Reaching substantive female representation among decision-makers

15 Pages·2017·0.53 MB·English

RESEARCHARTICLE
Reaching substantive female representation
among decision-makers: A qualitative
research study of gender-related experiences
from the health sector in Mozambique
TalataSawadogo-LewisID1*,Re´kaMaulideCane2,RosemaryMorgan1,MaryQiu1,
AmilcarMagac¸o2,Ka´tiaNgale1,TimothyRoberton1
1 DepartmentofInternationalHealth,JohnsHopkinsBloombergSchoolofPublicHealth,Baltimore,
Maryland,UnitedStatesofAmerica,2 HealthSystemsCluster,InstitutoNacionaldeSau´de,Ministryof
a1111111111 Health,Maputo,Mozambique
a1111111111
a1111111111 *[email protected]
a1111111111
a1111111111
Abstract
Background
OPENACCESS
Achievingsignificantfemalerepresentationingovernmentatdecision-makinglevelshas
Citation:Sawadogo-LewisT,CaneRM,MorganR,
QiuM,Magac¸oA,NgaleK,etal.(2018)Reaching beenidentifiedasakeysteptowardsachievinggenderequality.In2015,womenheld
substantivefemalerepresentationamongdecision- 39.6%ofparliamentaryseatsinMozambique,whichisabovethebenchmarkof30%that
makers:Aqualitativeresearchstudyofgender-
hasbeensuggestedastheturningpointforminorityrepresentationtomovefromtokensta-
relatedexperiencesfromthehealthsectorin
Mozambique.PLoSONE13(11):e0207225. tustohavingasizableimpact.Weundertookastudytoidentifygender-relatedbarriersand
https://doi.org/10.1371/journal.pone.0207225 facilitatorstoimprovingwomen-centeredpoliciesinthehealthsector.
Editor:ValerioCapraro,MiddlesexUniversity,
UNITEDKINGDOM
Methods
Received:May23,2018
Weconductedin-depthinterviewswith39individuals(32women,7men)involvedata
Accepted:October26,2018 seniorlevelinpolicymakingorimplementationofwoman-centricpolicieswithintheMozam-
Published:November15,2018 biqueMinistryofHealthandaffiliatedinstitutions.Weusedasemi-structuredinterview
guidethatincludedquestionsondifficultiesandfacilitatingfactorsencounteredinthepolicy
Copyright:©2018Sawadogo-Lewisetal.Thisis
anopenaccessarticledistributedundertheterms makingprocess,andtheperceivedroleofgenderinthisprocess.Weusedbothdeductive
oftheCreativeCommonsAttributionLicense, andinductiveanalysisapproaches,startingwithasetofpre-identifiedthemesandexpand-
whichpermitsunrestricteduse,distribution,and
ingthistoincludethemesthatemergedduringcoding.
reproductioninanymedium,providedtheoriginal
authorandsourcearecredited.
DataAvailabilityStatement:Datacannotbemade Results
publiclyavailablebecausetheycontainpotentially
Ourdatasuggesttwomainfindings:(1)thewomenwhoparticipatedinourstudygenerally
identifyinginformation,andareavailableupon
request.Datarequestsshouldbesentto:JHSPH donotreportfeelingdiscriminationintheworkplaceand(2)seniorhealthsectorperceive
IRBOffice(re:Study#00007086),615N.Wolfe womentobemorepersonallyattunedtowomen-centricissuesthanmen.Withinourspecific
StreetSuiteE1100,Baltimore,Maryland21205,
sample,wefoundlittletosuggestthatgenderdiscriminationisaproblemprofessionallyfor
Monday–Friday9a.m.–3p.m.Pleasereachout
femaledecision-makersinMozambique.However,thesefindingsshouldbecontextualized
toTobeyMcGuiness([email protected])at
theJHSPHIRBofficeforadditionalinformation. usinganintersectionallenswithrecognitionoftheimportantdifferencebetweendescriptive
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Funding:Thisstudywascarriedoutaspartofthe versussubstantivefemalerepresentation,andwhether“percentageofwomen”istrulythe
NationalEvaluationPlatformprojectfundedby bestmetricforgagingcommitmenttogenderequalityatthepolicymakinglevel.
