Hi,
It is only on rare occasions that I can follow a story of my choice. After all, we are to a large extent dictated by the news cycle, and reader preferences. So indulge me on this important story.
In this edition, we bring you an analysis of feminist health diplomacy. I wanted to explore what feminist health diplomacy is, and what it should be. For this story we spoke to several former and current health diplomats.
The topic also assumes greater significance in light of the forthcoming challenges in the politics and practice around sexual and reproductive health in many countries in the world, including the United States.
We understand feminist approaches in general, as efforts towards social, political, economic equality of all genders. For the purposes of this story, the discussion centers around the role of women and their leadership in health diplomacy.
The findings are universal. Do keep in mind though, that there are generalizations in the way women and men interact and work. But this does provide relevant pointers for reflection.
I am grateful for those who took the time to speak with me on this.
This story has been many months in the making. We’d love to hear from you - what do you think? Tell us!
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Priti
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I. ANALYSIS
Perspectives on Feminist Health Diplomacy
There was exasperation in the air, coupled with the usual hullabaloo that accompanies the proceedings of the World Health Assembly in Geneva in May 2024. Every year, 194 countries member states of the World Health Organization, meet to take stock and approve the agenda for global health.
Frustrated by the slow pace of the negotiations on the Pandemic Treaty in May 2024, a male senior diplomat from a developed country half-jokingly suggested, that consensus on the treaty could perhaps be achieved, if the negotiations were left to women, and the men walk out.
That conversation immediately brought to fore the role of women, not only in diffusing these contentious negotiations, but also overall in global health policy-making. Diplomacy for health has its own specificity, given the implications for women and girls, who constitute half the world’s population.
Further, the highly political and acerbic deliberations at WHO’s meetings of its governing bodies, including at the Executive Board (2024) and the World Health Assembly (2024), in recent years, sharply brings to focus the importance of women diplomats and experts. As health for all gets negotiated with the blunt instruments of votes, and what some say, the political use of cultural norms according to some, misogyny makes its presence felt in the hallowed corridors of power in global health.
The ability to exercise caution, discretion and empathy in these sensitive discussions also depends on the agency that diplomats, both men and women, have around the table. This is crucial as they represent, and speak on behalf of, the lives and choices of billions around the world.
This story examines, the opportunities for, and barriers to such agency, and how that impacts health policy-making.

WHAT IS FEMINIST HEALTH DIPLOMACY?
Well into the 21st century, the question gets asked what do women bring to the table.
While technical competence is a given, women also bring a range of skills that are decisive in shaping policy outcomes. These could range from simply “reading the room” and locating their interventions and actions in cognizance of how others are responding; they can be creative in their approaches to persuasion as a tool for effective diplomacy; they can also be intuitive and considerate in their interactions while being respectful of cultural boundaries. The seemingly feminine attributes do not take away from the fact that they can also be influential, straight forward and tough as the situation demands, several diplomats told us in frank and open conversations.
Feminist health diplomacy is also the way women bring their attributes to bear on difficult diplomatic situations. This could be pursuing less egotistical approaches, bridging the divide by reaching out across the aisle and by listening better, in order to diffuse tense discussions.
THE SPECIFICITY OF HEALTH DIPLOMACY AND THE IMPORTANCE OF FEMINIST APPROACHES
Goals for global public health can be negotiated as foreign policy, and in the realm of health. Experts are of the view that women-led health diplomacy can be especially helpful in meeting these overarching objectives.
Ilona Kickbusch, a lead actor in defining the field of health diplomacy said in a detailed interview:
“Ideally, global health diplomacy would want to reach certain goals that we have for global health, human rights, equity, and solidarity. Obviously, a lot of health diplomacy is a negotiation between those who want to go in those directions and those that don't.
Feminist health diplomacy, is similar to feminist foreign policy. A feminist foreign policy, would be closely aligned, and would need feminist health diplomacy, because then it would be linked to those goals of gender equity…. of my body belongs to me, and the human reproduction issues and all the things that are part and parcel of a feminist foreign policy.
