At the heart of the World Health Organization’s mission is universal health coverage — a basic principle that everyone everywhere should have access to the care they need, when they need it, in their own communities and without incurring undue financial burden.
Yet half of the world’s population still lack comprehensive access to the health services they need to survive.
That’s why universal health coverage is the focus for World Health Day on April 7th. And women must play a pivotal role if we want to see real and lasting progress.
Now is a particularly timely moment to address the role of gender equality and universal health coverage. Just last month, world leaders, experts, policymakers and advocates met in New York to discuss a global roadmap toward gender equality at the annual convening of the United Nations Commission on the Status of Women, the largest gathering of the UN’s 193 member states exclusively dedicated to women’s empowerment.
As one of the Sustainable Development Goals (SDGs), gender equality (SDG 5) is recognized as a global priority in its own right. But gender equality will also be crucial for achieving all 17 of the SDGs — from good health and well-being (SDG 3) to zero hunger (SDG 2).
This includes meeting the SDG target on universal health coverage, which includes “financial risk protection, access to quality essential healthcare services and access to safe, effective, quality and affordable essential medicines and vaccines for all.” This September, UN member states will adopt a political declaration re-committing themselves to universal health coverage at the UN General Assembly’s High-Level Meeting on the subject.
Yet many stakeholders have voiced growing concern about whether gender equality is being overlooked as part of these discussions. The Partnership for Maternal, Newborn and Childhood Health, for example, recently issued a Call to Action on Sexual and Reproductive Health and Rights, urging national governments and the international community to prioritize the health of women, children and adolescents through smarter financing and comprehensive, affordable and quality services that promote sexual and reproductive health and rights.
This call is especially urgent given a movement from some countries to reverse existing multilateral language on sexual and reproductive health and rights. Shockingly, and for the first time ever, the UN Commission on the Status of Women was subjected to personalized cyber and physical attacks on a senior diplomat responsible for wrapping up the discussions at the Commission last month. This troubling trend threatens to undermine the gains made in past decades on women’s health, as well as the overall goal of universal health coverage.
Following closely on the Partnership for Maternal, Newborn and Childhood Health’s action, Women in Global Health released a Call to Action on Universal Health Coverage, which highlights women’s role as providers, beneficiaries, leaders, and advocates for access to adequate health care. The organization also emphasized why women’s voices and leadership will be crucial for the UN to hold its member states accountable and move progress forward on gender equality, specifically calling on countries to bring gender-inclusive delegations to New York this September for the UN General Assembly’s High-Level Meeting on universal health coverage.
Women in Global Health, together with WHO and the Global Health Workforce Network, also released a report last month, “Delivered by Women: Led by Men,” analyzing gender equity in the global health workforce. Based on a review covering more than 170 studies on the topic, the report covers four main themes: 1) occupational segregation; 2) decent work free from bias, discrimination and harassment; 3) the gender pay gap and 4) gender parity in leadership. Reinforcing the importance of the topic, WHO and the International Labor Organization simultaneously published a complementary assessment on the conditions of the health workforce in 104 countries.
The results from the two studies are startling. More than 70% of the health workforce is female, yet some 50% of women’s work in this sector is underpaid or unpaid entirely. Both reports found that occupational segregation — or jobs being divided along gender lines — is the main driver of gender inequality in the health workforce. Nursing and caregiving for example, continue to be female-dominated, with low pay and low social value. High levels of sexual harassment and burn-out are experienced by women in these occupations, a reflection of unfair and unrealistic gender norms in which domestic roles and expectations continue to disadvantage women.
Compared to other sectors, the gender pay gap in the global health workforce, standing at 28%, is staggering. In one study cited in the report led by Women in Global Health, the salaries of female physicians was 11% less than their male colleagues if they were married, 14% less if they had one child, and a whopping 22% if they had two children. In other words, marriage and motherhood had serious financial consequences for women doctors — but not so for their male colleagues.
When it comes to leadership roles in global health, the situation is also dire. Only 31% of executive director roles in global health institutions are held by women, while only 20% of board chairs are female.
“We need gender-transformative policies that fix the system,” said Dr. Roopa Dhatt, Executive Director of Women in Global Health during the launch of the two reports. “We cannot have strong global health without gender equity. It’s about human rights, investment in the workforce and socio-economic development.”
But the challenges begin early. Speaking at the launch event, Niger’s Deputy Minister Mariama Chipkaou noted that only 45% of girls in her country complete high school. As a result, the number of girls and women being steered toward senior roles in Niger’s health workforce is extremely limited.
Another speaker, Edmaze Louis, who works for Partners in Health in Haiti, noted that women are systematically relegated to lower levels of management — not only in the country’s health workforce, but also within the NGO community. In her experience, few Haitian women in either sector have access to opportunities for advancement.
“We need to find ways to give incentives to institutions to increase the number [of women] at meaningful levels, and to ensure that women are involved in policy-making,” said Anne Guéngen, Deputy Permanent Representative of France to the UN.
At the same time, there is enormous opportunity here.
The International Labor Organization estimates that by 2030, 139 million jobs will be created in the health sector globally. By investing in training and leadership for women in particular, countries can reap a triple dividend: Improving healthcare, achieving gender equality and promoting sustainable development. All of these will fuel economic growth that will benefit everyone — male, female, young and old.
Put simply, if women in health are supported on all levels and in all corners of the world, societies will be healthier, fairer, and more prosperous. This is the very same promise of the SDGs. As an essential pathway to delivering the SDGs, universal health coverage can take the lead in adopting a feminist agenda. These reports and calls to action are an important step in showing us the way forward.