to start up At the 2023 United Nations High Level Meeting (HLM) on UHC, Member States and stakeholders will review progress against the 2019 HLM commitments and establish a roadmap to achieve UHC by 2030. We, as co-organizing organizations of the Alliance for Gender Equality and UHC, call on member states to protect gender equality and sexual and reproductive health and rights (SRHR) as part of UHC implementation, especially in light of the gender impacts of the COVID pandemic- 19.
To move forward, it is crucial to remember our cumulative past promises. In 2019, Member States adopted a Political declaration which contained strong commitments to ensure universal access to SRHR, including family planning; the integration of a gender perspective in health systems; and increase the meaningful representation, engagement and empowerment of all women in the health workforce. In addition, 58 countries have proposed a joint statement who argued that investing in SRHR is affordable, economical and comprehensive for UHC. These commitments are the result of advocacy and hard work by civil society organizations, including members of the Alliance for Gender Equality and UHC, and have charted a clear path on the steps needed to make of gender-sensitive UHC a reality.
However, following the 2019 NHN, the deadly and devastating COVID-19 pandemic drastically changed the way people around the world could access essential health services. Basic human rights, including hard-won gains for UHC, SRHR and gender equality, are now under threat as health and social services are strained and political attention is diverted. The protracted pandemic underscores how more important gender-sensitive UHC is 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 through gender-sensitive UHC.
To deliver truly gender-sensitive 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 of their intersecting identities, including explicitly addressing the ways in which race, ethnicity, age, ability, migrant status, gender identity, sexual orientation, class and caste are multiplying. risk and impact on health. Additionally, COVID-19 has widened inequalities for marginalized populations, and special attention is needed, now more than ever, to deliver UHC to those furthest behind.
2. Ensure that UHC includes comprehensive SRH services and provide lifelong access to SRH services for all individuals. These services must be free from stigma, discrimination, coercion and violence, and they must be integrated, of high quality, affordable, accessible and acceptable. The World Health Organization (WHO) advises on the Compendium of UHC Interventions and supporting documents for what it might look like. The pandemic has given way to multiple interruptions in SRHR care. For example, an estimate 12 million women may not have been able to access family planning services due to pandemic. The response and recovery from COVID-19 and the implementation of UHC must address these issues.
3. Prioritize, collect and use disaggregated data, especially data disaggregated by sex. UHC policy and planning can only be gender sensitive when informed by data disaggregated by sex and other social characteristics. In the current pandemic, not all countries are reporting disaggregated data on COVID-19 infections and mortality to WHO, and most countries have not implemented a gender-sensitive policy response. In June 2021, only 50% of 199 countries reported sex-disaggregated data on infections and / or deaths from COVID-19 in the previous month.1 The number of countries reporting statistics disaggregated by sex has also declined during the pandemic. Without this information, policymakers are unable to base their policies on evidence of how to meet the health needs of all genders – a critical lesson for UHC.
4. Promote gender equality in the health and care workforce and catalyze women’s leadership. The health workforce and health workforce approach in the pandemic has often failed to apply a gender lens, ignoring the fact that women make up 70% of the global health workforce and powerful drivers of health services. Gender inequalities in health workers were present long before the pandemic, with the majority of women health workers in lower status and low-paid roles and sectors, often in precarious conditions and facing harassment on a regular basis. Additionally, although women have played a critical role in the pandemic response – from vaccine design to health service delivery – they have been marginalized in the leadership of pandemic decision-making, from parliamentary level to community level. In reality, 85% of national COVID-19 working groups are predominantly made up of men. Urgent investment in safe, decent and equal work for women health workers, as well as an equal footing for women in leadership and decision-making roles, must be at the heart of delivering UHC .
5. Support commitments to advance SRHR, gender equality and civil society engagement in the design and implementation of UHC with the necessary funding and accountability. Now is the time to invest in health and the care economy, especially UHC. Governments everywhere are facing budgetary constraints linked to the pandemic. UHC is a critical part of investing in and rebuilding resilient health and social systems to avoid catastrophic spending in future pandemics and global health emergencies. UHC must be designed intentionally, with appropriate accountability mechanisms, to reduce inequalities between and within countries – and in particular gender inequalities, which undermine social and economic rights and resilience.
We, along with our civil society partners from the Alliance for Gender Equality and UHC, stand ready to work hand-in-hand with governments, the United Nations and all stakeholders to act on these recommendations. on track to RHN 2023 on CSU. 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 a gender-sensitive UHC that puts focus on gender equality and SRHR.
The authors are Ann Keeling of Women in global health, Divya Mathieu from Women deliver, Deepa Venkatachalam from Sama Resource Group for Women and Health, and Chantal Umuhoza from Spectra Rwanda. These four organizations are the co-organizers of the Alliance for Gender Equality and Universal Health Coverage.