The church is a fertile ground for nurturing and protecting patriarchy. Within the Christian church, gender equality remains a theoretical notion, and the Evangelical Lutheran Church in Southern Africa (ELCSA) is no exception in this regard. Written from the perspective of African women’s theology, this article critically reflects on and interprets gender issues in ELCSA leadership structures by exploring the gender biases involved in the running of the church and the implications of these biases for gender questions about reformation and pastoral care in ELCSA congregations. Findings indicate that the gender gap in ELCSA structures is neither biblical nor constitutional but is protected by the presence of wives of bishops, deans and pastors who are placed strategically in women’s leagues, particularly the Prayer Women’s League (PWL). In addition, qualifying the bishops, deans and pastors as ex-officio members of these groups constitutes an obstacle to achieving gender equality in the Church’s leadership structures and has implications for pastoral care in the ELCSA.Intradisciplinary and/or interdisciplinary implications: The article is written from a Christian-anthropological perspective. By reviewing literature from social sciences, practical and systematic theology, it integrates sociological and African traditional assumptions of gender and religion that hinder the African church’s reformation praxis, thereby affecting pastoral care.