The G20 summit in India should prioritize areas that would advance the gender equity agenda for nurses, midwives, and women, recognizing them as key leaders in global health, urges a Lancet article

The upcoming G20 meeting in India presents a unique opportunity for the country to further cement its global health leadership record and pave the way internationally to advance the gender equality agenda, says the latest Lancet article titled “Why G20 India Could Be a Game-Changer for Midwives and Nurses’ Leadership in Global Health.”

The authors have identified three priority areas that require commitment, action, and investments at the G20 summit to advance the gender equality and equity agenda. According to the authors the first priority must be safety, dignity, and fair pay of the healthcare workforce, followed by women’s participation in their sexual, reproductive, and maternal health and rights-based decision making supported by midwives and nurses. And lastly focus on midwifery and nursing leadership in health governance and policy making to aid universal health coverage and improve healthcare service delivery.

The article calls on the G20 summit in India to prioritize areas that would advance the gender equity agenda for nurses, midwives, and women, recognizing them as key leaders in global health. It says while there have been occasional spikes in women’s leadership, the same cannot be said for nurses and midwives in health policymaking, despite their crucial roles as primary healthcare providers in India. The lack of such leadership opportunities has prevented the normalization of women-led development in healthcare.

“This has also not occurred frequently enough to be normalised or transform into nurses and midwives-led; and women-led development to have a significant impact, as has been vouched under the G20 tagline.”

“The men-only-panels at the recent 76th World Health Assembly, the medical-men only panels at numerous platforms and the midwife-excluded Indian panels about midwifery at the 33rd International Confederation of Midwives’ triennial congress, are glaring examples of this reality,” the article reads.

The authors, Kaveri Mayra, Deepika Saluja, and Shubha Nagesh, emphasize the need for protecting and empowering women health and care workers as essential actors in health systems and global health security. They call for increasing the representation of women in leadership roles in healthcare, preventing harassment and violence against women health workers, and ensuring safe and decent working conditions for all healthcare workers through gender-responsive policies tailored to their specific needs.

The article calls for women’s participation in sexual, reproductive, and maternal health decision-making, supported by midwives and nurses. It argues that women should have a central role in decisions regarding their health and rights, with midwives and nurses being well-positioned to provide care, support, and advocacy.

“In general, women’s participation in their social, economic, and health-based decision-making is the most crucial aspect of ‘nothing about us, without us’ narrative in all sectors. Midwives educated to international standards can meet up to 90% of the care needs,” it says.

The Lancet article says there is need to prioritize midwifery implementation as a strategy to reduce maternal and neonatal deaths and stillbirths significantly, potentially saving 4.3 million lives annually by 2035.

The Lancet calls for the inclusion of women, including women health care workers like midwives and nurses, in health workforce governance, health service delivery, and policymaking spaces.

While it says India’s historical significance in having the world’s first female health minister, Rajkumari Amrit Kaur, and the importance of organizations like Women in Global Health (WGH) India chapter in advocating for greater representation of women in health leadership, it asks for addressing the inequalities exacerbated by the COVID-19 pandemic, particularly across gender, race, and socioeconomic lines.

Despite the naming of a nursing institute in Delhi after Rajkumari Amrit Kaur, the article says the continued sidelining of nurses and midwives from global health policymaking is appalling

The article also cites a UNWOMEN report, revealing the underrepresentation of women in COVID-19-related taskforces, despite the majority of India’s health workforce being composed of nurses and midwives.

The Lancet says the domination of leadership positions by men in health policymaking and governance, with women often relegated to lower-status roles with lower pay, such as Accredited Social Health Activists (ASHA), Auxiliary Nurse Midwives (ANMs), nurses-midwives, midwives, and nurses. It says the recognition of ASHA workers as global health leaders at the 75th World Health Assembly but points out the ongoing marginalization of women’s leadership in healthcare.

“In the area of health policymaking and governance, men, both medical and non-medical, dominate leadership positions, while women remain clustered into cadres accorded lower status and lower pay, such as Accredited Social Health Activists (ASHA), Auxiliary Nurse Midwives (ANMs), nurses-midwives, midwives, and nurses. This is the reality for the majority of female workforce in India, despite recent accolades at the 75th World Health Assembly (WHA) awarded to ASHA workers, who were recognised as global health leaders for their role in the pandemic response.”

The article says the organizations like Women in Global Health (WGH) and Academy for Nursing Studies and Women’s Empowerment Research Studies (ANSWERS) are advocating for gender equity and accountability and demanding action from global health leaders.

“WGH India and Academy for Nursing Studies and Women’s Empowerment Research Studies (ANSWERS) have been working to advance the gender transformative agenda through a range of advocacy efforts with grassroots and community leaders from various cadres,” it says.

It says working with ASHAs, ANMs, nurses, midwives, self-help group leaders, elected women representatives, and other allied health and care professionals, the WGH India chapter has engaged stakeholders at various levels, from grassroots to policy. It says drawing from their extensive groundwork, they have identified three priority areas that require commitment, action, and investments at the G20 summit to advance the gender equality and equity agenda.

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