Choice, Voice and Autonomy: Women’s Fundamental Rights And Health Under Threat


Advancing women’s leadership and gender equity are critical to delivering the Sustainable Development Goals, SDGs.

This was the verdict at an official side-event to the United Nations High-level Political Forum ‘Choice, Voice and Autonomy: Women’s political leadership for health in a fragile world,’ jointly organised by PMNCH, Women in Global Health, UHC2030 and Global Health 50/50, and hosted by the Government of Estonia last Wednesday, July 13, 2022.


Half-way toward the 2030 SDGs, and in the wake of the COVID-19 pandemic, the participants noted that the world is at a point where instead of working towards closing the gender equity gap, decades of progress are being rolled back, with women’s fundamental rights and health under threat

These reversals are being exacerbated by COVID-19 and other compounding crises, such as increasing incidences of conflict and the climate emergency. These come at a time when the world was just starting to see decades of hard-earned labour and effort bear fruit, with the number of girls in education increasing, maternal mortality rates falling, and child marriages and deaths decreasing.

The United Nations High-level Political Forum, HLPF, currently underway in New York, is a critical opportunity to reflect on progress made to date and agree on a way forward to tackle the significant risks being faced at this midway juncture.

The virtual leadership dialogue brought together global policymakers, government representatives, business leaders, health care providers, youth and community representatives from around the world. They reflected on the importance of women leaders in making a difference on social progress via gender equity in the context of health and education to deliver the Sustainable Development Agenda. 

“At a time when compounding crises are rolling back previous progress made on women’s empowerment and the health of communities, war is also being waged on the fundamental rights of women and girls,” Helen Clark, PMNCH Board Chair, and former Prime Minister of New Zealand, said.

And she added: “We need urgent and transformative action to reverse these worrying trends. Women must have both seats and voice at decision-making tables.

“To achieve the vision of leaving no one behind in development, societies must move beyond lip service to implementation of rights-based and gender sensitive approaches to achieving equality, resilience, and sustainability.”

Summit participants focused on solutions to increase women’s representation and participation in leadership roles and reduce gender gaps across every aspect of society, everywhere. Championing multi-stakeholder and multi-sectoral partnerships are key to these challenges, and the only way forward to address a problem as pervasive as gender equality.

Women and girls represent half of the world’s population, yet their full potential remains largely untapped. They are too often subject to sexual or physical abuse and exploitation, threatened with harmful traditions and practices, denied the right to education and healthcare, discriminated against in employment, and often deterred from participating in political processes, including voting.

Globally, 143 countries legally guarantee equality between men and women. But in practice, gender inequalities subsist in most parts of the world, and in many cases are being rolled even further back.

The recent decision by the US Supreme Court to repeal its 1973 ruling on abortion in Roe vs Wade provides one of the starkest examples yet of this worrying trend. Its effects will resonate way beyond US borders, including in West Africa. It may lend spurious legitimacy to those seeking to restrict the rights of women, and may encourage some other countries to roll back abortion law or provision, placing the health of women and girls at greater risk.

Abortion issues in Africa are as controversial as in the United States. The overturning of Roe v Wade may influence African law makers to update some of the draconian laws that most African women are exposed to. The legality of abortion in Sub-Saharan Africa falls along a continuum from prohibited to allowed without restriction as to reason. Restrictive laws either prohibit abortion altogether or restrict it to cases where a woman’s life or health are threatened.

As of 2019, 92 percent of the region’s women of reproductive age live in the 43 countries with highly or moderately restrictive laws. Data from 2019 shows that 2.4 million women in Western Africa have abortions in unsafe conditions and 14 million do not receive treatment for chlamydia, gonorrhea, syphilis and trichomoniasis. Among women who want to avoid a pregnancy, unmet need is higher for adolescents aged 15–19 than for all women aged 15–49 (64 percent versus 56 percent).

The Supreme Court’s decision to overturn Roe v. Wade could have drastic impacts on US funding and policies for sexual and reproductive health and rights (SRHR) in the region. Experts predict a fall in US bilateral and multilateral funding for family planning, sexual education, and gender-related public health programs for low- and middle-income countries. This outcome is even more likely if Republicans gain greater power in upcoming US midterm elections.

