Women in Global Health- #MeToo

#METOO

We stand with the those in the health workforce who are subjected to sexual harassment in their workplace

Written by: Kelly Thompson, Gender Specialist, Women in Global Health

Collaborators: Mehr Manzoor, Ann Keeling, Alexandra Williams, Women in Global Health

The recent resurgence of #MeToo on social media brought up many memories and sparked discussions amongst our team at Women in Global Health. It also prompted an exploration of my own trajectory in health and the various times at which sexual harassment impacted my career and experiences. From the beginning, as a 13-year old volunteer, I can recall an encounter: I was making my usual rounds at a nursing facility, checking in on the long-term patients to see if they needed water or the Sunday morning paper. As I softly knocked on the door to a patient’s room and entered to ask if he would like a paper, he called me to come closer, and quickly exposed his genitalia. Unsure of what to do, I quickly turned around and left the room, never mentioning what had happened to anyone. Five years later, as I made my way to my undergraduate job at a hospital in New York, I found myself on a crowded 4 train. Shoved under another person’s arm pit, as the train left Fulton Street, I had my first experience with frotteurism. No matter which way I moved, I was unable to detach myself from his intrusion. More recently, at a hospital I was working at in Australia, I was faced with the stark reality of the insecurities women face in healthcare settings during an overnight shift with the Obstetrics team. When a page came in for a case review in the Emergency Department, I was cautioned to not go anywhere without another doctor present. All female staff members were advised to travel in pairs, as there had been a recent spate of sexual assaults within the hospital and was not safe to venture out alone.

Threats to women’s safety in healthcare settings come from both internal and external sources, globally. During my training in Australia, shockwaves were sent through the medical community when Dr. Gabrielle McMullin, a senior vascular surgeon, noted at her book launch that she often tells women to comply with superior's’ sexual advances, as it will be easier for them in the long-term. In response, a parliamentary committee investigated and discovered gender inequity directly influenced women’s s experiences in medicine related to bullying, discrimination and sexual harassment[1]. An expert advisory group at the Royal Australasian College of Surgeons found that 49% of Fellows, Trainees and International Medical Graduates report being subjected to discrimination, bullying or sexual harassment[2]. Moreover, a survey of medical students in Western Australia found that 31% of respondents had experienced workplace-related sexual harassment, with women accounting for 81% of those reporting harassment[3]. Elsewhere, in South Korea, 19.7% of female nurses reported experiencing sexual harassment, where operating theatres were the most likely place for these events to occur[4]. Finally, in the United States, 1 in 3 female physicians has reported experiencing sexual harassment[5].

Not surprisingly, such stories extend beyond the clinical setting, and into global health and international health aid arenas. A recent report found that sexual assault against women working in aid and development is incredibly common[6]. The majority of perpetrators are their own colleagues in the aid industry, often men in superior or higher level positions[6]. However, the extent of the problem surrounding sexual harassment in the global health workforce is largely unknown, and the little data that does exist, represents only the tip of the iceberg.

Sexual harassment in the workplace creates a variety of negative impacts on women, including on their physical and mental health. Studies have shown sexual harassment experienced during medical training can impact decisions on specialty and residency program selection[7]. Furthermore, this effect extends beyond the impact on the individual experiencing the harassment to the health system, as a whole. Examples of systemic impact include “impediment of health workers’ advancement, increased stress and decreased morale and productivity, and a “limited pool of health workers to deal with today’s health challenges.”[8]

Globally, there is a lack of legal protections for women experiencing harassment or discrimination in the workplace. Overall, 1 in 3 countries do not have laws prohibiting sexual harassment at work, while 82 million women in 24 countries have no legal protections against gender-based discrimination at work[10]. Additionally, most countries (136) have no protections against discrimination in career advancement based on sexual orientation or gender identity[11]. It is challenging to apply an intersectional lens to the issue as data related to factors such as race/ethnicity, disability, and religion, are missing.

The lack of protection is a stark contrast to the interventions that are needed, including sexual harassment policies, grievance or reporting procedures, and education and awareness raising[12]. Effectively addressing sexual harassment within the global health workforce requires understanding of approaches that can integrate interventions at organizational, societal, and individual levels while driving preventative action.

The #MeToo campaign aimed to highlight the high prevalence of sexual harassment and assault on women throughout the world, where it is estimated that 1 in 3 women have experienced intimate partner or sexual violence[9]. Indeed, sexual assault and harassment have become so normalized for women, in all types of settings. For example, I quickly dismissed an experience my colleagues had, involving a man with an erect penis running at them in the street. Instead, I responded that things like this happen all the time, and did not explore their experiences at a deeper level. Such experiences are so common, we have stopped reflecting on how to change them. At another global meeting, an incident prompted a larger discussion about sexual harassment and violence among participants. We quickly recognized, as health care professionals, there is a startlingly large gap in our training and education on sexual harassment and violence.

Harkening back to the comments made by Tarana Burke, who started the original #MeToo movement in 2007, it is not enough to merely raise the profile of these stories. In some cases, such recounts can be traumatising or even re-traumatising for women and others who have encountered sexual harassment and violence. As such, we need to provide support beyond the hashtag. The onus should not be on women to share their stories, or to take actions to“protect” themselves, as we were told in my hospital. Rather, systematic action must be taken by men, as well as women, and by our systems and institutions as a whole.

So, what actions can we take to address sexual harassment in the health workforce? USAID suggests the following series of interventions[13]:

Create, monitor and enforce anti-discrimination policies, including sexual harassment policies
Ensure prevention and protection against sexual harassment are mainstreamed in occupational safety policies and programming
Develop reporting and grievance mechanisms which provides safeguards for those experiencing sexual harassment
Increase training and awareness exercises on sexual harassment, as well as workplace policies and reporting mechanisms

What can the health workforce do more broadly to address gender-based violence and sexual harassment?

Integrate training on these issues into basic health care provider education
Normalize screening for violence into all patient reviews
Conduct and increase research on violence. Check out this tool.

As Women in Global Health evolves its own internal strategies on sexual harassment in the global health workforce, we would love to hear from you. Please consider taking a few minutes to engage with us through: