Improving women’s health key Indian strategy

Detailed research of Indian health disparities has revealed that significant differences in access to health care exist even within families, with the health and nutrition of women and girls taking a backseat to that of men and boys.

That was the picture painted Monday (Oct. 22) by Gita Sen of the Indian Institute of Management in Bangalore, India, and an adjunct lecturer on population and international health at the Harvard School of Public Health (HSPH).

Sen was one of the speakers at a two-day symposium hosted by the Harvard School of Public Health, the Harvard-MIT Division of Health Sciences and Technology, Boston University’s Global Health Initiative, and Tufts University.

The symposium, “Boston-India Symposium on Essential Interfaces in Public Health,” brought together leading academics, innovators, and key government officials to forge new relationships and discuss ways to meet India’s public health challenges.

The event, held at the Westin Copley Place Hotel in Boston, featured a wide variety of speakers on many topics. Among the participants were HSPH Dean Barry Bloom; Maharaj Bhan, secretary to the Government of India, Department of Biotechnology of the Ministry of Science and Technology; Mary Y. Lee, associate provost at Tufts; Martha Gray, director of the Harvard/MIT Division of Health Sciences and Technology; and K. Srinath Reddy, president of the Public Health Foundation of India.

Sen was the first speaker in a conference segment hosted by Bloom. Bloom, an expert in international health who first visited India in 1971, said there’s been much progress in Indian public health since then, particularly in building the capacity of the public health system.

One of the holes in that system, however, is the service and care for women. Sen, whom Bloom described as the “gender conscience of India,” said that many health statistics don’t delve deeply enough to separate the effects of gender discrimination from those of economy, class, ethnicity and other social determinants.

That was illustrated by a study of illnesses lasting longer than three months that showed that, as one might expect, poor patients who could less easily afford treatments discontinued their medical care at higher rates than richer patients. When the data was examined more closely, however, it showed that, except for the poorest 20 percent, the difference was almost entirely among rich women and poor women.

Except for the poorest men, there was very little difference in a man’s access to medical care according to economic status. Among women, however, there were pronounced differences that accounted for much of the trend in the overall data.

“The gaps due to economic differences are almost entirely due to the differences between women, not men,” Sen said.

Sen said there is a “lack of acknowledgment” of illnesses among Indian women that isn’t the same as a lack of awareness. Women are often aware they’re ill but say they didn’t think it was serious — or their family didn’t think it was serious — as reasons they didn’t seek or continue care.

Sen traced the ripples of that “lack of acknowledgment” to nationwide Indian health statistics that seem to show an apparent contradiction: that poor Indian women are healthier than wealthier Indian women. One 2000 study that probed more deeply into the self-reported health statistics found that women underreported illnesses by 124 percent.

The health care discrimination against Indian women begins at a young age, Sen said, with girls experiencing poorer nutrition and health care and less playtime and rest than boys. Statistics about the long-term effects of these early differences are lacking, she said, so researchers don’t know if girls adjust as they grow or whether it affects them throughout their lives, becoming a problem during pregnancy.

One thing that appears clear, Sen said, is that the national policy of giving pregnant women iron supplements is “woefully inadequate,” that far more comprehensive statistics need to be collected if the extent of the problem is to be understood, and that women and girls need public health programs targeted specifically at them.