Table 1
Demographics of Survey Participants (N = 405).
| N(%) | |
|---|---|
| Age: | |
| 30 or under | 103 (25.5) |
| 31–40 | 146 (36.1) |
| 41–50 | 80 (19.8) |
| 51–60 | 50 (12.4) |
| 61–70 | 19 (4.7) |
| 71 or older | 6 (1.5) |
| Gender: | |
| Female | 392 (96.7) |
| Male | 13 (3.2) |
| Country of origin: | |
| Low- or middle-income country | 145 (36.0) |
| High-income country | 258 (64.0) |
| Country of current residence: | |
| Low- or middle-income country | 96 (23.8) |
| High-income country | 307 (76.2) |
| Race/Ethnicity: | |
| African | 72 (17.9) |
| Asian | 70 (17.4) |
| Hispanic | 18 (4.5) |
| White | 202 (50.1) |
| Mixed | 27 (6.7) |
| Other | 14 (3.5) |
| Marital Status: | |
| Married/domestic partnership | 220 (54.6) |
| Single (never married) | 146 (36.2) |
| Divorced/widowed/separated | 37 (9.2) |
| Employment status: | |
| Working full-time | 337 (83.6) |
| Working part-time | 34 (8.4) |
| Not currently working | 32 (7.9) |
| Career stage: | |
| Early career | 177 (43.8) |
| Mid career | 170 (42.1) |
| Late career | 57 (14.1) |
| Type of employer: | |
| Academia | 197 (48.8) |
| Private/for-profit | 34 (8.4) |
| Private/not-for-profit | 116 (28.7) |
| Public sector/government | 35 (8.7) |
| Other | 22 (5.5) |
| Leadership role: | |
| In a position of leadership | 147 (36.4) |
| Aspire to a position of leadership | 241 (59.6) |
| Do not aspire to leadership position | 16 (4.0) |
| Attended the Women Leaders in Global Health Conference: | |
| Attended in person | 221 (54.6) |
| Attended via livestream | 42 (10.4) |
| Did not attend | 142 (35.0) |
Table 2
Perceived barriers to advancement in global health, stratified by respondents who currently live in high-income versus low- and middle-income country.
| Overall N (%) who agreed/strongly agreed | High-Income Country Residents (N = 264) N (%) who agreed/strongly agreed | Low- and Middle-Income Country Residents (N = 88) N (%) who agreed/strongly agreed | Chi Square (P value) | |
|---|---|---|---|---|
| Women face unique barriers to advancing to positions of global health leadership compared to men (N = 352) | 317 (89.5) | 242 (91.7) | 73 (83.0) | 12.3 (0.015) |
| I personally feel like gender bias has affected my career growth in global health (N = 352) | 209 (59.0) | 153 (57.9) | 54 (61.3) | 3.7 (0.44) |
| Overall N (%) who marked as one of the most important barriers | High-Income Country Respondents N (%) who marked as one of the most important barriers | Low- and Middle-Income Country Respondents N (%) who marked as one of the most important barriers | Chi Square (P value) | |
| Lack of mentorship (N = 336) | 188 (56.0) | 130 (52.2) | 57 (67.1) | 6.5 (0.04) |
| Balancing work and home (N = 320) | 167 (52.2) | 117 (49.2) | 49 (60.5) | 3.4 (0.184) |
| Gender bias in home country (N = 320) | 161 (50.3) | 119 (49.6) | 42 (52.5) | 0.21 (0.896) |
| Lack of female mentors (N = 322) | 135 (41.9) | 98 (40.5) | 37 (46.8) | 1.01 (0.60) |
| Lack of assertiveness/confidence (N = 315) | 117 (37.1) | 85 (36.5) | 32 (39.5) | 1.4 (0.478) |
| Lack of opportunities (N = 312) | 109 (34.9) | 69 (29.7) | 40 (50.6) | 11.6 (0.003) |
| Lack of funding for meetings and networking (N = 313) | 104 (33.2) | 60 (26.0) | 43 (53.8) | 21.9 (<0.001) |
| Gender bias in partner country (N = 309) | 97 (31.4) | 74 (32.0) | 23 (29.9) | 5.25 (0.072) |
| Inadequate pay (N = 312) | 97 (31.1) | 65 (28.0) | 31 (39.7) | 4.4 (0.111) |
| Safety concerns (N = 302) | 72 (23.7) | 37 (16.4) | 35 (45.5) | 27.2 (<0.001) |
| Travel requirements (N = 302) | 68 (22.5) | 40 (17.8) | 27 (35.5) | 10.4 (0.006) |
| Work Load (N = 305) | 64 (21.0) | 32 (14.0) | 31 (40.8) | 30.6 (<0.001) |
| Lack of training (N = 294) | 53 (18.0) | 28(12.7) | 25 (34.3) | 21.9 (<0.001) |
Table 3
Illustrative quotes.
