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Subsidizing global health: Women’s unpaid work in health systems
by Ann Keeling
Women in Global Health
 
July 2022
 
Woman health workers are the backbone of medical care across much of the world, so why are they treated so poorly, asks Ann Keeling a Senior Fellow at Women in Global Health.
 
The Lancet Commission on Women and Health in 2015 estimated that women contribute $3 trillion to global health annually, half in the form of unpaid work.
 
During the pandemic, stories surfaced of women community health workers forming the critical frontline of global health security, going door-to-door tracing contacts, informing communities, often without adequate personal protective equipment and often unpaid.
 
It was the right time to ask who these women were, how many there were and why women from low-income families with already heavy work burdens, added unpaid health work to their busy days?
 
In a report just published by Women in Global Health, “Subsidizing Global Health”, we calculated that upwards of six million women are working unpaid and grossly underpaid - often as ”volunteers” - to prop up health systems worldwide.
 
This is the first time a figure like this has been calculated, and we were conservative in our estimate. Not all countries include frontline community health workers in their formal workforce or labor market statistics, even though they are delivering core health services.
 
In interviews, we found that women worked for now pay for a mixture of reasons. Though they were proud to carry out voluntary work, and were positive about the benefits to the community, it came at a personal cost.
 
For women from low-income families and with low levels of education, unpaid work was an opportunity that might lead to some paid work or an asset like a mobile phone or bicycle. Unpaid work in health can also bring women social recognition and in many contexts, it is seen as “honorable work” that families will approve of for a woman.
 
Our research showed that for others, it offered passage out of the home to freely move about for a positive purpose, an opportunity to learn, and also to achieve personal and professional rewards.
 
The bottom line, however, is that women do this work because are backed into a gendered corner, with their choices constrained simply by being women. Men have greater mobility and more options. And, although many women benefit in ways and would choose to continue doing this work, they want to be fairly paid and recognised.
 
BASIC MEASURES
 
“Subsidizing health systems” sets out recommendations to governments and policymakers to help address the problems faced by more than six million women.
 
First, we ask that the numbers of unpaid and underpaid workers are counted, both male and female. Once official numbers are known to health ministries, then the process of moving them from the informal into the formal health workforce can begin.
 
Next, we ask that proper working conditions with adequate pay are provided. This includes proper renumeration, adequate worker protection and the introduction of standards on a par with those working in the formal sector, such as paid holidays, maternity leave and workplaces free from sexual abuse and harassment.
 
Introducing basic policy measures to address inequities in the workforce would mean that women, their families, and whole communities would benefit from the shared economic dividends that would trickle down to lift whole communities out of poverty.
 
Formalising the informal workforce is not just economically sound, it is our moral duty. Taking advantage of women’s poverty, their lack of opportunity in male-dominated societies, particularly in low income countries, is not sound policy for the sustainability of resilient health systems.
 
Morale is at an all-time low in the health sector, as proven by the so-called “great resignation” of health workers in high-income countries. The projected shortfall in the health workforce of 18 million should be cause enough to cause alarm.
 
Women working without pay are creating social and economic value that is uncounted, unrecorded, and unrewarded. When we start to address this problem, we can address the inadequacies of global health systems, we can address the problems facing a burnt out, demoralised health workforce that lacks not just the viability to face future country-wide health crises, but also global pandemics.
 
* Women are 70% of the global health workforce and 90% of health workers in patient-facing roles.
 
http://womeningh.org/our-advocacy/paywomen/


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150 million more women than men were hungry in 2021
by CARE International
 
CARE Analysis : 150 million more women than men were hungry in 2021
 
An analysis by humanitarian organisation CARE highlights, for the first time, a global link between gender inequality and food insecurity. Analysing data from 2021, the report shows that across 109 countries, as gender inequality goes up, food security goes down.
 
Christine Campeau, CARE’s Global Advocacy Director – Food Systems, said, “Between 2018 and 2021, the number of hungry women versus hungry men grew 8.4 times, with a staggering 150 million more women than men hungry in 2021. And the implications of the escalation of conflict in Ukraine will make the situation even worse for women, who play a crucial role across food systems and in feeding their families and communities. Gender equality is highly connected to food and nutrition security at a local, national, and global level. To put it simply, the more gender inequality there is in a country, the hungrier and more malnourished people are.”
 
Of the four major global datasets on gender, including the World Bank’s Gender Data Portal, the only sex disaggregated food indicators reinforce women’s role solely for their importance in reproduction: measuring anemia in women of childbearing age and counting stunting for children.
 
Most food security datasets are strangely silent on gender. And, despite women being responsible for 90% of preparing and buying food, they are eating last and least.
 
Even when both men and women are technically food insecure, women often bear bigger burdens. For example, in Somalia, while men report eating smaller meals, women report skipping meals altogether.
 
Aisha, who lives in a village in eastern Somalia said, “I don’t remember how old I really am, the drought has affected me mentally and physically so much that I can’t remember. Most days we don’t get anything to eat, other days we eat one meal.”
 
In the World Bank Gender Data Portal on food and women, the only sex disaggregated food data is related to the number of women who believe, or do not believe, that a husband is justified in beating his wife when she burns the food.
 
Ms Campeau said, “As women keep feeding the world, we must give them the right space in our data collection methods and analysis to make the gaps they encounter visible and work with women themselves to find solutions to those gaps. Global datasets should be publishing sex disaggregated data on food—whether the focus is on gender or on food.
 
It is time to update our global understanding of food security and gender inequality, and, local actors, including women’s organisations in crisis-affected communities, need to get the flexible funding and support desperately needed to protect women and girls from hunger-associated gender-based-violence and protection risks.”
 
http://www.care.org/news-and-stories/press-releases/care-analysis-150-million-more-women-than-men-were-hungry-in-2021/ http://www.care-international.org/resources/hunger-response-policies-continue-ignore-gender http://www.care-international.org/resources/food-security-and-gender-equality


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