The 8th of March is commemorated as International Women's Day (IWD). The day is celebrated differently across the world, but the common value and spirit of IWD is equality.
According to the UN, ‘‘Equality means ensuring all people have equal opportunities to make the most of their lives and talents, and that no one has poorer life chances due to their background or status’’.
This is the very core of International Women's Day. One of our own great leaders, the late Kofi Annan was emphatic on why striving for gender equality is so important:
‘Gender equality is more than a goal in itself. It is a precondition for meeting the challenge of reducing poverty, promoting sustainable development and building good governance’2.
Justine Greening, a UK Development Secretary also observed that ‘No country can truly develop if half its population is left behind’. This is especially true for developing countries such as Ghana, where the majority of the population (nearly 51%) are women. It is also true that ‘Any society that fails to harness the energy and creativity of its women is at a huge disadvantage in the modern world’ (Tian Wei, CCTV News).
Notably therefore both the erstwhile Millennium Development Goals, and the current Sustainable Development Goals address the issues of gender and gender equality. Ensuring parity in access to education, health, employment and promotions, and also political participation is at the heart of the discourse on sustainable development.
Empowering Women in Health for Sustainable Development
As a female leader in health, I find it important to write some of my observations with women in health as a source of inspiration to the millions of young women and girls in the health sector who are at the forefront of health services delivery. When we talk about sustainable development, we have to talk about the social sectors, particularly health, because sustainable development cannot happen without a healthy population. As health workers are the backbone of the health care system, looking at gender equality in health care is a good starting point. So let’s look at how we are doing in terms of equality in the health sector, let’s talk for a moment about Women in Health.
At first sight the statistics in the health sector look promising: women constitute 70% of the health work force according to the International Labour Organisation. However, if you look at the specialized positions as well as the leadership positions, women only constitute 20% internationally and even less in low middle income countries. Decision making in the health sector is largely dominated by men.
Someone might ask, why is it an issue that we do not have women leading in the health sector? Well, a recent UNESCO report shows strong evidence from 100 countries that female leaders ensure an average of 3.4% more investment in health and welfare. This additional investment has a positive impact on the health status of countries, particularly for the most vulnerable. To achieve universal access healthcare therefore, we need women in leadership positions in health!
But where does this absence of gender parity in health-care leadership arise from? If there are so many women working in the health sector, what stops women from progressing?
The evidence suggests that if you ask women what the biggest barriers to leadership are, they cite:
- Lack of examples of female leaders
- No clear promotion criteria
If you ask men the same question they cite women’s domestic and childcare responsibilities.
This is a striking reality that is further supported by research evidence showing that the lack of progression of women is not due to a lack of interest of women in leadership positions, nor to differences in career commitment or years of education. Rather, there is a systemic gender bias in favor of men. Some of the key issues that are identified in the literature include the following;,:
- Occupational sex segregation: this means that jobs and positions primarily held by women are devalued and there are no adequate opportunities for career advancement.
- Uncompensated or undercompensated labor for health; primarily female frontline health works make up for gaps in the health systems –Women are seen to be caregivers so their frontline job is just a mere extension of the role of a woman in the household and therefore no need to be compensated.
- Discrimination based on Marital and Pregnancy Status and family responsibilities
- Wage discrimination – there is a gender pay gap whereby women are systematically paid lower wages and other benefits.
- Discrimination in education and training, even in the case of gender equal opportunity policies, strategies are put in place, men generally get more opportunities by adapting selection criteria that benefit men more.
- Sexual harassment and assault on the job; disempower women. Violence and harassment not only limit many health workers’ abilities to effectively complete their life saving duties, but also stifles their voice when advocating for advancement and increased responsibility.
I attended a presentation on sexual harassment and assault in the health sector in Uganda, and I must say the result was shocking. It ranged from unwelcome sexual comments and sexist remarks minimizing competence based on one’s sex, to attempts of sexual relationships, conditional sexual favors for career advancements, and to even threats of sexual assault and rape. My shock did not come from the fact that this is happening, but the realization that it is often normalized and acceptable as part of societal norms.
We need to recognize that inequality is a problem before we can start finding solutions. Voices are raised increasingly to address some of the key barriers for women. There is the coalition of The Frontline Health Workers Coalition, the Global Health Workforce Network’s Gender Equity Hub and international organizations like Intrahealth which are putting these issues on the international agenda, and also working assiduously to come up with solutions that could address this at the strategic and policy level.
Whilst change needs to come at that level, change can also come from the grassroot. The biggest revolutions came from society and informed policy change, not the other way around. Each one of us women in health is equipped in our own ways to challenge the existing status quo.
Based on some of the key barriers identified and based on my own experience, I would like to give some advice on how to go about challenging the existing situation:
First of all, as women, we need to be convinced that our voices are allowed to be heard. If you have an opinion speak out. Ursula Burns, the CEO of Xerox had some great advice on this: “ I did not learn to be quiet when I had an opinion. The reason they knew who I was is because I told them”.
Secondly, we need examples of great female leaders, ones that we can identify with and ones that will inspire us. For me, one inspirational leader is
Michelle Obama. She rightly observed that: "There is no limit to what we, as women, can accomplish." The Ghanaian Health system also has some strong women in leadership positions, for example dr. Selby at the NHIA, dr. Leticia Appiah, the Executive Director of the National Population Council, Mimi Darko, the CEO of the Food and Drug Authority, just to name a few.
Thirdly, once we are in leadership positions, we need to become champions and advocates for other women. We need to employ and be mentors to them. Often, once women reach higher positions, they demand other females to be as strong as them and fight for themselves, as they did not necessarily have the support when they were progressing. But like Michelle Obama rightly said: "When you've worked hard, and done well, and walked through that doorway of opportunity, you do not slam it shut behind you. You reach back."
Fourthly, planning your carrier is important and that does come with planning your family too. Access to and use of family planning, and women’s confidence that they can control their fertility, will have beneficial long term effects on women’s abilities to participate more fully in the paid health workforce and advance their carriers. That does not mean you can’t have children, but having them at the right moment helps in supporting your carrier goals and objectives. For you to plan well, knowing more about the different methods of family planning will ensure that you can have children by choice not chance.
That is what my organization, Marie Stopes International Ghana, stands for. We wish and work towards having a family, community, nation and world where every birth is wanted, and where women have the freedom and equal opportunities to be formidable positive forces in leadership in health and other sectors of the political economy.
Our men do not have to be part of the problem. They should be part of the solution by acknowledging reality and acting upon it. This is the only true way of equalizing opportunities for women. We should not leave anyone behind, as summed up by the spirit of the Sustainable Development Goals. More than ever, women need to be given opportunities to flourish, yet even more importantly, the women themselves need to step up and take hold of these opportunities, and lead the way to achieving universal access to health for our people.
The writer is the Country Director for Marie Stopes International Ghana, an international NGO headquartered in the UK, and with presence in 37 countries, specialised in the provision of sexual and reproductive health services.
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