| Systemic/cultural factors |
| “Lingering norms about what women can/can’t do and how they should/shouldn’t act in professional situations hold women back and subtly but powerfully discourage them from pursuing or being considered for leadership roles.” |
| “Implicit bias still exists significantly …(regarding) how a woman is supposed to run her life and behave compared to men. If we speak up, we are still treated like bitches vs. men are simply (seen as) assertive and speaking their mind. And women are… (judged by) whether or not they have children and the spouse. Either way we can’t win. Much easier for men. I don’t know that this is specific to global health though.” |
| Mentorship and sponsorship |
| “While there are many women working in lower level positions in global health organizations and government positions related to global health, there are many fewer women working in high level positions, which means there are fewer mentors available to help us navigate the different things that make a global health career more challenging for women. Having mentors that understand what it means to not be respected by male colleagues and men in upper level positions, who encourage you to speak up, who understand that there are different safety concerns to consider when working in the field in any country for women is invaluable.” |
| Need for Support |
| “There simply is not enough support from men. Men and the socialization of men to not actively integrate, support, or stand up for their women counter-parts has shaped an ethos where women’s voices are consistently unheard.” |
| “(We need more) programs that support mid-career women. Most new programs are aimed at early-career or students, which is great, but that has to continue through mid-career to get women into the C-suite.” |
| Role Conflict and work/life balance |
| “Women will do anything for their families. If faced with a trying situation… career suffers.” |
| “Our biology for making and rearing babies who become global citizens, while truly unique and beautiful, is so time consuming. There is a misconception that if women work outside the home (much more in some settings than other, very strong here in Mexico), they are neglecting their child rearing role and their children will be negatively affective by this. Social expectations and norms are so strong, and it is impossible to be everywhere and to do everything at once.” |
| Women are our own worst enemies |
| “I think for me currently, the biggest challenge is not extrinsic, it is intrinsic. I do not have the self-confidence that I can be a leader in this field yet and need to change how I act to change this.” “I’ve (had) problems with other women thinking they support women in leadership but (are) actually undermining other women. It’s a topic that is rarely discussed but if women are going to make progress we have to take a long hard look at how women do and don’t support each other.” |
| Additional challenges for women of color and other marginalized groups |
| “Considering a woman’s intersectionality (the other traits that work in combination to create bias (ageism, racism, genderism, etc.)) is also important to address so that as we work as women we do not recreate similar inequalities as historic systems have allowed.” |
| Differences in male and female leadership styles |
| “I think men and male-created institutions still define what a good leader (is) with a gendered lens. As a woman leading an organization…. I am judged according to a male-centric definition of leadership.” |
Table 4
Logistic regression analysis showing variables associated with a personal belief that gender bias has affected global health career growth.
| Variable | Odds Ratio | Standard Error | P Value | 95% CI | |
|---|---|---|---|---|---|
| Age (<=40, ref) | |||||
| 41 and above | 1.3 | 0.30 | 0.24 | 0.82–2.07 | |
| Race (African, ref) | |||||
| Asian | 2.6 | 1.01 | 0.012 | 1.23–5.61 | |
| Hispanic | 1.2 | 0.76 | 0.700 | 0.38–4.12 | |
| White | 2.6 | 0.94 | 0.007 | * | 1.29–5.31 |
| Mixed | 2.0 | 1.07 | 0.178 | 0.72–5.70 | |
| Other | 2.8 | 1.91 | 0.113 | 0.77–10.58 | |
| Employment type (Academia, ref) | |||||
| Private/for-profit | 0.5 | 0.21 | 0.115 | 0.23–1.17 | |
| Private/not-for-profit | 0.9 | 0.26 | 0.975 | 0.58–1.67 | |
| Public sector/government | 1.6 | 0.75 | 0.269 | 0.67–4.1 | |
| Other | 0.5 | 0.27 | 0.224 | 0.18–1.48 | |
| Country of residence (HIC, ref) | |||||
| LMIC residence | 1.8 | 0.57 | 0.069 | 0.95–3.36 | |
| Constant | 0.6 | 0.19 | 0.097 | 0.28–1.11 | |
Table 5
Barriers to Leadership with Suggested Solutions.
