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Health Systems Risk Reaching a Breaking Point: What’s Gender Got to Do with It?

07/04/2023     4 min read     By Ahlem Khattab

Photo by Amir Arabshahi / Unsplash

Pre-pandemic, the World Health Organization expected a global shortage of at least 18 million health care workers by 2030. With 70% of the current global workforce made up of women, solving this crisis seems to be very much a gender issue.

Nurse, doctor. When you read those words, chances are you thought of a woman for the first one, and a man for the second. If you did, it might not just have to do with an internalized bias.

According to the World Health Organization and the International Labour Organization, women make up 67% of the health and social workforce in the world. Looking into the different occupations, we find women mostly in midwifery (93% of the wider midwifery workforce) and nursing (89% excluding nurses with midwifery training), and men are in majority physicians, dentists and pharmacists.

“It is not necessarily a limitation that health is a female majority profession,” says Roopa Dhatt, executive director and co-founder of the women-led movement of health workers Women in Global Health, “but we should ask ‘why?’ whenever a profession is dominated by one gender or we see occupational segregation where one gender is clustered into sectors of the profession.”

Historically, care work has always been considered a woman’s job, whether unpaid at home or in their community, during wartime, or as one of the first outside-of-the-home, (low) paid professions women were allowed to occupy in modern times in many countries. 

“Records from early civilizations show women have long played an active role in medicine as healers, herbalists, surgeons, midwives, and more. Yet when medicine was formalized as a profession, women were banned from medical education and practice, and had to fight their way back in.” As universities developed in Europe during the Middle Ages, only men were allowed as students, while women could be placed on trial for practicing medicine (some of them resorted to pretending to be men to become doctors).

“There is evidence that wherever a profession is women majority it will tend to be accorded lower social value and lower status.” — Roopa Dhatt, co-founder and executive director of Women in Global Health

Today, health systems across the globe depend on women health workers, but power in the sector remains majorly out of their hands: men hold around 75% of leadership roles. This not only means that most workers’ perspectives and preoccupations are barely taken into account in decision-making, but it also contributes to a gender pay gap that is higher than average: 24% per the latest estimates.

On top of that, nursing and midwifery jobs tend to be not as highly regarded in society as those of medical doctors. “There is evidence that wherever a profession is women majority it will tend to be accorded lower social value and lower status,” points out Roopa Dhatt. There have even been studies that prove that once women outnumber men in a workforce, the occupation becomes so devalued that employers decide to simply pay it less. 

The Covid-19 pandemic further highlighted and aggravated the different difficulties female workers have to face in the field. After being applauded in the first months, they gradually found themselves pushed to their limits, if not beyond. “Women health workers typically manage a double burden of high patient numbers, long hours, high stress and risk at work, plus additional unpaid care work at home and in the community,” recounts Roopa Dhatt. And a number of them are affected by long Covid. “Understandably, women are leaving the health sector at all levels in a ‘Great Resignation’.”

The pressure isn’t just on women as individuals. Health systems all over the world are at risk of reaching a breaking point. Even prior to the pandemic, the International Council of Nurses and the World Health Organization projected a global shortage of at least 18 million health care workers in general, with 10 million nurses among them, by 2030. In 2023, they revised that prediction: the “number could be close to 14 million nurses in the future because of the ‘Covid-19 effect’ that both exacerbates and expedites the point of burnout and absenteeism or leaving the profession entirely.” And the countries with the most pressing shortages are in majority situated in Africa. 

But with women getting burned out or quitting, and men discouraged by the low pay and gender bias associated with nursing and midwifery, how to attract more workers? How to save healthcare as a whole?

For Women in Global Health, taking steps to fixing the gender inequalities within the sector is at the heart of the possible solutions. In a 2023 report on “the state of women and leadership in health,” they explain the role of opening leadership positions to women, the necessity of engaging the men that are already in the workforce, as well as accounting for the burden of unpaid care.

“Women health workers need fair pay and decent working conditions to do their jobs. Lacking these basic human rights, women health workers are understandably at risk of exhaustion, loss of morale and poor mental health, which in turn impacts health care delivery,” adds Roopa Dhatt. Her organization believes at least 6 million women are working “unpaid or grossly unpaid, essentially subsidizing global health.”

“This is a precarious situation for both the women and the health systems that depend on them,” she concludes.

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