By Dr Roopa Dhatt and Dr Becky Cox*
WASHINGTON DC | OXFORD (IDN) — The pandemic generated waves of applause for frontline health workers, 90 per cent of whom are women, but some others continued to behave in a more sinister way. Our two organisations received reports of increased issues around protection and safety and some of it related to sexual exploitation, abuse and harassment (SEAH). But when we looked for the data to see the scale, little had been formally collected.
That’s why we opened our respective online platforms #HealthToo and Surviving in Scrubs to hear from women in their own words. By establishing sites where women health workers who have been affected could contribute their stories anonymously, we aimed to better understand the dynamic that has led to, and covers up, widespread abuse in health.
Women in Global Health’s report “#HealthToo: Safe Work Environments for Women Health Workers,” published today signposts the types and causes of abuse, and makes recommendations for the systemic change which has to happen.
Hundreds of contributions reveal female health workers are experiencing work-related SEAH ranging from sexist comments and practices, to unwanted advances to physical assault. The testimonies are bleak:
A dentist from Nigeria remembered, “One day, he shut the door and asked me to kiss him and I said no. He slapped me across the face”.
In Senegal, a doctor described advances from a man old enough to be her grandfather who locked her into his office following a consultation, “He was well respected in the medical field. He tried to force me against the wall to kiss me, saying it was my fault for the way I was dressed (in uniform).”
In another instance, a Mexican student doctor faced harassment by her supervisor who offered grades in exchange for sexual favours saying, “I’m offering you an easy way out. If you reject my offer, you risk failing the rotation.”
One US community health worker said of her harasser, “He would loudly tell people in the office, ‘I don’t understand why we hired her’ and claimed that another manager hired me because I was there as a ‘pretty face’ for the office”.
Two significant problems highlighted by Women in Global Health’s #HealthToo project, were the lack of official statistics and reporting by victims of abuse, whether caused by fear, stigma, retaliation, no mechanism to report or being challenged on standards of proof. The testimonies highlighted several instances in which women felt unsupported on reporting:
A doctor from Ghana reported, “I didn’t report because I felt people would say I am making a mountain out of nothing. Also, I didn’t want to make enemies among my colleagues or bosses. Plus in the case of the first person I simply felt no one would believe me”.
A health technician from Rwanda reinforced that belief, when she declined to go to court, “because I had no proof and I gave up.”
A nurse from Spain had similar difficulties, “The impossibility of proving what he did. The belief that no one would support me and back up my claim.” A nurse from Ethiopia said she was threatened with dismissal if she said anything.
The lived experiences of work-related SEAH illustrate the deeply harmful impact on women including physical harm and long-term effects on their mental health and wellbeing. Add this to lack of career advancement, forced job changes and fear of unemployment, multiply it by the many women who have experienced it and it becomes a personal, professional and health systems crisis.
Work-related SEAH is a human rights violation that demands justice for its survivors. The personal stories shared lay bare the inadequacies of a global health system that has failed to keep women safe. Not only do women health workers, the majority in the sector, work in an environment that exposes them to abuse, in many cases the environment itself is conducive to the proliferation of abuse.
The report reveals that irrespective of country or context, the power imbalance that favors men creates an enabling environment for perpetrators and is one of the main root causes of abuse. It doesn’t help that three quarters of the leadership positions in health are held by men, despite women making up 70 per cent of the health workforce, and 90 percent of frontline staff.
Compounding the problem is the lack of a legislative framework particularly in lower- and middle-income countries to support gender equality at work, including laws to prohibit sexual discrimination and sexual harassment.
Other factors include low priority given to women’s safety that manifests as lack of appropriate infrastructure (shared duty rooms, changing rooms, dark corridors) and a culture of minimizing and normalizing abuse against women.
While local and national laws are needed, individual workplaces also must put in place policies and practices that recognise the issue and offer safeguards, from whistleblower mechanisms to mandatory training and redress for those affected.
An International Labour Organization (ILO) study showed that workplace violence affects practically all economic sectors and all categories of workers, but that one quarter of all workplace violence events occur in the health sector.
Our data and data and reports from various national studies in Ethiopia, the UK, Egypt, Pakistan and the US also reveal that SEAH is a widespread issue in global health.
At the global level, some progress has been made with ILO Convention No. 190, a landmark convention launched in 2019 to recognize the right of everyone to a world of work free from violence and harassment, including gender-based violence and harassment. The first international treaty of its kind, it came into force on June 25, 2021. Since then, just 22 countries have ratified this landmark convention.
It is time now for the ILO Convention to go further and for member states to add on and sign up to global standards for protecting health workers from SEAH at every stage of their careers. Women health workers suffer human rights violations every day with trainees and migrant workers in a particularly vulnerable position.
We are at the point that these violations are normalized despite them coming at a huge personal cost to women, and having a huge impact on health services. The alarm bells are ringing with the phenomenon of the Great Resignation in Health underway as women, especially, are leaving the profession and deepening a projected shortfall of 10 million health workers by 2030. It is time for the global health community to take charge as a matter of urgency, and provide safe and dignified work environments for all health workers.
As Director General of the World Health Organisation, Dr Tedros Adhanom Ghebreyesus has said, “No country, hospital or clinic can keep its patients safe unless it keeps its health workers safe.”
*Dr Roopa Dhatt, Executive Director, Women in Global Health and Dr Becky Cox, Co-Founder, Surviving in Scrubs. [IDN-InDepthNews — 07 December 2022]
Image: Collage of images from platforms #HealthToo and Surviving in Scrubs.
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