Gender pay gaps in nursing and midwifery: Evidence from cross-country comparative analysis

Gender pay gaps persist across labour markets and are particularly consequential in nursing and midwifery, two of the most feminised health professions globally. Pay disparities in these occupations undermine gender equality, contribute to the undervaluation of care work, and risk weakening health workforce sustainability and health system performance. Despite their importance to both gender equality and health systems, comparative cross-country evidence on pay gaps in nursing and midwifery remains limited.

To assess the magnitude, distribution, and structure of gender pay gaps in nursing and midwifery across countries at different income levels, and to examine the extent to which disparities can be attributed to differences in observable characteristics versus structural or institutional factors.

Cross-sectional, cross-country comparative study.

Twenty-seven countries spanning low-, middle-, and high-income contexts, using nationally representative labour force surveys.

Wage-employed nursing and midwifery professionals and associate professionals (ISCO-08 codes 222 and 322) working in human health, residential care, and social work activities without accommodation.

Gender pay gaps were estimated using three complementary approaches: (i) descriptive analysis of raw and factor-weighted differences in hourly and monthly earnings; (ii) multivariable regression models; and (iii) distributional decomposition combining propensity-score reweighting with unconditional quantile regression to separate explained and unexplained components across the wage distribution.

Raw, unadjusted estimates indicate gender pay gaps favouring men in many countries, but these measures often provide an incomplete and sometimes misleading picture due to occupational clustering and workforce composition. After accounting for compositional differences, pay gaps narrowed or reversed in several low- and lower-middle-income countries, with notable exceptions. In contrast, in most upper-middle- and high-income countries, gender pay gaps persisted after adjustment for socio-demographic and job-related characteristics, with men earning more than women in comparable roles. Distributional decompositions show that a substantial share of observed pay gaps remains unexplained by these characteristics in several countries, while regression analyses confirm statistically significant conditional pay gaps.

Gender pay gaps in nursing and midwifery are widespread but highly heterogeneous across countries. Raw pay gaps alone are insufficient for understanding inequality in these highly feminised occupations, underscoring the importance of robust, context-sensitive analytical approaches. Where pay gaps persist after adjustment, they point to structural and institutional factors related to wage-setting and progression. Addressing these disparities is essential not only for gender equality but also for the retention, motivation, and long-term resilience of the nursing and midwifery workforce and the health systems that depend on them.

Not registered.

Gender pay gaps in nursing and midwifery persist across 27 countries. Raw pay gaps often provide an incomplete picture, while adjusted analyses reveal substantial unexplained disparities, particularly in upper-middle- and high-income settings.