The
Lancet
Vol
404 August 24, 2024
Many
crises, one call to action: advancing gender equality in health in
response to polycrises
Rajat Khosla, Gita Sen,
Tedros Adhanom Ghebreyesus,
Winnie
Byanyima, Sima Bahous,
Debora Diniz, et al.
Published:
July 24, 2024
The
state of polycrises linked to concurrent conflict, climate
catastrophe, the COVID-19 pandemic, the ongoing HIV epidemic, and
geopolitical, economic, and social shocks is a cause of deep concern
for the global health community. Polycrises, including the ongoing
atrocities in Gaza, Sudan, and Myanmar, political movements in
different countries that threaten to over-turn human rights and
climate laws, or the flash floods in Bangladesh, Brazil, and
Tanzania, have led to a new era likely to worsen gender inequalities
and health challenges in terms of scale, severity, and complexity.
Not only have these crises laid bare injustices and entrenched
gender-based intersectional inequalities that exist in health, but
they have also deepened and widened health disparities within and
across countries, with differences starkly marked along lines of
income, sex, age, race, ethnicity, migratory status, disability, and
geographical location, among other factors.1
Taking
stock of the gendered impact of polycrises is the first step towards
forging a collective response from governments and the global health
community. Globally, women make up the majority of extreme poor among
people aged 15 years and older, with the gender poverty gap forecast
to widen by 2030.2 Disproportionate job losses and limited access to
financial resources in a climate of economic insecurity have pushed
women into precarious work environments, jeopardising their health,
integrity, and safety.3 The responsibilities of caregiving also
intensifies during polycrises, with women and girls taking on greater
responsibilities, including childcare, care of ill or dependent
persons, and older persons care, and frequently neglecting their own
health needs.4, 5 Clinic closures, resource shortages, and
displacement due to crises disproportionately affect women's access
to health services, such as reproductive health care, prenatal care,
and safe childbirth.6 Even some high-income nations are among the 19
countries that had a higher maternal mortality ratio in 2020 compared
with 1990. 7 Furthermore, conflict, climate displacement, and the
effects of the COVID-19 pandemic are contributing to concerning
increases in gender-based violence and harmful practices such as
child, early, and forced marriage, female genital mutilation, and son
preference.7
The
adverse impacts of polycrises on women's and girls' rights and health
extend to their crucial roles as health workers. Women, who make up
almost 70% of the global health workforce and 90% of nurses and
midwives, are the front line of the health system; they deliver vital
health services during crises and are often exposed to violence,
especially in places affected by conflict.8, 9 Yet women in the
health workforce are usually inadequately paid, insufficiently
valued, and under-represented in leadership and decision-making
positions.10
Alongside
polycrises, there have been unprecedented attacks on the bodily
autonomy, choices, and human rights of women and girls.7 Globally
organised movements have mobilised against laws related to access to
safe abortion and contraception, LGBTQI+ rights, and comprehensive
sexuality education.7 This is visible in different forms, ranging
from increasing levels of violence, hate speech, and misinformation
campaigns to difficulties accessing funding for health and human
rights organisations and the introduction of regressive laws or
failure to eliminate discriminatory laws and policies.11
In
this climate of competing priorities and recurrent crises,
governments, UN agencies, donors, and civil society groups
collectively hold immense power to ensure action is taken to advance
and prioritise women's rights, gender equality, and human rights,
including the right to health. This approach is paramount for
mitigating and preventing the deepening of future crises.12 Evidence
indicates that narrowing the gap in women's health would avoid 24
million life-years lost due to disability, add more than US$1
trillion to the global economy, and increase economic productivity by
up to $400 billion.13 However, these investments need to be combined
with enabling legislation and support for gender equality in health,
including bodily autonomy and integrity more broadly. In this
context, it is only through true collective action that we can bring
about the changes that are direly needed. In particular, our joint
efforts need to focus on three key areas.
First,
funding and increased support are needed to strengthen investments,
partnerships, and research led by grass-roots communities and
feminist and women-led civil society organisations. Communities,
notably, feminist and women-led civil society groups, hold a rich
understanding of how crises play out and affect gender disparities,
health, and rights of communities. They are well placed to document
and deepen our understanding of this impact and identify contextually
relevant solutions to advance gender equality and rights. During a
crisis feminist and women-led organisations are also often directly
involved in the provision of health services, including sexual and
reproductive health services and information, in contexts where
public goods and services are limited or no longer available.14, 15
Despite widespread evidence of the essential roles of feminist civil
society and movements, investments in community-led research and
partnerships are shrinking and being deprioritised in the context of
polycrises.16, 17 Governments, UN agencies, and donors must act now
and reverse this trend.
Second,
policies are needed to support alignment across institutions and
struggles for equality and rights. Fragmentation is happening at
multiple levels and includes disjointed systems that promote siloes,
competition, or polarisation between movements striving for gender
equality and women's rights.18, 19 These challenges can manifest as
the frequent exclusion of ministries of finance in discussions to
ensure the right to health and wellbeing of women and girls, or as
hostile attacks between gender equality and rights-based movements
that unfold on social media platforms, quickly degenerating into the
use of stigmatising labels and exclusionary language. Irrespective of
how this fragmentation develops, it is fuelling mistrust and creating
restrictive environments that hinder meaningful collaboration and
collective action. It is imperative that collective efforts better
integrate systems and processes and build links across struggles,
particularly the multiple intersections of inequalities.
Third,
financial responses at global, regional, and national levels need to
be formulated so that they support gender equality and women's
rights. Current financial responses during crises frequently impede
the upholding of human rights and in turn deepen income
inequalities.20 For instance, immense pressure on governments to
focus on austerity policies and debt repayments during and after
crises detracts from investments in essential public services and in
communities that have been most impacted.20 The global financial
architecture, right down to national budgets and ministries of health
and finance, needs to have a more deliberate approach to investing in
gender-related issues and women's rights to ensure support is
provided to the communities and groups most affected by crises.
Learning from and with feminist financing models offers a strong
baseline to build from.21, 22 Not only will this approach support
short-term stabilisation during crises, but it will also build
long-term resilience and equity in resource mobilisation and
allocation.
Global
overlapping crises are worsening gender equality and health
disparities. Addressing these issues requires us to unite political,
health, and civil society leadership efforts towards reinforcing
community-driven partnerships, reforming financial and health
strategies to support equality, and integrating systems to create
cohesive responses. Now is the crucial moment to act.
1
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2
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(accessed July 8, 2024).
3
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https://www.ilo.org/publications/gender-responsive-employment-recovery-building-back-fairer
(accessed July 8, 2024).
4
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(accessed July 8, 2024).
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