves with WHO's responsiveness framework, which includes aspects such as dignity, autonomy, confidentiality, clear communication, prompt attention, and quality of amenities.3de Silva A A framework for measuring responsiveness.https://www.who.int/responsiveness/papers/paper32.pdfDate accessed: October 5, 2018Google Scholar These factors are intimately linked to quality and trust, go beyond the immediate health-care needs people might have (eg, medicines and access to diagnostics), and focus on underlying issues related to provision of a high-quality service. This refocusing is in line with the view of strengthening instead of merely supporting the development of health systems in low-income and middle-income countries.4Chee G Pielemeier N Lion A Connor C Why differentiating between health system support and health system strengthening is needed.Int J Health Plann Manage. 2013; 28: 85-94Crossref PubMed Scopus (76) Google Scholar Although the authors of the Commission1Kruk ME Gage AD Arsenault C et al.High-quality health systems in the Sustainable Development Goals era: time for a revolution.Lancet Glob Health. 2018; 6: e1196-e1252Summary Full Text Full Text PDF PubMed Scopus (1007) Google Scholar do mention the roles of funders and researchers in creating a high-quality health system, we believe that this discussion should go further because a “revolution” in approaches, methods, and funding is needed. To improve the quality of health systems, it is necessary to thoroughly understand the needs of the community, as well as the existing conditions in which care is delivered and received. Accomplishing this task will require formative research with financial support from funders. As stated in the Crossing the global quality chasm report,2National Academies of Sciences, Engineering, and MedicineCrossing the global quality chasm: improving health care worldwide. The National Academies Press, Washington, DC2018Google Scholar “co-design” by communities and providers is needed for the responses from these formative studies to be adapted locally. Researchers will therefore have to work with communities through participatory processes to develop appropriate responses and interventions tailored to the communities' actual needs.5Beran D Lazo-Porras M Cardenas MK et al.Moving from formative research to co-creation of interventions: insights from a community health system project in Mozambique, Nepal, and Peru.BMJ Global Health. 2018; 3: e001183Crossref PubMed Scopus (24) Google Scholar They will need skills in communication and engagement to carry out this work successfully, as well as being able to deal with the uncertainty of not knowing what interventions they will implement in particular settings at the start of a grant or research project because the most appropriate interventions will only become apparent at the end of the formative research stage. Researchers and the academic establishment will have to adapt because not all studies will be randomised trials and the usual academic reward—publications in high-profile journals—will not necessarily be the currency of these research endeavours. Importantly, researchers will be challenged on their established approaches and ideas if they truly want to engage meaningfully in the co-creation of health systems. Similarly, funders also need to deal with these uncertainties by allowing room for innovation and development of interventions grounded in the needs of the communities they wish to impact. The complexity of research will need to be managed by both researchers and funders, and multicomponent rather than one-off interventions will be required to this end. Such interventions will add to the challenge of evaluating current health systems by necessitating the implementation of process evaluations, in conjunction with the measurement of traditional outcomes. The Crossing the global quality chasm report2National Academies of Sciences, Engineering, and MedicineCrossing the global quality chasm: improving health care worldwide. The National Academies Press, Washington, DC2018Google Scholar states that to improve quality of health care “this shift will require new skills, attitudes, and culture among health-care providers and new, more active roles for patients and families in shaping, evaluating, and delivering the care they need”. Given the chronicity of current challenges in health care, these factors should align with the principle of “careful and kind care”,6Montori V. Why we revolt: a patient revolution for careful and kind care. Rochester, MN: Patient Revolution, 2017.Google Scholar which aims to minimise the potential negative impacts of treatment on the individual, while ensuring high quality of care. We fully back such supportive care from the perspectives of health-care providers and the community but also believe that researchers will need new skills and attitudes and that a change in the culture of funding is essential. These changes require both researchers and their funders to take a more active role in focusing on the actual needs of populations. Moreover, researchers need to be given the space and time necessary to create the needed interventions and evaluate them appropriately. This shift in thinking, funding, and support for research should result in programmes and interventions that have a true impact on the quality of care provided to the world's poorest populations. The COHESION (COmmunity HEalth System InnovatiON) Project is funded by the Swiss National Science Foundation and the Swiss Development Cooperation under the Swiss Program for Research on Global Issues for Development. We declare no competing interests. High-quality health systems in the Sustainable Development Goals era: time for a revolutionAlthough health outcomes have improved in low-income and middle-income countries (LMICs) in the past several decades, a new reality is at hand. Changing health needs, growing public expectations, and ambitious new health goals are raising the bar for health systems to produce better health outcomes and greater social value. But staying on current trajectory will not suffice to meet these demands. What is needed are high-quality health systems that optimise health care in each given context by consistently delivering care that improves or maintains health, by being valued and trusted by all people, and by responding to changing population needs. Full-Text PDF Open Access

