By Sana Contractor (Center for Health and Social Justice, New Delhi) & Sara Van Belle (post-doc, ITM Antwerp)
In the year 2017, “gender equality” was undoubtedly one of the hot topics that was discussed and debated both on online spaces as well as in global events. As the year closed, the appointment of the UNICEF’s new executive director Henrietta Fore and seven new women to WHO’s leadership team drew wide attention and accolades in global development circles. After all, as Dr.Tedros in his letter to staff pointed out, “Despite setting a target of achieving 50% gender equity in 1997, WHO has not lived up to that goal. Two decades later, only 28% of the directors are women.”
The newly launched report “Global Health 50-50” released by the Center for Gender and Global Health at the University College of London, shows that, in the Global Health world, this is not unusual at all. The report attempts to assess the extent to which 140 major organizations either working in or influencing global health address gender equality both in their programming as well as at the workplace, by reviewing their gender-related policies. It explores seven key domains which examine gender-responsive programming in the organizations, and the extent to which they provide a gender equitable workplace. The findings of the report are sobering, to say the least. More than 20 years after Beijing, just over half of the organizations made a stated commitment to gender equality and less than half mentioned gender in their overall programme and strategy documents. Despite overwhelming evidence on the impact of gender on access to programmes, decision making, responsiveness of health care providers and exposure to health risks, two thirds of organizations do not disaggregate their data by sex. Organizations remain blind to queer concerns with just about ten percent recognizing the needs of persons with non-binary gender identities, and only one organization reported on health data of trans-persons. It is striking that among organizations that focus on the health of women and girls, most do so without a clear recognition of gender as a social construct. Many work largely on reproductive and maternal health that – ie, viewing women largely in their roles as mothers. The report rightly flags this as a problem, given that the changing patterns of NCDs clearly show women as a disadvantaged group, and therefore it is critical that women be looked at beyond their reproductive roles.
With regard to gender equitable work environments, the picture is quite dismal. Only a little over half of the organizations mentioned a stated commitment to gender equality at the workplace, and even among those, not all had specific measures to improve gender equality. As far as representation in decision making bodies and positions goes, it appears to lay heavily in the hands of men. The report points out this striking disparity, because close to 70 percent of those working in global health are women, but they seem to rarely occupy leadership positions.
At first sight, the standards seem rather simple and straightforward. What is striking however, is that even with these relatively “low-bar” indicators, organizations fare quite poorly. One wonders what the picture would look like, if a deeper analysis was carried out to understand the gender impact of the work of these organizations, and the roles that they play in global health policy making. Particularly for northern organizations, a critical question to ask would be – to what extent to they truly represent the needs of women on the ground, especially in the global south? To what extent are the aspirations of women’s resistance movements reflected in organizations’ programmes? And indeed, what actions of global organizations run contrary to women’s interests more broadly? The influence of the global political economy on global health policy making, and the functioning of key actors in that space have implications for gender equality. Previous research for instance has suggested that vertical channeling of resources by Global Health Initiatives has resulted in the fragmentation of the sexual and reproductive health rights agenda, moving the agenda away from comprehensive SRH services towards infectious diseases. This cannot merely be assessed through a review of policies and documents, but warrants a deeper investigation that must be undertaken moving forward, if we are serious about addressing gender equality.
Similarly, the discourse around women’s leadership in global health, although indicative of gender biases, lacks an intersectional lens. It seems to be premised on an assumption that having a greater number of women in leadership positions will improve the lot of women in the health workforce (which is predominantly female), and ultimately the health of women themselves. The assumption seems to be that women in leadership positions will represent interests of other women, irrespective of their relative social positions and leadership styles. But can that really be the case? After all, even Pepsico’s woman CEO Indra Nooyi did try to sell us women-friendly Doritos. Leadership at the top is not sufficient to change organisational culture, especially in organisations with affiliates across the world and in which “masculine” styles of leadership may well be adopted by women as well. Having workplace policies similarly often results in isomporphic mimicry: it might look like the real thing but it is really a fake handbag. Therefore it is crucial that the implementation of these policies, internal monitoring and accountability also be assessed.
Moving forward, however, as the report notes, there is a growing interest and pressure to show a commitment to gender equality and this certainly needs to be capitalized upon. It may be useful to undertake such an exercise periodically, but as the idea of gender equality becomes more mainstream, there is also a danger of dilution – the temptation to turn this into a “box-checking” exercise – when in fact, what is needed is to deepen our understanding of WHY there is no gender parity. Why are certain organizations outliers and what might be the reasons for these.Is it because organisations working on girls education would experience an uncomfortable contrast with workplace policy? Or are organizations blind to these contradictions? How do organizations differ based on their geographic location? How do country offices differ from international headquarters? Perhaps in the future, the authors could considera more theory-driven analysis informed by the myriad theories that are currently out there on crossing inequities (i.e.)intersectionality, post-colonialism, originating in (postmodern) power theories.
Overall, the report is timely and provides much food for thought and action. Ultimately, if we want to “do” gender equality in a substantive rather than tokenistic way, embracing the principles of feminism and intersectionality, the bar will have to be set higher. This report provides a starting point and hopefully will evoke a more nuanced, serious conversation on what it means to be “gender equitable”.