Gender Bias, Workplace Harassment and Violence Against Women in Healthcare Organizations: A wake up call

Authors: Riya Gogia, Apurvakumar Pandya and Medha Wadhwa. Ms. Riya Gogia is pursuing Master of Arts (Health, Gender and Society) from Indian Institute of Technology, Hyderabad and Intern at Indian Institute of Public Health Gandhinagar. Dr. Apurvakumar Pandya is a Psychologist & Faculty at Indian Institute of Public Health, Gandhinagar. Dr. Medha Wadhwa is a Healthcare Management Expert & Faculty at Indian Institute of Public Health, Gandhinagar. Both, Dr. Pandya and Dr. Wadhwa, are leading the Centre for Quality Improvement and Patient Safety (QUALIPS) at Indian Institute of Public Health Gandhinagar.

Summary

Gender bias, harassment and violence in healthcare sector is a pervasive yet often silent issue. Despite forming the backbone of the workforce, women face numerous obstacles, hindering their advancement. We highlight the glass ceiling, gender pay gap, quiet promotion, and workplace harassment, byproducts of societal gender bias. We propose a multi-pronged approach at individual, societal, and organizational levels, including gender-sensitive policies, mentorship programmes, training & education, and work-life balance initiatives to create a more equitable healthcare sector for all.

Introduction

The healthcare field, despite being a beacon of care and compassion, harbors a hidden epidemic: gender bias. Women, who make up a significant portion of the workforce, often face invisible and silent suffering. This manifests as the “glass ceiling” and workplace harassment, discouraging them from pursuing leadership roles. The Glass ceiling refers to the invisible abstract barriers that prevent particularly gender minorities and women from reaching leadership positions within organisations. According to a working paper published in 2019 on gender equity in the health workforce, where 104 countries were analysed, results showed that globally, women make up 67% of the health and social care workforce. Yet, they occupy only 25% of senior positions and a mere 5% of leadership roles in the healthcare sector worldwide. In India, according to a report by Dasra, “women account for 29% of medical doctors, at least 80% of nursing staff, including auxiliary midwives, and nearly 100% of Accredited Social Health Activists”. Despite women forming the majority of the healthcare workforce in India (approximately 70%), women hold merely 18% of leadership positions. In addition, the gender pay gap persists and the burden of work-life balance often falls disproportionately on women. Most women are concentrated at the frontline in low-paying jobs and remain in the same position in the country’s healthcare sector. As per the 2023-2024 Global Wage Report by the International Labour Organization, the gender pay gap in India stands at 27%. The pay gap issue results in fierce arguments and debates throughout the system and on social media, with male privilege and misogyny reeking in every response.

Gender-based workplace harassment is unwelcoming conduct based on a person’s gender that interferes with their work performance or creates a hostile work environment. This can take many forms, including offensive jokes or comments, unwanted physical contact, or threats of violence or exclusion (intentionally isolating someone or excluding from key responsibilities because of gender). Research highlights the persistence of harassment, particularly during odd hours and shift, and unfair treatment to women employees especially nurses and junior staff members in Indian healthcare sector by their counterpart. Additionally, according to Hosier, Zhang and Goh (2023) working mothers in healthcare professions continue to face workplace bullying, unfair treatment and limited advancement opportunities. These factors contribute to work-family conflict, hindering their ability to achieve a sustainable work-life balance. These encapsulate the silent suffering many women experience – qualified and dedicated, yet systematically held back from reaching their full potential.

Gender-based violence at healthcare workplace is also a concern. George and colleagues highlighted violence against female health workers. Recent scoping review of 226 studies across the globe concluded that more women than men experienced non-physical violence, including verbal abuse, sexual harassment, and bullying whereas men experience more physical violence. The World Health Organization (WHO) reports that violence and harassment are pervasive issues affecting healthcare workers globally. Up to 62% of healthcare professionals have experienced workplace violence, with verbal abuse, threats, and sexual harassment being the most common forms. Sexual violence is defined as any act of a sexual nature involving the use of force or coercion. Recent incident of Junior female doctor’s rape and murder at RG Medical College and Hospital in Kolkata has shaken us and led to nationwide protest in India. The safety and security of women in healthcare organizations is indeed a global concern.

