B Explanatory memorandum
by Ms Camilla Fabricius, rapporteurNote
1 Introduction
1. Gender discrimination
Note in health
is a global issue. Gender specificities are still not systematically
taken into account and cisgender men are still too often considered
the so-called norm. The fact that healthcare services are largely
designed by and for men reflects deeply rooted and structural gender-based
discrimination in our societies.
2. Profound gender-based discrimination in the health sector
leads to inequalities in both treatment and access to care. Gender
bias can be at the source of misdiagnosis, late diagnosis, absence
of treatment and a lack of attention to gender diversity, which
can obviously lead to harmful health consequences. There is a need for
systematic knowledge and evidence on diseases affecting primarily
women, as well as a focus on reducing gender disparities in healthcare.
Gender discrimination in health, amplified by intersecting forms
of discrimination related to disability, age, origin, sexual orientation,
sex characteristics, social status, or religion, has multiple long-term
consequences on health status and beyond.
3. Ignorance of, or lack of attention to pain has also been experienced
by many women. Their pain is minimised, not heard or not believed
and therefore not treated. Women’s health issues are often regarded
as "natural," and, therefore, disease and pain suffered by women
are not seen as something to be investigated into or invested in
preventing or treating. Symptoms are not recognised or detected,
and treatment is delayed, sometimes for years. Cardiovascular diseases,
for instance, are not characterised by the same symptoms in women
as in men.
Note In addition, women
also often prioritise the health of their family members over their
own.
4. In her book
Invisible Women: Exposing
Data Bias in a World Designed for Men,
Note Caroline Criado
Perez demonstrates that healthcare is “systematically discriminating
against women, leaving them chronically misunderstood, mistreated
and misdiagnosed”. Using a series of practical examples, she explains
how gender bias has an important impact on women’s health. In addition,
women’s health has been less prioritised for decades. As an example,
while menopause concerns all women, researchers showed little interest
in the topic.
5. Sexism and gender-based violence have also been reported in
the health sector regarding the relation between patients and health
professionals, and amongst health professionals themselves. In a
2019 report on obstetrical and gynaecological violence,
Note Ms Maryvonne Blondin
(France, SOC) analysed the unequal relationships
between patients and the medical profession, and the institutional
violence. She stressed that “women victims of gynaecological and
obstetrical violence are victims of both patriarchal and institutional domination”.
6. It is important to underline that LGBTI persons are victims
of discrimination and experience challenges in access to healthcare.
Victor Madrigal-Borloz, former United Nations (UN) Independent Expert
on protection against violence and discrimination based on sexual
orientation and gender identity
Note stressed in his 2022 report
that LGBTI persons experienced discrimination by health providers
and systems, stigmatisation, denial of legal recognition of gender
identity and of gender-affirming healthcare, as well as gender-based
violence.
Note
7. Economic aspects should also be taken into consideration.
According to a report prepared for the 2024 World Economic Forum,
Note the difference in care for women’s
health compared to men’s costs 1 000 billion dollars a year worldwide.
This figure is based solely on the loss, without taking into account
the potential returns from gender-specific medicine for women. Investing
in health, including women’s health, has economic benefits. The
Global Alliance for Women’s Health was set up at the Forum.
Note
8. In the political declaration on the occasion of the 30th anniversary
of the Fourth World Conference on Women, adopted at the 69th edition
of the Commission on the Status of Women, ministers and representatives of
the governments of United Nations member States recommitted to “taking
further concrete action to ensure the full, effective and accelerated
implementation and resourcing of the Beijing Declaration and Platform
for Action and the outcome documents of the twenty-third special
session of the General Assembly, which can contribute to the achievement
of the Sustainable Development Goals, including by (…) promoting,
respecting and protecting the right to the enjoyment of the highest
attainable standard of physical and mental health for all women
and girls, throughout their life course and without distinction
of any kind, towards the achievement of universal health coverage,
including safe, available, affordable, accessible, quality and inclusive
healthcare services, as well as maternal and neonatal health, menstrual
health and hygiene management and all communicable and noncommunicable
diseases”.
