Gender inequality in India creating barriers between different healthcare systems

By IMPRI Team

Day 1 | June 4, 2022

The three-day Online Certificate Training Programme on the theme “Perspectives on Gender through Healthcare Lens”, a joint initiative of the Centre for Ethics, Yenepoya (Deemed to be University) Mangalore, and Gender Impact Studies Centre at IMPRI Impact and Policy Research Institute, New Delhi, took place on 3 consecutive Saturdays.
Inaugurating the session Ms. Souravie Ghimiray, Researcher at IMPRI, welcomed the speakers and participants to the program with an introduction to the eminent panelists.
Day 1 of the program included Prof Vibhuti Patel as the course advisor; Dr. Vina Vaswani, Director, Centre for Ethics, Yenepoya, and Dr. Simi Mehta, CEO and Editorial Director, IMPRI as conveners, and eminent training experts Prof Mala Ramanathan, Brinelle D’souza, Dr. Padma Bhate-Deosthali, Sangeeta Rege, Dr. Ketki Ranade, Dr. Amar Jesani, Dr. Aparna Joshi, Renu Khanna, Prof Anita Ghai. The patron for the session was Farhaad Yenepoya, Pro-Chancellor, Yenepoya.
Commencing the program, the course advisor for the session, Prof Vibhuti Patel stated the difference between sex and gender, talking about the social and biological construction that exists between the two. She talked about how the understanding of gender shapes human personality, identity, perception of others, and health across our life cycle, and thus health and health outcomes need to be understood in the context of social determinants of healthcare in terms of unequal power balance where feminity has lower status amongst individuals, groups or communities.
This gender inequality has created various barriers among healthcare systems and its outcomes, also shaping stereotypes and preferences amongst society, such as son preference amongst South Indian nations, and impacts cultural and traditional value systems.
Dr. Vina Vaswani, Director, Centre for Ethics, Yenepoya, Mangalore:
Dr. Vina Vaswani gave a presentation on “Perspectives on Gender through Healthcare Lens” which covered an array of topics like the need for such a course in the first place, linking it to the existence of gender stereotyping and the need for gender sensitization. Strengthening the understanding of sex and gender, she stated the difference between gender, sex, gender identity, and gender expression. She expanded on Social Identity Theory, and how social identification plays an important role in our life and cultivates a sense of belonging vis-a-vis the ‘other’ group.
She also mentioned how the plight of gender and sexual minority groups, such as transgender people, was affected especially after the onset of COVID-19, and expanded on other topics such as gender-responsive care, the need for sensitization and how our cognitive biases affect our understanding.
Prof Mala Ramanathan, Professor, Achutha Menon Centre for Health Science Studies, SCTIMST, Thiruvananthapuram:
Prof Mala Ramanathan gave a presentation on “Reproductive Health” which traced the evolution around the discourse of reproductive healthcare, mentioning its historical and modern-day understanding. She then centered the discussion around India and talked about the ICPD Mandate and India and RMNCHA+ approach and goals, which included themes like family planning, methods, and raising the sex ratio.
She then presented data that traced contraception patterns year-wise and analyzed the data for different states, also talking about the decline in fertility from 2015-16 to 2019-21. She also talked about the unmet needs of contraceptives and how there is an urgent need to address the mismatched policy focus and focus on enhancing male responsibility and a need to re-orient our policies for gender-inclusive SRH.
Prof Vibhuti Patel, Visiting Professor, IMPRI, New Delhi:
Prof Vibhuti Patel’s presentation was based on “Gender Implications of the Pandemic” which broadly talked about vulnerable populations during the pandemic and the gender differential impact of social distancing. She talked about how statistically more women had to bear the burden of unpaid labor and domestic work like childcare and elder care whereas men focused on fewer tasks even during the pandemic such as shopping for the household and playing with children.
According to data presented, 70% of the healthcare workers in the system who worked as nurses, doctors, and ayabais were women, putting them at a disproportionate risk of infection compared to men. Themes such as the impact of migrants moving back to their homes and a comparison between how men and women spent their time doing unpaid work.
“Our economists and newspapers were screaming that the economy is closed. Actually, it was not closed, because everyone was cooking, cleaning, and taking care of their loved ones and not just valued by the economists because it is normally women’s unpaid labor and the same type of devaluation is extended to women’s health needs.”
She talked about certain barriers and needs that need to be incorporated into the system, including a helpline exclusively for pregnant women, access to menstrual hygiene, vaccinations, etc. Mental health wellness decline amongst women was also recorded, with a rise even in physical abuse of women, increased number of sex-selective abortions, and child marriage. Gender-based gaps were seen in vaccination rates, access to healthcare, and sanitation.
Themes such as unintended consequences of the pandemic, policy suggestions, and universal access to healthcare were also discussed.
Dr. Padma Bhate-Deosthali, Program Director, Creating Resources for Empowerment in Action (CREA):
Dr. Padma Bhate-Deosthali shared her views by presenting on “Integrating Gender in Medical Education”. Talking about International Obligation, she mentioned how gender inequalities are crucial determinants of health. She discussed and reviewed global initiatives that focussed on gender integration and then also discussed the themes within the Indian context which talked about attitudes toward abortion. She discussed the active need to approach and integrate gender in medical education by fostering partnerships, identifying opportunities, etc.
Gender has always been looked at as a social determinant but always understood as irrelevant when looked at in fields like MBBS, which has led to the perpetuation of various norms and stereotypes within the field. She also expanded on the understanding of gender, access to contraceptives, gender-based violence, and the various gaps that currently exist and the ways to amend that. This theme was concluded by a small film that consisted of interactions with various medical professionals.
Dr. Padma Bhate-Deosthali, Sangeeta Rege and Amruta Bawdekar
Dr. Padma Bhate-Deosthali, Sangeeta Rege, and Amruta Bawdekar shared their views by presenting “Testing Gender Integrated Modules-Lessons from Field Team” wherein they explored themes like gender as a social construct, violence against women, ethical issues in practice on the ground with methods such as role plays, quizzes, etc with the objective of measuring the shift in knowledge, attitude, and skill. The research calculated various metrics such as a change in gender attitude score, and gender sensitivity.
In concluding the presentation, Sangeeta Rege gave suggestions to upscale gender in medical education, followed by a Q&A session.

