OBJECTIVE: Communication tools have long been used to address complex social policy problems, known as wicked problems, in communities around the world. However, the challenge has remained, how do we measure the impact of social change with communication for development (C4D)? Evaluators recommend utilising evaluation tools that take a wider systems-based approach to assist in the evaluation of C4D projects. Health Communication Resources (HCR) Inc., a health promotion charity that supports C4D projects around the world, aimed to trial a tool to assist evaluation of a project addressing gender inequality, an underlying driver of family violence in the community.
METHODS: WickedLab\'s tool for systemic change was utilised to assist the evaluation of the complex adaptive system. The research team mapped the system that existed in Geraldton working towards addressing the wicked problem of gender inequality.
RESULTS: Mapping the system highlighted how integral C4D actions were in maintaining and strengthening the system as it works together towards gender equality in the community.
CONCLUSIONS: A systems-based approach can strengthen evaluation and demonstrates the role C4D projects play in addressing wicked problems in a defined location. SO WHAT?: WickedLab\'s tool for systemic change provides significant potential for the evaluation of other health promotion and communication for development projects.

This article exploits the unique consequences of the COVID-19 pandemic outbreak to examine whether time constraints drive the unequal division of unpaid labor between dual-earner couples in Israel. Using the first wave of longitudinal household data that was collected in Israel since the outbreak of the pandemic, we focused on 325 dual-earner couples who stayed employed during the first lockdown. By employing OLS regressions, we examined the association between changes in employment hours and changes in unpaid labor for partnered men and women. Strong evidence was found for a gendered translation of the time constraints mechanism: A decrease in hours of paid work is related to an increase in hours of care for children among men and women, but time devoted to housework increased only among women. We conclude that time constraints that resulted from the dramatic effect of the first lockdown on paid and unpaid work in Israel did not significantly change the gender division of unpaid housework but did change the distribution of childcare. The theoretical implications of this conclusion for future research are discussed.

This article analyses mothers\' work decisions and their determinants during the first three years of their children\'s life, based on data from a survey of 1219 mothers in the Barcelona area during 2020. The factors affecting the probability of mothers reducing their working day or leaving their job after having a child are studied through a descriptive analysis, as well as by estimating a multinomial logic model. The results obtained indicate the relevance of the following aspects: the mother\'s income level, her level of education, the number of children and the fact of having the daily help of grandparents for childcare. The survey data show that the main reason mothers decide to reduce their working day or leave their job is to care for their children. These results are relevant for the design of childcare policies and work-life balance policies with the aim of avoiding gender inequalities in the future.

Mobile applications (apps) have gained significant popularity as a new intervention strategy responding to violence against women and girls. Despite their growing relevance, an assessment from the perspective of public health ethics is still lacking. Here, we base our discussion on the understanding of violence against women and girls as a multidimensional, global public health issue on structural, societal and individual levels and situate it within the theoretical framework of structural injustice, including epistemic injustice. Based on a systematic app review we previously conducted, we evaluate the content and functions of apps through the lens of structural injustice. We argue that technological solutions such as apps may be a useful tool in the fight against violence against women and girls but have to be situated within the broader frame of public health that considers the structural dimensions of such violence. Ultimately, the concerns raised by structural injustice are-alongside key concerns of safety, data privacy, importance of human supportive contact, and so forth-crucial dimensions in the ethical assessment of such apps. However, research on the role and relevance of apps as strategies to address the structural and epistemic dimensions of violence remains scarce. This article aims to provide a foundation for further discussion in this area and could be applicable to other areas in public health policy and practice.

Persistent low rates of spacing contraceptive use among young wives in rural India have been implicated in ongoing negative maternal, infant and child health outcomes throughout the country. Gender inequity has been found to consistently predict low rates of contraception. An issue around contraceptive reporting however is that when reporting on contraceptive use, spouses in rural India often provide discordant reports. While discordant reports of contraceptive use potentially impede promotion of contraceptive use, little research has investigated the predictors of discordant reporting.
Using data we collected from 867 couples in rural Maharashtra India as part of a men-focused family planning randomized controlled trial. We categorized couples on discordance of men\'s and women\'s reports of current contraceptive use, communication with their spouse regarding contraception, and ideal family size, and assessed the levels of discordance for each category. We then ran multinomial regression analyses to determine predictors of discordance categories with a focus on women\'s empowerment (household and fertility decision-making, women\'s education, and women\'s knowledge of contraception).
When individuals reported communicating about contraception and their spouses did not, those individuals were also more likely to report using contraception when their spouses did not. Women\'s empowerment was higher in couples in which both couples reported contraception communication or use or in couples in which only wives reported contraception communication or use. There were couple-level characteristics that predicted husbands reporting either contraception use or contraception communication when their wives did not: husband\'s education, husband\'s familiarity with contraception, and number of children.
Overall there were clear patterns to differential reporting. Associations with women\'s empowerment and contraceptive communication and use suggest a strategy of women\'s empowerment to improve reproductive health. Discordant women-only reports suggest that even when programs interact with empowered women, the inclusion of husbands is essential. Husband-only discordant reports highlight the characteristics of men who may be more receptive to family planning messages than are their wives. Family planning programs may be most effective when working with couples rather than just with women, and should focus on improving communication between couples, and supporting them in achieving concordance in their reproductive preferences.
Clinical Trials Number: NCT01593943 , registered May 4, 2012 at clinicaltrials.gov.

Despite 20 years of democracy, South Africa still suffers from profound health inequalities. Gender roles and norms are associated with individuals\' vulnerability that lead to ill-health. For instance, gender inequality influences women\'s access to health care and women\'s agency to make health-related decisions. This paper explores gender-awareness and inclusivity in organisations that advocate for the right to health in South Africa, and analyses how this knowledge impacts their work?
In total, 10 in-depth interviews were conducted with members of The Learning Network for Health and Human Rights (LN), a network of universities and Civil Society Organisations (CSOs) which is explicitly committed to advancing the right to health, but not explicitly gendered in its orientation.
The results show that there is a discrepancy in knowledge around gender and gendered power relations between LN members. This discrepancy in understanding gendered power relations suggests that gender is \'rendered invisible\' within the LN, which impacts the way the LN advocates for the right to health.
Even organizations that work on health rights of women might be unaware of the possibility of gender invisibility within their organisational structures.

BACKGROUND: Although leprosy can affect both sexes equally, it is globally reported that men are affected, or simply report, more often than females at the average ratio of 2:1. If cases are simply not being reported, women may be suffering in silence more often than men, and, therefore, understanding the social reasons for this in a number of countries could support the prevention of long-term disabilities caused as a result of leprosy.
OBJECTIVE: The objective of this review is to recognise the current academic literature surrounding the potential factors for late diagnosis of women affected by leprosy, giving possible explanations for the 2:1 gender disparity observed in case detection globally. It is hoped that health practitioners will become more equipped to recognise these barriers and ensure they are doing whatever possible to encourage women to report the early symptoms of leprosy.
METHODS: The review used a systematic search process in order to identify gender-related publications using robust research, useful for gleaning a cross-cultural perception of issues women may confront on the prospect of a diagnosis of leprosy.
RESULTS: Identifying 12 publications from just five countries, the review found there to be four overarching areas which may be considered barriers more often faced by women: societal stigma; women\'s dependence and low status; self-stigmatising attitudes; and the gender insensitivity of leprosy services.
CONCLUSIONS: Stigma surrounding leprosy experienced from these four overarching areas can all be attributed to the later diagnosis of women affected by leprosy, in relation to their male counterparts. The need for future research surrounding the specific experience of women affected by leprosy is pressing.