Note
9. As stressed in the Council of Europe Gender Equality Strategy
2024-2029, “Acquired rights cannot be taken for granted. This is
confirmed by backsliding on gender equality policies and the rise
of anti-gender movements which weaken existing
acquis and seek to limit – among
other things – women’s access to health services, including sexual
and reproductive health and rights, and protections for lesbian,
gay, bisexual, transgender and intersex (LGBTI) persons and women
who use drugs”.
Note Restrictions
in access to sexual and reproductive healthcare are attempts to
control a person’s body and are discriminatory. The lack of attention given
to women’s health, in all their diversity, reflects an overall patriarchal
society and profound gender inequalities. It is time for the Parliamentary
Assembly to raise awareness of gender discrimination in health and call
for action to prevent and combat it.
2 Aims and scope of the report
10. This report aims to shed light
on gender-based discrimination in health and call for action to
prevent it. More specifically, I have investigated gender-based
discrimination in medical research and treatment, and in access
to healthcare for women in all their diversity. I have also investigated
gender discrimination against LGBTI persons in health and sexism
and gender-based violence in the health sector. I have also tried
to analyse why women’s health issues are still regarded as “natural”.
11. I have had a specific interest in examining the reasons behind
the lack of scientific research on endometriosis, menopause, and
women’s mental health. These specific topics have been under-researched for
years, which has resulted in delays in the discovery of effective
treatments. For example, it is estimated that 10% of women have
endometriosis, yet nowadays it still takes almost a decade to receive
a diagnosis.
Note Alzheimer's disease
and depression have a significantly higher prevalence among women,
and menopause has far greater implications than initially thought.
At the same time, in countries with a high number of women in the
workforce, women are observed to withdraw from the labour market
5 to 7 years earlier than men, possibly due to menopausal symptoms.
Note For many years in
Denmark, depression was considered to be a “women’s disease”. Women’s
health seems to be surrounded by prejudice.
12. I intend to present good practices enabling to ensure that
gender discrimination in health is prevented and combated and that
the intersectional dimension is taken into consideration. Adoption
of targeted health plans, investment in research, training of health
professionals and preventing and combating gender-based stereotypes
through campaigns and education are some of the practices which
deserve attention.
3 Working
methods
13. The Committee on Equality and
Non-Discrimination held a first hearing at its meeting on 12 September 2024,
with the participation of Ms Melanie Hyde, Gender, Equity and Human
Rights Technical Officer at the World Health Organization (WHO)
Regional Office for Europe, and Ms Marina Kvaskoff, epidemiologist
at the French National Institute for Health and Medical Research
(INSERM). They identified different forms of gender discrimination
in access to healthcare and described the lack of gender-based research
in health. We discussed the reasons behind the comparatively small
amount of funding allocated to treatment for women and to research
on women’s health.
Note
14. On 4 December 2024, I visited the Maison des Femmes in Saint-Denis.
On 5 December 2024, the committee held a hearing on addressing gender-based
violence in the healthcare sector and providing support for survivors
by medical staff, with the participation of Ms Violette Perrotte,
Executive director of La Maison des Femmes, Dr Sophie Tellier, Head
of the unit on sexual violence of La Maison des Femmes, and Dr Gilles Lazimi,
General practitioner.
15. On 21 January 2025, I held an online bilateral meeting with
Ms Andreea Petre-Goncalves, Director of Communications and Advocacy
at Women in Global Health. On 30 January 2025, I held in-person
meetings with Ms Charlotte Altenhoener Dion and Ms Katharina Kirchberger,
advisers to the Council of Europe Commissioner on Human Rights,
Dr Angelina Pace and Ms Manon Reinbolt, researcher, and Ms Caterina Bolognese,
Head of the Gender Equality Division of the Council of Europe.