Day 2 | June 11, 2022

Day 2 of the program included eminent panelists, Dr. Ketki Ranade, Faculty, Centre for Health and Mental Health, School of Social Work, TISS, Mumbai, Dr. Amar Jesani, Independent Researcher and Teacher (Bioethics and Public Health), and Prof Vibhuti Patel.
Starting with the session, Ms. Souravie Ghimiray, IMPRI, welcomed the speakers and participants to the program with an introduction to eminent panelists
Dr. Ketki Ranade, Faculty, Center for Health and Mental Health, School of Social Work, TISS, Mumbai:
Dr. Ketki Ranade gave her insight into the understanding of gender by presenting “Gender Diversity and Healthcare”. She spoke about gender norms and their origin, discussing how they get formed and incorporated into our social systems. She also discussed the Transgender Persons (Protection of Rights) Act and the legal standpoint on gay marriage, and conversion therapy, and discussed how it impacts the mental health of people from the LGBT community. She also talked about problems faced by the members of the LGBTQIA+ community and how they might also take the form of ‘minority stress’ caused by prejudice, stigma, and discrimination.
Dr. Amar Jesani, Independent Researcher and Teacher (Bioethics and Public Health):
Dr. Amar Jesani kicked off the discussion by presenting “Ethics and Assisted Reproduction”. The presentation mainly covered themes such as reproductive rights and the right to assisted reproduction, infertility and how it is neglected, the different contexts such as social, cultural, and religious to use assisted reproduction, safety issues concerning the same, and the respective laws in India.
His presentation covered the worldwide neglect of assisted reproduction, infertility as an ignored problem, and the kind of procedures that exist for the same. He also talked about the gendered perception of how masculinity and femininity are constructed around the idea of reproduction. He talked about various risk factors involved in the same, including issues related to preimplantation embryos, controlled ovarian stimulation, and embryo culture. He also talked about The Surrogacy (Regulation) Act of 2021 and analyzed its effectiveness in real-time.
Brinelle D’souza, Centre for Health and Mental Health, School of Social Work, TISS:
Brinelle D’souza, presented a brief presentation on “Gender and Nutrition”, discussing the importance of nutrition as something not optional, but mandatory to access and how that stands as a challenge. The COVID pandemic has made the pathway toward SDG2 even steeper, and around 660 million people would face hunger even in 2030.
Talking about India particularly, she mentioned how stunting is a huge challenge that the country faces, with 35.5% of people below 5 between 2019-2021 stunted and 32.1% underweight. Reasons for these standards of poor growth include the prevalence of poverty, inadequate availability of food grains, the relative status of women within the household, and landlessness amongst subsistence farmers. The effects of the same have been accelerated post-COVID with 77% of households consuming less food than pre-COVID times. Other concepts that she elaborated on included gender and nutrition, Agrarian Crisis and Farmer’s protests, and an increasing need to recognize women’s contribution within this sector.

