Health Systems as Justice Systems: Reimagining the Delivery of Rights for Women and Girls

9 March 2026

By Ebibote Opetu, 

Senior Communications Lead, Women in Global Health

When we talk about justice, we picture courtrooms, judges, verdicts, and the rule of law. But for most women and girls, justice is not first encountered under a national emblem or behind a wooden bench. It is encountered under fluorescent lights or dark rooms in a clinic, in the interaction with a nurse, in a maternity ward, or from the diagnosis of a physician, the treatment that is offered or denied.

A woman who hemorrhages during birth and is told to wait because supplies are short. A patient whose cardiac symptoms are dismissed as anxiety because diagnostic standards were set with male bodies in mind. A nurse who reports harassment and is quietly transferred instead of being protected. These moments rarely make headlines, yet they are justice in practice, or injustice in motion.

As UN Women emphasizes, Rights. Justice. Action. matters precisely because rights without enforcement remain words on paper and not lived experience. Globally, women hold only about 64 per cent of the legal rights that men do, even where protective laws exist, systems to implement them are weak or absent.

Where Rights Must Become Real

Healthcare settings are among the first places women seek help for violations of their rights, whether reproductive health, chronic illness, or workplace discrimination. Yet many health systems are not equipped to respond with dignity, equity, or justice.

Take maternal health: more than 260,000 women died from preventable causes related to pregnancy and childbirth in 2023. Most of these deaths occurred in low- and lower-middle-income countries and are preventable with quality care. This is more than a clinical failure. It is a justice failure. A system that allows women to die of conditions that effective care could prevent has failed to uphold their most fundamental rights.

Or consider how research bias translates into poorer outcomes: women remain underrepresented in major clinical trials, particularly in cardiovascular disease research, despite facing a high burden of morbidity and mortality from these conditions. A systematic review of cardiovascular clinical trials found that women made up just 41 per cent of participants, underscoring how gaps in research design limit understanding of women’s health needs.

The Workforce That Delivers Care — Without Equal Power

Women are not just patients; they are the backbone of health systems. According to the World Health Organization, women comprise approximately 70 per cent of the global health and social care workforce. But their numerical dominance does not translate into equal power. Across regions, women health workers earn significantly less than their male counterparts, hold fewer leadership roles, and face systemic barriers to promotion and safety.

If health systems cannot guarantee justice for the women who power them, how can they guarantee justice for the women they serve?

The same structural inequalities that limit women’s workplace rights — unequal pay, lack of advancement opportunities, weak enforcement of protective policies — also shape how women experience healthcare delivery. These are justice issues, not just human resources concerns.

Justice in Law, Silence in Practice

Many countries have ratified gender-equality conventions, yet laws often go unenforced. Discriminatory social norms, weak legal protections, and barriers to enforcement continue to block women’s access to justice across economic, family, and health domains. These systemic inequalities are reflected in health, too, from lack of affordable services to gaps in coverage for reproductive rights.

Justice, therefore, is not only about legal recourse. It includes economic access to care, respect for bodily autonomy, and equitable inclusion in clinical decision-making. According to global SDG data, in many regions, only a little over half of women have full decision-making power over their sexual and reproductive health. Without agency over their own bodies, rights, even when legally recognized, are not properly implemented.

Rethinking Justice

If we are serious about Rights. Justice. Action, we must stop treating health systems as neutral service providers. They are distributive institutions that allocate dignity, credibility, and protection. They determine who is taken seriously, whose symptoms are believed, and whose suffering is recorded.

Rethinking justice for women and girls means:

• Financing gender-responsive health systems that close gaps in care and ensure equitable access to services
• Mandating sex-disaggregated data to reveal and address inequities in policy and practice
• Ensuring equitable leadership pathways for women health professionals
• Implementing enforceable workplace protections for women in health care
• Holding systems accountable when discriminatory care and systemic failures occur
  

Justice is not only about redressing harm after it happens. It is about preventing harm and ensuring rights are fulfilled in everyday encounters long before a woman ever sees a courtroom.

Because before a woman ever stands before a judge, she stands before a health system. And if justice does not meet her there, it may never meet her at all.

That’s why Women in Global Health works to advance gender equity and women’s leadership across health systems worldwide. Through its global network of chapters, the organisation advocates for policies that close gender gaps in the health workforce, elevate women’s leadership in decision-making, and strengthen accountability for equitable care. 

By amplifying evidence, supporting leaders, and convening global conversations on power and equity in health, Women in Global Health seeks to ensure that health systems do not merely deliver services but actively uphold justice for the women who rely on them and the women who power them.