1. McSpedon, Corinne


Nursing and global health experts discuss the implications of gender inequity.


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"We are a gendered profession, and we know the consequences this presents," said Pamela Cipriano, PhD, RN, FAAN, president of the International Council of Nurses (ICN) and dean of the University of Virginia School of Nursing. "Nurses face gender and power biases in workplace policies and regulations."


Cipriano made these comments in a video message during a side event at the 66th session of the UN Commission on the Status of Women in March (the annual event took place in a hybrid format; all side and parallel events were virtual). Organized by the ICN and Women in Global Health, the side event-"Global Health Workforce Solutions for Gender Equality"-featured a panel of nurse and global health experts discussing solutions for advancing gender equality in the context of disaster risk reduction.

Figure. Pamela Cipri... - Click to enlarge in new windowFigure. Pamela Cipriano, PhD, RN, FAAN

The conversation was intended to give attendees an "opportunity to listen, learn, amplify our collective power, and strategically recommit to improve gender equality and disaster preparedness and response," explained moderator Michelle Acorn, DNP, NP, CGNC, FCAN, FAAN, chief nurse of the ICN.

Figure. Michelle Aco... - Click to enlarge in new windowFigure. Michelle Acorn, DNP, NP, CGNC, FCAN, FAAN. Photo courtesy of the Lawrence S. Bloomberg Faculty of Nursing.


Although women make up nearly 70% of the global health workforce, 89% of the nursing workforce, and 93% of the midwifery workforce, they hold only 25% of senior roles in health organizations, said Cipriano. She pointed out that 69% of global health organizations are headed by men, who hold 80% of board chairs. Only 20% of global health organizations have gender parity on their boards, Cipriano said, and 25% have gender parity at senior management levels. (For more, see Health Care Workforce Statistics.1, 2)


"We know gender leadership gaps are driven by stereotypes, discrimination, power, imbalance, and privilege," she said. "The devaluation of work associated with women is cited as a barrier to women's advancement in the profession and health care workforce as a whole."

Box 1 - Click to enlarge in new windowBox 1. Health Care Workforce Statistics

As Magda Robalo, MD, global managing director of Women in Global Health explained in her introductory comments, "Global health was built unequal, on the assumptions that women would deliver health care while men made most decisions, and that women's unpaid work would form the foundation for global health." This was exemplified during the pandemic, she said, when 85% of national COVID-19 task forces consisted mostly of men, and only 3.5% had gender parity. "This is replicated at the political level . . . with women accounting for fewer than one-third of health ministers in 2020."


This isn't just a loss for the women whose perspectives, experiences, and expertise are marginalized, but also for health systems, which lack these important contributions, Robalo said. "Global health will only be secure when women in health have a fair social contract based on safe and decent work and equality in decision-making."

Figure. Magda Robalo... - Click to enlarge in new windowFigure. Magda Robalo, MD


Panelist Prescola Rolle, MSN,RN, CMSRN, CM, JP, family medicine/oncology clinics supervisor at Princess Margaret Hospital, Nassau, Bahamas, discussed how the COVID-19 pandemic and recent natural disasters have highlighted how these events uniquely affect women and girls and the vital need to consider gender equity in mitigation measures.


"Disasters are not experienced uniformly by everyone in society. Men and women, boys and girls, people of diverse gender identities are affected differently by disasters, even if they live in the same household," Rolle explained, adding that "the vulnerability and exposure to disaster risks that disproportionately impacts women and girls is economically, socially, and culturally constructed."

Figure. Dyuti Sen, M... - Click to enlarge in new windowFigure. Dyuti Sen, MSc

Effective disaster risk governance, she said, requires the inclusion of women in leadership and decision-making roles and consideration of how gender dynamics influence a disaster's impact, including in terms of sexual and reproductive health and gender-based violence. During the pandemic, she noted, there was an increase in domestic violence. Education and training are vital to disaster risk reduction, Rolle said, as is a gender-responsive crisis preparedness plan. This includes collaborative, ongoing training for health providers and first responders to ensure they have the skills and knowledge to respond effectively to the needs of different populations.



