Kalaitzi S. Navigating barriers to gender equality in the European Union context: The case of healthcare sector [Dissertation: University of Maastricht, 2019]. SEEJPH 2020, posted: 01 June 2020. DOI: 10.4119/seejph-3492 P a g e 1 | 17 PHD DISSERATATION Navigating barriers to gender equality in the European Union context: The case of healthcare sector Stavroula Kalaitzi1 1 Department of International Health, Care and Public Health Research Institute (CAPHRI), Fac- ulty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands. Corresponding author: Stavroula Kalaitzi, PhD; Care and Public Health Research Institute (CAPHRI), Department of International Health, Maas- tricht University; Address: Duboisdomein 30, 6229 GT Maastricht, The Netherlands; Telephone: +306932285055; Email: valia.kalaitzi@maastrichtuniversity.nl. Kalaitzi S. Navigating barriers to gender equality in the European Union context: The case of healthcare sector [Dissertation: University of Maastricht, 2019]. SEEJPH 2020, posted: 01 June 2020. DOI: 10.4119/seejph-3492 P a g e 2 | 17 Abstract Context: Progress towards achieving gender equality in the European Union context is reported slow and fragmented, although some achievements have been made. Scholarship has been discuss- ing extensively the gendered barriers, yet their manifestation on a comprehensive and prevalence basis has received scant attention so far. Highlighting the big picture of all (in)visible gendered barriers and their manifestation in relation to countries’ specificity may contribute in understand- ing better the missing link between policy and practice. This study aims firstly, to identify com- prehensively the gendered barriers and their prevalence, and secondly, to gain deeper insights on how a persisting policy problem at the EU and Member States level remained poorly addressed for over two decades. Methods: A mixed methods approach was adopted to ensure the qualitative research quality cri- teria. The systematic literature review, questionnaire and semi-structured interviews methods to obtain and analyze data were included. Qualitative analysis was supplemented by the fundamental tenet of feminist research on the centrality of women. Results: Twenty-six gendered barriers with quantitative logic and varying degree of prevalence were identified and depicted in the Barriers Thematic Map (BTM) across healthcare, academia and business sectors. Twenty and twenty-one gendered barriers in Greek and Maltese healthcare set- tings were found respectively unveiling the country’s specificity in barriers’ manifestation. The sustainable development thinking in gender equality objectives in EU and MS was found suffering from inconsistencies and misplaced priorities. Conclusion: The gendered barriers are multiple, manifest themselves in chorus and with a varying degree of prevalence across sectors and are greatly influenced by country’s specificity. Evidence informed gendered policies respecting national priorities may need to be revisited by policy actors to deliver the promised egalitarian social orderand sustainable future for the EU citizens. Keywords: gendered barriers, gender equality, women’s leadership, barriers thematic map, Euro- pean Union gender policy. Kalaitzi S. Navigating barriers to gender equality in the European Union context: The case of healthcare sector [Dissertation: University of Maastricht, 2019]. SEEJPH 2020, posted: 01 June 2020. DOI: 10.4119/seejph-3492 P a g e 3 | 17 Introduction Progress towards achieving gender equality in the European Union context is reported slow, fragmented and uneven. Arguably, the centrality of gender equality in EU’s legal and policy commitments has not yet been translated in adequate gender equality out- comes across Member States, although some achievements have been made (1). For exam- ple, employment rates have reached histori- cally the highest levels in the EU and more women are in leading positions than ever, whereas the gender gap in education is being closed and even reversed in some disciplines. Yet, women participate in labor market at about 11,5% less than men, are paid at an av- erage 16% lower than men and they hardly reach an equal share on the highest decision- making echelons assuming only 6,3% of CEO positions in major companies across EU (2). Hence, many indicators on gender equal- ity are stagnating, while others are worsened in several Member States (3). Scholarship on gender equality and women’s leadership is productive in dispelling myths and facts about several forms of gender ine- qualities, yet shedding light in a scattered and fragmented way on gendered barriers. The manifestation of barriers within an organiza- tion or a sector on a comprehensive and prev- alence basis has