kick-off to the 2023 UN High-Level Meeting (HLM) on UHC, Member States and stakeholders will review progress made on the 2019 HLM’s commitments and set a roadmap to achieve UHC by 2030. We, as the co-convening organizations of the Alliance for Gender Equality and UHC, call on Member States to safeguard gender equality and sexual and reproductive health and rights (SRHR) as part of UHC implementation, especially in light of the gendered impacts of the COVID-19 pandemic.
To move forward, it is crucial to remember our cumulative past promises. In 2019, Member States adopted a Political Declaration that contained strong commitments to ensure universal access to SRHR, including family planning; mainstreaming a gender perspective across health systems; and increasing the meaningful representation, engagement, and empowerment of all women in the health workforce. Further, 58 countries put forward a joint statement that argued that investing in SRHR is affordable, cost-saving, and integral for UHC. These commitments were the result of the advocacy and hard work of civil society organizations, including members of the Alliance for Gender Equality and UHC, and set out a clear path on the steps needed to make gender-responsive UHC a reality.
However, following the 2019 HLM, the deadly and devastating COVID-19 pandemic drastically changed how individuals around the globe could access essential health services. Fundamental human rights, including hard-won gains made for UHC, SRHR, and gender equality, are now at risk as health and social services are strained and political attention is diverted. The protracted pandemic underscores how gender-responsive UHC is more important than ever.
We call on Member States to renew the commitments made in 2019 and affirm that delivering on the promise of health for all is only possible by way of gender-responsive UHC.
To truly deliver gender-responsive UHC, we offer the following five recommendations:
1. Design policies and programs with an intersectional lens that places SRHR and girls and women — in all their diversity — at the center of UHC design and implementation. To be effective, UHC must recognize and respond to the needs of women in all their intersecting identities, including by explicitly addressing the ways in which race, ethnicity, age, ability, migrant status, gender identity, sexual orientation, class, and caste multiply risk and impact health outcomes. What’s more, COVID-19 has deepened inequalities for marginalized populations, and special attention is needed, now more than ever, to deliver UHC for those pushed furthest behind.
2. Ensure UHC includes comprehensive SRH services, and provide access to SRH services for all individuals throughout the life course. These services must be free of stigma, discrimination, coercion, and violence, and they must be integrated, high quality, affordable, accessible, and acceptable. The World Health Organization (WHO) provides guidance in the UHC Compendium of interventions and supporting documents for what this can look like. The pandemic has given way to multiple interruptions to SRHR care. For example, an estimated 12 million women may have been unable to access family planning services due to the pandemic. COVID-19 response and recovery and UHC implementation must address these issues.
3. Prioritize, collect, and utilize disaggregated data, especially gender-disaggregated data. UHC policy and planning can only be gender-responsive when informed by data that are disaggregated by gender and other social characteristics. In the current pandemic, not all countries are reporting disaggregated data on infections and mortality from COVID-19 to the WHO, and most countries have not implemented a gendered policy response. In June 2021, only 50% of 199 countries reported data disaggregated by sex on COVID-19 infections and/or deaths in the previous month.1 The number of countries reporting sex-disaggregated statistics has also decreased over the course of the pandemic. Without this information, decision-makers are unable to base policies on evidence affirming how to address the health needs of all genders — a critical lesson for UHC.
4. Foster gender equality in the health and care workforce and catalyze women’s leadership. The approach to the health and care workforce in the pandemic has frequently not applied a gender lens, ignoring the fact that women are 70% of the global health workforce and powerful drivers of health services. Gender inequities in the health workforce were present long before the pandemic, with the majority of female health workers in lower-status, low-paid roles and sectors, often in insecure conditions and facing harassment on a regular basis. Moreover, although women have played a critical role in the pandemic response — from vaccine design to health service delivery — they have been marginalized in leadership on pandemic decision-making from parliamentary to community levels. In fact, 85% of national COVID-19 task forces have majority male membership. Urgent investment in safe, decent, and equal work for women health workers, as well as equal footing for women in leadership and decision-making roles, must be central to the delivery of UHC.
5. Back commitments to advancing SRHR, gender equality, and civil society engagement in UHC design and implementation with necessary funding and accountability. Now is the time to invest in health and the care economy, particularly in UHC. Governments everywhere are facing fiscal constraints from the pandemic. UHC is a critical part of investing in and building back resilient health and social systems to avoid catastrophic spending on future pandemics and global health emergencies. UHC must be designed intentionally, with appropriate accountability mechanisms, to reduce inequalities between and within countries — and especially gender inequality, which undermines social and economic rights and resilience.
We, along with our civil society partners in the Alliance for Gender Equality and UHC, stand ready to work hand-in-hand with governments, the UN, and all stakeholders to act on these recommendations on the road to the 2023 HLM on UHC. At this point in the COVID-19 pandemic, there is no time to waste in making the promise of health for all a reality, and this can only be achieved through gender-responsive UHC that centers gender equality and SRHR.
The authors are Ann Keeling of Women in Global Health, Divya Mathew of Women Deliver, Deepa Venkatachalam of Sama Resource Group for Women and Health, and Chantal Umuhoza of Spectra Rwanda. These four organizations are the co-conveners of the Alliance for Gender Equality and Universal Health Coverage.