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The International Men and Gender Equality Survey – Middle East and North Africa (IMAGES MENA) is the first study of its kind in the MENA region to take a wide-angle, comparative lens to the lives of men – as sons and husbands and fathers, at home and at work, in public and private life – to better understand how they see their positions as men, and their attitudes and actions toward gender equality. Equally important, IMAGES provides women’s perspectives on these same issues. Its wealth of quantitative and qualitative findings (a portion of which are included in this report, and are also presented in greater detail in separately published companion country reports) complements a growing body of research on men and masculinities in the MENA region.

The results of IMAGES MENA cut through the stereotypes and prejudices that too often obscure the complexity of dynamic gender identities and relations in the region. The
four countries included in this first phase of IMAGES MENA – Egypt, Lebanon, Morocco, and Palestine – are diverse, each presenting a particular political, economic, and social context that is central to the country-specific analyses presented in the multi-country report. The study results are strengthened by this diversity, and they show a rich variety, both across and within countries, of men’s and women’s perspectives on the ways in which gender roles and women’s rights are changing in their own lives and in the wider world around them.

A majority of the men surveyed in the four countries support a wide array of inequitable, traditional attitudes. However, a sizeable minority – a quarter or more of the men surveyed in every country – show support for at least some dimensions of women’s equality and empowerment. These men question violence against women, agree with certain laws that safeguard women’s rights, support women in leadership positions, and often want to spend more time caring for their children. Many men who were interviewed, and many women as well, showed a mixture of equitable and inequitable attitudes and practices. However, too many men in the region continue to uphold norms that perpetuate violence against women or confine women to conventional roles, and they act on these attitudes in ways that cause harm to women, children, and themselves. There is a long and winding road that must be travelled before most men – and many women, too – reach full acceptance of gender equality in all domains. 

Why are most famous historians men? How have women changed the writing of history over the last decades? What lives and stories have been hidden from history?

Until recently history was predominantly the domain of men. That men were the authors of our past meant that in many cases only half of the story was told. In the second half of the twentieth century, however, the picture changed. Women, and indeed some men as well, started to address gender history. Women had been investigated historically before, but never with such intensity, nor such breadth. The impetus for this writing was both political and academic as feminists were determined to explore lives which until then had been disregarded.

Gender and the Historian charts the entry and development of this new history, showing how such considerations furthered postmodernism and ultimately reinvigorated the very core of History.

Drug therapy is the most common and one of the most important forms of medical treatment used for men and women. Because of physiological differences, however, men and women can respond differently to the same prescription drug. %or example, women tend to metabolize some antihypertensive and cardiovascular drugs at a slower rate than men. Also, drug interactions with women’s hormones and women’s use of oral contraceptives during their childbearing years can cause different responses. Despite evidence of important differences in the way gender can affect drug response, drug manufacturers may not be studying drug test data for possible gender-related differences.

Given the potential for different responses to drugs based on gender, you expressed concern that women could be at risk if the Food and Drug Administration (FDA) approves drugs on the basis of clinical trials’ in which women were underrepresented. At your request, we examined FDA'S policies and the pharmaceutical industry’s practices regarding research on women in prescription drug testing.

We reviewed FDA'S policy guidance for drug manufacturers and interviewed FDA, National Institutes of Health (NIH), and Institute of Medicine officials; pharmaceutical representatives; and experts in pharmacology. We also performed an extensive literature search on topics related to drug testing and clinical trials.

In our examination of drug manufacturers’ testing practices in the United States, you asked us to provide information on the prescription drugs FDA approved over a recent 3-l/2-year period. Specifically, we were to determine (1) the representation of women in drug testing, (2) the sufficiency of female participation in drug trials to assesssignificant gender-related differences, (3) the extent to which trial data were analyzed for differences in response related to gender, and (4) whether studies were conducted to examine drug interaction with the varying hormonal status of women and oral contraceptive use. 

FDA guidance to drug manufacturers recommends that they test new drugs on representative patient populations. FDA, however, does not define “representative,” and manufacturers are not consistent in their application of FDA'S guidance. A quarter of the drug manufacturers in an industry survey reported that they do not deliberately recruit representative numbers of women as participants in drug trials. Further, more than half said that FDA asked them to include women in drug trials, but the remainder said they had not been asked.

Women were included in clinical trials for all the drugs in our survey but were generally underrepresented in those trials. Our standard of representativeness is a comparison of the proportion of women among clinical trial participants with the proportion of women among those persons with the disease for which the drug is intended. Using this approach, we determined that for more than 60 percent of the drugs, the representation of women in the test population was less than the representation of women in the population with the corresponding disease.

Although women may not be proportionately represented in trials for some drugs, there were enough to detect gender-related differences in response for most drugs in our survey. The absolute number of women in clinical drug trials is a key determinate of whether manufacturers can detect significant differences in response that may be related to gender, according to FDA. We observed, however, that while the trials supporting most drugs did include at least 250 women, the minimum number suggested by FDA, for about a third of the drugs, fewer than 250 women were included as trial participants.

Even when enough women are included in drug testing, often trial data are not analyzed to determine if women’s responses to a drug differed from those of men. Also, many drug manufacturers do not study whether their drugs specifically interact with the hormones present in women, including hormones commonly found in oral contraceptives. This lack of knowledge about gender-related differences in drug response can create a critical gap in information about how best to tailor drug therapies to women. 

An individual's sex has been long recognized as a key factor affecting cancer incidence, prognosis, and treatment responses. However, the molecular basis for sex disparities in cancer remains poorly understood. We performed a comprehensive analysis of molecular differences between male and female patients in 13 cancer types of The Cancer Genome Atlas and revealed two sex-effect groups associated with distinct incidence and mortality profiles. One group contains a small number of sex-affected genes, whereas the other shows much more extensive sex-biased molecular signatures. Importantly, 53% of clinically actionable genes (60/114) show sex-biased signatures. Our study provides a systematic molecular-level understanding of sex effects in diverse cancers and suggests a pressing need to develop sex-specific therapeutic strategies in certain cancer types.

For many cancer types, men and women are very different in terms of susceptibility, survival, and mortality. But our knowledge about the differences between male and female cancer patients at the molecular level is very limited. This is a fundamental issue for cancer prevention and therapy but has not been investigated systematically. Through a rigorous, multidimensional analysis of sex-affected genes, we revealed a two-group molecular classification of cancer types (weak sex-effect group versus strong sex-effect group) and demonstrated that >50% of clinically actionable genes showed sex-biased molecular signatures in certain cancer types. Our study helps elucidate the molecular basis for sex disparities in cancer and lays a critical foundation for the future development of precision cancer medicine.