Addressing gender inequities in healthcare amidst the rise of NCDs among women – ET HealthWorld

As India celebrates 77 years of independence, an emerging healthcare challenge for the country is the rapid rise of non-communicable diseases (NCDs) among women. Historically, owing to higher exposure to tobacco, alcohol, work-related stress, injuries and other hazards NCDs were often higher among men compared to women. However, women now report comparable burdens for all diseases, with marginally higher mortality due to cancers (10.3 per cent vs 9.1 per cent ) and chronic respiratory diseases (12.4 per cent vs 12.3 per cent ).

This rise in NCDs can be attributed to increased life expectancy of women (from 40.4 years in 1950 to 73.6 years in 2023), the feminised nature of ageing and the onset of the epidemiological transition, with large-scale shifts in mortality and morbidity from infectious diseases to non-communicable diseases (NCDs).

Our recent working Paper – ‘Health Insurance Access and Disease Profile for Women in India’ uses data from the India State-Level Burden of Disease Study and estimates that in the last two decades (from 2000 to 2018) mortality among women for the big four of NCDs increased. From 16.2 per cent to 25.7 per cent for cardiovascular diseases (CVDs), 5.9 per cent to 10.3 per cent for cancer, 8.2 per cent to 12.4 per cent for chronic respiratory diseases (CRDs) and 2.9 per cent to 5.1 per cent for diabetes and kidney disorders. The only exception to this trajectory was the declining but continued mortality from diarrheal diseases for women, accounting for nearly 9.4 per cent of all deaths. This burden also shows significant state heterogeneity, but previously presumed patterns of higher burden among southern states, and mostly infectious disease in the north are fast reversing. In Tamil Nadu, one in three women’s deaths were attributed to CVDs (35.2 per cent ), followed by diabetes and kidney disorders (11.8 per cent ), cancer (9 per cent ) and CRDs (7.9 per cent ).

However, now Haryana and Punjab are also reporting rising mortality due to NCDs. In neighbouring state of Rajasthan, chronic respiratory diseases have become the top reason for mortality; a similar trend was observed in Uttar Pradesh where nearly one in five women died due to chronic respiratory diseases and cardiovascular diseases each. Nearly one in three women (29.2 per cent ) in Chhattisgarh and two in five women (41.1 per cent ) in West Bengal died prematurely from CVDs. In Meghalaya, NCD-attributable mortality among women was much higher compared to men for respiratory tract infections (7.4 per cent vs. 6.4 per cent ) and CVDs (12.2 per cent vs. 9.4 per cent ), but similar proportions were reported for chronic kidney conditions, while cancers were higher for men compared to women (15.6 vs 11.3 per cent ).

So, what do we make of these trends and how do we enable access to healthcare for women? India has one of the world’s largest national health insurance schemes Pradhan Mantri Jan Arogya Yojana (PMJAY), in sheer numbers, along with several state-based public funded health insurance schemes. The vision for these schemes has been to reduce health-related out of pocket costs for households, but despite rising enrollment, there is limited understanding of how these schemes are used by women, and whether they truly enable them to avert crippling health costs and access the healthcare that they desire or need. Recent National Family and Health Survey data from 2019-21 have shown that women 15-49 years of age continue to report lack of health providers, particularly female health providers, and drugs as barriers to their health-seeking. Other reasons provided by these women included lack of agency in seeking healthcare (needing permission, accompaniment, and travel support). Research shows that despite insurance coverage, women’s health is often de-prioritised within households, and women often themselves, either delay health seeking or forgo health-seeking entirely. Delays in screening and treatment, and availability of poor quality healthcare can lead to later detection of risk factors related to diabetes, hypertension, and cancer, leading to poorer prognosis for NCDs.

In light of this, we recommend three areas of policy engagement where better understanding of the state of women’s health, especially in relation to NCDs, is needed.

Firstly, data are showing rising enrollment of insurance in greenfield states (i.e. states with no previous coverage). However, there is lack of nuanced understanding of how beneficiary identification- targeted versus universal – works or affects uptake among them, how the insurance is used by them, and despite greater digitisation, whether there are technological and systemic barriers to women’s engagement with health services. Our analysis from Meghalaya has for instance shown that even where insurance was universally available, men reported greater use of high-end tertiary care services, and women used secondary level healthcare. A similar trend has previously been reported from Rajasthan. Hence, a gender lens is needed to understand how women and their families are engaging with these insurance schemes and whether they are achieving the goals of greater healthcare access and reduced costs are being met.

Secondly, discussions on the access and use of health insurance cannot be decoupled from engaging on questions related to the structural nature and facets of the health system available to women, and how the health system engages with female patients. In the work on reproductive health, there is growing documentation of the disrespect faced by women in health-seeking, and these experiences may be more acute when female patients are not educated, employed, or empowered. Women’s health-seeking is often incumbent on the will of male family members or taken by health providers without consulting them. Greater understanding of female patient experiences can provide insight into how health services are engaging with women and improve the user experience. Interventions and programs particularly related to screening, diagnostics, and management related to NCDs, such as cancer and hypertension, can be more successful if they pay special attention to the needs and circumstances of women, and create services that are women friendly in appearance and tone.

Finally, investing in women’s empowerment, and their economic, digital, and social inclusion will be critical to enhancing women’s access and use of insurance. Having control over their own resources, overcoming fears related to use of technology, as well as greater decision-making for themselves while not a direct goal of NCD programs can be critical to their success, reach, and impact.

The article is written by Nandita Bhan, Visiting Fellow and Co-authored by Prajakta Shukla, Research Analyst at CSEP

(DISCLAIMER: The views expressed are solely of the author and ETHealthworld.com does not necessarily subscribe to it. ETHealthworld.com shall not be responsible for any damage caused to any person/organisation directly or indirectly)

• Published On Aug 31, 2024 at 08:34 PM IST

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