What is disaster response?  In answering this question, you should address the following:  identify elements of disaster response assistance; define emergency management; identify bo

International Journal of

Environmental Research and Public Health

Review

Beyond Binary: (Re)Defining “Gender” for 21st

Century Disaster Risk Reduction Research, Policy,

and Practice

Ashleigh Rushton

1

, Lesley Gray

1,2,

* , Justin Canty

3

and Kevin Blanchard

4

1 Joint Centre for Disaster Research, Massey University, Wellington 6140, New Zealand; [email protected]

2 Department of Primary Health Care and General Practice, University of Otago, Wellington 6242, New Zealand

3 School of Social Sciences, University of Tasmania, Launceston, TAS 7250, Australia; [email protected] 4 DRR Dynamics, London WC2 2JR, UK; [email protected] * Correspondence: [email protected]; Tel.: +64-(0)21-029-39729

Received: 26 August 2019; Accepted: 15 October 2019; Published: 18 October 2019 !"#!$%&'(! !"#$%&'

Abstract: The dominant discourse of gender focuses on the binary of woman/man, despite the known additional risks for diverse sexualities and gender minorities in disasters. Given the small but growing body of literature concerning gender minorities in disasters, this paper sets out to explore the place of sex and gender minorities in disasters and to examine whether a binary definition needs to be extended. A five-stage rapid review was undertaken following Arksey and O’Malley’s method. Peer-reviewed journal articles in English language were sought that included disaster and gender terms in the title, abstract, and/or body of the article published between January 2015 and March 2019. The search included MEDLINE and Scopus databases. Relevant information from the studies were charted in Microsoft Excel, and results were summarized using a descriptive analytical method. In total, 729 records were identified; 248 that did not meet the inclusion criteria were excluded and 166 duplicates were removed. A total of 315 records were sourced and their full text was reviewed. Of those, only 12 journal articles included content relative to more than two genders. We also recognized that sex and gender terms were used interchangeably with no clear di↵erentiation between the two. We recommend that disaster scholars and practitioners adopt correct terminology and expand their definition of gender beyond the binary; utilize work on gender fluidity and diversity; and apply this to disaster research, policy, and practice.

Keywords: gender; gender minorities; disaster; rapid review; binary

1. Introduction

The dominant discourse of gender within disaster focuses on the binary of woman/man or female/male [sic]. There is limited research documenting gender minorities’ experiences and health implications in disasters; what is written predominately identifies the heightened marginalization and exclusion that gender minorities face pre- and post-disaster [1–3]. While we acknowledge progress in gender and disaster research and practice, there is a disparity in the understanding of the lived experiences and health implications for gender minority individuals and groups. Notably, there is a gap in understanding the importance of applying appropriate gender terminology in disaster research, policy, and practice. This paper addresses this gap by providing useful instruction to minimize exclusion and marginalization of sex and gender minorities (SGM) in disaster research and management plans. This paper provides a summary of the field of gender and disaster scholarship and research which looks at the experiences of gender minorities in disasters, along with the framing

Int. J. Environ. Res. Public Health 2019, 16, 3984; doi:10.3390/ijerph16203984 www.mdpi.com/journal/ijerph

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of gender relating to the Western context and legislative shift. Results of a rapid review are presented, followed by a discussion of the key issues pertaining to gender minorities and disaster risk reduction (DRR), with recommendations for action.

2. Background

Gender and disaster scholarship grew from the recognition that women faced discrimination, exclusion, and additional challenges before, during, and after disasters. It was argued that gender played a role in how and why people were unequally a↵ected [4–14]. Given that women’s mortality rates are higher [15] and domestic and sexual violence against women is increasing [4,7,16,17], there was failure to detect how gender constructs people’s experiences of disaster. An example being not all women had access to a cyclone warning in Bangladesh due to cultural restrictions; consequently, high numbers of women were injured or died during a cyclone in April 1991 [18]. It is the socio-cultural factors that contribute to women having limited access to resources, shelter, or information [19]. The predominant focus on women within gender and disaster scholarship is warranted and the research provided evidence that the social constructions of gender work to exclude and marginalize people. Given that there is specific gender and disaster research that highlights how gender influences people’s disaster experience and health outcomes, we would argue that minority genders outside of the binary must also be considered.

