Addressing Health and Gender Inequality for Global Justice

Where you are born should not decide whether you survive childbirth or live past the age of five. Yet for millions of people, geography remains the single biggest predictor of health. A woman in sub-Saharan Africa faces a far higher risk of dying in pregnancy than one in Western Europe, and harmful practices rooted in gender discrimination continue to scar the lives of girls across continents. These two problems, unequal health and entrenched gender bias, sit at the heart of debates about global justice. They force us to ask a difficult question: do the wealthy and powerful parts of the world owe anything to those born into disadvantage?

What global justice means for health and gender
The unequal geography of health
Maternal and child mortality
Why these gaps exist
How gender inequality damages health and rights
Harmful practices as human rights violations
The clash between culture and universal rights
The Indian experience: progress and persistent gaps
What global justice asks us to do

What global justice means for health and gender

Global justice is the branch of political theory that asks whether principles of fairness should apply across national borders, not just within them. Traditional thinkers like John Rawls argued that justice operates mainly inside the boundaries of a single state. But cosmopolitan scholars such as Charles Beitz and Thomas Pogge challenged this view, arguing that the moral worth of an individual does not change based on where they happen to be born. For them, nationality is simply one more accident of birth, much like one’s race, gender, or family wealth.

This matters enormously for health and gender. If we accept that every person deserves equal moral concern, then a child dying of a preventable disease in one country is just as serious a moral problem as the same death anywhere else. The capabilities approach developed by Amartya Sen and Martha Nussbaum sharpens this further. It argues that justice requires ensuring all individuals have real access to the things needed for a flourishing life, including health, education, and the freedom to make choices about their own bodies.

Seen through this lens, health disparities and gender-based harms are not just unfortunate facts of life. They are injustices that demand a response from the global community.

The unequal geography of health

The numbers tell a stark story. Across the world, an estimated 287,000 women died from pregnancy-related causes in 2020 alone, and almost all of these deaths happened in low- and middle-income countries. Researchers describe this not just as a tragedy but as a flagrant violation of human rights, because the overwhelming majority of these deaths were preventable.

Maternal and child mortality

Low- and middle-income countries account for the vast majority of maternal deaths globally, with sub-Saharan Africa making up the largest share. The causes are usually direct obstetric complications such as severe bleeding or pre-eclampsia, conditions that are treatable when a skilled health worker and a functioning hospital are within reach. The problem is that for millions of women, they are not.

Child mortality follows the same cruel pattern. Most child deaths under the age of five are preventable, and they cluster in the poorest regions. As researchers have noted, maternal and child mortality act as a mirror of a society’s overall development, reflecting nutrition, education levels, housing conditions, and access to quality care. Where these foundations are weak, mothers and children pay the price.

Why these gaps exist

It would be a mistake to treat these disparities as purely natural or accidental. Many of them are rooted in long-standing structural inequities. The legacy of colonialism disrupted political and economic systems in many countries, leaving behind weak institutions, unstable governance, and limited public investment in health. These historical forces continue to shape who gets to access a hospital and who does not.

There is also the issue of inequity within countries, not just between them. Even in places that have made progress, the most disadvantaged groups, the poorest women in the most remote areas, consistently see the least improvement. The gap between the richest and poorest women often widens over time. This is why scholars draw a careful distinction between health inequality and health inequity. An inequality is simply a measurable difference, but an inequity is a difference that is unjust and avoidable, usually affecting groups with less wealth, power, and prestige.

How gender inequality damages health and rights

Gender inequality is not a separate problem from health. The two are deeply intertwined. When women lack decision-making power, education, or economic independence, their health suffers, and so does the health of their children. But gender inequality also produces specific, severe harms that the global justice framework treats as human rights violations in their own right.

Harmful practices as human rights violations

Female genital mutilation (FGM) is perhaps the clearest example. The United Nations describes it as a human rights violation that infringes on the fundamental rights of girls and women, with over 230 million women and girls alive today having undergone the practice. It carries lifelong physical and psychological consequences, from chronic pain and infection to depression and complications in childbirth.

