This document discusses the challenges of conducting qualitative health policy and systems research studies from a gender perspective. It notes that research often fails to sufficiently consider gender as a social relation and that the governance of the field lacks attention to power dynamics. The document then reflects on discussions from a meeting of researchers where they shared challenges of addressing gender and power in their work, such as resistance to gender analysis, misunderstandings of gender concepts, and power imbalances in research methods and relationships with respondents. Recommendations include building capacity on positionality, using participatory methods, and developing context-specific strategies to challenge norms respectfully.

1. 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

2. KEMRI-Wellcome Trust colleagues
Lucy Gilson & Catherine Goodman
Benjamin Tsofa Edwine Barasa Mary Nyikuri Evelyn Waweru

3. Colleagues from RinGs
a partnership bringing together 3 consortia
to galvanise gender and ethics thinking in HPSR

4. 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

5. Journal of International Development
J. Int. Dev. 21, 309–326 (2009)
Developing World Bioethics, 2016
ISSN 1471-8731 (print); 1471-8847 (online)

6. Voices from the research team… three
‘talking heads’
http://resyst.lshtm.ac.uk/resources/video-learning-more-about-ethics-
health-systems-research-kenya

7. 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

8. 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

9. 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.

10. 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

11. 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

12. 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

13. 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?

14. 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.

15. 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

16. Contact us & stay in touch
• Website: http://resyst.lshtm.ac.uk/rings
• E-mail: RinGs.RPC@gmail.com
• Twitter: @RinGsRPC
• Linked In: https://www.linkedin.com/groups/Gender-
Health-Health-Systems-Group-8293050/about
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• website: http://resyst.lshtm.ac.uk/rings