Gender and culture-informed approaches

Why is gender relevant to how charities deliver services?

Social norms and expectations around gender shape our experience every day of our lives. We know that:

• Women are around five times as likely as men to experience abuse, physical violence or sexual violence (5% of women vs. 1% of men).
• Women are three times more likely than men to experience common mental health problems, such as anxiety and depression.
• Women who experience trauma are more likely than men to experience additional psychological harm as a result. Traumatised women have been found to be at higher risk of clinical disorders such as PTSD, anxiety, depression, self-harm, eating disorders and emotionally unstable personality disorder.
• Women who have experienced abuse, including sexual abuse, are over-represented in the criminal justice system. More than half of women in prison have experienced domestic violence (over double the rate for men), and one in three have experienced sexual abuse (compared to one in ten men).
• Women in prison are more likely than their male counterparts to have a mental health condition and to use substances.
• Women have more regular caring responsibilities than men, including doing more than double the amount of unpaid childcare, and are more likely to define their lives in relation to their homes and children.

Women’s experiences influence their needs when accessing services from charities and statutory organisations. But research suggests that many services supporting people facing multiple disadvantage fail to consider the specific needs women are more likely to have, sometimes even being designed solely around men by default (perhaps inadvertently).

For example, given the higher rates of physical and sexual violence against women, and the strong association between this violence and mental ill-health, mental health services caring for women should consider how to care for someone who has suffered gendered violence and abuse. This is critical to stop services inadvertently acting like ‘another abuser’ by taking control of a woman in a way that mirrors her previous trauma, which could potentially re-traumatise her. This may include not permitting male staff to restrain women, not assigning male staff to conduct one-to-one observation on women, and strictly segregating male and female accommodation in in-patient settings.

At a simpler level, women can find it harder to access services because they’re more likely to have greater caring responsibilities. Few mental health and substance misuse services provide childcare, which makes them difficult for some mothers to access. Similarly, a service with inflexible appointments may not work for some women with children to look after and the school-run to do.

At the same time, don’t jump to conclusions about women’s experiences. Society’s expectations of women as mothers and ‘homemakers’ can lead to women who have experienced homelessness, prison, or who have had children taken from their care feeling deeply shamed or guilty. Such shame may lead them to withhold information, which can hamper their recovery. Services should be aware of what women are more likely to need, but still treat everyone as an individual by practicing trauma-informed care.

Stigma is one of the few areas where the academic literature on gender norms also mentions men’s specific experiences. Robinson et al discuss how men with poor mental health had distinct gendered concerns about showing vulnerability and being unemployed, which plays into society’s expectations of men as breadwinners. Their research showed that activities in a non-stigmatising location and promoted without specific reference to ‘mental health’ were more appealing to men.

How do men and women’s experience of multiple disadvantage differ?

Lankelly Chase’s 2015 Hard Edges research showed that multiple disadvantage overwhelmingly affects men. 78% of people affected by all three of homelessness, substance use and offending were men.

However, further research from 2020 which used an updated definition of multiple disadvantage (including experience of violence and abuse and poor mental health) showed that “a significant number of women […] face combinations of severe disadvantage at least as serious as those faced by men and on an equivalent scale.” In fact, of the 17,000 people in Britain experiencing all four of homelessness, substance misuse, mental ill-health and domestic abuse at any one time, 70% are women.

This demonstrates that while similar numbers of women face multiple disadvantage as men, the types of disadvantage they experience are different. Women are more likely to have experienced abuse and poor mental health, and men more likely to have offending histories.

Why is culture relevant to how charities deliver services?

Research suggests cultural background can significantly impact what people need and whether services are accessible to them. A 2019 study into addiction and recovery among Nottingham’s Black, Asian and Minority Ethnic community (BAME) showed that for some substance users their traumatic experiences of racist discrimination were partly to blame, but that shame and stigma of addiction in some communities (e.g. with Sikh heritage) kept their addiction hidden.

