Universal health coverage (UHC) means that all people, everywhere, have access to the health services they need, when and where they need them, without financial hardship. The concept of UHC is currently high on the global health agenda. For many, this seems like a utopia that is already set up for failure, considering that half of the people in the world today lack access to essential healthcare.

But: achieving UHC is possible, and gender equality and women’s empowerment are key to delivering it. Here’s why.

Gender equality drives better health outcomes for all

Achieving UHC is impossible without addressing gender equality, women’s rights and the critical role of women in the global health workforce. Men, women and people with diverse gender identities have different health needs, which also change throughout their life. Marginalised women and girls and those in vulnerable situations are amongst the hardest to reach with health services. This is especially the case for poorer women, and women living in rural areas or without formal education.

How are girls and women left behind in health, then? Pervasive gender inequality and patriarchal structures manifest in multiple ways, impacting women and girls’ lived realities, access to health resources, information and opportunities. They often face bigger barriers to accessing health information and services due to limited mobility and decision-making power, lower literacy rates and discriminatory attitudes of healthcare providers. Women and girls are also subjected to high levels of gender-based violence such as domestic violence, child marriage and female genital mutilation. Gender norms and discrimination also increase the risk of unwanted pregnancy, HIV and AIDS, and malnutrition for girls and women. HPV vaccinations are critical in saving lives from cervical cancer but many adolescent girls are not reached: Asia and Africa account for 80% of cervical cancer deaths globally.

Strict gender norms also negatively influence men’s health outcomes. Ideas about “hegemonic masculinities” can fuel health-impacting risk-taking behaviour among men, such as misusing alcohol or drugs, taking sexual risks, or not seeking healthcare when needed, especially for mental health issues. Suicide rates are almost twice as high among men than women. Moreover, people with diverse gender identities face additional stigma and discrimination, including in healthcare settings.

Addressing gender-related barriers and the specific needs of women, men and people with diverse gender identities in health services, advancing gender equality, and increasing women’s meaningful participation in the design and delivery of health services are critical building blocks for UHC. Also - since women are the majority of the world’s poorest people, they will be the main beneficiaries of UHC.

Sexual and reproductive health and rights must be kept high on the agenda for UHC, despite resistance from conservative elements. Still, essential reproductive, maternal and child health services do not reach those in need. The facts are alarming: 40% of women of reproductive age (ages 15–49) do not have four or more antenatal care visits during pregnancy, and 38% of sexually active women in need of contraceptives are not using modern methods. Young adolescents have the lowest coverage for essential contraceptives.

Why women will deliver UHC

Women currently make up 70% of the global health workforce. Women are key for delivering UHC – that is why they must be fully recognized as drivers of change and be part of decision-making at all levels  in global health.

Although women are delivering global health, they lack adequate support structures and protection. Gender gaps in pay, leadership and promotions persist. Securing a decent, safe work environment for women, free from all forms of harassment, violence and discrimination, is critical.

Women hold the majority of the jobs in the health sector but they are underrepresented in senior and decision-making roles at all levels - local, national and global. In 2020, over 70% of CEOs and board chairs of global health organisations are men, while just 5% of leaders are women from low- and middle-income countries.

Women’s limited opportunity to enter leadership roles in health is further compounded by the intersection with additional factors such as ethnicity, age, class, and gender identity. Taking decisive steps towards reaching gender parity at all levels of health decision-making should be a priority. The women who deliver global health must have an equal voice in its design and delivery - there is no other way.

UHC - How do we get there?

UHC is high on the global health agenda. WHO currently identifies achieving universal coverage as a strategic priority, with the goal of 1 billion more people benefitting from universal health coverage by 2023. The Sustainable Development Goals – especially SDG 5 to ‘achieve gender equality and empower all women and girls’ – emphasize gender equality as not only a fundamental human right, but a crtical foundation for a peaceful, prosperous and sustainable world. Advancing gender equality is critical to promoting health and well-being of all, and this notion must meaningfully underpin all action towards UHC.

Addressing gender norms, roles and relations must be at the heart of designing, implementing and monitoring universal health coverage in order to achieve progress. To truly “leave no one behind” requires an intersectional approach that addresses additional social factors beyond gender, including race, ethnicity, caste, age, sexual orientation, gender identity, socio-economic status and disability.

Achieving universal health coverage takes political will, dedicated resources and the necessary gender expertise at all levels. Women in Global Health have translated the required actions into critical, evidence-based “asks” for global leaders. The evidence is all there - there will be no UHC without gender equality. Gender-responsive health approaches drive better outcomes for all.