Her health, our wealth

This International Women’s Day, we the co-chairs of UHC2030 emphasize the urgent need to address gender disparities in health systems. Too many women and girls are still dying from preventable causes due to limited access to essential health services, particularly in low- and middle-income countries. Universal health coverage (UHC) cannot be achieved unless gender equality is placed at the core of health policies and systems. Improving financial protection to guarantee access to an affordable package of quality health services is critical to this effort. At a time when hard-won gains for women’s rights to health are under threat, we must heighten our commitment to ensuring financial protection, so women and girls are not left or pushed behind.

When populations are healthy, economies prosper. Each year of life expectancy gained across populations raises GDP by approximately 4%. When women are excluded from accessible, affordable, and quality healthcare, workforce participation declines, productivity suffers, and long-term economic growth slows. By prioritizing financial protection for women’s health, we unlock the potential of entire communities, drive inclusive and long-term economic growth, improve health and well-being for people of all genders, and promote sustainable development.

Currently, around 4.5 billion people lack access to essential health services. Moreover, 2 billion people are experiencing financial hardship due to health expenses which they must pay out of their own pockets – with 344 million being pushed even further into extreme poverty as a result. In 30 low- and lower-middle-income countries, out-of-pocket expenses remain the primary funding source for health.

Women, girls and marginalized communities are bearing the greatest burden – facing significant barriers to both health services and financial protection. These inequities are further exacerbated in fragile, conflict-affected and emergency settings, where disruptions in health systems limit access to essential care. Alarmingly, the UHC2030 State of UHC Commitment review confirms that UHC processes remain gender-blind, failing to consider the unique health needs of women and girls.

Health financing mechanisms continue to fail women, girls and marginalized communities. Women and girls shoulder, on average, a higher burden of out-of-pocket health expenses for health services than men, largely due to a lack of or insufficient coverage for sexual and reproductive health services and maternal health care. Many women also lack access to employer-based insurance due to informal or unpaid health care work. Meanwhile, effective social protection coverage for mothers with newborns remains low, covering only 44.9% of the group worldwide.

While financial protection is vital for equitable access to quality health care, addressing systemic gender inequalities across leadership and governance, service delivery, health workforce, information systems, and access to essential medicines and health products, is equally critical. Despite making up 67% of the global health workforce, women are undervalued, underpaid, overburdened by unpaid care work, and disproportionately hold only 25% of leadership roles in health governance. This lack of representation leads to policies that fail to meet the full spectrum of health needs. Additionally, gaps in gender-disaggregated data and gender-sensitive health research reinforce disparities. Only 42% of the necessary sex-disaggregated data for the SDGs is available, making it difficult for governments to design effective policies. Women remain misdiagnosed and underrepresented in clinical trials, limiting knowledge on drug efficacy and access to essential medicines. Political barriers, stigma, and legal restrictions further hinder inclusive data collection and gender-responsive health policies.

Health systems that are not gender-responsive will fail. To ensure UHC benefits everyone, governments and global health leaders must take decisive action by:

• Ensuring equal representation in leadership, governance and research, so policies reflect the realities of women and vulnerable groups.
• Designing health services that address gender-specific barriers, ensuring full access to essential care, including reproductive and maternal health, across the life cycle.
• Recognizing and addressing gender disparities in the health workforce, closing the gender pay gap, and valuing unpaid care work.
• Strengthening data systems to ensure sex- and gender-disaggregated data inform health policies.
• Applying a gender lens to health research and development, so medicines and health products are accessible and effective for all.
• Implementing equitable health financing models, reducing or eliminating out-of-pocket costs that disproportionately affect women.

When adopting the 2023 UN Political Declaration on UHC, UN Member States acknowledged that gender-responsive health systems are essential to achieving equitable health outcomes. However, commitments alone are not enough. Systematic change, investment and accountability are required to translate promises into action.

To accelerate action towards gender equality, governments must allocate adequate resources, implement policies that address gender disparities, and create mechanisms for transparency and accountability in the push for equitable health systems. By investing in UHC, which entails financial protection for health, we can address health inequalities while ensuring that no one is left behind or pushed further into poverty due to out-of-pocket health costs.