Public Health for Women in India: Some Thoughts

Indian decision makers and society must take stock of many gaps in public health for Indian women, particularly those from vulnerable communities.

We at are publishing a series of articles about the multiplicity of issues, concerns and hopes of women today, March 8, 2021, to mark the International Working Women’s Day.

Dr. Sylvia Karpagam is a public health doctor and researcher who is part of the Right to Food and Right to Health campaigns. 

On International Women’s day, it would be good for Indian decision makers and society to take stock of many gaps in public health for Indian women, particularly those from vulnerable communities (women who are dalit, Adivasi, Muslim, living with disabilities, transgender, employed in so called ‘unclean’ occupations, the elderly, single women, those who have had pre or extra-marital relationships, are victims of rape/abuse, prisoners etc.) The issues faced by women have been particularly evident during the Covid19 pandemic and subsequent lockdown, and these have to be identified and addressed on priority. However, from the recent budget announcement by the Central government it looks like no major lessons have been learned. It therefore becomes crucial that as citizens with voting rights, we constantly foreground demands that will make public healthcare in the country more robust, rational, comprehensive and non-discriminatory.

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Some of the issues that will need to be addressed for healthcare to become more inclusive, comprehensive and accessible for women are

Challenging male Centric and stereotypical Healthcare.

Healthcare in India, ranging from research, decision making and implementation has been largely male centric, with the health needs of women, being inserted as an after-thought or not at all. Any effort, if at all, is mostly limited to the reproductive (and allied) functions of women. Stereotypes such as ‘women don’t smoke’ ‘women don’t have pre-marital/extra-marital relationships’, are ‘more adjusting’ etc. can lead to some aspects of their healthcare being completely ignored.

While stereotyping can have an adverse impact on women’s health, it can also adversely affect men’s health as well, leading them to be slotted into narrow categories of masculinity and often unable to articulate what is commonly seen as ‘feminine’ or ‘women’s issues’ such as physical difficulties, loss of libido, depression etc.

Access to healthcare

Women are less likely to find carers if they require admission and less likely to be financially independent to pay for their treatment needs.

Research shows that women/girls in India tend to access healthcare later and in a more serious condition than their male counterparts owing in a large part to distance, cost and male centric healthcare services. This is even worse if the health situation arises out of marital/natal abuse, rape, pregnancies outside of marriage or health issues related to the reproductive system. For a woman to go and explain reproductive health symptoms to a male healthcare provider can be a daunting possibility.

Women are less likely to find carers if they require admission and less likely to be financially independent to pay for their treatment needs. It is almost impossible for women who are primary carers of children, elderly or people with disabilities to take time off to meet their own healthcare needs.  Healthcare expenditure on females was found to be lower than on males across all demographic and socio-economic groups, for both short-term and major morbidity. A study conducted by Pednekar et al. in 2011 found that out of 100 boys and girls with congenital heart disease, 70 boys would have an operation while only 22 girls will receive similar treatment. Centralised, corporatized, urban centric models of healthcare will not serve a purpose to the thousands of women living in remote and rural areas.

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It is important to remember that healthcare is not only a curative model. Social determinants of health such as women’s literacy, education, legal support, land rights, access to public spaces, livelihood etc. are necessary precursors for public health rights of women.

Absence of women in clinical trials

There is very little representation of women in clinical trials and in standardising treatment guidelines. The complex interaction of drugs, hormones and other interventions with female hormones, menstruation, age, genetics is often too daunting for researchers to address. Therefore women are either left out of trials or treated similar to men.

Women’s health symptoms are often mocked by families and healthcare providers as being mostly ‘psychosomatic’ or ‘in the head’. The term MKKS (mai kai kalususthu – fatigue of body, hands and feet) syndrome has been used to describe the often vague aches and pains that women complain of. However, in a country with more than 60% of its women being anemic and experiencing chronic hunger, these symptoms cannot be dismissed lightly.

Inequity in healthcare workforce

The Indian model of allopathic healthcare has been hierarchical, with male doctors from dominant caste groups located at the privileged end of the spectrum, highly paid and granted a ‘god like status’. At the other end of the spectrum, are women, mostly from vulnerable dalit communities, delegated to work associated with sanitation and waste disposal – labelled ‘dirty or unclean’ and often performed in exploitative conditions. A comprehensive or holistic approach to healthcare, where all personnel are viewed with dignity and as performing crucial roles would go a long way in making healthcare more equitable and accessible.

Women in the health work forces are often paid lesser than their male counterparts are exploited and often seen as a liability. They are often expected to behave within certain defined norms. Most healthcare and allied services see pregnancy as a liability and are ill-prepared to handle either pregnancy or child-care. It is important that the healthcare system becomes more diverse and inclusive. There should be a gender (and caste) breakup of access to healthcare, salaries and recruitments with representation of women, particularly from vulnerable communities, at all levels of healthcare such as research, policy making, administration, implementation, monitoring and evaluation.

The complex interaction of drugs, hormones and other interventions with female hormones, menstruation, age, genetics is often too daunting for researchers to address.

While all healthcare staff is at risk of exposure to occupational hazards, some of the workers, particularly women from dalit communities, are at even more risk in addition to being exposed to exploitative labour conditions, harassment, abuse etc.

An Occupational hazard is any injury or ailment resulting from the work one does or from the environment in which one works. It includes both long and short-term risks associated with the workplace environment.

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Housekeeping staff and non-nursing allied staff collect and segregate bio-medical waste generated by the hospital, clean toilets, floors, change sheets, shave/bathe patients, and in the event of the patient passing away, clean and wrap the body before it is handed over to the mortuary or the family members.  Some of the specific occupational hazards the workers are vulnerable are biological, chemical, physical, ergonomic, psychosocial, fires and explosion, electrical etc.

Pourakarmikas or sanitation workers are another group that have been exposed to a range of occupational hazards on a prolonged as well as accidental basis. Similarly, ASHA workers or Accredited Social Health Activists have reported experience of violence, stigma, delayed payments, lack of proper protective equipment etc.

Even in so-called ‘normal times’, these workers are not provided with protective gear, though they carry out work that is essentially hazardous. This was particularly worse during the Covid pandemic and several of these frontline workers contracted the virus and deaths have been reported.

Usually there are no accurate records on the number of people employed as housekeeping staff in healthcare facilities, especially in private facilities, and therefore the occupational hazards they are exposed to, their morbidity or mortality. This means that they are unlikely to receive adequate protection or compensation in case of disability or death.

The predominantly female and dalit workforce in the healthcare and sanitation system need a multitude of social, economic and occupational interventions.

In conclusion, the government has to invest in foregrounding women’s issues not just as tokenist slogans like ‘beti bachao beti padao’. Without committed interventions, the same inanities will be mouthed at the next International Women’s day in 2022 while women, especially from vulnerable communities, will continue to be treated as second class citizens.






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June 2024


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