Without addressing women's barriers to access to healthcare, there will be no universal health coverage

Introduction

Every year on 8 March, we celebrate International Women's Day, a time to reflect on the persistent inequalities that women face around the world, including in Europe [1]. Among these inequalities, access to high-quality healthcare remains a critical challenge. These barriers can be associated with gender bias in medical research and diagnosis, limited or denied access to reproductive health services, socio-economic factors and gaps in health policies that fail to address women's specific needs. 

Achieving our goal to universal health coverage in the EU by 2030 is not possible without addressing these barriers. A truly equitable health system must recognise and address the specific health challenges faced by women as well as ensure access to timely, affordable, and high-quality care for all [2].  

On International Women's Day, we call on all stakeholders to take concrete action to address health inequalities and ensure that all patients can benefit from the same high quality healthcare services across the EU.  

What barriers do women report when accessing healthcare? 

In the recent OECD - OCDE ’s Patient-Reported Indicator Surveys (PaRIS report), an important initiative to assess healthcare system’s performance from a patient perspective in which the European Patients’ Forum (EPF) participated, data show that “women’s well-being is still worse than men” and that “Gender inequalities are prevalent across many sectors, including healthcare, where disparities manifest in access to services and gender biases in treatment. This imbalance may contribute to the trust gap we identified in our data, where women express less confidence in healthcare systems [3].  

Let’s examine some of the key barriers that women face when accessing healthcare: 

• Gender bias in diagnosis: Research indicates that women's symptoms and pain are more likely to be underdiagnosed or dismissed [4] compared to men’s, leading to delayed treatments and poorer health outcomes [5]. This is the case for cardiovascular diseases, where gender stereotypes result in women being less likely to be referred to a cardiologist when they report chest pain [6]. Consequently, many women experience delayed or inadequate care, increasing their risk of serious complications. Another striking example is endometriosis, a debilitating condition affecting approximately 1 in 10 women [7]. Despite increasing recognition in recent years, it has historically been overlooked in both medical research and public awareness. As a result, the average time to diagnosis remains around seven years, forcing many women to endure prolonged suffering before receiving a proper treatment [8]. 
• Underrepresentation in clinical trials: Medicinal products are safer and more effective for all patients when clinical research includes diverse population groups. However, drug development has historically followed a “one size fits all” model. From preclinical research to clinical trials, drug testing has been predominantly conducted on men. This gender gap has led to critical disparities in treatment effectiveness and safety. For example, dosage recommendations for many medications are based on male physiology, increasing the risk of adverse effects in women, some of which can be more severe or even fatal [9]. Addressing this imbalance requires greater inclusion of women in clinical trials to ensure that treatments are equally safe and effective for all.  
• Restrictions on access to sexual and reproductive health services: Ensuring universal access to sexual and reproductive healthcare services and integration of reproductive health into national strategies and programmes is target 3.7 of the UN Sustainable Development Goals. Restrictions on SRHR increase the risk of several health complications, including life-threating outcomes [10], and disproportionately affect the most vulnerable women, further deepening social and economic disparities [11] reinforcing systemic inequalities.  
• Intersectional discrimination and financial barriers [12]: Certain groups of women experience more difficulties in accessing healthcare due to compounded discrimination. Women with a migrant/ethnic minority background, those with disabilities, single mothers, those with low levels of education, and older women are among those most affected [13]. Women are also more likely than men to report financial barriers as a reason for not seeking medical care. In particular, in a 2024 OECD’s report, data show that while older women can expect to live many more years than men, they are also more likely to have health issues and less resources to meet their health and long-term care needs. The report attributes this to the fact that in the EU, women received less in retirement benefits than men, reflecting persistent disparities in employment rate and unequal pay during their working years. Therefore, “The combination of higher health and long-term care needs with lower incomes impacts the ability of older women to afford health and long-term care services” [14].  

From our members

EUROPA DONNA - The European Breast Cancer Coalition - Marzia Zambon - Executive Director/C.E.O - EUROPA DONNA 

Breast cancer is the most commonly diagnosed cancer in women and accounts for 1 in 4 annual cancer cases worldwide.  Early detection is key to optimal treatment and demands targeted screening and equitable access to specialised treatment. Yet, persistent disparities in research funding, participation in clinical trials, healthcare availability, treatment accessibility and affordability, and societal awareness continue to put women at a disadvantage.    

