How the pay gap hurts women’s bodies
“I think it’s to do with [midwifery being] a female-dominated profession, the pay disparity … we’re not viewed as professionals because we’re women and we do that touchy-feely midwifery stuff, which should come from being ‘nice’ people.”
While many aspects of New Zealand’s enduring gender pay gap have been discussed, its physical impact on workers has been largely overlooked – until now.
New AUT research, published in the prestigious journal Organization Studies, shows how gendered pay inequities can also affect women’s physical health. Reported issues include chronic fatigue, weight gain, poor metabolic health, and even illness and injury. Gendered pay inequities refer to the experience of being paid less because of your sex or because you work in a female-dominated occupation.
Lead author, James Greenslade-Yeats, is a research fellow at AUT Business School. As part of a major project led by Tago Mharapara (senior lecturer, AUT), James and his colleagues interviewed 47 Lead Maternity Care midwives (LMCs) and 51 of their family members. The interviews explored how the structure and organisation of LMCs’ work impact their wellbeing and family life.
The publication of this research is timely: in March 2026, the NZ High Court ruled that the compensation model for LMC midwives has been inequitable and discriminatory based on gender since 2007. More than 99% of NZ midwives identify as female.
The findings are confronting.
LMC midwives practice under a 24/7 on-call model, where the lives of babies and their mothers can be at stake. And yet, LMC midwives are paid through a fixed-price, contractor model, similar to many gig workers. This creates a situation where midwives are unpaid for much of the work they do:
“You're actually responsible for two lives, you're responsible for the mum’s life, health, and wellbeing, and the baby’s life. And that’s a huge demand mentally, physically on you supplying that care to them. And monetary-wise, being on call, that’s definitely not recognised at all. It’s not compensated for anywhere.”
Midwives’ inequitable pay situation affects their health in indirect yet serious ways. For example, because almost all midwives are women, they often juggle their work duties with the women’s traditional responsibilities as primary caregivers. If midwives take on the role of primary breadwinners – either by choice or necessity – they are forced to take on physically exhausting workloads:
“My caseload was probably about 100 a year… [M]y husband didn’t earn a living, so it meant I was the primary earner, and had a mortgage to pay and all the rest of it … [So] you work 36 hours on the trot ‘cause you’re so desperate to make sure that women get the care they need and deserve.”
Respondents who tried to pursue their careers while also acting as primary caregivers reported feeling constantly torn between work and home responsibilities.
This physical and emotional tug-of-war leads to midwives regularly foregoing sleep, healthy eating, and exercise. Over time, these sacrifices can lead to an array of detrimental health consequences:
“I’ve got a chronic back ache … I can’t even remember when it started.”
“I’ve put a lot of weight on … your selfcare goes out the window … there isn’t space or capacity in this job to maintain your own cares and your own needs.”
“I did get sick a couple of times, very sick, like got put in hospital a couple of times.”
“A couple of years ago now she [the midwife] got diagnosed with diabetes.”
James says such physical impacts reflect what he calls a ‘triple bind.’ Because LMC midwives are not paid fairly at work, they have less negotiating power at home, and this imbalance is compounded by the physical toll of trying, as one respondent said, “to be everything to everyone”.
“While midwives are the focus of this research, their experiences likely reflect a broader trend affecting women across undervalued occupations,” says James. “In line with the High Court’s recent decision, our research shows why the gender pay gap must be closed not just within organisations, but across female-dominated occupations and professions around Aotearoa New Zealand.”
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