Basnama Ayaz, a PhD student at the Lawrence Bloomberg Faculty of Nursing has received the Margaret McNamara Education Grant (MMEG) in support of her timely PhD research which seeks to explore from a human resource and health policy perspective, why the nursing profession in Afghanistan sees so few female nurses.
This is despite global efforts from development agencies like the World Bank, United States Agency for International Development (USAID), and European Commission (EC), to increase gender equity within the healthcare workforce through Afghanistan’s Ministry of Public Health.
“In the context of Afghanistan, we tend to blame the culture and the undereducation of women for these issues,” says Ayaz. “Yes, cultural norms and low literacy among women are big factors, but there are other professions like midwifery, that are seeing an acceleration of women entering their programs, so I wanted to understand what was preventing women from pursing a nursing education specifically.”
Ayaz’s work is of particular importance because the majority of Afghan women can only seek health care from female health care providers. It is also significant because it seeks to bolster the promotion of women in the workforce in a country that was progressively rebuilding a foundation for gender equity after the decline of the Taliban in 2001.
The MMEG established in 1981, was created to empower women from developing countries by supporting their education, so that they can build a better world. That is exactly what Ayaz has set out to do from the time she chose to pursue higher education and a career as a nurse.
Ayaz hails from Gilgit-Baltistan a remote province in Pakistan and is the first in her region and in her family to pursue a PhD degree in nursing, a significant accomplishment. She recalls the many social, culture, and geographic obstacles facing women from hometown when they sought out higher education including her own experiences, when she first set out to become a nurse.
“My parents were not educated at all, and my elder brothers were quite opposed to me attaining my education in nursing after completing grade 10,” says Ayaz. “However, one of my brother’s did support me and agreed to take responsibility for me while I stayed in Karachi to study, which ultimately set my entire career path in motion.”
Ayaz says one of her main draws to the nursing profession, in addition to helping others, was that nurses could embark on a path towards higher education and research. Ayaz wanted to use her education to create change for women seeking care. After graduating in 1997 with a nursing diploma from Aga Khan University, Ayaz worked on a surgical unit at the university hospital, where she witnessed a concerning trend. Women were not being consulted to consent for their medical procedures; sometimes, even a male child (18 years of age and older) provided consent for them instead.
“On several occasions, I argued with the surgical team about this procedure, but I realized it would be difficult for me to survive as a patient advocate or advance my career in a competitive and male-dominated society without higher education,” says Ayaz.
Spurred by this experience and a desire to change things, Ayaz went on to complete her BSc and then MSc degree in nursing before later being transferred to Afghanistan to assist their Ministry of Public Health in establishing training standards and policies within their nursing education programs, particularly the inclusion of women in the health workforce.
In 2012, Ayaz visited several provinces in the country to review their nursing programs and found that in most places, there were no female students to be found. This was a considerable problem, and Ayaz knew she needed to investigate further. She knew women were seeking out midwifery programs, based on their numbers, but there was an opportunity here for them to provide greater care for women as nurses.
“I wanted to understand why more women were choosing midwifery compared to nursing, and I firmly believed that in order to have equality in the health care workforce, we need equity in the process, and that would equate to requiring 85 per cent of nursing students to be female,” says Ayaz.
This question became the basis for her PhD and under the supervision of Professor Sioban Nelson, Ayaz is currently looking at the ways in which gender equity is constructed in human resource policies in Afghanistan and whether they actively promote women’s participation in the health care workforce.
Prior to the collapse of the government, it was the Ministry of Public Health’s priority to work on realizing certain sustainable development goals such as gender equality in the workforce, however, Ayaz notes that one of the key issues she is coming across in her current research is that implementation of policies promoting equity is a huge barrier.
“There are definitely communication gaps among several other factors,” says Ayaz. “Donors like the World Bank, USAID and EC as well as other NGO’s have also divided their supports among different sections of the country making implementation of consistent policies an issue.”
Due to the current fragile situation in the country, Ayaz’s research has had to change course, including having to cease interviews with stakeholders because of the high-risk environment. While Ayaz is hopeful her research will still be able to have an impact, she recognizes there will be challenges in disseminating her thesis to those who would benefit most, now that the ideology of the current regime has changed. She instead hopes that her thesis can be used for advocacy activity, to influence those in power, or to establish initiatives that will promote the role of women in the health care workforce, particularly as midwives, nurses, and physicians.
“It has been my goal for over 20 years to promote equal care and equal opportunity for women,” says Ayaz, “I am thankful to the MMEG, U of T, and Bloomberg Nursing for supporting my timely research and the work of women scholars around the world. I am also grateful for the support from the PhD program, particularly my thesis supervisor Professor Sioban Nelson for her extraordinary guidance in conducting my thesis research and contributing to realizing my goal.”