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Kapoor et al. highlight one aspect of gender discrimination, gender injustice and gender prejudice in Indian society using data acquired from their hospital information system at AIIMS New Delhi.1 Under a title of introduction the authors write, ”There have been a handful of small sample studies on gender bias in access to healthcare in select patient groups or for specific medical conditions….” Then under a title of Discussion, they cite several studies, some conducted at their Institute in the department of Cardiology, some in Pediatrics and some conducted abroad. Here we want to state that we too conducted a manual small study in Emergency Department of our hospital. We assessed demographic profile of alleged self -harm patients presenting to our referral tertiary care public hospital. In our study -among other variables- when we estimated sex ratio among male and female patients, it was 62:38(2). And that’s eerily close to 63:37 in this study. So there is a difference of just 1 percentage point. When 38 women per hundred patients present in our hospital in Lucknow with a history of alleged self- harm , 37 present to AIIMS New Delhi on an average in OPDs.
Similarly at reference number 8, there is a study to estimate gender- bias in (availing) cardiovascular healthcare at a tertiary care center of north India. In the study Chhabra et al. assess that the ratio of girls to boys to avail cardiac interventions for their congenital and rheumatic heart disease is 38:62...
Similarly at reference number 8, there is a study to estimate gender- bias in (availing) cardiovascular healthcare at a tertiary care center of north India. In the study Chhabra et al. assess that the ratio of girls to boys to avail cardiac interventions for their congenital and rheumatic heart disease is 38:62 (same as in ours). So findings of the authors reveal an all pervasive ingrained truth of our patriarchal society- marginalising women, uncaring for even when they struggle for their survival while fighting to maintain their bodily integrity, and losing their battle many a times.
Early this year Government of India issued a Report on the Ranks of States and Union Territories, entitled “Healthy States Progressive India”(3). On page number 44 of this report, there is an indicator 1.1.5 - Sex Ratio at Birth (SRB). Y Axis of this diagram measures number of girls born per thousand boys born. On having a glance on this diagram it’s apparent that UP, Bihar and Haryana treat girl children badly (in fact Haryana fairs the worst). Therefore what is “normal’ in this study, including normal baseline ratio; is actually picked up from discriminatory population. What is normalised in our society is injustice meted out,
oppressing the body and minds of potential female workforce.
As in Discussion the authors write, “This discrimination of(against) women is not fully captured in the overall sex ratio or excess mortality of women relative to men, we want to draw attention towards reference number 1 of the Research Article. There Amartya Sen writes ,” But after conception, biology seems on the whole to favour women. Considerable research has shown that if men and women receive similar nutritional and medical attention and general health care, women tend to live noticeably longer than men. Women seem to be, on the whole, more resistant to disease and in general hardier than men, an advantage they enjoy not only after they are forty years old but also at the beginning of life, especially during the months immediately following birth, and even in the womb. When given the same care as males, females tend to have better survival rates than males.” So as women are less likely to fall ill due to their better biological design, our hospital based indicators of disease -monitoring of incoming patient population are likely to have their own limitations.
And in 1992, Prof. Amartya Sen wrote in the same journal, “Considerable direct evidence exists of neglect of female children in terms of health care ,admission to hospitals, and even feeding.” Under a title ,”Missing Women”(4). Therefore both the author and our team demonstrate a very small aspect of gender -discrimination ,and that’s reflected in admission to (and attendance at) hospitals. As usually research questions explore a very limited prespecified objective, other facets of differential treatment should be taken into account, which are likely to have a bearing on women’s health.
18 Years ago Prof. Amartya Sen wrote an essay- The Gendered Body. In the essay he writes in part 3, “Indeed there is some direct information about comparative medical neglect of girls vis -a vis boys in South Asia. When I studied, with Jocelyn Kynch, admissions data from two large public hospitals in Bombay (Mumbai), it was very striking to find clear evidence that the admitted girls were typically more ill than boys, suggesting the inference that a girl has to be more stricken before she is taken to the hospital. Undernourishment may well result from greater morbidity, which can adversely affect both the absorption of nutrients and the performance of bodily functions.”(5) This area needs further exploration in our times.
Moreover while visualising the world, sometimes our lens of scrutiny should move inwards too. While we discuss and debate gender- bias in the population at large, it’s time to have a fair opinion for ourselves too: the academia. While it’s a routine experience that female patients are short -changed, same is also true for healthcare providers. Female workforce in the position of authority makes only a minor proportion in several regions(6-8). Government of India recognises the fact and plans to make suitable amendments in rules(9). In this paper our government states,”Sex ratio is also a major area of concern for our country.” And on course correction ,”India is expected to gain from its ‘demographic dividend’ in the coming years and women are an integral part of this development process if India wants to tap its full potential. It is only through empowering the women in all forms that women will transcend beyond the constraints they presently face. It is essential to focus on these aspects if India wants to achieve its vision of ‘A society in which women attain their full potential and are able to participate as equal partners in all spheres of life and influence the process of social change (Draft National Policy for Women 2016)”.
What is intriguing is that out of 6 authors of this research article, only one is female although it looks specifically into female subjugation and mistreatment to women. We believe that in near future when more women are around, hitherto unexplored areas will be investigated to give us a new vision. With the beginning of harmonious representation of all the sections of our society in our investigative team, new avenues of research will be created and together we will make a world where injustice of any sort will be rapidly identified and timely course correction be made. And to begin with, in that utopian world, women will not die soon!
(1) Kapoor M, Agrawal D, Ravi S, et al. Missing female patients: an observational analysis of sex ratio among outpatients in a referral tertiary care public hospital in India. BMJ Open 2019;9:e026850. doi: 10.1136/bmjopen-2018-026850
(2) Agrawal M, Tiwary NK, Nigam N, et al. Assessment of demographic profile of patients admitted with a diagnosis of alleged self-harm at a teaching hospital in Hindi heartland. J. Evid. Based Med. Healthc. 2019; 6 (17), 1288-1291. DOI: 10.18410/jebmh/2019/267 ,available at https://jebmh.com/latest_articles/98391
(3) Healthy States Progressive India , by NITI Aayog , available at https://www.niti.gov.in/writereaddata/files/document_publication/NITI-WB...(Web%20Ver)_11-06-19.pdf
(4) Sen A. Missing Women. BMJ 1992;304:587 ,available at https://doi.org/10.1136/bmj.304.6827.587
(5) Sen A. Many faces of gender inequality. Frontline 2001 Nov 9; 18(22) ,available at https://frontline.thehindu.com/static/html/fl1822/18220040.htm
(6) The Editors of the Lancet group. The Lancet group’s commitments to gender equity and diversity. Lancet 2019 Aug 10; 394: 452-453 ,doi https://doi.org/10.1016/S0140-6736(19)31797-0
(7) Rexrode KM. The gender gap in first authorship of research papers. BMJ 2016;352:i1130 https://doi.org/10.1136/bmj.i1130
(8) Chaudhary K, Dhanda SK. India’s top science awards heavily gender skewed. Nature India 2019 Feb 11 doi:10.1038/nindia.2019.14 ,available at https://www.natureasia.com/en/nindia/article/10.1038/nindia.2019.14
(9) National consultation on SDG 5 - Gender Equality , by NITI Aayog , available at https://www.niti.gov.in/writereaddata/files/National%20Consultation%20on...
We accessed all the webpages at the time of submission of this letter.