Sassy Molyneux, University of Oxford, KEMRI-Wellcome Trust Research Programme

Gender and ethics in practice: experiences of researchers

conducting qualitative health policy and systems research

(HPSR) studies

KEMRI-Wellcome Trust colleagues

Lucy Gilson & Catherine Goodman

Benjamin Tsofa Edwine Barasa Mary Nyikuri Evelyn Waweru

Colleagues from RinGsa partnership bringing together 3 consortia to galvanise gender and ethics thinking in HPSR

Many ways to think about ethics in practice…• How do existing guidelines apply in practice for my

kind of study/project/work… • Issues/realities in relation to those concepts/requirements

on the ground? • How should I do my study, or respond to a situation?

• What are the ethical issues I/we face on the ground?• What situations in ‘the field’ / in our work that make us

question whether we are doing the ‘right thing’?• What do stakeholders and literature, including guidelines,

suggest we should do

Journal of International DevelopmentJ. Int. Dev. 21, 309–326 (2009)

Developing World Bioethics, 2016ISSN 1471-8731 (print); 1471-8847 (online)

Voices from the research team… three ‘talking heads’

http://resyst.lshtm.ac.uk/resources/video-learning-more-about-ethics-health-systems-research-kenya

Challenges emerged, often about relationships• Being informed about or observing apparently

unethical behaviour - really unethical? if and how to intervene? Research team responsibilities?

• Being requested to assist - If and how? Sustainability? and implications for more sustainable interventions?

• Researchers not objective observers but part of – embedded in - complex social relationships - potential to influence relationships in intended and unintended/ unexpected ways (‘an intervention’)

Importance of positionality and reflexivity

Cautionary approach vs transformative agenda? Where intervene ‘for good’, track for unintended perverse effects

So where does gender come in?Gender and ethics are inter-twined

• Deal with power relations and equity and how these are transformed over time and space• Pay attention to fairness,

vulnerability and agency in diverse contexts• Consider how gender interacts

with other social stratifiers

Two inter-related concerns regarding HPSR

Research often fails to sufficiently consider

gender as a social relation

Governance of the field remains underdeveloped

and contested, with limited attention to the role of power and how

this is experienced within different contexts.

Gender and power in conducting HPSR: reflections from RinGs funded researchers

• In March 2016, RinGs brought together 9 grantees conducting health systems research on gender and ethics in Kilifi, Kenya

• During meeting discussed key challenges they faced related to gender and power in HPSR

Ways in which gender and power shapes interactions during research process

Resistance to gender

perspective in research

Misunderstanding gender analysis

Questioning relevance of gender

analysis

Power relations in methods

Power relations between

researchers and respondents

Gender &

Power

Questioning relevance of gender analysis …Power and gender abstract and difficult to engage with, even for those with an interest in equity.

Beyond maternal and child health, research from a gender perspective questioned:• What you need are health services for all. • Do diseases differentiate between males and

females?• Do mosquitoes disaggregate by gender?• If we are to study malaria, let us study malaria,

not gender because malaria catches all equally

Resistance to gender perspective in research…By those who feel criticised or challenged, or who do not believe that gender discrimination is a reality.… by women who don’t want men encroaching in their ‘space’

Specific concerns:• ‘Is focusing on women a punishment of men? And

are all men guilty of women’s suffering?’• ‘But some women oppress men!’ …. The focus on

women ignores men’s suffering! Ie are we talking about gender or women?

Misunderstanding of what gender analysis is…• Continued focus of women and girls within

gender analysis.

• While important, it does not necessarily address determinants of gender inequality that can also undermine such a focus, and underestimates ingrained power relations and men’s roles.

• Heteronormative nature of much international development also means that people who define their gender as neither man nor women are often excluded.

What worked well – reflections from our workshop…• Build our capacity for quality ethical research:

• reflect on positionality and implications• co-learn with others• Use methods that flatten power relations as much as

possible – participatory, narrative, visual

• Ask about gender & power without using the words; draw on frameworks to probe

• Develop/agree/debate strategies and appropriate approaches to respect local norms and requirements, and challenge them • Specific to study and socio-cultural and policy context• At least do no harm

Photo credit: Robyne Hayze

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