Journal of Women's Health Care
Open Access
ISSN: 2167-0420
ISSN: 2167-0420
Research - (2022)Volume 11, Issue 9
Introduction: Women shoulder major functions of health system, still they experience discrimination, inequality, even violence in all the health disciplines globally. Although there is substantial evidence of economic, health, social gains by addressing inequalities in gender norms, women are underrepresented in positions of power, leadership, be it education, health care or research or administration and are undervalued too. Actually it should be equity, a matter of justice and rights in view of gender differences in body functions. Objectives: To know about present status of women in global health, in education for health, health care, research, health policies and management. Material and Methodology: Literature search was done for getting desired information as per objectives. Research studies, reviews, opinions in english language, whatever could be accessed were looked into with no special criteria. Self observations and experiences were added. Results: Women comprise around 70% of health work force for global health, quite a lot unpaid. But they are underrepresented in health disciplines in positions of power, in leadership positions, policy making, program management and specialized clinical areas such as surgical specialties. Globally in health systems women are undervalued and experience discrimination and suffer violence too. There is poor inclusion of women in medical research as main researchers. Also in research findings, gender related reporting is limited, which affects utility of results of global research for best of the use for societies around the world. Conclusion: Gender bias continues in all the aspects of health systems. There are barriers to full participation of women in global health. Collective action is needed in many areas for essential change.
Women, Global health, Inequality, Health system.
Over all 70% health work force is females but 70% leadership positions are occupied by men. Not only women are underrepresented in positions of power, leadership in health care, education for health, research, administration, but are also undervalued. They experience discrimination violence in health disciplines globally. Shanon et al reported that intersectional approaches have provided insights into how differences in ethnicity, class, geography, disability, and sexuality interact with gender to compound gender inequalities in health. Payne reported that there was evidence of substantial economic, health and social gains if inequality in gender norms was addressed [1]. Ideally it should be equity which is a matter of justice and rights in view of the gender differences in body functions for the crucial needs and for the best of global health.
To know the present status of women in global health, education for health, health care, research and administration.
Literature search was done from available search engines for getting the desired information in relation to the objectives, without any special criteria for inclusion. Studies, reviews, opinions in english language, whatever were accessible, were looked into. Self experiences and observations were also added.
In the leading, decision making positions in global health, policies, health care, education for health and research, women are in small numbers. Gender equality matters for improving health quality which is dependent on women being able to plan, be their own pregnancies, or access to contraceptives, other such issues and for policies, and for programs such matters in health. Career advancement of female scientists is reported to be adversely affected by gender disparities from financial stage. Jackson reported that there is history to these happenings [2]. It has been reported that it was ‘on 18 Nov, 1870, seven women arrived at the Surgeons' Hall in Edinburgh of United Kingdom to appear for anatomy examination. They were met by fellow male medical students, who pelted mud, shouted obscenities, and blocked the gates for them. However a sympathetic student let them through. The women completed their examinations, while the protestors continued what they were doing. The “Surgeons’ Hall Riot”, as it was dubbed, was probably the lowest point in a 4-year campaign aimed at preventing the seven women from completing their medical degrees at the University of Edinburgh. The women, who became known as the “Edinburgh Seven”(ES) were refused the right to graduate. They had to seek their medical qualifications elsewhere. One hundred fifty years after ES were first enrolled to study medicine, the university of Edinburgh sought to make amends by awarding the posthumous degree to them in its annual graduation ceremony on 6 July 2019.
On behalf of E.S. degrees were presented to seven other medical students, in front of an audience that included descendants of the original pioneers. Although women now comprise of 55% of Edinburgh medical schools, intake in line with the United Kingdom’s average, women are still under represented at the higher academic medicine even in the university [3-5]. Betron reported that women contributed to US3 Trillion $ annually to global health work, half of which was in the form of unpaid work. Minkina reported that the history of gender discrimination in medicine in the USA began in the mid-19th century when the first woman attempted to become a doctor [6]. Harriot Kezia Hunt was the first woman to apply to Harvard Medical School in 1847, but she was asked to withdraw her application. Robinson reported that Harvard Medical School admitted the first batch of women as late as 1945. According to the Association of American Medical Colleges, since 2015 around 34% of active American doctors were women, with more women than men getting enrolled in American medical schools [7,8].