Financial barriers play a critical role in these disparities. Women, on average, earn less than men, experience more career interruptions, and are more likely to be in part-time or precarious employment – all factors that directly impact their ability to afford healthcare, take time off for medical appointments, or access essential treatments.  Many women also remain financially dependent on spouses or family members, which can limit their autonomy in making proper and timely healthcare decisions. Additionally, women disproportionately shoulder unpaid caregiving, often prioritizing others' well-being over their own, further delaying necessary care. 

Therefore, a truly universal healthcare system must include financial protections for women by investing in paid caregiving leave, supporting those balancing work and care, and ensuring affordable access to life-saving treatments like breast cancer screening. High-quality, gender-sensitive data is also crucial for detecting disparities, improving treatment outcomes, and guiding equitable healthcare policies. Without it, universal health coverage remains an unfulfilled goal.  

Fertility Europe - Anita Fincham - Advocacy Manager 

True universal health coverage is impossible without equal access to fertility care. Fertility treatment is gender-specific, and therefore ensuring women can access reproductive healthcare, free from legal, social, financial, and other systemic barriers, is not just a matter of health - it’s a matter of fundamental rights.

Next steps and EU policy actions  

The European Union and its Member States have a responsibility to ensure universal access to healthcare. This commitment is included in the European Pillar of Social Rights, with Principle 16 which states that “Everyone has the right to timely access to affordable, preventive and curative health care of good quality”. [15] It is also in line with the Sustainable Development Goals (SDGs) set by the United Nations, in particular the goal of achieving Universal Health Coverage for All by 2030 [16], which the European Union committed “to help achieving” [17].  

On this occasion, reaffirming our commitment and priorities to ensure equitable access to all remain more topical than ever:   

• Maintain healthcare as a priority on the EU agenda. In particular, we call for the fundamental principle of equitable access to treatment for all to be enshrined in the legislative framework and to safeguard this commitment as a key objective of the ongoing revision of the EU pharmaceutical legislation and in the future Critical Medicines Act.  
• Support a strong healthcare workforce. It is also essential in this aspect to remember that women constitute the majority of health and social care workers across all EU countries, yet they often face discrimination and unequal career opportunities. While current debates focus on healthcare workforce shortages, addressing these inequalities is not only a matter of fairness but also essential to maintaining high-quality patient care across Europe. 
• Promote greater inclusivity in clinical trials by ensuring better representation of women and other underrepresented groups. EPF is part of the recently launched IHI READI project, which aims to create a patient-centred, inclusive clinical study ecosystem and create a framework to improve representation of underserved and underrepresented communities in clinical studies. The READI consortium strives to tackle these challenges by fostering a more cohesive and integrated clinical studies ecosystem for underserved and underrepresented communities. It will actively connect all key stakeholders who can facilitate access to a wide range of patient populations. It will provide these stakeholders with the necessary tools, training programs, and approaches essential for the recruitment and retention of underserved and underrepresented patients in clinical studies. Moreover, READI takes an intersectional approach, recognizing that underserved and underrepresented patients may face multiple layers of disadvantage, such as migrant women with lower socioeconomic status, and that these complexities must be addressed to ensure equal access to clinical research opportunities.  
• Ensure that emerging health technologies are reducing inequalities, not reinforcing them. To ensure AI-driven innovations serve all populations equitably, they must be designed without systemic biases. Given women's historical underrepresentation in medical research, AI trained on incomplete or biased data risks widening these gaps. Truly effective AI-driven health solutions require diverse datasets, fairness testing, and active measures to reduce disparities.  
• Securing sufficient and sustainable EU healthcare budget to support EU health systems. Adequate funding is essential not only to implement policies that promote equity in healthcare but also serve the public health interest with the involvement of patient organisations.   

References

[1] https://www.un.org/en/observances/womens-day

[2] For more information, EPF’s roadmap to achieving universal health coverage for all by 2030: https://www.eu-patient.eu/globalassets/campaign-on-access/access_to_healthcare_ii.pdf

[3] OECD (2025), Does Healthcare Deliver?: Results from the Patient-Reported Indicator Surveys (PaRIS), OECD Publishing, Paris, https://doi.org/10.1787/c8af05a5-en.

