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By Rachel Horton
This blogpost draws on a report (the ‘Commission Report’) co-authored by Professor Tamara Hervey and Dr Rachel Horton on behalf of the European Commission and presented in Brussels at the Legal Seminar of the European Commission in November 2025 and at the EQUALS conference in Utrecht in February 2026. The report includes data gathered from the legal experts in gender equality in the European Equality Law Network, covering all the 27 European Union Member States plus the UK, Iceland, Liechtenstein and Norway.
Introduction
Across Europe, there are significant and persistent problems of gender inequality in access to healthcare. These are now receiving increasing academic and policy attention and give rise to important questions about the role of law – equality law, in particular – in addressing them.
Sources of gender inequality in access to healthcare
Gender inequality in healthcare takes several forms. First, some areas of healthcare, relevant to gender equality, such as reproductive care, contraception as well as preventive care and screening are not always covered, or fully covered, by national insurance arrangements meaning access is restricted for those who cannot afford to pay or insure privately. A lack of facilities in rural areas and of professionals in certain specialisms, including obstetrics and gynaecology, together with other administrative and legal barriers, can mean access to care is unequal even where publicly funded.
Second, there is a lack of gender sensitive research and data. This leads to poor understanding by clinicians of conditions which predominantly affect women, such as endometriosis, and poor understanding of the ways in which conditions present differently in men and women, such as cardiovascular disease. The result is deficiency and delays in diagnosis and treatment.
Third, there is evidence that women face discrimination at the point of care including what is sometimes referred to as ‘medical gaslighting.’ Research published in the Lancet in 2024 found that women ‘are more likely to encounter scepticism regarding the severity or legitimacy of their symptoms as a result of gender biases’ and that healthcare professionals may attribute women’s pain to psychological or hormonal factors rather than seek to understand the underlying medical conditions.
Finally, there is evidence of sexual harassment and assault. A report from the UK, for example, found that more than 6500 rapes and sexual assaults have been recorded in hospitals in England and Wales, over the course of four years. Obstetric violence which can include denial of pain relief and physical intervention without consent during childbirth, is now recognised as a serious concern in some countries, including in Portugal where obstetric violence has been described as a public health problem.
As in other areas of life, these problems are often magnified for those at the intersection of different protected characteristics. Particularly vulnerable are girls, very young or older women, those with disabilities, and women with migrant or refugee status.
The role of EU anti-discrimination law
The Goods and Services Directive prohibits gender discrimination in access to healthcare. While there are some important gaps and exceptions, the view of the national experts in the Commission Report is that the Directive has been implemented in the national laws of the Member States in respect of healthcare. In principle, this offers a remedy for at least some of the problems identified above (although, importantly, it remains ill-equipped to deal with intersectional discrimination.) Other ‘Gender Equality’ Directives, including the Social Security Directive and the Directive on Violence Against Women, also have a potentially important contribution to make. However, at least as things stand, this body of equality law appears unlikely to be able to tackle gender inequality in healthcare for two main reasons.
First, many of the problems that need to be addressed are structural and systemic. Existing EU anti-discrimination provisions cannot tackle, for example, the lack of research and data and the poor institutional coordination which underlies so many of the problems identified above.
Second, even where the existing legal framework is capable in theory of providing a remedy, evidence suggests that enforcement in practice is highly problematic. The almost complete absence of both case law and relevant enforcement action by equality bodies and other institutions regulating healthcare in all of the countries we drew data from is striking. The difficulties of proving discrimination in any context are well known but these can be exacerbated in the case of healthcare. As noted in a recent report by the French Defender of Rights (Défenseur des droits), discrimination (on any ground) in the context of healthcare provision can be particularly hard to recognise because ‘the ethical requirement to treat all patients, and the seemingly neutral medical knowledge that underpins medical practices, contribute to making discrimination in care invisible’ (p. 5 – the translation from French to English belongs to the author of this piece).
Evidence in the Commission Report also suggests that there is a general lack of effective complaint mechanisms in healthcare settings which, together with fear of victimisation, may both deter individuals from seeking redress and make it more difficult to identify and address recurrence and patterns of discrimination and inequality. Reliance on existing mechanisms of individual enforcement are therefore unlikely to be able to bring about the changes necessary.
Next Steps
While the EU gender equality Directives do have a contribution to make, it is unlikely that, at least in their current form, they will prove capable of effecting the change required. Positive duties on relevant institutions, and a focus on gender mainstreaming in the design and commissioning of healthcare services, of healthcare research and of professional training, as already exist in a number of countries, are likely to be needed, The Commission Report identifies a range of options already in the EU legal toolkit – including, for example, competence in regulation of data, of professional qualifications, and of cross border healthcare - which, together with the obligations on gender mainstreaming, may offer creative ways to tackle some of the specific problems identified above. The full report explores these possibilities at length.
Bio
Rachel Horton is an Associate Professor in Law at the University of Reading, UK and the UK gender expert on the European Equality Law Network.