By now, every Republican-led move related to women's health feels like a legislative subtweet directed at feminism and the female body—perhaps a thinly-veiled backlash to the perceived threat on male supremacy, or just a muscle-flexing reminder of the gendered power dynamic behind healthcare policy. (See, for instance, the all-male contingent reveling in the House's passage of the American Health Care Act, and the Senate's unveiling of its new healthcare working group of 13 white men.)
In theory, political representation shouldn't determine political priority: Our elected officials should represent the interests of their constituents regardless of gender. But in reality, the gender of our public servants sets the women's health agenda, and in the US, men control a filibuster-proof majority.
Despite totaling less than half the population, men make up roughly eight in ten members of Congress. This ranks the US among the most gender-lopsided governments in the developed world, and in the middle of the pack globally. It's tied with Saudi Arabia, where women aren't allowed to drive or leave the house without a male guardian. Among the countries with more equal political representation include some you'd expect, like Sweden (56 percent male) and Germany (63 percent male), and some you might not, like Cuba (51 percent male) and Rwanda (36 percent male—the lowest rate in the world).
The idea that countries with more women in government would have better women's healthcare holds in many examples: Scandinavian countries have some of the world's highest rates of women's political representation, and, accordingly, they have among the best health access and outcomes; Yemen doesn't have a single woman in government, so it's no surprise that women struggle to access contraception or give birth in a hospital.
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Nonetheless, given the multitude of social and economic factors that contribute to women's health and the ongoing debate over the effect of female legislators on policy, it would be impossible to draw a single, direct line from political representation to women's health statistics. According to political science experts, a more accurate indicator is "substantive representation"—attention paid to women's policy concerns as opposed to numerical representation. This analysis factors in other considerations, like where women rank in government and their ability to bring on male champions.
"It is not enough to simply include women in government," says Joyce Banda, Malawi's former president and Africa's second female head of state. "Women must be in positions of influence, with authority over budgets and policies that affect women's health, and respect from male power brokers."
President Banda would know. When she took office, she allocated funding to programs for nutrition, childbirth care, family planning and economic empowerment, which she notes is critical for women to be able to negotiate with their husbands when it comes to their healthcare. She also enlisted local male leaders as women's health advocates and personally lobbied for male parliamentary support for a bill to prevent domestic violence.
Women in other countries have managed to exert similar authority without the benefit of a female head of state. In Rwanda, President Paul Kagame wields near-authoritarian control, but women now comprise two-thirds of Parliament, including heading the budget commission and key ministries. Through these roles, they've been able to keep the health of women and girls front and center in policymaking—particularly on related issues like education and sexual violence. Rwanda is now the most gender-equal country outside of Scandinavia—meaning women have better access to health, education, economic opportunity and political representation. Elsewhere, like in Cuba, women's high-ranking ministerial and provincial positions have correlated with better abortion policy and systems for women's care.
Of course, even if a country includes women in government, poor socioeconomic standing and weak health infrastructure may prevent it from achieving progress on women's health. For instance, in Bolivia and Mozambique, women are well-represented in government (relatively speaking) yet their health outcomes are significantly below average for their respective regions. And on the other side of that same coin, Japan and Lebanon both have better maternal health and female life expectancy than the US, despite almost entirely male governments.
Research published last month in Social Sciences looked at this issue in the US context: What is the effect of women's political representation on health spending? Authors Marie Courtemanche and Joanne Connor Green, political science professors at Thiel College and Texas Christian University, respectively, found that the presence of women in US state legislatures did lead to improved spending on women's healthcare, but only when the need among constituents was high enough to convince men to champion the cause. "Because women never comprise a majority," says the study, "it suggests that men align with women's interests when great need is present to build support for heightened allocations."
Courtemanche also pointed out the importance of context like seniority and committee leadership. "Women must hold positions of power in order to pass policies important to them," she says, acknowledging the competing demographic priorities that sometimes arise among women of more than one political minority, like race and education level.
This relationship between governing power and policy speaks volumes about men's ability to control women's health in the US—and Congress' 4:1 male majority actually under-represents the disparity: Men chair 87 percent of House and Senate committees and 90 percent of Congressional subcommittees. Similar percentages exist among state governors (90 percent men), mayors of large cities (81 percent men) and the administration's cabinet heads (86 percent men). And while both major parties have filibuster-proof male majorities, Republican chairs are filled with far more testosterone: 15 of 16 Senate committees are run by men (compared to Democrats' nine)—a sign that a redder Congress is one in which women have significantly less influence.
It goes without saying that gender should never dictate policy—that how one looks or identifies should never affect their priorities as a public servant. But as long as our government representatives make laws based on who they are versus who they serve—and if positions of power are disproportionately held by men—women's health will continue to be under-supported and overlooked. Kind of like the women in this photo.
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