Gendered Disparities in Accessing Healthcare in India: A Policy Analysis

About the author:

Arundhati is a 17-year-old student from Bangalore, India. She is deeply interested in Economics, Public Health and Policy and wishes to create an impact in these areas. Currently in the 11^th grade at Stonehill International School, she hopes to develop her knowledge to be able to make meaningful contributions to society. Through this research, she explored the influence of gender on health policy in India to broader her understanding of both areas.

Abstract

This research paper investigates the gender-based disparities in healthcare access within India, a country marked by diverse socio-economic and cultural landscapes. It highlights the significant barriers that women face compared to men in accessing essential healthcare services. Key findings indicate that women are disproportionately affected by factors such as lower socioeconomic status, limited educational opportunities, cultural norms prioritizing men’s health, and inadequate gender-sensitive health policies. Rural areas exhibit more pronounced disparities due to scarcity of healthcare facilities and skilled providers. The analysis also explores how these disparities impact maternal health, chronic disease management, and overall life expectancy. Policy recommendations are proposed to address these inequities, including enhancing healthcare infrastructure, implementing community-based health education programs, and promoting gender-sensitive health policies. This study contributes to the broader dialogue on gender equality in healthcare access, aiming to inform policy makers and healthcare providers about the urgent need for targeted interventions in India.

Introduction

Health continues to be a critical success factor to measure the development of nations worldwide. As it is widely known to contribute towards national development, nation-states across the world endeavour to maintain the health of their citizens and health is recognized as a critical input for human development globally.

The last few decades witnessed decolonization, making many nations independent in terms of their policy landscape. The political parties that came to power announced their commitment to social sector goals among others, especially in achieving education and health for all. Intergovernmental organisations like the United Nations (UN) also declared its commitment to health through the introduction of the 8 Millennium Development Goals (MDGs) in 2000, out of which three (Goals 4, 5, 6) focused on the area of health. India has been steadily developing in terms of its gender specific health policies over the last few decades with the sex ratio rising to 985 females to 1000 males as opposed to a previous 771 females per 1000 males in 199l. Furthermore, Maternal Mortality Ratio(MMR) of India for the period 2018-20, as per the latest report of the national Sample Registration system (SRS) data is 97/100,000 live births, declining by 33 points, from 130/ 100,000 live births in 2014-16.

If one traces back these policy goals to Indian health policy, it has interesting insights to offer. With India having the largest population of nearly 1.44 billion, and a large portion of this population living in rural areas, the challenges for effective healthcare delivery have been many. India’s Human Development Index value has increased to 0.644, placing the country 134 out of 193 countries and territories in the recently released 2023/24 Human Development Report (HDR) by the United Nations titled, “Breaking the Gridlock: Reimagining Cooperation in a Polarised World.”

The Intersection of Gender and Health Policy

From many circumstances and perspectives, women in South Asia find themselves in subordinate positions to men and are socially, culturally, and economically dependent on them. Women are largely excluded from making decisions, have limited access to and control over resources, and are restricted in their mobility. Gender-related differences in health status have led to an unbalanced sex ratio for the past 100 years, which is declining further. In some parts of India, the sex ratio had fallen as low as 770 women per 1000 men. Gender discrimination at each stage of the female life cycle contributes to this imbalance (Canudas-Romo, Saikia & Diamondsmith, 2015). Sex selective abortions, neglect of girl children, reproductive mortality, and poor access to health care for girls and women have all been cited as reasons for this difference.

Research on unmet need for health care was largely carried out in developed countries like the United States, and many European countries. These studies identified a range of sociodemographic factors impeding or facilitating access to formal healthcare services (Agarwal, 1997). Beyond health system barriers, unequal distribution of resources, information asymmetry, cultural barriers, wage loss, self-treatment, mediation through socioeconomic factors shape the access to healthcare. In India research studies have used class, caste, gender, region, religion, age etc to understand group differences in health opportunities. Among them three important factors such as economic differences, social exclusion, gender discrimination are often considered as the possible explanation for unmet need (Anderson & Ray, 2012). These studies show individuals of lower socioeconomic position do not use healthcare to the same extent as the better off.