| Barrier | Individual-level solution | Meta-level solution |
|---|---|---|
| Common to both HIC and LMIC respondents | ||
| Lack of mentorship/sponsorship | - Reach out: Senior level women reach out to junior women; include them on committees and invite them to important meetings - Be pro-active: Junior women seek out mentors and make desire for mentorship and leadership known | - Incentivize mentorship at the institutional level - Increase recruitment of women into training programs where they can be connected with mentors in their fields, and in turn mentor other women |
| Balancing work and home | - Ask for help: Women refuse to accept sole responsibility of raising children and keeping the house: ask for help - Men (and families) step up and provide women with more support at home and at work | - Targeted funding for travel: More funding available to support women leaders traveling with their children - Family-friendly policies: Policies that promote family-friendly work environments - Structural fixes (e.g. childcare at conferences, delayed tenure clock, funding for maternity leave) |
| System/culture/gender bias | - Lead with courage: Women leaders refusing to adopt a male leadership style, but instead re-defining what it means to be a leader: “I am, as a leader, less interested in moving up (a) ladder than creating a larger and more collaborative table.” - Increase visibility: Nominating female colleagues for prestigious awards to help establish legitimacy - Speaking out about potential for bias, advocating for unconscious bias training in the workplace | - Blinded recruitment and selection of finalists without revealing gender - Increasing diversity on multiple axes, not just gender - Instituting requirements for percent of leaders that are female - Support for unconscious bias training in the workplace |
| Women’s lack of assertiveness | - Believe! Women need to increase their confidence and believe in themselves - “Coaching to help women recognize and overcome that little voice that says ‘I’m not good enough.” | - Leadership training courses designed for women - Targeted Recruitment: Explicit solicitation of female applicants for leadership positions: “Women are less likely to apply for jobs unless they meet 100% of the requirements, versus men who will apply even if they meet 60% of the requirements… (Some organizations) now actively reach out to qualified women who might not otherwise apply and ask them to interview without waiting for them to apply. They do this because they also know that having more women in the applicant pool is beneficial.” |
| More pronounced among LMIC respondents | ||
| Lack of opportunities | - Be persistent and creative: Make known what you want, and ask everyone in your network if they can help you make it happen. Many opportunities are created rather than advertised. - Look out: Watch for leadership, communication and negotiation skills workshops; apply for scholarships to attend | - Open the door: Institutions need to seek out and consider non-traditional candidates, looking beyond finding a candidate that feels familiar - Be creative: Organizations can think about ways to send two employees instead of one to a meeting or workshop, or invite outside experts in for networking events rather than expecting employees to travel |
| Lack of funding for meetings/networking | - Capitalize: Never miss an opportunity to introduce yourself/meet with leaders in the field; network locally; keep up with contacts electronically and via phone meetings - Prioritize: Ask for or put aside your own professional development budget to participate in one or two key annual conferences or meetings | - Leverage: Institutions can offer small grants or matching funds for conference travel, can petition conferences for LMIC scholarships - Sponsor local, inclusive networking events: Organizations can sponsor local networking events that do not focus on ‘male’ zones such as bars or sporting events and do not occur late at night |
| Safety concerns | - Partner: Travel with a group, find partners to accompany you, identify on-the-ground safety allies - Be Aware of the potential safety issues, work to avoid most dangerous areas/times of day | - Protect your investment: Organizations can budget for security personnel to accompany all employees – not just women – into the field - Be clear about sexual harassment and discrimination policies and the pathway for grievances as well as the mechanisms of accountability |
| Travel requirements | - Pace yourself: Identify which travel is essential and which is optional - Use your networks: Identify resources to help with non-work responsibilities while you travel | - Invest in technology: Organizations can explore the use of telecommuting and virtual meeting technologies, even in low-bandwidth settings, using such platforms as WhatsApp and GoToMeeting - Discuss and revisit what constitutes essential and non-essential travel, being aware of the risk of over-valuing the employee who says yes to every trip. |