EDEHN

Auteur.e.s

• Hélène Maisonnave
• Luis Escalante
• Claudia Abreu Lopes
• Pascale Allotey
• Margaret Chitiga
• Martin Henseler
• Ramos Emanuel Mabugu
• Michelle Remme
• Alexandra Solomon
• Lavanya Vijayasingham
  WELL-ESTABLISHED GENDER-RELATED BARRIERS AND INEQUITIES IN HEALTH ACCESS AND DELIVERY REMAIN UNRESOLVED
  Women are both providers and users of health within healthcare systems, but gender-re- lated barriers and inequalities influence their work and access to health resources. For in- stance, women generally have greater healthcare needs over their life course. Yet they often have fewer resources and less agency to pay for healthcare, including indirect costs such as travel even when services are free or subsidized (Witter et al., 2017a ; Vijayasingham et al., 2020). Women can also have less autonomy to make decisions about their health and the related use of their income or household resources. Even within health systems, women tend to do more unpaid or undervalued care work, receiving lower remuneration and less employment protection, which affects their healthcare access. Additionally, multiple intersecting forms of structural marginalization : race/ethnicity, indigeneity, socio-economic and migration status, age, disability or pre-existing conditions and sexual orientation amplify these challenges.
  Yet action on the gender-related barriers in access to and delivery of healthcare services is fragmented and poorly addressed at systemic and structural levels (Levy et al., 2020), largely ignoring, maintaining or building upon existing, inherently inequitable gender dynamics (Morgan et al., 2018 ; World Health Organization, 2019a).
  The COVID-19 pandemic has exacerbated gender-related circumstances. Gaps in data systems have led to the invisibility of real-time impacts. There has been a reliance on anecdotal and advocacy-based messaging in shaping the programme and policy response. Women continue to be largely excluded from leadership, decision-making and policy-shaping discussions.
  Disruptions in access to essential health services, such as sexual and reproductive health (SRH) services, have jeopardized global achievements in improving development indicators and closing gender inequality gaps (World Health Organization, 2020). Recent reviews out- line an increase in unmet need for contraception, unwanted and teenage pregnancies, and worsening mental health, maternal outcomes and infant mortality, particularly in low re- source settings (UNDP, 2020 ; Chmielewska et al., 2021 ; UNFPA, 2021). The COVID-19 response has also led to a disproportionate increase in women’s unpaid care work, employment loss and safety concerns within the home (Roesch et al., 2020 ; United Nations, 2020).