In Conversation with Ms. Ann Keeling on the upcoming #HealthToo Policy Report
29 November 2022
We spoke to Ann Keeling, Senior Fellow with Women in Global Health (WGH) about WGH’s upcoming report, Her Story: Ending Sexual Violence and Harassment of Women Health Workers. Due for publication on December 13, the report is the culmination of testimonies collected through #HealthToo, an online platform and research project on sexual exploitation, abuse and harassment (SEAH) in the health workforce. The report analyzes the testimonies of 230 women in 37 countries to determine the root causes of SEAH in health, and puts forward recommendations for driving reform to end it.
Tell us about the upcoming report #HealthToo: What led to Women in Global Health publishing this report?
We’re launching this new report #HealthToo because violence and sexual harassment against health workers, especially women health workers is a long-standing and really serious issue. Male health workers are also subject to violence, but sexual violence and harassment is mainly directed at women. It has very serious impacts for the women concerned, but also for health and health systems. It’s under-recorded, it’s under-reported, and it’s not often sanctioned. It’s an abuse of power and it can be stopped. We want to bring this to light, so we can catalyze action.
When you talk about prevalence of sexual exploitation, abuse and harassment in the health workforce – how prevalent is it?
Sexual exploitation, abuse and harassment of health workers is very common, particularly some forms of violence against health workers and sexual harassment of women health workers.
The figures are very difficult to get and there are no global figures. There are some small studies of nurses in one country, or health workers in another country but some of it is not disaggregated by sex. But what we do know when we speak to women health workers is that it’s extremely common. Women are facing violence and sexual harassment from three sources: from male colleagues; from male patients; and from men in the community, depending on what their jobs are, but particularly those women health workers who are outreach workers. It’s almost normalized. It’s almost seen as a very unpleasant part of the job that women health workers have to manage and we think that’s totally unacceptable.
Why did you take the approach of storytelling?
For two main reasons, one because the data simply isn’t there. Very few employers and very few countries are routinely collecting data of sexual harassment against health workers disaggregated by sex, and then keeping information on what actually happened in those cases and what the outcome was. When that happens, then this very widespread abuse is simply invisible and policy action isn’t taken. So, we want women’s testimony to be treated as data.
We also felt that with storytelling, real abuse against real women actually becomes real. If you read a bunch of statistics, it’s not nearly the same as reading some of those women’s stories about the things that actually happened to them, in their own words.
Quite often sexual harassment is trivialized, it’s treated as something that’s not very serious, it’s just a bit of banter, it’s just a bit of a joke, and women can’t take a joke. But when you realize what happens to women, you realize that this shouldn’t happen to anyone when they come to work to do a serious job. There’s absolutely no justification for the sort of abuse women are facing routinely, and real stories bring that to life.
What are the top causes of SEAH in the health workforce?
From the data that we have, it seems that sexual harassment of women in the health sector is actually more prevalent than it is in some other economic sectors. We believe that’s because medicine is very hierarchical. This is an abuse of power. It’s an abuse of power more than it is motivated by sexual attraction, for example, it’s an abuse because of where women are in the health workforce.
And that’s the second point, this is a reflection of gender inequality. It’s about where women are in society, and it’s about the lower status jobs that women tend to have in the health workforce, which means women are in a weaker position to complain when they are sexually harassed.
And thirdly, men do this because they know they can get away with it. If men knew they would be sanctioned and if senior male health workers would lose their jobs and that they would be publicly shamed, they almost certainly wouldn’t do this. It’s because they know they can get away with it and that women are in a weaker position to complain, and that’s why they do it.
What is the impact of SEAH on women? Are there secondary impacts?
For women affected by sexual violence and sexual harassment, there are all sorts of physical and psychological harms. The psychological harm can manifest in stress, depression, absenteeism and it really breaks the bond of trust with an employer.
Because women who are harassed at work feel they don’t have any form of redress, fear they may face retaliation if they do report, or there’s just no mechanism for them to report, they lose trust completely in their employer because everyone should be receiving that basic protection from their employer.
So the secondary effects are really upon health services, not just on women, because women are the majority of health workers at 70 per cent of the overall workforce, with 90 percent working as midwives and nurses. So if those women that we all rely on for health services are feeling distracted, unhappy, or their morale is low, then we can’t expect them to be doing their jobs in the best way they’d want to be as health professionals. It has impacts on systems and everyone’s healthcare. And it can have a direct impact too, because where cases are taken forward, women may end up winning large sums of compensation against employers, so there can be real financial costs to health systems for inaction and not doing something about this.
What is being done to address the problem?
Last year, we had a landmark step forward and that was when the International Labor Organization launched a new global convention called ILO190 on work-related violence and harassment. That’s the first time that we’ve ever had any sort of global standard that says that work-related violence and harassment is a human rights abuse and actually details what that abuse is and how it should be eradicated. Around 20 countries have ratified that convention and we’re urging all countries to ratify that convention to bring their domestic law into line with the convention so that women have the protection of law in many countries. Sexual harassment at work is still not a legal offence in many countries and women don’t have the protection of law.
The other thing that needs to happen is that women are coming together, just as they did with the #MeToo movement, and they are talking more about the abuse they’re suffering. This is why we’re calling our platform and report #HealthToo, because the issue is coming out of the shadows and eventually that will make this sort of abuse less normalized and less socially acceptable.
What more needs to be done?
Starting from the global perspective, we’d want every country to ratify the convention and then every country to review their employment legislation and employment rights in light of that convention. Then we’d want those measures to trickle down to every single employer so that they can put policies in place to enable women or anyone subject to violence and harassment to report their experiences confidentially and be taken seriously. We’d want to see the convention feeding through into how perpetrators are being sanctioned, so these sanctions can serve as a lesson to other would-be perpetrators. So this has got to go from global level to institutional level down to personal level, so there’s a culture change and men feel they don’t have a right to abuse women in this way.
