The theme for International Women’s Day 2024 is “Count Her In: Invest in Women. Accelerate Progress.” This year gender equality is at a crossroads. While there is a collective will to improve the lives of women, girls and gender diverse people living in Victoria, there is still work to be done…here’s why:

Gender inequality is bad for our health. It’s bad for our bank balances, our mental wellbeing and the social development of our children. In fact, gender inequality is just plain bad. Bad for people, bad for business, bad for the economy and bad for the future. There are those that would have us believe we have achieved gender equality, or something acceptably close to it – that because we have legislated against gender-based discrimination, we can all pack up and go home. Unfortunately, there is a gender-pay gap sized bushel of evidence to the contrary. The impact of gender inequality is a toll measured first and foremost in human lives, with one woman every ten days becoming a victim of femicide. It is also measured through the physical, emotional and mental health, safety, economic security and overall quality of life for women living in Australia. For many women experiencing abuse, isolation, poverty and housing insecurity the stakes couldn’t be much higher. To put a dollar amount on the cost of gender inequality, the Women’s Economic Equality Taskforce last year estimated that it cost the Australian economy $128 billion. (2023).

To meaningfully address gender inequality we must invest in women – in their health, in their safety and in their ability to access choices. In the spirit of transparency and good faith it is here that the reader should know – this article is written at a critical time for the Victorian Women’s Health Services. The Victorian Women’s Health Services are currently advocating for the Victorian Government to permanently extend boost funding secured over a two-year period, due to be reassessed in this year’s budget. This funding has meant that the 12 Victorian women’s health services have been able to grow workforce capacity and expand projects and initiatives in the areas of workplace gender equality, sexual and reproductive health, mental health and climate justice. But transforming systems and challenging entrenched inequality cannot be achieved over just two years. Those of us working within this space know that no matter how well designed, well implemented and well evaluated they are, short term projects with uncertain funding cannot drive the type of sustainable long-term change necessary to ensure equitable health and safety outcomes for future generations of Victorians. Without sustainable funding, infrastructure and resources to ensure projects, initiatives and organisations can undertake the work of preventing gender inequality over decades, real transformative change with real-world impact will remain elusive.

The myriad ways gender inequality shapes the lives of so many women and gender diverse people has a ripple effect on families, communities and society as a whole. It impacts childhood development and informs women’s experiences accessing health, legal, immigration, disability and social services; housing, transport, technology, education and employment. Rates of gender-based violence are disproportionately high in First Nations communities dealing with the ongoing impacts of colonisation, like intergenerational trauma, racism, geographical isolation and poverty (AIHW 2024). The same is true for women with disability and women living rurally, who already face additional barriers accessing basic services (WDV 2019; AIFS 2015). Gender inequality limits men and boys in how they are socialised to express themselves under prescriptive definitions of masculinity. For people who are not cis-gender or heterosexual, experiences of gender bias and intimate partner, family or sexual violence are exacerbated by societal stigma and intersecting forms of discrimination (Our Watch 2024). Anecdotally and statistically, these factors contribute to Victorian’s physical and mental health outcomes at a large scale (Vic Health n.d.). And of course, all of these compounding factors serve to limit the ability of our health system to serve the diverse needs of those people it strives to benefit. We need to invest in these areas over a sustained period of time to see a greater return on that investment – because when gender inequity has a foothold in society, women’s health takes a backseat.

Gender as a determinant of health

Often when we think of health, we immediately jump to physical wellbeing and how to best take care of our bodies. Of course, there are many elements to good health – physical, mental, emotional and psychosocial. Collectively, our experiences of health are shaped by the systems and institutions we must all navigate, and the settings through which we conduct our daily lives. A person’s demographic circumstances – their income bracket, postcode, migrant or disability status; their gender, cultural background or sexuality – will inform their interactions with the systems and institutions governing healthcare, justice, education and social services, to name a few. These interactions will play a significant role in how we experience health and achieve wellbeing throughout a lifetime.

