Intended for healthcare professionals


Mandatory pay gap reporting is key to achieving workforce gender equality in the global health sector

BMJ 2023; 383 doi: (Published 22 November 2023) Cite this as: BMJ 2023;383:p2753
  1. Victoria Olarewaju, researcher1,
  2. Jasmine Gideon, senior researcher1, professor2,
  3. Aaron Koay, research officer1, PhD student3
  1. 1Global Health 50/50, Cambridge, UK
  2. 2School of Social Sciences, Birkbeck, University of London
  3. 3Institute of Global Health, University College London

Tackling the gender pay gap is essential for a more inclusive global health sector, but progress towards closing the gap has remained slow, highlighting the need for better transparency and accountability. Mandatory reporting is an important first step in pushing for change, say Victoria Olarewaju and colleagues

This year’s Equal Pay Day in the UK is 22 November. The UK based Fawcett Society, which campaigns for gender equality, reports that the nation’s mean gender pay gap based on hourly pay is 10.7% among full time workers. In other words, 22 November is the date when women effectively start working for nothing until the end of the year, as compared with their male colleagues.1 So, why does this matter for the global health sector?

In 2019 the World Health Organization highlighted the lack of women’s leadership in health, even though women constitute over 70% of the global health workforce. The WHO report advocated for more inclusive leadership, not only for social justice reasons but also to strengthen health systems.2 Tackling gender related wage inequalities is integral to building more inclusive health sectors—yet we’ve still seen a reversal of some earlier progress.3

The gender pay gap measures the difference in earnings between women and men.4 It reflects systemic inequalities driving gender differences across all aspects of the labour force. The gender pay gap differs from equal pay, which refers to equal pay for work of equal value. Although both are important indicators for highlighting pay inequalities, they’re not mutually exclusive. The global gender pay gap currently stands at 20%,5 and the gender pay gap in the global health and care sector is about the same.6 This is unsurprising given that 70% of employees in the global health sector are women, yet only 25% hold senior positions.7

The gender pay gap has multiple causes, which all have considerable relevance in the health sector. In particular, health is a female intensive area of employment with greater numbers of women employed than men across the sector, and crucial “female” caring roles such as nursing are perceived to have low status—with correspondingly low remuneration—despite their critical value in society. Meanwhile, women’s participation in traditionally male dominated areas such as STEM (science, technology, engineering, and mathematics) remains limited, as just over a quarter of the UK’s overall STEM workforce in 2023 were women.8

Unpaid care work and the “motherhood penalty,” which refers to the wage deficit faced by women with caregiving demands, often necessitate their uptake of lower paying jobs with flexible or part time hours9—with important longer term implications for their future income derived from pensions.

Reluctance to report

Some countries, including the UK, require some form of gender pay gap reporting from employers.10 The mandatory annual reporting initiated in 2017 by the UK government for organisations with at least 250 employees11 can be credited for some of the progress made in closing the gap in the UK. In 2022-23 the median hourly pay gap decreased by 0.6 percentage points (from 9.8% to 9.2%), and the mean pay gap fell by 0.2 percentage points (12.7% to 12.2%).12 But progress is slow.

Pay transparency and accountability can be enhanced by wider mandatory reporting on pay. Without mandates, organisations seem unlikely to report their gender pay gap. Global Health 50/50, an organisation that tracks the policies and practices of nearly 200 organisations active in global health to make their gender equality commitments visible, has reported since 2019 that, without mandates, very few organisations publish their gender pay gap information. Among 197 organisations assessed in 2023, only 48 (24%) publicly reported on their gender pay gap.13 Of note, 90% of those 48 organisations are based in the UK, which arguably demonstrates the effectiveness of the UK legislation on gender pay gap reporting.

The move towards gender pay gap transparency in the UK has enabled Global Health 50/50 to calculate that, among 42 UK based organisations active in global health that reported their gender pay gap data to the UK government, the 2022 median gender pay gap was 10.9% and the mean was 10.8%.13 Similar to the Fawcett Society’s findings, women working in UK based organisations that are active in global health in the Global Health 50/50 sample, which include some of the most influential and powerful organisations, also “stop getting paid” from today—this year’s Equal Pay Day—until the end of the year.

Reporting the gender pay gap is an important mechanism that can be used to illuminate inequalities and drive positive change. Closing this gap is crucial if we’re to have more inclusive health sectors, but merely committing to pay transparency isn’t enough. Assessing and tackling the reasons for pay gaps is essential, and this will require examining and tackling inequalities and inequities throughout society, as well as in the global health sector.


This opinion is based on the Global Health 50/50 report The Space Between: Analysis of Gender and Ethnicity Pay Gaps in UK-Based Organisations Active in Global Health, which is funded by the Bill and Melinda Gates Foundation (INV-045074). The findings and conclusions contained within are those of the authors and do not necessarily reflect the positions or policies of the Bill and Melinda Gates Foundation. Sonja Tanaka, David Zezai, Alex Parker, Kent Buse, and Sarah Hawkes of Global Health 50/50 also supported the development of the report.


  • Competing interests: The authors declare that they are either employed or associated with Global Health 50/50. They were involved in the production of the Global Health 50/50 report The Space Between: Analysis of Gender and Ethnicity Pay Gaps in UK-Based Organisations Active in Global Health, on which this opinion article is based. They have no other interests to declare.