This paper focuses on the interconnections between policies to move toward universal health care (UHC), as a key element of social protection, and those to advance gender equality, women’s empowerment and human rights. It is set against the backdrop of Agenda 2030 and the Sustainable Development Goals (SDGs). Rising concern over the exclusionary and impoverishing effects of out-of-pocket health expenditures, and the extent to which financial barriers tend to block access to health-care services, has been a major driver of the growing policy attention to UHC over the last two decades or so.

Recent years, especially since 2010, have seen advances on each of these fronts. Nevertheless, there has been considerable ongoing concern whether UHC is being designed to address women’s specific needs, particularly their sexual and reproductive health and rights (SRHR). In this paper, we examine whether the experience with UHC has been gender-aware in its conceptualization and gender-responsive in its implementation. We argue that a human rights based approach with an emphasis on the importance of solidarity is needed. We show that standard approaches to achieving UHC often exclude or marginalize gender concerns when framing problems, identifying and gathering data and evidence and designing programmes and policies.

We also argue that considering all elements of a health system and its functioning is necessary to advance towards UHC: governance, health service delivery, health information systems, human resources, financing and medical products and technologies. We show how gender is a key fulcrum on which all these elements are leveraged and is hence central to achieving UHC. Applying a gender lens to UHC by examining the health system entails recognizing and analysing how gender power relations affect all six of its building blocks. The paper considers the current state of evidence on the implications, through a gender lens and where feasible an intersectionality lens, of UHC reforms based on an analysis of country experiences.