Thinking about the ways one person’s experience might be different from that of the next, depending on any number of unique interactions between individual, social, cultural and systemic factors, suggests we have less individual agency to influence our health and wellbeing long-term than we might initially assume. The choices we make are limited in scope to what we can afford, how far we can travel, whether an interpreter is available, who will mind the kids, the accessibility of services that feel culturally safe or what sources of information are easiest to understand. If we follow this thread, we begin to see the imperative of ensuring that the systems and social structures we rely on are equitable and just, in order to meet the health needs of the community. Employing a ‘one size fits all’ approach might tick the boxes in terms of bureaucratic expedience but is unlikely to work well across multiple regions of diverse populations with unique needs. The social and economic cost of underestimating the interplay of systemic and cultural factors in determining health and wellbeing is high (Women’s Economic Equality Taskforce 2023).

Years of evidence-based knowledge tells us that when girls and women are subordinated, objectified and devalued, gender-based violence and social disadvantage thrive. Gender inequality manifests in many different facets of society and impacts women across social and economic classes – but of course, women and girls from the lowest socioeconomic brackets are inevitably less insulated from experiencing the negative outcomes. Women will earn less pay, less super and accumulate less wealth over a lifetime (WHSN 2023). Women are more likely to be in insecure, part-time or casual work and face economic ramifications for taking time out of their careers to care for children and other relatives – with little thanks for the enormous benefit this unpaid care work delivers society. Economic deprivation has significant ramifications on health and wellbeing – it will inform the uptake of health insurance, elective procedures and the ability to prioritise preventative health and fitness. The link between poverty and lower educational attainment has implications on the way health information is accessed and interpreted, not to mention that economic exclusion indicates higher risk factors for teen pregnancies, STIs and exposure to gender-based violence – particularly in young people (Couch et. al. 2006).

Gender-based violence is perhaps the most immediately recognisable and emotive outcome of gender-inequality when it comes to the impact on women’s health. There is an evidence-based link between societal attitudes that support inequality and the prevalence of gender-based violence, and a further link between gender-based violence and health (Australian Institute of Health and Welfare, 2023). Nation-wide, intimate partner violence alone accounted for 46% of homicides and violence in 2018 figures pertaining to women, and was identified as a significant contributing factor to rates of suicide, self-harm, early pregnancy loss, and depressive and anxiety disorders (AIHW, 2023). The Victorian Crime Statistic Agency reports that in the 2022-23 period, 842 women were admitted to emergency departments, 1,149 were treated by paramedics and over 5,000 came into contact with Women and Children’s services due to reported incidents of gender-based violence (Family Violence Database, 2023). Data tells us that 39 per cent of Victorian women have experienced some form of gender-based violence since the age of 15. (Respect Victoria, 2023; Our Watch, 2024).

Gender-inequality is shown to impact mental health, partially through the high rates of gender-based violence experienced by women living in Victoria and across the country. But the relationship between gender and mental health is nuanced beyond this cause and effect dynamic. Worldwide, women experience mental illness at double the rates of men. Australian women are more likely to experience mental ill health, suicidal ideation, depression, anxiety and eating disorders (Mental Health Alliance, nd). As with all of the ill effects gender inequality has on health, intersecting forms of discrimination or disadvantage compound the already disproportionate rates of mental illness among women.

The ongoing impacts of colonisation on First Nations people, additional barriers to service accessibility for people with disability, intergenerational trauma and poverty are all associated with a higher likelihood of experiencing negative mental health outcomes (Darwin et. al. 2023; Isaacs et. al. 2018; AIHW 2022). Women who live rurally are further vulnerable to anxiety and depression due to increased exposure to climate-based emergencies and their aftermath, combined with the expectation of providing care and carrying the mental and emotional load for their partners and families without balanced reciprocation. Research has found that women living rurally are at higher risk of mental ill health and gender-based violence following disaster (Care through Disaster 2023; Morrissey 2007; WHO 2022).

Alongside the numerous ways in which women’s health is impacted by factors outside of the traditional medical model of health, so too does gender inequality inform women’s experiences within the medical system. Women’s bodies have long been ignored in favour of the male form as the default subject of medical research, or otherwise reduced to incubators throughout medical history. This has resulted in a modern-day healthcare system which is still catching up on research around how gender impacts physical health in different ways (Burrowes 2021). Recent research has shown that women who live rurally and remotely have significantly heightened risk of chronic illness and early mortality (AIHW 2023).