2.1. Defining Sex and Gender Minorities

For the purpose of this paper, we define gender as being the socially constructed processes and di↵erences, often aligned with being feminine, masculine, blended elements of both, or neither. Therefore, gender minority refers to a person whose gender identity does not exclusively align with masculine or feminine polarities. Sex is defined as the physical characteristics used to identify di↵erences between males and females; this does not mean that a person’s gender or physical sex characteristics necessarily align with their sex assigned at birth based on visible genitalia. Gender binary refers to the binary system whereby gender is assumed or considered as being a woman or man only. Therefore, gender non-binary is defined as genders outside of the woman and man binary.

2.2. Western Context of Gender, Sex, and Sexuality

The terms indicated in the acronym LGBTIQA+ (lesbian, gay, bisexual, transgender, intersex, queer, asexual) are derived from a Western context. It is evident in disaster responses as elsewhere that the terms are problematic in relation to conceptualizing both diverse sexualities and diverse experiences of both sex and gender in non-Western contexts alongside the existing critiques of the focus on these identity labels.

The Western concept of sex is commonly associated with physical or biological characteristics of bodies. It can be understood as equally socially constructed through both dominant discourses and biological theories, such as Laqueur [20] and Fausto-Sterling [21,22]. The social constructedness of sex categories and, specifically, the binary sex categories of male/female were illuminated by ongoing research into sex and sex characteristics. Discoveries made possible by genetics and inductive exploration of the diversity of human anatomy and experience equally disrupted the simple binary attributed to human sex di↵erentiation, with the proposal that sex may be more properly understood as a spectrum [23]. In this regard, sex characteristics may be better described as bimodal rather than binary. As Ainsworth [23] observed, “biologists may have been building a more nuanced view of sex, but society has yet to catch up.” In order to perceive and redress negative e↵ects of either omission or discrimination on the basis of sex characteristics, it is important to critically review not only the binaries of woman/man and female/male, but also of sex and gender.

In the Western context at least, gender is a concept based on the construction of systems of di↵erence [24]. The woman/man gender binary is based on the assumed existence of only two points on a gender “scale” treated as coextensive with an apparent binary quality of physiological sex. This is

Int. J. Environ. Res. Public Health 2019, 16, 3984 3 of 14

commonly linked to perceptions of nature, biology, and the body and is, thus, accepted as “truth” [25]. Second-wave feminist theory contributed to disrupting an assumed link between sex and gender through arguing for a distinction between them to disrupt the equation of physical characteristics with social roles [26,27], which in itself creates another problematic binary [28]. However, conflation of physical characteristics, identity, expression, and social roles and norms remains common and has impacts on people of diverse experience and cisgender people alike.

Disrupting these dominant assumptions from a Western cultural foundation is vital to acknowledging the existence, rights, and needs of multiple genders within and beyond Western society that do not fit within the woman/man gender binary [25,29]. As such, it has relevance to e↵orts toward decolonization, as well as moving beyond the binary. Lorber [29] argued that gender as a paradox was a meaningless rhetoric in a binary gendered system whereby social structures continue to support gender inequality. Johnston [25] contends that it is Western culture and societal expectations that encourage and uphold the binary of gender. It is also argued that a two-gender binary frame developed into a rigid and discriminatory tool to support male privilege and power [29–31]. By using the woman/man binary, gender inequalities are further enforced [29]. Habitual application of the two-gender, two-sex binary frame similarly undermines queer and feminist scholars and campaigners who challenge essentialist thinking of gender and how social constructs are used as methods to reinforce “appropriate” behaviors for women and men and multiple forms of oppression such as sexism, homophobia, and racism [32–34]. What needs to be considered in disaster management is that neither gender nor sex are fixed terms; rather, their meanings are open to interpretation and fluidity. In this discussion, we adopt the term sex and gender minorities (SGM) from the United States (US)-based National Institutes of Health (https://www.edi.nih.gov/people/sep/lgbti/about), which is recognized as an appropriate acronym. The Yogyakarta Principles (YP) and Yogyakarta Principles plus 10 (YP+10) prepared by the International Service for Human Rights [35] provide a more useful non-binary foundation for disaster response, research and literature. This allows identification of specific dimensions of sexuality, sex, and gender that are made relevant through discrimination, omission, or persecution in the context of disaster response, independent of specific identity terms. This includes the recognition of culturally specific and intersectional experiences. The dimensions are sexual orientation, gender identity, gender expression, and sex characteristics (SOGIESC).