GlobalAffairsCanada(http://w05.international.gc.
ca/projectbrowser-banqueprojets/project-projet/
details/M013604001).Thefundershadnorolein Conclusions
studydesign,datacollectionandanalysis,decision
topublish,orpreparationofthemanuscript. Mozambique’slongstandingsignificantrepresentationofwomenmayhaveledtocreating
anenvironmentthatleadstopositiveexperiencesforfemaledecision-makersinthegovern-
Competinginterests:Theauthorshavedeclared
thatnocompetinginterestsexist. ment.However,whilethecurrentleveloffemalerepresentationshouldbecelebrated,it
doesnotnegatetheneedforcontinuedfocusonfemalerepresentationindecision-making
positions.
Introductionandcontext
Genderequalityisapriorityontheglobaldevelopmentagenda,asexemplifiedbythefifthSus-
tainableDevelopmentGoal(SDG):“Achievegenderequalityandempowerallwomenand
girls”.Beyonditsimportanceforhumandignityandrespectforhumanrights,empowering
womenleadstobetterhealth,educationandeconomicoutcomes[1].SDGtarget5.5–“Ensure
women’sfullandeffectiveparticipationandequalopportunitiesforleadershipatalllevelsof
decision-makinginpolitical,economicandpubliclife”–explicitlypointstofemalerepresenta-
tionwithindifferentlevelsofdecision-makingasafactorinachievinggenderequality[2].
Thereisevidencethatincreasingwomen’srepresentationinleadershippositionsleadsto
moreequitablehealthoutcomes,particularlyforwomenandchildren[3].Randomizedtrials
suggestthat“womeninleadershippositionsingovernmentalorganizationsimplementdiffer-
entpoliciesthanmenandthatthesepoliciesaremoresupportiveofwomenandchildren”[4].
AfieldstudyinIndiashowedthatwomenpolicymakerstendtoinvestininterventionsand
infrastructuremorecloselylinkedwithwomen’sconcerns,suchascleandrinkingwater,while
malepolicymakerstendedtoinvestmoreininfrastructuremorecloselyalignedtomen’scon-
cernsandactivities,suchasirrigationsystemsforfarming[3,4].AnotherstudyinIndia,by
BhalotraandClots-Figueras(2014),suggestedalinkbetweenincreasedpoliticalrepresentation
forwomenanddecreasedneonatalmortality.Increasedfemalerepresentationwasfoundto
haveapositiveassociationwithwomen“attendingantenatalcare,takingironsupplements
duringpregnancy,givingbirthinagovernmentfacilityasopposedtoathome[...],andearly
initiationofbreastfeeding”[5].Moregenerally,havingamorebalancedgenderdistributionin
government—aswellasinallorganizations—mightbebeneficialsincestudieshavesuggested
thatwomenbehavemorehonestlythanmen[6],whichmightbewelcomechangeinsome
politicalarenas.
Inthispaper,“woman-centeredpolicies”refertopolicieswhichpromotethehealthand
wellbeingofbiologicallyfemaleindividualsbyaddressingconcernswhichdisproportionally
affectthefemalesex(e.g.maternalhealthandchildhealthfocusareas).Wealsouse“decision-
maker”torefertopolicyandprogramimplementersatsenior-ormid-level,aswellasindivid-
ualswhohavebeeninvolvedintheelaborationofpolicies.Literatureexploringwomen’s
involvementindecision-making,anditseffectonwomen-centeredpolicies,suggeststhat
women’srepresentationcanbeeitherdescriptiveorsubstantive.Descriptiverepresentation
seesawomendecision-makerrepresentingwomensimplybythembeingawomanthem-
selves.Insuchinstances,thewomendecision-makerdoesnotactivelypushawoman-friendly
agenda.Alternately,substantiverepresentationreferstowomennotonlybeingpresentinthe
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Fig1.%ofparliamentaryseatsheldbywomenperyearinselectcountriesandregions[9].
https://doi.org/10.1371/journal.pone.0207225.g001
arena,butactivelyactingonbehalfofwomenbypursuingwomen-centeredpoliciesthatfocus
onwomen’shealthandhealthneeds[7,8].
InMozambique,womenheld39.6%oftheseatsintheMozambicanparliamentin2015[9].
