In light of well-known gender gaps in health, education, economic participation and opportunity, and political empowerment 
, some have expressed concerns that women may also have less access to health care and medicines than men 
Based on a standardized survey of large populations of adults and children from 53 countries in six regions, our results suggest that women in many countries report significantly more need for health care and medicines than men. However, contrary to expectations, we did not find consistent differences across countries in indicators of access to treatment between women and men needing care. Similarly, there were few significant differences in selected indicators of access to preventive or curative care for children. In addition, gender and care relationships among poor households were similar to those among non-poor households. Thus, although situations in individual countries 
will likely differ, our aggregated analyses do not support the notion of uniform gender inequity in access to health care or medicines for the selected conditions measured in the WHS.
How can we explain the discrepancy between our findings and prior expectations of gender inequities disadvantaging women? First, adult respondents to the WHS were a heterogeneous group both within and across countries in terms of health needs, access to care, and their determinants; thus, noise could have masked statistical relationships between gender and access to care. Further, relatively few respondents reported chronic conditions, which may in part be due to self-reported ascertainment of these conditions in the WHS. Given self-reported need for chronic care, relatively few respondents reported having access to care. Similarly, in some countries, larger than expected proportions of children under 5 years of age were reported to not have been sick. Thus, samples could have been too small to detect significant gender differences. However, given the overall large WHS sample sizes and number of countries, we would expect to see consistent trends emerge to support evidence of gender inequity, either overall or among the poor; yet our analyses do not show such trends. In addition, we cannot exclude differential reporting of symptoms, diagnoses, or treatments between men and women; given the heterogeneity of cultures represented in the survey, such differences may have biased our results toward the Null.
We did not examine areas of widely-reported health disadvantages for women, such as physical and sexual violence, sexually transmitted diseases, HIV/AIDS, or pregnancy and child birth and cannot comment on possible inequity in access to care for these health needs or on the social factors that might increase women's health risks 
Our findings that women report equal or greater prevalence of common health problems and equal access to needed care is consistent with evidence from a number of recent studies, including a report on management of diabetes and cardiovascular risk factors in seven countries 
; a study of prescribing patterns for men and women with diabetes in Bahrain 
; one that demonstrated higher age-adjusted prevalence of medicines use among women in Spain 
; reports of more frequent and earlier access to anti-retroviral treatment among women in countries in Africa, Latin America, and Asia 
; a UNICEF report 
showing that treatment for childhood pneumonia, diarrhoea, and malaria does not vary by gender, and studies showing equal access to care for boys and girls in Bangladesh and Tanzania 
Several factors may increase rates of diagnoses and access to care among women. Women have more frequent interactions with the health care system, both because of reproductive health needs and because they serve as family caregivers. They may thus have more opportunity for diagnosis and treatment of the types of acute and chronic conditions we studied. In addition, female community health care workers may facilitate access to care for women 
and men may be more reluctant to seek care for cultural and other reasons 
Importantly, the low reported levels of chronic and preventive care for both women and men are disconcerting. For example, in 10 of 52 countries with sufficient data, less than a third of adults with diagnosed diabetes reported treatment. With the prevalence of chronic conditions increasing, health system interventions to enable affordable access to long-term therapy are urgently needed 
. In 13 of 39 countries, less than a third of children had received Vitamin A prophylaxis in the past year and in 20 of 50 countries, less than a third had received measles and or one DPT vaccine. These results attest to the global need for effective health system interventions to improve child survival 
From these data, we cannot know whether women and men utilize the same providers or receive the same quality of health care. Gender-stratified assessment of the management of chronic conditions in seven countries seemed to indicate more ineffective management of blood glucose, blood pressure, and hypercholesterolemia among women with diabetes in four low and middle income countries 
; others found no gender difference in quality of malaria case management 
We also do not know whether women and men faced similar circumstances when negotiating access to care within households and health care systems, or experienced the same economic consequences of accessing care. Given that women generally have less power and are poorer than men 
, they may have to expend more effort to access care and experience greater economic repercussions. However, notably, women reported more satisfaction than men with their health care systems and did not feel that they were treated worse than men because of their gender.
The WHO has called for increased attention to gender and poverty in health research 
. Data on gender are typically available in facility-level and community-level studies of medicines access and use 
, but gender differences have rarely been the focus of empirical analyses. Reporting results of such studies by gender would provide evidence about the generalizability of these finding in different settings, for other health problems, and over time.
More empirical studies are needed to provide evidence about the interrelationships of gender, poverty, and access to health care and medicines, while social and behavioural studies are needed to understand reasons for differences where they exist, negative impacts on health, and potential mechanisms to redress them. These interrelationships are likely to differ by culture, geography, health system structure, and extent of social protection. Given the dearth of empirical literature, we need studies in a wider variety of settings to begin to disentangle the distinct roles of poverty and gender in determining perceptions of illness, patterns of care seeking, access to services, quality of the care, clinical effectiveness, economic impacts, and consumer satisfaction. Documenting specific gender differences in medicines access, use, and affordability would highlight key policy issues and potential solutions to achieve gender equity.