Sector Overview
Gender-related power imbalances limit women’s and girls’ health decision-making and their access to and use of health services, contributing to excess female morbidity and mortality. Men and boys also experience health inequities, such as higher rates of tuberculosis and gender-related disincentives to utilize health services. Harmful gender norms affect men and boys by encouraging risk-taking and limiting health-seeking behaviors. Norms that sanction gender inequalities and GBV increase risks for early pregnancy, childbirth complications, maternal mortality, transmission of HIV and other sexually transmitted infections, and poor mental health outcomes. These and other challenges persist and worsen the health and well-being of women and girls, men and boys, LGBTQI+ individuals, persons with disabilities, Indigenous populations, and families across the life course.
Subsectors
Family Planning and Reproductive Health (FP/RH)
Internationally agreed principles established at the 1994 International Conference on Population and Development have centered sexual and reproductive health (SRH) programming, including voluntary family planning, on the rights of individuals and couples to decide their family size and avoid unintended pregnancies. Access to voluntary family planning reduces maternal mortality and improves women’s and young people’s opportunities for education, employment, and full participation in society. The broad benefits of family planning and reproductive health services enable advancements in health, economic well being, human rights, and civic and political participation. Despite significant improvements, some 218 million women worldwide would like to avoid pregnancy but are not using a modern contraceptive method, which may lead to unintended pregnancy, unsafe abortion, delayed antenatal care, and poor pregnancy outcomes. Inequitable gender and power dynamics limit women’s and girls’ access to high quality, voluntary FP/RH information and services and their agency to decide whether and when to have sex, with whom, and/or whether and when to have children and how many. Harmful gender norms and GBV can also limit couples’ communication and cooperative decision-making. Furthermore, approximately 12 million girls aged 15–19 give birth each year in developing regions, and many lack decision-making agency around the conditions of marriage, contraceptive use, or the timing of pregnancy and access to voluntary, high-quality family planning services.
Gendered barriers also prevent men from using and/or supporting women’s use of contraception. Negative attitudes rooted in perceptions about men’s and boys’ role in reproductive health can also prevent men from seeking and receiving full care. In these ways, inequitable gender norms act as barriers to men and boys supporting their partners’ reproductive goals. Using rights-based and developmentally appropriate approaches to address gendered barriers across the life course helps to promote safe, healthy, and equitable relationships; ensure access to high-quality voluntary family planning services; and support all individuals to make and act on informed choices about their reproductive lives without fear or violence.
Maternal and Child Health
Inequality between women and men contributes to increased levels of female morbidity and mortality across the lifespan. Adolescent pregnancy, especially among very young adolescents, is associated with significant risks for both mother and child. Women who experience intimate partner violence in pregnancy are 16 percent more likely to suffer a miscarriage and 41 percent more likely to have a preterm birth, and are more likely to experience depression and anxiety disorders. Injuries from sexual violence, including labor and delivery complications, can contribute to reproductive tract fistulas, which profoundly undermine a woman’s health, well-being, employment, education, and social status. In addition, disparities persist in maternal health: specifically, unsafe abortion remains one of the leading causes of maternal morbidity and mortality globally.
Nutrition
The nutrition and food security needs of women and children are often neglected at the household level because of social, cultural, and economic inequalities between men and women. Women are more likely than men to be affected by hunger. In societies that favor sons, girl children receive less or lower-quality food. Some countries hold traditions in which women eat last, after all the male members and children have been fed. Women are more likely to suffer from nutritional deficiencies than men, due in part to low social status and inequalities in income and education. Burden of household work and other sociocultural disparities can also increase women’s chances of being malnourished. Worldwide, 50 percent of pregnant women are anemic, and at least 120 million women are underweight, which is associated with increased risk of illness or death.
HIV/AIDS
Structural barriers to HIV epidemic control are rooted in gender inequality, unequal power relations, and unrelenting stigma and discrimination. Adolescent girls and young women face an increased vulnerability for HIV acquisition when compared to their peers; globally, there are 20 million women living with HIV, and young women ages 15-24 are two to 14 times as likely to acquire HIV than males of the same age. Boys and men are less likely than girls and women to know their HIV status, initiate or remain on lifelong treatment, or attain viral suppression. Additionally, members of key populations and gender and sexual minorities, including LGBTQI+ individuals, experience high levels of gender-related stigma, discrimination, and violence that affects HIV outcomes. Research has shown that exposure to, or perpetration of, violence is a proximate determinant of HIV acquisition and transmission, and exposure to GBV, particularly intimate partner violence, is associated with lower use of antiretroviral therapy; 50 percent lower odds of self-reported adherence to treatment; and significantly worsened viral suppression among women. Holding gender-inequitable beliefs—particularly norms sanctioning violence against and control of women—decreases the odds of antiretroviral therapy use among people living with HIV. Advancing gender equality and ending GBV, including violence against children, is essential to achieving sustained HIV epidemic control.
Infectious Diseases and Pandemics
Biological differences between males and females affect vulnerabilities to infectious diseases; for example, pregnancy increases the risk for morbidity and mortality associated with malaria and zika. Cultural and societal gender norms surrounding workplace and caregiving roles have a differential impact on the transmission of Ebola and Neglected Tropical Diseases. The impact of stigma-related barriers associated with tuberculosis diagnosis also differs between men and women because of their effects on health-seeking and treatment-retention outcomes. During pandemics, as seen with COVID-19, women can experience exacerbated inequalities, job losses, economic stress, GBV, and unmet health care needs.
Health Systems and the Health Workforce
For health systems to remain responsive and effective, they must evolve to ensure equitable access to respectful, client-centered health care for all people. This includes addressing restrictive gender norms and inequalities within the health system and tackling systemic barriers blocking full participation of women in the health workforce and addressing the specific health needs of LGBTQI+ communities. This includes expanding pathways to formality and professionalization of informal health cadres, including community health workers key to advancing health goals and women’s economic security.
Globally, women comprise up to 70 percent of frontline workers in formal and informal health care delivery. Therefore, women are disproportionately at risk of exposure and the deleterious effects of shortages of sanitary medical supplies, personal protective equipment, hygiene supplies and facilities, and livelihood support for health care workers. Women health workers carry a high burden of unpaid work and face safety concerns including harassment, GBV, and other gender-related barriers that negatively affect the workforce and service quality. Addressing GBV and discrimination through worker protections paves the way for leadership opportunities and career advancement among women.
Promising Approaches
- Implement transformative social and behavior change (SBC) and service delivery interventions that engage women, men, and gender-diverse individuals in mutually reinforcing ways to shift inequitable gender norms, increase health decision-making agency, and encourage healthy behaviors.
- Strengthen health services to provide integrated, client-centered, respectful, gender-affirming, and high-quality care.
- Enhance the health workforce through gender-equitable decent work, fair remuneration, and workplace safety from abuse and other forms of violence.
- Prevent and respond to GBV and violence against children within households and communities.
- Promote and support health-related laws, policies, and accountability mechanisms to advance gender equality and reduce violence within communities and institutions.
