Why do women hold less than 25 percent of global health leadership roles?

The majority of students pursuing global health careers are female, but less than a quarter of leadership roles in the field belong to women.

During a recent interaction with a clinical adviser in Cameroon, one member of global health’s sliver of women leaders — Dr. Elaine Abrams — looked as the woman pointed out her son’s school. She lived right nearby, she told Abrams, allowing her to drop him off in the mornings, walk to work and travel quickly to pick him up if a problem arose. She heard of the same story, Abrams said, when she visited women health workers in Mozambique.

“These are the microdecisions that women are making every day in global health to balance work and careers,” explained Abrams, professor of epidemiology and pediatrics at Columbia University, Monday at the Weill Cornell Center for Global Health’s Women in Global Health Symposium in New York City.

Working toward gender parity in global health, by extension, will impact women's health worldwide — a cause-and-effect case supported by randomized trials in India and Afghanistan, where neonatal mortality dropped, adolescent girls received significantly more education, and women were more likely to generate their own income when a woman was in a leadership position.

With potential positive results within reach and the initial enrollment numbers present to meet the need, what then is stopping women interested in global health before they reach leadership level? A combination of factors, according to those who have managed to climb their own career ladder: lack of female role models as mentors; decreased access to research training and leadership development; difficulties balancing career and personal life; and health and safety risks in the field.

Of the approximately 50 female global health researchers present at the symposium on Monday, 78 percent voted that balancing career and personal life has the largest impact in causing women to leave the field.

Abrams recalled a friend describing the dilemma: “When we’re at work, we want to be at home. When we’re at home, we want to be at work.”

Abrams, senior research director of ICAP at Columbia University, didn’t sidestep her own experience of raising a family while simultaneously treating pediatric AIDS at Harlem Hospital and, later, developing integrated HIV treatment programs as cases skyrocketed throughout sub-Saharan Africa.

“I had gone to school and had framework for my career … I was somewhat clueless about the family side of things — how to be a spouse, a parent, how to run a household,” she said.

Maternity leave was a blur, she explained, and breastfeeding endless. She recalled bringing all four of her children to the hospital with her at different points, falling asleep at her first National Institute of Health meeting and arriving to another with only one of her shoes. She began suffering migraines brought on by stress. She recounted the story of making hurried, once-a-week phone calls from a hotel lobby in Zambia, shouting in order to be heard over the bad connection.

Though her children are now grown and she has contributed immensely to progress in the field of HIV treatment — nearly 12 million people were on antiretroviral therapy by mid-2014, according to the World Health Organization — Abrams still works to find a better balance. The advent of impressive communication technology has made it easier to stay in touch while at work in the United States or overseas, but it’s also ushered with it the inability to unplug — yet another challenge.

Abrams’ own work has shifted from performing service delivery and startup activity to creating guidelines and mentoring other professionals in the field. Along the way, she’s come up with a few pieces of advice:

1. Find something you are passionate about. Your work has to give you a charge. If it doesn’t, you won’t find the balancing act worth the effort.

2. Be attentive. Each decision counts — even the microdecisions.

3. Be flexible and willing to experiment.

4. Embrace your babysitter and the fact that other people will play a crucial role in your children’s lives.

5. Work with people you like and respect.

6. Talk to other women; oftentimes they will have a solution or will help you find one.

Many women attendees of Monday’s symposium called for institutional change, too. One workshop presented a mentoring exercise where attendees were encouraged to advise the invented case of a recently married 35-year-old female assistant professor who spent the last five years conducting research in rural Uganda, but whose partner’s job is not compatible with living overseas.

Suggestions ranged from encouraging the woman to think long-term about her own personal and professional goals to asking whether there might be wiggle room for her work. Could she do similar work in a larger urban center where her partner could work? What might she be able to let go of or hire out to make such a situation feasible? What about revising goals and contracts?

Still, hard decisions remain, especially when colleagues might not view the wish to work from the United States as wishing to contribute to global health — or when the desire to start a family does overtake one’s desire to continue working 18-hour days.

“Creating a work-free space earlier on would’ve been a good thing,” Abrams shared in response to a question from Devex about what she’d tell her younger self, knowing what she knows now. “From the very beginning of the international work, it’s easy to become completely absorbed because it’s so pressing. But recognizing the value of some off time … it would’ve been easier to start with it than to try and build it in later.”

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