Sexual Reproductive Health & Rights

Chapter 4: Without Gender Equity, Universal Health Coverage is a Pipe Dream

Posted On
Tuesday, September 10, 2019


15 years of impact

Women shape healthcare but are kept out of the executive suite.

Gender equality in Human Resources for Health (HRH) is defined very specifically. ‘Women and men have an equal chance of choosing a health occupation, developing the requisite skills and knowledge, being fairly paid, enjoying equal treatment and advancing in a career.’ Yet, gender inequities are rampant among the health workforce and this issue is even more pronounced when it comes to policy development, planning and research.

In India, it is estimated that there are seven female health workers per 10,000 people. This means  that women comprise one third of the total health workforce in the country. Conversely, the health system sees men dominate high-status health occupations. They are made doctors and managers and are trusted with policy making roles. Women on the other hand, tend to be over-represented in nursing, midwifery and other ‘caring’ cadres.

In fact, gender analysis conducted in a few select countries has revealed many such disparities. Women were sidelined to associate professional roles, typically for nursing and midwifery positions. They also tend to average fewer working hours than men and earned significantly less than their male counterparts.

Issues like stereotyping, marital status, sexual harassment and family responsibilities deter women from entering healthcare occupations. These disparities contribute to attrition and low morale among health workers.

In many parts of India, for example, women users express a wish or need for female practitioners, particularly for maternal and child health care services, but there is continued shortage of women doctors, supervisors and specialists.

Inequity preys on men too. Male doctors may want to serve in rural areas but are demotivated by the absence of appreciation and support from colleagues as well as from the community.

Certain female-dominated occupations, notably nursing and midwifery, are often not given market value commensurate with their skill level, as the work is seen simply as “women’s work.” For instance, gender considerations exclude men from involvement in reproductive health services. Gender stereotypes or feminisation of caregiving work may reduce men’s participation in such occupations.

In developing countries, women are routinely passed over when it comes to senior positions at the central and the state levels, even if they are as qualified as or more qualified than their male col- leagues. Instead, they are boxed into roles that give them no autonomy or decision-making authority.

Frontline health workers are mostly women and their supervisors are mostly men. These health workers not only meet targets of the programme, they also build reach within the community, for which they receive lower wages and are least acknowledged. They compensate for the shortcomings of health systems through individual adjustments, at times to the detriment of their own health and livelihoods.

Women comprise about one third of the health workforce, yet their salary is not on par with men in the same job. Women often leave the paid workforce when they get married or to care for their families. This means that they don’t save or plan for retirement. There are no special policies to address their parallel needs as mothers and wives, whether it is childcare or protection from violence. Sometimes sexual favours are conditions for career progression or continuation in service.

The frontline health workers meet the targets of the programme and reach the community. In return, they receive lower wages and are least acknowledged. They compensate for the shortcomings of health systems through individual adjustments, at times to the detriment of their own health and livelihoods.

In a study in Karnataka, India, female community health workers have reported that they are sexually harassed on their way to work or during work, making them reluctant to attend to obstetric needs of patients at night. Another study in Rajasthan has revealed that although supervisors informally acknowledge such problems, they do not assist female health workers in dealing with them be- cause it is not part of their supervisory remit. The health workers also reported strained relationships between themselves and male supervisors who of- ten ignored complaints of harassment and violence expecting the health workers’ presence on the job against all odds.

Unless we address gender disparities among the health workforce in India, we cannot tackle the shortage and maldistribution of health workers or improve access to quality services.

This is one of the series of fifteen studies published by the People for Health project. This project was a four-year initiative that focused on strengthening health workforce related policies and practices across state and non-state actors. ‘People for Health’ was jointly implemented with Public Health Foundation of India and supported by the European Union. 

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