As per another report by WHO from 2019 on ‘gender equity analysis of the global health and social workplace,’ workplace gender biases, discrimination, and inequities are systemic, and the gender gap and gender pay gaps are only seemingly widening.  As reported by Alobaid, A.M. et al in 2020 women employed in the health sector face barriers at three levels: Individual, Societal Organizational. Challenges at the individual level include conflicts between home and work responsibilities, travel restrictions due to priorities in the family, a lack of self-belief, self-silencing tendencies, and fear of taking risks are a few challenges at the individual level. At the societal level, unconscious societal biases might play a role in this. Women might be perceived as less suited for specific jobs, work and leadership roles than men. The glass ceiling is often reinforced by unconscious bias. Despite their good intentions, decision-makers may have preconceived notions about the leadership capabilities of women. According to research by Babic and Hansez (2021), the growth of women in leadership positions is often impeded by the perception that they are less capable or decisive. The patriarchal inherent notion of women being weaker and to be protected puts them in positions of powerlessness throughout their career trajectory, with them having to prove their capabilities around the clock. These cultural and social norms reinforce gender inequality in healthcare settings. At the organizational level, a lack of gender sensitivity is a challenge. An article in the Annals of Global Health states that a lack of mentorship, and resources for professional development for women; harassment in the workplace; patriarchal (often men-centric) metrics for success often skew promotions and institutionalize gender bias in the practices. Further, workplace harassment takes such skewed forms that even when women are ‘promoted’, their vulnerabilities do not subside but rather increase manifold. One case of that is the practice of ‘quiet promotion’, where these women workers are given additional responsibilities without commensurate increases in pay or resources.

Gender bias, workplace harassment and violence are interrelated

Gender bias, workplace harassment, and violence can be understood as interconnected points on a continuum, with each form of discrimination potentially leading to or reinforcing the others (See Figure 1).

Figure 1. Continuum of Gender bias, gender-based workplace harassment and violence

At one end of this spectrum lies gender bias, often subtle and invisible, manifesting in unequal opportunities, stereotypes, and unconscious prejudices. As we move along the continuum, harassment emerges in various forms and degrees of visibility, ranging from microaggressions to more overt discriminatory behaviors. At the far end of the spectrum, we find violence, the most visible and extreme manifestation of gender-based discrimination. This progression illustrates how unchecked biases can escalate into more severe forms of mistreatment. The invisibility of gender bias can make it particularly insidious, as it may go unnoticed and unchallenged, potentially creating an environment where harassment becomes normalized and, in extreme cases, violence may occur. Recognizing this continuum is crucial for developing comprehensive strategies to address gender-based discrimination at all levels in the workplace.

Organizational culture plays a crucial role in either perpetuating or preventing gender bias, harassment, and violence against women and gender minorities. In many organizations, deeply ingrained beliefs, practices, and power structures can create an environment that tacitly or explicitly supports discriminatory behaviours. Gender bias often manifests in subtle ways within organizational structures, such as unequal promotion practices, pay disparities, or the undervaluation of work typically performed by women or gender minorities. These biases can be reinforced through informal networks, mentoring relationships, and decision-making processes that favour dominant groups. Harassment may be enabled by a culture of silence or normalization of inappropriate behaviours. When leadership fails to address minor infractions or dismisses complaints, it sends a message that such conduct is acceptable. This can create an atmosphere where more severe forms of harassment are more likely to occur. In extreme cases, organizational cultures that consistently devalue and marginalize certain groups can foster environments where violence, whether psychological or physical, becomes a risk.

Consequences of gender-bias, workplace harassment and violence

Gender bias, workplace harassment, and gender-based violence have far-reaching consequences that impact individuals, organizations, and society at large. Workplace stress, lack of leadership opportunities, work shifts (especially for nursing staff) and work-life conflicts due to fulfilling work and home responsibilities can lead to psychological distress, anxiety, and burnout. Such vulnerabilities increase the chances of harassment and violence which further creates a hostile work environment and increase the risk of physical and emotional harm. Survivors often suffer psychological trauma, career setbacks, and financial losses, while organizations face decreased productivity, higher turnover, and potential legal repercussions. These issues perpetuate gender inequality, reinforce harmful stereotypes, and result in significant economic losses due to reduced workforce participation. The effects can be long-lasting and intergenerational, eroding social cohesion and trust. Addressing these problems requires comprehensive approaches, including policy reforms, education, and cultural shifts, to create equitable and safe work environments that benefit everyone. All these potentially affect their wellbeing and the quality of care they provide.

Solutions

A multi-pronged approach is required to empower women and gender minorities to advance gender equality in the healthcare. Such comprehensive approach that tackles both visible manifestations of gender bias, discrimination and the underlying cultural norms that allow them to persist is necessary. Healthcare organizations need to implement gender-sensitive policies and create a culture of support for women and gender minorities. This includes providing opportunities for professional development, mentorship, and access to resources like childcare facilities, resources to manage stress and burnout. At the same time, there is a need to break down gender stereotypes through education and awareness campaigns in the organization as well as society at large. Integrating gender sensitization in schools and higher education curriculum including medical, nursing, health and allied sciences can be welcoming step. Trainings in health and allied health sciences should incorporate cross-cutting session on gender. Finally, more research on the theme is required. While organizations are making some effort, achieving gender equality requires collective and sustained efforts. We can build a more equitable and effective healthcare system for all when we prioritize advancement and well-being of women.