Title: How Gender-Sensitive Disaster Management is Addressed in the Turkish Parliament: A
Qualitative Study from Feminist Bioethics Perspective
Version: 2 Date: 23 Sep 2024
Reviewer's report:
PEER REVIEWER ASSESSMENTS:
OBJECTIVE - Full research articles: is there a clear objective that addresses a testable research
question(s) (brief or other article types: is there a clear objective)?
No - there are minor issues
DESIGN - Is the current approach (including controls and analysis protocols) appropriate for
the objective?
No - there are minor issues
EXECUTION - Are the experiments and analyses performed with technical rigor to allow
confidence in the results?
No - there are minor issues
STATISTICS - Is the use of statistics in the manuscript appropriate?
N/A - there are no statistics in this study
INTERPRETATION - Is the current interpretation/discussion of the results reasonable and not
overstated?
No - there are minor issues
OVERALL MANUSCRIPT POTENTIAL - Is the current version of this work technically
sound? If not, can revisions be made to make the work technically sound?
Maybe - with major revisions
PEER REVIEWER COMMENTS:
GENERAL COMMENTS: The study addresses a vital and under-researched area, investigating
the ethical dimensions of women’s health in post-disaster settings, particularly after the Turkey
earthquake of February 2023. It is unique in its use of parliamentary session records (from the
Turkish Grand National Assembly) as a primary data source, which offers insights into how
women's health and ethical concerns are reflected and prioritized at the policy level. The study
provides an ethical analysis of disaster response, with a strong focus on gender-specific needs.
While the study has considerable merit, including the exploration of critical themes such as
gender-based vulnerabilities and ethical obligations, it has limitations in its methodological
rigor, lack of triangulation, and somewhat surface-level interpretation of the ethical complexities
involved.
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Objective
• Strengths:
o The study objective is timely and significant, particularly as it aligns with global discussions
on gender-sensitive disaster management.
o The emphasis on the ethical dimensions of women's health in disaster settings, including
gender equality, vulnerability, and care, reflects a growing recognition of these issues at the
international level.
• Areas for Improvement:
o The objective could be more specific in detailing what specific gaps in ethical discussions
or disaster response this paper addresses. For example, it could clarify whether the goal is to
critique the GNAT’s discourse, inform future policies, or provide a framework for addressing
women’s health in similar contexts globally.
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Study Design
• Strengths:
o The qualitative approach allows for an in-depth exploration of ethical discussions.
o The choice of parliamentary records is innovative, as these are official documents reflecting
public policy discourse.
• Areas for Improvement:
o The study design could benefit from data triangulation. While the GNAT records provide
important insights, they reflect a top-down perspective. Including data from women directly
affected, NGOs, or health professionals could offer a more comprehensive view of the ethical
and health challenges women faced.
o The rationale for choosing parliamentary records alone as the data source is not fully justified.
These records may not capture the lived realities of women in disaster areas.
o A broader qualitative methodology could enhance the robustness of the study. Incorporating
interviews or focus groups with key stakeholders (e.g., policymakers, health workers, and
disaster-affected women) would provide a richer, more nuanced data set.
______________________________
Execution
• Strengths:
o The authors successfully identified key ethical principles, such as gender equality, harm
prevention, care, and empowerment, and discussed how these were reflected in the parliamentary
discourse.
o The inclusion of direct quotes from the transcripts adds authenticity and grounding to the
analysis.
• Areas for Improvement:
o The coding process for identifying themes is not well-explained. How were the themes
derived? Was there a coding framework or protocol? Were multiple coders involved to ensure
reliability? Clarifying these aspects would improve the study's transparency and methodological
rigor.
o The data is descriptive, and while important themes are identified, there is a lack of deep critical
analysis. For instance, while gender-specific issues are noted (e.g., lack of hygiene products,
higher workload for women), the underlying systemic inequalities that contribute to these issues
could be explored in greater detail.
o The study could be improved by quantifying the prevalence of themes or categorizing them
based on their importance in parliamentary discussions.
o The discussion of health ethics is fairly surface-level. Concepts such as justice and
vulnerability are discussed but could benefit from a more philosophical or theoretical
underpinning. What specific ethical frameworks (e.g., principlism, feminist ethics) are guiding
the analysis?
