The war on equality

Equality feels like oppression to those accustomed to privilege, the adage goes. To certain petty political leaders and their supporters, it must. There is no other explanation for the current erasure of support for diversity and inclusion efforts, which are known to equalise opportunities and bring benefits to societies, economies, science, and health. Redistributing resources, sharing power and privilege, recognising unearned advantages—these strategies are in the recipe for health equality and leadership. None apply in the authoritarian playbook. The present war on equality demands action from us all.

In the United States the expurgation of equality has been swift under Trump 2.0. “Anti-DEI” policy has led to the federal health funder mass terminating grants for studies of inequalities (doi:10.1136/bmj.r476) and to global health organisations based in the US removing language to do with gender equality, diversity, and inclusion from their websites (doi:10.1136/bmj.r468).12 On 4 March the US denounced the world’s sustainable development agenda and confirmed that 83% of its foreign aid funding through USAID was cancelled. On 8 March, international women’s day, the New York Times reported that even the word “women” was being erased by US policies (https://www.nytimes.com/interactive/2025/03/07/us/trump-federal-agencies-websites-words-dei.html).3

In fact, the war on equality is synonymous with the devastating war on women. Under the guise of strengthening traditional family values and appealing to conservatives, US foreign and domestic policy has drastically removed reproductive rights and bodily autonomy from tens of millions of women worldwide, with deadly consequences: 12 million women and girls denied healthcare, more than four million unintended pregnancies, and nearly 8500 maternal deaths came in the first 90 days of the USAID freeze alone, the Guttmacher Institute estimated (doi:10.1136/bmj.r459).4 Restrictive abortion laws have reduced access to safe obstetric care (doi:10.1136/bmj.r489).5 Horrifyingly, abortion is being considered as homicide in nine US states, in eight of which the penalty for homicide is death (doi:10.1136/bmj.r481).6

Deadly US policies are exported globally. The Geneva Consensus Declaration, a US led anti-rights blueprint developed in the later stages of Trump 1.0, which now has the support of at least 36 other nations, including Brazil, Egypt, Hungary, Indonesia, and Uganda, is committed to abolishing DEI, gender equality, abortion, contraceptives, and comprehensive sexuality education. The declaration is also intended to provide the platform for a new global order, one based on a religious and conservative ideology advancing traditional family roles and pro-natalism, eroding health and human rights, and dismantling multilateralism (doi:10.1136/bmj.r459).4 As a European parliamentary forum reinforces (https://www.epfweb.org/node/1124),7 Trump 2.0 is not only reshaping policy to deny sexual and reproductive rights for women: these moves are part of its larger authoritarian push to consolidate a far right global regime. The fight for women’s rights and gender equality is literally the fight for democracy.

In the context of this chaos, what does response and resistance look like?

For researchers and clinicians, instead of anticipatory obedience to anti-gender and anti-DEI threats Amy Gottlieb and Reshma Jagsi urge medical and scientific organisations to follow the data, think critically about the consequences of our decisions, reaffirm shared values, and expose untruths and injustices (doi:10.1136/bmj.r468).2 In clinical research, actions can include more deliberate (and defiant) inclusion of ethnic and racial minorities. Sonia Anand and colleagues lay out how funders, regulators, trialists, and journals can enable diversity and inclusion actions to bring effective treatments to people from all ethnic groups and thus narrow health inequalities (doi:10.1136/bmj-2024-082485 doi:10.1136/bmj-2024-082486).89

For leaders in global health the US’s retreat provides an opportunity to reframe foreign aid, equalise global north and south relations, and centre local health needs. African governments and civil society must insist on partnerships on their own terms and on controlling what gets funded, rejecting processes that undermine health systems and self-sufficiency, argue Catherine Kyobutungi and colleagues (doi:10.1136/bmj.r479).10 Crucially, African leadership must also protect and advance women’s health and rights, which are being eroded across the continent, buoyed by Trump 2.0 (doi:10.1136/bmj.r305).11

For women’s rights advocates, strategic mobilisation against threats has never been so urgent. This week in New York the United Nations convenes its Commission on the Status of Women (CSW) to track progress on promises on gender equality made by member states in the historic 1995 Beijing Platform for Action. Thirty years on, there is improvement in women’s health and rights but not nearly enough, and gains are tenuous: UN Women reports that maternal mortality fell by a third but has stalled since 2015. Women’s representation in parliaments has more than doubled, but women still have only 64% of the legal rights of men, and just a quarter of law makers are women.

The gender equality mobilisation at CSW coincides with the 80th anniversary of the UN and the kick off of the leadership race for its top job, secretary general. A movement is building to elect a woman for the first time (doi:10.1136/bmj.r414).12 As the world faces growing polycrises and unrelenting conflicts, the UN has been criticised for failing to speak out against atrocities and rights backlashes. The stakes couldn’t be higher. New approaches and fresh leadership are needed, which a Madame Secretary General can bring.

The BMJ stands unequivocally for equality and integrity, and we will not acquiesce to political orders (doi:10.1136/bmj.r253).13 We strongly reaffirm our EDI strategy (https://bmjgroup.com/our-equity-diversity-and-inclusion-promise),14 which forms the foundation of the journal’s mission for a healthier world for all. As our audience and content globalise, we are committed to ensuring the gender equality, diversity, and inclusion of our staff, communities, contributors, and partnerships. Together we will fight for equality, for human rights, and for the shared values of health and opportunity.