Troubling politics of global elite’s approach to women’s health

Over the past two decades, women’s health has claimed a prominent place on the global stage. Govts, multilateral agencies, and philanthropic foundations have poured in billions of dollars. High-profile conferences have become routine, while celebrities, and political leaders have amplified the urgency of addressing women’s health and rights. Yet, for all this, a stark and unsettling reality persists: AIDS continues to be the leading cause of death among young women, with one woman contracting HIV every minute. And, every two minutes, a woman dies from complications related to pregnancy and childbirth.

In Sick Of It: The Global Fight for Women’s Health, Sophie Harman interrogates this contradiction, unpacking the politics that shape global health priorities. What began as a necessary and overdue effort to correct centuries of male bias in medicine, has, in many cases, evolved into a space influenced by cynical political calculations, corporate interests, and Big Pharma priorities.

Harman begins her exploration with Rwanda, often hailed as a success story in women’s health. Emerging from the devastation of the 1994 genocide, Rwanda placed women’s health at the centre of its agenda. Results were remarkable: under-five child mortality dropped by 70%, deaths from malaria and AIDS declined sharply, and maternal mortality fell by an astonishing 85%. These achievements have made Rwanda a darling of international donors, and a model frequently cited in global forums.

However, Harman complicates this narrative by arguing that Rwanda’s success also serves a strategic purpose. The country’s impressive health outcomes are used to “healthwash” the more troubling aspects of its governance. Rwanda operates effectively as a one-party state under Paul Kagame, with allegations of political repression, restricted media freedoms, and silencing of dissent. Its involvement in regional conflicts further clouds its image. In this context, women’s health achievements become a powerful tool to deflect scrutiny and maintain goodwill.

The book also examines the global obsession with “saving mothers”, a central rallying point for donors and govts alike. While undeniably important, this focus has narrowed the scope of women’s health. The emphasis persists because it is politically palatable – saving mothers is synonymous with saving babies, a narrative that resonates universally. Yet it also reinforces traditional gender roles, positioning women primarily as caregivers, whose labour – often unpaid and invisible – sustains families and societies, especially during crises like the Covid pandemic.

Harman further critiques policies such as the Mexico City Policy, or the “global gag rule”, which restricts US funding to organisations that provide or even discuss abortion services. This represents a form of hard power in global health, where ideological positions are imposed through financial leverage. Framed as pro-life and supportive of mothers and children, such policies constrain women’s autonomy, and limit access to essential healthcare.

Perhaps, most unsettling is the emergence of an industry built around women’s suffering. Aid organisations often rely on personal narratives of trauma to mobilise funds, encouraging vulnerable women to share their stories, as a condition for support. In effect, women are required to perform their pain, to access services that should be fundamental rights. Men, notably, are not subjected to the same expectations. And it is in this imbalance – this unequal burden of visibility and vulnerability – that the deeper injustice of global women’s health truly lies.

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