______________________________
Interpretation
• Strengths:
o The interpretation highlights the ethical failings in Turkey’s disaster response, particularly in
addressing women’s needs.
o The focus on gender-sensitive disaster management and the call for more inclusive policies is
well-placed and aligns with global best practices.
• Areas for Improvement:
o The discussion and interpretation are relatively narrow and repetitive. The study identifies
issues but does not fully explore why these gaps exist in Turkish disaster management or how
ethical theories can inform solutions.
o Practical recommendations could be more robust. What should policymakers or healthcare
providers do differently? How can Turkey ensure that gender-sensitive ethics are integrated into
future disaster responses?
o The interpretation does not sufficiently consider intersectionality. While gender is a central
focus, other factors like ethnicity, disability, age, or socioeconomic status that exacerbate
vulnerability are not thoroughly explored. Addressing these would enrich the ethical analysis.
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Best Practice Considerations
• What the authors did well:
o The authors highlighted the gender-specific needs of women in disaster settings and
emphasized the importance of ethical disaster management.
o They explored key ethical principles essential in disaster recovery, such as justice,
vulnerability, and empowerment.
________________________________
• Areas where it does not meet best practice:
o As mentioned, relying on one data source (parliamentary records) limits the depth of the
analysis. Best practice would involve triangulating data from multiple sources (e.g., first-hand
accounts from women, NGOs, and medical personnel).
o The ethical analysis could benefit from being more theoretically grounded in ethical
frameworks. Referencing feminist ethics, bioethics principles, or disaster ethics could provide
more depth and sophistication to the analysis.
o The coding process and overall methodological rigor could be enhanced by providing more
detail on the analytic process. Multiple coders, inter-rater reliability checks, or software-assisted
qualitative analysis (e.g., NVivo) could strengthen validity.
o While the study calls for gender-sensitive approaches, it falls short of specific, actionable
recommendations for policymakers. More concrete suggestions for improving women's health
and rights in disaster contexts would make the study more impactful.
REQUESTED REVISIONS:
General Feedback:
• The study addresses a crucial and underexplored topic, analyzing the ethical dimensions of
women's health in post-disaster settings, specifically after the Turkey earthquake. The focus
on GNAT transcripts is original and highlights gaps in disaster management, particularly for
vulnerable populations like women. However, certain aspects could be expanded to increase the
manuscript's clarity, rigor, and impact.
Introduction
• Line 10-19: The introduction clearly states the study’s objectives, but there is a need for a
more specific research question. The problem statement could be more focused, outlining how
women’s health has been historically neglected in disaster management. You mention various
key themes, but it would help to state upfront what gaps in knowledge this paper seeks to fill.
Methods
• Line 104-110: The manuscript uses content analysis of parliamentary records, which is
appropriate given the research questions. However, the rationale for choosing the GNAT
documents as the sole data source needs further elaboration. Would including data from NGOs,
hospitals, or survivor interviews strengthen the findings? Consider triangulating your data
sources to provide a more comprehensive understanding.
• Line 112-122: The exclusion criteria are clearly defined, but there is a potential bias in relying
solely on parliamentary records, which may not fully capture the on-the-ground experiences of
women affected by the earthquake. A suggestion here would be to acknowledge this limitation
more explicitly and recommend future research that includes perspectives from women directly
impacted.
• Line 160-164: While the explanation of the ethics process is clear, an analysis of how ethical
decisions were made during the analysis could be expanded. For instance, how did you address
potential biases when interpreting politically sensitive material?
Results
• Line 166-170: The results section identifies relevant themes but lacks specific details regarding
the prevalence of each theme. It would strengthen the study by quantifying or at least providing
more examples of how frequently each ethical issue was raised in the GNAT sessions.
• Line 174-180: You mention that gender-specific issues were under-emphasized in disaster
relief, but the manuscript could benefit from further exploration into why these gaps exist
and how they affect women's health. The data on women's needs (e.g., hygiene products,
healthcare) is compelling but needs deeper analysis regarding structural inequalities within
disaster management that perpetuate these problems.
• Line 181-200: There is a strong emphasis on gender blindness in aid distribution, which is well-
founded. However, discussing examples from other countries (e.g., Nepal, and Haiti) would be
useful to compare and contrast Turkey’s response. This would allow for a broader perspective
on gender-sensitive disaster management.