The power relations within the household influence the intra-household resource allocation. Unfavourable socio-cultural values operate against females – women as well as girls – in the distribution of food, especially when there is food shortage in the family (Behrman, 1988). Indian women may be malnourished often because of the poor nutritive quality of what is available even when they take food. Ethnographic literature reveals that in northern India females are fed less in preference than the males. Cultural values also very often forbid women from taking nutritious non-vegetarian food, thus resulting in their nutritional deficiency (Batra, Gupta & Mukhopadhyay, 2014). Unfavourable distribution causing poor nutrition becomes evident among females during infancy; it persists through childhood and tends to increase with age. Girls are often neglected soon after their birth; breast-feeding is less frequent and for a shorter duration for girls than for boys. A study of two Delhi slums found that only 50%-65% of the female infants below the age of one had received adequate nourishment; for female children (5-9 years), the percentage fell to about 30-35.

Although India has been steadily progressing in developing health policies, there have been major implementation problems due to poverty, gender discrimination, and illiteracy. While the overall maternal mortality for India has dropped to 97/100,000 live births, anaemia during pregnancy is a significant public health problem with 45.7% of pregnant women in urban areas and 52.1% in rural areas having low haemoglobin levels. Anaemia is the underlying contributing factor for 20-40% of maternal deaths in India, which account for 80% of maternal deaths attributable to anaemia in South Asia. Socioeconomic factors are responsible for maternal deaths to a large extent — money in 18.3%, transport in 13.7%. When the mother dies it doubles the chances of death of her surviving sons and quadruples that of her daughters (Borooah, 2004). Among the avoidable factors in maternal deaths, lack of antenatal care is the most important.

Additionally, by their nature reproductive health hazards are borne by women alone. Poor outcomes for both mother and child are inevitable for a large proportion of the population if many South Asian mothers are too young to receive minimal antenatal care and are malnourished or anaemic during pregnancy. Poor vital registration systems in South Asia also pose a challenge to measuring maternal mortality at the national level (Pande, 2003). Maternal deaths – most commonly from haemorrhage, sepsis, and eclamps – continue to exact a high toll. Unsafe abortions also contribute to deaths from haemorrhage and sepsis. Home deliveries by unskilled attendants, a paucity of knowledge of intrapartum danger signs, and poor transport mechanisms to and lack of appropriate care at health facilities all contribute to this burden. Women cite economic circumstances and spousal or familial opposition to delivery in hospital as the most common reasons for delivery at home (Gupta, 1987).

Finally, compared to women in rich households, women in households of poor and middle wealth in India were less likely to access maternal tetanus vaccination during pregnancy. Education and employment opportunities for women (or the lack thereof) are linked to better health outcomes as the research indicates deficiency (Batra, Gupta & Mukhopadhyay, 2014). Reducing societal barriers that prevent women from accessing healthcare (including consent of male family members, low literacy rates among others) is a crucial aspect of addressing gendered disparities in healthcare. By bearing in mind socio-economic factors of gendered discrimination in Indian society, policy instruments that effectively tackle the root causes of the unequal access to healthcare for women can be designed and implemented.

Current Policy Landscape of Healthcare in India

There is a persistent gender disparity in hospital utilisation despite the insurance subsidy, consistent with evidence from other similar programmes in India. Females account for 45% of hospital visits under insurance and this is particularly low among children under 10 years (33%) and the elderly (43%). As a result of these disparities, public expenditure favours males: females accounted for only 44.4% of total programme spending in 2019 (Shaikh et al. 2018, Kaur et al 2020).

Subsidising healthcare has been a key policy for reducing inequalities in access, including along gender. Over the last 15 years, India has expanded government health insurance programmes to provide free care to low-income households at public and approved private hospitals. These schemes include (but are not limited to):