However, the enrolment increase did not address gender in the recruitment and advancement of women into faculty ranks. Within global health, Swedish government showed commitments to sexual and reproductive health and rights, including access to contraceptives, and safe abortions and maternity care [9]. Shetty reported that Anandibai Gopalrao Joshi and Kadambini Ganguli were the first Indian women practitioners of western medicine. Anandi was the first woman from Bombay Presidency of India to study and graduate with a two-year degree in western medicine from the United States [10]. At the age of 9 she got married to Gopalrao Joshi, a widower, almost twenty years older to her. At the age of fourteen, she gave birth to a baby, but the boy did not survive beyond ten days due to lack of medical care. This proved to be a turning point in Aanandi’s life and inspired her to become a physician. Her husband supported her well. Many things have changed over the decades with many women doctors in various positions as in other walks of life but certain differences continue as in other parts of the world. In a recent review Betron also reported that a key challenge was women not being in decision making and leadership positions [11-15].
Only 25% of global health organizations have gender parity at senior management levels, and only 20% of organizations have gender parity in their governing bodies. Mackee reported that in leadership positions women were under-represented, as academic leaders [16]. Australian Academy of Science12 also reported that in obstetrics and gynecology, only 17% of senior academicians were women. Although nearly half of all doctors in the UK were women, but at senior levels there were proportionately low numbers. Evidence suggested that they were disadvantaged in their endeavors or unwilling to deliver the necessary commitment, which could result in few women reaching medical leadership roles [17]. Consequently, policy making remained male-dominated and policies were implicitly set to male norms. The absence of gender parity in policy making leadership position did not seem to be due to lack of interest or differences in career commitment, or years of education. It was due to systemic gender bias, scarcity of opportunities for advancement and ceiling that existed within health systems as in other sectors in society globally [20].
Discrimination also included wages gaps between men and women in the health sector, estimated at 26% in high-income countries and 29% in upper-middle income countries [21]. Both under compensation and no compensation can be traced to the devaluing skills of largely female health workers, in which their tasks or roles were assumed to be an extension of their household work, specially for community health workers10. In a study by Mathad it was revealed that 47% participants stated that their jobs resulted in insufficient time for their families and 37% reported that it negatively affected their childbearing decisions [22]. Gender discrimination included experiences of being made to feel inferior and discouragement from promotions at leadership positions on the basis of gender, the spectrum of micro- and macro-aggressions and inequities that women in medicine face on a daily basis. Penning reported that gender inequalities contributed to increase in stress and anxiety, among women through their role as caregivers. Gender issues of sexual harassment and violence also continue in medicine [23,24].
In a study researchers15 reported that unwelcome sexual advances were reported by 29% women, however only 22%of those who experienced violence reported it to someone. Reasons for not reporting included assumptions that it was normal, or the feeling that it would not be resolved even if reported or lack of a reporting system, or fear of negative repercussions, or fear of jeopardizing their academic standing and worst was fear of not being believed. Anderson and Sen also reported that many women experienced violence and harassment in the workplaces and lacked safe and unbiased system for seeking help following harassment or assault [25,26]. Betron reported that the devaluation of women’s work in the health sector can also be linked to their disproportionate experience of violence and harassment at the workplaces [5]. Violence and harassment limited many health workers’ abilities to effectively optimize work and stifle their voice when advocating for advancement and increased responsibility18. Experiences of gender inequity, sexual harassment, and assault became visible globally when the MeToo, movement went viral. Academia and tertiary education have joined the movement, with the notable examples of MeToo STEM MeToo Academia19.