Discussion
• Line 300-350: The discussion links back to ethical principles well, but the recommendations
for policy and practice could be more robust. For instance, the mention of gender-based violence
(Line 320) and the lack of secure spaces for women (Line 330) is important. Still, more concrete
suggestions are needed on how to implement better protection mechanisms for women in future
disaster scenarios.
• Line 355-360: Empowering women as active agents in disaster relief is an excellent point, but
it feels underdeveloped. Given the clear need for more gender-sensitive leadership in disaster
response, how could this empowerment be operationalized within Turkish policy? What are the
barriers to including women more prominently in decision-making roles?
Conclusion
• Line 370-380: The conclusion succinctly summarizes the findings but could benefit from
a more pointed call to action. Highlight specific steps Turkish policymakers or international
organizations should take to ensure gender equity in disaster response.
Specific Ethical Considerations:
• Line 350: The ethical principle of benefit provision vs. harm prevention is critical when
discussing resource allocation. While you touch on this, a more nuanced ethical debate around
resource prioritization for women vs. other vulnerable groups (e.g., the elderly, children) would
add depth to the analysis.
• Line 340: The manuscript mentions justice and fairness but could better explore systemic
ethical challenges, such as how existing power dynamics in Turkey may hinder the
implementation of equitable health policies for women.
Minor Comments:
• Overall, the manuscript reads clearly but could benefit from tighter editing in repetitive sections
(e.g., mentions of undergarments and hygiene products).
• Line 85: The statistical data on earthquake impacts are useful, but providing more context or
analysis on the disparity in injury rates between men and women could enhance the narrative.
ADDITIONAL REQUESTS/SUGGESTIONS:
1. Introduction
• Consider expanding the literature review to include international studies on the ethical
implications of disaster management for women (e.g., case studies from Haiti, Nepal, or Japan).
This will help frame the Turkish case within a global context and enhance the relevance of the
research to a broader audience.
2. Clarity of Research Questions
o The authors should articulate the core research questions they seek to address (e.g., "How are
women's health issues and ethical principles discussed in Turkey's disaster response policies
after the February 2023 earthquake?").
3. Methods Section
o Provide a detailed breakdown of the steps involved in the content analysis, such as how the
GNAT transcripts were selected, how themes were coded, and whether coders were trained.
o Include information on data saturation and whether new themes emerged as analysis
progressed.
o If possible, include a flowchart or diagram illustrating the coding process.
4. Results Reporting
o Provide more examples and quotes from the GNAT records to support each theme.
o Consider subdividing the themes further. For example, under "Vulnerability," you could
distinguish between psychological vulnerabilities, physical vulnerabilities, and socioeconomic
factors.
o If applicable, quantify the themes by showing how frequently certain topics were raised in the
transcripts (e.g., gender equality vs. care provision).
5. Discussion and Interpretation
o Strengthen the discussion by providing actionable recommendations for policymakers and
disaster managers. How can the findings inform future disaster responses in Turkey or other
countries?
o Expand on practical examples of how gender-sensitive policies could be implemented or
improved.
o Discuss potential barriers to implementing ethical disaster response policies, such as cultural
norms or bureaucratic challenges in Turkey.
6. Scope of Discussion
o Compare Turkey's handling of gender-specific health needs in disaster contexts with global
standards.
7. Language and Style
o Streamline sections where points are repeated (e.g., references to hygiene needs or violence
against women) to avoid redundancy.
o Ensure that technical terms (e.g., ethical principles) are clearly explained for readers who may
not have a background in health ethics.
o Improve sentence flow by varying sentence structure and avoiding overly complex phrasing.
8. Visual Aids
o Consider adding a table or figure that summarizes the main ethical themes discussed in the
GNAT sessions, such as "Vulnerability," "Gender Equality," "Care Provision," and how they
were addressed in the parliamentary discussions.
o A timeline of key GNAT sessions relevant to the earthquake could help illustrate how the
discourse evolved.
9. Ethical Framework
o Introduce and integrate specific ethical theories (e.g., feminist ethics, utilitarianism,
principlism) to provide a stronger theoretical foundation for the analysis.
10. Limitations
o Expand the limitations section to discuss not only the reliance on GNAT records but also
potential biases in the selection of transcripts, the lack of direct data from impacted women, and
issues with generalizability of the findings beyond Turkey.