A Four Week Online Certificate Training Course on Healthcare & Gender Equity: Emerging Dimensions, Policies, Impact & Way Forward was organized by the Gender Impact Studies Center (GISC), at the IMPRI Impact and Policy Research Institute, New Delhi and Center for Ethics (CFE), Yenepoya (Deemed to be University), Mangalore from August 28th, 2023 to August 31st, 2023. Inaugurating the session Fiza Mahajan, a visiting researcher at IMPRI, welcomed the speakers and participants to the program with an introduction to the eminent panelists.
Day 1 of the event began with a presentation on “Gender Implications of Health Policies” by our first speaker, Prof. Poonam Naik, Professor & HOD, MBBS, MD, FAIMER FELLOW, PGDBEME, Yenepoya Medical College, Yenepoya (Deemed to be) University, Mangalore.
During the presentation, Professor Naik shed light on the facts and figures of the National Family Health Survey-5 (NHFS), elucidated the distinctions between equity and equality, discussed the role of gender in shaping health policies, and presented solutions and approaches for operationalizing commitments.
Key findings of NHFS -5
Professor Naik highlighted a decrease in the prevalence of child marriages from 27% to 23% over the last five years. Despite this positive change, the remaining 23% is still alarming due to the detrimental effects that child marriages have on women’s health, socio-economic status, and overall social well-being. Furthermore, anemia remains the most common nutritional disorder observed among women, with 57% of women aged 15-49 being anemic in 2019-21, up from 53% in 2015-16. This makes them vulnerable to various other health problems.
She emphasized the interconnectedness of women’s health and the overall well-being of the family. The health of children is intricately tied to the health of their mothers, making the prioritization of women’s health imperative for the broader societal health landscape. In the year 2000, the Millennium Development Goals were adopted, but they did not focus much on gender. This flaw was recognized and corrected in the Sustainable Development Goals by placing gender equality as goal 5, ensuring that the most vulnerable groups, with a focus on disaggregated data, are targeted.
Equality vs Equity
The presentation employed visual aids to elucidate the distinction between equality and equity. While equality involves providing the same resources to everyone, equity emphasizes allocating a larger proportion of resources to those who are more vulnerable. She stressed that healthcare must not only be accessible to those who can afford it but should be a universal right, necessitating government involvement.
Basic necessities should be met first since significant inequality in access to medical care, sustenance, and shelter offends the social conscience more than inequality in cars, books, or furniture.
Despite healthcare being a critical determinant of well-being, its cost often places it beyond the reach of many individuals. Therefore, active government participation becomes important to ensure equitable distribution of healthcare services among diverse socioeconomic groups.She emphasized that equity not only aligns with principles of social justice and human rights but can also significantly enhance the efficiency of health systems.
Social Determinants of Health
Prof Naik explained the various social determinants of healthcare that influence an individual’s health choices and, ultimately, the outcomes. Education, as a primary determinant, plays a crucial role in healthcare-seeking behavior. Aware and literate women are more likely to make optimal decisions concerning their health. The low socio-economic status of women makes them financially dependent on others, leading to refraining from accessing required healthcare services. High out-of-pocket expenditures, along with indirect medical costs such as medication and traveling, may affect the healthcare-seeking practices of women.
Moreover, living in poor environmental conditions, such as increased exposure to indoor air pollution due to the burning of fuel for cooking or residing in overcrowded places, and the poor sanitation conditions in government schools result in increased dropouts of girls. This situation could make them vulnerable to reproductive infections and morbidity, significantly altering their healthcare-seeking behavior and, consequently, health outcomes. This stems from an inability to recognize that women’s health is equally important and is often overlooked.
Gender Equity in Health Policies
The insufficient representation of women on committees or boards of policymakers, contributing to gender inequality in policies was highlighted .To address this gap, community engagement, involvement of civic society, and active participation of women’s forums are essential. Health policies should emphasize gender components and consider other social determinants.
Professor Naik strongly advocated for a bottom-up approach in health policy formation, urging a shift from the traditional top-down model. Decentralization becomes crucial in identifying gender-based issues and devising region-specific solutions, considering diverse regional and geographical factors.
The necessity of monitoring and evaluating gender-sensitive aspects was underscored to ensure the prioritisation of gender in health policies. Health systems lacking gender-appropriate services, policies, or strategies contribute to the perpetuation of gendered social inequality.
The lack of evidence-based research on health policies in India hampers progress, leading to a dearth of actionable evidence. Professor Naik emphasized the importance of a health information system, calling for gender-based data collection and thorough analysis. Evidence-driven, operational research is imperative for translational research.
Legislative reforms were recommended to combat gender-based violence, protect and promote health-related rights (including those of migrants, women, children, and sexual minorities), and implement non-discrimination measures. Health program reviews at district, state, and central levels should incorporate gender equity and human rights as core components.
Adequate resource budgeting at the political level was identified as a critical tool for making services accessible to the masses. An illustrative figure depicting how to identify missing groups was suggested to enhance the functioning of the health system.
The session provided a comprehensive perspective on the health issues discussed, urging stakeholders to recognize the social determinants of health and prioritize gender equity in policy formulation. The need for robust research, legislative reforms, and community engagement were identified as crucial elements in shaping a more equitable healthcare landscape.
Professor Poonam Naik ended her session with an insightful and interactive Q&A round.
Acknowledgement: Tanu Paliwal is a research intern at IMPRI.