And then it would also mean that feminist health diplomacy would not only be conducted by women. Of course, if you look at the debates like in the US now, you can see very closely that women's issues, driven by women actually then drive the overall agenda. And that's also something we want feminist health diplomacy (to do)… that it doesn't just fill gaps, but that it's actually a leader, a leader in the way that we really fulfill our commitments to health for all and an equitable world.
Values should be in the forefront. But at this point feminist health diplomacy seems to be relegated …the situation is dire. Take the latest news from Afghanistan for example. Feminist health diplomacy should lead because health is linked to human rights, about the possibility to live your life to the full. That's why speaking about health and well-being is so important. So, it's not just about health indicators in a narrow sense, but this broader package that you can live your life to the full and decide yourself.”
THE EVOLUTION OF WOMEN-LED DIPLOMACY
In a somewhat paradoxical development, things have gotten better, even as they have become worse. While there are more opportunities and awareness on women’s leadership and participation in international policy-making in general, the climate itself has become harsh.
For example, in 2024, more than 45% of the ambassadors appointed for the first time were women, the government of France has said. But some believe that this is not adequate, and is certainly not the case across many other countries.
Kickbusch is of the view: “First of all, there are still not enough top female diplomats, in practically all countries. And the same applies to foreign ministers. There are fantastic exceptions, but they too, when they're in the job, face tremendous difficulties.
There are more senior ambassadors today than there would have been five or 10 years ago. But definitely there continues to be a judgmental thing about female diplomats.”
Bente Angell-Hansen, a Norwegian former diplomat, who among other assignments in her career, also led the negotiations on the Pandemic Influenza Preparedness Framework, told us in a wide-ranging conversation:
“As a diplomat, I would say that up till about 2011, developments were overarchingly moving in a positive direction also for women health diplomats. Why am I saying 2011 because it was then that the Human Rights Council adopted their resolution on traditional values. This resolution introduced an exemption for women when it comes to universal human rights. I believe this was in part a response to the consensus mandate that we got in 2010 on addressing the discrimination against women in law and practice. I believe it is the responsibility of every government to ensure universal human rights and furthermore I cannot understand how any country rich or poor can afford not to give women the possibility to develop and utilize their full potential. It's such a waste of resources. At the core is equal access to health and education.
We are regrettably in a period where important rights are being weakened and ambitions in this area is eroding in many parts of the world. Looking back at the UN program for the least developed countries that we negotiated in the 1980s there was an important chapter on women that was quite progressive. I am not sure we could have negotiated such a chapter today in the present international climate.
A LACK OF TRUST
In addition to these challenges, diplomats also feel how much geopolitics and other factors have resulted in a lack of trust that impacts how diplomacy is practiced and conducted.
Angell-Hansen added:
“…Somethings have been essential since I began as a diplomat in the late 70s, and that is the importance of the human factor, the networks that we create among women, but also and equally important, the alliances we make with men. In my experience women negotiators and women in health diplomacy can do very well if we stick to certain ethical principles like transparency, respect and listening to all countries as a basis for building compromises. For me respect is key, because regardless of how much I disagree with a country's position, it doesn't mean that you should treat the person with disrespect. When aggression enters the negotiations, we never achieve positive and sustainable outcomes. We need to build trust and trust is sorely lacking today.
Trust in health diplomacy was eroded during and after COVID-19 but many other things have impacted on the trust factor, such as some of the rhetoric from politicians. There is a strong and urgent need to rebuild trust.”
THE ATTRACTIVENESS OF HEALTH NEGOTIATIONS
Experts are also of the view, that often there are judgments on what kind of issues should women diplomats be negotiating?
So, when it comes to health matters, while there is a need to make women’s voices, their issues and concerns heard, should it primarily be only women diplomats doing so? After all male diplomats play a crucial role, in the context of the wider push back on gender issues including at WHO. Many believe that it is important to have the “gender lens” on the issues being discussed. This is not uncontested.
These kinds of negotiations have become competitive and contested, diplomats told us. Typically, many health issues have been negotiated by women. But, according to some, the COVID-19 pandemic changed this.
