Poor research and sexism lead to gaps in healthcare access and quality for women. Maintaining a sustainable health workforce and closing the healthcare gap is crucial for universal health coverage.
Poor research leads to gaps in access and quality of healthcare for women. Photo: Mayur Kakade, Getty Images
In January 2024, the gender disparity in health outcomes gained widespread attention when the World Economic Forum in collaboration with the McKinsey Health Institute published their report, “Closing the Women’s Health Gap: A $1 Trillion Opportunity to Improve Lives and Economies.” They documented a compelling economic case that investments in closing the gender health gap could boost the global economy by $1 trillion per year by 2040. This gap is seen in access to healthcare by women, the quality of care received by women, as well as limited research and evidence to guide innovations to address the unique healthcare needs of women.
While the existing health disparities are documented to some extent, what remains unclear is their link to the underlying contributing factors. According to McKinsey, cardiovascular diseases constitute one third of the gender health gap in the US. It is further known that during cardiac arrest, women are significantly less likely to receive CPR. Yet little attention seems to be paid to the fact that CPR training centres in the US and even worldwide are continuing to use only male CPR manikins. In February 2024, students at Harvard University and MIT developed female manikins to make CPR training more inclusive of women. Why was this ignored for so long despite the difference in anatomy?
Women’s health has remained under-researched and underfunded. Erectile dysfunction affects 19% of men while premenstrual syndrome (PMS) impacts 90% of women—yet five times more research has been done on erectile dysfunction than on PMS. For a very long time, women were excluded from clinical trials, and diagnosis and treatment protocols were based on research that was predominantly conducted on men. Such disparities in health research contributed to widening the gender health gap. In 2016, the National Institutes of Health (NIH) had to make it mandatory for preclinical studies to include sex as a biological variable.
Supporting women in the healthcare workforce
The health workforce serves as the most critical pillar of the health system for achieving universal health coverage (UHC). With 59 million health workers globally, the World Health Organization (WHO) estimates a shortage of 10 million by 2030. This shortage serves as the major bottleneck in achieving UHC, particularly in low- and middle-income countries (LMICs)—which are home to 80% of the global population but have less than 45% of its healthcare workers. Africa, with 25% of the global disease burden, has only 3% of the global health workforce pool catering to its healthcare needs.
Almost 70% of the health workforce globally is comprised of women, but they are clustered in entry-level and frontline roles; their representation diminishes in the higher echelons. Globally, women occupy only about 25% of leadership positions within the health sector, which, according to a 2022 report by the WHO, has a gender pay gap of 24% even after controlling for age, education, job category, and other factors. Women make up 85% of community health workers—which, in many LMICs, are the only health workforce accessible to a vast segment of the population, despite being underpaid and undervalued. It is often debated in male-dominant policy rooms whether these women should remain as a voluntary cadre.
These inequities in pay and career advancement have resulted in a huge turnover of female health workers, making UHC a far more daunting goal in LMICs. Health programs and innovations are often designed without considering the unique needs of women or raising demand for gender disaggregate data, and often without including any women’s voices in the policy rooms.
Promoting research and policies for women’s health
Women in Global Health (WGH) is one of the largest voluntary global health networks, with 58 country chapters across 53 countries. It has led research and evidence-guided policy support for addressing gender inequity within the health workforce, supporting the delivery of gender-responsive quality health services, and designing health programs for promoting women’s health in marginalised settings. As a co-convener of the Alliance for Gender Equality and UHC, it actively supported work on the UHC Action Agenda. The Alliance also campaigned for the global movement UHC 2030 to expand its scope to include a component focused solely on gender equality.
It is important that we not only conduct research into women’s health issues but also delve deeper into the data to identify the systemic causes of gender inequity within the health system. Gender inequities negatively affect health outcomes as well as the sustainability of the health workforce, leading to high turnover rates, burnout, and migration, reducing quality of care and access to health service delivery in LMICs.
Addressing the gendered challenges of the health workforce is a key strategy towards improving its performance and ensuring that all health programs and policies are planned in consultation with women health leaders, taking into account the unique needs of women for better health outcomes.
The opinions expressed are those of the author and do not necessarily reflect the position of Re:solve Global Health.
Dr Shabnum Sarfraz is a global health systems and policy expert with over 15 years of experience leading high-impact projects focused on policy reform and advancing gender equity. As Member Social Sector at the Planning Commission, Government of Pakistan, she spearheaded the covid-19 response plan for the prime minister. She has also led research, advocacy, and policy initiatives across 53 countries in the Women in Global Health network to promote gender equity in health leadership.
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