A continuum of micro-aggression to gender-based violence

Violent sexual assault is the extreme end of a spectrum of gender-based workplace microaggressions. Micro-aggressions extend beyond physical or sexual assault and include emotional, psychological, and economic harm [6]. Small actions, over time, create hostile workplaces that hinder women’s career growth, limit leadership opportunities, and leave them invisible and undervalued [7].

Within health care, microaggressions can include discrimination, bullying, harassment, and both verbal and non-verbal hostility towards women [8]. Additionally, research has shown that gender bias, sexism and misogyny in mentorship and training environments can undermine women’s professional growth and lead to inequities in patient care. This can manifest in subtle ways, such as the undervaluing of women’s input, lack of opportunities for advancement, and the perpetuation of gender stereotypes [9].

Microaggressions are often dismissed as harmless fuel, a culture of silence and marginalization in healthcare [10]. They become the firmament for perpetuating all forms of sexual exploitation, harassment, abuse and violence. To tackle gender-based violence in public health, we must address its roots, not just the aftermath.

Gender norms, occupational segregation, and the blurring of public and private spheres

Globally, 70% of healthcare workers are women, yet leadership roles are predominantly held by men, perpetuating systemic inequities [11]. The gender-based occupational segregation within health systems is underpinned by ‘gender essentialism’ and ‘male primacy’, reflecting gender-based perceptions and stereotypes about women’s and men’s traditional roles in society at all levels – the household, community, organisational, and institutional [12].

The concentration of men in senior positions of power within healthcare creates a toxic hierarchy.

where sexual harassment and violence thrive. Although data on GBV against healthcare workers in.

India are unavailable, global studies reveal high prevalence of workplace violence and sexual exploitation, abuse, and harassment (SEAH) against women healthcare workers due to the prevailing gender-imbalance and male-dominated hierarchies within health systems [13,14]. In India, class and caste difference between doctors and mostly female nurses and community level front line workers exacerbates gendered consequences.

The false divide between public and private spheres traps women health workers in a cycle of discrimination. They enter private spaces for work yet face societal expectations to balance caregiving with professional duties. Public and private patriarchies work hand in hand to disenfranchise women in both spheres, pushing women into lower-paying, lower-status roles with heavier workloads, while men take on high-status, decision-making positions. This reinforces the gender divide in the workplace, limiting women’s career growth and opportunities.

Toward inclusive leadership and effective policies

Institutions must take responsibility for creating safe and inclusive workplace cultures. Legal frameworks like the POSH Act are crucial, but they are not enough. We require more gender equitable health systems, beginning with transparent grievance redressal mechanisms, accountability structures, and proactive training on gender inclusivity and diversity at all levels of clinical and managerial cadres. We need stronger policies to tackle both overt and subtle gender based discrimination in healthcare— from occupational segregation to inadequate security.

Gender-responsive leadership is key to transformation. We urgently need more women in leadership roles to drive change and challenge inequalities in healthcare [15] Leadership is not just about filling a position of power—it is about creating a culture that empowers everyone to succeed, regardless of their gender. Healthcare leaders, including and especially men in decision-making roles, must not only champion gender equity but also be held accountable for progress—or the lack thereof.