Perceptions, priorities, and project delivery problems in women's and environmental health in Peru: a qualitative study

BACKGROUND: Women living in low-income and-middle-income countries experience increased exposure and worse effects of environmental threats and climate change. Peru is especially susceptible to a range of environmental exposures, including high levels of pollutants, contamination associated with extractive industries, and flooding exacerbated by the ongoing climate emergency. International policies and movements are increasingly calling for a gendered approach to planetary health. However, little research has been done explicitly examining environmental threats to women's health in Peru. We aimed to understand the current Peruvian research, advocacy, and policy landscape at the environment-gender health nexus. METHODS: We did in-depth semi-structured interviews in Spanish via online Zoom video conferencing (audio only) with key informants from the Peruvian Government, academia, and non-governmental organisations to explore their perception of environmental health threats and priorities, population vulnerability factors, awareness of projects and collaborations on these topics, and the role of gender in their work. We used thematic analysis to compare priorities, gender sensitivity, and barriers and facilitators to delivering successful women's environmental health projects in the country. FINDINGS: Since July 14, 2020, we have interviewed 16 people, with four further interviews planned to take place before the end of May, 2021. Several interviewees mentioned the detrimental role of weak institutions, multilevel corruption, and the absence of interdisciplinarity and intersectorality across programmes and research. Barriers to successful collaboration across organisations and sectors were clearly identified, including funding scandals related to extractive economies, high staff turnovers impairing long-term programme implementation, and machismo culture in both organisations and communities. By contrast, some interviewees highlighted that successful collaborations were instead built on direct relationships, reputation, trust, and transparency. Women's empowerment was also described as important for successful programme delivery, especially in female-led associations. Some interviewees emphasised the so-called invisibilisation of vulnerable groups, such as girls, teenagers, pregnant women, victims of gender-based violence, and LGBTQI people. Existing health inequalities varied by setting and cultural context and were deeply and silently exacerbated by the COVID-19 pandemic. INTERPRETATION: These qualitative findings highlight the multiple and inter-related contextual issues faced by environmentally threatened communities in Peru, and how macrostructural barriers contribute to a paucity of sustainable, gender-oriented, environmental health projects. FUNDING: Partially funded by the UK's Economic and Social Research Council.