16. On 4 February 2025, I held an online bilateral meeting with
Ms Tlaleng Mofokeng, United Nations Special Rapporteur on the right
to health, and she took part in a hearing with the committee on
12 May 2025.
17. I took part in the Commission on the Status of Women held
in New York in March 2025, where I held bilateral meetings and attended
side events on issues related to the topics covered by this report,
including mental health, period poverty and investing in women’s
health.
18. On 18 March 2025, the committee held a hearing on addressing
discrimination against LGBTI persons in the health sector during
a joint meeting of the committee and the Parliamentary Platform
for the rights of LGBTI persons in Europe, with the participation
of Mr Graeme Reid, United Nations Independent Expert on sexual orientation
and gender identity, Ms Evgenia Giakoumopoulou, Head of the Council
of Europe Sexual Orientation, Gender Identity and Expression, and
Sex Characteristics Unit, Council of Europe, Dr Eszter Mihály, LGBTQI+
Rights Officer, Amnesty International Hungary, and Dr Serge Covaci,
Leader of the University Clinic, Faculty of Medicine of Strasbourg,
general practitioner.
19. On 28 March 2025, I held an online meeting with the founding
members of the Alliancen for Kvinders Sundhed (Alliance for Women’s
Health), an organisation which was established in Denmark: Ms Susanne
B. Christensen,
Note Ms Marianne Lynghoj
Pedersen and Ms Anne Sophie Callesen.
20. On 10 April 2025, I held an online meeting with Ms Choolwe
Jacobs and Ms Flata Mwale representing Women in Global Health Zambia.
21. I also carried out desk research and received valuable information
from committee members during our hearings. I would like to thank
them for the information shared and the questions raised, which
helped me progress in the preparation of the report.
4 Lack
of research on women’s health
22. In its Recommendation CM/Rec
(2008)1
Note on
the inclusion of gender differences in health policy, the Committee
of Ministers of the Council of Europe acknowledged the gender gap
in research. It also recognised that gender differences and inequalities
affected treatment, and it presented concrete recommendations.
23. At our hearing on 12 September 2024, Ms Hyde underlined the
lack of data and research on women’s health. According to her, systemic
historical gender biases have perpetuated the under-representation
of women in clinical trials and health research and underinvestment
in research for conditions that exclusively, disproportionately
or differently affect women. She emphasised that inadequate analysis
of sex and gender in health research, male dominated leadership
and control of research funding and publishing, and bias in public health
education and medicine could also explain sex and gender blindness
in medical research.
Note She stressed
that the first 3D anatomical model of the female body was only developed
in 2022. At the same hearing, Ms Kvaskoff stressed, among other
points, that women’s health was not only under-studied but also under-funded.
24. Women are still under-represented in clinical trials.
Note At first, they were excluded from trials
as these could prove risky for a possible early-stage pregnancy,
which would not be known yet by the woman participating in the trial.
The reception conditions for patients participating in trials may
also act as a deterrent for women. They are not systematically gender-sensitive,
for instance in some cases requiring participants to sleep in dormitories
for days or even weeks, irrespective of their gender, which could
make women, in all their diversity, reluctant to participate.
25. Gender bias leads to the “underrepresentation of women in
research on cardiovascular disease, hepatitis, HIV, chronic kidney
disease and digestive disease”. The Council of Europe Steering Committee
for Human Rights in the fields of Biomedicine and Health (CDBIO)
reported that there was a data gap on women’s health due to their
under-representation in clinical trials and research.
Note
26. International guidelines on integrating gender in health research
are still lacking. At the hearing of the committee, Ms Hyde underlined
that only 4% of registered Covid-19 studies included gender or sex
as an analytical variable, and over 75% of treatment trials excluded
pregnant women despite the fact that they were at high risk of severe
Covid-19 illness. Until now, research into women’s health has focused
largely on diseases with high mortality rates, such as cancer. According
to analyses of global data, just 1% of overall healthcare research
and innovation has been invested in female-specific conditions beyond
oncology, such as endometriosis.