ThisranksMozambiqueasthe40thhighestcountryintheworldand16thinAfricaintermsof
percentageofparliamentaryseatsheldbywomen.Fig1belowshowsMozambique’sstanding
relativetoitsneighbouringcountries,sub-SaharanAfricaandworldaverages.Mozambique’s
rulingpartyhasaquotasystemforthepercentageofwomeninlegislature—originallysetat
30%–whichwassetin1994andaccomplishedin2000[10].Since1997,Mozambiquehas
soughttopromoteequalrightsforwomenandmenandeliminateallformsofgenderdiscrim-
inationthroughthereviewoflegalplans,policiesandstrategies.Inaddition,Mozambiquehas
apoliticalinstitutionalandlegalframeworkfavorabletoaccountingforandimprovinggender
equality[11].
TheMozambicanconstitutionexplicitlyprohibitsgender-baseddiscriminationinanumber
ofpoliciesandstrategicplans.Mozambiquehasa“NationalGenderPolicyandStrategyforits
Implementation”,a“NationalplanfortheAdvancementofWomen”,anda“StrategicPlanfor
GenderinthePublicFunctionandforthePreventionandEliminationofPrematureMar-
riages”.Thehealth,energyandmining,education,andagriculturesectorseachhaveagender-
focusedstrategy.Additionally,lawsontopicswhichdisproportionallyaffectwomen(suchas
gender-basedviolence,family,land,humantrafficking,andlabour)arealsoinplace[12].
Inthehealthsector,themissionstatementoftheStrategicalPlanfortheHealthSector
2014–2019(PESS),issuedbytheMozambicangovernmentin2013,implicitlyreferences
womenas“vulnerablepopulations”:“allMozambicans,especiallythemostvulnerablegroups,
maybenefitfromthebesthealthpossible”.Thisismadeexplicitintheaccompanyingtext,
whichstatesthatthismissionstatementdemonstratesthecommitmentofthehealthsectorto
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theuniversalityofhumanrights,“includingtheprincipleofattentiontotheneedsandrightsof
themostvulnerablegroups,particularlywomen,children,adolescentsandyouths”.ThePESS’
secondprincipleis“addressingissuesofequity”,inwhichaddressinggenderrelationsare
explicitlyidentifiedaspriority.Thefirsthealthpriority–“Accelerateprogressinreducing
maternalandneonatalmortality,includingthereductionofthegeneralfertilityrate”–isitselfa
woman-centricpriority[13].
Despitetheseefforts,a2016MozambiquegenderprofilestudybytheMinistryofGender,
ChildandSocialActionshowedthatgenderroles,powerdynamicsandrelationshipsbetween
menandwomeninfluencemostpolicymakingdecisionsforhealth.Thestudysuggeststhat
socioculturalfactorscontinuetoresultindiscriminationagainstwomenatthesocial,political
andeconomiclevel.Whilelawsexisttoprotectwomen’srights,limitedawarenessandpoor
implementationoftheselawswashighlightedasanongoing,majorchallenge.Lowsocialand
economicempowermentofwomenalsocontinuetoimpacthealthsectoroutcomes[12].This
suggeststhatwhilewomenmightbesignificantlyrepresentedatthepolicy-makinglevel,this
hasnotnecessarilytranslatedintobetterhealthoutcomesforwomeninMozambique.
Inthisstudy,weexaminetheroleofgendernorms,roles,andrelationsintheexperiences
offemaleandmaleseniorandmid-leveldecision-makersinthehealthsectorinMozambique,
includingbothself-reportedpolicymakersandpolicyimplementers.Ourgoalwastoidentify
gender-relatedbarriersandfacilitatorstodevelopingandimplementingpoliciesandpro-
grams,asperceivedbyseniorandmid-leveldecision-makersthemselves,withthelargeraim
ofidentifyingopportunitiesforactiontoimprovewomen-centeredpolicies.
Methods
Weundertookaqualitativestudyofmid-andsenior-leveldecision-makersinthehealthsector
inMaputo,Mozambique,fromJanuary2017toMarch2017.Thestudyteamwasapartnership
betweentheJohnsHopkinsSchoolofPublicHealth(JHSPH)andtheInstitutoNacionalde
Sau´de(INS)inMozambique.Informedwrittenconsentwasobtainedfromallparticipants.