1. Surakshit Matritva Aashwasan (SUMAN), which provides assured, dignified, respectful and quality healthcare at no cost and zero tolerance for denial of services for every woman and newborn visiting public health facilities to end all preventable maternal and newborn deaths.
2. Under Janani Shishu Suraksha Karyakram (JSSK) provides that every pregnant woman is entitled to free delivery, including caesarean section, in public health institutions along with the provision of free transport, diagnostics, medicines, blood, other consumables & diet.
3. Adolescent Girls Scheme is a special intervention was devised for adolescent girls using the Integrated Child Development Scheme (ICDS) infrastructure. ICDS with its opportunity for childhood development, seeks to reduce both socio-economic and gender inequities. The Adolescent Girls (AG) Scheme under ICDS primarily is aimed at breaking the intergenerational life-cycle of nutritional disadvantage and providing a supportive environment for self-development.
4. Swadhar Greh Scheme is the scheme of the Central Government and is designed to provide relief and rehabilitation to destitute women and women in distress.
5. Universalisation of Women Helpline is intended to provide 24 hours immediate and emergency response to women affected by violence
6. Janani Suraksha Yojana (JSY) is a demand promotion and conditional cash transfer scheme for promoting institutional delivery.
7. Pradhan Mantri Surakshit Matritva Abhiyan (PMSMA) provides pregnant women a fixed day, free of cost assured and quality antenatal check up by a Specialist/Medical Officer on the 9th day of every month.
8. LaQshya improves the quality of care in labour room and maternity operation theatres to ensure that pregnant women receive respectful and quality care during delivery and immediate postpartum.

Policy Recommendations

The Indian government should establish more primary healthcare centres (PHCs) and sub-centres that are targeted specifically for female patients to ensure that women have access to basic healthcare services close to home, leaving out the need for transportation over large distances. Mobile health clinics that can travel to underserved areas to provide regular health checkups, vaccinations and maternal care facilities for women must be deployed in large numbers (Asfaw, Klasen & Lamanna, 2007). Provision of subsidies and free healthcare services for women, especially for maternal and reproductive health services must be put in place by the government. Existing healthcare schemes like the Pradhan Mantri Jan Arogya Yojana (PM-JAY) must be expanded to cover a broader range of women’s health issues, including reproductive and mental health.

While specific government schemes and resources for enabling access to health services is important, implementing widespread health education campaigns to inform women about available healthcare services, their health rights and the importance of regular health checkups must be made available as well. Training and deploying more community health workers (ASHAs) to educate women within their communities about health practices and facilities available to them is a crucial component of this (Anderson & Ray, 2012). For this purpose, gender sensitivity training for healthcare professionals on practices that ensure respectful and unbiased treatment of women is important. Additionally, there must be a drive to recruit and train more female doctors, nurses, and community health workers to make healthcare environments more welcoming and comfortable for women.

To support the above-mentioned policy tools, developing and implementing integrated women’s empowerment and livelihoods policies and programs to improve outcomes related to adolescent health must become a priority for the Indian central government. Enforcing strict regulations to prevent discrimination against women in healthcare settings, ensuring that all women receive equitable treatment, expanding telemedicine services to provide remote consultations (especially for women in rural areas who may not be able to travel easily over long distances to access healthcare), implementing digital health records to streamline patient information and improve women’s continuity of care and establishing women’s health committees at the community level to involve local women in policy-centred resolutions to health crises are some of the many measures that the government should design and implement to foster gender inclusivity in healthcare (Mckinsey Global Institute, 2015).

Conclusion

This study has comprehensively explored the policy challenge of gendered disparities in healthcare access in India, uncovering critical barriers that predominantly affect women. Our findings reveal that these disparities are deeply embedded in socio-economic, cultural, and structural dimensions, which collectively hinder women’s ability to receive adequate healthcare. In rural areas, these barriers are compounded by the additional challenges of fewer healthcare facilities and a scarcity of trained medical professionals. The consequences of these disparities are profound, influencing various health outcomes including maternal mortality rates, the prevalence of untreated chronic diseases, and overall life expectancy differences between genders (Sen, Iyer & George, 2002). Without targeted intervention, these disparities are likely to persist, perpetuating cycles of health inequity and economic disadvantage.

To address these challenges, this research paper recommends a multifaceted approach that includes the following strategies: enhancement of healthcare infrastructure, particularly in underserved rural areas; implementation of comprehensive, community-based health education programs that address both men and women; and the development of robust, gender-sensitive health policies that acknowledge and aim to mitigate the specific obstacles faced by women in accessing healthcare. Additionally, there is a need for ongoing research to monitor the effectiveness of implemented policies and to ensure continuous improvement based on evidence-based practices.

In conclusion, addressing the gendered disparities in healthcare access in India requires concerted efforts from policymakers, healthcare providers, community leaders, and scholars. By adopting an inclusive approach that focuses on both immediate and systemic changes, India can move towards a more equitable healthcare system where gender no longer dictates one’s ability to achieve optimal health.

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