Healthcare & Gender Equity: Emerging Dimensions, Policies, Impact & Way Forward

Event Report

Tanu Paliwal

Gender Impact Studies Center (GISC) at IMPRI Impact and Policy Research Institute, New Delhi, and Center for Ethics (CFE), Yenepoya (Deemed to be University), Mangalore organized a course ,Healthcare & Gender Equity: Emerging Dimensions, Policies, Impact & Way Forward A Four Day Online Certificate Training Course from August 28th, 2023 to August 31st, 2023. 

The chair for the program was Prof Vibhuti Patel, Visting Distinguished Professor at IMPRI

The sessions were hosted by  Fiza Mahajan, an IMPRI researcher who welcomed and introduced the eminent speakers for the event. 

Convenors of the program were,Dr Vina Vaswani, Director, Centre for Ethics; Professor, Department of Forensic Medicine and Toxicology, Yenepoya (Deemed to be) University, Mangalore,Farhaad Yenepoya,Pro-Chancellor, Yenepoya (Deemed to be University),Dr Simi Mehta, CEO and Editorial Director, IMPRI

Day 1 : Gender Equity in Health Policies, Medical Education and Healthcare Systems.

Professor Poonam Naik’s presentation on the key findings of NHFS-5 underscored a positive decline in child marriages from 27% to 23% over the past five years. However, the remaining 23% remains concerning due to its adverse effects on women’s health and socio-economic status. Anemia, affecting 57% of women aged 15-49 in 2019-21, poses additional health risks. The presentation emphasized the interconnectedness of women’s health and family well-being, highlighting the importance of prioritizing women’s health for societal health. It discussed the visual distinction between equality and equity, stressing the need for universal healthcare as a fundamental right.

The discussion delved into social determinants influencing healthcare choices, such as education, socio-economic status, and environmental conditions. Prof. Naik advocated for gender equity in health policies, addressing the lack of women’s representation and emphasizing community engagement. A bottom-up approach in policy formation, legislative reforms against gender-based violence, and resource budgeting were proposed to enhance gender equity in health.

In conclusion, the session urged stakeholders to recognize social determinants, prioritize gender equity, and highlighted the need for research, legislative reforms, and community engagement in shaping a more equitable healthcare landscape. 

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The subsequent session by Ms. Sangeeta Rege explored “Gender in Medical Education,” incorporating an engaging activity on societal roles defined by gender dynamics, emphasizing the fluidity of gender across time and regions.

Professor Rege distinguished between gender and sex, emphasizing sex as a physiological trait and gender as a socially constructed concept encompassing roles and expectations. The presentation expanded to include gender identity, incorporating transgender and intersex perspectives, emphasizing the importance of recognizing intersex variations in health care.

Addressing stereotypes perpetuated in cultural definitions of gender roles, the session underscored the impact on women’s health-seeking behaviors. It discouraged creating hierarchies based on gender differences, emphasizing the value of diversity. Prof. Rege explored gender inequalities in health systems, highlighting disparities resulting from global research often extrapolating from male subjects. Challenges faced by trans individuals accessing healthcare facilities were discussed, with an example from Mumbai advocating for dedicated trans wards.

The presentation delved into root causes of gender inequalities, citing research on unnecessary hysterectomies and emphasizing the need for sensitive responses to diverse needs. The session lamented the stagnant health budgets and emphasized the importance of gender-integrated education, revealing instances of stereotyping and violence in labor rooms.

The focus on gender in education, particularly in the 2019 MBBS curriculum, highlighted positive outcomes from integrating gender perspectives. Four overarching themes—gender analysis in health, sexualities and reproductive rights, gender-based violence, and gender, ethics, and rights—were outlined. The session concluded with a film presentation addressing stigmas around adolescent pregnancy, emphasizing the role of healthcare providers in destigmatizing reproductive health issues.

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Prof Vibhuti Patel’s presentation on “Gender as a Social Determinant of Health” delved into five levels at which gender functions as a social determinant, emphasizing the need for transformative strategies. She highlighted the impact of intersectionality, considering factors like class, caste, ethnicity, and location in healthcare access. Advocating beyond the biomedical model, Prof Patel addressed the deeply rooted patriarchal mindset perpetuating stereotypes, particularly evident during the pandemic’s discrimination against vulnerable groups.

