Gender gap, inequality in access to health care


Only four states have an equitable sex ratio in COVID vaccination. On health and survival front, India is already in South Asia’s five worst performers

As the world battles the Covid-19 virus, giant toy company Mattel’s design of a Barbie doll featuring Sara Gilbert, the co-creator of the Oxford / AstraZeneca jab, is indeed a coup de thumbs up to women scientists. A number of women of science such as K. Sumathy (Covaxin), Hanneke Schuitemaker (Janssen), Elen Smolyarchuk (Sputnik V) and Katalin Kariko (BioNTech), are also at her side in this pioneering work.

Yet pandemic response strategies have remained “largely exclusionary and male-dominated in decision-making platforms,” ​​observes a Lancet study. A United Nations Development Program review committee found only 24% women in national Covid-19 task forces.

The low gender diversity in policy planning forums for the purchase, distribution and treatment of vaccines has indeed “exacerbated the existing inequality of access to health care based on gender”, lamented the Federation. International of Red Cross and Red Crescent Societies (IFRC). The 2021 report of Global Health (GH) 50/50, a research initiative for gender equality in health, stated categorically that “the fight against the virus has clearly revealed that” gender is the main engine of health, such as who gets sick and who lives or dies, etc. ”.

The Lancet study inferred that “since gender equity has remained largely unrecognized, it has created a wider blind spot, going beyond vaccine deployment and uptake, and has influenced the process of data collection and reporting ”. The June 2021 GH 50/50, Sex-Disaggregated Data Tracker, reported that only 34 of around 180 countries reported sex-disaggregated data between mid-April and mid-May 2021, which saw “a drop in 30% ”in June.

Additionally, the Sex, Gender and Covid-19 Health Policy Portal, which reviewed more than 450 policies from 76 countries across all WHO regions and World Bank income groups, has confirmed that in assessing people’s health outcomes, “sex and gender factors were not taken into account”.

Looking at India, Dr Suneela Garg, an advisor to the Indian Council for Medical Research and a member of the Lancet Commission Covid-19 working group, confirmed that “there is already a vaccination gap of around three Crores and a half until Aug. 31, 21, which is likely to grow more in rural areas, where women depend heavily on men for their resources ”. While Dr Sivakami, professor at the Tata Institute of Social Sciences (TISS), commented: “Even though vaccines are available, it does not imply that women will get them automatically, as the predominant non-binary gender prevents them. to take advantage of vaccines. . In addition, the power structure in families prioritizes men as breadwinners and discourages women for vaccines, anticipating post-vaccination health problems and therefore disruption in housework.

In India, only four states, namely Kerala, Karnataka, Chhattisgarh and Himachal Pradesh, have maintained an equitable sex ratio for immunization, while in Delhi and Uttar Pradesh, the two high prevalence states. , a difference of more than 10% was observed. One study, extrapolating age-disaggregated data from Co-Win Portal to June 4, established the case of obvious gender bias, as only 36.5% of women in the age group (45 and over) received injections, despite women having a favorable sex ratio in that particular age group.

Dr Harshita Sehgal, who teaches “Gender, Development and Community Health” at SNDT University, said that “the immunization gap reflects the gender health gap that persists in India”. The Global Gender Gap, 2021, places India 140th among 156 benchmark countries, falling 28 places from last year, when the gap widened to 62.5%.

On the health and survival front, India is one of the five worst performing countries in South Asia. In 2016, a joint study of experts from India and Harvard University found severe gender-based discrimination in health, with only 37% of women having access to health care, compared to 67% of women. men. Further, “there is a close relationship between gender and average health expenditure (HCE), which is extremely low for women, let alone, though, HCE has to be paid for by a struggling funding source, regardless of who. or the type of disease from which a woman suffers “, observed a joint study by Indian researchers and the International Institute for Applied Systems Analysis, Austria.

Nevertheless, many researchers consider socio-cultural factors such as the lack of decision-making power of women. According to data from the NFHS (2015-16), only 40% of women are allowed to go out on their own, which includes visiting a health facility, limited access to a smartphone, less than 20% of women in India own such devices, or the Internet, only three in ten women in rural areas have access to them, compared to half of men (NFHS-2019-20) and reluctance to vaccinate, due to misinformation, rumors, etc. ., contributes to the low vaccination rate.

Dr Sivakami added that “women may not have all the information about vaccines because they suffer from denial of access to digital facilities within the family.” through a door-to-door campaign, sensitizing both men and women “.

Now, official data claims that more than half of India’s eligible population has received at least one dose of the Covid vaccine. They also reveal an immunization gender gap of around six percent. The NCW took it up with states and UTs and urged to step up public health awareness campaigns to counter the idea that “women’s health is not a priority.” Dr Harshita Sehgal, regrets that “the vaccination campaign underway in India is another example of a lost opportunity for gender mainstreaming and inclusive planning for equal access”. However, some states have opted for the establishment of “pink stands reserved for women” to facilitate the vaccination of women, ensuring their safety and comfort.

At the 65th United Nations Commission on the Status of Women in 2021, the WHO Senior Advisor called on countries to “put gender equality at the forefront in planning and deploying vaccines, and eliminate all gender-related obstacles ”. Further, in an article co-authored in The Lancet by the six UN world leaders, stressed the imperative need for sex-disaggregated data for an “effective pandemic stimulus package”, and he feared that “The absence of such data, or their storage under cover, will only prevent the development of any concrete action plan sensitive to gender.”

Now, this pandemic has not been a portal for gender equality. This has therefore required gender-focused containment and recovery efforts, strengthening institutional capacities, committing to disseminate gender-specific data, which gives visibility to gender disparities, and also in a timely manner, in restoring the balance in the structural determinants of gender bias. .

(The author is the former Managing Director of Doordarshan and All India Radio. The opinions expressed are personal.)

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