In my previous blog post, I noted how universal health insurance schemes often fail to help women and adolescents in need of sexual and reproductive health services. This shortcoming seriously undercuts the aim of universal health coverage to protect against “financial risk” and increase access to health care for low-income populations.
But an equally important weakness of universal health coverage as a concept is that it fails to address the non-economic factors that play a significant role in determining whether women and young people can access and use the health services they need. These factors include:
- Laws and policies that restrict access, such as policies requiring parental or spousal consent or couples treatment, or laws that restrict the provision of and access to certain services, such as safe abortion.
- Social and cultural norms and practices that embody persistent gender inequalities. This can result in, for example, low immunization rates for girls or stigma and discrimination when unmarried women seek sexual health services. These norms and practices can keep women and girls from using services that are otherwise available.
- Lack of individual empowerment, information, and education, which impede women’s and adolescents’ knowledge about health and health-seeking behaviors.
- Weaknesses in health systems that may result in poor quality of care or inaccessible, inadequate, and inappropriate services. These range from resource issues such as the inequitable distribution of services between urban and rural areas and insufficient numbers of trained health care workers to systemic problems like discrimination and abuse of marginalized patients, including women, adolescents, and people who are lesbian, gay, bisexual, and transgender.
- Other social determinants of health, such as food and nutrition, security, water and sanitation, and other environmental and occupational factors that can have specific negative health consequences for women and girls, including for their sexual and reproductive health.
A draft discussion paper prepared for next week’s Global Leadership Meeting on Health acknowledges the critical gap of universal health coverage in addressing the social determinants of health and other barriers to health care. Indeed, this gap might even make universal health coverage something of a pipe dream when sexual and reproductive health is on the line. Without concomitant efforts to address these and the economic factors outlined in my previous blog, women and girls will continue to face challenges accessing and using sexual and reproductive and other critical health services and exercising their rights. The government and civil society leaders meeting next week would do well to discuss the full range of factors that can facilitate or impede people’s ability to achieve the highest attainable standard of health.
We at the International Women’s Health Coalition hope that global leaders agree to take a more holistic approach to improving health care by recommending development goals specifically for women and adolescents—two population groups who face the biggest barriers to care and whose health is critical for overall development. Such an approach would allow for focus on the particular health challenges faced by women and young people, the contextual factors that can jeopardize their health and erect barriers to care, and the specific interventions needed for both prevention and treatment of health conditions.
Universal health coverage is important, but it alone is not enough to guarantee access to health services and improve health. We need specific goals that address the diversity of barriers to care faced by women and adolescents, along with a dose of political will and resources adequate to meeting these goals.