EthicalapprovalwasobtainedbytheInstitutionalReviewBoardofJohnsHopkinsBloomberg
SchoolofPublicHealth(IRB#7086)andfromtheInstitutionalCommitteeofBioethicsatINS.
Sampling
Weconductedsamplingintwophases:(1)systematicrandomsamplingofaninitialsampleof
20individuals;and(2)snowballsamplingtoidentifyadditionalrespondents.
FromalistofstaffoftheMozambiqueMinistryofHealth(MISAU),weidentified95indi-
vidualswhosedepartmentwasdeemedrelevanttowomen’shealthissues,whoserolewas
deemedrelevanttothepolicy-makingprocessbasedonjobtitle,andwhosepositionwasas
seniorasDepartmentChieforhigher.Ofthe95identifiedindividuals,59werewomenand36
weremen.
Weusedsystematicrandomsamplingtoselectastartingsampleof15womenand5men.
Weoversampledfemalerespondentsbecausewewereinterestedinexploringtheexperiences
offemaledecision-makersinthepolicy-makingprocess.WeusedExceltoconductsystematic
randomsampling,creatingtwolistsofwomenandmen,usingtheRANDfunctiontoorder
womenandmenrandomly,andselectingevery4thwomanand7thmantofurtherensure
randomization.
Attheendofeachinterview,weaskedrespondentstosuggestthreeadditionalparticipants
whotheythoughtwouldbeimportanttoincludeinourstudy.Everypersonthatwasrecom-
mendedinthiswaywasaddedtothesamplinglist.Ifthepersonhadnotalreadyparticipated
inthestudy,heorshewascontactedbythestudyteamandaskedtobeinterviewed.Such
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Table1. Respondentcharacteristics.
Gender
Female(n=32) Male(n=7)
YearsofExperience 0–2 0 1
3–5 2 0
5–10 7 2
10–20 11 3
20+ 11 1
Unknown 1 0
Self-identifyaspolicymaker Yes 18 2
No 14 5
Institutionalaffiliation MinistryofHealth 27 5
NGOs 4 1
MunicipalityofMaputo 1 1
https://doi.org/10.1371/journal.pone.0207225.t001
snowballsamplingwascontinueduntilthestudyteamconcludedthatsaturationhadbeen
reachedandtherewasnoneedtointerviewmorerespondents.
Demographiccharacteristics
Intotal,39respondentswereinterviewed,ofwhom32werefemale,and7weremale.See
Table1foradditionaldetailsonrespondents.Themajorityofrespondentswereseniorlevel
staffwithover5yearsofpolicy-makingexperience.
Datacollection
WerecruitedthreeMozambicandatacollectorswithexperienceconductingqualitative
research,andhelda2-daytrainingonmethodologyandtofamiliarizedatacollectorswiththe
interviewguide.
Datacollectiontookplaceoveraperiodof3months,fromJanuarytoMarch,2017.Data
collectorsconductedallinterviewsinPortuguese,atalocationandtimethatwasconvenient
totherespondent.Datacollectorsscheduledappointmentswithrespondentsbyphonewhere
possible,orattemptedtoscheduleappointmentsin-personattheINSwhencontactinforma-
tionwasnotavailable.Datacollectorsmade3attemptstoreacheachrespondent,beforethe
respondentwasremovedfromthesamplinglistandreplaced.Thenextparticipantonthelist
wasthenintervieweduntilthelistwasexhausted.Afterthis,participantswereselectedfrom
thelistofindividualsrecommendedbytheoriginalparticipants.
Wecontinuedthisprocessuntilreachingsaturation,at39participants,whenwefeltthat
newthemeswerenolongerbeingofferedorelicitedfromrespondents.
Oralandwrittenconsentwereobtainedfromeachrespondentbeforetheinterviewwas
administered.Interviewswererecordedusinganelectronicvoicerecorder,anddatacollectors
tookdetailednotesthroughouttheinterview.Datacollectorsusedasemi-structuredinterview
guidedevelopedbythestudyteam,thatfocusedonboththeexperienceofthedecision-maker
intheirrespectiverole,andwhattheypersonallyfeltwereprioritiesaroundwomen’shealthin
Mozambique.Eachinterviewlastedonaveragebetween30to45minutes.