Women and girls consistently experience delays in diagnoses of sexual and reproductive health conditions like Endometriosis and PCOS, and their pain is too often dismissed or trivialised when facing these and other gendered health challenges, like birth injuries. Women with disability are often stripped of their agency to make choices around their own sexual and reproductive health, subjected to medical procedures like IUD insertion without consent (WWDA 2016). The ability to access specific, timely sexual and reproductive healthcare is an ongoing issue for women, particularly in rural and regional areas. This is not an esoteric or rare form of healthcare, but a common, innate requirement for half of the population. These are the interconnected threads that inform the daily lives of millions of Victorian women and provide an insight into the breadth of the work that still needs to be undertaken to overcome gender inequity.

What drives gender inequality?

To understand why this problem persists across the birth of modern human rights, various waves of feminism and anti-discrimination laws, we must look more broadly to factors like the societal acceptance of rigid gender norms and gendered expectations, encoded into relationships, language, behaviour, familial and social structures. All of this informs the assumptions we make about the world and how it works. These factors manifest and cultivate within social and cultural settings and are upheld and strengthened through the systemic and institutional frameworks still bearing the legacy of patriarchal gender-norms. While the ‘why’ of gender inequality can be dense, jargon heavy and complex, the issues facing women, girls and gender diverse people are increasingly recognised and represented within public discourse and popular culture.

Collectively we are more educated around issues relating to gender inequality than ever before. It is now considered gauche to refer to babysitting as an activity undertaken by fathers parenting young children. Those same children increasingly understand the importance of using preferred pronouns and know that they don’t have to give anyone a hug if they don’t want. Issues like the gender pay gap, the pink tax and men’s misuse of power to court sexual favours from women are mainstream news. Concepts and terms like love-bombing, relationship red-flags, coercive control, affirmative consent, victim-blaming, stealthing, revenge porn and rape culture have entered the common lexicon. No longer do we perceive gender-based violence as exclusively physical – we know that there are insidious process by which abusers gain control gradually, employing financial, familial, reproductive, technological, emotional – and yes, physical – means to gain control of victim-survivors, enabled by the social, systemic and cultural drivers that condone and manifest this behaviour. Questions like ‘why doesn’t she just leave?’ or ‘what was she wearing?’ are now understood to be unhelpful and damaging cliches.

Yet, the disrespect, objectification and dehumanization of women and gender-nonconforming people remains a stubborn cultural thread, seen within increasingly violent mainstream pornography, the online radicalization of boys and men through the facilitation of incel, red pill and pick up artist sub-cultures and backlash to discourse around sexual assault and harassment, and of reproductive and trans rights. One has only to read the comments under a mainstream news article about gender-based violence – or a review of a movie with a female-led cast, or a blog post about feminism – to understand that some sections within the community have not accepted ideas of gender equality and social justice at all and continue to view some men’s contempt for and violence against women as justifiable in certain circumstances.   

Collective, widespread action to address the entrenched sexism in social and structural settings is called primary prevention. Many of us have heard the cliché, ‘prevention is better than a cure’. In essence, this phrase explains why we approach gender-based inequity and violence through a preventative lens – if we can identify and address the factors which cause a problem, we might just be able to take action to avoid it from reoccurring in the future. The broader prevention sector is at a critical crossroads in terms of the need to secure long-term, sustainable funding in order to embed gender equality across the settings and systems which inform the health and wellbeing of Victorian women. The impacts of the prevention work undertaken from budget-to-budget will otherwise be limited by the short-term funding of projects and programs, breeding uncertainty and discontinuity. The Victorian Government has shown commitment backed by action when it comes to preventing gender-based violence and fostering gender equity across areas like health, education and employment. This leadership can only be strengthened and expanded upon with the support of a public health and prevention sector with the capacity to enact long term change.

Women’s health and the prevention sector

It is the transitional space between systemic inequity and optimal health and wellbeing that drives the work of the Victorian Women’s Health Services – transitional because we are confident that a collective, well-funded and fully resourced commitment to act on the evidence will ultimately lead to transformational change. The good news for Victorian women is that significant goodwill exists within the Victorian Government towards embedding principles of gender equality and social equity, through the apparatus of legislation and public policy reform. The Gender Equality Act (2020) is one such example of innovative policy, developed to address issues like workplace gender segregation, income and leadership disparity, flexible work and workplace sexual harassment. In the area of gender-based violence, the Victorian Government is implementing the final stage of its ten-year plan to end family violence, with the aim of establishing all 227 recommendations from the 2015 Royal Commission into Family Violence (Vic Gov 2016).

