Bargaining with patriarchy through the life course: obstacles faced (and overcome) by women leaders in Kerala’s health sector

Background: The COVID-19 pandemic has helped shine the spotlight on the role of women’s leadership in tackling the world’s health and health system challenges. Women are less often than men occupy positions of leadership in the health sector, even as they may constitute a vast majority of the work force. The South Indian state of Kerala is an exception to this trend, a phenomenon that we sought to understand and contextualise. We undertook a study to understand the personal and professional journeys of some women leaders in the Kerala health sector to determine the antecedents of their leadership positions, the challenges came their way of leadership and strategies adopted to overcome these challenges. We also investigated into how these experiences shaped their styles and approaches to leadership. Methods: : We employed a qualitative field research methodology like in- depth interviews among women leaders. Sixteen women leaders were identified from public records and through peer nomination and interviewed in their language of preference following written informed consent procedures. Interviews focused on participants’ professional and personal trajectories, work-life balance, style of leadership, challenges, enablers, lessons learned in their path, and their vision for the health system. Transliterated English transcripts were analysed using a thematic analysis approach and Atlas.Ti8 software by three researchers. Results: : Our study participants were aged 40 to around 80 years, from 8 out of 14 districts of the state. Women leaders in Kerala’s health sector faced challenges through the life-course: during their early school education, in professional service as well as in their roles as leaders. There were myriad experiences – including gender stereotyping and discrimination at the intersection of gender and other social identities. Women developed manifold ways of overcoming them and evolve unique – and again myriad - leadership styles. Conclusions: : Women leaders in Kerala have faced shared challenges through their life-course to climb up the ranks of leadership and have adopted manifold ways of overcoming them with myriad leadership styles. This reflects various patterns of bargaining with patriarchy, which in turn suggests a feminist consciousness on the part of Kerala women leaders as well as the society in which they are seeking to lead.