2.3. Legislative Shifts on Gender

Disasters can impact a person’s human rights. Set out in the International Covenant on Civil and Political Rights, these rights include the right to housing, the right to access healthcare, and the right to liberty and security [36]; however, enforcing humans rights is di�cult. The inter-agency standing committee acts to coordinate humanitarian responses and sets out guiding principles to protect people’s human rights when a↵ected by disaster. However, there is no binding agreement that enforces the protection of people’s human rights in crisis [36]. The guidelines are there but the willingness to use them to protect the human rights of individuals is dependent on the country(ies) involved. Given that many countries globally still persecute people whose gender and sexuality are outside the gender and heteronormative binary, it is unlikely that SGM’s human rights are going to be guaranteed protection in times of disaster.

Nevertheless, within the context of disaster, when the law, legislation, and serving government of a country do not recognize genders outside of the binary, people who do not conform to heteronormativity and who are not cisgender are marginally positioned and, thus, excluded with increased discrimination and risk. These legislation changes and challenges provide a brief look into how progress was made for issues around SOGIESC globally but also into how far the progress has yet to go. Natural hazard events disrupt society as we know it, often exacerbating inequalities and prejudices; thus, laws that protect rights and criminalize discrimination are vital to support the health and needs of those individuals who are more likely to be excluded.

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There is slow progress within law to recognize genders outside of the binary. However, countries including Aotearoa New Zealand, Canada, Pakistan, Italy, Denmark, Australia, Germany, Malta, and some states in the United States of America provide a gender-neutral option on passports. Countries such as Nepal and Bangladesh provide a third gender option on their passports. Since 2015, Aotearoa New Zealand includes a “gender diverse” option when collecting statistical data, and Iceland provides a third gender option on o�cial documents. Cuba also made significant changes to its law which now not only forbids discrimination against SGM, but also replaces the words “woman and man” with “spouse” within their definition of marriage [37]. Despite some progress globally to recognize genders outside of the binary, “ . . . stepping outside the bounds of heteronormativity (and by extension, gender normativity) remains illegal in many parts of the world, e↵ectively hindering any integration of the needs of sexual and gender minorities into DRR policy and practice in a significant number of national and regional jurisdictions” [1] (p. 22).

Countries such as Iraq, Iran, Tanzania, Burundi, Uganda, Kenya, Paraguay, Brazil, Honduras, and El Salvador are just some of the countries that still criminalize SGMs [37]. Indeed, these countries with their cultural opposition to SGM communities were often the most vocal in terms of developing political barriers related to the inclusion of SGM groups during the Sendai Framework negotiations [38]. Worryingly, the United States of America government is presently and publicly working to undo progress made by previous governments through laws that help protect the rights of SGM people including the Department of Health and Human Services O�ce of Women’s Health pushing to legally define gender on a biological basis [37,39]. If successful, the health of SGMs will be compromised, which could leave gender minorities with significantly poorer service provisions post-disaster.

2.4. Minority Genders in Disaster Risk Reduction

The Sendai Framework for Disaster Risk Reduction (2015–2030) [40] emphasizes health and the importance of providing su�cient identification of vulnerability and disaster risk in all dimensions, as well as care and training to healthcare systems and professionals [40–42]. Given that gender minorities may require healthcare following a disaster, it is problematic that the World Health Organization identifies gender as socially constructed identities of women and men [43] despite the recognition of third, fourth, and fifth genders in some cultures and countries [44,45] and evidence that SGMs can face restricted access to appropriate healthcare [46,47].

