Gender and intersecting inequalities in access to health services

Timely access to good-quality, affordable healthcare (both preventive and curative) plays a critical role in maintaining good health. It is considered an important social determinant of health (WHO, 2019e). In the EU context, access to health services has been acknowledged as a right and recognised as a key principle of the European Pillar of Social Rights. In a survey carried out by EIGE, respondents ranked nine public services in order of the extent to which they enabled their participation in different everyday life activities[1]. The respondents, women and men alike, ranked health services as the most important type of public service and those that have the most transformative potential towards advancing gender equality in society. They create opportunities for people to be involved in education, employment and leisure (EIGE, 2020d).

Despite the EU standing out among industrialised regions for the health coverage of its population (OECD, 2019), universal access to health services is not yet achieved, and there are great variations in the level of access across the EU (Burns et al., 2019). Ethnic minority groups and migrant populations are seen to be over-represented among the population without, or with inadequate, health coverage (OECD, 2019). This section analyses which population groups are lagging behind in terms of access to health services and explores some of the reasons behind this.

Gender intersects with other social positions to hamper access to healthcare

Gender inequalities and gender norms intersect with socioeconomic, geographic and cultural factors and create structural barriers when accessing healthcare (WHO, 2019a). As highlighted in the domain of health chapter (Figure 22), several population groups, such as lone par­ents, older people, migrants and people with disabilities, and women in particular, stand out as highly vulnerable to unmet healthcare needs. Gender is an important determinant of healthcare access and uptake. Gender socialisation tends to deter men from seeking diagnosis and treatment, resulting in men being less likely than women to visit medical practitioners. A study in the United Kingdom found that men were 8 % less likely to consult a doctor than women, even when excluding consultations for reproductive reasons (Wang et al., 2013). The fact that women’s greater familiarity with the health and social services system is often attributed to the fact that they dedicate more of their time to childcare and long-term care.

Reasons for unmet needs and underutilisation of medical services

This section will touch on three main sets of factors inhibiting access to medical services, namely the cost associated with them, experiences of discrimination and issues related to cultural sensitivity and a lack of gender sensitivity.

While unmet needs for medical services is a self-reported measure and, as such, could reflect certain biases, exploring reasons why individuals are not accessing the medical services they need can point to certain important determinants and inequalities and how they affect certain groups in particular.


According to EU-SILC data, about one quarter of individuals who reported unmet medical needs gave cost as a reason for being unable to access care (‘Could not afford to (too expensive)’). The other most common reasons for unmet medical care needs were ‘Wanted to wait and see if problem got better on its own’, lack of time (‘Could not take time because of work, care for children or for others’) and waiting times. In the case of dental care, the proportion of unmet needs due to financial reasons is far higher: half of the respondents gave this as an explanation. Women were a little more likely than men to mention cost as the main reason for not consulting, for either medical or dental care (Chaupain-Guillot and Guillot, 2015). Likewise, the cost of healthcare is a reason why women in financially unstable situations avoid care services, for example those who experience homelessness (Kneck et al., 2021).

As highlighted in Section 7.2., on the domain of health, women aged over 65 are slightly more likely than women overall to experience unmet needs for medical services[3]. The share of women and men aged 65+ experiencing unmet needs is highest in Estonia (22 % of women and 15 % of men), Romania and Greece (18 % of men and 13 % of women)[4]. Difficulties in accessing healthcare in old age are related to the fact that women are at higher risk of poverty or social exclusion than men when they reach old age (EIGE, 2020g), which reflects the accumulation of economic inequality over the life course. This is of particular importance since women are more likely than men to experience health limitations in old age (Ogg and Rašticová, 2020). Among people aged 65 and older, the leading reasons for unmet medical needs are affordability, especially among women, followed by being on a waiting list. Men are more likely than women to delay medical examination in the hope that the health issue will resolve itself (Figure 37).

Discrimination and other systemic barriers

Accessing health services involves social interactions between patients and health workers in which societal power relations shape patients’ experiences (WHO Regional Office for Europe, 2016b). WHO’s 2019 global monitoring report on primary healthcare sheds light on how gender norms and power influence access to health services. The report found that gender norms and power relations influence women’s access to health services and timely diagnosis, while harmful notions of masculinity increase men’s risk-taking and reduce their willingness to use health services  (WHO, 2019f).

Age, wealth, marital status, ethnicity, religion, caste, disability, education level, homelessness and migration status can lead to stigma and discrimination, which influence access to and use of health services (WHO, 2019a).

A survey by FRA found that 16 % of respondents felt discriminated against by healthcare or social services staff because of being LGBTI in the preceding 12 months[5]. Trans and intersex people were the most affected, with 34 % of respondents reporting feeling discriminated against in a health context, followed by lesbian women (16 %), bisexual women (14 %), gay men (11 %) and bisexual men (10 %). Members of the LGBTI community are still, at times, refused healthcare services or experience discrimination, and many feel unable to be open with healthcare professionals about their sexual and/or gender identity, or about being intersex. In the EU-28, 46 % of LGBTI respondents reported that none of their medical providers was aware of their LGBTI status. However, this figure varied greatly by country, from 28 % in Denmark  to 82 % in Lithuania[6]. Discriminative behaviours experienced by LGBTQI individuals include stigma, denial or refusal of healthcare, and verbal or physical abuse. Knowledge and educational levels, beliefs and religion affect healthcare providers’ attitudes towards LGBTQI patients and can lead to homophobic behaviour (Ayhan et al., 2020). Heterosexism, transphobia and homophobia are barriers to healthcare service access; these phenomena are systemic factors, not just individual practices, and may cause LGBTQI people to avoid treatment altogether (Smalley, 2018).