Panelist Dyuti Sen, MSc, regional advisor, Frontline Health Workers Coalition, recalled that during the pandemic there was a shortage of physicians, nurses, and laboratory technicians in rural East India, where she was working. Local governments typically hire men for these roles, she said, but the shortage led them to employ women as well. Women are usually expected to perform unpaid or underpaid work, she explained, while the more technical work is reserved for men.


"Pandemics create opportunities," observed Acorn, offering women a chance to "show they have the knowledge, skills, judgment, and experience during these events of crisis." She emphasized the importance of nurses and health care workers showing evidence of the value they bring to their roles.

Figure. Barbara Stil... - Click to enlarge in new windowFigure. Barbara Stilwell, PhD, RN, FRCN

Panelist Barbara Stilwell, PhD, RN, FRCN, executive director of Nursing Now, the three-year campaign to elevate the status of nursing that ended last year, said data are essential when advocating for change. "We know from research that high levels of occupational segregation in the labor market is associated with stronger tendencies to devalue women's work," she said, while also describing reports of women receiving lower salaries than men despite holding the same position and having the same education and experience.


"The question we need to be asking is, 'What's the big data that's going to help us, as women in the workforce, move ahead?' And that big data has got to be about pay, and it's got to be about effectiveness," said Stilwell. Nurses need to become "much more curious" and "collectors of data," she argued. "The most powerful thing is to tell our stories and back them up with data."


Panelist Kavita Bhatia, PhD, MA, an independent researcher, said women also need to remind men "what they're losing if they don't let us participate equally. It's a matter of statistics. It's a matter of data. It's a matter of the progress of a country, of the globe, that women should be equal participants. Nobody is doing anybody a favor here."



When asked about actions to advance gender equity, panel members had several recommendations. Rolle said it was important to "get women around the decision-making table. Allow them that opportunity."


Stilwell noted that "many nurses are still reporting, particularly women, that they're not comfortable speaking in a big meeting." Her advice to nurses and health care workers? "Do whatever it takes so that you can stand up, give your side of the story, and advocate for women in the health workforce."


Emphasizing the importance of recognition that all work in a health system is payable, Bhatia said, "Get that acknowledged and everything else will follow."


Sen noted the need for greater investment in health care workers and systems. "It's not that there's a lack of funds, or governments or organizations don't have the money," she said. "More actions have to be taken and money has to be put in."


In her remarks, Cipriano observed that the COVID-19 pandemic has both amplified the burdens of women in health care and disrupted the progress that's been made to increase investments in nursing and nurses' visibility as leaders, such as during the International Year of the Nurse and the Midwife and the Nursing Now campaign. She called for renewed efforts to elevate the status and profile of nursing in the health sector, fund leadership development among nurses, and foster access to professional networks and mentoring.


"We need to analyze national pay scales and make sure we have fair and gender-neutral systems of reimbursement to nurses. And we need to enforce zero tolerance policies for gender discrimination and verbal, physical, and sexual harassment," Cipriano asserted. "These gender inequities can be fixed, and an alternative, positive future scenario is possible."



Robalo, who provided the discussion's concluding remarks, described how such a scenario would result in "a triple gender dividend": (1) a health dividend, in which equal opportunities and decent work attract and retain female health workers, helping to fill the global health worker gap; (2) a gender equality dividend, in which women gain more income and decision-making power; and (3) an economic dividend, in which the new jobs created in the health sector fuel economic growth and strengthen health systems and outcomes. All of this contributes to efforts to achieve universal health coverage and the Sustainable Development Goals, she pointed out.


"Gender equity in the health workforce is not a marginal women's issue," Robalo asserted. "It is central to strong health systems and global health security."-Corinne McSpedon, senior editor



The Gender Pay Gap in the Health and Care Sector: A Global Analysis in the Time of COVID-19


Delivered by Women, Led by Men: A Gender and Equity Analysis of the Global Health and Social Workforce


Nurses: A Voice to Lead


Subsidizing Global Health: Women's Unpaid Work in Health Systems




1. World Health Organization. Global strategic directions for nursing and midwifery 2021-2025. Geneva, Switzerland; 2021; [Context Link]


2. World Health Organization. Delivered by women, led by men: a gender and equity analysis of the global health and social workforce. Geneva, Switzerland; 2019. Human resources for health observer series no. 24; [Context Link]