Communal lands and natural resources in rural Cambodia have transformed over the past 30 years as the country attempts to transition from conflict to liberal democracy and integrates into global agricultural value chains. We find that gender relations are changing as a result of land privatization and the ensuing social and ecological crises of production and reproduction. The forest has become a space for the articulation of new masculinities modulated through class and racialised power, while women are increasingly relegated to the private space of the home and village, negotiating expectations that they perform care, farming and food provisioning work while juggling household debt. We ground our argument in a large sample of qualitative interviews conducted between 2016 and 2020 in the upland provinces of Kampong Thom, Kratie and Ratanakiri that provide narrative accounts of the transformation of common forest and grazing lands, logging livelihoods and food provisioning practices. Using a feminist political ecology perspective, we highlight the contradictory processes of enclosure of the commons, which operate simultaneously as sites of violence, resistance, adaptation and continuity.

Feminist ideas have entered the neoliberal agricultural development agenda, including increasingly ubiquitous public-private partnerships and businesses. Rhetorically committed to gender equality, these new development actors have reduced equality to a matter of numbers, seeking to include women in their projects while disregarding intersectionally gendered power relations that suffuse any development context. This article seeks to illustrate how such power relations inhabit business-led development projects. Based on ethnographic research of a ‘best practice’ large-scale land investment in Ghana's Volta Region, we argue that a narrow focus on including women and superficial Corporate Social Responsibility (CSR) promises fail to address intersectional inequalities because they pay inadequate attention to local institutions for resource management and the power relations they embed. Focusing on gender equality without regard to local institutions at best serves to empower a few well-connected women and at worst acts as a cover-up of highly exploitative practices.

BACKGROUND: Previous literature reports that low male partner support is a barrier to women's adherence and retention in HIV care programs. OBJECTIVE: This qualitative study explored the relationships between partners to understand what is meant by male partner support in adherence of HIV-positive women in four healthcare facilities in Southern Malawi. METHODS: We conducted 8 semi-structured focus group discussions (FGDs) with 73 participants (40 men and 33 women) and 10 in-depth interviews (IDIs) between August 2018 to December 2019. Participants were HIV-positive patients, healthcare workers (HCWs), expert patients (EPs), and couples attending the clinic. All data were digitally recorded, transcribed verbatim, and analysed using a gender-responsive grounded theory approach. RESULTS: This study confirms previous literature, which suggests male partner support is expressed by providing access to transport to the clinic and accompaniment to appointments. However, we found that men can also control access to resources and decision-making. Support is more complex than previous literature reported and, in some cases, gender norms significantly limit women's capacity to engage in care independently of male support since women need male partner permission to access the resources to attend clinics. CONCLUSIONS: This paper suggests that restrictive male-partner gender norms limit women's power to engage in care. Most importantly, the gender analysis reveals that what previous literature describes as male partner support can sometimes hide male partner control in permitting access to resources to attend health facilities. For this reason, policies enhancing male support should consider the gender power relationship between partners to avoid reinforcing gender inequality.