Gender equality, good health and well-being all feature in the Sustainable Development Goals (SDGs), and the disparity experienced in women’s health-seeking behaviour are alarming. With health gaining centrality like never before due to the advent of the pandemic, the issue of negligence regarding this subject needs to be discussed and addressed. Like the slogan “Healthy Women, Healthy World” their health and well-being are directly linked to the well-being of the household unit. Under the series, the State of Gender Equality – #GenderGaps, Gender Impact Studies Center (GISC), IMPRI, Impact and Policy Research Institute, New Delhi organized a #WebPolicyTalk, on the topic A Socio-Economic Analysis of Health Seeking Behaviour of Women in an Urban Area with Special Reference to their Employment Status by on November 30, 2022.
Dr Lakshmi Priya is an Independent Researcher, who worked as a Research Coordinator at IRIS Knowledge Foundation for 11 years and anchored TATA Trust and GATES foundation projects. The chair for the event, Prof Vibhuti Patel is a Visiting Distinguished Professor at IMPRI and a Former Professor at Tata Institute of Social Sciences (TISS), Mumbai. The discussants of the event were Prof N. Manimekalai, Professor at the Department of Women’s Studies, Coordinator, RUSA Social Sciences in Bharathidasan University Tiruchirapalli, Dr Suchita Krishnaprasad, Former Associate Professor and Head of the Department of Economics, at Elphinstone College, Mumbai, Prof Manisha Karne, Director at Dr Babasaheb Ambedkar International Research Centre, Professor at Mumbai School of Economics and Public Policy, University of Mumbai.
Distribution and Inequality
According to Prof Vibhuti Patel, women have been challenging for policymakers due to mirror factors like poor status in the economy, and women subordinated to the status of society irrespective of class background women face neglect and exclusion in health-seeking patterns. Even Africa has better performance after Millenium Development Goals (MDGs) but India remains at an extremely high maternal mortality rate. In the United Nations, our then prime minister Indira Gandhi proclaimed, ‘the aim of health for all.’ Further Prof Patel explained the need to check on women’s health-seeking behaviour as culturally man is seen as the breadwinner, and the whole priority infra household, care, concern, and resources are unequally distributed. She quoted the World Health Organization (WHO) constitution states that “the enjoyment of the highest attainable standard of health is one of the fundamental rights of every human being…”
Role of Financial Factors
Dr Lakshmi Priya presented a part of her thesis which she did under the guidance of Prof. Manisha Karne. Dr Priya gave a brief introduction on the employment status of women and their health-seeking behaviour as she shared the key findings about India’s position being very low in labour force participation of women and on public health expenditure but at the same time highest in out-of-pocket expenditure. According to Dr Priya, very few studies focus exclusively on the health expenditure of women. She shared that the logistic regression was done and it was found that access to healthcare services is positively related to health insurance and if women are employees. Affordability problems were faced by women who suffered chronic illnesses like thyroid, blood pressure, and joint pains.
The findings on hospital admission of women and their source of financing to healthcare show that 66.5% of women were admitted due to chronic illness, 44% of women were admitted to private hospitals, the cost of medicine was very high for women and even the fees of doctors was highest for chronic illness. Around 44.5% of women were aware of health insurance but only 16.1% of them have insurance. Dr Priya highlighted some policy recommendations; first, she emphasized on effective implementation of Ayushmaan Bharat which will help in extending to cover basic health facilities to a large number of people. Second, strengthen public healthcare by making it a public-private partnership model. Third, provide better dissemination of information about health schemes. Fourth, implement effective Universal health coverage and a National health protection scheme. Fifth, improve the quality and infrastructure of public hospitals.
International Labour Organization Report and Paradoxes
Dr Suchita Krishnaprasad was asked by Prof Vibhuti Patel to relate recent studies of the International Labour Organization (ILO) i.e. ‘Extending the Social Health Study to Informal Sector Workers in India’ which is done along with the Institute of Human Development. To this Dr Suchita explains the four states covered by the ILO report; West Bengal, Kerala, Haryana, and Rajasthan, and ESIC, a state-sponsored insurance scheme for the workers. She mentions the ILO findings i.e. in case of an accident at work place there is large out-of-pocket expenditure happening in industries like fabrication, and manufacturing units and less in the agriculture industry but only 13% who suffer an accident at work place get it paid by insurance.
Dr Suchita emphasized making the health sector more affordable by being parallel to the expunction of Employees’ State Insurance Corporation (ESIC). As per the ILO report, in the last five years, less than 14% of female workers or spouses of male workers have undergone pregnancy episodes and assistance was received only in 54 cases, around two-fifths of women have access to Janani Suraksha Yojana. She gave the two paradoxes: first, India is called a global pharmaceutical industry but the ratio of the medical profession to population is disheartening, and second, 20% of registered professional practitioners are out of a job, as a result, if women start seeking health there might be a block on the supply side.
Role of Social Factors
Prof. N. Manimekalai congratulated Dr Lakshmi Priya for bringing out micro-level studies. She explains how on the one hand, insurance is there but people are not aware of the scheme whereas, on the other hand, the urban settlement sample becomes a very important part of the discussion on intersectionality. The social determinants are considered more determining the health-seeking behaviour of women than the economics as such. Prof. Manimekalai further emphasized the interconnection between SDGs goal 3 i.e. regarding health and goal 6 regarding sanitation and water.
According to the professor, sanitation and clean water are connected to health, and when it is to occupational health; women are involved in some hazardous industries like tanning industries. Further, Prof Manimekalai gave three strategies for the state to make intensive awareness about insurance. First, the use of social media especially among the marginalized sections of society in vernacular language, second, door-to-door service for health to be undertaken by more states, third, doorstep education should be offered to compensate for the loss due to Covid-19.
The Question of Healthcare Access
Prof. Manisha Karne responding to Prof Patel’s question on the framing of policy and access given to the people, Prof Karne said that geographical access is more important in the health sector rather than holistic access. As per the population norms, hospitals/clinics should be within certain kilometres of where the residents are residing but this is generally violated. And the main reason behind this is transport as schemes like Janani Suraksha Yojana gives transport allowance to women but in reality, rarely women are given this provision. Further, Prof Karne showed concerns about the health outcomes.
First, the health sector has become a burden to poor people due to out-of-pocket expenditure as today 80% of the health sector in India is the private health sector. Second, healthcare services are provided in three domains, low-cost healthcare intervention, public health, and catastrophic health expenditure. Third, the concern is about ability, accessibility, and quality. Fourth, as good policies are stopped in between, it needs to be continued in India. And lastly, according to the professor, public health should be re-emphasized as public health facilities can be good gatekeepers.
Acknowledgement: Nayna Agarwal is a research intern at IMPRI.