It is estimated that 2.2 billion people around the world have some form of vision impairment, out of which 1 billion could have prevented it or have eye issues that are yet to be addressed In India alone, over 15 million people are blind, and the numbers rise further when considering visual impairments.
Population coverage and treatment resources are disproportionately distributed and such inequities should be fully addressed. Additionally, social, economic and demographic factors can reduce an intervention’s success. A large proportion of the “neglected population” (Galambos, 2005; Rao, 2015) constituting people from urban slums or tribal areas, illiterates from socially and economically backward groups, women and children, people with disabilities, migrants and refugees, are at the receiving end of relatively poor health care. Inequity in healthcare can take place at the level of availability, accessibility, and affordability.
Costs of Visual Impairment
Social determinants based on scheduled castes, scheduled tribes, women and children, religious minorities and the queer community determine the accessibility patterns of healthcare in India. These social inequities are unfair and unjust and reveal the societal make-up of a country. Apart from social determinants, statist interventions also play a significant role in ensuring accessibility of healthcare services. For example, Information, Education, and Communication (IEC) services and their prevalence in a society determine the ease with which citizens can approach and access healthcare services.
With the Indian government’s National Program for Control of Blindness and Visual Impairment (NPCBI) along with several state action plans and the involvement of large NGOs and international organizations, the eye care scenario has been steadily improving. This is the need of the hour, as experts determined a loss of 88,900 crore rupees to the economy due to vision impairments, 35% of which are preventable in India. The National Program for Control of Blindness 2017-2019 is applauded for considerable success for most of its target achievements, but experts argue that the targets were not set high enough and not enough was done for specific problem areas such as tackling the gender disparity in the treatment of visual impairments.
Implications for Women
Women bear a disproportionate burden of health inequity everywhere around the world, and the case is no different for visual impairments. This is due to several factors, such as their traditional household roles, and the fact that they are less likely to receive access to care and treatment. 139 million out of the 253 million people around the world who are visually impaired are women, which is about 55%. The gender disparity widens further where eye care is concerned. The coverage of cataract surgery among women is always lower, sometimes even half of that of men.
Several national surveys and Rapid Assessment of Avoidable Blindness Studies (RAABs) have confirmed that women account for about 64 percent of the total number of blind persons globally and that in many areas, especially in the Global South, men are twice as likely as women to be able to access eye care.
The cause of higher rates of visual impairments is usually explored from the perspective of higher risk factors such as being primary caregivers to children and the elderly, from whom preexisting eye infections such as trachoma may be contracted. Women’s general lack of mobility in developing countries hinders them from seeking thorough medical treatments, especially since they may not have financial decision-making authority within the family to pay for eye care services. In addition, women’s childcare responsibilities may make it difficult for them to leave home.
Illiteracy can affect women from availing refraction services across their life course, for example, if they believe that eye care services are for those who can read and write, and for people who need their eyesight to do their job. Even when younger, girls can be discouraged from getting their eyesight sorted with a pair of spectacles. As they age, women may have less access to financial resources or be reluctant to ask for it from the wider family as they prioritize the needs of their children and other family members. Women put themselves at the back of the queue because of previous discrimination they experienced, and families do not challenge that view.
There is evidence that adult men and women still have unequal access to cataract services. Because women have a slightly higher incidence of cataracts and tend to have a longer life expectancy than men, women should account for 60–65 percent of all cataract operations. However, a recent analysis of 22 population-based studies in 17 low- and middle-income countries showed that, in all studies except one, more men than women received cataract surgery.
Trachoma is one of the few ‘life cycle’ eye diseases affecting people of all ages in endemic areas of the world. Recent work in Southern Sudan has demonstrated trichiasis in children, with girls being 1.5 times more likely to have trichiasis than boys. As the SAFE strategy indicates, addressing trachoma requires planners and health care providers to consider all of the various ways we reach into communities and address the needs of women and girls. Interventions can be related to water use, latrines, distribution of antibiotics, or surgery for trichiasis.
Rural outreach programs have proven to be the most successful in shrinking the gender disparity in eye health as they actively address the barriers that are preventing women or girls from accessing eye care services. However, in order to thoroughly and more effectively combat this unfair disparity, it is necessary to devise an intensive strategy that is permanent rather than periodic, which would allow eye care services to be equally accessible for men and women, responsive to their actual needs.
Given both the diversity and variable nature of disabilities and the intersection with other disciplines, from sociology and cultural studies to health science and rehabilitation science, a comprehensive introduction to the field is problematic.
Acknowledgment: Malcolm Antony is a Research Intern at IMPRI