Recently, I found myself in Taraba (but that’s not the point yet), in deep thought, reflecting on why women sometimes seem to age considerably faster than the men around them. My curiosity raced: if women generally have a biological survival advantage and live longer than men, what exactly is going on?
Then I came across a term that stopped me: the male-female health-survival paradox, also known as the morbidity-mortality paradox. In simple terms, it describes a fascinating contradiction: women tend to live longer than men, but spend more of their lives living with illness, disability, or poorer health.
And that got me thinking. What if the question is not simply how long women live, but how well they live those additional years?
This is where I want us to take a deeper dive. Because while biology may give women a baseline survival advantage, socioeconomic conditions, health systems, and the way societies structure women’s lives can profoundly shape what happens to those extra years. In other words, women may have the advantage in lifespan, but the real question is whether we are doing enough to protect their healthspan.
Why Women Live Longer but Not Necessarily Healthier
The caregiving penalty is one of the first places where this paradox becomes visible. Women carry a disproportionate share of unpaid domestic and caregiving work, and over time, caring for everyone else can come at the expense of their own health. The physical strain, chronic stress and exhaustion accumulate, while women often defer their own healthcare, postponing medical appointments, screenings or attention to persistent symptoms while caring for children, spouses or ageing parents. There is also an economic cost. Time spent outside the formal workforce to provide care can interrupt career progression and reduce the income, savings and assets women accumulate across their lifetimes.
This connects directly to systemic barriers to healthcare access. Women are more likely to work in lower-paid, informal or part-time employment, often without comprehensive health coverage, making the management of chronic conditions financially difficult over many years. There are also gaps within healthcare itself. Medical research has historically relied heavily on male models, leaving important gaps in understanding how some conditions present in women. As a result, women can experience delayed diagnosis or have their symptoms dismissed, particularly when dealing with chronic pain and complex conditions. And in many low- and middle-income settings, access to healthcare depends on more than whether a health facility exists. It depends on whether a woman has the money, transport, time and decision-making power to actually use it.
Then comes what I think of as the cumulative old-age trap. Living longer does not automatically mean living better or living with greater financial security. If women spend their working years earning less, accumulating fewer assets and taking time out of the workforce to care for others, their additional years of life can also become additional years of financial vulnerability. They are also more likely to outlive their spouses and experience widowhood in later life. After spending much of their lives caring for others, some women eventually reach old age without the same care, financial security or social support they once provided to everyone else.
And that, perhaps, is the uncomfortable side of the longevity story: women may be winning the race for survival, while losing too many of the conditions that make those extra years healthy, productive and dignified.
So, What Would It Take to Close the Healthspan Gap?
Universal childcare: Reliable, affordable childcare is not only a family-support policy; it is a women’s health intervention. When women have predictable support for caring for young children, they have more time for work, rest, healthcare, and self-care. It can reduce the psychological strain associated with constantly balancing caregiving and employment, while also making it easier for women to remain economically active. Over time, this can improve both wellbeing and financial security.
Paid family and sick leave: Women should not have to choose between caring for themselves or an ageing parent and keeping their income. Paid sick and family leave can reduce the physical and psychological wear associated with managing family health crises while working. Paid maternity leave is equally important, particularly in reducing postpartum stress and depression and giving women a healthier physical and emotional foundation from which to return to work.
‘Daddy quotas’ in parental leave: If we want to reduce the lifelong caregiving burden carried by women, we also have to change who provides care. Reserving a portion of parental leave specifically for fathers, on a use-it-or-lose-it basis, encourages men to participate in caregiving from the beginning. This does more than support fathers; it establishes a more balanced distribution of household responsibilities and can reduce the cumulative physical and psychological burden women carry over decades.
Gender-responsive universal health coverage: Universal health coverage must recognise that removing the cost barrier is not enough if women’s specific health needs remain invisible. Health systems should deliberately incorporate preventive and reproductive health services, alongside screening and management of conditions that disproportionately affect women across the life course. When women can access care without having to weigh the cost against competing household needs, they are more likely to seek care early rather than waiting until a condition becomes harder and more expensive to treat.
Design health systems around the whole female life course: Perhaps most importantly, women’s health cannot be treated as a series of isolated moments: menstruation, pregnancy, childbirth and menopause. Health systems need to follow women across the life course, recognising how experiences in one stage can shape health decades later. The question should not simply be how long women live, but how many of those years they can live in good health, with financial security, independence and dignity.
Final Thoughts
So, I mentioned how I found myself in Taraba, and perhaps now I can explain why it stayed with me. I was in a room filled with decision-makers discussing policy priorities for women and girls. As a non-profit leader, it was a proud moment because it reminded me that the work we do at Women in Successful Careers (WISCAR) matters, particularly because we count on institutions and public policy to create the enabling environment women need to advance.
But sitting there, I also found myself thinking about this article differently. We spend a lot of time talking about getting more women into education, into the workforce, into leadership, and into positions of economic power. All of that matters. But what happens if, after much talk about helping women access opportunities, we do not build societies that enable them to enjoy those gains?
This is why policy matters. As a member of the Women in Leadership Coalition comprising WISCAR, WIMBIZ, WILAN and the Nigeria Governors’ Forum, we continue to advocate for policies that can change the conditions under which women live and work, including 35% representation of women in state and federal cabinets, boards and executive management, as well as stronger parental leave protections – minimum 16 weeks maternity and 14 days paternity leave with full pay.
Perhaps the real measure of progress is not simply that women are living longer than men. It is whether those additional years are healthy, productive, and dignified years. Because if women are living longer but spending too many of those years caring for everyone else, struggling to access healthcare, carrying financial insecurity and ageing without adequate support, then longevity alone is not the victory we think it is. The goal should not simply be to add years to women’s lives. It should be to add life to those years.