The United Nations o�ce for Disaster Risk Reduction (UNDRR; formally known as UNISDR) o↵ers “basic definitions on disaster risk reduction to promote a common understanding on the subject for use by the public, authorities, and practitioners” [48] (https://www.unisdr.org/we/inform/terminology). However, UNDRR does not include a definition of gender. Given that there is recognition that SGMs face heightened marginalization, increased discrimination, and abuse, it is disappointing that the Sendai Framework for Disaster Risk Reduction [40] does not include guidelines to minimize discrimination against diverse sexualities and gender minority groups and/or suggestions how to improve or safeguard health in relation to SGM individuals. Implementing gender analysis and providing a framework to support gender considerations in DRR is dotted throughout the document; however, disappointingly, gender within the Sendai Framework is discussed only in relation to women.

The UNDRR online registration for the 2019 Global Platform to review progress by countries on the Sendai Framework provided only two options of gender (female and male), which attributes to gender incorrectly and excludes people whose gender identity is not within the gender binary. The registration pathway sat alongside an announcement in October 2018 regarding the mainstreaming of gender throughout the 2019 global platform discussions, promoting women’s participation at international meetings [49].

A rapid review was conducted to identify peer-reviewed research journal articles in the four years since commencement of the Sendai Framework [40] to identify those with a disaster focus including minority genders, going beyond the binary. The sections below set out the approach and provide results from a rapid review of journal articles (2015 to 2019). A discussion about the findings of the

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review and the proposal of an appropriate definition for gender to be adopted for the disaster-related field of research are provided.

3. Method

A rapid review was selected to synthesize how gender is referred to and what exists in published journal articles relating to SGMs in disaster literature using systematic review methods in the time available [50]. The rapid review was undertaken following the framework of Arksey and O’Malley [51], which sets out five stages which provides a transparent and comprehensive process allowing for reliability and replication of the search strategy. This approach follows the preferred reporting items for systematic reviews and meta-analysis (PRISMA) [52].

Stage 1—Identify initial research question: This review intended to assess the extent to which disaster literature that refers to gender is limited to or goes beyond a binary framework in journal articles published in English language between 2015 and early March 2019 and to quantify the terms utilized. The timeframe was chosen to align with the commencement of the Sendai Framework for Disaster Risk Reduction [40] and the resources and timeframe for writing this paper.

Stage 2—Identify relevant studies: A wide definition of key search terms was adopted to ensure good coverage of the literature and to account for peer-reviewed journal articles that mix gender and sex terms. Inclusion and exclusion criteria took account of available time and funding limitations. We did not include hazard terms such as drought, storm surge, storms, cyclone, or typhoon, as these terms brought up many thousands of results, many of which did not appear to be disaster-related; moreover, time would not allow for a detailed review of results in the thousands. The search strategy inclusion and exclusion criteria are outlined in Table 1.

Table 1. Search strategy inclusion and exclusion criteria.

Search Strategy

Male, men, men’s, man, man’s Female, women, women’s, woman, woman’s

Gender or gender with identit or nonconforming, non-conforming, divers, binary, nonbinary, other, unspecified, nonspecified, non-specified, androgyn, intermediate, minorit, spectrum, cisgender, transgender, trans-gender,

transsexual, trans-sexual, queer, lgbt, glbt, twospirit, two spirit, two-spirit, uranian, fa’afafine, faafafine, berdache, pangender, bigender, genderqueer, androgyne, intergender, intersex, third sex, fourth sex, ashtime, mashoga,

mangaiko, palao’ana, palaoana, fakaleiti, mahu wahine, mahu vahine, whakawahine, akava’ine, akavaine, waria, warias, baklâ, baklas, binabae, bayot, bantut, bading, femminiello, muxe, biza’ah, bizaah, travesties, xanith, khanith,

tritiya-prakrti, ubhatobyanjanaka, pandaka, quariwarmi Disaster, earthquake, avalanche, landslide, mudslide, land slide, mud slide, tsunami, tornado, mass casualty,

volcan, flood.