A woman diplomat from a developed country told us that negotiating global health matters has assumed a security dimension. “A lot more men have been dominating global health negotiations since the pandemic. Because this concerns global health security. I think the balance has shifted the other way, it has shifted the tone, because we are negotiating hard law, a treaty…,” the diplomat said pointing to the coveted nature of these historic negotiations.
WHO member states negotiated the amendments to the International Health Regulations, that concluded in June 2024. These were adopted by the World Health Assembly last year. The negotiations for a new Pandemic Agreement have been ongoing for the past few years in the aftermath of COVID-19, and are expected to conclude in May 2025. (Half of the bureau of the Intergovernmental Negotiating Body to establish the Pandemic Agreement, is composed of women.)
These on-going negotiations have been protracted and difficult. Not very different from previous negotiations at WHO, diplomats said.
A FLASHBACK FROM THE PIP TALKS
Angell-Hansen, who played a prominent role in the negotiations for the PIP recounted:
“Looking back at the PIP negotiations one has to swallow a little rough language when people were tired and the stakes were high. I think women do this more easily and move on and don’t hold a grudge. As a woman chair, I would always focus on what we want to achieve and not let emotions and pride distract me. And then of course patience and more patience.
During the negotiations of the Pandemic Influenza Preparedness (PIP) Framework, my Co-chair and I, had decided that we would not achieve anything if we let grumpiness enter the room. We need to understand that it is not only about country positions it is also about procedure and emotions. This also holds true also for health diplomacy.”
WOMEN’S ATTRIBUTES IN DIFFICULT NEGOTIATIONS
Finding consensus in multilateral negotiations is fraught with difficulty given the diversity among member states, varying interests and pressures. Women do play a particular role in these settings, diplomats and experts said.
Angell-Hansen added, “It is always individuals who make a difference in the negotiations. Individuals that colleagues trust and who they are willing to close deals with. Often not only do they trust them, they also like them and have worked with them for some time. It takes time to build trust. It is always an advantage in a negotiation that you like people and that you are interested in understanding their positions and help find agreement. I have seen women being successful at solving difficult negotiations applying their human skills in combination with impressive knowledge of the subjects under negotiation. You need both. Women have promoted negotiating methods, created ownership and fast-tracked solutions. This injects positive energy into the negotiations.
Global health diplomacy is an area where it should be possible to reach agreements that hold benefits for all. But to do that we need real negotiations and not posturing. We need trust. A common understanding needs maturing the issues and creating ownership. It is hard work.”
She said that there was also a group of women diplomats who helped close the PIP deal. “There was serious resistance on some issues, so between sessions, we worked continuously to sound out positions and see what countries could accept.”
Kickbusch also emphasized not only attributes that women bring, but also how they are deployed. She said, “There is a lot of evidence that women make [a difference] in negotiations. We know from the security sector in particular, that the probability of reaching an outcome is higher if you have women in your group of negotiators. For example, there is a greater willingness to listen.
A lot of it is also how you do this, how you say things does make a difference. Women are more relational than men, and I think even when they are interested in power, they don't manifest it in a way that men do. Power is per se not a dirty word. The question is, how you manifest it, use it and if you want power to affect change.
I do think women are, in general, more committed to cooperation, multilateralism, interventions. But there are always examples to the contrary.
It seems that the women will try more sort of informal line first, and then try to see how much is possible. Of course, once you're in the negotiating setting, you do have to follow your capital's direction. Which is why, whether it's called a feminist foreign policy or not, one of the things one needs to push for, also from the outside, is that women's rights and everything that comes with it is a foreign policy goal. In global health negotiations we must make the equity and human rights agenda very concrete, certain rights must be non-negotiable.
This also applies to female heads of states or foreign ministers…but of course there is always a public and a confidential part of negotiations.”
TOOLS AND STRENGTHS OF FEMALE DIPLOMATS
To understand, how current day diplomats deal with pressures on the negotiating floor and elsewhere, we spoke with several Geneva-based women diplomats with global health portfolios.