received scant attention so far. For example, stereotypes, gender pay gap, bias, sexual harassment have been ex- plored on a one to one basis, but rarely through the big picture perspective and how each barrier contributes to shape this picture (4-6). This study aspires to highlight the big picture of all (in) visible gendered barriers, the context within which they are developed, the underlying mechanisms that feed the du- rability and transferability of each barrier within socio-cultural and economic reality and which may be the missing link between policy and practice. Thereby, understanding the barriers that make up the labyrinth of women’s leadership (7) may provide deeper insights on how to address effectively the complexities of gender equality challenges at both social and economy level. Furthermore, it may make it easier to understand how to dismantle and de-power deeply rooted gen- dered perceptions, and to develop effective and gender responsive policies. Thereby, this study aims firstly, to identify the gendered barriers and their prevalence across sectors, such as healthcare, academia and business on the grounds that these sectors cover a big part of society and economy, and, secondly, to gain deeper insights on how a persisting and central policy problem at the EU and Member States level remained poorly addressed for over two decades (8,9). To have a clearer focus and gain deeper insights on gendered barriers, current research con- centrated on healthcare sector for three rea- sons: firstly, women are significantly un- derrepresented in leading positions across healthcare although the sector being women populated and their added value is widely acknowledged; secondly, healthcare sector is currently considered one of the major em- ployers, encompassing several domains, such as academic, clinical and medical, and job categories; and, thirdly, healthcare is of criti- cal importance to health systems’ sustainabil- ity; health workforce is a key component to health systems, whereas the gender balanced health workforce is linked to health systems’ improved performance (10,11). These fea- tures are considered to offer ample ground to gain deeper insights on the research question. Thereby, the research is developed at the in- tersection of gendered barriers in the healthcare sector within country’s socio-cul- tural and economic contexts. Kalaitzi S. Navigating barriers to gender equality in the European Union context: The case of healthcare sector [Dissertation: University of Maastricht, 2019]. SEEJPH 2020, posted: 01 June 2020. DOI: 10.4119/seejph-3492 P a g e 4 | 17 Methods This study applied a qualitative research methodology built on a profound concern to understand the explored phenomenon and of- fer an interpretation of informed and sophis- ticated knowledge reconstructions (12). Adopting the social constructionism para- digm and on the grounds that some methods are more suited than others for conducting re- search on human construction of social reali- ties (13), this study applied a mixed methods qualitative approach to ensure the quality cri- teria of trustworthiness, authenticity and tri- angulation incongruence of experiential and practical knowing (12). In alignment with the qualitative research commitments, the research included obtain- ing and analyzing textual data, such as com- ments on a questionnaire and interviews’ transcripts and data generated from the inter- action between researchers and participants. Reflexivity relied on critical subjectivity; transparency as the study progresses, contex- tual understanding of particular social pro- cesses and application of qualitative research findings to other situations were also in- cluded in methodology considerations (14). Qualitative research was supplemented by the fundamental tenet of feminist research on the centrality of women aiming to “put the so- cial construction of gender at the center of one’s enquiries” (15) and interpret the expe- riences through immersion in the data (16). Study design and methods A mixed methods qualitative approach was applied to collect a variety of enriched data on the barriers to women’s leadership and gender equality, validate the findings and tri- angulate the results (17). Following progres- sive analysis and comparison of collected data, an explanatory theory was formulated on addressing effectively the explored phe- nomenon and be plausibly applied and tested in other contexts (18). The study was supple- mented by qualitative findings on EU gender equality policy and implementation to deduce conclusions on potential policy inconsisten- cies and ways of improvement. The study was grouped into three parts (Figure 1). Figure 1. Study design and methods Kalaitzi