Manorama Bakshi and Arjun Kumar
You cannot build Nari Shakti (Women’s Power) on political quotas alone; you need health security as its bedrock. As India’s health spending crosses the historic ₹1.06 lakh crore milestone and the government fast-tracks the 106th Constitutional Amendment to operationalize the 33 per cent reservation for women, we are at a national inflection point. Yet, these two consequential policy shifts—representation and resilience—continue to move on parallel tracks. Representation is a victory of numbers; resilience is a victory of survival.
We must ask: Can a woman effectively lead a constituency if her own household is anchored in medical debt? Political reservation gives women a seat at the table, but without a Universal Right to Health, it does not give them the power to stay there. Health vulnerability in India is not a monolith; empowerment and outcomes are fractured by caste, tribe, and region. While those with social independence show better health markers, women from deprived groups remain dangerously exposed to the next medical shock.
The ‘Shock Absorbers’ of the Economy
The blind spot in our national discourse is the “missing middle”—nearly 40 crore Indians who are neither poor enough to qualify for state subsidies nor affluent enough to afford private insurance. This space is not gender-neutral. In most Indian households, women are the primary caregivers but the “last care-seekers.” Preventive screenings are delayed, oncology checks are postponed, and reproductive care is often sacrificed to preserve family savings.
With India still recording nearly 47 per cent of health expenditure as out-of-pocket (OOPE), a medical emergency is rarely just a health crisis; it is a financial slide that evicts families from economic stability. In this silent calculus, women become the shock absorbers of the economy. They absorb risk through deferred care and worsening health, eventually reducing their own participation in the workforce. By universalizing health insurance as a residency-based right, we do not just protect bodies; we protect the economic agency that the reservation framework seeks to unlock.
Health as Economic Infrastructure
If the intent of Nari Shakti is to enable women not only to enter the corridors of power but to sustain their presence there, health must be understood as economic infrastructure, not mere welfare. A guaranteed insurance right is a high-yield macroeconomic multiplier. It stabilizes households and releases women from the “care-poverty trap” that continues to suppress India’s female labour force participation.
This shift turns women from unpaid “crisis managers” into productive economic agents, strengthening national resilience. India’s digital health backbone, with over 60 crore ABHA IDs already active, has already laid the “rails” for this portable social protection system. The infrastructure exists. What is needed now is the political will to run the train.
From Fiscal Gatekeeper to Caring State
India is not starting from scratch. States like Assam, West Bengal, and Punjab are already experimenting with residency-based models, signaling a shift from fragmented schemes toward universalism. Here, the role of the state must evolve: from a fiscal gatekeeper to a “caring state” that guarantees protection as a right rather than extending it as a benefit.
Health entitlements must be decoupled from “deprivation criteria” and anchored in residency, ensuring protection follows the citizen rather than the poverty line. Simultaneously, public health financing must incorporate a gender lens, with at least 30 per cent of health outlays ring-fenced for women’s insurance entitlements, protected from mid-year fiscal cuts. Global evidence shows that when insurance design is gender-responsive, women utilize it as effectively as men, provided the “last-mile” systems are built with empathy.
Conclusion: Breaking the Ceiling
If you want women to lead, you must first ensure they can survive, work, and remain economically secure. Political reservation gives women a voice in governance, but a legally codified Right to Health gives them the strength to exercise that voice.
The 2026 election cycle should mark a transition from subsidizing vulnerability to guaranteeing security. The real glass ceiling in India is not the absence of representation; it is the persistence of health insecurity that limits agency. Break that, and Nari Shakti will not just be visible—it will be unstoppable.
About the Authors:
Dr. Manorama Bakshi is Director and Head of Healthcare and Advocacy at Consocia Advisory, Founder/Director of the Triloki Raj Foundation, and a Senior Visiting Fellow at IMPRI.
Dr. Arjun Kumar is Director, IMPRI Impact and Policy Research Institute, New Delhi.
Disclaimer: All views expressed in the article belong solely to the author and not necessarily to the organisation.
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Acknowledgement: This article was posted by Anish Pujapanda, a Research and Editorial Intern at IMPRI.
