Presentation in the UNESCO's regional conference on women's health and research (Cairo University, Dec. 8, 2011)

1. Assistant Professor of Bioethics
Faulty of medicine, King Fahad Medical City
Riyadh, Saudi Arabia
Email: ghaiathme@gmail.com
Phone: 00966566511653

2. • Basic definitions
• What are the sources of ethical concerns in
healthcare for and research on/for women?
• Conceptual challenges related to care for
women
• Ethical challenges to healthcare for women
• Examples of the ethical issues that arise
during provision of care to women
• Ethical challenges to research on/for women
• Recommendations for future steps

3. What do we mean by
Ethics Conceptual Practical
To what do we refer in
Morality: the beliefs and deciding what is How are we going to so
standards of good and bad, right/wrong? what we decided as right
right and wrong, in healthcare, research?
Philosophy? Utlitarian,
Ethics is defined as the deontology, feminisme, virtue,
systematic study of morality. rights-based, principle-based?
How are we going to
manage situations when
Bioethics: is normative ethics ethical guidance is
applied to decision-making and violated?
Religion? Islam? Which
public policy in the domains of interpretations? Christianity?
biology, health care and Which church?
research.

4. What makes healthcare/research to
women ethically sensitive?
Status Ethical implications
•Diminished physical  diminished decision-making capacity
power Prone to coercion, abuse, exploitation
•Less educational levels Absent or inefficient contribution to care/research
(bear more burden, e.g. contraceptives)
•Less involvement in Less representation in ethics committees (policy,
ethics research, clinical)
•Economic dependence Diminished access to care
•Diminished political Laws/regulations/guidelines that protect woman
empowerment are either absent, irrelevant, or not affective
Lack of gender-sensitive healthcare (research
agenda)
Diminished representativeness in research
oversight mechanisms
•As a child-bearer Restricted personal rights (vs. rights of the fetus
&/or the father?)

5. Conceptual Challenges
• Lack of guidance (moral status of fetus,
surrogacy, new RH technologies)
• Contradicting guidance (national vs. int’l)
• Different interpretations of notions in
guidance (int’l declarations)
• De-alignment of legal and ethical guidance
• Dominance of community values over
religious guidance (female circumcision)
• Abuse of variation in religious interpretations
▫ catholic church and pro-life groups
▫ irrational jurisprudence rulings (Fawtas)

6. Practical challenges in care provision
• Lack of gender-sensitive healthcare
▫ Waiting areas
▫ Privacy
▫ Confidentiality (e.g. husband access to the wife’s
medical information)
• Gender insensitive policies (e.g. consent)
• Male-led management
• Gender insensitive (discriminative) practices
(e.g. C-sections)

7. Examples of gender imbalanced care
• Men’s interference (marital authorization) in the women’s RH
decisions (contraception, abortion, protected sex);
• Diminished freedom of consent (in non-RH issues)
• Woman’s right to know (her spouse’s STD status, treatment
alternatives, etc.)
• STDs protection (and contraception) is more woman-dependant
(pills, IUCDs, hormonal therapy, etc.)
• Women with HIV/AIDS: right to treatment, stigmatization,
confidentiality, counseling strategies on pregnancy continuation/
termination, future child bearing, and use of contraception
• Breach of woman’s confidentiality by male family members
• Women get tested in ANC visits, while men are discovered only
on voluntary basis (except for visa purposes?)
• Women’s dependence on men to get access to care
• Undue denial of safe abortion, even when religiously allowed

9. Challenges related to research
Research Research
Research topics
methodologies oversight
•Clinically-focused • Inclusion/exclusion • Women’s issues
topics biases (risks) are not well
•Lack of gender- • Facility-based acknowledged
related studies on studies (access) • Ethical guidelines
determinants of • Consent are developed
• ‘don’t get pregnant mostly by ‘white
health
during trial’ men’
•Lack of studies on
• Inadequate • Gender-
vulnerable groups Imbalanced REC
among women (age, Compensation
memberships
sexual-orientation,
disability)

10. How our network can help in
resolving conceptual and
practical challenges to women’s
health & research?

11. Approach to ethical challenges in healthcare
• Individual level
▫ Raise awareness about patients right, in general, and women’s
right in particular
▫ Positive involvement of men in advocacy for women
▫ Assist in minimizing the women’s illiteracy and financial
dependence
• Organizational/Institutional level
▫ Provide gender-sensitive care (waiting areas, examination
rooms ,etc.)
▫ Train providers on ethics (FAB)
▫ Balanced gender management
• Policy-making level
▫ Develop gender-sensitive policies
▫ Encourage women involvement in policy-setting
▫ Continuous communication with Ulama (scholars) regarding
women health
▫ Advocate for women’s health issues among politicians and
policy makers

12. Approach to ethical challenges in
research
• Train researchers in research ethics, especially vulnerability
• Improve gender balance in REC structures
• Educate ethics committees members on women’s health
research, gender analysis, and participatory action
methodologies, and to ensure gender issues and analysis are
part of funding criteria
• Train more female researchers on research methods and
ethics
• Encourage/Adopt community-based methodologies
• Review the current guidelines to makes them more gender-
sensitive
• Funding agencies should encourage research with members
reflecting the diversity of the population;
• North-South exchange of experience and head for sustainable
development, guided by the MDGs related to maternal health

13. Questions and
Discussion
Please feel free to contact me:
Ghaiath M. A. Hussein
Email: ghaiathme@gmail.com
Phone: 00966566511653
Website:
https://sites.google.com/site/medicalethicscourse