"We saw during COVID-19 lockdown time that people who were from the most marginalised groups, were furthest pushed behind. These included: peoples from gender diverse communities, women in all diversities, women in sex work, women who use drugs, or young girls, for whom there was hardly any access to care, support and services. Gender-based violence was being more reported during the pandemic. We have learnt the harder way that how we want to ensure marginalised people are included in strengthening the health systems and making them resilient in gender-transformative manner," said Dr Harjyot Khosa, Regional External Relations Director, International Planned Parenthood Federation (IPPF) and member of Civil Society Engagement Mechanism for UHC 2030.
"We need to engage marginalised communities in all their diversities to adapt and redesign health systems to better protect them within the framework of universal health coverage," Dr Khosa added. She was speaking at a special Side Event alongside 78th World Health Assembly organised by Global Centre for Health Diplomacy and Inclusion (CeHDI), International Planned Parenthood Federation, Fos Feminista, CNS, and partners.
Are health systems designed for gender diverse peoples?
Dr Harjyot Khosa reminded that health systems are defined and designed for heterosexual married people, like ‘good couples’ as per the harmful social norms rooted in patriarchy. “So, perception and level of stigma and misogyny within healthcare systems is what we all grapple with every day. Sexual and reproductive health, rights and justice has to be the first push to deliver on UHC at all levels,” she said.
"Just because of the colour of your skin, people become a victim of sexual assault. When they go the police, they are turned away because they are 'not citizens of the country.' Or a woman is denied mental healthcare because of language barriers. These are the realities I face daily in Dominican Republic,” said Dr Eliezer Lappots-Abreu, Executive Director, Health Horizons International, Dominican Republic.
"Although we live in Dominican Republic where health access and universal health coverage is part of the norm, but it is not accessible for everybody because it excludes women of colour and immigrants. One of my patients, a Haitian woman, was diagnosed with cervical cancer but when we connected her to services to treat her cancer, she was turned away because of the language barrier. When we arranged a translator for her, we were told that they can understand her but unable to serve her without documentation. Patient wondered if her options was to get palliative care or just die in the house,” he added.
UHC is not about coverage alone but Universal Health Care
“It is not accidental that 'C' in 'UHC' (Universal Health Coverage) stands for 'coverage' in the official language but it should be about Care – Universal Health Care. No wonder due to governments focussing on UHC, or coverage, we see increasing space for ‘health insurance.’ Universal Health Care (and not Universal Health Coverage) better links us with the spirit of Alma Mata Declaration of 1978 (which heralded WHO led call to deliver on Health For All),” said Baba Aye, Health and Social Services Officer, Public Services International (PSI), who earlier worked for two decades in the Medical and Health Workers Union of Nigeria.
"We cannot talk of universal health care without health workers for all," said Baba Aye of PSI. He said that when 13% of maternal mortality are from unsafe abortions, and two-thirds of healthcare workers are women themselves, imagine the struggle in countries where abortion is criminalised.
Connect the dots: Leprosy, gender justice, human rights, and SDGs
Leprosy (also known as Hansen’s disease), once feared as an incurable disease, is now treatable with modern medicine. When diagnosed early and accurately, and treated early with right medicines, it is not disabling too. But leprosy-related stigma and discrimination continues to cause havoc in lives of people affected with leprosy and blocks access to care even today.
But only when we put leprosy under gender lens, we get to see the alarming inter-sectional stigma and discrimination that impacts women with leprosy.
“Women with leprosy receive lower wages than men for the same work, which is a clear example of gender inequality. These issues are compounded by the stigma of leprosy. But perhaps the most serious impact is in the area of healthcare. Women with leprosy often suffer in silence. Social stigma, economic dependence, and a lack of agency prevent them from seeking timely medical help or sharing their experiences. This intersection of gender and disease requires urgent attention. If we want to truly support people affected by leprosy, we must also address the gender-based injustices they face every day,” she added.
“We need to ensure people living with HIV are covered under UHC (under Indian government’s health insurance). Although government of India has done a commendable job in ensuring people living with HIV receive lifesaving antiretroviral therapy and support at government-run healthcare facilities across the country, there are other healthcare needs too which people face - and often have to pay. Out-of-pocket expenses often become catastrophic costs for people with HIV, especially women who face inter-sectional stigma and discrimination at all levels,” said Daxa Patel, co-founder and former President of National Coalition of People Living with HIV in India (NCPI Plus) and leader of Gujarat State Network of People living with HIV (GSNP Plus).
Gender inequality and violation of rights exacerbate during conflicts and humanitarian crises
Parwen Hussaini of Afghanistan is at risk of her life along with her lesbian lover Maryam (Maryam is under arrest). Parwen was born in Gazhni province of Afghanistan and identifies as a lesbian and Afghan. She narrowly escaped persecution and arrest by the Taliban on 20th March 2025 and she is now in Iran. Parwen and her lover were engaged to get married when they tried to escape. Her lover (Maryam) is being tortured and imprisoned by the Taliban and in prison for over one and a half months (as on 10 May 2025).
Nemat Sadat, CEO of “Roshaniya” (an advocacy network dedicated to assisting LGBTQI+ Afghans) and one of the first Afghans to have openly come out as gay person and to campaign for rights, gender freedom and liberty, said: “We have a list of over 1,000 LGBTQI+ peoples who still remain in Afghanistan. To this date, we have supported the safe evacuation of 265 people to different countries and we hope that Parwen will also get to a safe place.”
“The ongoing conflict in South Sudan has disempowered a lot of excluded and marginalised peoples including women, LGBTQI+, people living with HIV, persons with disabilities, sex workers, among others. So, when it comes to gender justice the issue of gender-based violence becomes central. There is physical violence, domestic violence, and sexual harassment and sexual abuse. They are raping women rampantly. Due to the conflict there is also increased risk for the displacement of women and girls in South Sudan (which puts them at greater risk of violence). There is also limited access to justice and support for young women, women with disability, and people with HIV because of their condition,” said Rachel Adau, Executive Director of the Women’s Empowerment Centre South Sudan.
Let us hope that at the upcoming UN intergovernmental High Level Political Forum were UN Sustainable Development Goals for health (SDG3) and gender equality (SDG5) are under review, governments commit to get on track to deliver on all SDG goals and targets. We cannot 'pick and choose' rather deliver on all SDGs.
(Shobha Shukla is the award-winning founding Managing Editor and Executive Director of CNS (Citizen News Service) and is a feminist, health and development justice advocate. She is a former senior Physics faculty of prestigious Loreto Convent College and current Coordinator of Asia Pacific Regional Media Alliance for Health and Development (APCAT Media) and Chairperson of Global AMR Media Alliance (GAMA received AMR One Health Emerging Leaders and Outstanding Talents Award 2024). She also coordinates SHE & Rights initiative (Sexual health with equity & rights). Follow her on Twitter @shobha1shukla or read her writings here www.bit.ly/ShobhaShukla)
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