Hostname: page-component-7c8c6479df-94d59 Total loading time: 0 Render date: 2024-03-18T06:28:59.325Z Has data issue: false hasContentIssue false

GROW: a model for mentorship to advance women's leadership in global health

Published online by Cambridge University Press:  22 April 2018

K. M. Yount*
Affiliation:
Hubert Department of Global Health and Department of Sociology, Asa Griggs Candler Chair of Global Health, 1518 Clifton Rd. NE, Atlanta, GA 30322, USA
S. Miedema
Affiliation:
Department of Sociology, Emory University, Atlanta, Georgia, USA
K. H. Krause
Affiliation:
Department of Behavioral Sciences and Health Education, Emory University, Atlanta, Georgia, USA
C. J. Clark
Affiliation:
Hubert Department of Global Health, Emory University, Atlanta, Georgia, USA
J. S. Chen
Affiliation:
Hubert Department of Global Health, Emory University, Atlanta, Georgia, USA
C. del Rio
Affiliation:
Hubert Department of Global Health, Emory University, Atlanta, Georgia, USA
*
*Address for correspondence: Kathryn M. Yount, Hubert Department of Global Health and Department of Sociology, Asa Griggs Candler Chair of Global Health, 1518 Clifton Rd. NE, Atlanta, GA 30322, USA. (Email: kyount@emory.edu)
Rights & Permissions [Opens in a new window]

Abstract

In this essay, we discuss the under-representation of women in leadership positions in global health (GH) and the importance of mentorship to advance women's standing in the field. We then describe the mentorship model of GROW, Global Research for Women. We describe the theoretical origins of the model and an adapted theory of change explaining how the GROW model for mentorship advances women's careers in GH. We present testimonials from a range of mentees who participated in a pilot of the GROW model since 2015. These mentees describe the capability-enhancing benefits of their mentorship experience with GROW. Thus, preliminary findings suggest that the GROW mentorship model is a promising strategy to build women's leadership in GH. We discuss supplemental strategies under consideration and next steps to assess the impact of GROW, providing the evidence to inform best practices for curricula elsewhere to build women's leadership in GH.

Type
Perspective
Creative Commons
Creative Common License - CCCreative Common License - BY
This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.
Copyright
Copyright © The Author(s) 2018

Women's under-representation in global health leadership

Women are under-represented in leadership in global health (GH) across academic, governmental, and non-governmental institutions [Reference Barry1Reference Downs4]. Across 191 countries, only 51 have a woman minister of health [Reference Magar5]. At Emory University, 91% of undergraduate minors and 84% of masters students in GH are women; yet, 75% of full professors (31 of 41) and 75% (six of eight) of named professors in GH are men. Women, including women of color, sexual minority women, indigenous women, other minority women groups, and women from lower income countries, remain disproportionately under-represented in leadership positions [6]. Women from different backgrounds face disparate barriers to leadership, which must be overcome to support the leadership potential of all women in GH [Reference Bowleg7].

Rationale for women's leadership in GH

Women's representation in GH leadership matters on the simple grounds of justice. Empirically, women make up 50% of the world's population, bear the unique burden of certain causes of death [Reference Alkema8], experience more years than men of life lost due to disability [Reference Vos9], comprise at least two-thirds of the GH workforce [Reference Magar5], and provide disproportionate unpaid care for the sick [Reference Magar5, Reference Berg and Woods10]. Women contribute around US$3 trillion to GH care, but nearly half of this (2.4% of global gross domestic product) is unpaid [Reference Dhatt2]. Given women's unique needs and contributions, women should have equal formal, descriptive, and substantive representation in the ranks of GH leadership. Equality in formal representation means having the same opportunities as men to participate in leadership, without discrimination based on gender or other intersecting identities. Equality in descriptive representation means that women are represented in equal numbers in positions of leadership. Equality in substantive representation means that women's interests are advocated in decision-making circles. Emerging evidence suggests that women need to be in leadership to have their interests represented [Reference Swers and Rouse11, Reference Wängnerud12].

Call to action and role of women's mentorship networks

The recent inaugural Women Leaders in Global Health (WLGH) conference established principles to advance women's leadership in GH. Recommended strategies included increasing the visibility of women by ensuring gender balance in all spheres of academia, nominating and promoting women for important committees and awards, advocacy for a culture that values work-life integration, eliminating gender gaps in pay, cultivating thought leadership among women professionals, addressing data gaps that mask persistent gender disparities in leadership, and promoting accountability. One strategic priority of the WLGH Initiative includes mentorship for women's leadership in GH.

GROW empowerment model for mentoring women leaders in global health

Given this ambitious agenda, models for mentorship are needed to position women for leadership in GH [Reference Talib and Barry3, Reference Downs4]. Mentorship can be a powerful tool to enhance the capabilities of individual women and to strengthen their collective capabilities to advance in the ranks. Our focus on mentoring to enhance capabilities differs from the typical psychosocial and professional outcomes that feature in the mentoring literature [Reference Hopwood13, Reference Dominguez14]. Enhancing individual and collective capabilities are essential to empower women for leadership in GH.

