Who designs the Empty Chair for Women in Health care?

by Dr. Eros Tsegaye, MD MPH - GEIGS Advocacy Member

The Early Stage of the Motherhood Penalty

She had done everything right.

The day began as it always did. At a busy university teaching hospital in Africa, after the early-morning session with the resident doctors, she walked back to her office. She hung her white coat on the coat rack by the door, wiped her desk with a soft cloth, and opened her laptop. Emails waited, documents needed signatures, and the quiet rhythm of the day began again. It was a routine she had followed for years. But behind that routine sat a surgeon who had spent years at the operating table and now carried a larger ambition: to shape the system itself.

Her trajectory had always seemed clear. Two weeks earlier, she had been on leave for her wedding. After years of long shifts, night duties, and operating rooms, it was a rare pause in a life built around medicine. Almost everyone from the hospital had been there, colleagues, residents, department heads, and directors, celebrating with her. When she returned, nothing had changed in her spreadsheets. Her performance remained as sharp as ever. Her availability had not changed.

But opportunity had. Multi-year projects quietly moved elsewhere. A regional leadership role went to a male colleague with similar qualifications and experience. Informal strategy conversations began happening without her. When she asked about the shift, the answers came gently wrapped in reassurance. “You’re doing excellent work.” “This isn’t about performance.” “We just want to be mindful of your new phase.” It sounded supportive. Nothing official excluded her. No policy blocked her advancement.

Yet over time, the pattern became difficult to ignore. The projects that build visibility no longer carry her name. The stretch assignments that signal executive readiness went to others.

Nothing in her work had changed. What changed were the expectations around her future.

This is how institutional bias quietly takes hold, not through formal decisions or written policies, but through small adjustments in opportunity. For women, the interpretation often changes. Long before motherhood arrives, expectations begin to adjust around the possibility of it.

And slowly, the system begins to create an empty chair she has not yet left.

Where Do the Women Go Along the Way?

What happened to her is not rare. Women make up nearly 70 percent of the global health and social care workforce. They are present across clinics, wards, operating rooms, and community health programs that sustain daily care.

In Sub-Saharan Africa, the numbers entering medicine are increasingly balanced. In several countries, women now account for around 40–50 percent of medical graduates. Yet, their representation narrows sharply in senior academic and hospital leadership roles, where they often hold fewer than one in five positions as full professors, deans, or teaching hospital executives. And internationally, a similar pattern appears. 

The difficult question is: is this a woman's problem, or is the system itself creating the empty chair? This is not about who enters the system. It is about who rises within it.

If She Were a Superwoman, Would There Be an Empty Chair?

She stayed in the system, even as expectations quietly shifted around her. Then she became a mother for the first time, returning to the same hospital corridors while learning a new life of sleepless nights, recovery, and the quiet weight of guilt that many new mothers carry.

In many African health systems, maternity leave lasts only about fourteen weeks, and structured supports such as hospital childcare, mentorship for physician mothers, or peer support networks remain uncommon. She continues, carefully organizing work, motherhood, and exhaustion, admired for managing to hold everything together despite it all.

But her resilience raises another question: are those who step away truly weaker, or are they facing a system that was never designed for them to stay? And if the chair becomes empty, did they leave it or was it quietly designed that way from the beginning?

Who Can Bring Her Back to the Table?

The empty chair is rarely created in a single moment. It takes shape slowly, through assumptions, expectations, and systems that were never redesigned as the workforce changed. Women continue to enter medicine, train, and sustain the daily work of care.

But when that chair remains empty, the loss goes far beyond one career. Health systems lose clinicians they have trained, younger professionals lose mentors, and patients face the reality of fewer caregivers. In places already struggling with shortages, an empty chair can mean longer waits, less care, and sometimes lives that could have been saved.

The real question, then, is whether our institutions are built only for women to arrive, or whether they are designed for them to arrive, thrive, and live fully within the work they have committed their lives to.

And perhaps the most important question of all is this: who is willing to bring her back to the table?