When looking across the global health workforce, have you noticed a disproportionate number of men in leadership roles? Did you know that women make up only 25% of leadership positions in the global health field although we make up 70% of the workforce. So what now?
I have found working in global health that although there is a large focus on women's health issues and addressing gender disparities, many of the decisions affecting programs and policies across organizations are lead largely by men. This has been my experience and although I am keenly aware of the irony in this, I didn't fully grasp the breadth of the problem until I read a paper titled, Increasing Women in Leadership in Global Health in the journal Academic Medicine (Downs, Reif, Hokoror & Fitzgerald, 2014). Here is a quick blurb taken from the abstract:
"Globally, women experience a disproportionate burden of disease and death due to inequities in access to basic health care, nutrition, and education. In the face of this disparity, it is striking that leadership in the field of global health is highly skewed towards men and that global health organizations neglect the issue of gender equality in their own leadership."
One of the interesting thing this paper does is showcase studies that provide evidence of how female leadership impact communities. In one study conducted in India, increases in female elected officials resulted in decreases in neonatal (newborn, up to one month of age) death. Women were also more likely to invest in public works that were more closely aligned with women's concerns, for example, clean drinking water; whereas men were largely focused on works linked to men's concerns like farming. Women leaders are also more likely to favor health infrastructure, and programs focused on antenatal care and immunizations.
But how does that relate to women in the global health workforce? In my opinion, the authors were pointing to how female leadership drives different priorities not only at the community level, but also within our own field by expanding the health agenda. The paper then highlights that although there are a greater number of women at the undergraduate and graduate levels interested in global health and within the workforce, fewer than 25% of leadership roles are held by women in the field. The authors hypothesize that women leave the global health career path because of 'gender-based obstacles' they encounter. These obstacles include challenges climbing the institutional career ladder, tensions between career and family responsibility, and health/safety concerns. Potential solutions are also offered to help overcome these barriers, like providing greater mentoring opportunities, more global health research enabling grants, and extended maternity leave.
But what can be done; how do we change this culture?
This lead me to some google searching, and I stumbled across the non-profit organization, Women in Global Health. It was established in 2015 and works "to encourage stakeholders from governments, civil society, foundations, academia and professional associations and the private sector to achieve gender equality in global health leadership in their space of influence." This inevitably lead me to another research paper that Women in Global Health published with the World Health Organization (WHO) that analyzes gender and equity in the global health workforce. It is fittingly titled, Delivered by Women, Led by Men. They identified and reviewed over 170 studies on this very issue; and although research is largely lacking in low and middle-income countries, they were able to identify critical trends that would first need to addressed in order to put forth policy recommendations. Some of their key findings show that:
Occupational segregation by gender tend to cluster women in to lower-paid and lower-status work limiting women's full participation in the workforce;
Women overwhelming experience more workplace discrimination, biases and sexual harassment compared to men and such gender discrimination and inequality is linked to low morale, low self-esteem, and low productivity, affecting the mental and physical health of female workers;
The gender pay gap is prevalent globally, and even in occupations where women play a large role, such as health care, they are unable to gain equal job status, respect, and pay as their male counterparts; and
Although women make up a majority of the global health workforce, they are a minority within leadership roles due to limited opportunities, power imbalances, gender stereotyping, and discrimination.
Overall, they recommend greater recognition of the gender disparity in the global health workforce and the adoption of gender-transformative policies that address the causes of gender inequities. This would help to "maximize women's economic participation and foster empowerment though institutionalizing their leadership, addressing gender biases and inequities in education and the health labor market, and tackling gender concerns in health reform processes." But these policies would need to be contextualized across countries and be reinforced across government and private sectors.
There is so much to unpack here, and its disheartening to read because the barriers highlighted across the research is something I have experienced in my own career path. I am no stranger to sexual discrimination and harassment. I also know that I have been paid less than my male colleagues for doing the same work. I have not always had the opportunity to represent my own work; often passed off to a male counterpart or supervisor especially in the presence of clients. I have done what I could in those situations, but also there is also level of expected acceptance in situation like these, no matter how loudly I protest. It's not easy, but in the moment of #MeToo I feel that there is more awareness of these gender issue, and organizations such as Women in Global Health have created a space for women activists to demand for greater gender equality. As a collective force, we have the power to push beyond these barriers for better pay, respect, and upward mobility. Because we {women} are global health.
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