Day 3 | June 18, 2022

Day 3 of the program included eminent panelists, Dr. Aparna Joshi, Assistant Professor, School of Human Ecology, and Project Director, iCALL & Sukoon, Tata Institute of Social Sciences (TISS), and Renu Khanna, Researcher and Activist; Founder-Trustee, SAHAJ-Society for Health Alternatives, Vadodara.
Dr. Aparna Joshi, Assistant Professor, School of Human Ecology, Tata Institute of Social Sciences (TISS):
Dr. Aparna Joshi started off the day by presenting a small presentation on “Gender and Mental Health”. Talking about mental health at first, she gave us a brief regarding what the umbrella term of ‘mental health’ looks like, with various disorders such as anxiety, depression, schizophrenia, etc, later expanding on the dimensions of mental health.
She then took up the Indian context of mental health, reporting how in 2017,197.3 million people had mental disorders in India. Discussing gender and mental health later, she talked about how the exclusion of women from medical research studies proves to be a harm in identification and diagnosis, also expanding on gender-related stressors.
Renu Khanna, Researcher, and Activist; Founder-Trustee, SAHAJ-Society for Health Alternatives:
Renu Khanna shared a presentation on “Gender in Health Programmes in India” where she covered the gender equity continuum, explaining how policies can be exploitative, and how current policies in India since post-dependance have characterized the role of a woman only as a ‘mother’. She also expanded on the growth of the women’s health movement during the 1980s, which highlighted how the government’s policies are anti-poor and anti-woman.
She took the example of malaria as a gendered case study, showing the lack of gendered information on the disease, with only 10 lines out of 80 pages for pregnant women with malaria. The HLEG recommendations talked about gender-responsive service delivery, gender issues in human resources, and health and provision of essential medicines. She also critiqued various publicly funded insurance schemes with many conditions not being listed, no access to gynec morbidities, and the exclusion of female-headed households in the schemes. This also raised questions like better access, the condition of women, and inclusion in policy decisions.
This was followed by a discussion and engagement between Prof Anita Ghai, Prof Vina Vaswani, and Renu Khanna, talking about similar themes regarding access, policy, healthcare, and gender inclusion.
Closing the 3-Day training session convenor, Dr. Vina Vaswani, Director, Centre for Ethics, Yenepoya (Deemed to be University), gave her concluding remarks and thanked all the eminent panelists. She highlighted various essential key points that had been brought up in training.
The training program ended with a vote of thanks by Souravie Ghimiray, IMPRI.
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Acknowledgment: Sanya Sethi, research intern at IMPRI