‘BAME’ covers a vast range of people with a very diverse needs. Many people reject the term and instead refer to their specific ethnic identity. We have used the term here because it is still the one most widely used in the literature, but we acknowledge its shortcomings. The key point is that people’s experience of multiple disadvantage can reflect their culture and context so anyone running support services needs to understand and respond to people’s specific cultural identities without resorting to stereotypes.

Culture intersects with gender. Some women from minority communities can find it more difficult to access conventional services which haven’t been designed with them in mind. The 2019 National Commission on Domestic and Sexual Violence heard evidence from women from Black, Asian, Minority Ethnic and Refugee backgrounds (BAMER) about the additional barriers they faced:

• Services often lacked specialisms for supporting specific groups of women, both in terms of staff understanding what they had been through and in providing appropriate services.
• Women who did not speak English found the language barrier made it difficult to seek help or access therapeutic services. In some cases, abusers used this to further disempower their victims, telling them they would not be understood if they tried to speak out. One woman explained that when she tried to access support from a domestic violence service, the generic interpreting service did not make her properly understood so she ended up leaving.
• Some women, particularly from migrant backgrounds, had little knowledge of their legal rights in Britain, which compounded barriers to accessing support.
• In extreme cases, the commission heard that some women were scared of seeking help through fear of honour crimes.

When women were able to access a specialist BAMER service, they described it as transformative. Talking to professionals that understood their experiences, being able to speak in their own language and feeling supported without judgment can make all the difference to people’s experiences.

How is multiple disadvantage experienced by people of different cultural backgrounds?

Much of the research into multiple disadvantage uses ethnicity or religion as a proxy for culture, since cultural groupings are challenging to define for measurement purposes. This makes it hard to determine how culturally diverse the population of people facing multiple disadvantage is.

We know from Hard Edges that less than 15% of people identified as facing multiple disadvantage come from Black, Asian or mixed race backgrounds, which is lower than the proportion of the general population. We also know that less than 10% of people facing multiple disadvantage migrated to the UK as adults.

Taken together, and assuming that ethnicity is a reasonably proxy for cultural background, this may imply that there is less cultural diversity among people facing multiple disadvantage than the general population. But it is also likely that services aren’t picking up on the complexity of need within some communities. Data collected on minority ethnic groups often comes in small sample sizes, which limits our ability to understand the needs of a specific ethnic group.

People’s needs might remain hidden and unmet because of assumptions about cultural norms. For instance, services may wrongly assume that the Muslim women they support do not have substance use issues (see case study below).

How can we move to a gender and culture-informed approach?

There is significant overlap between gender and culture-informed support.

• Both require meaningfully engaging with people to understand their needs and preferences.
• Both promote a wider understanding and appreciation of people and their experiences, so we can respond in a holistic way.
• Both are intimately linked to trauma-informed care, so organisations looking to move towards providing gender and culture-informed care should first use our guide on this to embed the key principles of a trauma-informed approach.

Research by the charities AVA and Agenda (who tackle violence against women and girls) suggests the values and approaches underpinning a service are as important as delivery itself. An ethos which prioritises understanding the reality of women’s needs and lives is fundamental to delivering gender-sensitive services.

This can be embedded structurally:

• Ensure a safe and enabling environment.
• Change your approach to working.
• Alter organisational practice.

The case study on their ‘Mapping the Maze’ framework below gives further detail on the practical steps they recommend when designing services for women facing multiple disadvantage.

Unfortunately, there is relatively little literature on what constitutes best practice for culturally-sensitive services, beyond practical suggestions around displaying information in a range of languages and ensuring interpreters are available.

What research has been done suggests taking a holistic approach to the needs of the individual, and enabling people to receive support from those who have a shared understanding and experience of:

• Cultural norms.
• Being from a particular BAME group.
• Memories and knowledge of a country of origin.
• Experience of racism or prejudice.

This could have implications for recruiting staff and volunteer teams. Matharoo and Davis suggest that ‘brokerage’ roles can help support people from BAME backgrounds to access services at a similar rate to the majority white population.

