Gender justice and health equity are inextricably linked but are programmes linked ?

Shobha Shukla *

The Lancet Commission on Gender and Global Health launched a new report in April 2025 on "achieving gender justice for global health equity" in Delhi, India. The report reflects how a lack of understanding of the link between gender and health is negatively affecting health outcomes.

The report makes a very valid point that achieving gender justice in global health encompasses the realisation of universal rights in relation to health equity and gender equality, while also addressing the drivers of gender-based discrimination and exclusion. This would improve health outcomes, reduce health inequities, and ensure more inclusive and equitable global health workplaces and workforce governance for all people. This also happens to be a core focus of SHE & Rights (Sexual Health with Equity & Rights) initiative.

But despite promises made by our governments to deliver on both, gender equality and health, progress is off track: "We are not on track to realise the right to health and gender equality. Despite committing to Agenda 2030 with a common vision and work plan, we are not doing well on delivering on the promises of UN Sustainable Development Goals,” said Dr Tlaleng Mofokeng, the United Nations Special Rapporteur on the Right to Health in a SHE & Rights session hosted last month.

The Lancet Commission report comes at a very timely moment - right on the heels of the recently concluded 69th United Nations Commission on the Status of Women (CSW69), and ahead of the UN High-Level Political Forum on Sustainable Development (HLPF 2025). Sustainable Development Goal 3 (Good Health and Well-being) and Goal 5 (Gender Equality) will be under review at HLPF 2025.

The Lancet Commission report also alerts us to the rising tide of anti-gender rhetoric and rollback of gender rights which is impacting health policies and gender equity.

Gender misunderstandings have resulted in unequal health outcomes

Indrani Gupta, one of the commissioners of The Lancet Commission on Gender and Global Health, and Head of the Health Policy Research Unit, Institute of Economic Growth, said at the report launch: "Misunderstandings of gender have contributed to unequal health outcomes and we urgently need to tackle the gap in research, ideas and action on gender in global health. In India we have to guard against any backsliding in the progress we have made in understanding gender and health, especially in the context of a global wave towards an anti-gender view of the world."

Three main biases in relation to gender exist even in the global health sector, that have resulted in misdirected actions. These are:
- Gender and sex can be used interchangeably. While sex and gender can influence each other in various ways, they are not interchangeable terms;
- Gender relates only to women and girls. Health policy makers often use gender as shorthand for talking about women and girls rather than gender as a relational construct;
- Gender has little effect on most health outcomes. The global health community tends to overlook the role of gender in health outcomes, except in relation to the sexual and reproductive health of women and girls. However gender affects health outcomes across a broad range of conditions, including infectious diseases, non-communicable diseases, mental health disorders, and injuries.

Gender diversity and intersectionality

A noted activist and writer Farah Naqvi, sums this up succinctly: the International Conference on Population and Development (ICPD) in 1994 (and its Programme of Action) which was followed closely by the Beijing Declaration 1995 (and its Platform for Action which were adopted at 4th World Conference on Women), are landmark documents that outline a comprehensive agenda for women's empowerment and gender equality.

Farah added that ICPD 1994 followed closely by Beijing Declaration 1995 gave a new traction to the phrase "gender equality." And policymakers adopted it, not because they understood the potential depth of this term, but because it had become the language of international currency. In India (perhaps in other countries too) gender became a mere synonym for woman. It signified nothing else. Women and development became gender and development; women's equality became gender equality, justice for women, became gender justice; budgeting for women, became gender budgeting. It was a change of a term, but it did not carry any deeper meaning forward.

“When you are asked about gender diversity in your workplaces, for the most part it meant how many women do you employ. That is what gender diversity is perceived as. So in terms of policies (including for education and health), representation and inclusion were turned into bodily presence. Basically, we brought in more women and girls. But a gender lens is not about an add-on to an existing template of policy or programme. It means a discussion on how do women - as gendered beings with cultural histories of educational denial - learn? How do girls who have been told to shut up being visible and not have an opinion, learn to express themselves?”

“Intersectionality is about multiple and overlapping axes of exclusion, marginalisation and subordination. It is not something you can either add on or separate. We cannot extricate the health or the educational needs of, say Dalit girls and Muslim girls from the health needs of the entire community of girls. Intersectionality does not intensify gender exclusion, which is how people normally perceive it. Being a Muslim (or a Dalit) woman is not a hyphenated identity. It's not woman, plus Muslim. It is an entirely new subject and it needs to be addressed on its own terms. Intersectionality is about allowing new epistemic frames to emerge. It is about creating honest and new knowledge that can actually inform interventions in general health, because that will inform the larger game plan of gender equality in our societies," says Naqvi.

Naqvi also lambasts the anti-gender movement which says women are 'biologically female, men are biologically male.' Such anti-rights rhetoric also says 'gender ideology and gender identity are false and dangerous claims.' Their primary target is transgender rights, because insisting on a binary biological definition of sex, denies the existence of transgender people. But its explicit attack on gender ideology is an alliance with a much bigger, wider and broader movement against gender. Gender is taken as a chosen identity, and/or as a socially constructed reality. And we therefore need to be prepared to battle for gender on both counts.

Imposed motherhood

The biggest institutionalised violence of patriarchal society is the idolisation and glorification of motherhood.

The conservative Christian would refer to family and marriage as a lifelong union between a man and a woman. And in India we also pepper it with a strong dose of nationalism - a strong family means a strong nation. Sections of the nationalist right-wing in India are fixated on pregnancy and motherhood, and these are two issue that lie squarely in the gender and health sector. People in public life with power have actually declared their demands on our wombs. Each person enthusiastically spouts a different number they want our wombs to produce. This choiceless and imposed burden of motherhood is not a vision that we can stand with and not counter, says Farah.

Gender disaggregated data is important

Dr Zoya Ali Rizvi, Deputy Commissioner of National Health Mission, Ministry of Health and Family Welfare, Government of India, insists on the importance of gender-segregated data. "Disparity in gender begins right from the time the child is born. Many women still do not have access to education, to skilled jobs and to positions of decision making, whether at home or within communities or in positions wherever they are working. One-size-fits-all policies will not work because the challenges are varied. We have to look at tailored solutions. To achieve this, gender-segregated data is very important. So policymakers need to establish gender specific indicators within our programmes and make the implementing agencies accountable for reporting on that. Also, as gender is intersectional, we also need to involve the local communities, whether it is for adolescent health, mental health, or education programmes, so that people across all genders have access to not just health programmes but also information about the health services available."

Stop weaponising gender

Gender indeed has been weaponised, manipulated and politicised globally, that is not only affecting gender equality but also damaging the health of people. Moreover, the power of the commercial sector is exploiting and manipulating gender norms in relation to health-harming products (particularly, but not limited to, tobacco and alcohol use). The health sector must put in place resources and strategies to counter anti gender forces and develop inclusive frames of social justice; and promote gender-responsive research and action on the commercial determinants of health.

Only a feminist health response can deliver on SDG3

Evidence shows that gender-responsive interventions result in improvements in population-level health outcomes. The Lancet Commission report rightly calls for a feminist approach for realising inclusive and transformative governance for global health. A feminist world order is rooted in sharing and caring rather than in power and violence.

Unlike the patriarchal systems that dominate today, where power is concentrated in the hands of a few through violence and exploitation, a feminist system emphasises solidarity and equitable redistribution of power.

It involves examining how gender shapes social structures, policies, and relationships, and advocates for change to create more equitable, socially just and ecologically sustainable societies, ensuring justice and sustainability for everyone, everywhere.