Drawing inspiration from Vietnam’s resilience post-independence, she stressed the importance of enabling environments for flourishing lives. Prof Patel outlined seven key strategies to tackle gender-based health inequalities, including normative frameworks, legal instruments, and showcasing good practices. In conclusion, her presentation called for comprehensive, inclusive, and transformative approaches to address gender’s role in health disparities, offering a roadmap for a healthcare system promoting equity and justice.

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Day 2 : Gender-Based Violence and Health Indicators 

Professor Sangamitra Sheel Acharya initiated a discussion on the unprecedented impact of the COVID-19 pandemic, emphasizing the century-long gap since the Spanish flu and the critical need to scrutinize its repercussions, particularly on women. The significant role of mobility restrictions in combating the virus posed challenges, especially for women in densely populated households, exacerbating the struggles of those in the informal sector.

Citing United Nations data, she highlighted the plight of around 2 million women, particularly mothers, forced to reconsider employment and shoulder the responsibility of caregiving. Migrant women faced exacerbated challenges, with approximately 47 million pushed into extreme poverty, and 740 million experiencing a drastic 60% income reduction during the initial three months of the pandemic, according to an Oxfam report.

Examining the impact on women’s healthcare, Acharya revealed systematic exclusion from quality services during the pandemic, affecting antenatal, birthing, and postnatal care. This led to global disruptions, heightening risks of unintended pregnancies, sexually transmitted diseases, and escalating maternal deaths by 8-40% in low and middle-income countries.

The discussion also addressed challenges faced by women in healthcare and essential roles, including juggling medical duties and domestic responsibilities, increased workloads, and gender disparities. The pandemic exacerbated gender-based violence, with a 33-34% surge in intimate partner violence cases during its early months and a reported 31 million additional gender-based violence cases globally by July 2020. Child marriages increased due to school closures and economic strains.

In conclusion, Professor Acharya painted a stark picture of the multifaceted challenges faced by women during the pandemic, emphasizing the need for comprehensive research, informed policies, and robust international cooperation to effectively address these issues and provide vital support to women in times of crisis.

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Professor Mala Ramanathan’s presentation focuses on understanding health statistics in India and creating gender-specific indicators from diverse data sources. She highlights the transformation of health outcome data into meaningful indicators, emphasizing their role in reflecting an individual or group’s health status. Various sources, including the Census of India and the Ministry of Health and Family Welfare, contribute valuable data for developing these indicators.

Analyzing the gender gap in healthcare access and preferences, the data reveals variations in treatment between men and women in rural and urban areas. While rural areas show a female advantage in accessing medical treatment, urban areas tend to favor men. Professor Ramanathan emphasizes the need to investigate the reasons behind these disparities and stresses the importance of gender-specific health indicators to identify potential unfairness or disadvantages. The central message underscores the significance of analyzing microdata for meaningful insights, advocating for gender-sensitive health care policies and ongoing efforts for true gender equity.

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Day 3 : Gender Diversity and Pandemics

Dr. Padma Bhate Deosthali delivered a presentation on “Health Systems Response to Gender-Based Violence” delved into the critical role of health systems in addressing violence against women and gender-based violence. A key distinction was made between the two, with the latter encompassing all forms of violence against diverse genders. The global consensus, as outlined by WHO guidelines, emphasizes the role of health systems in providing supportive care, irrespective of a country’s developmental status.

In the Indian context, the recognition of gender-based violence as a health issue emerged in 2017 through health policy, with legal mandates existing for healthcare providers before this acknowledgment. Despite legal provisions, challenges in policy implementation persist. The biomedical model often inhibits survivors from disclosing their experiences, and health systems may inadvertently perpetuate gender norms, hindering effective responses.

Dr. Padma highlighted the interconnectedness of health systems with other institutions and the challenges in medico-legal care implementation. The session emphasized the need for ongoing discourse, collaborative efforts, and a paradigm shift in societal perceptions to address gender-based violence effectively through health systems.

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Dr. Aqsa Shaikh delivered a presentation on “Response of Health Care System with regard to Gender Diversity & Intersectional Marginalities” addressed the multifaceted challenges faced by trans individuals within the healthcare system. She emphasized the often overlooked issue of violence against men in homosexual relationships and broader concerns related to gender diversity. Dr. Aqsa highlighted the intersectionality of gender identity, discussing the complex layers of marginalization faced by trans individuals, including factors like religion, caste, and tribal identity.

