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Gender disparity in nursing and midwifery in Jamaica: Time for Action

Adella
Campbell

Tuesday, May 08, 2018

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It is long believed that gender stereotyping and marginalisation are barriers to males opting to study nursing and midwifery globally. What is the situation like for Jamaica in the 21st century? This article will focus mainly on nursing, although the concern resides with both professions.

Irrespective of gender, nurses and midwives have ethical, legal and professional responsibilities to patients, and implicit in this is the duty to cause no harm to patients. As such, males and females can equally choose to study nursing and midwifery as suitable career paths. However, the number of males choosing nursing and midwifery as suitable career paths is only marginally increasing. Nursing and midwifery remain female-dominated professions.

Notwithstanding this phenomenon, in some countries, such as Jordan, more males (95 per cent) constitute the nursing profession (Whiteside & Butcher, 2015).

By and large males seem challenged to enter traditionally female careers for disparate reasons. In contrast, females are less challenged to enter traditional male careers in health such as pharmacy, medicine and dentistry.

There's, however, a disconnect: Gender stereotyping is rife in the clinical settings, where male nurses and midwives are often perceived as doctors. In some cultures males are viewed as outsiders in nursing and midwifery and are often asked this infamous question, “Why didn't you do medicine?”

Generally, misconceptions pervade society as to how males fit into nursing and midwifery roles. Supervisors in some settings may also be guilty of perpetuating the stereotype by assigning males to male wards, and it is not unusual for male midwives to be forbidden in facilities caring for the childbearing family. This is quite troubling, since some members of the health team and some patients are often more acquiescent to male medical practitioners rather than male nursing and midwifery practitioners.

A frequently asked question is, if the males, on completing midwifery, will be called “mid-husband”? Mine is often the painful task of explaining that 'midwife' is a nomenclature used to describe a category of health practitioners; there is really no gender connotation to it. Further compounding this issue is the fact that males are often not amenable to some job titles used for nurses and midwives, for example 'sister' and 'matron'.

It is important to note that paid nursing was traditionally a male profession. While the current structure in the health field, including nursing and midwifery, does not directly translate to the provision of care in the past, a history of male presence in caring for those in need cannot go unnoticed. It is often said that males provided inordinate service, innovations, and historic credibility to the nursing profession. Historically, men (Parabolani) in ancient Rome provided nursing care during 300 AD. Early religious, military and lay orders comprised men who provided nursing care during the Middle Ages. Among them were St Benedict, who founded the Benedictine nursing order, the Knights of St Lazarus, the Knights Hospitallers (Order of St John), the Hospital Brothers of St Anthony, and the Teutonic Knights. Further, the term “nosocomial” meaning “hospital” is derived from the term 'nosocomi' the name for male caregivers.

During the Crimean War, male orderlies (attendant in a hospital) provided nursing care prior to and after Nightingale's and Mary Seacole's arrival. In addition, after the Battle of Solferino in 1859, Jean Henry Dunant administered care to the sick. He was instrumental in establishing the International Red Cross and the Geneva Convention. He won the first Nobel Peace Prize in 1901. By the same token, men served as nurses during the US Civil War. Male nurses were mainly on the front line while female nurses were often restricted to hospitals.

The professions of nursing and midwifery education and practice in Jamaica are grounded in the British system. In addition, we have reciprocity with the United Kingdom and, as such, I will draw on their experience.

During the mid-16th century males provided maternity services to women in need. For example, there were men-midwives such as Percival Willoughby, Fielding Ould, and Matthew Carter. Of note, is that some of these practitioners, although described as men-midwife, were also medical doctors.

It is believed that the world's first nursing school, founded in India about 250 BC, only had male students because they were considered 'pure'. Following this, the Mills School for Nursing and St Vincent's Hospital School for Men were founded in New York in 1888. The Pennsylvania Hospital in 1914 also opened nursing school for men. By comparison, during the post-19th century epoch, men were forbidden to attend some nursing schools, for example in the United States of America. This resulted in interventions by the American Assembly for men in nursing to reorient this thinking and had males trained in established nursing schools.

The wars of the 19th and 20th centuries annihilated the male population, resulting in significant transformation of the nursing profession. It morphed from being a male-dominated career to a female-dominated profession. Further, Nightingale's era led to the association of the profession of nursing with women and seemingly the departure of men from this career. Nightingale's idea of a nurse was unequivocally female; she held the belief that “every woman is a nurse”.

This shift of men out of nursing should also be considered within the context of the prevailing ideology of the Victorian era. This period saw an emergence of commanding male and female stereotypes, which are still dominant today, resulting in further feminisation of nursing.

In Jamaica, during the plantation era, there were 'sick nurses', 'grandee', 'nanas', and 'doctresses' suggesting that nursing and midwifery services were offered mainly by females.

There's a dearth of literature regarding the history of males in nursing and midwifery in Jamaica. Males in Jamaica, however, have been accessing various training programmes, albeit in small numbers. The first male midwife to be trained was George Marshall, who earned his place in various positions, including director at the Kingston School of Nursing.

Checks with the regional health authorities revealed that there are 58 males working in various health institutions across the country. Of note, however, is that 10 of these males are expatriates from Cuba. This is less than two per cent of the nursing and midwifery population in Jamaica.

Checks with nursing schools across the country revealed that there are 18 male students in training at the Caribbean School of Nursing, pursuing the BSc Nursing and Midwifery courses of study. There were an additional 23 male students in training at the other nursing schools.Of note is that in some instances, men's choice to study nursing and midwifery is not supported by family and peers, and as such, serves as a deterrent to enter the profession.

On completion of training, however, because of gender-based role stress and intimate-touch required in nursing and midwifery care, males opt to work in areas with non-feminine roles such as psychiatry/mental health, technical and rapid assessment areas such as emergency room, intensive care units, operating theatres, male wards, and advanced practice nursing (nurse practitioner and nurse anaesthesia).

Males in nursing in Jamaica argue that, while they enjoy good working relationships with staff and patients generally, they sometimes encounter pockets of stereotyping among their female counterparts. They add that while it is accepted for male doctors to perform tasks in physically vulnerable positions, they usually encounter challenges.

It is safe to conclude that, despite a marginal increase in males entering the profession of nursing and midwifery, fewer males than females view nursing and midwifery as viable career options. It is also true that since the 19th century feminisation of these careers, males have embraced the status quo, resigned to societal perceptions, and opt for career choices that are considered masculine.

To overcome these hurdles proponents have intimated that attracting males to the field of nursing and midwifery require:

1) reorientation in public perceptions of nursing and midwifery as women's career;

2) a change of the nomenclature;

3) strategies to tackle the gender-imbalance in nursing and midwifery;

4) sensitisation of the public generally towards acceptance of males in nursing and midwifery by patients and health practitioners;

5) chaperones where necessary;

6) encourage diversity in nursing and midwifery; and

7) manage hostility to males in nursing and midwifery once detected.

I concur with these strategies. Tackling gender disparity in nursing and midwifery in Jamaica requires concerted effort. For this reason, I implore families, communities, relevant ministries, policymakers and stakeholders in health, to embrace diversity in nursing and midwifery. This will, no doubt, redound to the benefit of the nation's health care system.

Adella Campbell, PhD, JP, is an associate professor and head of the Caribbean School of Nursing at the University of Technology, Jamaica. Send comments to the Observer or adcampbell@utech.edu.jm.


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