Changing the agenda: A women-first approach to health and social justice
In the ever-evolving landscape of global health, two crucial aspects often overlooked are how gender plays out in care-giving and in decision-making.
In the context of World Social Justice Day on February 20, I have tried to unknot this conundrum: gender justice lies at the foundation of health justice which lies at the foundation of social justice. Are we doing enough in either of the first two spaces to win the fight ahead in the third?
It should be no surprise to anyone that periods, pregnancy and childbirth aside, the mere fact of being a woman has profound consequences for one’s health. In a country such as South Africa (as with so many other countries worldwide) gendered power dynamics, status and societal roles are key to a woman’s care-seeking behaviour, her experience of care and health outcomes.
Before a woman even reaches a facility, factors such as education, economic power and traditional roles mean that there is a high likelihood that she has avoided essential care she should have had earlier in her health journey and her diagnosis, when given, will be late.
And while we would love to think that the gender barrier ends there, studies have shown that bias is pervasive in clinical care. This results in knowledge gaps regarding the presentation and treatment of health conditions in women compared to men because healthcare workers, regardless of gender, are more familiar with how they present symptomatically in men and with treatment protocols for the male body.
And it doesn’t end there. When it comes to medical research, scientific bias is towards males to the extent that research into female health is all but neglected. Distressingly, this manifests in the serious abuse and neglect of women at every stage in the healthcare system due to the dismissal of their concerns.
A prime and anger-inducing example is the medical studies into how male partners are impacted by the debilitating gynaecological condition endometriosis.
Endometriosis is an often misdiagnosed condition that affects approximately 10% of women (although this is probably an underestimate). Treatment is symptomatic and there is no cure.
Regularly, patients report that their symptoms are dismissed at various stages in the healthcare system before they finally receive a diagnosis. This is something I relate to from personal experience. I was diagnosed with endometriosis at the age of 32 after 20 years of misdiagnoses.
Surely a better focus for research funding would be improving diagnostics and treatment for endometriosis sufferers? Given the uproar over the studies that prioritise the wellbeing of men over the women who directly suffer due to the condition, it appears I am not the only person to think so.
While this anger in no way negates the need for holistic approaches to health conditions and an understanding of the impact of health and disease on support systems, the prioritisation of men in conditions primarily impacting women, that are still so poorly understood in how they impact women, warrants closer scrutiny.
Which brings me to my current workspace — global policy and advocacy. In recent meetings about North-South health collaboration, it was impossible not to notice that the Global North team members were predominantly white men, while those from the Global South were predominantly women of colour.
While women make up a significant portion of the health workforce, again due to predominant narratives around nurturing and care-giving, this proportionality diminishes in management and leadership positions.
Out of the 66% of women occupying entry-level roles, less than half progress to C-Suite level. Why? Again — periods, pregnancy and childbirth, as well as gendered power dynamics, status and societal roles. This time, coalescing in the lack of workplace policies for women and biased hiring and employment practices.
Why should we care? Because in order to ensure social justice, we need the very people we’re making decisions for to start being represented in decision-making spaces. In South Africa’s healthcare system, these are the frontline health workers in primary healthcare spaces. We need to be turning to them for realistic ideas on how women’s health should be addressed.
It is these women healthcare workers who will advocate for the endometriosis sufferer over, or alongside, their partner. And who will understand the intersectional complexity of being a woman — whether in need or in charge.
The clock is ticking. Addressing gender inequities in South Africa’s health system is not just about justice; it’s about saving lives and shaping a healthier future. And if we cannot ensure that women are adequately represented in a female-dominated field, what hope do we have for other sectors?
Dr Atiya Mosam is an independent public health medical specialist with experience in health system strengthening initiatives from national policy development to health management and implementation of interventions. She is also an honorary lecturer at the University of the Witwatersrand’s School of Public Health; chair of the InterAcademy Partnership Young Physician Leaders Alumni Committee and a member of the World Health Organisation’s Roadmap for the Public Health and Emergency Workforce.