Dataanalysis
Datacollectorsuploadedtheinterviewrecordingsontostudylaptopsaftereachday.Interviews
weretranscribedverbatiminPortuguese,anddatacollectorsproducedshortsummaryreports
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ofeachinterview.Thestudyteammetregularlytodiscussemergingthemesandtotriangulate
findingsacrossrespondents.
Weusedaninitialreviewoftheliterature[14–17]asapointofdepartureforidentifying
themesandadjustedasmoreanddifferentonesemergedfromthedatathroughregulardebrief-
ingmeetings.TranscriptswereuploadedintoDedoose(version7.6.6)andthestudyteamdevel-
opedapreliminarycodebookbyconductingathematicanalysisofthedatadevelopedfroma
prioriandemergingthemes[18]using8randomlyselectedtranscripts(20%oftotaltranscripts).
Weexcludedtheinitial8fromtheselectionandusedthisfirstcodebooktoagaincode8
randomlyselectedtranscripts.Aftermakingsomefinaladjustmentstothefinalcodebook
basedonourfindingsinthissecondroundofcoding,wethenproceededtocodealltranscripts
inPortugueseline-by-line.
Afterexploringthedataafirsttimethroughthecodingprocess,weexportedthecodes
fromDedooseintoExcelandre-arrangedthembymajorthemes.Weusedthefrequencyof
occurrenceofspecifictopicasthedeterminanttodefinethemasmajorthemes.Wepresenta
summaryofthefindingsbelow,andincludesomeexcerptsselectedbecausetheybestrepre-
sentedthemajorthemes.
Results
Twomaintopicsemergedfromthedataanalysis:(1)perceptionsofgender-baseddiscrimina-
tionand(2)perceptionsofwomen’sinsightsonwomen’shealth.Eachofthesethemesrepre-
sentadifferentaspectofparticipants’gender-relatedexperiencesandobservations.
Perceptionsofgender-baseddiscrimination
Mostwomenspeakingabouttheirownpersonalexperiencedidnotbelievethattheirgender
hadledtodiscriminationintheworkplace.Whilenoparticipantarguedthatgenderdiscrimi-
nationdoesnotexistinMozambique,mostreportedthatthiswasnotanexperiencethatthey
hadpersonallylivedintheirwork.Someattributedthislackofdiscriminationtothefactthat
theyworkinthehealthsector,whichtheyperceivetobeawoman-friendlyfield.Othersattrib-
uteditmoretothefactthattheyareeducatedwomenandthattheiracademicorprofessional
qualificationsarerespected.
“Me,asawoman,Ineverfeltdiscriminatedagainst.Maybeit’sbecauseofthefieldIchoseto
study,butIhavenotlivedanexperienceofdiscriminationbecauseI’mawoman,no.”
Woman25
Whenmentioningdifficultiesintheworkplace,participantspointedtothestructureand
limitationsofthesystem,tothelackofdatatosupporttheirarguments,ortothelackofboth
humanandfinancialresourcestocarryouttheirwork.Inallcases,participantssaidthatdis-
criminationbasedontheirgenderhadnotbeenpartofthatexperience.
“It’snotbecauseI’mawoman.It’sbecauseI’magovernmentworkerandI’mleadingateam
withmanyshortcomings.It’smorebecauseofthat.”
Woman4
Interviewersaskedquestionsspecificallyaboutwhethertheparticipant’sgenderhad
affectedthelevelofattentionorprioritygiventotheirworkduringthedevelopmentofpoli-
cies.Femaleparticipantsdidnotexpressfeelingthatbeingawomanhadaffectedthe
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attributionoftheirideastoothersortheirupwardmobilityintheworkplace.Theydidnot
expressthattheyfeltthattheirworkwasvaluedlessormorethantheirmalecolleagues’.
“Me,personally,Ican’tcomplain.Idon’tthinkithasanyinfluence.Istoppedbeingadirector
becauseIwantedto,notbecausesomeonewantedtoremovemeandputamaninstead.No.
No,personally,Ididnotfeelthis”
Woman31
Onlyoneoutofthe32femaleparticipantsflaggedthatshefeltthatsometimesheropinion
waschallengedmorethanaman’swouldhavebeen.Shealsomentionedthatshehadheard
commentsaboutwomenbeingslowandlazy,whichtoherhadanimpactonhowwomen’s
opinionsandworkwereperceived.Otherparticipantsdidspeaktowomenhavingahigher
rateofabsenteeismorlatenessatworkduetocompetingpriorities,buttheydidnotfeelthat
thisaffectedtheoverallqualityofwomen’swork.