Here, we describe the theory of change and present pilot data for the mentorship model, Global Research for Women (GROW). GROW is an interdisciplinary, global initiative to catalyze empowerment, health, and freedom from violence for women and girls globally. Our guiding principle is that women's and girls’ empowerment is a pillar of sustainable development and is inextricably linked with their health and freedom from violence. Our strategic priorities are to advance scholarship, to cultivate leadership, and to generate dialogue that catalyzes social change through evidence-based policies, programs, and collective action for women's and girls’ empowerment.

Inclusive with all women and with men, the GROW mentorship model is adapted from a theory for women's empowerment developed by feminist economist, Naila Kabeer [Reference Kabeer15]. We define women's empowerment in GH as the process by which women acquire new human, economic, and social resources, which enable them to exercise agency, or the capacity to make strategic life choices to enhance their professional development in a context in which these capabilities were once denied. Below, we describe the components of this empowerment-based mentorship model to advance women's careers in GH (Fig. 1).

Fig. 1. GROW empowerment model for mentorship and the advancement of women's leadership in global health.

Expanding human resources involves advanced theoretical and methodological training enabling scholars to acquire new knowledge and skills in subfields of GH; opportunities to lead and to co-author publications with our global network of affiliates; in-country practicums to build field experience; guidance on how to build effective teams for research, practice, or advocacy; discussions on emotional intelligence, including skills to negotiate on one's own behalf and to manage professional conflicts; and training on ethical principles for robust work in GH.

Investing economic resources includes advocacy for undergraduate, graduate, and post-graduate scholarships; recommendations for prominent internal and external fellowships, awards, and positions; mentorship on grant writing; opportunities to participate on externally funded team projects at all stages of career; and financial support to attend and to present at professional conferences.

Expanding social resources includes integration into interdisciplinary, project-based teams and peer groups to build collaborations; exposure to formal and informal professional networks; opportunities to attend professional conferences; introductions to professionals with similar career interests; and in-country internships to deepen global networks. Social resources also include the amplification of accomplishments via the media, including press releases, webinars, newsletters (http://www.growemory.org/archives), blogs (http://www.growemory.org/growblog), and social-media posts.

Agency is an intermediate outcome that may arise from the above enabling resources. Agency encompasses an intrinsic belief in one's capabilities, the strategic enactment of one's aspirations or preferences, and the collective action of women to advance women's leadership in GH. Intrinsic agency, or power within, entails the development of self-confidence, self-efficacy, and a critical awareness of one's professional worth and potential contributions. Instrumental agency, or power to, entails the enactment of strategic, or meaningful, decisions that advance one's career. Collective agency, or power with, entails a group's shared belief in its joint capabilities to organize and to execute mutually agreed actions for shared achievements. More than the sum of individual agencies, collective agency emerges from the interactive, coordinated, and synergistic dynamics of the group [Reference Bandura16]. Intrinsic and instrumental agency, as individual-level outcomes of mentoring, are rarely examined in mentoring models [Reference Hopwood13, Reference O'Meara17]. Collective agency has never been conceptualized or measured as an outcome of network-based models for mentoring. Through these pathways, GROW leverages the achievements of women leaders in GH to benefit women at all career stages.

An overarching theme of GROW is feminist praxis. Research documenting the inequalities, injustices, and violence faced by women and girls, and advocacy for women's equality, has been met with scrutiny, and even backlash [Reference Dragiewicz and Mann18]. GROW trains scholars to develop new theory and to apply rigorous methods, producing exceptional evidence to meet this resistance and to inform debates that advance women's interests. GROW's mission to empower early career professionals to produce scholarship of exceptional quality necessitates robust, feminist approaches to the design, implementation, analysis, and dissemination of research [19]. Mentorship from senior GROW affiliates on feminist ethical guidelines enables scholars to balance participant autonomy and safety in each study of empowerment and violence. GROW's networks provide opportunities for training on disciplinary standards within this specialized field.

Testimonials from GROW mentees

In Table 1, we present qualitative testimonials from graduates who received a pilot implementation of GROW since 2015. Qualitative evidence suggests that the focus on empowerment is attractive and capability enhancing. Trainees highlight the relevance of an interdisciplinary network supporting mutual growth, and rigorous research undergirded by a shared commitment to improve collectively the lives of women and girls. Excerpts from testimonials contextualize the capability-enhancing benefits realized by graduates mentored using the GROW framework. These testimonials reveal how GROW mentees have benefitted from the resources provided and the enhanced agency cultivated to advance their careers in GH. More information about the GROW network, access to scientific resources, and testimonials of the capability-enhancing benefits of GROW can be found at http://growemory.org/.

Table 1. Testimonials of the impact of GROW mentorship on the capabilities for leadership in global health

Excerpts include testimonies from women and one man mentee of GROW.