Women seem to be more open to crafting compromises but not necessarily giving the interests of their capitals away, many of the diplomats we spoke with were of the view.
PROBLEM-SOLVERS
A woman diplomat from a developing country said, “I think, from my experience, sometimes women try to get to the outcome in a different way compared to men, for example. From my experience, when I did a resolution, I was the chair at the time, and I had someone who is male and more senior, who had an opposing view. I tackled it in a different way, where I decided to meet this person. I wrote to him and said I would like to meet you and discuss about it. And so, I met with this person and it helped. So sometimes women are not egoistic in a sense. I'm the chair, or you're the one who has the problem, so you should come see me. But my goal was, I need to get this done.”
In general, women speak of other women diplomats as “problem-solvers”. They are more likely to reach out to those even beyond their regions, than compared to men, some were of the view. “We are more likely to move things around. When you negotiate, you need allies, right? I am now also more open to explore reaching out to even those who are not likely to agree with me,” the diplomat said.
This was a view also echoed by the developed country diplomat as well.
BETTER LISTENING SKILLS
There was also a general perception that on many occasions, women can be better listeners.
“Usually, women tend to be better listeners. Sometimes, men can get incredible excited, they like to listen to their voices more. It is as if there is a lot of ego in it for them. But if everybody is talking and there is less listening, it does not lend itself [to more understanding]…” the developed country diplomat who has spent years negotiating in global health said. She also clarified that these were broad generalizations, admitting that women also tend to speak more sometimes.
Women are also more likely to come in later in a discussion, sources shared. “From what I've seen, it tends to be easier for women to look at the multiple sides, and try and come up with something else. So, while male voices are more dominant, that may not always be the way to come to a solution,” the developed country diplomat added.
CREATIVITY IN NEGOTIATIONS
What does being creative mean, particularly in difficult situations?
All diplomats receive instructions from the capital, broadly with certain amount of flexibility. “The instructions are kind of an invitation to give you a sense of what the interests in the capital are. They are not like hard and fast. This is what we must have. I feel like it's my job as a diplomat to work out the best way to meet what I think our interests are in a way that also meets everyone else's interests. I don't think it's my role as a diplomat to kind of push our position to its absolute limit and repeat it and repeat it. But people have different views of their roles as diplomats, whether that is, whether that probably partly and really fundamentalist. Maybe men feel like their role is important to project the national position. [But] I'm there to find a multilateral solution, so I can be creative in that space” the developed country diplomat said.
READING THE ROOM
Women also shared experiences of quite literally reading the room, picking up signals, body language, and being sensitive to people and proceedings.
“I remember when I was in the IHR negotiations…we always sit around the round table, so you can see the opposite side. The diplomat from a large country who was right in front of me, proposed some text and was looking at me, as if gesturing for me to support his position. I took the floor and lent support because I agreed to it. So, we have this intuition also…” the developed country diplomat said.
Women also shared experiences of when to “back off”, when things got heated up in formal sessions. But this may not often be the case with men, some suggested.
FINDING THE MIDDLE GROUND
While many diplomats both men and women, can stick to their positions, the latter seem more amenable to finding middle ground, sources told us.
“Sometimes, I feel I share a middle position between two extremes in a difficult discussion. There can be advantages, because probably some women are more inclined to have that conversation and try to find middle ground. But tough negotiators, usually men, do not want to compromise. So, women are probably more inclined to move first compared to men,” the developing country diplomat said.
…I am certain women diplomats were and are as good at defending their country´s position as men. Negotiations is also about finding countries with similar positions as you have and working together. Women are generally good at that.”
LETTING OTHERS TAKE CREDIT
There are common themes emerging from experiences women diplomats shared including on drawing solutions by letting others seemingly drive the process.
“Even if we are co-chairing, there are suggestions that we are playing the role of a mid-wife. But for me, as long as the work gets done, I am fine with it. I do not mind, if male colleagues think it is they who are running the things. Sometimes it's easier to let the person think they're running than throwing it down. Depends on what your priorities, right?” the developed country diplomat added.
