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Globally, women hold around 70% of health-worker jobs, over 80% of nursing and over 90% of midwifery roles and deliver the majority of unpaid care and domestic work in families and communities. If leadership roles were allocated proportionally (assuming that women and men have equal merit) then 70% of health sector leaders would be women. The reverse is true.
Building on reports from the World Health Organization, Women in Global Health conducted research to assess why just 25% of senior leadership positions in health are held by women. The research included deep dive case studies in Nigeria, Kenya and India to examine why women from the Global South, the primary focus of many global health organisations and programs, are underrepresented in global health leadership.
Despite women delivering the majority of health services, the system remains biased in favor of men, and women’s representation in global health leadership has stagnated over the past five years.
Our global policy report, The State of Women and Leadership in Global Health, has revealed that despite women delivering the majority of health services, the system remains biased in favor of men, and women’s representation in global health leadership has stagnated over the past five years.
The stress test of the COVID-19 pandemic highlighted another uncomfortable truth: when the world moves into emergency response mode, men assume the default role of ‘natural leaders’. A WGH study in 2020 found 85% of 115 national COVID-19 task forces had majority male membership and at WHO’s Executive Board meeting in January 2022 only 6% of member state representatives were women, down from a high of 32% in 2020.
Also on the Forum Network: 268 years to close the economic gender gap? It is time to consider CARE as a human right by Valerie Bichelmeier, Vice-President, Make Mothers Matter (MMM)
Unpaid care work is fundamental to ensure the sustainability of life, but it is time-consuming and it is women who bear the costs. The so-called ‘3Rs Framework’, Recognise-Reduce-Redistribute, provides concrete avenues on which to act to accelerate progress on Gender Equality and social sustainability, explains Valerie Bichelmeier.
In most countries, there is no shortage of women in the health leadership pipeline; as they make up the majority of junior doctors, nurses, pharmacists and dentists. However, there are leaks in the pipeline making it challenging for women to achieve leadership positions.
Throughout the pandemic, women tirelessly worked on the frontlines of the response, often facing high patient volumes, long hours, elevated stress, in addition to shouldering the burden of unpaid care at home and in their communities. Unsurprisingly, after three years of the pandemic, many women health workers are experiencing burnout and trauma, and are leaving the sector as evidenced through the ‘Great Resignation’ in health.
Women often experience systemic gender discrimination in a system that rewards a ‘default male bias’ in health leadership. This extends to the practical challenges faced by women in a sector that has been historically designed for the ‘default man’. For example, policies governing the health workforce often treat issues such as menstruation, pregnancy, and childcare as exceptions, despite women representing the majority.
On average, women in global health earn 24% less than their male counterparts, which underscores the need for systemic change.
The report states that the solution is not to ‘fix women’ to fit into workplace systems and cultures that favor men for leadership, but to fix the systemic gender bias that limits women’s opportunities. This bias can stem from a lack of educational opportunities, cultural restrictions, and even a failure to outlaw sexual harassment at work. Gender bias in hiring, and pay gaps also serve as obstacles for women in advancing their careers. On average, women in global health earn 24% less than their male counterparts, which underscores the need for systemic change.
Our collective failure to ensure women have a fair pathway to health leadership has negative effects both on women and on health outcomes for everyone. Denying women their right to equal leadership in the health sector also means that health systems are missing out on the expertise of the millions of women working in global health.
Feasible policy solutions are available, what is needed now is intentional action to implement gender-transformative policy measures.
Our key recommendations include:
- Enabling diverse women to lead by creating tailored leadership opportunities for women from marginalised backgrounds who may have missed out on formal education and qualifications
- Fast tracking actions to redress gender inequality in global health leadership with measures such as all women shortlists
- Mobilising men to lean out and step up as allies, ending the ‘male bonus syndrome’ by normalising paternity leave and other family friendly policies that shift gender norms to share the burden of care work equally
- Ending the ‘default man’ bias by recognising that the default women worker, unlike the default man, may need support for breastfeeding, as well as personal protective equipment (PPE) that adequately fits her needs
- Implementing and tracking measures to reduce the gender pay gap in global health
A recent UN report projects that it will take 140 years for women to achieve equal representation in leadership positions in the workplace, but there is no reason for women in the health sector to wait that long. Providing equal opportunities for women to access health leadership can have far reaching effects right across the health workforce and on those entering the sector. It can send a message that expertise is valued, and opportunities for career progression exist. Crucially, it can unlock a “gender triple dividend” of improved health systems, progress towards gender equality and stronger economic growth.
Women health workers have been overlooked for too long. The COVID-19 pandemic presents an opportunity to break the cycle of ‘male bonus syndrome’ in health leadership and enable women to shape the future of global health.
The OECD Gender Initiative examines existing barriers to gender equality in education, employment, and entrepreneurship. Find out more!
And check out also the OECD report: Man Enough? Measuring Masculine Norms to Promote Women’s Empowerment
Masculinities can either support or hinder women’s empowerment and greater gender equality. However, a lack of consistent and comparable data hinders efforts to understand and assess harmful, restrictive masculinities. This report identifies and describes ten norms of restrictive masculinities to be urgently addressed within the political, economic and private spheres.
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