Why it must be a feminist global health agenda

Elsevier, The Lancet, Volume 393, Issue 10171, 9–15 February 2019, Pages 601-603.
Sara Davies, Sophie Harman, Rashid Manjoo, MariaTanyag and Clare Wenham

We need to re-think the interconnection between women, gender, and global health. Beyond increased physical risk factors, women are disadvantaged structurally, being over-represented in informal care roles and under-represented in leadership, decision making, and senior research roles. Global health policy and programmes are often blind to the differences between women's needs and men's needs (gender equity), and to women's unequal position in society (gender equality), rendering women “conspicuously invisible”. In response, initiatives such as Women in Global Health have established a target of 50:50 representation in global health leadership by 2030. Tedros Adhanom Ghebreyesus has called for gender “balance” in senior management roles at WHO, including its regional and country offices. However, addressing women's representation in the workplace (ie, by quotas) is not the same as promoting gender-inclusive and gender-mainstreaming practices.

In this Viewpoint, we outline how a feminist research agenda can advance gender equality in global health. Feminist research challenges structural and social power inequalities within patriarchal societies that produce inequalities that disadvantage women. Feminist research and methodology have particular relevance in addressing some of the key issues that the women and global health movement is currently grappling with: substantive representation (ie, active rather than token representation, diversity of senior roles and leadership positions, and sustained inclusion), organised political movement, the role of the welfare state, intersectionality, and sexuality. These feminist insights inform four recommendations for the global health community. First, feminist leadership requires more than gender quotas: it requires formal and informal cultural change within institutions across all areas of global health governance. Second, gender inequality cannot be addressed without tackling race and socioeconomic inequality; global health must be intersectional across research, programme delivery, and implementation. Third, global health is dependent on women in unpaid care roles, and this reality needs to be recognised and calculated, and the labour paid. Fourth, gender inequality is often informal, and diverse methods of research are required to expose, recognise, and address the informal and hidden ways in which inequality takes place. These four recommendations are fundamental to achieving women's representation and gender-inclusive practices at every level of science, medicine, and global health.