WHEN THE PERSONAL BECOMES THE POLITICAL: NEGOTIATING ON WOMEN’S HEALTH
In addition to fighting stereotypes that many women face, diplomats are increasingly encountering a harsh political climate when it comes to sexual and reproductive health, for example.
That this unfolds in clear and unequivocal terms at the UN’s only technical agency - the WHO, has caused more consternation among any one concerned about safeguarding rights of women and girls.
In May 2024, countries also debated the resolution on Strengthening health emergency preparedness for disasters resulting from natural hazards. (76 in favor, 8 against). The heart of the disagreement was language on gender in this resolution.
There was also a persistent lack of consensus on inducting the Center for Reproductive Rights (CRR), into official relations with WHO. Countries spoke in highly emotive tones on reproductive rights of women. And how some member states saw working with the CRR as a threat to their cultural and legal systems.
On June 4, countries went through protracted discussions, including voting through secret ballot in order to decide on the CRR. In fact, they also had a vote on whether would adopt the method of secret ballot to reach such a decision. Finally, the draft decision was adopted after a bitter debate between countries. Some of the exchange was perceived by many as aggressive and dominated by male perspectives.
Several countries including from WHO’s Regional Office for the Eastern Mediterranean, and the 47-member WHO African Group, said that they would take this discussion further.
A number of diplomats from these countries are also represented by women. So how do diplomats reconcile their personal beliefs with instructions from their home countries, especially on contentious issues like sexual and reproductive rights?
“Yes. It can be a difficult thing to do, because sometimes we don't even know what we're talking about. Are we talking male and female or more groups when we talk about gender? So that's the first question, because it’s decided on that. So, some will take it as including LGBTQ groups, but others would perceive it as male and female. It's according to context. For example, you have data to show women are more infected, or women are more impacted when it comes to natural hazards, it is backed by evidence. So, when it comes to gender issue, it is important to understand the context, what's on the ground and support based on that. But not to think, it is an ideology thing,” the developing country woman diplomat said.
Sometimes gender issues also boil down to egotistical contests between countries. And women diplomats are not comfortable with that, some were of the view.
Referring to the live wire discussions on the resolutions during the WHA, the woman diplomat from a developing country said, “While we would support neutral language, we had to think, how to approach without going to the extremes. We did not want to simply prove a point, and we're not that kind of extreme, you have to use other tools.”
Describing such proceedings, the developed country diplomat said, “That was tricky. You know the tension in the room, and you have to walk up to this colleague and talk to him. How to negotiate that? What is the strategy going forward? Because obviously this is something that's going to keep growing, and certain countries will not back off. But this is, really not only women diplomats, but in general, everyone around the table. It is really depressing and really difficult. I mean, it's not something we can't afford to let go. So, we are working it out pragmatically, on a case-by-case basis, what is the best solution? So, nothing that we produce, from a government's perspective, should stop WHO from doing what it needs to do, like the practical outcomes for women's health.”
So, what is the way out?
THE USE OF BACK CHANNELS
Diplomats suggested using back channels to diffuse these kinds of situations including by meeting outside the forum, setting up informal sessions, and trying to strike a balance. Some emphasized the importance of the formulation of words and the difficulty in making all sides happy. “These issues get people upset and exercised. But this is not a mental game. This really affects people's health,” a woman diplomat said.
Some suggested continuing to strategize among those who care about these issues and to wait for the tide of such politics to turn.
But what happens in the meantime?
Angell-Hansen said: “I regret these regressive developments. I believe these debates need to be taken at home in our countries, in local communities and around the kitchen table. I see that many young women take present day rights for granted and a pleased with what my generation achieved. But I continue tell the young you cannot take anything for granted you must be ready to defend what you have. There needs to be a fact based raising of awareness. Women must defend and work for their rights, not only in the health area but also others such as education and equal pay for equal work.
