Invisible patients: Reframing women informal caregivers' access to healthcare and support services as a gendered health systems issue.

Women informal caregivers are overrepresented in unpaid and informal caregiving roles yet remain underrecognized as patients and policy subjects within health and social care systems. Despite extensive evidence that caregiving affects women's own health and healthcare engagement, their access barriers are frequently attributed to individual help-seeking behaviors rather than to systemic and gendered conditions. This conceptual paper argues that women informal caregivers' access to healthcare and support services should be understood as a gendered health systems issue shaped by sociocultural expectations, material constraints, organizational design, interprofessional recognition, and the embodied consequences of caregiving. Drawing on purposively selected contemporary and foundational literature including evidence on women informal caregivers' healthcare engagement, ethnic minority caregivers' service access, rural caregivers' financial barriers, and caregivers' self-identified support needs this paper synthesizes key evidence to develop an explanatory conceptual framework. The Gendered Caregiver Access Framework conceptualizes women informal caregivers' access across five interacting domains: sociocultural and gendered expectations, material and policy conditions, organizational and system design, interpersonal and provider recognition, and individual caregiving burden and embodied consequences. Cross-cutting equity modifiers including race and ethnicity, rurality, income, language, disability, and caregiving intensity shape how barriers are experienced and compounded across domains. Drawing on intersectionality scholarship, the framework treats these conditions as mutually constitutive rather than additive. The framework has implications for policy (caregiver-responsive infrastructure, navigability, disaggregated measurement), practice (routine caregiver identification, culturally responsive recognition, access friction reduction), and research (intersectional, longitudinal, and multilevel intervention designs). Women informal caregivers' access to care is not a peripheral issue; it is a central indicator of whether health and social care systems equitably support the people on whom they depend. Reframing access as a gendered health systems issue is essential for more just and responsive policy, practice, and research.