A 2018 report by the US National Academies also identified sexual harassment as an enduring problem in medicine. A random sample of 3332 full time faculty in 24 medical schools across the US found 47–70% rates of discrimination [27] .Unfortunately, sexual harassment and suicide rates among women physicians have not changed over the years. Harassment happens both in faculty– student relationships or in manager employee relationships, between doctors, medical personnel, management, and the academic faculty [28]. After a systematic review, Nearly 60% of medical students and trainees of all grades had experienced harassment or discrimination of some kind during their training. Policies against sexual harassment are widely in place and have been for many years with women in medicine having sexual harassment for decades, but sexual harassment in academia continues. Raj reported a decrease in sexual harassment over the time among female academic physicians and further, that experiencing more severe harassment aligned with reaching a higher academic rank but an enduring environment of gender discrimination that enabled ongoing victimization of 1 in 5 female faculty [29].
Women Researchers and Gender Analysis in Research
It is visible that disparities in the inclusion of the sex in medical research and so analysis accordingly, substantially reduces the utility of the results when research results are reported for the entire population. Large scale studies are needed to identify the extent of sex-related reporting [30]. Some researchers did a cross disciplinary analysis of the degree of sex- related reporting across the biomedical, clinical, and public health research and the role of gender in reporting and found that between 1980, and 2016, sex-related reporting increased from 59% to only 67% in clinical medicine and from 36% to 69% in public health research [31]. Lariviere reported less inclusion of women in medical research. Several studies have shown that there are less women researchers in medicine [32]. Some have also evaluated whether scarcity of women in research also lead to disparities in sex inclusion and reporting. Scientific papers with women as first and last authors had an increased probability of reporting sex related findings, but publications in journals with low journal impact factors [33]. Gender disparities in the scientific workforce and scarcity of policies on sex-related analysis and reports at the institutional as well as journal level could inhibit effective research translation from bench to clinical use and further research [34,36].
In the recent past Hawkes also reported that over several centuries, health research has generally been dominated by men [37]. From the earliest days of anatomical research, the bodies used for dissection and drawings were overwhelmingly male. Thompson also reported that sex blindness in educational materials and medical research has consequences like erroneous diagnosis, missed opportunities for interventions, or the wrong dose or even the wrong drug given to sick [38]. Peters and Peters reported that women were underrepresented in cardiovascular disease trials, despite known sex differences in risk, prevention, treatment, and outcome parameters [39,40]. Millett reported that the incidence of myocardial infarction was higher in men in the UK, but the important risk factors, hypertension, smoking intensity, and diabetes, were more strongly associated with myocardial infarction in women than in men [41]. Thompson and Holly reported that across countries and disciplines, research revealed that men received more research funding than women [42].
They may look small differences, but have the potential to yield substantial disparities when compounded over the times [43]. The American College of Physicians has specifically reported that gender discrimination violated the principles of professionalism, one of the core competencies mandated by the Accreditation Council for Graduate Medical Education in the USA [44]. For more than 20 years: gender on editorial boards has not been equal and many reports have detailed gender inequities associated with medical journals [45]. Aakhus reported that among mixed-gender co-first authors publishing in high-impact clinical journals, women were significantly more likely to be placed second [46]. Organizations must be held accountable for the ethical inclusion of all broader implications of first co authorship for gender equity. The co-first authorship offered a flexible way for women to lead on high-impact research and to obtain the academic recognition, they deserved [47]. Failure to recognise the importance of sex and gender in health and medical research is closely intertwined with the gendered nature of academic publishing [48]. A systematic review of 52 studies from 13 countries on women's choice or rejection of careers in academic medicine found that women were interested in teaching more than in research but they lacked adequate mentors and role models; and they experienced gender discrimination and bias [49].
In physician-focused medical specialty societies, an analysis of gender equity in leadership revealed that between 2008 and 2017, advancing women in science, medicine, and global health, illuminated crucial problems about gender equity and gender gaps [50]. It has been reported that girls’ interest in health was also influenced by the broader sociocultural environment that could enhance or thwart parent modeling . Liang identified factors, like inability to take leave, poor mental health, inadequate support, and fear of repercussion, which led to attrition of women in surgical training. Khoushhal identified other issues like insufficient role models and institutional support, gender discrimination, sleep deprivation, adverse interactions with seniors, pregnancy and birth, and childrearing duties.