“It’sabattle.Youyourselfsay‘Hey!Listen!’.Ifitweresomeonefromtheoppositesexwhohad
thesameopinionthatIhave,Idon’tthinkitwouldbechallengedthismuch.Youalmosthave
tobangonthetable”
Woman31
Bothwomenandmenparticipantsemphasizedthattheirownworkisvaluedindepen-
dentlyoftheirgender.Theamountofrespectthattheyreceiveandtheirauthorityinthework-
placeisseenasequivalent.Aperson’spersonalinvestmentintheirwork,theircharacterand
theirtechnicalskillsarevaluedovertheirgender.Thesolidityoftheirarguments,thestrength
oftheevidencebehindthemandthescientificmethodologythattheyusetobuildthemwere
alsokeyfactorsinacceptability,beyondgender.
“No,no,no.It’snotbecauseI’mawoman,butit’sbecausetheargumentsIgiveorwegiveto
convincepeoplearereasonableandtrue!”
Woman25
“Itdoesn’tmatterifit’sJohanna[...]orJohn,butitdoesmatterthatthispersonisinvestedin
thetopicwe’retalkingabout”
Woman22
Accordingtoparticipants,thisrepresentationofwomenwasnot,however,expectedto
yieldanyparticularresultsintermsofplacingmoreemphasisonwomen’shealth.Participants
expressedfeelingthatwithinwomenandmen’swork,respectandinfluenceweredeemedgen-
erallyequivalentandeveninterchangeable;asaresult,theydidnotseehavingmorewomen
presentaseitherbeneficialordetrimentaltoadvancingwomen’shealth.
“Themajorityofourhumanresourcesarefemale,andIneverfeltthatgenderwaseitheran
advantageoradisadvantage.”
Woman29
Finally,accordingtorespondents,womenarenotonlyoccupyingthemajorityofpositions
inthehealthsector,buttheyarebeingincreasinglynominatedtoleadershippositions,and
thatleadershippositionscanbeoccupiedbybothmenandwomen.
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“Thesamepositionscanbeoccupiedbywomenandmen.That’swhat’shappeningeveryday.
Thisyearthedirector’saman,thenextit’sawomanandviceversa”
Man6
Perceptionsofwomen’sinsightsonwomen’shealth
Despitetheconsensusamongparticipantsthatwomenandmenarenottreateddifferently
withregardstotheirwork,manymentionedthatwomenmayhaveincreased“sensitivity”to
topicsthatsheorotherfemalemembersofherfamilyhaveexperienced.Participantsrepeat-
edlyusedthisspecificword:sensitivity.Fromthecontext,weunderstooditgenerallytomean
“havingfirsthandexperienceoftheexperienceofbeingawomanandthushavinganincreased
awarenessofcertaintopics”.
Accordingtosomeparticipants,beingawomanaffectspersonalinvestmentwithwoman-
centeredpolicies,increasessympathyforthoseaffectedbythepolicies,andincreasespersonal
satisfactionandpridewhentherearesuccessfulresults.
“Ithinkthatasawoman,thesensitivity...ifwecomparemenandwomen,womenaremore
sensitiveevenjustforlistening,forunderstanding.[...]whenwewanttogetsomewhere,wedo.
Whenwedecidesomething,wefightforit.There’ssomethinginherenttowomenthatisspecial”
Woman26
Thispersonallinktowomen-centeredpoliciesbyfemaledecision-makerswasrecognized
assomethingthatamplifiestheimpactofwomen’svoicesandpointsofview.Womenreported
personallyfeelingthatthiswasthecase,andsomemenalsosupportedthisfeeling.
“Icanunderstandasaperson,asawoman,asayoungperson,asafriend,asasister.I’vewit-
nessedmanycasespersonally,soIthinkmyvoiceinthistechnicalworkinggrouphasitsimpact.”
Woman11
“Ithinkmyvoiceasawomaninthiscaseisloudandimportant”
Woman31
Beingabletorecognizeone’sselfinthepoliciesgavesomefemaledecision-makersasense
ofpersonalaccomplishmentandprideintheworkbeingdone.Beinginvolvedinimproving
women’shealthaswomenthemselveswasseenasgratifyingonapersonallevel.