Note Research
is mostly carried out on cisgender male bodies, using masculine
standards, and as a consequence, the possible dangers or side effects
of new treatments or vaccinations are better known for men than
for women.
27. Investing in research on women’s health can have an important
impact but is unlikely to become a reality without clear support
from public authorities. The University of Vienna has a sponsored
professorship on gender medicine which is a good practice.
28. Investing in women’s health is beneficial to society, and
it is evident that better care can also have a positive impact at
economic level. Investing in gender-responsive medicine, research
and training will have long-term positive effects. Moving away from
the assumption that the cisgender male body is the norm and thus requiring
that research proposals include women in all their diversity across
the life course, are first obvious steps to ensure that medical
research is more inclusive. To achieve this aim, the inclusion of
a gender dimension and inclusion of female cell lines as a funding
condition could be an incentive. As stressed by Ms Dunja Mijatović,
former Commissioner for Human Rights of the Council of Europe, “all
health efforts must (…) be gender-responsive, taking gender norms
and inequalities into account and acting to reduce their harmful
effects.”
Note
29. In Denmark, the Alliance for Women’s Health is a multi-party
organisation which was created with a view to triggering change
and joining forces to make women’s health a public policy priority.
Their premise is that no one disagrees that women deserve to have
better healthcare, more research and more innovation for treatment.
The objective of the Alliance for 2025 is to secure the adoption
of a budget for a national research centre on women’s health under
the Ministry of Health. In addition, public/private partnerships
would be built. So far, 6 000 persons have joined the Alliance.
5 Pain
bias
30. Pain experienced by women is
often minimised or overlooked. A diagnosis for endometriosis takes
about 7 to 10 years. At the committee hearing, Ms Kvaskoff underlined
that women with endometriosis were often dissatisfied with their
care and that their symptoms were dismissed. On average, they were
obliged to consult 8 healthcare professionals before arriving at
a diagnosis. Despite the prevalence of endometriosis, the intensity of
its painful symptoms, the economic consequences and life impact,
this condition is not yet well known and there is no treatment for
it. The dismissal or minimisation of the pain felt by women is certainly
linked to a gender stereotype: women’s pain is simply considered
as less important and less worrying by health professionals.
31. Period pain is considered “normal”, although the levels of
pain which are experienced by women with endometriosis can be unbearable.
Some municipalities and businesses recognise the right of their
workers to menstrual leave, but it is not yet generalised, and it
is often criticised.
32. I would like to stress that period poverty and menstrual health
are not just about access to products, they are structural issues
requiring a multidisciplinary approach. Period poverty limits women’s
and girls’ participation in economic, political and social life.
33. According to Ms Hyde, the misalignment between investment
in women’s health and the actual burden of disease is deeply rooted
in gender bias, including the dismissal of women’s pain by health
providers. For instance, while research and development for Viagra
progressed from lab to market in under six months, endometriosis
and menopause have faced decades of underinvestment. This disparity
reflects a societal tendency to normalise women’s pain, while prioritising
and valuing men’s sexual performance – ultimately reinforcing persistent
gender-based health inequities.
34. Ms Petra Bayr spoke to the committee about the Austrian film Nicht die Regel which focuses on
the years of suffering of women with endometriosis. This kind of
awareness-raising initiative should be further encouraged. As already
stated, women’s health is a global issue, with a global impact.
Contribution to awareness-raising through documentaries, films and
popular culture can be useful as it improves global public understanding
of the challenges of gender inequalities in care. Awareness-raising
among young teenagers, including boys, is of crucial importance.
35. The French Rights Defender reported on differences in healthcare,
depending on the patient’s sex, origin, nationality or economic
vulnerability. According to her findings, emergency services underestimate
the pain and gravity of symptoms felt by women, notably when they
are young, of foreign origin or perceived as such.