It could also change how services work with people they support, such as by embedding a culture of co-production whereby services are shaped by the lived experiences of people from different genders and cultural backgrounds.*

*Matharoo, D. and Davis, S. (2007) Equality, Diversity and Housing: Future Prospects. Journal of Integrated Care, 15 (5), pp. 34-38.

Case study: Mapping the Maze

Mapping the Maze is a good practice framework for commissioning and delivering services to meet the specific needs of women facing multiple disadvantage.

The framework has four main components:

1. An organisational commitment to delivering gender-responsive services and interventions

• Recruit staff and volunteers with specialist knowledge of women’s lives and experiences.
• Recognise multiple disadvantage, including diversity issues.
• Understand inter-related needs requiring individual holistic care.
• Recognise the impact of trauma, particularly violence and victimisation.
• Accept women by viewing behaviour as adaptation and resilience rather than symptoms and pathology.

2. A safe, welcoming and enabling environment

• Provide women-only spaces that are physically safe, particularly when women may be affected by violence and abuse.
• Prioritise emotional safety to minimise the risk of re-traumatisation.
• Encourage an environment that promotes dignity, self-respect and wellbeing.

3. A focus on how support is given just as much as on what services are offered

• Make safety, respect and acceptance paramount; build trust through consistent relationships.
• Work with the individual, including being culturally competent.
• Build on strengths and ways of coping.
• Enable choice and control, which in turn builds self-efficacy.
• Collaborate by building a plan with a service user not for, and work with other agencies.
• Offer time and flexibility.

4. Organisational structures that enable gender-responsive interventions

• Recognise the challenges of working with women experiencing multiple disadvantage.
• Give staff sufficient support, with informal and line management/clinical supervision and continued staff development.
• Work with partners to develop integrated multi-agency responses
• Confront the causes of women’s multiple disadvantage.
• Be aware of the need to develop cultural competence and address issues relating to intersectionality.

Case study: The Nelson Trust

The Nelson Trust provides support to people with complex and multiple needs, including those affected by addiction and those involved in the criminal justice system, in the West of England.

Its Women’s Community Services offer trauma-informed and gender-specific support. Each woman receives individual assessment of their needs—looking holistically at their needs across accommodation, physical and mental health, drugs and alcohol, finance and benefits, family and relationships, domestic abuse, sex work, education and training, attitudes, and thinking and behaviour.

Individual key workers support women to develop their own support plans which meet the needs identified through the assessment process. As part of this, women can access individual and group sessions provided by Nelson Trust as well as specialist services. Women can make use of an onsite crèche, showers, washing machine, garden and cafe.

The Nelson Trust’s strength-based collaborative approach views women as a human beings first, not just someone with needs and risks, but someone with strengths, interests, personal experiences and goals. It provides a safe and non-judgemental space where women come together, where their strengths are recognised, their past/present trauma is acknowledged and resolved. Women are able to build trust, develop choices, work closely with peers and staff, and ultimately make their own decisions to achieve positive change in their lives.

Case study: The Muslim Women’s Network UK

The Muslim Women’s Network UK runs a confidential and non-judgmental helpline offering information, support, guidance and referrals for Muslim women suffering from or at risk of abuse. Callers seek support on a diverse range of issues: from divorce and child custody to forced marriage, disclosures of child sexual abuse and questions of faith and spirituality.

The network emphasises the importance of not stereotyping people based on their cultural background. Instead, they develop a trusting, non-judgemental and open relationship with each individual which acknowledges how faith and culture influence her experience.

For instance, some services assume that—given her faith—a Muslim woman will not be misusing drugs or alcohol. That assumption may be incorrect, and hamper a woman’s access to appropriate support. Instead, the team are trained in how to ask questions around drug and alcohol use sensitively (from a health and harm perspective), and build a trusting relationship that enables women who may feel particularly stigmatised by their substance use to talk about it.

The network supports helpline workers to recognise and respond to challenges women may face in a culturally sensitive way. For instance, the network reports that some women who contact their helpline following sexual violence mayfind that their marriage prospects have been affected, which may place them at risk of forced marriage.

This context needs to be taken into account when considering the appropriate safeguarding response.