Challenges Faced By Girls In Accessing Healthcare In India

Introduction:

In a paper published in 2018 the Indian Journal of Community Medicine, titled “Challenges to Healthcare in India - The Five A's”, the author Arvind Kasthuri identified 5 intrinsic challenges for healthcare in India. These were, Awareness, Agency, Absence, Affordability and Accountability. Gender adds a separate dimension to these challenges which are often untouched while formulating policies and plans for women’s healthcare, a fact acknowledged by several studies conducted by Indian and Global Health Institutions such as the All India Institute of Medical Sciences and and Harvard. 

Awareness: There is a lack of knowledge in the scientific community about understanding the female body. However, the knowledge gap widens in its dissemination. Young girls are often unaware of their body, including hormones and sexual organs and it’s changes. They are even lesser aware of the distinct symptoms of their specific disease. E.g. anaemia on a smaller scale and Breast and cervical cancer on the larger scale.

This lack of awareness can be attributed to the general reluctance amongst the community to discuss women related topics combined with the lack of weight given to discomfort suffered by women. Public platforms like schools and colleges often go about the issue as if they are fulfilling the syllabus and not dealing with something life changing for women. They often transfer this responsibility towards parents. By the time girls are in higher education, it might be thought of as no longer necessary to impart such knowledge.

There is also a lack of awareness among the women themselves about the avenues that are open to them to get better medical care. For example, many girls faced with critical conditions such as heart defects are unaware that they can pay for their treatment by raising money through donation for heart surgery or through government schemes. This in turn, negatively impacts their health seeking behaviour. 

Agency: Indian society is still by large patriarchal, which means that most of the decisions are taken by the men of the family. For women, combined with their lack of knowledge about their own health, taboo of discussing such health topics with men result in lack of agency in accessing healthcare. The financial cost associated with healthcare with a lack of earning entity often dictate that either the healthcare needs of the men of the household will be prioritised or that women’s healthcare will be limited to less expensive options. 

Absence: India has a population of 1.4bn people which is unevenly distributed across its geographic expanse. There is a primary lack of manpower in densely populated cities to cater to the humongous crowd while infrastructure facilities lag behind in rural pockets. Government hospitals are often ill equipped to deal with the varying public that sees them as the first and last resort. Private hospitals have their exclusive circle of operation and clientele that is limited in effectiveness and affordability. This gains specific prominence when it comes to specialised medical care such as hole in heart treatment and cancer. Facilities that provide such focussed care are non-existent especially in the villages and Tier III cities. 

The end result of all this lack means that even after crossing the hurdle of awareness and agency, often girls and women find themselves out of reach of healthcare facilities. In certain cases, the nearest health centre and its employees are the only source of knowledge for women.

Affordability: The cost of healthcare as a portion of opportunity cost for women is often ignored. Similar to how there is no calculation of unpaid labour of women doing household chores, there is a lack of understanding of how much time and money is lost when a woman falls sick. Hence, it is understandable why the very service that might seem as affordable to a man, because he can pay for it, becomes unaffordable for women. 

For women, pregnancy related medical issues are part of life and need healthcare treatment. It is not an accident or coincidence but an eventuality of life. Pregnancy related complications are a set of risk factors that raise the entire cost of healthcare in a women’s life. However, they are not calculated in the overall cost structure. Again, when it comes to specialised medical care such as cancer and cardiac defects, when families who are already burdened with financial issues are faced with the challenge of expensive medical care, it is usually the girls and women who are put on a back burner.

Accountability: Women who do not know their rights, cannot take decision for their own health, cannot access health care facilities and cannot afford to pay for their health needs will not be able to hold accountable the community and the state for neglecting their needs. 

Way Forward:

First of all, heathcare for girls should be projected as a basic necessity like schooling. They should be made aware of their own body, its feature and growth and recommended to undergo periodic health check ups to assess their state of health at different stages of life. The primary stakeholders of early healthcare objectives are the families, schools and communities. They must be supported by government organisations and non-government organisations alike in accessing materials and infrastructure to take care of health of their girls. This could be in the form of awareness campaigns, camps and hospital visits. The more accessible and affordable healthcare is for girls and women, the easier it will be to convince everyone to be a part of it. 

India has already initiated several women oriented health initiatives that aim to bridge the gender gap in Healthcare. E.g. Beti BAchao, beti padhao scheme, Janani Surakhsha Yojana, Free Drug and Diagnostic initiatives. In addition to this initiatives that target specialised medical care such as neurological disorders, hole-in heart treatment and caner also need to be focussed on and efforts made to make healthcare for these conditions more accessible.