Note With similar symptoms, white
men would have more chances of being considered a vital emergency when
consulting an emergency service for chest pain.
36. Risks also arise with the increasing use of artificial intelligence
(AI) in healthcare settings. AI systems may simply reproduce human
gender bias and minimise women’s pain, basing diagnostic on perceived
needs, rather than on needs expressed by women.
Note For
example, many AI algorithms used in diagnostics and treatment are
trained on datasets that primarily reflect male patients, which
can lead to misdiagnoses for women, particularly regarding conditions
such as cardiovascular disease, where symptoms often differ between
women and men.
Note It is therefore crucial
to monitor the gender impact of AI systems and to test them regularly
for gender bias.
6 Discrimination
against LGBTI persons in the healthcare sector
37. In its
Resolution 2048 (2015) “Discrimination against transgender people in Europe”,
the Assembly called on member States to provide protection from
discrimination on grounds of gender identity in access to healthcare.
In its
Resolution 2191
(2017) “Promoting the human rights of and eliminating discrimination
against intersex people”, the Assembly stressed the importance of
ensuring that intersex persons have access to healthcare without
obstacles. These calls are still valid today.
38. Ms Giakoumopoulou underlined at our hearing on 18 March 2025
that cultural norms, anti-LGBTI rhetoric, institutional barriers,
and insufficient training for healthcare professionals, contribute
to inadequate healthcare access and quality for LGBTI persons across
Europe. The 2020 European Union Agency for Fundamental Rights (FRA)
survey found that 16% of LGBTI persons faced discrimination in healthcare,
this figure rising to 34% among transgender respondents. “Minority
stress”, which leads to persons avoiding medical consultations,
has an impact on health status.
39. The report entitled “Right to the highest attainable standard
of health and access to healthcare for LGBTI people in Europe”,
published in 2024 by the Council of Europe, highlights that there
are heightened rates of mental health issues within the community,
exacerbated by intersectional factors such as ethnicity, disability and
socio-economic status.
Note This report includes 38 key
recommendations to address these issues, including adopting human
rights-based health policies and improving data collection on LGBTI
health needs. There is also a need for better training for healthcare
professionals, stronger community participation and targeted support
for trans-specific healthcare and older LGBTI persons. It is of
crucial importance to ensure that women and LGBTI persons are reaching
leadership positions in healthcare and politics so as to have an
impact on health-related decision making.
40. Mr Reid underlined that some progress had been made in countries
like Portugal, Iceland, and Spain by taking steps towards integrating
LGBTI health into national plans and providing training for healthcare professionals.
Throughout career training on combating discrimination and respecting
identities should be provided. Extending non-discrimination laws
to cover healthcare services and all Council of Europe Sexual Orientation,
Gender Identity and Expression, and Sex Characteristics grounds
is essential to tackle discrimination against LGBTI persons in health.
41. Pathologising legal gender recognition hinders access to healthcare.
In Hungary, the project “Wishing well” showed that a considerable
number of transgender persons experience humiliation and discrimination
in healthcare. Bureaucratic hurdles also complicate their access
to healthcare.
42. In Denmark the number of centres offering care for transgender
and non-binary persons has increased from one to three in the past
five years. There are still long waiting times, which can significantly
impact mental health and leads some persons to seek treatment abroad
to avoid delays in the Danish healthcare system. Transgender persons
continue to report discrimination in healthcare services. Trans-specific
healthcare for minors is being politicised throughout Europe.
7 Gender
stereotypes and mental health
43. Socially constructed gender
differences in roles, status, and power contribute significantly
to mental health disparities. Gender norms and societal expectations
shape behaviours and attitudes. This has an influence on how mental
health concerns are expressed by patients and how they are recognised
and treated by health professionals.
Note LGBTI persons are disproportionately
affected by mental health issues due to stigma and exclusion.
44. Gender-based discrimination increases the risk of depression
and lowers self-esteem. Adolescent girls, for example, often experience
lower self-esteem and greater body-image anxiety than boys, increasing
their risk of depression.
