Because her wellbeing matters too...

It is not surprising to know that India has some of the worst records in terms of gender equality. According to the 2014 United Nations Development Programme report, India occupied the 130th rank amongst a list of 188 countries. Women have traditionally suffered from the stigma of being less valuable in the families, have a lower share of household income, weaker bargaining power, poorer political participation and are more likely to be the victims of domestic violence. What’s more ironical is that most of the women’s issues, including those related to health, are framed by men.

Women’s health agenda was first articulated in the Fourth World Conference on Women held in Beijing in 1995. The Beijing Declaration discussed a roadmap for gender equality and women’s empowerment, with the focus on Sexual and Reproductive Health (SRH) issues, given the high rates of maternal mortality and morbidity. Twenty years later, the women’s health landscape has changed dramatically. SRH outcomes have shown dramatic improvements around the world. The Global Burden of Disease (GBD) study has shown that the contribution of communicable, maternal, neonatal and reproductive diseases, to deaths amongst Indian women had declined from 53% of 1990 to less than 30% in 2013.

On the other hand, non-communicable diseases(NCD) have emerged as the largest killers of women in India — responsible for 60% of all deaths amongst women in 2013, up from 38% in 1990. The most common  causes of death in women, as in men, are now ischemic heart disease (known as heart attack), stroke, chronic respiratory diseases and diabetes.

It is commonly perceived that heart disease and stroke are predominantly male diseases. In fact, the number of deaths from these causes in women outnumber that in men because of their longer lifespans. Also, since the symptomatology is based on data from men, the warning signs in women are ignored as ‘atypical’, leading to under treatment. Compared to men, women with diabetes are more likely to be obese and have a higher risk of heart disease and stroke. Certain complications of pregnancy like pre-eclampsia, which causes high blood pressure and gestational diabetes — once thought to have no long-term consequence — actually increase the lifetime risk of developing NCDs in the affected women.

This calls for a women’s health agenda for India. Not only are we ignoring the most important conditions responsible for ill-health, limiting the focus on women of childbearing age discriminates against women who do not have children and women who are no longer of reproductive age. Moreover, risk behaviours that cause NCD later in life need to be managed in adolescent girls and women in childbearing years. Finally, appropriate management of pregnancy has bearing on the risk of development of NCDs in the newborn baby once she reaches adulthood. This knowledge argues in favour of developing a ‘life course’ approach to women’s health, in which the focus is not limited to SRH issues, but rather broadens to include pregnancy as an event in the lifetime risk of disease burden in the mother  and the newborn.

The world has announced a number of initiatives to combat the emerging NCD epidemic in women. These include the Global Strategy for Women’s and Children’s Health launched in 2010 by the UN Secretary General, the Every Woman Every Child Movement; the Lancet Commission on Women and Health; the UN Global Strategy for Women’s, Children’s and Adolescents’ Health (2016-2030), and the Global Leaders’ Meeting on Gender Equality and Women’s Empowerment: A Commitment to Action hosted by the UN General Assembly in 2015.

As a result of these initiatives, billions of dollars have been committed to women’s health by governments, regional organisations, NGOs, charities and foundations. Yet, a full appreciation of women’s health seems to be missing as shown by the continued focus on SRH, with the occasional reference to violence and genital mutilation. The broader women’s health agenda still seems to be unappreciated. It is time we woke up to these issues and took steps to eliminate the disadvantage faced by girls and women in healthcare delivery.

(The author is executive director, The George Institute for Global Health, India)