Time to act now for gender equality to achieve universal health coverage

On International Women’s Day 2021, we, the UHC2030 Co-Chairs, call on all national political leaders to empower women, who are proving to be highly effective leaders in health emergencies. This is critical to build a safer and healthier future. UHC processes are gender blind, and COVID-19 has shown that women and girls are still being left behind. To achieve Sustainable Development Goal 3 of health and wellbeing for all, it is imperative to transform health systems so they are intersectional- and gender-responsive.

At the end of 2020, UHC2030 produced the first synthesis review to document ‘The State of Commitment to UHC’. It provides a multi-stakeholder consolidated view on the state of progress being made towards UHC at country and global levels. Findings show that the COVID-19 pandemic, like previous pandemics and infectious disease outbreaks, is exacerbating gender inequality in many ways:

• Women and girls are still struggling to access health services and that women and girls are disproportionately affected by barriers to accessing and using health services. For example, women and girls experience structural barriers, including financial hardship, lack of transport (especially if they live in rural areas) and lack of time because of a care burden or other unpaid labour. The existence of specialized sexual and reproductive services for women is essential in addressing the huge structural barriers that women and girls across the world experience in accessing health care. Much more must be done to communicate the importance of gender as a barrier to access health services.
   
• The experiences of women and their experiences within health systems are not uniform, and are heavily influenced by factors including race, ethnicity and age. During the COVID-19 pandemic, and especially in conjunction with the Black Lives Matters protests in the summer of 2020, the disproportionate suffering of Black, Asian and minority ethnic communities has risen up the political agenda. Age has also been shown to be an important predictor of the severity of COVID-19 symptoms. Further, it is important to remember that gender is not binary, and that many members of LGBTQ+ communities face significant discrimination in the health system.
   
• Globally, women make up 70% of frontline health workers who are at increased risk of COVID-19 infection due to their frontline roles.(2) Some have deliberately stayed away from their children to reduce the risk of infecting them. Women who do not work in the health sector have also been disproportionately affected by the pandemic.
   
• In many countries, women work in sectors that have been heavily impacted by the pandemic or in the informal sector and have been more likely to experience economic loss. Furthermore, curfews and lockdowns have been instituted in many countries without consideration of the continuity of maternal health services, putting pregnant women at risk. According to UN Women, discriminatory legislation prevents around 2.5 billion women and girls from fully exercising their rights. In addition, gender-based violence has been reported to increase during lockdowns in several countries.(1)
   
• The patriarchal nature of global and public health systems received increasing attention during 2020. The majority of the members of national COVID-19 task forces member are men and a similar power dynamic is seen on the global stage. For example, only one quarter of the participants in the first three committees on International Health Regulations Emergency were women. This mirrors the representation of women in other national institutions such as parliaments, where the global proportion of women MPs has reached 25.5 per cent, which is an all-time high but still falls short of genuine equality.(3)
   
• Women are proving to be highly effective leaders in health emergencies and increasing evidence is emerging that countries with women leaders are experiencing fewer COVID-19 related deaths.

The harsh reality is that UHC processes, during and emergency or otherwise, are still gender-blind, and women and girls are still being left behind. Indeed this year’s Global Health 50/50 report ‘Gender equality: flying blind in a time of crisis’ which confirms that vast majority of programmatic activity to prevent and address the health impacts of COVID-19 largely ignores the role of gender.

A gender-sensitive response to disease outbreaks is crucial, and responses will be more likely to be effective for everyone if there is diversity in leadership panels. There is much to be done to ensure adequate support to front-line health workers, to meaningfully engage all stakeholders in decision-making and to ensure gender-equitable responses. Humanity’s diversity should be reflected in a truly intersectional, gender-responsive health systems approach which is inclusive not only of gender but also of race, sexual identity, socio-economic status and geography, reflecting the UHC commitment of leaving no one behind.

References:

1. https://www.unwomen.org/en/digital-library/publications/2019/03/equality-in-law-for-women-and-girls-by-2030
2. https://www.who.int/news-room/commentaries/detail/female-health-workers-drive-global-health
3. https://www.ipu.org/news/women-in-parliament-2020 

Photo: WHO / Blink Media - Ricci Shryock