Breaking barriers and building bridges: reimagining a feminist health workforceBMJ 2023; 381 doi: https://doi.org/10.1136/bmj.p1268 (Published 02 June 2023) Cite this as: BMJ 2023;381:p1268
- Zaida Orth, postdoctoral researcher1,
- Zesca Meyer, medical doctor2,
- Sagri Singh, chief gender and health3,
- Johanna Riha, research fellow1
There are around 65 million health workers globally—including millions more not formally integrated into health systems. They live and work in societies and healthcare settings founded on systemic inequalities and power imbalances that hinder their work, professional development, and personal wellbeing.12 For instance, women, who make up more than 67% of the health and social care workforce, as well as health workers from ethnic minorities, immigrants, or from indigenous groups, regularly experience racism, sexism, gender inequalities, discrimination, and xenophobia.2345 These challenges are multifaceted and rooted in unequal power dynamics which are both visible and invisible. These range from overt forms of bullying, harassment, or gender-based violence to more subtle forms such as health workers from ethnic minorities or women receiving the worst rotas or working hours.2367 These issues facing the health workforce are well documented and it is widely recognised that the global community must re-evaluate the effectiveness of past strategies and structures and move towards a shift in how we plan, recruit, train, empower, deploy, remunerate, manage, and promote health workers.589 However, global commitments to empower and invest in the health workforce, though well intentioned, rarely address the root causes of these oppressive structures. In this context, it is worth considering why transforming the health workforce through a feminist approach is the answer. What would a feminist health workforce look like, and how can we work towards creating it?
Feminism recognises the multidimensional levels in which power exists—from the visible, invisible, and the hidden—and advocates for transforming oppressive forms of power both in the formal and informal spaces.51011 Feminist principles and values are inherently aligned with the principles of primary healthcare. At its core, primary healthcare is a holistic approach that recognises the interconnectedness of social, economic, and environmental factors in determining health outcomes.12 Similarly, feminist principles centre on the recognition of systemic inequalities and the need for intersectional approaches that prioritise the voices and experiences of marginalised groups.45101113 As such, feminism goes beyond advocating for women's rights—rather it involves confronting the systemic challenges women and many others face in society. Feminism provides a pragmatic framework that applies to everyone irrespective of sex and gender and puts the onus on everyone in society—everyone in the health workforce—to overcome the systematic power structures that run along socially constructed lines including race, gender, and class which affect who gets what, who decides what, who sets the agenda, and who does what.11
For us, reimagining a feminist health workforce, which includes all those involved from policy formulation to care provision, involves reimagining a few key aspects.
Firstly, leadership. A feminist workforce is one that has radically dismantled hierarchical organisational structures and individualised top-down management, empowering all individuals in the workforce to be leaders and experts in their own ways. This feminist workforce values the cleaning staff just as highly as the surgeons and seeks genuine collective input in decision-making.
Secondly, the self. A feminist workforce creates space and time for individual self-reflection and healing, recognising the individual privileges, internalised power structures, and traumas which shape how each individual uses power in their day-to-day lives. The health workforce comprises individuals, each bringing their own history and experiences that directly impact their work and behaviours. For example, poorly resourced and stressful work environments were identified as drivers of disrespect and abuse of women during childbirth in facilities perpetuated by nurses, midwives, and doctors.14 Prioritising self-work supports health workers to gradually unlearn internalised biases, deal with unprocessed traumas and rethink the ways in which they exercise and experience power, ultimately holding themselves accountable for their actions in the workplace and communities they work in.
Thirdly, deep informal work structures. Deep structures refer to the hidden cultural and organisational norms and patterns of behaviour that are often unspoken, yet strongly shape actions and behaviours at work.1011 This is evidenced in the deep-rooted gender norms in communities that define the activities and services assigned to female frontline health workers and their career pathways.15 A feminist workforce does not shy away from collectively confronting uncomfortable truths to interrogate and transform the internalised social norms and practices that perpetuate inequalities and power imbalances operating within the health system and private settings.
To create a feminist health workforce, it is crucial to break down existing informal and systemic barriers by forging partnerships with actors in the global health community and other sectors to prioritise equity and inclusiveness in all levels of healthcare management and delivery. This requires changes to occur at the individual, inter-personal, wider organisational level (formal and informal spaces), with a critical focus on how power manifests itself at the different levels of recruitment, training, deployment, remuneration, roles and responsibilities, career progression and opportunities for all.
Although the vision of a feminist health workforce may seem ambitious, if not idealist, numerous organisations worldwide have pursued and are still persistently striving towards this objective, even if it is not explicitly labelled as “feminist.” It is crucial to articulate this vision especially in the context of power. The journey towards achieving it is ongoing, with no definitive endpoint, as there is always room for personal growth and progress. It requires a continuous effort of self-reflection and action to bring this vision to life.
Competing interests: none declared.
Provenance and peer review: not commissioned, not peer reviewed.