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Background: Women comprise 75% of the health workforce in many countries and the majority of students in academic global health tracks but are underrepresented in global health leadership. This study aimed to elucidate prevailing attitudes, perceptions, and beliefs of women and men regarding opportunities and barriers for women’s career advancement, as well as what can be done to address barriers going forward. Methods: This was a convergent mixed-methods, cross-sectional, anonymous, online study of participants, applicants, and those who expressed an interest in the Women Leaders in Global Health Conference at Stanford University October 11–12, 2017. Respondents completed a 26-question survey regarding beliefs about barriers and solutions to addressing advancement for women in global health. Findings: 405 participants responded: 96.7% were female, 61.6% were aged 40 or under, 64.0% were originally from high-income countries. Regardless of age or country of origin, leading barriers were: lack of mentorship, challenges of balancing work and home, gender bias, and lack of assertiveness/confidence. Proposed solutions were categorized as individual or meta-level solutions and included senior women seeking junior women for mentorship and sponsorship, junior women pro-actively making their desire for leadership known, and institutions incentivizing mentorship and implementing targeted recruitment to improve diversity of leadership. Interpretation: This study is the first of its kind to attempt to quantify both the barriers to advancement for women leaders in global health as well as the potential solutions. While there is no shortage of barriers, we believe there is room for optimism. A new leadership paradigm that values diversity of thought and diversity of experience will benefit not only the marginalized groups that need to gain representation at the table, but ultimately the broader population who may benefit from new ways of approaching long-standing, intractable problems.

Aim: Encouraging women to deliver in facility settings is one strategy to improve maternal and neonatal outcomes in the developing world. However, in much of sub-Saharan Africa, fewer than half of pregnant women deliver in health facilities. Fear of maltreatment during labor and delivery has been shown to be one barrier to facility delivery, yet previous studies have focused solely on reports from women, rarely seeking insights from practicing midwives. Method: All seven practicing midwives from a rural hospital in Ghana and ten pregnant women seeking antenatal care from the same hospital were recruited to participate in in-depth interviews regarding their perceptions of care during labor and delivery. A semi-structured interview tool and qualitative field interviewing approach were utilized. All interviews were audio taped, transcribed, and analyzed using NVivo 9.0. Results: Respondents described situations that precipitate abuse during facility deliveries, yet not all abuse was seen as acceptable. Two overarching themes emerged: 1) The interaction between midwives and their patients is analogous to a mother/daughter relationship, including both a knowledge imbalance and the need for disciplinary action when necessary; and 2) Midwives feel a strong sense of responsibility for the delivery outcomes and as a result, they will do whatever it takes to deliver a live baby to a healthy mother. Hitting, yelling, and neglecting women were reported as common occurrences in the labor and delivery ward. However, each was undertaken to encourage women to do what was needed to deliver safely. Conclusion: These findings suggest that the issue of patient maltreatment in low-resource labor and delivery settings is complex and may be undertaken in what is perceived to be the laboring woman’s best interest.