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Rosemary Morgan, Research in Gender and Ethics (RinGs): Building Stronger Health Systems, Johns Hopkins Bloomberg School of Public Health
Gender inequity with global health leadership is becoming an increasingly recognized issue. Calls to action are being made to increase women’s representation in the global health policy arena, health sector, and academia. Despite this, the women’s representation remains low across these sectors.
Women, for example, “constitute only 25% (14/54) of African ministers of health and 24% (12/50) of directors of global health centers at the top 50 U.S. medical schools”. These numbers are surprising as women in general comprise over 75% of the health workforce, cover roughly half of medical school graduating classes, and make up the vast majority of those working in global health. If women encompass the majority of the global health workforce, why are so few making it to the top?
This was a question addressed at this year’s Consortium of Universities for Global Health Conference. During the conference women leaders in global health came together to discuss barriers to women’s advancement and how we can support more women entering leadership positions. Three important themes emerged from the discussion:
1. Gender equity at the leadership level leads to better decision-making and better health outcomes
Increasing women’s representation at the leadership level, for example, has been shown to improve maternal and child health outcomes. A study by Bhalotra and Clots-Figueras, showed that improvement in women’s political representation in India decreased neonatal mortality. In addition, female representation was found to have a positive effect on the “number of antenatal care visits a woman has, the probability of giving birth in a government facility (as opposed to at home), the probability of a child being immunized by the age of one, and the probability of breastfeeding in the first 24 hours after birth”.
Better decision-making leads to better health outcomes. By not having more women at the global health leadership level, the global health community is missing an important opportunity to improve health outcomes, particularly in the areas of maternal, reproductive, and child health.
2. There are parallel hierarchies within global health leadership that need to be addressed
Increasing women’s representation within global health leadership as a whole is an important goal; however, it is important that we consider which women are making it to the top. While the percentage of female leaders within global health is low, it is even lower for women of colour.
Much of the work that has been done to date about increasing women’s representation at the global health leadership level does not distinguish challenges faced by women of colour (or other minority women) from women in general. It is important that we recognize that while many challenges will be relevant to women as whole, such as sexual harassment and family responsibilities, women of colour face unique challenges as a result of their race. In addition, some of these challenges – like sexual harassment – may be even more acute depending on the context in which a woman works.
Geographical hierarchies must also be considered within global health leadership. The global health community must not put the expertise of women (and men) from high-income countries above those from low and middle income countries. During the discussion, for example, an African woman from a low-to-middle income country observed that despite her years of experience she often loses leadership positions to young less experienced white women from Western countries.
If we are to truly increase diversity at the leadership level solutions must be found which address the challenges of all women, with special attention paid to the parallel hierarchies that exist within the global health community.
3. Pragmatic solutions are needed if we are to reduce gender inequity within global health leadership
While individual stories of how woman leaders overcame barriers in their careers are important, these are not always helpful in addressing the systemic and underlying barriers to increasing women’s representation at the leadership level. More research is needed to explore the common and underlying barriers preventing women’s representation across global health sectors. Only then can pragmatic solutions to promoting women’s leadership be developed and implemented.
When solutions to increasing women’s representation are discussed, too often the onus is put on women themselves – they must act more like a man, find a supportive husband or partner, or make enough money to afford childcare – if they are to obtain and succeed in a leadership role. While it is important for women to recognize what might be holding them back at an individual level, it is equally if not more important that global health institutions implement appropriate policies and procedures to address the barriers which lead to inequities in global health leadership in the first place.
Moving forward we are likely to see more discussion on these issues, particularly as organizations like Women in Global Health and RinGs work to advocate for increased representation of women in global health leadership. In addition, Stanford University’s upcoming conference on Women Leaders in Global Health will provide a forum to discuss these issues in greater depth. It is hoped that through such efforts we will begin to see greater representation of all women within global health leadership, and with that better health outcomes for all.