Crucially, FGM is understood not as an isolated custom but as a manifestation of gender inequality that is deeply embedded in social, political, and economic structures. It reflects a desire to control girls and women and to enforce unequal gender roles. Human rights bodies have found that the practice violates a wide range of protections, including freedom from discrimination, freedom from violence, the right to health, and the prohibition against torture and cruel treatment.

Practices such as honour-based violence and so-called honour killings follow a similar logic. They treat a woman’s autonomy, her choices about marriage, relationships, or behaviour, as something a family or community has the right to police, sometimes fatally. Like FGM, these are not defensible as mere cultural difference. The global justice perspective insists that the moral equality of individuals cannot be overridden by tradition.

The clash between culture and universal rights

This is where global justice debates become genuinely difficult. Defenders of cultural autonomy argue that outsiders should be cautious about imposing their values on communities with different traditions. Cosmopolitan thinkers respond that certain harms are simply not negotiable, because the individual girl who suffers them is a moral equal regardless of the customs around her.

Most international approaches now try to resolve this tension through community engagement rather than top-down condemnation. The long-running UN programme to eliminate FGM, for example, focuses on transforming social norms from within communities rather than simply banning practices by law. The recognition is that lasting change comes when communities themselves choose to abandon a harmful practice, supported by education and the empowerment of women.

The Indian experience: progress and persistent gaps

India offers a useful case study in how rapid progress and stubborn inequality can coexist. The country once carried one of the heaviest burdens of maternal death in the world. As recently as 2017, it accounted for a large share of global maternal deaths, second only to Nigeria.

The turnaround has been substantial. According to the Ministry of Health and Family Welfare, the Maternal Mortality Ratio fell from 130 per lakh live births in 2014-16 to 93 in 2019-21. Government data also shows that India’s MMR declined by 86 percent between 1990 and 2023, far outpacing the global reduction of 48 percent over the same period. Child mortality has dropped sharply too, putting the country ahead of global averages and on a path toward its Sustainable Development Goal targets for 2030.

Yet the national picture hides deep internal inequities. The MMR in a high-performing state like Kerala is dramatically lower than in a state like Assam, revealing that where a woman lives within the country still strongly shapes her chances. Gender bias also remains visible in the sex ratio at birth, which the government reports improved from 899 to 913 over recent years but still reflects a historical preference for sons. India’s experience shows that overall progress, while real and worth celebrating, does not automatically erase the gaps between regions, classes, and genders.

What global justice asks us to do

If health and gender inequalities are injustices rather than misfortunes, then the global community has obligations to address them. Thinkers like Thomas Pogge argue that wealthy nations are not merely failing to help, but are often actively connected to the structures that keep others poor and unhealthy, which generates a stronger duty to reform global institutions. His institutional approach calls for redesigning the rules of the global economy so they do not systematically disadvantage the world’s poorest.

In practice, this translates into several concrete commitments. It means achieving universal coverage of essential health services so that no woman dies for lack of a midwife. It means building strong, sustainable health institutions rather than relying on short-term charity. And it means tackling the gender norms that lie beneath both poor health outcomes and harmful practices, because empowering women is consistently identified as central to ending these harms.

The Sustainable Development Goals represent the most ambitious global attempt at this so far, setting shared targets such as reducing the global maternal mortality ratio to below 70 per 100,000 live births by 2030. Whether the world meets them is uncertain, but the goals reflect a growing acceptance that health and gender equality are not just national concerns. They are matters of justice that belong to all of humanity.

What do you think? Do wealthy nations have a genuine moral duty to fund healthcare and gender equality in poorer countries, or should responsibility rest primarily with each national government? And where would you draw the line between respecting cultural traditions and protecting universal human rights?

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Table of Contents

What global justice means for health and gender 🔗

The unequal geography of health 🔗

Maternal and child mortality 🔗

Why these gaps exist 🔗

How gender inequality damages health and rights 🔗

Harmful practices as human rights violations 🔗

The clash between culture and universal rights 🔗

The Indian experience: progress and persistent gaps 🔗

What global justice asks us to do 🔗