Backsliding in gender equality: a reminder that progress is a constant struggle
BMJ 2022; 379 doi: https://doi.org/10.1136/bmj.o2469 (Published 14 October 2022) Cite this as: BMJ 2022;379:o2469Linked Opinion
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Who could argue with the principle of gender equality? Beyond being the right thing to do, gender equality is the smart thing to do. Societies that are more gender equal outperform unequal ones. Gender balanced teams are associated with better decisions and healthcare outcomes and more inclusive and egalitarian leadership.1 But just as we think gender equality has been accepted as routine and non-controversial, agreement evaporates and it has to be argued for all over again.
As far back as 1979, with the Convention on the Elimination of All Forms of Discrimination against Women, and then in 1995, with the Beijing Declaration and Platform for Action, governments worldwide agreed to balanced political participation and power sharing between women and men in decision making. In the current context of inter-related and complex global crises—pandemic recovery, unrelenting conflict, economic crises, and the climate emergency—it is more crucial than ever to ensure women and men are equally represented in policy and decision making in health and beyond. Failure to ensure women’s leadership is a failure of the global response.
Gender equality in representation is by itself no guarantee that the structures and cultures that allow power and privilege to advantage men and disadvantage women will automatically change. As others have noted,2 efforts to increase the number of women around the table or on panels often fail to highlight the structural barriers to women’s political and health leadership, including those which result in abuse and harassment,3 unequal pay,4 and harmful stereotypes about women’s competencies and commitment. But ensuring women’s participation and inclusion is a prerequisite to change—a most modest expectation given half the world’s population and the next generation is female. This is particularly critical in health,5 where women in leadership are more likely to expand public health agendas, strengthen health systems,6 and prioritise issues such as gender based violence.7 If women are not equally included in decision making in all areas, there will be no fundamental change to a global status quo that continues to generate inequality, injustice, and conflict.
Stalled progress
And yet representation of women in global health governance remains dismal so far in 2022. At the World Health Assembly (WHA) in May, just 23% of member state delegations were led by women.8 Over seven decades of the WHA, male dominance has scarcely reduced: between 1948 and 2021, 83% of delegations had a majority of men, and since 2000 only 14% of delegations had gender parity.9 Having reached a peak of 30% women chief delegates in 2017 and 2018, progress has since stalled with a mere 24% of delegations headed by a woman in 2019, 22% in 2020, and 24% in 2021.9 Similarly, while female executive board members of the World Health Organization reached 32% in 2020, just two of 34 (6%) members were women in January 2022.5
In September, during the United Nations General Assembly (UNGA), just 22 speakers representing the 193 member states were women.10 To confront problems of gender inequality, a new UNGA platform was conceived, but it convened just these women leaders to discuss needed change.11 Similarly, at last month’s Global Fund replenishment conference, eight of the 10 pledge partners presented were men, as if to say, “this is where the power lies and this is what it looks like.”12 The factors responsible for excluding women are compounded by the intersection of gender with race, ethnicity, class, sexuality, religion, and disability, among others, creating increased barriers for women from marginalised groups and lower middle income countries.
The diminishing representation of women is a devastating prospect given the extent to which gender equality goals also appear to be slipping. The covid-19 pandemic and the backlash against women’s sexual and reproductive health and rights have been regressive for gender equality. A new UN Women policy paper reports alarming increases in gender based violence, transactional sex for food and survival, sexual exploitation, and early, child, and forced marriage as a result of worsened living conditions in conflict, crisis, and humanitarian contexts worldwide.13 And despite the pandemic exposing the risks and value their essential work entails, an astonishing 90% of the world’s 67 million women domestic workers still lack access to any form of social protection, according to the International Labour Organization.14
Creating change in the face of adversity
Where to find hope in the struggle? The invisibilising of women at the top tables stands in stark contrast to their active presence on the front lines. Women have continually fought in resistance against conservative forces and oppressive regimes throughout history, drawing the world’s attention to injustice and creating change. Even in present settings where women are targeted or face extreme oppression and violence, they are standing strong in the face of adversity and serve as unrelenting leaders. In Iran, women-led protests have shown women as both symbols and catalysts of change, fuelling international solidarity against repressive government.15 In Afghanistan, educated midwives resist Taliban rule and restrictions by using their unique skills and community knowledge to deliver essential care.16 And in Ukraine, young women’s resourcefulness is helping to protect HIV rights and treatment in the midst of war.17 Women are clear changemakers and get the job done, often serving as inspiration for the public and leaders everywhere.
But now is a moment to stop the backslide on gender equality. Women are not going away. So once the battles are won and regimes have changed, women must not be sent home and side lined as men divide the most powerful political positions among themselves. We must ensure women move from the front lines as activists, change agents, and community health and service workers to positions where they are fully enabled to have an equal say in decision making.
We can only make sense of the suffering and the losses of global crises—including the pandemic, ongoing conflict, climates emergencies, and economic uncertainties—if we treat these crises as a break in history and change the status quo. In the health sector, women with talent, professional expertise, agency, and experience are everywhere. Women cannot be expected to simply deliver health systems while men make decisions. At the World Health Summit 2022 this week, where we expect gender parity in chairs and moderators, we will argue strongly that meaningful leadership and response to tackling global challenges and paving the way to sustainability depends upon women’s inclusion and gender equity in leadership.
Footnotes
Competing interests: none declared.
Provenance and peer review: commissioned; not externally peer reviewed.