(1) Global health and gender equality goals are intertwined.
According to UN Women, gender equality is central to the achievement of all 17 SDGs, and as a result, an understanding of — and attentiveness to — the differential impact of gender on the lives and health of men and women is indivisible from the success of the global health sector.
(2) Gender in global health is not only about women and girls.
Global health actors have embraced the rhetoric of women’s empowerment, gender equality and reducing inequities in health.
However, too often, this approach has led to the restrictive idea that gender in health equates only to women — particularly maternal issues.
Gender initiatives, typically undertaken in low-income countries but funded by wealthy Western donors, are often synonymous with projects targeting women and girls only.
This tendency has resulted in a failure to address the specific health needs of men and the impact of masculinity on health equity.
Global health programming that addresses the contextual inequalities between women and men can be used to transform unequal gender norms.
(3) Lack of data hides gender issues.
To inform gender transformative global health research, policy and practice, data must be disaggregated by sex and analysed in the context of societal gender norms.
This analysis enables the understanding of differential service access or health outcomes for women, men, girls and boys and is crucial to uncovering key gender gaps and inequities.
In epidemiology — the statistical study of disease — all data is analysed by sex yet this is not the case in global health practice where organizations often fail to collect sex-disaggregated data from programmes, or more recently, focus their data collection exclusively on women and girls.
Less than half of 198 leading global health organizations report sex-disaggregated data on programmatic delivery.
(4) Gender equality is important but, as yet, it is unrealized in global health organizations.
Women’s equality is one of the Sustainable Development Goals integral to all dimensions of inclusive development and the success of Agenda 2030.
Increased diversity in global health organizations is important both to reap the rewards identified in other sectors but also for the sector to legitimately promote progress towards key gender and health-related goals.
While 70 per cent of the global health sector are women, compared to an average of 41 per cent across other sectors, most decision-making roles within global health organizations are held by men.
A new report by Global Health 50/50 shows that fewer than 3 out of 10 organizations have achieved gender parity in senior management while 71 per cent of board chairs and 72 per cent of chief executives are men.
Many global health organizations still fail to make any explicit commitment to gender equality and less than one third of organizations define gender in a way that is consistent with global norms.
Furthermore, the median earnings of male employees are 13.5 per cent higher than for female employees and flexible leave policies for parents are not yet the norm.
(5) Sexual harassment is an unresolved issue.
Sexism and sexual harassment in medicine are well-documented and female medical students witness many outdated sexist attitudes not least because many global health leaders are male medical doctors.
But so too do young women and men working in global health organizations. Global health organizations are implicated in the 2018 abuse allegations against many well-known NGOs. Yet according to Global Health 50/50, only one-third of organizations publish their sexual harassment policies online and less than half organizations stipulate mandatory training for staff.
This is a priority area for improvement.
(6) Women from the ‘global south’ are underrepresented.
Global south representation in the global health sector has been widely critiqued with racism in global health institutions uncovered.
Although initiatives such as Women in Global Health and The Lancet Women are drawing attention to gender inequalities, there are concerns that efforts focused on increasing opportunities for women — often privileged Western women — may be distracting from the arguably more urgent need to increase participation from ethnic minorities and to #decolonizeglobalhealth.
Efforts to promote gender equality cannot be separated from wider discrimination issues and this is another priority area for urgent improvement.
(7) Transformation in global health is possible.
Commitment to changing gender in the global health sector is growing. However more practical action at the level of organizational policy is required as well as more open discussions to confront inequities — whether related to sex, gender, race, wealth or privilege .
With increased data for accountability, with more flexible working policies for parents to help promote the important role that men can play in domestic labour for example, with more representative voices given platforms and with more honesty about underlying prejudices, then transformation is possible.