Gender and Development

Gender Imbalance in Global Health

Contributor Ana Zhelyazkova explores the gender dynamic within the sphere of global healthcare policy making, where a majority of both patients and healthcare providers are female, yet the policy makers instituting legislation on healthcare are not. While the imbalance is apparent in the gender composition and wage gap, more steps need to be taken to ensure that these gaps are closed and legislation on women's healthcare is equitable.


In January 2017 the World Health Organization (WHO) issued a call for action to the Members of the WHO Executive Board and Governing bodies of the global health community, demanding action on a very well known and old epidemic – gender imbalance in healthcare. Noting that the Organization itself needs to further advance gender parity, the letter represented a much needed push for the international community to act on gender equality. Additionally, on many occasions throughout the year the Secretary-General of the United Nations, Antonio Guterres, made it clear that gender equality will be at center of his term. Those statements were put into action with the introduction of the System-Wide Strategy for Gender Parity in September 2017. “Achieving gender parity is an urgent priority not only as a basic human right, but also as it is essential to the UN’s efficiency, impact and credibility”, read the Press Release, stressing the crucial role of gender equality in a year that has much emphasized the inequitable distribution of power and representation between the sexes.

With this topic now being in the spotlight of the United Nations reform and with the WHO actively addressing the issue, it is essential to reflect on the basics before reviewing the progress in couple of months.


The philosophy of the United Nations system, the WHO included, is that in order to efficiently plan and execute policies and actions for the well-being of everyone, the international community should fairly and equally represent the populations it is supposed to mirror. That is currently not reflected in any of the levels of global health politics.

In 2015, only 23% of the delegations to the World Health Assembly, WHO’s decision-making body, were led by women, while 49.6% of the global population is female, a ratio that must be reflected in its agenda. Furthermore, only two of the nine WHO Director-Generals have been female – a ratio staggeringly asymmetric to the sex distribution of the health workforce, where women comprise over 75% of health professionals in some countries. In other words, since the establishment of the United Nations and the WHO, women have had only limited opportunities in determining the allocation of financial and human resource instruments among populations and problematic areas.

The argument of gender balance demand is based on the idea of unity and equality – the pillars of the international community. Given that women make up the majority of both the receivers (due to the specifics of maternal and perinatal care) and providers of healthcare, it is self-evident to demand gender representation within the UN system, similarly regulated to the geographical representation.


Despite women making up the majority of students, graduates and professionals in healthcare disciplines in the United States, they are rarely seen in managing, higher-level and better paying positions than their male peers. Approximately 90% of nursing care professionals in the US are women, yet they annually earn on average $5,000 less than their equally qualified male colleagues; 79% of Master of Public Health graduates in 2016 were women, nevertheless, their male peers make roughly $10,000 more per year despite same competencies. These numbers are not limited to the United States only, as women are generally more likely to choose a career in healthcare than men.

The relevance of providing women with the needed education, work resources and recognition goes beyond acknowledging their work as care providers. In many cultural and individual contexts having access to a female professional is essential to the health and well-being of community members. Validating the link between female empowerment in the healthcare sector and women’s health, by actively allocating resources towards awareness, education and social policy, is the most efficient and long-term investment to be made in this regard.


Female professionals in every field are faced with specific challenges attributed to their gender and the social obstacles that come with it. One of those universal and still prevalent social challenges is family planning. The solution should, therefore, also be universal and applicable to all sectors.

Family planning is associated with a career time gap, which still affects women more than their male partners. Currently the total fertility rate per woman equals to 2.5, meaning that a woman in reproductive age (15-49 years) would have 2.5 children on average. That number multiplied by the amount of time needed for maternity and parental leave (period varying by country and social determinants), could add up to 5 years on average. To briefly mention another obstacle arising from this context – the financial perspective. Maternity and parental leave legislation is differently organized in every country and company (unpaid, partially or fully paid for a period of time), making new parents financially vulnerable.

The main perspective to take into account is that family planning can place an undue burden on the female partner, where they are expected to be the child’s primary caregiver and thus compromise their careers. Scheduling a career gap raging from a couple of weeks to (a) whole year(s) can pose a challenge for their professional development. Despite the average age of first-time mothers increasing in the United States and other countries, women still tend to go through their first pregnancy before the age of 40, bearing in mind that a large majority have not yet reached seniority level positions. Consequently, setting a time gap of any kind hinders female professionals from accelerating their careers and developing their qualifications leading to reducing the opportunities available for a better employment status and a better-paying position. Moreover, females are still faced with the stigma of seeking long periods of maternity leave, which makes them less desirable to employers. Thus, even if a woman is to decide against having a child, she is still likely to face discriminatory practices in the workplace. Due to the higher rate of female professionals in healthcare and to the increasing demand, that represents a specific challenge to the sector.

Encouraging the conditions in which women might have to choose between career development and family is by no means a solution. Establishing gender quotas for managing positions could, on the other hand, be a faster solution to promote a more balanced sex distribution. However, the sustainability and fairness of this practice remains a rather controversial question.

A rather unpopular approach until now was introduced this year by the UN Women Goodwill Ambassador Anne Hathaway at the UN commemoration of the International Women’s Day, March 8th. The idea: in order to empower women we need to redefine and balance out the societal roles of both genders. Or as Ms. Hathaway expressed it: “to liberate women, we need to liberate men.”

Throughout societies with different perceptions of culture, religion, various levels of development, the female role as a guardian of the home and family caregiver has been established. As Aristotle had argued, a society has two units – the polis and the oikos. Men were the ones taking care of the macro perspective of society by discussing politics at the polis (polis → politics/policy/polity), while women were managing the micro perspective – taking care of everything and everyone in the oikos (oikos → economy; in German: oikos → “Ökonomie, die”, but also “Haushalt, der” = household, budgeting). As ubiquitous as this societal concept is, the complexities of individual and communal needs in the 21st century require a more disruptive approach – both bottom-up, from society members themselves, as well as top-down from the modern-day polis with legislative adjustments.

The concept introduced by Anne Hathaway combines both and suggests that female empowerment can be advanced through male empowerment by disrupting the polis-oikos dichotomy. Allowing male partners to be equally present in the “oikos” as well as for female partners to be equally present in the “polis” would be the pinnacle of gender equality. Legislation allowing fathers to take equally long and paid parental leave as mothers would be beneficial for female professionals, as well as for families, companies and society. This model is already proving to be effective in Germany where both mothers and fathers can take paid parental leave (“Elternzeit”) during which their employment is guaranteed by law.

Although the problem and the solution refer to women in all employment sectors, introducing the concept of equal parental leave is crucial to healthcare worldwide. As this is the sector concerned with the well-being of all people, it is more important for global health institutions like the WHO to advance the agenda of parental equality, in order to accelerate gender equality in the interest of women both giving and receiving health care. WHO’s call for action and the UN System-Wide Strategy for Gender Parity are a good start and certainly a good baseline to come back to and measure progress in the months and years to come.

Ana Zhelyazkova is a student in the Master of Public Health program of Ludwig-Maximilians University. She also serves as Social Engagement Coordinator for the Association for UN Interns, New York, student employee at the Max-Planck Institute for Social Law and Social Policy and volunteer for the German branch of Médecins du Monde.

Please note that opinions expressed in this article are solely those of our contributors, not of Political Insights, which takes no institutional positions.

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