S. Navigating barriers to gender equality in the European Union context: The case of healthcare sector [Dissertation: University of Maastricht, 2019]. SEEJPH 2020, posted: 01 June 2020. DOI: 10.4119/seejph-3492 P a g e 5 | 17 I)Problem statement and hypothesis: A sys- tematic literature review was undertaken aiming a) to uncover gendered barriers across healthcare, academy and business sectors, b) to contrast the differences in gendered barri- ers across sectors and c) to develop the gen- dered Barriers Thematic Map (BTM)with quantitative logic and a prevalence chart. The geographical target of the study was Europe with the time range for publications from 2000 to 2015 (19). II) Hypothesis testing: the hypothesis testing on BTM and barriers’ prevalence was fo- cused on healthcare sector within two EU countries’ socio-cultural and economic con- texts: Greece and Malta. It was deployed in two sub-studies: one exploratory study con- ducted within one country’s healthcare sector and one comparative study realized in two countries’ healthcare sector (academic, clini- cal and medical facets): The exploratory study was set out aiming to forage for the most and the least important barriers to women’s leadership based on BTM. The study was drawn upon perceptions of women healthcare leaders in Greece in re- lation to gendered barriers; interest stemmed from country’s poor performance on gender equality index and current economic turbu- lence (20). The semi-structured interviews, comparative study was conducted aiming to assess empir- ically gendered barriers to women’s leader- ship in healthcare through the lens of national socio-cultural and economic contexts. Study focused on Greece and Malta; interest was drawn from countries’ poor performance in the gender employment gap and the rapid so- cio-cultural and economic changes occurring in the European Mediterranean region (21), and III)EU policy and implementation level: An interpretive discourse analysis was followed to gain deeper insights of the sustainable de- velopment thinking in gender equality policy agenda adopted by EU and in relation to its relevance to interests and challenges faced by Member States’ citizens. In particular, the relevance of EU SDG5 themes and indicators and the prioritization of policy objectives to actual social reality across Member States was considered. A qualitative analysis of organizational change was used to explore the transforma- tive capacity of the developed EU gender mainstreaming toolkits aiming to unpack the complexity among toolkits, organizational culture, climate and outcomes and to gain nu- ances on potential room for improvement. Data collection To ensure the trustworthiness of the findings, qualitative and quantitative data was har- vested from primary and secondary sources (12). Primary data:  Primary data on barriers to women’s leadership and their prevalence was harvested applying a systematic liter- ature review method (19).  Primary data of an online question- naire harvested by 30 purposively in- vited women healthcare Greek lead- ers (20).  Primary data was collected from 36 semi-structured interviews with healthcare leaders, including women and men in Greece and Malta (21). Secondary data:  A content analysis of ten websites of key organizations, such as European Parliament, European Institute for Kalaitzi S. Navigating barriers to gender equality in the European Union context: The case of healthcare sector [Dissertation: University of Maastricht, 2019]. SEEJPH 2020, posted: 01 June 2020. DOI: 10.4119/seejph-3492 P a g e 6 | 17 Gender Equality, Standing Commit- tee of European Doctors, The World Bank, McKinsley Global Institute.  EU evaluation reports and policy doc- uments, communications, minutes of high level  A narrative literature search in Google Scholar, PubMed, Web of Science and on dedicated websites discussing the implications of eco- nomic crisis on gender equality and on healthcare sector.  A narrative literature search on inter- pretive discourse analysis of EU gen- der equality policy and the adoption of EU sustainable development goals (SDGs).  