The Gender Gap in Health Strategies: A Pending Challenge

Women continue to face more barriers in accessing healthcare. We examine why gender justice is key to achieving universal health coverage.

[This text was jointly written by Lalama Jabby and Consuelo Bautista.]

Accessing healthcare without facing financial hardship should be a guaranteed right. Yet, for millions of people —especially women and girls— this right remains far from reality.

On December 12, the International Universal Health Coverage Day was celebrated, a commitment made by the United Nations in 2012 to ensure that all people have access to essential, quality health services without financial hardship.

Despite progress made between 2000 and 2015, recent years have seen worrying stagnation. Globally, the number of people facing “catastrophic” health expenditures continues to rise. Catastrophic expenditures are defined as those exceeding 10% of a household’s total budget. In 2021, these costs affected nearly 2 billion people. Behind these numbers are everyday realities: families having to choose between paying for treatment or rent, young people interrupting their education to contribute to household income, or individuals choosing between food and medicine.

In this context, ISGlobal published a policy brief in 2024 analyzing key initiatives to achieve and consolidate universal health coverage in Spain, as well as outlining a commitment to advance this goal.

Women, girls, adolescents, and other vulnerable groups face greater structural obstacles in accessing basic health services. Effectively incorporating a gender perspective into universal health coverage strategies is therefore essential to building more equitable and resilient health systems.

Gender inequality in health coverage affects women the most

Even in contexts with near-universal health coverage, gender inequality continues to shape access, quality, and health outcomes.

In the European Union, 41% of women report difficulty covering an unexpected dental procedure, and 39% consider mental health services unaffordable

In many European Union countries, despite nearly universal population coverage for essential health services (OECD, 2024), women more frequently report unmet healthcare needs due to financial reasons, distance to services, or long waiting lists. They also perceive lower quality of care and face greater obstacles in diagnosis and treatment processes.

These inequalities are amplified in areas marked by stigma, such as mental health and sexual and reproductive health. There are still areas where a male-centered view of biomedicine persists, with differences in clinical presentation of diseases being overlooked, treatment effects insufficiently studied in women, and limited inclusion of gender diversity in health research.

Unmet health needs are closely linked to economic instability. In the EU, 41% of women report difficulty covering unexpected dental procedures, and 39% consider mental health services unaffordable. Although the EU prohibits sex-based differentiation in private insurance access, specific exclusions still disproportionately affect women, such as restrictions during pregnancy or lack of fertility-related benefits in basic insurance.

Without financial protection, inequalities multiply

Without economic protection, universal health coverage becomes a fragile promise, especially for women.

Social determinants of health, such as socioeconomic status, intersect with gender roles and cultural factors to create inseparable networks of inequity. Many women combine precarious jobs with unpaid care work, limiting their economic autonomy and reducing access to health services.

These inequalities have structural and historical roots: women’s traditional role as caregivers, shorter and fragmented work trajectories, and lower pensions further hinder continuous access to care

People with low incomes, living in rural areas, or in households with at least one older adult are particularly exposed to economic barriers and lower coverage of essential services. These inequalities have structural and historical roots: women’s traditional role as caregivers, shorter and fragmented work histories, and lower pensions further complicate continuous access to care.

The gender gap in health is also digital

The rise of artificial intelligence (AI) in health professions risks amplifying existing gender biases. AI relies on previously published content, which is historically male-centered and exclusionary, perpetuating patterns of inequality and discrimination.

One key current challenge is promoting the development of AI applications that integrate a gender and intersectional perspective from the outset, helping to reduce access barriers and promote greater equity in the use of these technologies.

The conclusion is clear: advancing universal health coverage requires integrating gender justice into the design, implementation, and evaluation of public health policies. Without this perspective, universal health coverage will remain a partial and incomplete goal.