Across many mineral-rich developing countries, artisanal and small-scale mining (ASM) has been noted as a crucial socioeconomic activity for most rural people. Over the past 2 decades, there has been growing participation of women in the ASM sector with extant studies examining why women participate in ASM, the roles they play and how their involvement enhances their socioeconomic development. However, the socio-structural dynamics and gendered relations within ASM are poorly understood and underexplored despite the increasing participation of women in the sector. Based on field observations and interviews involving 49 women miners in the Prestea-Huni Valley Municipality of Ghana, this paper discusses the on-site challenges of women in ASM through multiple standpoint and African feminism theoretical perspectives. It also examines how understanding the struggles of women can reduce their work-related risks and promote gender-sensitive policies for rural women's empowerment in ASM. The study finds that the struggles of working women in ASM involve cultural marginalisation and gendered work patterns, poor working environment, poor work support services for women with children, lack of legal and economic rights, and inter-ethnic discrimination by employers. We argue that policymakers, relevant stakeholders, and the government through the district assemblies should collaborate with small-scale mining employers to enhance gender-sensitive on-site regulatory policies, ensure safe working environments for workers, and provide locally appropriate work support services for women in ASM. We further argue that, government and regulatory institutions need to promote gender mainstreaming for 'inclusion of women' in the management structure at mine sites and also the extraction and processing stages of ASM.