A narrative literature review on the- ory of organizational and social change and on implementation sci- ences. Ethical approval Ethical approval was received from Ethics Committees from Maastricht University (No METC 16–4-266, January 19, 2017), Na- tional and Kapodistrian University of Athens (Medical School) (February3, 2017) and from the University of Malta (March 10, 2017). Theoretical and conceptual considerations The explored topic involves several aspects and thus requires an all-encompassing ap- proach which may not fall easily into a single theoretical framework. The study applies the- ories of gender equality, women’s leadership, gender equality policy and implementation at EU and Member States level. Gender equality In this study the concept of gender is ap- proached as a cross-cutting socio-cultural and economic variable (22, 23). Gender is under- stood as “the socially constructed roles, be- haviors, activities and attributes that a given society considers appropriate for women and men” (24) in contrast to “sex” referring to “the different biological and physiological characteristics of males and females such as reproductive organs, chromosomes, hor- mones, etc.” (25). These characteristics tend to differentiate humans as men and women, whereas gender refers to a socially acquired identity connected to “being male or female in a given society at a given time and as a member of a specific community within that society” (26, 27). Hence, gender identity pre- scribes what is expected, allowed or valued in a woman or a man within a given context (22, 23). Gender equality refers to “equal visibility, empowerment, responsibility and participa- tion of women and men in all spheres of pub- lic and private life. It also means an equal ac- cess to and distribution of resources between women and men and valuing them equally” (28). Also known as “equality of oppor- tunity” (29), it implies that women’s and men’s interest, needs and priorities are taken into consideration irrelevant to their gender. Thus, it is recognized that gender equality is not a women’s issue but should interest and fully engage men and women in the sense of supporting women’s capacity to make life choices in a context where this capacity was previously denied to them (27,28). Gender equality policy in the EU context European Union anchored firmly the concept of gender equality in the European Treaties and expressed its commitment with policies on economic development, social cohesion and democratic societies (30). The mile- stones of the trajectory of gender equality policy agendas arrayed from the Treaty of Rome (1957, Art 141) focusing on “equal pay Kalaitzi S. Navigating barriers to gender equality in the European Union context: The case of healthcare sector [Dissertation: University of Maastricht, 2019]. SEEJPH 2020, posted: 01 June 2020. DOI: 10.4119/seejph-3492 P a g e 7 | 17 for equal work” to the Treaty of Amsterdam (1997, Art 3.2) “to eliminate inequalities and to promote equality between men and women” in all EU activities (31-33). Later, in the Treaty of Lisbon (2009) (34) EU broad- ened its binding commitment to observe gen- der equality principle and pursuit gender equality objectives. In 2015 EU committed to fully integrate the UN sustainable develop- ment goal towards achieving gender equality and women’s empowerment (SDG5) in EU policy framework under the concept of social and economic development. Gender equality and women’s leadership Women’s leadership has been perceived as central component towards achieving gender equality and women’s empowerment objec- tives within EU sustainable development pol- icy framework (33). In particular, the target of women’s leadership advancement was em- bedded directly to the theme of “leadership positions”, but was also related indirectly to themes of “education” and “employment” (35). Hence, women’s leadership advance- ment was approached to a certain extent by EU policy agenda as a driver to equal oppor- tunities for full and effective participation to leading positions at all levels of decision making, in all employment areas and in all societal spheres (2). Women’s leadership in the healthcare sector Healthcare is populated mainly by women; 74% of health workforce are women but only 14% assume high level positions in decision making (10). The healthcare sector is re- garded as an investment driver across Euro- pean Union (36,37) and, thereby, is consid- ered a key component for health systems’ sustainability. It also enjoys a prominent po- sition among the biggest employers in EU (35). However, health systems miss female talent and perspectives, especially in higher echelons and turn weaker, underperformed since the women who deliver them do not have an equal say in the management and leadership of the systems, they know best (38). Hence, a substantial share of talents pool remains untapped, whereas the deficit for transformative leaders in healthcare grows bigger. Findings The undertaken qualitative study produced the following findings: Part I explored the barriers to women’s lead- ership and gender equality across three vital sectors, healthcare, academia and business in EU context. A comprehensive map of barri- ers to women’s leadership was devised. The Barriers Thematic Map (BTM)included twenty-six barriers with quantitative logic and varying degree of