How TB is silently killing India's mothers

According to the WHO, TB is the third leading cause of death for women aged 15-44 worldwide.

When did we last consider TB as one of India’s biggest health problems? To refresh memories, here are a few forgotten facts about TB in India: one of the leading causes of death in India, TB kills one person every two minutes and 750 people every day. The direct and indirect annual costs of treating TB stand at $23.7 billion. The disease primarily affects people in their most productive years of life – almost 70 per cent of patients are between 15 and 54 years. A communicable, air-borne disease that attacks the lungs, if left untreated, a TB patient can infect 10-15 people every year.

If the above facts do not shock you, recent reports of 12 Extensively Drug Resistant (XXDR) TB cases in Mumbai’s Hinduja hospital should.  Drug-resistant TB is a mutated strain of the bacteria that’s immune to anti-TB drugs. Extensively drug-resistant TB or XXDR-TB is a condition where patients become resistant to all 12 drugs used to cure TB. 
When it comes to TB, women face the severest consequences. The disease takes a disproportionately large toll on young women. More than 50 per cent of female cases occur before 34 years of age. According to the World Health Organisation, TB is the third leading cause of death for women aged 15-44 worldwide. It is the fourth leading cause of death among women aged 10-19 in low-income countries and the fifth leading cause of death among women aged 20-59 worldwide. Poverty is a major factor in developing active TB. Since women comprise 70 per  cent of the world’s poor, this accounts for their high morbidity and mortality rates due to TB.

Risk for women

Moreover, TB endangers the lives of pregnant women and their babies. Women with TB are twice as likely to give birth to a premature or low-birth-weight baby and four times more likely to die in childbirth. The risk of infant death also greatly increases. Women are more likely to have TB outside the lungs. Unknown to many, the disease is a leading cause of infertility in low and middle-income countries, a condition due to which women often face humiliation, discrimination and even physical abuse.

Certain gender-specific risk factors make women more vulnerable to TB. Women infected with TB bacteria are more likely to develop infectious TB than men. Yet, they are less likely to visit a qualified healthcare provider because women often neglect their own health and accord more importance to their families. In the process, they place themselves at continuous risk. Stigma, low socio-economic status and lack of education are some factors that cause significant delays in the diagnosis and treatment of TB in women. Like in other low or middle-income countries, Indian women often cook indoors within confined spaces using biomass fuel such as wood or animal dung. This naturally puts them at higher risk. Such women are more likely to develop active TB. Furthermore, women living in poverty are at an increased risk of being sold into the sex trade. Women and girls engaging in sex work are more vulnerable to contracting TB from clients. This risk is exacerbated by their confined living conditions and susceptibility to HIV.

Once diagnosed with TB, women face various social and economic consequences. The stigma of having TB affects women more drastically than men. In some communities, a positive diagnosis may force women into divorce or, if unmarried, create hurdles in finding a partner. TB mostly affects women in their economically and reproductively active years, placing a substantial burden on the women and their families. As a mother, caretaker and often bread winner of the family, women suffering from TB are often unable to care for their children and have trouble performing household chores.  This affects their role in the family and the family’s economic status.

We live in a world where many women themselves understand little of their own health and well-being. Society also undervalues their health and is ignorant of women’s health issues. It is critical that we work to remove barriers to access, reduce delays and improve the diagnosis and treatment of TB, especially in women. A gender-sensitive approach is urgently needed to understand the inadequacies of diagnosing and treating TB in women, including gender-sensitive treatment options. A beginning could be made by providing women sufficient information on TB and incorporating routine TB screening and tests into maternal and child health programs for effective TB prevention and control. Most importantly, India’s TB control efforts must evolve a comprehensive advocacy and communication strategy to eliminate the stigma associated with TB. Simultaneously, we need to build consensus to mobilise actions and resources that impact policies and programmes. If TB and its impact on women are ignored any longer, the goal of a healthy India is unlikely to be realised. India cannot be called a healthy nation if its women are unhealthy. To ensure the well-being of our mothers, wives, sisters and daughters, we need to make their health one of our national priorities today. Tomorrow may be too late.

(The writer is an MP, Rajya Sabha)

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