Inclusion and Exclusion Criteria

Included Included Excluded Year 2015 to March 2019 Pre-2015 and after March 2019

Language English language articles Non-English language articles Format Journal articles Book or book chapter Disaster Disaster focus No disaster focus

Gender terms Articles that did not mention gender or sex terms Age Articles focused on infants or children (age 10 and under)

Non-human Adults Animals and plants

Search terms within articles

Gender (binary/non-binary), female, male, woman/women, man/men, other gender/sex terms

Stage 3—Study selection: Medline and Scopus searches produced 728 results in total. After exclusions and duplicates were removed, this left 315 references to be sourced and reviewed.

Stage 4—Chart the data: A summary table was completed for each of the included articles, including year, authors, and what terms were used to refer to gender.

Stage 5—Collate, summarize, and report results: The results section below provides details on the fifth stage.

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The review approach involved two authors (A.R. and L.G.) with the assistance of a reference librarian (M.F.) to conduct the initial search. After duplicates were removed, an electronic library was created utilizing suitable referencing software. The two authors each searched for half of the articles, reading and assessing article content. Details were then entered into a shared Microsoft Excel spreadsheet. The results were shared between A.R. and L.G., and queries relating to the articles were discussed. The reference librarian (M.F.) assisted with sourcing full text of articles that the two authors were unable to locate initially.

4. Results

The initial search identified 729 records; of these, 248 records did not meet the inclusion criteria and were excluded, and 166 duplicates were also removed. This left 315 records to be sourced and reviewed as full texts. Full texts were located, obtained, and reviewed. Once full texts were reviewed, a further 55 records were excluded. Two records were pre-2015, two were conference presentation abstracts, and one was a news summary. Four records were not related to disasters, and one specifically looked at volunteers in humanitarian settings. A small number of articles were about dental forensics and body identification methods (n = 5), health skill development around procedures (n = 8), and dietary intake (n = 1). Results relating to books or book chapters were excluded (n = 11). Those related to school, children, youth, and/or adolescents were excluded (n = 15), and we observed that none of these included content relating to more than two genders. A further five articles were excluded as they did not include any reference to gender or sex. This left 260 journal articles.

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Figure 1. Preferred reporting items for systematic reviews and meta-analysis (PRISMA) flow diagram for rapid review article selection.

Table 2. Rapid review: papers referring to minority genders outside of the binary (n = 12).

Year Citation Beyond Binary

Summary

2018 Myers, A.; Sami, S.; Onyango, M.A.; Karki, H.; Anggraini, R.; Krause, S. Facilitators and barriers in implementing the Minimum Initial Services Package (MISP) for reproductive

health in Nepal post-earthquake. Confl. Health 2018, 12, 35. [54] LGBTI

2018 Gorman-Murray. A.; McKinnon, S.; Dominey-Howes, D.; Nash, C.J.; Bolton, R. Listening and

learning: Giving voice to trans experiences of disasters. Gend. Place Cult. 2018, 25, 166–187. [55]

Gender minorities Transgender

Baklâ Waria

Aravani

2018 Dominey-Howes, D.; Gorman-Murray, A.; McKinnon, S. On the disaster experiences of

sexual and gender (LGBTI) minorities: Insights to support inclusive disaster risk reduction policy and practice. Aust. J. Emerg. Manag. 2018, 3, 60–68. [53]

Gender minorities Non-binary

Sexual minorities LGBTI

2017 Wisner, B.; Berger, G.; Gaillard, J.C. We’ve seen the future, and it’s very diverse: Beyond gender and disaster in West Hollywood, California. Gend. Place Cult. 2017, 24, 27–36. [56]

Non-binary Cisgender,

Transgender Transsexual Gender fluid

2017 Ong, J.C. Queer cosmopolitanism in the disaster zone: ‘My Grindr became the United

Nations’. Int. Commun. Gaz. 2017, 79, 656–673. [57] LGBTQ

2017 McKinnon, S.; Gorman-Murray, A.; Dominey-Howes, D. Disasters, queer narratives, and the news: How are LGBTI disaster experiences reported by the mainstream and LGBTI media? J.