In recent years, the Victorian Government has been equally active in efforts to improve access to sexual and reproductive healthcare, with the rollout of dedicated sexual and reproductive health hubs across the state. A recent development in this space is the newly announced Inquiry into Women’s Pain, which is underpinned by the radical notion that women might just have something valuable to say about how they are treated within the health system, based on the findings of the Listening to Women’s Voices survey. All of these positive steps have set the stage for great things to come – with the proviso that we continue to build on successes and match political will with a budgetary commitment to achieving the goals that we so obviously aspire to.

In spite of the complex ways gender inequality impacts the lives of women, the Victorian Government’s demonstrated commitment to act on evidence and in collaboration with the prevention sector manifests a hopeful vision for the future of Victorian women. The Victorian Women’s Health Services have engaged in collective advocacy for the past several years, first through the Sick of Small Change campaign which secured boost funding for our sector between 2022-24, and now under the auspices of the Women’s Health Services Network (WHSN) to secure that funding on an ongoing, long-term basis. Throughout these campaigns, the government has responded with a genuine desire to improve gender and health equity, with MPs from all sides of the political fence showing up to support women’s health and wellbeing at a recent showcase of the WHSN’s work at Queen’s Hall in Parliament House.

Victorians have benefited from this collective drive towards equity and a more holistic view of health and wellbeing in recent years. According to a review undertaken by the Women’s Health Services Network in 2023, Victorian women experience gender-based violence, teen pregnancy and a number of common STIs at lower rates, when compared with the national average (WHSN 2023). In economic terms, Victoria’s comparatively lower rate of gender-based violence alone has resulted in a $600 million cost reduction per year. While ascribing monetary value to human suffering does not begin to capture the true cost to the people impacted, it does paint a stark picture of the scale of the problem. More positively, this figure also points to the far-reaching benefits addressing gender inequality will have for society as a whole. Last year the Women’s Health Services Network released the Small Change, Big Impact report. The report demonstrated that a boost in funding for the 2022-23 and 2023-24 financial years has allowed the WHS’ to leverage existing resources, sector-specific knowledge, experience and relationships to achieve a return on investment through a unique placement within Victoria’s public health infrastructure and programmatic landscape (WHSN 2023).

Through the funding boost, each Women’s Health Service was able to expand its workforce, and as a result the collective capacity to implement a suite of programs and projects, tailored to regional needs as well as the collective needs of the state. These have ranged from innovative training delivery to capacity building for local government and other entities listed under the Gender Equality Act. The Women’s Health Services have provided insights and contributed submissions advising on the application of a gendered and intersectional lens to policy and strategy. The individual services have further engaged in research, community consultations, strategic planning and place and needs-based health promotion activities. A number of the services were engaged by government to provide on the ground support to women and communities during and after the pandemic, as well as in response to other place-based emergencies, like the 2022-23 floods in northern Victoria. Much of this work would not have been possible without boost funding and will not continue without its renewal (WHSN 2023; WHSN 2023).

Among the key aspects to addressing the health impacts of gender inequality in the long term, is collective action and inter-sector cooperation. This is where the women’s health sector asserts that it is well placed to use its tailored, regional knowledge, networks and evidence-base to support government in delivering gender equality. Pursuing social, cultural and systemic change is by necessity an incremental process, with many barriers to progress along the way – but it has proven to be effective and achieve results. Gender inequality is not inevitable. It is not harmless, natural or acceptable. Sometimes the overwhelming scale of gender-based violence is a catalyst for inertia – it is easier to mark a problem as too big than to do the painstaking, ongoing work of long-term prevention. But it is past time to invest in sustained long-term action to embed gender equality within our communities, institutions, systems and within our daily lives. With the expertise, experience and place-based infrastructure in place to work with all levels of government and the broader prevention sector, we can collectively make an impact – after all, gender equality is good for the economy, good for the future and good for our health.