Health as an Equality Infrastructure

United Nations Sustainable Development Goal 5 (SDG 5) aims to “achieve gender equality and empower all women and girls,” recognizing that equality is not merely a matter of formal rights, but the outcome of material, institutional and social conditions that enable women to effectively exercise their capabilities and freedoms. Within this framework, health and the health sector represent a structural, yet often underestimated, component of the architecture of SDG 5. Numerous targets of the goal, from universal access to sexual and reproductive health (5.6), to economic participation (5.4) and the reduction of gender-based violence (5.2), depend directly on the functioning of health systems.

Health and Gender Equality: A Bidirectional Relationship

Traditionally, health has been interpreted as an outcome of gender equality: more equitable societies produce better health outcomes for women. This interpretation, however, is incomplete. A growing body of research shows that the relationship is bidirectional: access to appropriate health services, particularly in the areas of maternal, reproductive and sexual health, act as a primary determinant of gender equality, shaping opportunities for education, employment, decision-making autonomy and social participation throughout life.

The Role of Health Services in Achieving SDG 5

This perspective underpins my recent narrative review together with Yuxi Wang (2024), which examines how improvements in maternal, reproductive and sexual health arising both from the overall strengthening of health services and from targeted interventions can contribute to achieving specific SDG 5 targets and, more broadly, to promoting gender equality. The review deliberately adopts a narrowly defined analytical scope, focusing exclusively on studies that assess the causal impact of health and health services on different dimensions of gender equality.

The reviewed literature analyzes how maternal, reproductive and sexual health influence gender equality across diverse contexts, highlighting both direct and indirect effects on labor market participation and education, with fertility decisions and women’s autonomy as central mechanisms. We show that these services generate benefits that extend beyond the clinical dimension, producing “co-benefits” in terms of empowerment, human capital and the reduction of structural inequalities, with differentiated patterns in developed and developing countries.

Maternal Health and Reproduction: Autonomy, Work and Education

In the case of maternal health, improvements in antenatal, childbirth and postnatal care contribute directly to target 5.1 by reducing extreme forms of inequality stemming from health risks that are disproportionately borne by women. In developing countries, reductions in maternal mortality and morbidity are a prerequisite for survival itself and for any meaningful possibility of economic and social participation. In high-income countries, where such risks are more limited, the quality and organization of services affect women’s ability to reconcile motherhood and work, influencing wage gaps and occupational segregation.

A central contribution to SDG 5 also emerges from reproductive health services, which are directly linked to target 5.6 on the universal right to sexual and reproductive health. Access to modern contraception, family planning and safe abortion strengthens fertility autonomy, enabling women to decide whether, when and how many children to have. In developing countries, this translates into higher levels of education and economic participation, in developed countries, into lower opportunity costs of motherhood and improved long-term employment trajectories.

Sexual Health, Gender-Based Violence and Integrated Policies

Sexual health also contributes to the achievement of SDG 5, particularly target 5.2 on the elimination of gender-based violence. Integrated services for prevention, counseling and victim support enhance personal safety and access to institutional protection. In low-income settings, such services can reduce exposure to stigma and violence; in high-income countries, they help make formal rights effective by narrowing the gap between legal norms and actual practices.

The review nonetheless highlights the need for more sophisticated evaluation approaches. Indicators commonly used to monitor SDG 5, such as female labor force participation, do not always reflect genuine progress in gender equality unless they are accompanied by measures of job quality and intersectional inequalities.

Although empirical evidence remains limited, collaboration between the health sector and other domains — such as education and justice — can further strengthen women’s bargaining power and autonomy. Fully integrating health into the SDG 5 agenda requires recognizing health systems as infrastructures of gender equality. Consequently, investing in maternal, reproductive and sexual health services does not merely improve health outcomes; it creates the structural conditions for gender equality to be substantive, measurable and sustainable over time. This vision is essential to guide future priorities in the health sector and to support the global agenda for gender equality and sustainable development.