* Any views expressed in this opinion piece are those of the author and not of Thomson Reuters Foundation.
There can be no health for all without the contribution of nurses and midwives: it is time they got seats at the table
Roopa Dhatt is the executive director and co-founder of Women in Global Health, a movement that strives to bring greater gender equality to global health leadership.
Barbara Stilwell is the chief executive of Nursing Now, a three-year global campaign aimed at empowering nurses and midwives.
Renditions of the Christmas story these days do not feature midwives. There are shepherds, kings and an ever-diversifying range of animals, but no midwives. Yet, for thousands of years, midwives were considered to be present at the birth of Jesus. They were stock characters in medieval mystery plays about the Nativity and depicted in early paintings too. It is only more recently that the midwives have disappeared.
Nurses and midwives are – to this day - often invisible until they are needed. They tend to be women, to be paid less than physicians (or even male nurses), and to be absent or underrepresented in key decision-making roles, especially in countries where most physicians are men.
This underrepresentation is certainly present in global health, which remains stubbornly unequal, with the vast majority of power still in the hands of white, Western men. Too few of the highest positions go to women, and, by association, to nurses or midwives. Compassionate care—which is at the heart of nursing—is sometimes mistaken for a kind of weakness.
This is a picture that women and men across the sector are now seeking to change. A huge advantage of the 21st Century is our ability to communicate instantaneously across borders. This enables us to raise awareness of disparities, build and nourish networks of current and future leaders, and collate data on a global scale. Nursing Now, a three-year campaign launched earlier this year, has built a diverse team of nurses, midwives and supporters in over 60 countries, linking them together to demand better treatment and investment in nurses and midwives on a local, national and global scale.
Nurses offer a wealth of clinical skills that can be harnessed to make health systems stronger, more responsive and able to cope with changing demands. When nurses are enabled to lead, innovate, and transform health systems for the better, they will be able to pinpoint and solve gaps in care that others may not be able to. Raising the status of nurses will create more opportunities for women to lead, as well as more effective health systems that cater to the specific needs of women rather than overlooking them. Partnering with like-minded movements like Women in Global Health, Nursing Now is working to empower women by empowering nurses.
This is not about fighting for equality just for the sake of it (though that in itself is a noble aim). Research into the Gender Dividend has shown that investment in the human capital of women and girls has multiple positive effects on the global economy. Many of those to benefit from gender equality will be the women who deliver health care, formally and informally, to over five billion people worldwide. These are the same women who will be absolutely critical to achieving the world’s most important health goal: universal health coverage. This is supported by a report released in November which shows that without increased investment in nursing and midwifery, it will not be possible to achieve health for all.
If there is to be an effective response to global disease threats, ranging from pandemics to noncommunicable diseases, nurses will be essential. They will—literally for some people—mean the difference between life and death.
Nurses lead on the frontline, but to maximise their contribution, they must also be empowered lead and influence at all levels. Governments must invest in the talent pipeline of the health workforce, by educating and empowering nurses and midwives to become influential leaders. This must be supported by professional health associations, who should aim to build capacity and coalitions that support nurse leadership across health systems. Finally, this should be underpinned by governing health bodies at the global, regional and national levels, who should set a minimal quota of having 60/40 gender parity targets and the voice of at least once nurse and midwife in a decision-making role.
The global health workforce is increasingly populated by women, and we will be invisible no longer. If there can be lobsters at the nativity, there can be midwives too (frankly, it makes much more sense). There can be no health for all without the contribution of nurses and midwives: it is time they got seats at the table.
