At the 25th anniversary of the Beijing Declaration and Platform for Action, there is evidence of progress towards greater representation of women in different spheres of life; yet, their under-representation in decision-making positions in most spheres stands out.
It is not that women’s contribution in leadership roles is not recognised. Studies have demonstrated that women in leadership positions in government organisations implement different policies than men; policies that are more supportive of women and children. A global study on publicly traded companies across 91 countries found women’s presence in top positions of corporate management to correlate with increased profitability. The impact of women’s leadership is not limited to financial outcomes alone, but equally to greater innovation in teams, the development of more creative solutions to problems, a more inclusive culture and improved employee engagement and satisfaction.
Villages in India, with women leaders in local governance institutions have shown to have a higher availability of public goods than other villages. Studies in India have shown the availability of women physicians in districts to be associated with higher maternal healthcare utilisation. Women’s leadership has been known to contribute to strengthening women’s voices, influencing career aspirations and educational attainment of adolescent girls. Clearly, the benefits of women’s leadership are wide.
Yet, gender-related gaps in leadership remain wide. Women constitute 70% of health workers, but constitute less than a quarter of the senior roles in health institutions globally; the pipeline for leadership positions is disproportionate to the wide base of women in lower positions. In India, women constitute about 46% of the health workforce overall, much of it as nurses, where almost 80% are women. This dwindles to less than 30% in the case of doctors and others, comprising pharmacists, physiotherapists, diagnostic and other technicians.
The question of why women’s participation in health declines on the path to decision-making roles has a complex set of answers, ranging from lack of confidence, women’s multiple roles including unpaid work, the absence of agency to navigate institutional structures, gender discrimination, sexual harassment and the dearth of networks and support/ mentoring structures, to name a few. Promotion of women’s leadership requires all of these to be addressed, by enabling access to the tools and resources – social and political – that can help overcome constraints.
Studies have highlighted trust as key to moving up the decision-making ladder; trust in turn requiring ability, affinity and integrity (building on work by Roger Mayer, James Davis and David Schoorman). Affinity, an intangible but significant factor on hiring decisions, is invariably built through networks, which are not prioritised by women in the same way as men; nor do women have the same opportunities to ‘network’. With men dominating leadership roles, opportunities for women to connect with men in informal settings may be lower.
As Oliver Wyman’s 2019 report on women in healthcare leadership points out: “Because they have a harder time expanding their networks and implicitly building more affinity – and because few executives truly appreciate the impact that affinity has on trust and decisions – women have essentially defaulted to over-relying on ability and delivering results to get ahead.” The ambiguity in defining ‘ability’, entailing different assumptions of leadership by different people, further reinforces the role of affinity as a decisive element.
It is also suggested that women are less likely to have mentors than men, to help them navigate the institutional ecosystem. Upward movement, when it entails disruption for the family, is often harder for women to undertake, due to their roles as family caregiver and their hesitation to uproot children.
Despite large numbers of young women interested in health as a profession, a gender balance across levels will remain elusive unless proactive measures are taken to remove obstacles for women reaching leadership positions. This imbalance can be addressed: Kerala has a female health minister, several women technical directors and eight times the female doctor density than several other Indian states.
Women’s leadership in healthcare is not only possible but imperative: For themselves, to realise their full potential, and equally for the health sector, so that gender responsive policies and technology are aimed at women’s needs. A better job of hiring, promoting, enabling networks and mentoring will bring many more women in leadership roles. As Anne-Marie Slaughter states: “Only when women wield power in sufficient numbers will we create a society that genuinely works for all women.”
The writer is Fellow, Lancet Citizens’ Commission on Reimagining India’s Health System