45. In addition, so-called traditional gender roles can limit
women's autonomy in key life decisions, further contributing to
mental health challenges.
Note Women are
expected to prioritise the needs of others over their own emotions.
46. Self-silencing is characterised by suppressing self-expression.
While both men and women may engage in self-silencing, women are
more often socialised to adopt this behaviour, which can have an
impact on mental well-being.
Note Women’s
mental health should be understood in terms of structural inequalities
and power dynamics. Self-silencing serves as a critical mechanism
through which gendered expectations shape women’s well-being.
47. Gender-based violence has severe mental health implications,
with women being disproportionately affected.
Note Survivors often experience anxiety, vulnerability,
loss of confidence and depression. Other effects include sleep difficulties,
panic attacks, and long-lasting psychological distress.
Note These compounded
impacts highlight the need for a deeper understanding of how gendered
experiences shape mental health.
48. At the hearing on 18 March 2025, Mr Reid noted that mental
health issues were directly linked to the environment in which people
found themselves, highlighting that factors such as social, economic,
and physical surroundings played a crucial role in well-being. He
emphasised that more training was needed for professionals to better
understand and address these influences.
49. Societal gender stereotypes can also contribute to delayed
diagnoses of mental health conditions; symptoms may not be recognised
or adequately addressed by health professionals. Autism research
has historically focused on boys, especially white boys, further
perpetuating the belief that autism is predominantly a male condition.
Consequently, traditional diagnostic tools were designed for boys,
and, as a result, they often fail to capture the subtler manifestations
of autism in girls. Furthermore, autistic girls tend to use more
verbal communication, which can lead to misinterpretations and underdiagnosis,
as the symptoms may not align with standard diagnostic criteria
typically associated with males.
Note
50. This gender bias, combined with behavioural differences, has
contributed to the misdiagnosis or omission of autistic girls in
clinical assessments. Girls with autism, particularly those with
higher verbal abilities and without severe psycho-social disabilities,
often learn to camouflage or imitate social behaviours. Additionally,
the higher prevalence of co-occurring mental health conditions in
females, such as anxiety and depression, may further complicate
the diagnosis.
Note
51. The historical view of autism as a primarily male condition
perpetuates the underdiagnosis of women and girls, as teachers and
healthcare professionals may not take the possibility of autism
into consideration, leading to delayed or missed diagnoses for many
girls. This underscores the need for a more inclusive, gender-sensitive
approach to autism diagnosis, ensuring that the specific ways in
which autism manifests in women are recognised and addressed.
8 Ensuring
access to sexual and reproductive health services
52. Access to sexual and reproductive
health services can also be challenging. Barriers include any attempts
to restrict access to abortion care services, access to contraception
and access to information about sexual and reproductive health and
rights (SRHR). It is vital to ensure that all generations have access
to information about SRHR so as to be in a position to make informed
choices: restricting information about these matters is in essence
a way to undermine the empowerment and agency of those concerned.
53. There is also discrimination with regard to access to medically
assisted reproduction (MAR). Some States like Spain, Denmark and
Belgium have adopted inclusive MAR policies, France granted access
to MAR to single and lesbian women in 2021. Bulgaria and Latvia
allow MAR for single women, but not for lesbian couples.
54. Several Council of Europe member States, including Italy,
Poland, Czechia, Serbia and the Slovak Republic allow neither single
women nor lesbian couples to access MAR.
Note
55. Even when access is legally provided for, same-sex couples
can encounter prejudice and judgement when consulting a doctor about
MAR, leading some couples to decide to conceal their relationship.
56. A transgender person may also face discrimination in accessing
MAR. Spain appears as an exception. In 2021, the Spanish Government
adopted a ministerial order restoring free access to MAR for single
women, lesbians, bisexuals, and transgender persons.
