Disrupting gender norms in health systems: making the case for change
Open accessAbstract
Restrictive gender norms and gender inequalities are replicated and reinforced in health systems, contributing to gender inequalities in health. In this Series paper, we explore how to address all three through recognition and then with disruptive solutions. We used intersectional feminist theory to guide our systematic reviews, qualitative case studies based on lived experiences, and quantitative analyses based on cross-sectional and evaluation research. We found that health systems 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 than men and are often devalued and abused. With regard to potential for disruption, we found that gender equality policies are associated with greater representation of female physicians, which in turn is associated with better health outcomes, but that gender parity is insufficient to achieve gender equality. We found 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. Our findings suggest we must view gender as a fundamental factor that predetermines and shapes health systems and outcomes. Without addressing the role of restrictive gender norms and gender inequalities within and outside health systems, we will not reach our collective ambitions of universal health coverage and the Sustainable Development Goals. We propose action to systematically identify and address restrictive gender norms and gender inequalities in health systems.
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Health research and practices can be entangled with sex and gender inequalities and biases.
“Consequently, health research and practices can be entangled with sex and gender inequalities and biases20.”
From Sex and gender differences and biases in artificial intelligence for biomedicine and healthcare (2020) · cites this paper as [20]
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Self-citationAbusive Supervision and Links to Nurse Intentions to Quit
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The gendered health workforce: mixed methods analysis from four fragile and post-conflict contexts
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Psychological entitlement and abusive supervision
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Gupta, J., Falb, K., Ponta, O., Xuan, Z., Campos, P. A., Gomez, A. A., Valades, J., Cariño, G., & Dı́az-Olavarrieta, C. (2017) · BMC Medicine · doi:10.1186/s12916-017-0880-y · Cited by 64 · see citing works
Pattenden, J. (2010) · The Journal of Peasant Studies · doi:10.1080/03066150.2010.494372 · Cited by 63 · see citing works
The importance of gender analysis in research for health systems strengthening
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Mattocks, K. M., Sullivan, J. C., Bertrand, C., Kinney, R. L., Sherman, M. D., & Gustason, C. (2015) · LGBT Health · doi:10.1089/lgbt.2014.0131 · Cited by 57 · see citing works
Organizing Womenas Women: Hybridity and Grassroots Collective Action in the 21stCentury
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Health systems and gender in post-conflict contexts: building back better?
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Kuhlmann, A. S., Galavotti, C., Hastings, P., Narayanan, P., & Saggurti, N. (2013) · AIDS and Behavior · doi:10.1007/s10461-013-0626-6 · Cited by 48 · see citing works
Self-citationShabalala, F. S., Vernooij, E., Pell, C. L., Simelane, N., Masilela, N., Spiegelman, D. L., Chai, B., Khan, S. A., & Reis, R. (2018) · Journal of the International AIDS Society · doi:10.1002/jia2.25120 · Cited by 46 · see citing works
Self-citationThe Structure of social exchange in self-help support groups: Development of a measure
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Gender bias in careseeking practices in 57 low– and middle–income countries
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The global gender gap report 2009
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Self-citationGender imbalance in science journals is still pervasive
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Hasebrook, J. P., Hahnenkamp, K., Bühre, W., Boer, D. D. K., Hamaekers, A. E. W., Metelmann, B., Metelmann, C., Bortul, M., Palmisano, S., Mellin‐Olsen, J., et al. (2017) · JMIR Research Protocols · doi:10.2196/resprot.7632 · Cited by 33 · see citing works
Alcohol and gender gaps in life expectancy in eight Central and Eastern European countries
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Masculinity lost: a systematic review of qualitative research on men with spinal cord injury
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Cultural aspects of caregiver burden in psychiatric disorders
Chakrabarti, S. (2013) · World Journal of Psychiatry · doi:10.5498/wjp.v3.i4.85 · Cited by 29 · see citing works
Gender inequities in curative and preventive health care use among infants in Bihar, India
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Self-citationSridharan, S., Dey, A., Seth, A., et al. (2017) · Global Health Action · doi:10.1080/16549716.2017.1287493 · Cited by 28 · see citing works
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Rethinking the family in the context of care for adolescents living with HIV in Swaziland
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Self-citationHealthy Settings in Hospital – How to Prevent Burnout Syndrome in Nurses: Literature Review
