Published by Women in Global Health, this report documents a 'XX Paradox' in global health, where women make up 70 per cent of the health workforce but hold only 25 per cent of senior leadership roles. Drawing on global data and country case studies from India, Nigeria and Kenya, it finds women lost ground in health leadership during COVID-19 and identifies systemic barriers requiring action to fix, alongside examples of successful affirmative action measures from countries including Argentina, India and the UK.