Disrupting gender norms in health systems

Restrictive gender norms and gender inequalities are replicated and reinforced in health systems, contributing to gender inequalities in health. We explore how to address all three, first through recognition, and then with disruptive solutions. We used intersectional feminist theory to guide our systematic reviews, qualitative case based on lived experiences, and quantitative analyses based on cross-sectional and evaluation research. We found that: systems of healthcare delivery reinforce patients’ traditional gender roles and neglect gender inequalities in health; health system models and clinic-based programmes are rarely gender responsive; and women have less authority as health workers, relative to men, and are often devalued and abused. In looking at the potential for disruption, we found that gender equality policies are associated with higher representation of women physicians, and higher representation of women physicians is associated with better health outcomes, but that gender parity is not sufficient to achieve gender equality. We found indications that institutional support and respect of nurses improves quality of care, and that women’s empowerment collectives can increase health care access and provider responsiveness. We see promise from social movements in supporting women’s reproductive rights and policies. Combined, our findings suggest we must go beyond seeing gender as code for ‘women and girls,’ and as an ‘add on’, but rather, as a fundamental factor that predetermines and shapes health systems and outcomes. Without intentionally addressing the role of restrictive gender norms and gender inequalities both within and outside of the health system, we will not reach our collective ambitions of Universal Health Coverage, and the Sustainable Development Goals more broadly. We propose action to systematically identify and address restrictive gender norms and gender inequalities in health systems.