No less than 53 of the 251 SDGs’ indicators make direct reference to gender equality, women and girls. Yet women are not given seats at decision-making tables commensurate with their numbers. As of 1 September 2021, there were 26 women serving as Heads of State and/or Government in 24 countries. At the current rate, gender equality in the highest positions of power will not be reached for another 130 years. Among 138 organizations tracked over five years by Global Health 50/50, 54 (39 percent) have had neither a female CEO nor a female board chair in this period.

The pervasive leadership gap between women and men can only be closed by addressing systemic barriers to women’s advancement. This is especially important as emerging evidence from the pandemic shows that female-led countries have generally fared better in terms of outcomes during COVID-19 through instilling proactive and coordinated policy responses.

 For future pandemics, women must not only have equal participation in COVID-19 response and recovery efforts, but also equal decision-making power and leadership opportunities, and policies and programmes must also include a gender lens.

Global Health 50/50 co-directors Professor Sarah Hawkes and Professor Kent Buse said “The collective failure to deliver equality in global health is inextricably linked to a failure to ensure equality in voice, representation, and inclusion at the top. We urgently need feminist leaders, especially women and other under-represented groups, to push for health rights, equity and gender equality. But promises and commitments are not enough.

“We also need robust systems of accountability to ensure that promises made are promises kept – something we at Global Health 50/50 aim to deliver.”

Attitudes towards gender roles deteriorated further amid COVID-19 as outdated social norms and stereotypes continue to hold society back from reaching gender equality.

Millions of dollars for programmes providing health services to women, girls and adolescents have been cut due to competing priorities and demands amid the pandemic. Sexual and reproductive health (SRH) services are too often made ‘optional’ rather than essential services, leading to increases in deaths of and harm to women.

Emerging data estimates that for each COVID-19 death, more than two women and children have lost their lives because of disruptions to health systems since the start of the pandemic.

“Health is a right, not a privilege. It requires political will and leadership. But women need to have an equal say in the health systems that impact their health and well-being. Yet, they only have 25 percent of the seats in parliaments and hold 25 percent of the senior roles in global health. The rules must be change to advance from this unequal reality,” said Gabriela Cuevas Barron, Co-Chair, UHC2030 Steering Committee.

Some 11 million girls might not return to school this year due to COVID-19’s unprecedented education disruption. This not only threatens decades of progress made towards gender equality, but also puts girls around the world at risk of adolescent pregnancy, early and forced marriage, and violence.

Women have been disproportionately hit by unemployment, losing 4.2 percent of jobs as a result of the pandemic, compared to 3 percent job losses for men. If no action is taken to counter the gendered effects of the pandemic on women’s jobs, it is estimated that global GDP growth will be $1 trillion lower in 2030 than it would if women’s unemployment simply tracked that of men.

Women are the majority of the global health workforce (70 percent of all workers and 90 percent of frontline workers), yet only 25 percent of senior leaders in health.

 A 2021 report revealed that just 11 percent of countries surveyed reported ZERO midwives in leadership positions; and almost half of all countries reported no midwife leader in their ministry of health. 

Gender gaps are pervasive the world over and closing them requires significant progress on issues as broad-ranging as violence against women, access to contraception, and women’s labour-force participation.

Gender inequality cuts across all sectors, interlinks with other areas of development, and requires solutions from many actors including those in government, corporations, and nongovernmental organizations (NGOs).

Dr Magda Robalo, Global Managing Director, Women in Global Health, noted that even before the pandemic gender inequity was hard wired into the global health workforce, with women clustered into lower status sectors and jobs, marginalised in leadership and frequently subject to violence and harassment.

“Although women are the majority of health workers, they hold only 25 percent of decision-making roles in health, and women from the Global South are particularly marginalised,” she said.

She added: “Women in Global Health research shows that women have actually lost ground in leadership since the start of the pandemic.

“A total of 85 percent of our survey of national COVID-19 task forces had a majority of men as members. Earlier this year, the WHO Executive Board had just six percent of women members, down from 32 percent in January 2020.

“Women are experts in the health systems they largely deliver, and health systems are weaker when women’s knowledge and professional expertise are marginalised in decision making.”

Participants noted that multi-stakeholder and multi-sectoral partnerships can be an engine for powering the effort needed to close the gender parity gap.

Also, they said there is a need to redouble efforts to enhance partner capacity for joint advocacy, meaningful inclusion and greater accountability. Stronger partnerships with communities are also needed to enhance and entrench gender equality into societal structures.

This is even more important as the world seeks to restore and rebuild societies following the pandemic.

Pix: Helen Clark


Leave a Reply

Your email address will not be published. Required fields are marked *