Women may be missing out on outpatient hospital care in northern India

Women account for only a little over one third of appointments at a major hospital in India’s capital, New Delhi, highlighting extensive gender discrimination in access to healthcare services, researchers say.

Looking at outpatient visits to a large hospital in the capital, the analysis found that about half of the women who ought to have received care were “missing.” Women under age 30 and over age 60 were the most conspicuously absent, relative to their actual population numbers, the study team reports in BMJ Open.

Gender disparity in healthcare is usually studied by comparing mortality rates of females versus males, said study coauthor Mudit Kapoor, an associate professor of economics at the Indian Statistical Institute in New Delhi.

However, missing out on healthcare services may not always result in death, so death rates may not capture the extent of gender disparity, he told Reuters Health in a phone interview.

For the current study, Kapoor’s team analyzed data from more than 2.3 million visits to New Delhi’s All India Institute of Medical Sciences (AIIMS) in 2016, across all departments excluding obstetrics and gynecology, made by more than 880,000 outpatients.

More than 90% of these patients were from Delhi and three neighboring states: Haryana, Uttar Pradesh and Bihar. The researchers also used census data to characterize the populations of the four states by sex and age.

Overall, the ratio of male AIIMS patients to female patients was 1.69, meaning nearly two thirds of the outpatient visits were made by males.

But among children and adults up to age 30, twice as many males as females made visits. Between ages 31 and 59, there were about four women patients for every 10 men, then after age 60, women started disappearing again, with one woman for every three men.

The gender disparity worsened for women living farther from the hospital. The sex ratio increased from 1.41 in Delhi to 2.37 in Bihar, which is furthest from Delhi. This ratio is also much higher than Bihar’s overall sex ratio of 1.09, according to 2011 census data.

Disparities may be driven by the perceived productivity of women across various stages of their life, which ultimately determines whether they get to visit a healthcare center, the researchers note.

“If you’re in the middle-aged group, then you are a useful member in the family. The moment you become elderly or when you’re a child, you’re not a useful member to the family, and as a result this discrimination goes up,” Kapoor said.

Younger and older women are also likely to rely on people to accompany them to the hospital, which may result in them not getting timely care, noted Dr. Ambuj Roy, a study co-author and professor at AIIMS.

“When resources are limited and distributed in a skewed manner, the more dominant people in the society, which are unfortunately men, would get more of it than the less fortunate ones,” Roy said in a phone interview.

Changing people’s perceptions to provide women with better access to healthcare is not enough when the public health system in India remains inadequate for most people, said Kapoor, citing the example of serious doctor and nurse shortages in community health centers in the northern state of Uttar Pradesh.

Compared to northern India, public health facilities in southern states such as Tamil Nadu and Kerala are better equipped and are well-utilized by people of various income groups, and this gives the government the incentive to maintain healthcare centers in these areas, he said.

Dr. Meghana Kabra, a senior consultant for internal medicine at the Batra Hospital & Medical Research Centre in New Delhi, hasn’t seen gender disparities in outpatient visits at her hospital.

Patients visiting private hospitals such as Batra may belong to middle-class households while AIIMS caters to patients from various sections of the society including those of lower socioeconomic status, noted Kabra, who wasn’t involved in the study.

The study is limited by being based on outpatient visits from a single hospital and does not account for women who visit healthcare facilities closer to their homes instead of the AIIMS hospital in New Delhi, the team acknowledged.

Extensive research on this gender disparity is required to raise awareness among policymakers to look beyond the areas of maternal and child healthcare and focus on setting up as well as maintaining local hospitals and wellness centers, the authors said.

SOURCE: bit.ly/2ZCABmS BMJ Open, online Aug 7, 2019.