57. I believe that fertility preservation should be offered to
any persons going through a transition process and any obligation
to be sterilised during this process should be removed. Transgender
persons often experience exclusion, misgendering, and micro-aggressions
that compromise medical safety, and may for such reasons hide their
reproductive goals from their health practitioners, fearing stigma
and discrimination.
9 Preventing
and combating gender-based violence in the health sector
58. During the committee meeting
on 4 February 2025, the UN Special Rapporteur on the right to health stressed
that the health sector had to be considered as part of a broader
social system. Power dynamics, gendered social norms and asymmetries
also affect this sector, both from the standpoint of health workers
and that of patients. Choolwe Jacobs stressed, during our online
meeting, that “when frontline healthcare workers do not feel safe,
motivation, performance and quality of service delivery can go down.”
59. Women working in the health sector often face gender pay gaps
and poor working conditions. They are also the targets of sexist
comments made by patients or colleagues. Women health workers, in
all their diversity, may find themselves in vulnerable situations,
at work and at home. Training for health professionals should include
strategies to counter sexism and gender-based violence as well as
education against sexist behaviour and violence.
60. A #metoohealth hashtag on social media has helped collect
testimonies of violence and bring to public attention that gender-based
violence and discrimination are widespread in the health sector.
Note Some
health workers realise that they are survivors of gender-based violence
when hearing testimonies of other survivors and, in turn, need support.
The WHO Regional Office for Europe has prioritised strengthening
the health response to violence against women and girls, including
within the health workforce, as part of its next five-year work
programme.
Note
61. Some female doctors are completely in denial about the existence
of gender bias. They have integrated sexism and stereotypes in their
own approaches to female patients. In parallel, some male health
workers have started raising their voice to denounce a climate of
gender-based violence and sexism in the health sector.
Note More needs to be done at multiple
levels to prevent this violence and combat it.
62. Health practitioners may also be perpetrators of gender-based
violence against patients or co-workers, and cases of psychological,
physical and sexual violence against patients have been reported.
63. The question of consent is also at the heart of the relationship
between a health professional and a patient, as a vital element
contributing to building trust. There should certainly be no imposed
medical procedure on a patient without prior consent, except in
emergency situations where expressed consent is not possible.
10 Leading
role of health practitioners in preventing gender discrimination
64. At the committee hearing held
on 5 December 2024, Ms Violette Perrotte explained that the Maison
des Femmes had been created after realising that women were more
likely to disclose violence to health professionals than to dedicated
organisations. The structure provides a holistic, one-stop model
offering care in family planning, support for women victims of violence,
support for survivors of female genital mutilation and sexual assault
and support for women leaving violent households. It brings together
doctors, psychologists, social workers, lawyers, police officers,
and other professionals in a multidisciplinary approach. 26 similar structures
based on the Maison des Femmes model are now operating in France
and Belgium. Ensuring medical confidentiality and vocational training
is essential. La Maison des Femmes also plays a preventive role by
training healthcare professionals, law enforcement and military
personnel, and by working with perpetrators of domestic violence.
65. Health professionals have the responsibility to prevent gender-based
violence. Dr Lazimi spoke about the importance of asking patients
if they were survivors of gender-based violence. They tend to open
up when asked direct questions in a safe and trusted environment.
A general practitioner can play a crucial role in detecting violence
and providing support to survivors.
66. All health professionals stressed the importance of training,
and the persisting difficulties in training medical staff on gender-related
topics. In the Mid-term Horizontal Review of baseline evaluation
reports,
Note the Group of Experts
on Action against Violence against Women and Domestic Violence (GREVIO)
underlined the importance of training health workers to interact
with victims of sexual violence and domestic violence, including
co-operating with the police to report cases, collecting data and
ensuring women’s access to justice.
67. “Medicine is a powerful tool to protect human rights” stressed
the UN Special Rapporteur on the right to health. Unfortunately,
in some cases, health practitioners are the ones who discriminate
on the grounds of gender, social status or origin.
