Gender inequalities, inequities in healthcare, clinical research are alive!

Gender imbalances can be deadly, especially in healthcare. Let no one tell you otherwise! While healthcare services in India have grown by leaps and bounds, women’s health by and large has remained a bottom-of-the-list 'priority', especially in India’s rural areas.

Not seeing women’s health as an investment is then the greatest irony.

The reasons for this lie in centuries-old patriarchy and being locked inside cultural citadels. This, compounded by lack of accessibility, lack of financial independence, and inability to take health-related decisions, leaves women – the ‘caregivers’ – not seeking treatment at the right time leading to late diagnoses and serious consequences, including socio-economic ones.

“When it comes to healthcare services for women or girls in India, there is certainly a gender gap," says Dr Mansi Khanderia, a consultant medical oncologist. “Though I don’t think the services are deliberately aimed to deliver to fewer women, we certainly have lesser women seeking healthcare access and insurance,” she says.

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“Our society’s demand from women to be only caregivers and not receivers is one of the major reasons,” she emphasises.

“Besides, the dependence of women on men for transport, finance or even accompaniment, added to the stigma of getting examined by male doctors and lack of support system to take care of children while the mother is seeking care at a hospital, do influence women to defer seeing a doctor for as long as possible,” she said.

According to the latest estimates released in a report by United Nations (UN) agencies, every two minutes, a woman dies during pregnancy or childbirth.

Health equity, therefore, has as much importance as equality in healthcare.

“The gender bias or gender discrimination for access to women and healthcare in India depends on the situation or the rural or urban setting where it plays out,” says Dr Nitin Yashas, Consultant Medical Oncologist and Hemato-Oncologist.

He elaborates on how a large section of women is unable to access healthcare facilities, especially for life-threatening diseases like cancer.

“From the viewpoint of oncology, particularly in rural and semi-urban areas, there still is a lot of lack of awareness. Breast cancer is the most common cancer in the country and yet we do not see women in these areas having enough awareness about self-breast examination, mammography, and the warning symptoms,” he says.

He highlights that statistics show that these cancers are often picked up in Indian women, most of the time, in a locoregional advanced stage as compared to the early stage seen in Western populations. "Furthermore, there is probable psychology that they do not want to be seen as an extra burden on the financial resources of the family and most of the time, do not report the health ailments or symptoms they are suffering from. They also do this from the viewpoint of some important upcoming event in the family and again, don’t want to be seen as a burden on their children or spouse,” Dr Nitin adds.

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But are health insurance plans being utilised by women despite schemes like Pradhan Mantri Jan Arogya Yojana (PMJAY), a government-funded health insurance scheme which provides financial protection to economically weaker sections of society by offering them cashless access to secondary and tertiary healthcare services?

“Studies have shown that the utilisation of government health insurance schemes is also low amongst women as compared to men,” says Dr Nitin.

Lack of education, non-awareness about health insurance schemes, dependence on the male breadwinner of the family and societal pressures have played a part in this and continue to do so.

Closing the gender gap in healthcare, at best, remains wishful thinking, across the world and indeed at home.

“The first step,” says Dr Mansi, "to solve the problem would be to acknowledge the problem.”

There should be focused systematic societal and governmental actions to narrow the gap by raising awareness and providing social and psychological support, 'for the women by the women' clinics, and home visits by female nurses to triage patients for tertiary care centre visits.

‘Create national programmes on awareness’

Lack of education especially for girls and women growing up in poverty denies them awareness about their bodies and the need to seek help when things go wrong.

“Knowledge is power,” says Dr Nitin. “It is important for society, NGOs, and healthcare workers to spread awareness about the most common health problems and information on ways for prevention, early detection, and treatment about it."

“It is pertinent that issues like the mental health of women which were previously a topic which was considered a taboo or stigma need to be given importance and facilitation. Given that the common cancers found in Indian women, of which breast cancer and cervical cancer are highly curable when detected in an early setting, we need to have national programmes which focus on awareness and implementation of screening of these cancers for early detection and ensure high coverage of HPV vaccination in a bid to prevent the development of cervical cancer,” he explains.

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Clinical trials and women

Clearly, many health concerns of women are different from that of men. Unfortunately, when it comes to clinical trials, it is a known fact that women are underrepresented.

“Most clinical trials still are conducted on Caucasian populations; even in the more affluent societies women are underrepresented,” says Dr Mansi while adding that of late, one does see an attempt at a conscious effort by researchers to ensure the gender distribution in a study is more representative of the actual incidence of diseases in the respective genders.

“But we have a long way to go,” she avers.

Pay gaps in Medicine

In the field of medicine itself, how grave is the gender inequality issue?

“The pay gap is as common as most professions. The number of women in low-paying jobs is higher than those in high-paying jobs and the gap only widens with rising income," says Dr Mansi, adding that women are grossly underrepresented in leadership roles.

The attrition rates are much higher amongst women because of a lack of support system; and negligible efforts are made by healthcare organisations whether it is considerate maternity leave, crèche childcare or psychological support to help navigate life-changing events and overcome social barriers, she says.

“On another note, female surgeons are the most affected professionally by socio-cultural biases both from the patients and their own staff – be it, male doctors or nurses,” adds Dr Mansi.

While closing the gender gap in healthcare seems like a utopian reality, in the years ahead, perhaps only a slit remains. Or not even that!