Opinion: Global health organizations must extend SRHR policies to staff

Global health organizations do not consistently have workplace policies in place that consider sexual and reproductive health rights. Shifting leave policies to account for aspects of SRHR such as menstrual or menopause leave, rather than ignoring them or bundling them as general sick leave, is a step toward true gender equality and more women leadership in global health. In July, we — and more than 6,000 other delegates — descended upon Kigali, Rwanda, to attend the 2023 Women Deliver conference. As delegates from Global Health 50/50, or GH5050, a nonprofit organization that generates evidence to drive accountability for gender equality, we were thrilled to connect with feminist leaders, advocates, and researchers from around the world to catalyze action toward gender equality and SRHR. SRHR refers to “a state of physical, emotional, mental, and social wellbeing in relation to all aspects of sexuality and reproduction, not merely the absence of disease, dysfunction, or infirmity.” SRHR concerns everyone but has a particular impact on women, whose life course experiences can include menstrual pain, pregnancy, abortion, stillbirth, miscarriage, and menopause. In addition, women are more likely than men to suffer from domestic violence. With this background, GH5050’s annual report for 2023 “Workplaces: worse for women” — which The Guardian described as “damning” — uncovered that considerations for SRHR in workplace policies by organizations active in global health are virtually absent. Analyzing 197 organizations headquartered in 37 countries and employing over 4.5 million people, we only found one menstrual leave policy, offered by the Global Health Innovative Technology Fund, and one menopause policy, offered by MSI Reproductive Choices. Moreover, the World Health Organization estimates that more than a quarter of women have been subjected to violence from an intimate partner, yet only 21 organizations — about 11% of those analyzed — reported having a policy and/or offering resources to staff experiencing violence at home. Why do SRHR policies in the workplace matter? Our concern was that workplaces while ostensibly looking to recruit women into the workforce had not necessarily taken their unique needs into consideration. Notably, numerous organizations indicated to us that staff could avail of sick or annual leave if they are unable to work due to menstrual or menopausal symptoms. However, we think this risks being discriminatory with the framing — through the lens of Talcott Parsons’ “sick role” — that normal physiological functions of the female body are deviations from social norms. We are early-career health researchers from Malaysia and Nigeria — Aaron Koay is also a pharmacist — who joined GH5050 because we believe in the power of evidence to drive gender equality. Throughout the Women Deliver conference, we discussed our report with delegates across sectors and seniority. They were shocked by our findings. They unequivocally agreed that the current state of affairs is unacceptable. Despite being lauded as beacons of social justice, many organizations in global health often misunderstand or do not consider gender in their policies and programs. In this light, the absence of workplace policies to realize SRHR may be less surprising. Limiting women’s potential SRHR policies across the life course can help reverse the structural norms and practices that disadvantage women and limit the potential of women to thrive and lead in the global health space. Global health sector leadership is already dominated by men — our report shows that 66% of chief executive officers and board chairs are men — and having appropriate SRHR policies may help change that imbalance. Data does not move mountains — people do. We heard many moving words, astute acronyms, and smart alliterations at the Women Deliver conference. But speeches and exhortations without concrete policies, financing, and accountability are mere rhetorics on what sounds like a broken record. Jane Caldwell of the Medicines Patent Pool, who initiated a comprehensive menstrual and menopause policy in her previous workplace, stated in our report that data and facts are critical to driving organizational change. We want attendees of the 2023 Women Deliver conference and Devex readers — whatever your role is — to know that our report, which was built on rigorous research, can be leveraged for SRHR advocacy in your workplace. A core objective of the Women Deliver conference was to create inclusive spaces that facilitate solidarity-building for collective action. We hope our report will prompt men to reflect on how male privileges structurally advantage them — and disadvantage women and people with diverse gender identities — in the workplace and other aspects of life. This is because we need allies and coalitions to dismantle patriarchal norms, which drive poor health not only in women but also — arguably more so — in men. Our conversations with conference attendees also revealed that although most people and organizations desire to champion SRHR in the workplace, there is a lack of clarity regarding what equitable policies should be. Importantly, we are acutely aware that small civil society organizations, particularly grassroots organizations, are often constrained by resources to establish robust workplace policies that support SRHR. From local to global standards for SRHR Indeed, our research found a lack of globally agreed norms and standards on SRHR workplace policies. Legal environments are also critical to enabling SRHR, e.g., laws mandating menstrual leave in Japan, Spain, and Zambia. Against the global backdrop of regression in SRHR and the rise of anti-gender movements, we implore multilateral bodies, governments, trade unions, and feminist organizations to promptly convene to establish global guidance that can support the development of national legal frameworks in politically contested environments to realize SRHR in the workplace. Realizing SRHR for everyone in the workplace will undoubtedly require arduous advocacy, political efforts, and coordination. But if we really want structural transformation for gender equality, we need to start getting our own house in order.