Gender inequality still underpins and weakens our social, economic, and health systems, says Roopa Dhatt
International Women’s Day is always an opportunity to celebrate the contribution of women to our social, political, and economic wellbeing and development. With the world changing so profoundly in the past year during the covid-19 pandemic, it feels even more apt to stop and reflect on not just the achievements of all women, but the extraordinary contribution women have made as 70% of the health and social care workforce.
The theme for International Women’s Day 2021 is “Women in leadership: Achieving an equal future in a covid-19 world.” At the moment, however, achieving an equal future in the healthcare sector is a distant dream, whether now or in a post covid-19 world. Women may deliver the majority of healthcare but, in general, they do not lead the health systems they know best. Women hold only 25% of senior leadership posts in healthcare, while making up 90% of nurses—many of whom have borne the brunt of long hours, mental trauma, and risk of infection in this pandemic, all while coping with surges of desperately ill patients.
Logic would suggest that during such an unprecedented global health emergency, countries and global bodies would assemble the best range of talent around the table to design measures to contain and respond to the pandemic. Unfortunately, that has not been the case. The “majority male leadership model” seen in “normal times” has been repeated in the pandemic. A Women in Global Health survey of 115 national covid-19 taskforces found that 85% had majority male membership. There is no shortage of qualified women with relevant expertise, but they have largely been sidelined in pandemic decision making, with the result that some policies put in place have cost lives needlessly. Many health systems have shifted resources to covid-19 from other areas of health, including maternity and reproductive health services. This is despite the fact that pregnancy does not stop in a pandemic and we know from other disease outbreaks, such as Ebola, that women die when they cannot access safe delivery services.
You might also think that during a critical health emergency, greater value would be placed on protecting the women our lives depend on. Again, this has not happened. Health workers may have been applauded in many countries, but in others women health workers have faced stigma and violence, even being attacked on the mistaken assumption that they were spreading SARS-CoV-2.
In many countries and contexts, far from protecting the health and lives of women in patient and community facing roles, personal protective equipment (PPE) has not been available, has been in short supply, and has been modelled on men’s bodies, exposing women to a higher risk of infection and compromising their dignity. The United Nations Population Fund sent adult diapers and sanitary towels to female health workers in Wuhan, China who were unable to remove their PPE during long shifts. In other countries, Women in Global Health chapters have reported that women health workers avoid drinking liquids during long shifts to avoid the need to remove PPE that is not designed to meet women’s needs. As a practising physician I can attest that it is hot, uncomfortable, and exhausting to work in full PPE even for short periods of time. I praise the dedication of the women who put their patients’ welfare before their own. However, dedication and self-sacrifice are not built into women’s DNA. Systemic discrimination and bias leaves women with no choice.
Logic would also suggest that we should build global health security on the strongest possible foundations, given the high human and economic costs when it goes wrong. Yet this is far from a reality in many countries. The alarming truth is that the women going house to house at a community level to raise awareness of and identify covid-19 in many countries have been unpaid or underpaid community health workers. Half the $3 trillion women contribute to global health every year is in the form of unpaid work. Some of the world’s poorest women subsidise global healthcare with their unpaid labour. The gender pay gap of around 28% in the health sector is higher than in most other sectors of the economy and would be far higher if women’s unpaid work was factored into the calculation.
As we celebrate International Women’s Day in this extraordinary year, it is the right time to state that we cannot go back to business as usual when this pandemic is under control. Covid-19 has exposed the deep inequalities, including gender inequality, that underpin and weaken our social, economic, and health systems. We cannot continue with systems that create a path to leadership for one social group and put barriers in the way of everybody else.
To achieve our vision of equitable leadership in global health in a covid-19 world and beyond, Women in Global Health will work to catalyse change in four critical areas:
First, history must record and celebrate women’s contribution to the pandemic. We will bring stories of women’s experiences in healthcare that in the past have been unspoken. Sexual harassment of women in healthcare is not new. PPE modelled on men’s bodies is not new. The fact that men earn more than women in the sector is not new. And women’s marginalisation in leadership is just one more longstanding problem that has been hiding in plain sight. Not acknowledging the role women play in health and social care sidesteps the need for gender transformative change.
Second, women in health and social care need a new social contract. Women are largely clustered into lower status and lower paid (often unpaid) roles driven by discrimination and gender stereotypes that brand nursing a suitable job for a woman and surgery a suitable job for a man. This gendered occupational segregation drives disadvantage and reinforces privilege. Stereotypes and bias impact even further on women from marginalised groups and geographies. Moreover, majority female professions such as health and social care are typically given lower social value and therefore attract lower status and pay. Covid-19 should have taught us the value of our health and the women who protect it.
Third, looking at the abysmal performance on the pandemic of some high income states, it is clear that although the global north may have a near monopoly on covid-19 vaccines, rich countries have much to learn from less well resourced regions. Women in Global Health are working to rebalance the geography of power and leadership in global health. We create a platform for women from low and middle income countries to take their place in global health leadership.
Fourth, we need gender parity in global health leadership but we need to go beyond gender parity and counting numbers, to judging health leaders of all genders on how far they challenge inequity and exclusion. We ask leaders of all genders to be gender transformative leaders, challenging power and privilege and promoting gender equality in health because that will, in turn, promote strong, resilient health systems. Beyond gender parity we want leaders of all genders to come from diverse groups representing the make-up of their communities.
This year Women in Global Health has launched a Gender Equal Health and Care Workforce Initiative with the government of France and World Health Organization because we believe this is the year for investment in safe and decent work, equal pay, and equality in leadership for women in the healthcare sector. This is more vital than ever because the world needs an additional 18 million health workers to achieve universal health coverage by 2030 and, after a year of this pandemic, many women healthcare workers are exhausted, mentally stressed, and considering leaving the profession. Covid-19 should have taught us that we cannot afford to lose even one healthcare worker. This is not a women’s issue, it is everybody’s health and everybody’s business. On International Women’s Day, it is time we protected women in the healthcare sector so they can protect us.
Roopa Dhatt, executive director, Women in Global Health. Twitter @RoopaDhatt
Competing interests: none declared.