Building a Future of Equity in Health: a Conversation with Dr. Maribel Ponferrada Arteaga

11/03/2024

Interview with Dr. Maribel Ponferrada Arteaga, PhD in Anthropology and expert in gender perspective in research.

-What is your view on gender equity in health?

The gender perspective, in any field, involves uncovering and addressing gender inequalities in access to material resources, considering the interaction with other inequalities such as socio-economic status, age, origin, citizenship status, racialization, discrimination based on sexual orientation and gender identity, and disabilities.

This involves several dimensions:

1) Ensuring that women and men, in all their diversity, enjoy a complete level of physical, mental, and social well-being. This implies diagnosing and correcting the structural factors that condition health, coordinating health policies with economic and territorial policies. Although women have a longer life expectancy, the inequalities they suffer translate into a poorer quality of life in old age.

2) Guaranteeing equal access to the benefits of health systems, including prevention and treatments, and addressing gender biases in diagnosis and care. There are unconscious gender biases in the diagnosis of diseases that result in delays in diagnosis and underdiagnosis, and there may also be biases in the time dedicated to the care of women and men. On the other hand, the LGBTI community may also experience gender biases, such as greater difficulties in accessing reproductive and sexual health.

3) Integrating the gender perspective into health research, including the inclusion of women in clinical trials and the analysis of sex differences and gender inequalities in all phases of research. In addition, research on specific health problems of women at different stages of life, such as adolescence, pregnancy, and aging, should be prioritized.

In certain research, biological issues will be relevant, but in others, the inequalities that specifically affect women due to their living conditions must be taken into account.

-Do you think women face limitations in accessing research and health fields?

In the field of research and health, women face significant limitations in their professional trajectory. Despite being the majority at the university level and in the early academic levels such as doctoral studies, there is a significant decrease in the presence of women as they become established in their careers. This phenomenon, known as the "leaky pipeline," is manifested by a lower representation of women in tenure positions and, especially, in professorial positions.

Underrepresentation persists in research, with fewer women leading projects and a notable inequality in funding. Despite a higher success rate for women applying for projects, the financial amount awarded to projects led by men is significantly higher.

Motherhood emerges as a prominent obstacle, negatively affecting women's research careers. Difficulties in accessing funding and lack of support for reconciling career and care also contribute to this gender discrimination.

Qualitative studies and in-depth analysis of selection and funding processes are needed to address these persistent inequalities. Training in gender perspective and promoting women in leadership positions are crucial for advancing towards greater equity in research and health.

A small example in data is provided by "Científicas en cifras 2023," which indicates that in terms of tenure positions and consolidation of the scientific career, women account for 44.5% compared to 55.5% of men. In addition, the glass ceiling is evident, with only 26.6% of professorial positions occupied by women.

Source: "Científicas en Cifras 2023" (https://www.ciencia.gob.es/InfoGeneralPortal/documento/f4f6bb28-cae5-4da2-85f4-067508c410eb)

-How do you think gender affects the perception of health and access to health services among the elderly?

Regarding the perception of health and access to services among the elderly, gender can influence the level of autonomy and decision-making of elderly women, many of whom still experience the consequences of the patriarchal system. This influence diminishes, but some women still suffer the consequences of social and familial pressures that have limited their participation in work and public life. In addition, socio-economic and environmental factors also influence access to health services, with a poorer environment leading to more limited access to resources unless there are specific improvement programs. Women request more services from primary care centers, but they may be underdiagnosed in certain diseases, possibly due to a bias in the perception of their symptoms compared to men. Health services can act as prevention agents, connecting elderly women with home-based physical activity and preventive physiotherapy services, although this offer is not uniformly developed in all territorial areas.

-How has your understanding of the relationship between masculinities, femininities, and health evolved from your early work in schools to your postdoctoral research?

In my early work, focused on the school experiences of young people through ethnography in schools, I observed issues related to the socialization of femininity, especially among working-class women. Initially, women were affected by the perception of lack of competence and opportunities, mainly due to the patriarchal system. In the school environment, I detected the persistence of hidden masculinities, and I believe that, instead of improving, the situation may be worsening.

In addition, gender inequalities experienced during youth translate into emotional problems among the

 elderly, especially those who have been immersed in patriarchy and have been dispossessed. This population presents higher rates of dementia, psychological, and cognitive illnesses, especially when there is dependency and lack of education.

Despite advances in education and access to paid jobs for women, the lack of voice continues to affect younger generations. This inequality has negative repercussions on the mental health and perception of health of young girls, highlighting the need to address these issues and promote female agency from the earliest stages of life.

-How do you assess the role of health and gender research in promoting equality and social justice in educational and health systems, and how do you think this research can contribute to addressing structural inequalities in society?

It is crucial that all health research incorporates the gender perspective and that both male and female researchers participate and lead projects to contribute their knowledge and life experience as gendered beings. This perspective is essential to recognize the differentiated experiences of women, of all ages and circumstances, and to make their health and life problems research priorities.

The need to increase the presence of women in research is imminent, especially those with training in gender perspective. Traditional scientific culture has been transmitted without questioning and without including the perceptions and experiences of women, especially those from marginalized and subalternized sectors due to reasons of origin, social class, or age.

-How do you view the evolution of the field of health and research in relation to gender, and what do you think will be the key areas of research in the coming years?

The evolution of the field of health and research in relation to gender presents significant progress, with the European Commission giving greater importance to projects that transcend disciplinary boundaries. This approach encourages the integration of people from other disciplines, promoting interdisciplinarity as a common practice. The need for a more transversal and multidisciplinary perspective emerges, as interdisciplinary collaborations, although perceived in doctoral courses, are still not the norm.

It is important to break down barriers not only from a disciplinary point of view but also by promoting research with social responsibility, focusing on practical application, with instrument designs that incorporate the voices of those affected and with practices such as ethnographies that bring research closer to citizen realities.

It is also expected that socially excluded populations due to reasons such as climate change, wars, age, or disability will be incorporated. Likewise, it will be crucial to integrate the gender dimension and intersectional gender perspective, ensuring a more inclusive and equitable medical care and research for everyone, and giving a more active and protagonist role to women in all areas of their lives and in future generations.