Abstract
ObjectiveTo assess the gender composition of guideline contributors for all World Health Organization (WHO) guidelines published from 2008 to 2018.MethodsWe searched for guidelines in the WHO Guideline Review Committee database. We extracted data about the guidelines (title, publication year) and individuals participating (name, role, gender). Guideline roles included: member or chair of guideline development group, WHO steering group, external reviewer or methodologist. We used descriptive statistics to analyse gender composition for each role and the proportion of guideline development group members and chairs who were female.FindingsWe included 230 guidelines involving 13 329 individuals: 219 guidelines (95.2%) reported a guideline development group (4912 individuals). More group members were male (2606; 53.1%) than female (2241; 45.5%). The median proportion of female members per guideline was 47.1% (interquartile range: 35.7–56.3). Half of the guidelines (110; 50.2%) had a development group composed of 40.1–60% females and 75 guidelines (34.2%) had ≤ 40% females in the group. From 2016 to 2018, there were some improvements: one quarter of groups were composed of ≤ 40.0% females in 2016 and 2017, and this reduced to 9.1% in 2018. Among 243 group chairs, 145 (59.7%) were male and 96 (39.5%) were female.ConclusionParticipation on a guideline panel is a prestigious leadership role in global health. The under-representation of women across most WHO guideline roles shows that inequalities persist even where standards and policies call for gender balance. Attention can be shifted to strengthening accountability mechanisms and understanding the root causes of this imbalance.
Highlights
Despite women making up most the health workforce globally,[1] persistent gender inequalities have been documented in terms of pay, leadership opportunities, and management.[2,3] For example, women often earn less for the same work compared to men,[2,3] and are overlooked for leadership positions in global health.[3,4] These harmful gender norms can lead to women leaving scientific fields more frequently than men,[5,6] in addition to limiting diversity in innovation, thought and opportunity
We cross-referenced this database with a book search of the PubMed® online database for “World Health Organization (WHO) guidelines approved by the guidelines review committee,” which lists all WHO guidelines published by year and identified by an international standard book number
A total of 289 documents were identified by the WHO Guideline Review Committee secretariat and our database search
Summary
Despite women making up most the health workforce globally,[1] persistent gender inequalities have been documented in terms of pay, leadership opportunities, and management.[2,3] For example, women often earn less for the same work compared to men,[2,3] and are overlooked for leadership positions in global health.[3,4] These harmful gender norms can lead to women leaving scientific fields more frequently than men,[5,6] in addition to limiting diversity in innovation, thought and opportunity. At the 70th World Health Assembly in 2017, only 31% of the 191 heads of Member State delegations were women.[14] Likewise, at the start of the new Director-General’s mandate in July 2017, only 30% of Directors were women,[14] and only 42% of WHO staff in professional categories were women.[15] In October 2017, the Director-General appointed a senior leadership team, made up of 67% women (10/15) While this is a promising shift, gender imbalances persist throughout WHO’s staffing, which may impact its technical work globally. WHO acknowledged this in its 13th General Programme of Work: “WHO cannot work effectively on gender equality and health equity without turning the mirror upon itself.”[14]
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