Journal Article
30 May 2019
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Disrupting gender norms in health systems: making the case for change

The Lancet Katherine Hay, Lotus McDougal, Valerie Percival, Sarah He...+22 more
The Lancet
Katherine Hay, Lotus McDougal, Valerie Percival, Sarah Henry, Jeni Klugman, Haja Wurie, Joanna Raven, Fortunate Shabalala, Rebecca Fielding-Miller, Arnab Dey, Nabamallika Dehingia, Rosemary Morgan, Yamini Atmavilas, Niranjan Saggurti, Jennifer Yore, Elena Blokhina, Rumana Huque, Edwine Barasa, Nandita Bhan, Chandani Kharel, Jay G Silverman, and Anita Raj*, Gender Equality, Norms, and Health Steering Committee
Global
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What you'll learn
Health systems have a role to play in reducing gender inequalities
  • This article identifies and explores the ways in which restrictive gender norms and gender inequalities are replicated and reinforced in health systems, contributing to gender inequalities in health
  • Gender-transformative approaches address how gender intersects with other social stratifiers and shift gender norms, reduce inequalities, and improve health outcomes
A gender equitable system
What is it?
Overall, a gender-equitable health system is one that reflects and reinforces a gender-equitable society; addresses gender norms and root causes of inequalities across the life course; provides equal opportunity for health-care professionals of all genders; ensures equal access to and utilization of high-quality health services by people of all genders, across all contexts; and is held accountable at all levels.
An elderly woman holds a notebook, dressed in a sari, in India.

This evidence suggests that we need to move from a consideration of gender as something that can be easily patched upon existing health systems, towards a recognition that gender inequality fundamentally predetermines and shapes health systems and outcomes in ways that require fundamental changes.

Key Takeaways
1
Gender inequalities are linked at all levels of society
Gender inequalities are linked at all levels of society
Gender equality in the larger social environment can prevent and reduce gender inequalities in the health workforce.
2
It starts with respect
It starts with respect
Respect and value for women’s professional work are needed from family, community, and institutions to support their productivity and impact, including through shifting norms to reduce their burden of unpaid domestic labour.
3
Involve community-led movements to drive progress
Involve community-led movements to drive progress
Community mobilisation through, for example, social movements and women's empowerment collectives can provide external accountability and push health systems to provide universal and gender-equitable care.
Affiliations
  1. Katherine Hay, Bill & Melinda Gates Foundation, Seattle, WA, USA
  2. Lotus McDougal, Center on Gender Equity and Health, Department of Medicine, School of Medicine, University of California San Diego, La Jolla, CA, USA
  3. Valerie Percival, Norman Paterson School of International Affairs, Carleton University, Ottawa, ON Canada
  4. Sarah Henry, Department of Pediatrics, Stanford University School of Medicine, Stanford University, Stanford, CA, USA
  5. Jeni Klugman, Georgetown Institute for Women, Peace and Security, Georgetown University, Washington, DC, USA
  6. Haja Wurie, College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
  7. Joanna Raven, Liverpool School of Tropical Medicine, Liverpool, UK
  8. Fortunate Shabalala, Faculty of Health Sciences, University of eSwatini, Mbabane, eSwatini
  9. Rebecca Fielding-Miller, Center on Gender Equity and Health, Department of Medicine, School of Medicine, University of California San Diego, La Jolla, CA, USA
  10. Arnab Dey, Sambodhi Research & Communications, Noida, Uttar Pradesh, India
  11. Nabamallika Dehingia, Sambodhi Research & Communications, Noida, Uttar Pradesh, India
  12. Rosemary Morgan, Johns Hopkins Bloomberg School of Public Health, Department of International Health, Baltimore, MD, USA
  13. Yamini Atmavilas, Bill & Melinda Gates Foundation, Seattle, WA, USA
  14. Niranjan Saggurti, Population Council, New Delhi, Delhi, India
  15. Jennifer Yore, Center on Gender Equity and Health, Department of Medicine, School of Medicine, University of California San Diego, La Jolla, CA, USA
  16. Elena Blokhina, Vladman Institute of Pharmacology, Department of Psychiatry, First Pavlov State Medical University of St Petersburg, Saint Petersburg, Russia
  17. Rumana Huque, The ARK Foundation, Dhaka, Bangladesh
  18. Edwine Barasa, Kemri-Wellcome Trust, Kenya Research Programme, Nairobi, Kenya
  19. Nandita Bhan, Center on Gender Equity and Health, Department of Medicine, School of Medicine, University of California San Diego, La Jolla, CA 92093, USA
  20. Chandani Kharel, HERD International, Thapathali, Kathmandu, Nepal
  21. Jay G Silverman, Center on Gender Equity and Health, Department of Medicine, School of Medicine, University of California San Diego, La Jolla, CA, USA
  22. Anita Raj, Center on Gender Equity and Health, Department of Medicine, School of Medicine, University of California San Diego, La Jolla, CA, USA
  23. Gender Equality, Norms, and Health Steering Committee
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