To the negotiators I would say, we cannot accept to negotiate rights away and we have core documents that everyone should read and be reminded of, such as the UN Charter, the Universal Declaration of Human Rights, the WHO Constitution and the UN SDGs. None of these documents discriminate against women and girls, on the contrary and they overarchingly guide any UN negotiation to promote equal rights and equal treatment. Any global health negotiation is also about fulfilling the objectives of these documents. This cannot be negotiated away. If I was a present-day chair these would be the red lines and I would focus on what can unit us and not what divides us.”
BARRIERS FOR WOMEN
Apart from prevailing politics, diplomats also face certain barriers. While meritocracy is a preferred criterion, diplomats are also cognizant of the unequal playing field for women.
“A lot of top-level positions are male dominated ones. But I think I prefer meritocracy based on competencies or experience, based on skill,” a woman diplomat from a developing country told us.
At the same time, the unspoken burden on women is seldom acknowledged. “Women have caring responsibilities, often due to family circumstances. They are taking on more roles. So, while in theory, everybody is equal but women still tend to bear more of the burden than men. This is not a structural consideration. When there are late nights, you know, we are like, ‘hey, we need to go over to our kids.’ But we need to just keep going, regardless what you're doing”.
Like other multilateral negotiations, health negotiations in recent months and years, often stretched into the small hours of the night.
ON NETWORKS, AND ARE WOMEN MOVING OUT?
Given the challenges women face, diplomats have built networks to support each other, experts said. But many are also giving up, unable to take the pressures that come with the job.
Kickbusch said, “Female diplomats have built networks, and that's something relatively recent, with the exceptions of Nordics who started earlier. Particularly at the UN or in Geneva, women diplomats take the initiative to come together with other women diplomats and, discuss the issues on the table and how they can move agendas forward - … they wouldn't probably call it a feminist approach.
We must also consider though foreign policy and diplomacy is a tough environment in every way. Women can meet with quite intense opposition, even hatred, and of course disrespect. This can be intense and even dangerous. It can be extreme on-line. The hatred expressed towards the German foreign minister on-line is extreme for example.
I think it's really gotten worse, and combined with the geopolitical rise of autocracy we witness a revival of patriarchy. You don't resolve this by just being nice.
And yes, you need the male allies. It's noticeable that many of the strong women seem to have great husbands. I remember meeting with young women professionals in Geneva with Gro Brundtland, and one of them asked, what's your advice as we embark on a career. So Gro says, find the right husband. First the audience was shocked. What’s this feminist telling us to have a husband? Right? And then she clarified: you need somebody that supports you. It's really difficult to go through this alone. No matter what gender, what she wanted to say is, if you choose a partner, choose wisely, because if you're going out on a career, subjected to these dreadful things in your work life, you've got to be picked up and carried at home. And I think still, many women who embark on this journey may underestimate the amount of backlash and the amount of support they need.
And we are seeing that women are moving out as the attacks mount and they decide they don’t want to fight this fight any longer.”
TAILPIECE:
To be sure, diversity and inclusion is much more than merely sitting at the table, or merely being heard. It is about agency, and taking the opportunities to shape outcomes that reflect certain kinds of unique sensibilities. The topic is complex also given race, identity and other intersectionalities in this conversation. There is a long way to go, especially in uncertain times as these.
RELEVANT REFERENCES:
Towards a Feminist Global Health Policy: Power, intersectionality, and transformation
Eger H, Chacko S, El-Gamal S, Gerlinger T, Kaasch A, Meudec M, Munshi S, Naghipour A, Rhule E, Sandhya YK, Uribe OL. Towards a Feminist Global Health Policy: Power, intersectionality, and transformation. PLOS Glob Public Health. 2024 Mar 7;4(3):e0002959. doi: 10.1371/journal.pgph.0002959. PMID: 38451969; PMCID: PMC10919653.
Feminist Diplomacy Shifts Mindset ‘Away from Confrontation, towards Dialogue, Engagement, Cooperation, Peace’, Underlines Deputy Secretary-General
https://press.un.org/en/2023/dsgsm1875.doc.htm
How Global Politics Exploits Women’s Health https://www.e-ir.info/pdf/106215
Yukta N contributed with the production of this story
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