Next steps

Our pilot data suggest that the GROW model to build women's leadership in GH is promising. GROW strategies continue to evolve as we recognize, build up, and realize the potential for women's leadership in GH, inclusive of all women in this field. Our team is surveying masters-of-public-health and mid-career fellows alumni to assess, using the GROW model, (1) the human, economic, and social resources that men and women received during their usual training and (2) the associations of these resources with the measures of career-related intrinsic and instrumental agency and with acquiring a leadership position in GH. This survey will enable us to select additional content to further the leadership capabilities of women in GH. We expect that post-graduate leadership training and on-going career mentoring will be a promising supplemental strategy. If the survey findings corroborate our expectations, we will design a supplemental program and conduct a randomized-controlled trial to compare the empowerment processes and career trajectories of women graduates randomly selected for the program, v. women graduates randomly selected for usual training only and all male graduates in the same cohorts who receive usual training. A favorable causal impact of the program would guide best practices for all Departments of Global Health to modify and to supplement their graduate curricula in ways shown causally to enhance women's leadership in GH.

Acknowledgements

The authors thank Dr. Michelle Lampl, Director of the Center for the Study of Human Health, and Ms. Agnes Mackintosh, Associate Director of Program Innovations and Development at the Center for the Study of Human Health, for providing data on the gender distribution of undergraduate minors in Global Health at Emory University.

References

1.Barry, M, et al. 2017 A new vision for global health leadership. The Lancet 2017, 390(10112) 25362537.Google Scholar
2.Dhatt, R, et al. The role of women's leadership and gender equity in leadership and health system strengthening. Global Health, Epidemiology and Genomics 2017; 2.CrossRefGoogle ScholarPubMed
3.Talib, Z, Barry, M. Women leaders in global health. The Lancet Global Health 2017; 5: e565e566.Google Scholar
4.Downs, J, et al. Increasing women in leadership in global health. Academic Medicine 2014; 89: 11031107.Google Scholar
5.Magar, V, et al. Women's Contribution to Sustainable Development Through Work in Health: Using a Gender Lens to Advance a Transformative 2030 Agenda. Health Employment and Economic Growth: An Evidence Base Geneva. World Health Organization Forthcoming, 2016.Google Scholar
6.American Association of University Women. Barriers and Bias: The Status of Women in Leadership. Washington DC: AAUW, 2016.Google Scholar
7.Bowleg, L. The problem with the phrase women and minorities: intersectionality – an important theoretical framework for public health. American Journal of Public Health 2012; 102: 12671273.CrossRefGoogle ScholarPubMed
8.Alkema, L, et al. Global, regional, and national levels and trends in maternal mortality between 1990 and 2015, with scenario-based projections to 2030: a systematic analysis by the UN Maternal Mortality Estimation Inter-Agency Group. The Lancet 2016; 387: 462474.Google Scholar
9.Vos, T, et al. Global, regional, and national incidence, prevalence, and years lived with disability for 310 diseases and injuries, 1990–2015: a systematic analysis for the Global Burden of Disease Study 2015. The Lancet 2016; 388: 15451602.CrossRefGoogle Scholar
10.Berg, JA, Woods, NF. Global women's health: a spotlight on caregiving. The Nursing Clinics of North America 2009; 44: 375384.Google Scholar
11.Swers, ML, Rouse, SM. Descriptive Representation: Understanding the Impact of Identity on Substantive Representation of Group Interests. 2011. The Oxford Handbook of the American Congress Oxford: Oxford University Press. 242271.Google Scholar
12.Wängnerud, L. Women in parliaments: descriptive and substantive representation. Annual Review of Political Science 2009; 12: 5169.CrossRefGoogle Scholar
13.Hopwood, N. A sociocultural view of doctoral students’ relationships and agency. Studies in Continuing Education 2010; 32: 103117.Google Scholar
14.Dominguez, N. A Research Analysis of the Underpinnings, Practice, and Quality of Mentoring Programs and Relationships. Los Angeles, London, New Delhi, Singapore, Washington, DC, Melbourne: The SAGE Handbook of Mentoring: SAGE Publications Ltd, 2017, 6785.Google Scholar
15.Kabeer, N. Resources, agency, achievements: reflections on the measurement of women's empowerment. Development and Change 1999; 30: 435464.Google Scholar
16.Bandura, A. Exercise of human agency through collective efficacy. Current Directions in Psychological Science 2000; 9: 7578.CrossRefGoogle Scholar
17.O'Meara, K. Advancing graduate student agency. Higher Education in Review 2013; 10: 110.Google Scholar
18.Dragiewicz, M, Mann, RM. Special edition: fighting feminism-organised opposition to women's rights; guest editors’ introduction. International Journal for Crime, Justice and Social Democracy 2016; 5: 15.Google Scholar
19.World Health Organization. Putting Women First: Ethical and Safety Recommendations for Research on Domestic Violence against Women. Geneva: World Health Organization, 2001.Google Scholar
Figure 0

Fig. 1. GROW empowerment model for mentorship and the advancement of women's leadership in global health.

Figure 1

Table 1. Testimonials of the impact of GROW mentorship on the capabilities for leadership in global health