Feminization of the health workforce in China: exploring gendered composition from 2002 to 2020

Abstract

Abstract Background Feminization and gender diversity of the health workforce has been global documented and has stimulated wide discussion, but it has not been investigated in China. This study aims to analyze the change of the gendered composition of health workforce, and explore the trend in different professions and different health organizations within China’s hierarchical health system. Methods The data were collected from China Health Statistical Yearbook from 2002 to 2020. We focused on health professionals, doctors, nurses, pharmacists, and management staff in health organizations. Trend analysis was employed to examine the change in the ratio of female health workforce over 18 years. The estimated average annual percent change (AAPC) was estimated, and the reciprocals of variances for the female ratios were used as weights. Results The number of health professionals in China increased from 4.7 million in 2002 to 10.68 million in 2020. The number of health professionals per 1000 population increased from 3.41 in 2002 to 7.57 in 2020. The ratio of female health professionals significantly increased from 63.85% in 2002 to 72.4% in 2020 (AAPC=1.04%, 95%CI 0.96%-1.11%, P<0.001). Female doctors, pharmacists, and management staff increased 4.7, 7.9 and 3.5 percentage points from 2002 to 2020, respectively. Female health workers at township health centers, village clinics, centers for disease control and prevention had higher annual increase rate (AAPC=1.67%, 2.25% and 1.33% respectively) than those at hospital (0.70%) and community health center (0.5%). Female doctors in traditional Chinese medicine, dentistry and public health had higher annual increase rate (AAPC=1.82%, 1.53% and 1.91% respectively) than female clinical doctor (0.64%). Conclusions China’s health workforce is mainly composed of women, and has been feminizing steadily over the last 18 years. Health workforce in rural areas has been feminizing faster than urban areas. Marginalized professions like doctors in public health and traditional Chinese medicine have been feminizing at a faster speed than the prominent professions in clinical medicine. Gender equity， especially on pay gaps, should be considered in policies over the career course for health workforce to foster a more supportive environment to improve gender diversity.