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Five years post Nirbhaya: Critical insights into the status of response to sexual assault
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Female doctors in China: challenges and hopes
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An Assessment of Physician Supervision of Nurse Practitioners
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Analyses confirm effect of women's groups on maternal and newborn deaths
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Expanding health coverage in India: role of microfinance-based self-help groups
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Knowing Your Worth: Salary Expectations and Gender of Matriculating Physician Assistant Students
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A tale of two countries: women’s reproductive rights in Ireland and the US
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Self-citationSelf Help Groups and Women empowerment: Appraisal of Drang Block in Mandi District of HP
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Flagged first, then by citations
Research works printed but not linked: 4
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Cited by
Sorted by citations
Gender inequality and restrictive gender norms: Framing the challenges to health
Heise, L., Greene, M. E., Opper, N., Stavropoulou, M., Harper, C., Nascimento, M., Zewdie, D., Darmstadt, G. L., Greene, M. E., Hawkes, S., et al. (2019) · The Lancet · doi:10.1016/s0140-6736(19)30652-x · Cited by 1,163 · see citing works
Self-citationReport of the Lancet Commission on the Value of Death: Bringing death back into life
Sallnow, L., Smith, R., Ahmedzai, S. H., Bhadelia, A., Chamberlain, C., Cong, Y., Doble, B., Dullie, L., Durie, R., Finkelstein, E. A., et al. (2022) · The Lancet · doi:10.1016/s0140-6736(21)02314-x · Cited by 807 · see citing works
Sex and gender differences and biases in artificial intelligence for biomedicine and healthcare
Cirillo, D., Catuara-Solarz, S., Morey, C., Guney, E., Subirats, L., Mellino, S., Gigante, A., Valencia, A., Rementeria, M. J., Chadha, A. S., et al. (2020) · npj Digital Medicine · doi:10.1038/s41746-020-0288-5 · Cited by 553 · see citing works
Enhancing brain health in the global south through a sex and gender lens
Baez, S., Castro-Aldrete, L., Britton, G. B., Ibañez, A., & Santuccione-Chadha, A. (2024) · Nature Mental Health · doi:10.1038/s44220-024-00339-6 · Cited by 15 · see citing works
- Authors
- Hay, K., McDougal, L., Percival, V., Henry, S., Klugman, J., Wurie, H., Raven, J., Shabalala, F., Fielding-Miller, R., Dey, A., Dehingia, N., Morgan, R., Atmavilas, Y., Saggurti, N., Yore, J., Blokhina, E., Huque, R., Barasa, E., Bhan, N., Kharel, C., Silverman, J. G., Raj, A., Darmstadt, G. L., Greene, M. E., Hawkes, S., Heise, L., Henry, S., Heymann, J., Klugman, J., Levine, R., Raj, A., & Rao Gupta, G.
- Affiliations
- Gates Foundation (US)
- University of California San Diego (US)
- Carleton University (CA)
- University of Sierra Leone (SL)
- Liverpool School of Tropical Medicine (GB)
- University of Eswatini (SZ)
- Sambodhi Research and Communications (IN)
- Johns Hopkins University (US)
- Population Council (IN)
- First Pavlov State Medical University of St. Petersburg (RU)
- ARK Foundation (BD)
- KEMRI-Wellcome Trust Research Programme (KE)
- HERD International (Nepal) (NP)
- Stanford Medicine (US)
- ORCID
- Hay, Katherine
- McDougal, Lotus
- Percival, Valerie
- Wurie, Haja
- Raven, Joanna
- Shabalala, Fortunate
- Fielding-Miller, Rebecca
- Dey, Arnab
- Dehingia, Nabamallika
- Morgan, Rosemary
- Saggurti, Niranjan
- Yore, Jennifer
- Blokhina, Elena
- Huque, Rumana
- Barasa, Edwine
- Bhan, Nandita
- Silverman, Jay G
- Darmstadt, Gary L
- Greene, Margaret Eleanor
- Hawkes, Sarah
- Heise, Lori
- Heymann, Jody
- Venue
- The Lancet
- Publisher
- Elsevier BV
- Published
- 2019-06
- Volume
- 393
- Issue
- 10190
- Pages
- 2535-2549
- ISSN
- 0099-5355 (ISSN-L)
- 0140-6736
- PMC
- PMC7233290
- OpenAlex
- W2947175323
- Cited by
- 442
- References
- 159
- Citations by year
- 2026: 53 · 2025: 94 · 2024: 69 · 2023: 58 · 2022: 46 · 2021: 33 · 2020: 76 · 2019: 12 · 2014: 1
- FWCI
- 6.83
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- The Lancet (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- eScholarship (California Digital Library) (submittedVersion)
- Funders
- Wellcome Trust
- National Institute of Mental Health (K01MH112436)
- National Institute on Minority Health and Health Disparities (L60 MD011114)
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Sex and Gender in Healthcare
- Social Sciences › Sociology and Political Science › Gender, Health, and Social Inequality
- Social Sciences › Gender Studies › Diversity and Career in Medicine
- Keywords
- gender norms, gender inequality in health, health care system, female health workers, gender equality policy, female physicians, gender parity, nurses, women's empowerment, reproductive rights, social movements, intersectional feminism, universal health coverage, Sustainable Development Goals
- MeSH terms
- Female, Humans, Male, Global Health, Occupational Health, Nurse's Role, Healthcare Disparities, Sexism
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