On UHC Day 2019 Women and Global Health Calls on Governments to Keep the Promise on Gender Equalit
One year ago, on UHC Day 2018, looking forward to the UN High Level Meeting on UHC in September 2019, we asked whether it was necessary to restate what the world had already agreed? Over the last 25 years many global commitments have been made to make gender equality and the rights of women and girls central to health - ICPD, Beijing, MDGs and SDGs to name just a few. The evidence is clear. #HealthforAll rests on reaching the most marginalised women and girls, not just with services but with the rights that will ensure they can access those services. Surely it wouldn’t be necessary to say it all again for UHC?
But we live in a world where, despite great words and some great intentions, the most marginalised women and girls are not at the heart of health systems; the gender determinants of health (for all genders) are not widely understood; and decision makers fail to acknowledge that the majority of health workers are female. Our role as advocates is to speak the same truth to power like a broken record until those with power prioritise gender equality in health as unremarkable and the default. And that was especially true in the lead up to the UHC High Level Meeting since when we had already seen a push back against women’s rights in many multilateral fora. There was every reason to believe it would be the same for UHC.
One year ago our concern was that UHC was being approached as a purely technical issue. Dr Tedros, Director General of the World Health Organisation who has led the global push for UHC has always been clear that UHC is a political choice(1) not a technical matter. But it is not a political choice that those most in need of UHC are able to make since they lack the power and voice to influence such major political decisions. Although women are more than half the world’s population, they form only 24%(2) of the world’s Parliamentarians who decide health budgets, the overall design of health systems and the rights framework for their citizens. In 2018, only 31% of health ministries were headed by women and only 25% of Member State Chief Delegates to the World Health Assembly 2015-2018 were female (3). There are huge inequities within countries and between countries in whose perspectives are heard in health decision making. UHC has long lacked women’s perspectives, particularly women from the Global South.
Political choices are made by the powerful. The September 2019 UN High Level Meeting on UHC
was a landmark event in convening Heads of State and Government for the first time to make commitments on UHC. It was critical to ensure that the Political Declaration agreed by Member States that would be the future high level roadmap for UHC, contained strong and unequivocal commitment to gender equality and the rights of women and girls. Going into 2019, however, we faced the reality that there were people in power willing to deny women and girls the rights, especially SRHR (sexual and reproductive health and rights), essential to their health and wellbeing.
As the UHC process unfolded in 2019, it was clear that, once again, gender equality would not be the default unless we worked with others to make it so. Women in Global Health published articles, ran events, spoke on panels, lobbied at meetings including the WHO Executive Board, contributed to UHC consultations and in March 2019, issued a Call to Action 'Gender Equality and Women’s Rights in UHC Drive Better Health for All' (4) for the Multistakeholder Meeting held to gather NGO perspectives for the September HLM.
In March, appreciating we needed a bigger voice, WGH joined with the International Women’s Health Coalition and Women Deliver to co-convene a new global Alliance for Gender Equality and UHC. Within two months the Alliance had 107 NGO members working together at national and global levels. And when we saw that the UHC2030 Six Asks for the UHC HLM did not include gender equality or the rights of women and girls, we called for a ‘7th Ask ‘Commit to Gender Equality and UHC ‘ issued with the Alliance in May. Between May and September Alliance members worked with likeminded Member States and many others to support strong commitments in the Political Declaration on gender equality and the rights of women and girls, against strong opposition by a small number of governments. We applaud the likeminded states who stood firm during negotiations.
The final Political Declaration on UHC, agreed unanimously by the world’s governments, contains strong commitments on gender mainstreaming, the rights of women and girls (including SRHR) and gender equity in the health workforce (see summary by UHC2030 on the left). We are delighted with those commitments, which set a strong framework for UHC at global and national levels and were not in the original drafts of the Declaration. But we tell the story of 2019 to demonstrate that gender equality was not the default in the UHC process or global health generally. Women still struggle to get to the table and be heard. It is significant that only 76% of speakers at the UHC HLM were women. So after a rollercoaster but successful year for gender equality and UHC, we have six key messages for governments and UHC partners going forward:
Seven point call to action for UHC Day:
Keep the Promise on Gender Equality and the Rights of Women and Girls in Universal Health Coverage (UHC)
Keep the promise on mainstreaming a gender perspective in UHC design, delivery and monitoring with a view to achieving gender equality and the empowerment of women in health policies and systems: this will require radical, deliberate action and will entail women playing an equal part in UHC leadership at all levels from community to global. Global health will look different and be different.
Keep the promise on integrating SRHR into UHC and by 2030 ensure universal access to sexual and reproductive health care services: this will require action at national level to integrate SRHR into national UHC plans and to embed the wider rights needed to underpin this, particularly for women, girls and youth.
Keep the promise on enabling and empowering female health workers and addressing barriers to leadership and decision making: women are 70% health and social care workers but hold only 25% of leadership roles. If women are to fill the 18 million health worker jobs needed to reach UHC, urgent action will be needed to address gender gaps in leadership and pay as well as the discrimination and bias that constrains their careers.
Keep the promise on protecting health workers from all forms of violence and ensure safe working conditions: we urge all Member States to ratify and implement ILO Convention 190 on Violence and Harassment coming into force in 2020, to address the sexual harassment and violence experienced by a large percentage of female health and social care workers.
Make a promise on women’s unpaid work in health and social care: commit to recording, recognising and rewarding women’s unpaid work in health and social care, estimated at half the $3 trillion women contribute. A serious omission in the UHC Political Declaration, health systems are currently subsidised by this unpaid work which takes women out of the paid labour market and girls out of school and needs urgent action.
Make a promise to fund women’s organisations at community, national and global levels: OECD data shows increased funding being allocated to gender equality in 2016-17 but only 1% of gender focused aid went to women’s organisations. The feminist organisations that have driven gender equality and rights for decades need substantial, long term funding to enable them to scale up their work in health and social care. The story of the UHC process in the last year highlights the political and technical role played by women’s movements and organisations, particularly those in the Alliance for Gender Equality and UHC, in keeping gender equality and
the rights of women and girls on the UHC agenda.
Make a promise to have women’s voices and leadership in all UHC conversations. This includes gender parity, diversity and inclusion in all conversations. We must ensure that women and other underrepresented groups are at the decision-making table to ensure #LeaveNoOneBehind is being implemented from design to delivery.
Join the Alliance for Gender Equality and UHC and Commit to Gender Equality and Women’s Rights.
Endorsed by: WGH Chapters
1. Universal health coverage: a political choice Remarks by Dr Tedros Adhanom Ghebreyesus High-Level Political Forum, 17 July 2017 https://www.who.int/dg/speeches/2017/universal-health-coverage
2. Inter Parliamentary Union 2019
3. Women in Global Health
4. Women in Global Health Call to Action Gender Equality and Women’s Rights in UHC Drive Better Health for All’ 2019