prevalence. The BTM uncovered gendered inequalities across sec- tors and drew attention to under-studied bar- riers’ prevalence across sectors (Figure 2, Figure 3, Figure 4) (19). Kalaitzi S. Navigating barriers to gender equality in the European Union context: The case of healthcare sector [Dissertation: University of Maastricht, 2019]. SEEJPH 2020, posted: 01 June 2020. DOI: 10.4119/seejph-3492 P a g e 8 | 17 Figure 2. Gendered barriers across healthcare, academy and business sectors – systematic literature review findings Figure 3. Gendered barriers in business (%), academia (%) and in healthcare (%) Kalaitzi S. Navigating barriers to gender equality in the European Union context: The case of healthcare sector [Dissertation: University of Maastricht, 2019]. SEEJPH 2020, posted: 01 June 2020. DOI: 10.4119/seejph-3492 P a g e 9 | 17 Figure 4. Barriers Thematic Map (BTM) to gender equality Part II focused on hypothesis testing by in- vestigating the BTM within social reality, contextualizing and interpreting the findings and gaining in depth insights in relation to re- search hypothesis on healthcare sector within the context of two, comparable countries, Greece and Malta. Firstly, empirical findings (online survey) on perceptions of Greek women healthcare lead- ers on barriers to career advancement identi- fied the twenty-six barriers included in BTM (Figure 5) (20). Six barriers (stereotypes, work/life balance, lack of equal career ad- vancement, lack of confidence, gender gap, and gender bias) prevailed in women leaders’ perceptions in constraining opportunities for pursuing leading positions in Greek healthcare setting, whereas all twenty-six barriers presented varying degree of preva- lence. Secondly, qualitative research find- ings (semi-structured interviews) identified twenty and twenty-one barriers to women’s leadership within the Greek and Maltese healthcare settings, respectively (Figure 6) (21). In both research settings prevailing bar- riers included work/life balance, lack of fam- ily (spousal) support, culture, stereotypes, gender bias and lack of social support, yet countries’ similarities and differences in prevalence of the identified barriers were ob- served. Notably, cultural tightness was found to be experienced against socio-cultural transformation in Maltese context; the recent economic crisis was found to be responsible for a backlash in previously achieved gender equality objectives in Greece. Thus, research findings unveiled underlying interactions Kalaitzi S. Navigating barriers to gender equality in the European Union context: The case of healthcare sector [Dissertation: University of Maastricht, 2019]. SEEJPH 2020, posted: 01 June 2020. DOI: 10.4119/seejph-3492 P a g e 10 | 17 among gender, leadership and countries’ so- cio-cultural and economic contexts elucidat- ing the varying degree of strength of norms and barriers embedded in a society’s egalitar- ian practice. Figure 5. A BTM-based Best-Worst Scaling (BWS) assessment on gendered barriers across Greek women healthcare leaders Part III turned to gender equality policy agenda at the EU level. The chapter consid- ered the sustainable development thinking in gender equality policy objectives in EU per- taining to its relevance to challenges faced by Member States’ citizens. In particular, the chapter explored the relevance of EU SDG5 themes and indicators and the prioritization of policy objectives to actual social reality across Member States. Findings identified in- consistencies in application of gender equal- ity related articles binding for both EU and MS (Treaty of Lisbon, Art 2, Art 3.3, Art 6.1, and Art 9), posing thus questions about the prioritization of gendered challenges from EU and national policy actors and stakehold- ers. The translation of SDG5 into national achievable targets was discussed under the perspective of persistent and uneven gender inequalities across MS. The study argued for EU’s proactive leadership, underpinned by academia and civil society contributions to optimize support to the MS to revisit their na- tional policies and develop evidence-in- formed policies; thus, the sustainable devel- opment efforts may be strengthened to align with the gendered priorities and challenges at MS level. Moving to the policy implementation realms, the study identified that the inherent duality of toolkits (gender and governance) may be held responsible for their suboptimal trans- formative capacity within organizational context; furthermore, the under-developed qualitative elements of the toolkits, such as the SESAME features (simple, easy, specific, affordable, measurable and efficient) and the lack of gender expertise at policy and deci- sion makers level may also need to be further