68. The training of health professionals concerning these questions
should be improved and be more inclusive. It is striking that most
leadership positions in the health sector are held by men, while
women represent the majority of health workers. Investing in primary
care research and providing training for young healthcare professionals,
so as to drive forward changes in medical practices, which fully
reflect the most progressive human rights principles, will help
reduce, and finally prevent, gender discrimination in health.
69. Health professionals must also play a crucial role in providing
support to LGBTI patients. A doctors’ surgery, where the identity
and dignity of each individual patient are fully respected and protected,
can be a safe haven and must never be a place where one feels judged
and discriminated against.
11 Raising
awareness
70. One of the keys to removing
gender discrimination in health is raising awareness of its existence
and consequences, both among professionals and the public at large.
For example, targeted awareness-raising campaigns on detecting heart
diseases in women
Note have been launched
in several Council of Europe member States and could inspire other
campaigns.
71. Recent years have seen an upsurge in debates and discussions
about menopause, endometriosis, and menstrual healthcare. These
efforts should be intensified to ensure that these topics are no
longer a taboo and that the pain related to them is no longer ignored.
72. Age-specific awareness-raising campaigns about women’s health
should also be explored. Investing in research on treatment and
care for endometriosis and menopause is crucial. Ensuring access
to information on pre-menopause and menopause, and their effects
can help women going through these phases. Making endometriosis
and menopause public health priorities is important so that the
professionals and public are aware of and understand these important
health matters affecting women.
Note
73. Data collection on women’s health and gender discrimination
in health and its effects needs to be further developed, as does
data collection on the challenges faced by LGBTI persons in accessing
healthcare services. Such data collection can inform awareness-raising
campaigns and policy making.
74. Non-governmental organisations working on women’s health and
on the health of LGBTI persons must be supported in their important
work. In today’s context of budget restrictions, allocation of grants
for health-related projects remains critical and should not be reduced.
75. Several States, such as France
Note and Canada, have
adopted feminist foreign policies and made women’s health and rights
a strategic priority in their external relations. They fund programmes
supporting sexual and reproductive health and rights throughout
the world.
76. The withdrawal of the United States Agency for International
Development (USAID) from many countries will leave gaps in this
field, especially with regard to sexual and reproductive health
and rights programmes, which might not be filled by European donors.
The rise of populist movements on our continent also brings threats
to investment in women’s health and women’s rights, both at national
level and as regards funding to external aid programmes.
12 Conclusions
77. As parliamentarians, we have
the responsibility and the possibility to put women’s health and
the health of LGBTI persons on the parliamentary agenda and to support
funding of related health services during parliamentary budget discussions.
We can raise awareness of the gender dimension of healthcare and
thus contribute to reducing gender bias in this area.
78. National action plans for women’s health, with roadmaps for
action, are essential and require dedicated budgets for research,
treatment, awareness-raising and prevention campaigns. In addition,
national LGBTI health strategies can contribute to a more inclusive
approach and to addressing any gaps in provision of care for LGBTI
persons.
79. Systemic change is required in the healthcare sector to tackle
gender discrimination and gender-based violence, both of which affect
access to healthcare. Mandatory training on preventing and combating
gender discrimination should be organised throughout health workers’
career.
80. We must be pro-active in countering the narrative and initiatives
of anti-gender movements aiming at restraining women’s bodily autonomy.
At the United Nations Women’s Commission on the Status of Women (CSW69)
in March 2025, Ms Mofokeng underlined that “The moment we stop fighting
for people who are invisible, who cannot fight for themselves for
whatever reason, we lose even humanity for ourselves.”
81. Preventing and combating gender discrimination in health is
a way to fight for ourselves and for others and to invest in a future
of equality. Health systems must be first and foremost person-centred
and certainly not economy driven. Ensuring access to healthcare
for all is a way of shaping more equal societies. We must show the
political determination and courage to push forward with a human
rights-based approach in health policy making.
