Unhealthy dynamics

Gender bias in cancer care reflects a larger health care crisis

Barely a week after Indian politicians basked in the triumph of passing a law mandating reservation of seats in the Lok Sabha for women, The Lancet published a sobering study highlighting the innate gender bias in cancer care. The study, titled “Women, Power and Cancer”, examined women and cancer in 185 countries and discovered a clear link between societal power dynamics and women’s access to cancer diagnosis and treatment. Cancer ranks among the top three causes of premature deaths in most countries. For India, The Lancet findings should be worrying for public health administrators. It said around 63 per cent of premature deaths due to cancer in Indian women could have been prevented by screening and diagnosis; 37 per cent could have been averted by timely and proper treatment. The irony of these statistics is that even though men are at higher risk of cancer, the incidence and mortality rate among women is higher. Seen in stark numbers, the evidence of Indian women’s higher vulnerability to cancer is disquieting. It does not, however, come as a major surprise. The average Indian’s access to health care is poor — a fact that was starkly revealed during the Covid pandemic’s worst phases — and women are far worse off, especially among poorer sections of society.

The problems, medical practitioners point out, are manifold. The first is the absence of adequate knowledge about various types of cancer and their causes. For women, who are particularly vulnerable to breast, cervical, ovarian and uterine cancer, the danger is multiplied because they mostly lack the decision-making and financial power to go for regular checkups and screening for early diagnosis. Added to this is the reluctance to subject themselves to examination by mostly male doctors. This in itself is a reflection of the need for more qualified women doctors — only about 17 per cent of allopathic doctors are women and minuscule 6 per cent of those are in rural areas. Added to this is the problem of travelling to big cities or towns for screening and treatment — a near impossibility for rural women who bear the burden of housework and fieldwork. The lack of agency in women’s health care was starkly highlighted in a 2019 joint study by the All India Institute of Medical Sciences (Aiims), the Indian Statistical Institute, the Economic Advisory Council to the Prime Minister, and Harvard University. Examining the medical records of 2.3 million patients who visited Aiims between January and December 2016, only 37 per cent of women had access to health care compared to 67 per cent for men.

As with education, greater agency in women’s health care, including cancer treatment, is dependent on the nature of the public health care system. Although the central government has launched many health schemes for women at state level, most of them are for expectant and new mothers; the other aspects of women’s health care — of awareness programmes, regular checkups, and screening for cancer — are largely ignored. Yet the data from the massive Ayushman Bharat-subsidised medical insurance scheme points to solutions, given that cancer is among the top tertiary care speciality treatments accessed under the programme. Significantly, women account for 49 per cent of the 500 million people who access Ayushman Bharat, a pointer to how empowering women with greater agency in health care can yield tangible benefits that parliamentary reservations may not.