developed to facilitate effectively the organ- izational change processes Kalaitzi S. Navigating barriers to gender equality in the European Union context: The case of healthcare sector [Dissertation: University of Maastricht, 2019]. SEEJPH 2020, posted: 01 June 2020. DOI: 10.4119/seejph-3492 P a g e 11 | 17 Figure 6. A BTM-based semi-structured interviews study on gendered barriers across women and men healthcare leaders in Greece and Malta Discussion European Union’s high level legal and polit- ical commitment towards achieving gender equality objectives has produced suboptimal outcomes. The gendered priorities misplaced by policy makers and the inconsistent com- mitment across EU bodies and agencies fos- tered the persistence of gendered barriers and equal representation in economy and society, undermining thus the undertaken efforts. The policy intentions and policy implementation have not been sufficiently bridged; the suboptimal transferring of the academic knowledge to policy practice servants and the lack of gender disaggregated data feeding bottom up, customized policies at both coun- try and EU level may be hold responsible, amongst others, for shortcomings in policy prioritization and effective implementation (3,9,39,40). Inconsistent commitment and lack of collec- tive action Gender scholars argue that EU gender poli- cies are the battleground for EU institutions underpinned by shifts in power relations (41). The way gender (in)equality is framed, en- gages differently the different actors across the EU policy making arena which results in fading away the centrality of the policy prob- lem; hence, the gender equality policy objec- tive is placed as the “side dish” of the actual EU policy making goals (42). For example, the European Commission framed gender equality policies through gender mainstream- ing in all policies undertaken by actors nor- mally involved in policy making (40,41,43); yet it ended up to bureaucrats with a rather technical than political conceptualization of Kalaitzi S. Navigating barriers to gender equality in the European Union context: The case of healthcare sector [Dissertation: University of Maastricht, 2019]. SEEJPH 2020, posted: 01 June 2020. DOI: 10.4119/seejph-3492 P a g e 12 | 17 gender equality principle shaping accord- ingly the policy agenda (44,45). On that note, inconsistencies in funding and budgeting may conflict directly with the EU’s full legal and political commitment (Art 2, Art 3.3, Art 6.1, Art 9; Treaty of Lisbon, 2007) (34) and, then, result to limited positive impact on gen- der equality issues, such as gendered unem- ployment (41,46). Lack of gender disaggregated data Putting evidence into practice is complicated and context dependent; yet, it remains a dy- namic process with a continuous interaction between academic research and policy mak- ers which may identify priorities and evaluate the level of responsiveness to key audiences. Almost none of the EU gender related poli- cies incorporate a systematic and consistent mechanism, such as disaggregated data col- lection, to evaluate whether the policy has successfully responded to its objectives and the potential room for improvement (3,47). The critical gap of a gender disaggregated data pool enhanced the fuzzy evaluation of the gender equality policies, in particular at Member States implementation level (47). Robust evidence generated by academic knowledge may fill in the gaps in the policy cycle and contribute in developing evidence informed gendered policies, responsive to gendered barriers faced within country’s spe- cific socio-cultural and economic contexts. Gendered barriers: The case of healthcare sector The interest of scholars, civil society, Euro- pean and international agencies on the per- sisting underrepresentation of women in leading positions and the implications to health systems, economy and society has been growing rapidly during the latest years. For example, a growing interest on gender in- equalities in health and healthcare from civil society actors has been observed in recent years. Non-Governmental Organizations (NGOs) (e.g., Women in Global Health Re- search Initiative) and associations (e.g. Euro- pean Health Management Association) advo- cate gender equality in health workforce from several perspectives, such as equal opportu- nities to career advancement and equal pay. In the same line, European and international agencies keep a close eye to EU region and discussed intensively in recent years the women’s underrepresentation in healthcare. In particular, Dr Tedros, Director General of WHO, re-stated the necessity for gender transformative action in health (38) and launched the WHO Global Health Workforce Equity Hub in 2017 (48). Arguably, the