“Ibelievethatyes,[...]wefeelfulfilledwhenwedogoodforotherwomen.It’sthefactthatwe
arewomenourselvesandwespokeupandsharedourexperienceandwelivedthesethings,
andnowweseethingshappening.”
Woman15
Itwasalsosuggestedthatawomanmayhavebetterinsightsintowhatwomen-centeredpol-
iciesmayormaynotbesuccessful,becauseshehasfirst-handexperiencewithtopicsrelatedto
beingawoman.Thissentimentwassharedbybothmenandwomen.
“Youcouldsay‘injectionsarethebestmethod’[forfamilyplanning],butawomanmightsay
‘injectionsgivemeconvulsions,itdoesn’tworkforme,Ipreferotheroptions,Ipreferto
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monitormymenstrualcycle’[...].Soawomanwouldbebetterpreparedandmightbeready
tosuggestotheroptions,whileformeasamanIwouldjustsay‘No.Injectionsisthebest
method’.”
Man5
However,despitesuggestingthatbeingawomanmakesthemmorepersonallyattunedto
certaintopics,thesestatementswerenotlinkedtoanyperceivedimprovedordecreasedpro-
fessionalperformance.Indeed,whilewomenmightbeseenasmoreawareofwomen’sissues,
thiswasnotexplicitlylinkedtowomenbeingseenattheexclusiveauthoritiesonwomen-cen-
tricissues.
“Maybewhenseeingasituationwhereawomanisinvolved,Imighthavemoreempathysince
I’mawoman.Icanidentifymorewiththesituation,butthisisnotsomethingthatinfluences
work”
Woman24
Althoughrespondentssawwomenasmoreattunedtowomen’sissues,theimplicationwas
notthatmenwereindifferenttotheseissues.Bothmaleandfemaleparticipantsdescribethe
menwhoworkindevelopingorimplementingwomen-centeredpoliciesasbeingactively
engagedinwomen-centrictopics.Despitenothavingpersonallylivedsomeexperiencesfirst-
hand,menwhocontributetowomen-centeredhealthpoliciesareseenasempatheticto
women-centriccauses.
“Wehavethedepartment[ofCooperationoftheMinistryofHealth]itselfwhichhasmore
women.It’sabiginequality—therearealotmorewomenthanmen,butIthinkeventhemen
whoarehereareverysensitivetothecause.”
Man2
Discussion
Ourresultssuggestthreemainfindings:(1)womenwhoparticipatedinourstudygenerallydo
notreportfeelingdiscriminationintheirworkplace;(2)decision-makersperceivethatwomen
areaswellrepresentedinthehealthsectorinMozambique;and(3)decision-makersperceive
womenasmorepersonallyattunedtowomen-centricissuesthanmen.
Althoughatfirstglanceourdatasuggestthatgenderbiasisnotaconcernforwomeninthe
healthsectorinMozambique,contextualizingthesefindingswithinexistingliteratureallows
ustoseeotherfactorsatplay.GivenMozambique’slongstandingcommitmenttofemale
representation,itispossiblethattheeffectsofhavinghadfemalerepresentationforsolonghas
indeednormalizedfemaleleadership,atleastinthehealthsector.Nevertheless,eveninthe
mostresource-richandgenderequality-focusednations,genderdiscriminationstillexistsand
affectswomenworldwide[19].ItseemsunlikelythatMozambicanwomenwouldbeanexcep-
tion.Inthissection,weexplorecontextualfactorsthatwouldhelpexplainourfindings.
Considerationsofintersectionality
Beforediscussingtheseresultsanyfurther,wewanttoemphasizethatthisstudyonlylookedat
averyspecificpopulationgroup.Theparticipantsincludedinthisstudywerepurposefully
selectedbecauseoftheircredentialsandbecauseoftheirroleasseniordecision-makers.The
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findingsfromthisstudymustbeunderstoodthroughthislens,whereparticipantscomefrom
aplaceofrelativewealthandeducation.Theirperspectivesareinherentlyinfluencedbythese
factorssincetheirexperienceliesattheintersectionofwealth,education,andgender.We
wouldstronglycautionagainstexpandingthegeneralizabilityofthesefindingsacrossallwork-
placesinMozambique,oracrossallofMozambicansociety.
