REACH, USAID call for integrating gender in India's TB programmes

To mark this month's celebration of International Women's Day and the upcoming World TB Day, REACH (Resource Group for Education and Advocacy for Community Health) and the U.S. Agency for International Development (USAID) organised a TB centresstage discussion here on the urgency to integrate gender in India's tuberculosis (TB) programs.

The meeting convened experts from TB and gender sectors, government representatives, civil society organizations, and TB survivors who argued for more gender-sensitive programming in India.

Dr. Soumya Swaminathan, Director-General, ICMR and Secretary, Department of Health Research, Government of India, said, "Despite there being plenty of anecdotal evidence, we have a lack of hard data, leading to a lot of myths and misconceptions. In order to address issues such as stigma, we need to first make an effort to carry out better research. I hope that we are able to identify and highlight important research questions through gatherings like these."

According to a recent World Health Organization report, TB affects an estimated three million women every year and remains a leading cause of death among adult women globally. Despite the severity of this issue, attention to the gender-specific aspects of the disease is still lacking. Issues such as stigma and poverty are heightened for women TB patients, who are often abandoned by their families or blamed for endangering the health of the family.

"It is essential to look at TB as social suffering. It is not just a clinical problem. The disease impacts your roles as a worker, mother and wife, which go through periods of great disruption. So even if biologically, women are less susceptible to TB, socially, their burden is much greater than that of men," said Professor Rama Baru, Centre of Social Medicine and Community Health, Jawaharlal Nehru University.

Highlighting these socio-economic aspects and inequities of gender and TB, Xerses Sidhwa, Director, Health Office, USAID/India, said, "As we work to address these disparities, we must employ a multi-faceted approach for TB that puts women and girls at the center and engages their families, communities, and governments in innovative programs that strengthen the enabling environment and transforms systems."

Dr Sundari Mase from WHO described the epidemiology of TB in men and women, globally and in India, stressing upon the impact of TB on maternal health. Ms Blessina Kumar from the Global Coalition of TB Activists spoke on the need for a gender-sensitive assessment of the TB scenario in India.

Moderating the discussion, Dr Anuradha Rajivan, Former ADB Advisor, Strategy and Policy Department, said, "Social conditioning prevents access to coming out and speaking about TB. So, a gender-sensitive approach, required in all walks of life, becomes acutely critical in the context of TB."

"This meeting marks the first in a series of steps for the coming year to draw attention to gender integration as we continue to advocate for effective and evidence-based policies that will help reach the collective goal of ending TB in India by 2025," said Dr. Nalini Krishnan, Director, REACH.

The event also saw the launch of Nine Lives, a book by Chapal Mehra and Zarah Udwadia.

This publication chronicles the journey of nine brave women who survived TB despite significant barriers due to stigma, lack of awareness and economic status.

Two of the survivors featured in the book, Nandita Venkatesan and Deepti Chavan, read excerpts from their stories.

"When we began documenting these stories, we wanted to record the lived journeys of women surviving TB in a patriarchal society where they often have limited access to health services and little agency to negotiate their own well-being. They live with stigma, fear and discrimination when infected with TB. Even when cured, they are told never to talk of TB again, as if it were somehow their failing, their fault," said Zarah Udwadia and Chapal Mehra, authors of the book.

The Tuberculosis Call to Action project, implemented by REACH and supported by USAID, advocates for gender-sensitive policies at the national and state levels in Assam, Bihar, Jharkhand, Odisha, Rajasthan, and Uttar Pradesh.