considerable, multi-discipli- nary effort to unpack the complexity of barri- ers to gender equality demonstrates scholar- ship’s unanimous voice on achieving gender equality objectives and, thereby, on address- ing the gendered barriers in a feasible and ef- fective way. However, although all involved actors argue for the importance and urgency of gendered challenges in healthcare and es- tablished the relevance of gender equality in health workforce to sustainable transfor- mation and governance of health systems, the results remain poor. Health workforce is the beating heart of healthcare and health sys- tems which are mainly populated by women. Thereby, maybe the extra mile towards achieving a gender balance workforce may need to be undertaken by academia with the main aim to detail the health workforce’s ca- pacity as a change agent towards achieving gender equality objectives within work and social contexts and project the gender bal- anced health workforce as a paradigm to so- ciety and economy. Kalaitzi S. Navigating barriers to gender equality in the European Union context: The case of healthcare sector [Dissertation: University of Maastricht, 2019]. SEEJPH 2020, posted: 01 June 2020. DOI: 10.4119/seejph-3492 P a g e 13 | 17 Implications The study introduces the feature of compre- hensiveness and prevalence of gendered bar- riers; nonetheless, there is ample room for further research, which would be extremely informative and would maximize the impact of the findings at hand. Additional study on the twenty-six identified barriers through a multi-disciplinary lens would be of added value to the field; in particular, the barriers’ contextuality in terms of their durability and transferability might have also been recog- nized and assessed differently through the lens of several academic disciplines, such as sociology, psychology, political science, management and organizational behavior sci- ence, gender science, feminism; similarly, gendered barriers manifestation across vari- ous sectors (e.g. NGOs, agriculture) would offer interesting insights to the explored phe- nomenon’ prism. On the grounds of the provided evidence-in- formed insights on the context sensitive and country specific gendered barriers, policy ac- tors and decision makers are invited to follow the “think globally – act locally” strategy in gender equality policies and practices in their efforts to close the gap between policy and reality. Furthermore, the findings of this re- search may serve to raise awareness to policy and social actors on the gender asymmetries’ influence in terms of power and authority within a country’s social and cultural context. Policy and social stakeholders are invited to revisit the level of responsiveness of adopted policies to social audiences and to re-evaluate the dynamic dialogue among societal culture, leadership and gender in enabling social and cultural change. At the author’s best knowledge, this study is one of the first to develop a Barriers Thematic Map (BTM) with a prevalence feature. The BTM may be developed to a digital tool for self-awareness and a reality check on gen- dered challenges at organizational level. Ap- plying the BTM, a snapshot of the gendered barriers’ manifestation and prevalence within organizations may be generated. Providing data anonymization, the tool may offer the room to unveil both apparent and implicit barriers experienced by all genders bypass- ing, thus, potential power relations within or- ganizations. This evidence-based overview may disclose policy gaps and be linked to or- ganizational practices for improvement. The yielded evidence-based information will also contribute to effective use of resources, which may be channeled to fulfil customized needs and, therefore, improve organization’s change capabilities and performance. Conclusions The study demonstrated that the gendered barriers are numerous, manifest themselves in chorus and with a varying degree of prev- alence across and within sectors and are greatly influenced by country’s socio-cul- tural and economic contexts. Hence, in con- trast to published literature, the findings sup- port that barriers to gender equality need to be addressed comprehensively, not on a one to one basis, aiming to capture the wholeness of the problem and, thus, design and imple- ment effective strategies, policies and prac- tices to address the actual priorities and chal- lenges across sectors and within countries’ specificity. The lack of consistent and collec- tive commitment on gender equality objec- tives at both EU and Member States level, may have put forward misplaced gendered priorities and compromise the progress dy- namics. 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