Furthermore,examiningthesefindingsthroughanintersectionallensprovidesanaddi-
tionallayertotheseresults.Intersectionalityisthenotionthataperson’sexperienceisnotuni-
dimensional,butratherliesattheintersectionofmultipleidentities.Indeed,eachindividual
belongstomultiplegroupsrelativetotheirgender,sexualidentity,able-bodiedstatus,wealth,
class,etc.Someofthesearediscriminatedgroups,otherareprivileged[20].Quantifyingand
rankingtheexactimpactofbelongingtoeachgroup—discriminatedagainstornot—isessen-
tiallyunfeasiblesinceapersoncannoteasilydivorcehisorherselfofpartsoftheiridentity.
Femaleparticipantsinthisstudygenerallyreferencedtheirpositionsofpower(whichin
thiscaseimplicitlyindicatesrelativewealth),theireducation,andtheirorganizationaland
othersoftskillsasfactorsaffectingtheirachievementsintheworkplace.Inmostcases,they
explicitlyrejectedthenotionthattheirgenderhadplayedanyroleintheirprofessionalexperi-
ence.TheseresponsescorrelatewithNixon&Humphrey’sfindingswhichsuggestthatsome
groups“donotnecessarilyidentifygenderoppressionastheprimaryframethroughwhich
theyunderstandtheirlives”[21].
Femalerepresentationindecision-makingpositions
InMozambique,womenhaveheldatleast30%ofparliamentaryseatssince2000,exceedingthe
benchmarkof30%ofwomeninparliamentsetbythe1995BeijingDeclaration[22].Another
countrytoachievethisisRwanda,whichhasbeenhailedasanexampleofequalgenderrepre-
sentationingovernment.InRwanda,womennowhold61%ofparliamentaryseats[22].
Rwandaachievedthesepercentagesthroughacombinationofconstitutionalguarantees,quota
systemsandelectoralstructures.However,criticsoftheuseofquotasystems—whicharealsoin
useinthecurrentelectedpartyinMozambique—havepointedtopublicperceptionofwomen
beingappointedtopositionsofpowerbecausetheyarewomen,ratherthanbecauseoftheir
qualificationsorprofessionalmerit,asbeingharmfultowomen’soverallcredibility[23].Never-
theless,priortotheinstitutionofquotas,femalerepresentationingovernmentinRwandahov-
eredat25.7%ofparliamentaryseats[10].Forbetterorforworse,quotashaveallowedfemale
representationtoincreasemuchfasterthanitwouldpresumablyhavewithoutthem.
AnotabledifferencebetweenMozambiqueandRwandaisthatwhilethecurrentlyelected
politicalpartyinRwandadoeshaveadditionalincentivestoensureastrongfemalerepresenta-
tion,theRwandeseconstitutionitselfhasa30%quotaforpositionsheldbywomen[23].In
contrast,Mozambique’scurrentlyelectedparty—theFrentedeLibertaçãodeMoçambique
(FRELIMO)–hasaquotasysteminplaceforwomenrepresentation“inallpartystructuresat
alllevelsandinalllistsforanyelection”originallysetat30%,butnowat40%ofpositions[24].
TheMozambicanconstitution,however,doesnot[25].OtherMozambicanpoliticalpartiesdo
nothaveexplicitgender-sensitivepoliciesinplacetoguaranteeorexplicitlypromoteamore
gender-balancedrepresentation.Whilemostdeclarethatgenderequalityisapriorityorat
leastaconsideration,theinstitutionalmechanismsthatguaranteefemalerepresentationare
lacking[24,26].However,womeninMozambiquehavealowerliteracyratethanmen,have
fewereducationalopportunities,andareculturallysocializedtonotbeoutspoken.Theseele-
mentscontributetoreducingthepoolofqualifiedpotentialwomeninpositionsofpower[12].
Evenifthequotasystemisn’tadoptedbyotherparties,withoutsomeconcreteplanonhowto
ensurefemalerepresentationismaintainedorwithoutintegratingsomethingofthekindin
PLOSONE|https://doi.org/10.1371/journal.pone.0207225 November15,2018 10/15