Homosex. 2017, 64, 122–144. [58]

Cisgender Transgender

Gender minorities

Figure 1. Preferred reporting items for systematic reviews and meta-analysis (PRISMA) flow diagram for rapid review article selection.

Int. J. Environ. Res. Public Health 2019, 16, 3984 7 of 14

Two articles meeting inclusion criteria had content relating to gay men. Whilst not having specific content relating to more than two genders, these articles, along with one article that briefly noted transgender groups, did acknowledge non-gender-normative and heteronormative identities and included important considerations in relation to disaster risk reduction and the aftermath following disaster (see Supplementary File S1: Included papers). When reviewing the full-text articles for the purpose of this review, we determined that “LGB” was related to sexuality and not gender; however, we included papers that used the acronym LGBT, given the fluidity of “T” (i.e., transgender and/or transsexual individuals), which may identify as a gender beyond the binary [53]. During the review, we recognized that 200 out of the 260 articles used the terms sex and gender interchangeably with no clear distinction between the two terms. Figure 1 shows the record selection process.

Following our review of 260 peer-reviewed journal articles, we noted that only 12 went beyond the gender binary of woman/man. Two out of the 12 articles referred to the acronym LGBT(I/Q) and a further one article mentioned transgender groups. Four articles reviewed included the terms gender minorities and non-binary. Unsurprisingly, only five articles that we reviewed discussed specific genders beyond the binary such as Aravani, Fa’afafine, Baklâ, and Waria. Another observation is that eight of the 12 articles specifically focused on gender minorities and/or LGBTI groups. A further two articles specifically focused on gay individuals; however, as both papers included the acronym LGBTI/LGBTQ, they were included. The remaining two articles did not specifically aim to examine minority groups in DRR, yet they made reference to genders outside of the binary. Table 2 below provides a summary of these papers.

Table 2. Rapid review: papers referring to minority genders outside of the binary (n = 12).

Year Citation Beyond Binary Summary

2018

Myers, A.; Sami, S.; Onyango, M.A.; Karki, H.; Anggraini, R.; Krause, S. Facilitators and barriers in implementing the

Minimum Initial Services Package (MISP) for reproductive health in Nepal post-earthquake. Confl. Health 2018, 12, 35. [54]

LGBTI

2018 Gorman-Murray. A.; McKinnon, S.; Dominey-Howes, D.; Nash,

C.J.; Bolton, R. Listening and learning: Giving voice to trans experiences of disasters. Gend. Place Cult. 2018, 25, 166–187. [55]

Gender minorities Transgender

Baklâ Waria

Aravani

2018

Dominey-Howes, D.; Gorman-Murray, A.; McKinnon, S. On the disaster experiences of sexual and gender (LGBTI) minorities:

Insights to support inclusive disaster risk reduction policy and practice. Aust. J. Emerg. Manag. 2018, 3, 60–68. [53]

Gender minorities Non-binary

Sexual minorities LGBTI

2017 Wisner, B.; Berger, G.; Gaillard, J.C. We’ve seen the future, and

it’s very diverse: Beyond gender and disaster in West Hollywood, California. Gend. Place Cult. 2017, 24, 27–36. [56]

Non-binary Cisgender, Transgender

Transsexual Gender fluid

2017 Ong, J.C. Queer cosmopolitanism in the disaster zone: ‘My

Grindr became the United Nations’. Int. Commun. Gaz. 2017, 79, 656–673. [57]

LGBTQ

2017

McKinnon, S.; Gorman-Murray, A.; Dominey-Howes, D. Disasters, queer narratives, and the news: How are LGBTI

disaster experiences reported by the mainstream and LGBTI media? J. Homosex. 2017, 64, 122–144. [58]

Cisgender Transgender

Gender minorities

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