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By guest contributors Matea Cañizares and Zahra Zeinali
The Inter-American Development Bank (IDB) has recently published a report on its gender parity initiatives in Latin America (in Spanish) highlighting positive advances such as the drafting of policy to reform the labor market as a tool to promote gender equality in the region. The publication also makes recommendations for the path forward. According to IDB, Ecuador has a “robust regulatory architecture” favoring gender equality, however, 81% of women work in professional fields with low remuneration, such as agriculture, commerce, and services. Unfortunately, the initiative does not have the health sector as a partner, so we would like to reflect on the potential of involving the Ministry of Public Health (MoH) of Ecuador.
The MoH in Ecuador employs more than 92,000 people; it is the largest provider of healthcare services in the country, attending to the largely uninsured population (66.7%). The MoH has administrative offices, including its headquarters, regional and subregional offices, and clinics and hospitals across the entire country, in both rural and urban areas. In the study we are conducting on gender equality in the health workforce in Ecuador, we find that there is a high level of parity among medical personnel in the MoH. The distribution of general practitioners and medical specialists is 54% women and 46% men, and their leadership positions in hospitals are divided into 44% women and 56% men.
How this level of parity has been achieved at the MoH in Ecuador may set an example and hold valuable lessons for other government institutions and the private sector. Moreover, the MoH may still need to promote gender parity in its own facilities where there are still gaps. Here, we briefly reflect on the country’s policy framework and social-cultural context, thinking of the next steps for the health sector.
Legal framework promotes gender parity
Ecuador’s 2008 Constitution stipulates that gender parity and equality are a right, and that the justice system and elected positions must follow rules of gender parity between men and women. However, the legal framework has proven insufficient to reach the levels of parity that could be expected. In 2022, Ecuador earned only 59 out of 100 points in an assessment of the political participation of women, meaning that there are persistent inequalities in their representation in elected office and in the courts and justice system.
At the beginning of 2023, the Organic Law to Boost the Violet Economy was passed, mandating the government to implement public policies to develop conditions for parity and equality in women’s professional careers. However, the Law of Health Careers passed in 2022 does not contemplate measures to ensure gender parity in the public sector.
Health profession choices of women in Ecuador
Globally, women continue to be relegated to responsibilities and choose professions related to care. From Scandinavian countries like Norway, to China, and Latin American countries like Ecuador, the nursing profession is largely dominated by women. According to the data shared with us by the MoH, there are seven women nurses for each male nurse in the MoH system. This higher representation of women in this professional cadre may be due to cultural and historical motivations that discourage men from choosing this career as much as making women feel driven to choose nursing over another profession. Tradition could be the push behind women being further represented in additional health professions such as obstetrics (91% women / 9% men) and nutrition (78% women / 22% men). However, the tendency expands to dentistry (62% women / 38% men), biochemistry (69% women / 31% men), and technical cadres (60% women / 40% men).
The answer to why women have greater representation in all health professions in the MoH is not simple. It is possible that there are more women pursuing careers in the health sector, but it also could be that the MoH offers better opportunities to women compared with the private health sector and the social security system. Worryingly, there are more women than men entering the university to pursue medicine but fewer women graduating than men in Ecuador. The lower percentage of women medical doctors in the MoH could implicate some form of discrimination in higher education or other gender-specific challenges.
Next steps for the Ministry of Public Health
The sheer number of women pursuing careers in the health sector, as represented in the MoH personnel distribution, could respond to incentives such as the social value and prestige awarded to the health professions. This means that the key to changes in gender parity may not lie exclusively in policy and other legal instruments. This is why we call for the MoH to identify the reasons behind gender parity or higher representation of women in their institution, including in leadership positions occupied by medical doctors. Furthermore, we recommend that the MoH becomes a partner of the IDB and other gender parity initiatives across the public and private sectors in Ecuador, as it would give other institutions the opportunity to learn.
Reducing gender imbalance is an important step but not the final goal; progressing toward equality demands further understanding of how race and socioeconomic background intersect with gender in “women’s career trajectories and experiences of leadership”. Ecuador has high socioeconomic inequality and is a racially diverse country. To expand gender-responsive focused initiatives, the MoH will need to attend to, for example, pay gaps, working conditions, and professional development opportunities using an intersectional lens.
Any efforts towards improving gender equality will demand that the Ecuadorian government consistently disaggregates public data by gender, even though it is not required by the Law of Transparency and Access to Public Information. Ideally, the law should be reformed so that advocates and decision-makers have readily available evidence to help bring progress, beginning with parity and following with greater equality.
About the authors:
Matea Cañizares is a high school student at Johannes Kepler school in Quito, Ecuador. She is currently working with Dr. Zahra Zeinali on a study on gender parity in health personnel in her country. She is also conducting research on climate and environmental factors of school play spaces from a perspective of health. She was one of the 80 participants of the 2023 Children’s General Assembly held in Denmark.
Dr. Zahra Zeinali is a medical doctor and global health professional from Iran. She obtained her MPH from the Johns Hopkins Bloomberg School of Public Health in 2018 and started pursuing her Doctor of Global Health Leadership and Practice at the University of Washington in 2022. Her research revolves around creating conditions conducive to achieving health and well-being for people by leveraging policy mechanisms that impact the social and structural determinants of health with a strong intersectional gender lens.
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