Female healthcare workers highlight gender disparities, poor working conditions, and systemic injustices as privatization reshapes the sector
The privatization of Iran’s healthcare sector has exacerbated systemic inequalities, leaving female healthcare workers grappling with unfair pay, unstable contracts, and exploitative conditions. Nurses, midwives, and other staff describe an environment where women face lower wages than their male colleagues for similar work, limited opportunities for promotions, and long hours without adequate benefits. “Equality of pay between men and women never existed,” shared Leila, an operating room supervisor with experience in both public and private hospitals in Iran, underscoring the entrenched gender disparities.
Beyond pay inequality, healthcare workers also face job insecurity and a lack of support from labor authorities. Parissa, a midwife, detailed the harsh realities of working in the private sector, noting the absence of insurance and the constant threat of dismissal for raising concerns. “We are forced to sign documents waiving our rights, or we risk losing our jobs,” she explained. This environment, compounded by systemic favoritism in promotions, has left many women feeling trapped, even as they provide critical care to their communities.
Amidst the challenges posed by privatization, Leila also addressed the specific struggles faced by women in the healthcare profession. She pointed out that longer shifts were predominantly assigned to male colleagues, while women often received less favorable pay. “The challenges we women and male colleagues faced in these hospitals were that longer shifts were mostly given to men…This ‘per-case pay’… was always calculated less for women.”
Leila emphasized the lack of benefits in the private sector, detailing how these conditions disproportionately affect female healthcare workers: “The work environment… doesn’t have the benefits that public-sector environments enjoy. We don’t have insurance. The working hours are long. The income compared to the hours we work is very low.”
The questionable legal status of their work contracts also limits the nurses’ ability to seek out the help of regulators. “Since the workers are not officially employed, the labor department does not help, and any protest leads to termination or dismissal,” Leila added. “The situation is almost like slavery, and others are forced to endure these stressful and difficult jobs to meet their living needs.”
This systemic issue extends to management’s response to recent protests. In a move to quell unrest, healthcare staff were pressured to sign documents relinquishing their rights. “If we don’t sign, we will be dismissed,” said Parissa, the midwife.
She detailed the precarious nature of their employment. “They can easily fire us because we don’t have any insurance contracts. Whenever management wants, for whatever reason, they can tell any healthcare staff member to leave.”
Parissa also talked about the decrease in pay in private-sector salaries, which can be up to 20 percent lower than their public-sector equivalents: “For example, if in public centers [nurses] receive 15 or 16 million tomans ($217-232, at an exchange rate of 69,050 tomans/$1), we might get 12 or 13 million tomans ($174-188),” she said.
Adding to this narrative, Sima, a nurse at a private hospital affiliated with the Foundation of Martyrs and Veterans Affairs, shared her firsthand experience working in an environment shaped by privatization. “In public hospitals or government healthcare centers, salaries can reach 20 to 25 million tomans ($290-362), along with benefits like insurance, years-of-service bonuses, and overtime pay,” she explained, contrasting her own earnings of 15 million tomans ($217). Sima highlighted the unpredictability of her income: “In some months, no overtime is paid, and sometimes wages are not paid for a month or two.”
Sima voiced concerns about working conditions, stating female staff often “work long hours and have little rest. Overall, women in these centers, whether nurses or in service roles, are physically and mentally impacted.” She connected these challenges to the consequences of privatization, noting that budget cuts have contributed to an environment detrimental to workers’ well-being.
The instability of employment contracts has created an atmosphere of anxiety for Sima: “The contracts we sign are temporary and unstable, meaning the employer can dismiss them at any time.” She also noted a lack of advancement opportunities: “There are no opportunities for women to receive training or advance in their careers. They are essentially limited to the specific work they were initially hired for.”
Promotions are often based on “affiliation with specific groups or family background,” she explained, underscoring how privatization exacerbates nepotism. “Higher positions are usually filled by familiar or selected individuals.”