[4] Bever, Lindsey. “From heart disease to IUDs: How doctors dismiss women’s pain”, The Washington Post. 13 December 2022: https://www.washingtonpost.com/wellness/interactive/2022/women-pain-gender-bias-doctors/

[5] Sun TY, Hardin J, Nieva HR, Natarajan K, Cheng RF, Ryan P, Elhadad N. Large-scale characterization of gender differences in diagnosis prevalence and time to diagnosis. medRxiv [Preprint]. 2023 Oct 16:2023.10.12.23296976. doi: 10.1101/2023.10.12.23296976. PMID: 37873224; PMCID: PMC10592987: https://pmc.ncbi.nlm.nih.gov/articles/PMC10592987/

[6] Keteepe-Arachi T, Sharma S. Cardiovascular Disease in Women: Understanding Symptoms and Risk Factors. Eur Cardiol. 2017 Aug;12(1):10-13. doi: 10.15420/ecr.2016:32:1. PMID: 30416543; PMCID: PMC6206467: https://pmc.ncbi.nlm.nih.gov/articles/PMC6206467/

Santi, Pascale. “Un appel pour mieux prendre en compte la santé des femmes, sous-représentées dans les essais cliniques » , LeMonde, 8 March 2022: https://www.lemonde.fr/sciences/article/2022/03/08/un-appel-pour-mieux-prendre-en-compte-la-sante-des-femmes-sous-sous-representees-dans-les-essais-cliniques_6116552_1650684.html (in French)

[7] Gaubert, Julie. “One in 10 women worldwide suffer from endometriosis. Why do we still know so little about it?”, Euronews. 27 March 2023: https://www.euronews.com/health/2023/03/27/one-in-ten-women-worldwide-suffer-from-endometriosis-why-do-we-know-so-little-about-it#:~:text=One%20in%2010%20women%20worldwide%20suffer%20from%20endometriosis.

[8] De Corte P, Klinghardt M, von Stockum S, Heinemann K. Time to Diagnose Endometriosis: Current Status, Challenges and Regional Characteristics-A Systematic Literature Review. BJOG. 2025 Jan;132(2):118-130. doi: 10.1111/1471-0528.17973. Epub 2024 Oct 7. PMID: 39373298; PMCID: PMC11625652: https://pmc.ncbi.nlm.nih.gov/articles/PMC11625652/

[9] European Commission: Directorate-General for Research and Innovation, Gendered innovations 2 – How inclusive analysis contributes to research and innovation – Policy review, Publications Office of the European Union, 2020, https://data.europa.eu/doi/10.2777/316197

[10] https://www.who.int/news-room/fact-sheets/detail/abortion

[11] Rutai, Lili. “Dozens of Hungarian women travel to Austria for abortions every week, amid tightening laws”, Euronews, 16 August 2023: https://www.euronews.com/my-europe/2023/08/16/dozens-of-hungarian-women-travel-to-austria-for-abortions-every-week-amid-tightening-laws?utm_source=chatgpt.com

[12] EPF’s paper: Tackling discrimination in healthcare EPF Position Statement: https://www.eu-patient.eu/globalassets/policy/anti-discrimmination/epf-position-discrimination-jan2015_final.pdf

[13] The European Institute for Gender Equality (EIGE), Gender Equality Index 2021 Health, Publication Office of the European Union: https://eige.europa.eu/publications-resources/publications/gender-equality-index-2021-health?language_content_entity=en

[14] OECD/European Commission (2024), Health at a Glance: Europe 2024: State of Health in the EU Cycle, OECD Publishing, Paris, https://doi.org/10.1787/b3704e14-en

[15] https://employment-social-affairs.ec.europa.eu/european-pillar-social-rights-20-principles_en#:~:text=16.,health%20care%20of%20good%20quality.

[16] https://www.who.int/data/gho/data/themes/theme-details/GHO/universal-health-coverage#:~:text=Universal%20health%20coverage%20means%20that,effective%20while%20also%20ensuring%20that

[17] https://international-partnerships.ec.europa.eu/policies/human-development/health-and-demography_en