All gender inequality is not equal

The Lancet Global Health Published: 07 March 2018 Open Access DOI: https://doi.org/10.1016/S2214-109X(18)30105-0 | showArticle Info Summary Full Text No one could have failed to notice the rise of women in the collective consciousness over the past year: their under-representation at the highest levels in the workplace, their discrimination in terms of pay, and their ongoing subjection to power-related assaults in the form of physical, psychological, and sexual violence and harassment. The #MeToo movement has perhaps captured the lion's share of recent attention, triggered by revelations from women who were themselves viewed as being in positions of power. Yet the women who are lucky enough to benefit from enabling environments that value girl children as much as boys, provide ready access to contraception and safe abortion, offer high quality maternal health services, and legally mandate support structures for working parents are, of course, not the women who suffer most. The World Economic Forum's latest Gender Gap Report shows a chasm between the countries with the greatest gender parity (Iceland, Norway, Finland, Rwanda) and those with the least (Chad, Syria, Pakistan, Yemen). Yet these rifts are driven not by national differences in educational attainment or health and survival, although there clearly remain pockets of alarming imbalances there too (eg, adolescent girls and HIV in sub-Saharan Africa), but by the dimensions of economic opportunity and participation and of political empowerment. The global health community has taken a welcome lead on spotlighting this inequity within its own ranks. The Women in Global Health movement successfully lobbied WHO to include a set of gender equality recommendations in its 13th General Programme of Work. The first Women Leaders in Global Health conference last year galvanised a groundswell of support and excitement, culminating in a practical call to action. And The Lancet has committed to publishing a special issue on “the representation, experience, and promotion of women in science, medicine, and global health”. Putting some data on the table in this regard is a new report published today by the Global Health 50/50 initiative. The authors of the report examined publicly available sources for the gender-related policies and practices of 140 organisations in the global health field, including public-private partnerships, UN organisations, philanthropic and non-governmental organisations, and the private sector. The authors report scorecards for each organisation based on seven domains, including public commitment to gender equality; collecting and reporting of sex-disaggregated data from programmatic activities; availability of workplace policies that promote gender equality; and gender parity in the governing body. Some of the findings are incredibly dispiriting. Only half of the organisations explicitly commit to gender equality and only a third report gender-disaggregated data. 80% of boards are gender-biased and 80% are chaired by men. The latter statistic, in particular, is a terrible advert for a field in which gender equality plays such a key role. Yet it is useful to highlight this fact alongside some of the other dimensions of the report. Both private sector and UN organisations, for example, tended to score very well on the workplace gender policy dimension, yet almost all were still dominated by men at the highest level, suggesting either that these policies are ineffective or that they have yet to become embedded in the culture. If the organisations that implement these policies and schemes that look good on paper (eg, mentoring circles and executive leadership programmes) are not actually monitoring their effect on gender balance within the organisation, they should start to do so immediately. Finally, as the Global Health 50/50 authors admit, the organisations studied are largely based in high-income countries and thus the true extent of gender imbalance in global health organisations is likely to be much worse. Similarly, the Women in Global Health movement may not be benefiting the women most in need of support in their careers. In a Comment in this month's issue, representatives of the MRC Unit The Gambia Women in Science Working Group highlight how gender barriers still exist on a much more fundamental level in regions such as Africa. The perception of women and men as intellectually equal (by both men and by women themselves) is still not a given, and flexible working hours, parental benefits, and quality daycare (both for young children and elderly parents) are a distant dream to many. This International Women's Day, those of us concerned with gender parity in global health should turn our focus towards a more progressive agenda in which the most unequal of the unequal are given priority. http://www.thelancet.com/journals/langlo/article/PIIS2214-109X%2818%2930105-0/fulltext#.WqEZ1nyKC6Y.twitter