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Throughout history, girls' education has been a contested social, economic, political, and religious issue in the Pashtun region of Pakistan. Studies suggest that the root causes of this gender gap are multifaceted and complex. Poverty, the lower status of women in society, and sociocultural issuescoupled with poor access to schools, security, transportation, and lack of female teachers-are some key areas discussed in the literature (Khalid & Mujahid-Mukhtar, 2002). Two decades of continuing war and conflict, extremism, and the introduction of strict cultural and religious ideologies have further complicated and magnified the issue of gender justice in education. The impact of these pressures is most clearly visible in the Pashtun tribes of Pakistan bordering Afghanistan, where only 13% of primary-school-aged girls are enrolled (the United Nations International Children's Emergency Fund [UNICEF], 2010). Despite some progress in South and West Asian countries, where the number of girls out of school shrank from 24.2 million in 2000 to 6.

ImportanceA safe and effective treatment for recurrent Clostridioides difficile infection (CDI) is urgently needed. Antibiotics kill toxin-producing bacteria but do not repair the disrupted microbiome, which promotes spore germination and infection recurrence.ObjectivesTo evaluate the safety and rate of CDI recurrence after administration of investigational microbiome therapeutic SER-109 through 24 weeks.Design, Setting, and ParticipantsThis phase 3, single-arm, open-label trial (ECOSPOR IV) was conducted at 72 US and Canadian outpatient sites from October 2017 to April 2022. Adults aged 18 years or older with recurrent CDI were enrolled in 2 cohorts: (1) rollover patients from the ECOSPOR III trial who had CDI recurrence diagnosed by toxin enzyme immunoassay (EIA) and (2) patients with at least 1 CDI recurrence (diagnosed by polymerase chain reaction [PCR] or toxin EIA), inclusive of their acute infection at study entry.InterventionsSER-109 given orally as 4 capsules daily for 3 days following symptom resolution after antibiotic treatment for CDI.Main Outcomes and MeasuresThe main outcomes were safety, measured as the rate of treatment-emergent adverse events (TEAEs) in all patients receiving any amount of SER-109, and cumulative rates of recurrent CDI (toxin-positive diarrhea requiring treatment) through week 24 in the intent-to-treat population.ResultsOf 351 patients screened, 263 were enrolled (180 [68.4%] female; mean [SD] age, 64.0 [15.7] years); 29 were in cohort 1 and 234 in cohort 2. Seventy-seven patients (29.3%) were enrolled with their first CDI recurrence. Overall, 141 patients (53.6%) had TEAEs, which were mostly mild to moderate and gastrointestinal. There were 8 deaths (3.0%) and 33 patients (12.5%) with serious TEAEs; none were considered treatment related by the investigators. Overall, 23 patients (8.7%; 95% CI, 5.6%-12.8%) had recurrent CDI at week 8 (4 of 29 [13.8%; 95% CI, 3.9%-31.7%] in cohort 1 and 19 of 234 [8.1%; 95% CI, 5.0%-12.4%] in cohort 2), and recurrent CDI rates remained low through 24 weeks (36 patients [13.7%; 95% CI, 9.8%-18.4%]). At week 8, recurrent CDI rates in patients with a first recurrence were similarly low (5 of 77 [6.5%; 95% CI, 2.1%-14.5%]) as in patients with 2 or more recurrences (18 of 186 [9.7%; 95% CI, 5.8%-14.9%]). Analyses by select baseline characteristics showed consistently low recurrent CDI rates in patients younger than 65 years vs 65 years or older (5 of 126 [4.0%; 95% CI, 1.3%-9.0%] vs 18 of 137 [13.1%; 95% CI, 8.0%-20.0%]) and patients enrolled based on positive PCR results (3 of 69 [4.3%; 95% CI, 0.9%-12.2%]) vs those with positive toxin EIA results (20 of 192 [10.4%; 95% CI, 6.5%-15.6%]).Conclusions and RelevanceIn this trial, oral SER-109 was well tolerated in a patient population with recurrent CDI and prevalent comorbidities. The rate of recurrent CDI was low regardless of the number of prior recurrences, demographics, or diagnostic approach, supporting the beneficial impact of SER-109 for patients with CDI.Trial RegistrationClinicalTrials.gov identifier: NCT03183141

This paper examines how Pashtun men perceive women’s role and girls’ education. A modified two-round Delphi exercise was followed by in-depth qualitative interviews with Pashtun men of diverse backgrounds, including representatives of religious and political groups. The interviews demonstrated that the sociocultural status of women, and consequently their access to education, remains deeply tied to Pashtunwali (tribal code) and rigid religious interpretations. Though at times contradictory, the ideas and stereotypes arising from religion, culture, and politics were found to meaningfully shape men’s attitudes about women’s participation in community and education. However, the study found that, compared to rural and tribal areas, these traditions and restrictions are not as rigidly practiced in the urban and plains areas. Understanding men’s views is a starting point. The next step is to engage men in the collective struggle for gender justice.

Resistance to girls' education is a social justice and human rights issue in many countries. In Pakistan, where the lowest school enrollment for girls is in Pashtun areas bordering Afghanistan, it is especially problematic. Pashtun society is patriarchal: Men have the power to construct obstacles to girls' education, and to remove them. This article therefore explores a different way of overcoming barriers to gender justice, namely through the participation of men. A qualitative Delphi process and in‐depth interviews with Pashtun men led to their consensus on seven key points of leverage where action could be taken. Participants agreed that progress toward gender parity could be achieved only by making allies of powerful community leaders, especially religious leaders, and by utilizing existing institutions, such as the mosque, Jirga (council of elders), and the men's guest house. For each point of leverage, a policy recommendation is made for increasing girls' participation in education.