The session underscored the lack of understanding in society leading to transphobia and homophobia and advocated for recognizing the diversity within the trans community. Dr. Aqsa navigated through educational challenges, legal milestones, and societal perceptions affecting trans individuals’ access to healthcare.

The healthcare landscape for trans individuals revealed issues such as unregulated gender-affirming surgeries, the prevalence of conversion therapy, and the lack of affordable healthcare options in rural areas. Dr. Aqsa provided a comprehensive overview of these complex issues, touching on legal, societal, and medical dimensions.

The presentation concluded with suggestions to address these challenges, including the need to decriminalize trans individuals, pathologize gender identity, and revise blood donation guidelines. Dr. Aqsa advocated for the inclusion of gender-affirming care in essential healthcare services and proposed the creation of a medical board to evaluate the necessity of gender-affirming surgeries. The session highlighted the importance of ongoing discourse, legal advocacy, and policy changes to create an inclusive and equitable healthcare system for trans individuals.

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Day 4 : Gender and Human & Reproductive Rights 

Dr. Amar Jesani’s session on the intersection of Gender, Health, and Human Rights provided a comprehensive exploration of healthcare inequalities and their relation to human rights. Addressing the “inverse care law,” the discussion delved into philosophical frameworks like Egalitarianism, Sufficientism, and Prioritarianism, emphasizing the goal of Universalism for equitable healthcare access, irrespective of financial capacity.

Highlighting the significance of the Universal Declaration of Human Rights, Dr. Jesani underscored the interconnection between civil and political rights and socio-economic dimensions for comprehensive well-being. The historical development of healthcare systems revealed the impact of social and economic factors on health, with post-World War II solidarity principles fostering universal access.

Critiques of developed healthcare systems exposed biases based on gender, caste, class, and race, prompting the need for progressive universalism. Dr. Jesani advocated for public financing, progressive taxation, and regulation of the private healthcare sector to prioritize vulnerable groups. The session also stressed the importance of gender-affirmative healthcare as a fundamental aspect of human rights, supporting individuals’ authenticity and self-identification. Overall, Dr. Jesani’s presentation serves as a catalyst for reimagining and reforming healthcare systems to achieve greater equity, inclusivity, and respect for human rights.

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In her session on ‘Gender and Reproductive Rights,’ Dr. Uma Kulkarni underscored the significance of recognizing and protecting these rights, particularly for marginalized women. The historical evolution of reproductive rights, beginning with the International Conference on Human Rights in 1968, highlighted subsequent milestones that shaped the understanding of women’s reproductive autonomy.

Reproductive rights in India, enshrined in legislation, face challenges in implementation, especially for women in the unorganized sector. Dr. Kulkarni addressed issues such as child marriage, challenges in maternal health, and the limitations of schemes like the Rashtriya Swasthya Bima Yojana, emphasizing the need for comprehensive and equitable healthcare solutions. The session illuminated the intricate challenges in realizing reproductive rights and maternal health in India, urging ongoing efforts for improvement.

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Professor Vina Viswani’s session on Gender Justice in Forensic Medicine emphasized the vital role of gender justice in shaping forensic practices. In sexual assault cases, she stressed the need for a compassionate approach during forensic examinations, recognizing victims’ humanity and the trauma they endure. Gender disparities in autopsy procedures were highlighted, emphasizing the urgency of ensuring equality in death investigations. Professor Viswani articulated gender justice as a fundamental principle, demanding equitable treatment irrespective of gender identity. 

The session addressed the historical use of sexual violence in conflicts and atrocities, discussing the various forms of violence and their impacts. Challenges in achieving gender justice were outlined, including biases, patriarchal notions, and media objectification. Professor Viswani advocated for a comprehensive legal framework addressing gender-based violence, ensuring survivors’ rights through anonymity, confidentiality, and informed consent. The importance of intersectionality in understanding diverse experiences was underscored, emphasizing the need to challenge biases within legal, social, and medical systems. In summary, the session highlighted the imperative of a compassionate and equitable approach in forensic medicine to address systemic gender biases and promote justice for survivors of gender-based violence.

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Acknowledgment: This event report is written by Tanu Paliwal


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