A new Women in Global Health report shows that we still have a long way to go to achieve gender equity, although there have been strides.
The report, The State of Women and Leadership in Global Health, addresses the “XX Paradox,” 70% of frontline health workers are women, but they comprise only 25% of leadership roles in health.
The role of women in health delivery is enormous—they lead the care for 5 billion people and contribute $3 trillion (USD) to global health. Unjustly, half of that comes through unpaid work. This work is largely from essential community health workers subsidizing the care of their communities. Estimates are that there are a minimum of 6 million women working unpaid in health systems while, at the same time, they are trying to support themselves and their families.
At the same time, these community health workers often risk their lives in providing this too often unpaid work by providing vaccinations in Afghanistan or Pakistan, for example. They are also at risk from caring for patients with acute infections, even though they are often not provided personal protective equipment, which is prioritized to be given to higher-ranking healthcare workers. PPE, such as gloves, are often sized for men rather than women, creating another hazard.
Women in Global Health believes that equal leadership will catalyze a “triple gender dividend.” Better and equitable working conditions for women will attract more women to become healthcare workers, helping assuage the 10+ million shortage of workers. If conditions improve, more will stay on, producing a “health dividend.” As women gain income, agency, and autonomy, this also improves conditions for their children, which is part of the gender dividend. And new health sector jobs will drive economic growth and have a huge multiplier effect.
While women’s status has very gradually improved over decades, the pace has been glacially slow. A recent UN estimate is that it will take 140 years for women to achieve equity in leadership representation. And during the Covid pandemic, women actually lost ground. Ann Keeling, Women in Global Health’s Senior Fellow, said that 85% of 115 National Covid taskforces were majority male and 81% were headed by men. It was as though, given the sudden emergency, men decided, “this is a high-profile, powerful place to be. This is where resources are; this is where we’re going to be. And women were just shoved aside,” Keeling observed.
Women have been held back by many factors—such as many cultures favoring male children and providing them with better educational opportunities. Women tend to be shunted to lower-paying jobs, such as nursing, rather than becoming higher-paid physicians. There is a “motherhood penalty” and pressure to focus on home and family.
With a wealth of personal experience internationally, from Papua to Pakistan, Keeling focuses on gender equity in leadership “because women are the majority and they come with a diverse perspective and different knowledge.” She stresses, however, the need for “male leaders to be gender transformative leaders, to be to be challenging” the current norms.
Asked about mentoring women, Keeling responded, “Men get get picked up from job to job and sponsored by more powerful men to go into other powerful jobs, and women don’t get that sort of sponsorship.” From her perspective, mentorship suggests that “women have got some sort of deficit that we have to fix.” She added, “I actually think the most important training that we can give women is in political analysis. And it’s to look at the power dynamics of the organizations that they’re working in.” It’s clear, in her experience (and that of others), that merit is not enough. It’s essential that women line up the necessary political sponsorship if they are to succeed.
Equity is not just the morally correct path to follow; it’s also smart from a business perspective. “This is not just a marginalized women’s issue. It’s a rights issue for sure,” Keeling said. “But if we get this right, it’s got a huge multiplier effect.”
Reflecting on her international career, often in dangerous settings, Keeling didn’t express regrets. She concluded, “I really worked with some of the most courageous women in the world for sure.”