Gender gap, inequity in healthcare access

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Gender gap, inequity in healthcare access

Saturday, 11 September 2021 | ARCHANA DATTA

Gender gap, inequity in healthcare access

Only four States show a fair sex ratio in COVID vaccination. On the health and survival front, India already is one of the five worst performers in South Asia

As the world fights the Covid-19 virus, the giant toy company Mattel’s designing of a Barbie doll in the likeness of Sara Gilbert, the co-creator of the Oxford/AstraZeneca jab, is indeed a thumbs up to women scientists. A number of women of science like K. Sumathy (Covaxin), Hanneke Schuitemaker (Janssen), Elen Smolyarchuk (Sputnik V) and Katalin Kariko (BioNTech), are also in league with her in such pioneering works.

Yet, the pandemic response strategies remained “largely exclusionary and male-dominated in the decision-making platforms”, observed a study in the Lancet. A UN Development Program’s review panel found only 24 per cent of women in national Covid-19 task forces.

The low gender diversity in policy planning fora for vaccine procurement, distribution, and treatment, has indeed “exacerbated the existing gender-based unequal access to healthcare”, rued the International Federation of Red Cross and Red Crescent Societies (IFRC). The Global Health (GH) 50/50’s 2021 report, a research initiative towards gender health equality, categorically stated that “the fight against the virus starkly revealed that ‘gender is the major driver of health, like who gets sick and who lives or dies, etc.”.

The Lancet study inferred that “since gender equity remained largely unrecognised, it created a wider blind spot, going beyond vaccine roll outs and uptake, and influenced the process of collecting and reporting data”. The GH 50/50’s June, 2021, Sex-Disaggregated Data Tracker, reported that only 34 of about 180 countries reported sex-disaggregated data between mid-April and mid-May, 2021, which registered “a decline by 30 per cent” in June.

Moreover, the Sex, Gender and Covid-19 Health Policy Portal, which reviewed over 450 policies from 76 countries across all the WHO regions and World Bank income groups, confirmed that in assessing people’s health outcomes, “factors of sex and gender haven’t been taken into consideration”.

Looking at India, Dr Suneela Garg, advisor Indian Council of Medical Research, and member, Lancet Commission Covid-19 Task Force, confirmed that “there is already a vaccination gap of about three and a half crores till August 31, 21, which is likely to grow more in rural areas, where women are heavily dependent on men for resources”. While, Dr Sivakami, Professor, Tata Institute of Social Sciences(TISS), commented:” Even if vaccines are available, it doesn’t imply that women will get them automatically, as the prevalent gender non-binary prevent them from availing the shots. Besides, the power structure in families, prioritise men as breadwinners, and discourage women for jabs, anticipating post-vaccination health disorders and thereby disruptions in the household work.”

In India, only four states, namely, Kerala, Karnataka, Chhattisgarh and Himachal Pradesh, maintained a fair sex ratio in vaccination, while in Delhi and Uttar Pradesh, the two high-prevalencestates, a difference of over 10 per cent was found. A study, extrapolating Co-Win Portal's age-segregated data till June 4, made out the case of a clear gender bias, as only 36.5 per cent of women in the age group (45-year and above) received shots, despite, women having a favourable sex ratio in that particular age group.

Dr Harshita Sehgal, who teaches 'Gender, Development and Community Health' at SNDT University said that "vaccination gap is reflective of the gender health gap persisting in India". Global Gender Gap report, 2021, places India at 140 among the 156 countries benchmarked, slipping 28 places below from last year when the gap widened further by 62.5 per cent.

On the health and survival front, India is one of the five worst performers in South Asia. In 2016, a joint study by experts from India and Harvard University, noticed serious health-based gender discrimination, with only 37 per cent of women getting access to health care, as compared to 67 per cent of men. Moreover, "there is a close relationship between the gender and average health care expenditure (HCE), which is abysmally low for women, and even lesser, if, HCE has to be paid by any source of distressed financing, regardless of the type of disease a woman suffers", observed a joint study by Indian researchers and the International Institute for Applied Systems Analysis, Austria.

Nonetheless, many researchers consider socio-cultural factors like women's lack of decision-making power. As per NFHS (2015-16) data, only 40 per cent of women are allowed to go out alone, which includes visit to a health facility, poor access to a smartphone, with less than 20 percent of women in India own such devices, or internet, only three in 10 women in rural areas have access to it, as compared to half the men (NFHS-2019-20) and vaccine hesitancy, stemming from misinformation, rumours, etc., are contributing to low rate of vaccination.

Dr Sivakami added that "women might not have all the information about vaccines, as they suffer from denial of access to digital facilities within the family".Dr Garg feels that "the vaccine hesitancy should be addressed with the help of community health workers like ASHA through door-to-door campaign, sensitising both men and women". 

Now, the official data claim that more than half of India's eligible population has received at least one dose of the Covid vaccine. They also reveal a vaccination gender gap of about six per cent. The NCW took it up with the states and UTs and urged for mounting public health awareness drives to counter the notion that “women’s health is not a priority”.Dr Harshita Sehgal, regrets that “India’s ongoing vaccination drive is another instance of a lost opportunity for gender mainstreaming and inclusive planning for equal access”. However, some states have gone for establishing "all-women pink booths" to facilitate immunisation for women, ensuring their safety and comforts.

At the 65th UN Commission on the Status of Women, 2021, the senior advisor, WHO, called upon the nations to “put gender equality at the forefront in planning and rollout of vaccines, and address all gender-related barriers”. Furthermore, in a jointly authored article in the Lancet by the six UN global heads, underscored the imperative need for gender-disaggregated data for an “effective pandemic recovery plans”, and it feared that the “absence of such data, or keeping them undercover, will only pre-empt devising any concrete gender-responsive action plan”.

Now, this pandemic, hasnot been a portal for gender equity. It has, thus, necessitated a gender-focused containment and recovery efforts, by reinforcing the institutional capacities, committing to disseminate sex-based data, which provide visibility to gender disparity, and also in due course, restoring balance in structural determinants of gender bias.

(The writer is former Director-General, Doordarshan, and All India Radio. The views expressed are personal.)

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