In a survey in Great Britain and Ireland, women perceived surgery as a male-dominated field, and many had experienced discrimination, and reported use of gendered language at work [51]. Poor work–life balance was the main perceived barrier for women in their surgical careers. Results of a similar US national survey by Yeo revealed that the attitudes, experiences, and expectations of general surgery residents varied by sex and number of years in training. Female surgeons in Africa were only 9% of all practicing surgeons [52]. In Australia and New Zealand, unavailability of leave, a distinction between valid and invalid reasons for leave, poor mental health, absence of interactions with the women in their professional body and other supports, fear of repercussion, and lack of pathways for independent and specific support were the reasons of not taking surgical specialties.
The interventions seeking to improve retention and advancement of women in surgical specialties, must address the underlying multiple factors rather than narrow focus on the ultimate triggers. Ideally, such interventions should not overtly focus on women alone. The relationships between factors are complex and sometimes paradoxical. Ghadirian reported that providing medical services to women by women was introduced in Iran after Iran’s Islamic revolution reported that the Iranian Ministry of Health and Medical Education adjusted its services in line with Islamic rules, which was known as the gender conformity plan (GCP) [53]. Almost 40 years since the Islamic revolution, the GCP still presented a serious challenge in providing health services. Norms on health could be context-specific, demanding care when designing effective gender-transformative health policies and programs48. Gender inequality and gender norms, unequal power dynamics, and other intersecting factors within society that often leave women disempowered, disenfranchised, and vulnerable, also impede progress on the global goal to achieve health for all. Potential advances in health and development are thwarted by systemic neglect of gender norms and inequalities in program design, implementation, monitoring, and evaluation, despite the adoption of gender mainstreaming by global health institutions .
Women’s representation in all aspects of health system, be it training, care, policy, management research, have slowly increased over the past few decades. But women still encounter bias and discrimination compared with men across a variety of outcomes. It is essential to understand exactly how power operates not only within class rooms and at the bedside in health care institutions, but buildings of power and policies too. The evolving landscape of global gender data, the overall pattern of gender equality for women’s health is one of mixed gains and persistent challenge too. It has the potential to lead to substantial health, social, and economic gains. The inability of the health sector to accelerate progress on a range of health outcomes brings into sharp focus the substantial impact of gender inequalities and restrictive gender norms on health risks and behaviors. Heise reported that for decades, advocates have worked to eliminate gender discrimination in global health, but only with modest success [54].
New plans and political commitments are needed if the global health aspirations and the SDGs are to be achieved. Hay reported that without addressing the role of restrictive gender norms and gender inequalities, within and outside health systems, it will not be possible to reach the collective ambitions of Universal Health Coverage and the SDGs. Serano reported the need of intersectional, equitable, and inclusive efforts to embrace women in the gender equality movements in science, medicine, and global health, particularly in the training and educational contexts. Female volunteers are behind the reduction in child and maternal mortality through various programs and most governmental health-care programme prefers to use the female community health volunteers to achieve the targets for their community-based programmes, owing to the trust women have developed selflessly volunteering their services to the community. Leaders and practitioners in medicine continue to be unaware and poorly educated about the nature, extent, and impact of barriers to full participation of women in health around the world. Connecting the gender, health workforce, and act on SDGs is the need of hour. Collective action is needed to fight pervasive threats to health and rights. Many groups have long led such actions call on governments to recognize women's role in the health workforce, including unpaid health care work. Connecting gender, health workforce, and the work agendas is a win–win situation for achieving health gains. But the world’s community does not seem to be on track to meet SDGs for health or for gender equality. A collective and strategic understanding of the need to mobilize individuals and institutions to redress imbalances in the gender- health relationship, producing a politically informed, globally relevant, and intersectional feminist strategy for structural change for global health, is the need of hour.
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Citation: Chhabra S (2022) Women in Global Health Persisting Challenges for Equity. J Women's Health Care. 11(8):597
Received: 10-Aug-2022, Manuscript No. JWH-22-18789; Editor assigned: 16-Aug-2022, Pre QC No. JWH-22-18789; Reviewed: 09-Sep-2022, QC No. JWH-22-18789; Published: 20-Sep-2022 , DOI: 10.35248/2167-0420.22.11.600
Copyright: © 2022 Chhabra S. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution and reproduction in any medium, provided the original work is properly cited.