Women’s Health Issues in India

Women in India face a multitude of health challenges that are exacerbated by systemic barriers, including poverty, lack of education, cultural stigma, and inadequate healthcare infrastructure. Here, we will explores these factors in detail, highlights key health issues affecting women, and discusses government initiatives aimed at improving women’s health.

Factors Leading to Limited Access to Healthcare

Poverty

Poverty is a significant barrier to healthcare access for women in India. Many families prioritize spending on male family members’ health due to entrenched gender biases, leading to underinvestment in women’s health. The National Family Health Survey (NFHS) indicates that 21.4% of women cite financial constraints as a reason for not accessing medical care. This economic disparity is compounded by high out-of-pocket expenses for medical treatments, which can be prohibitive for low-income households.

Lack of Education  

Education plays a crucial role in health literacy and empowerment. Women with lower educational attainment are less likely to seek medical care or understand their health needs. The NFHS data shows that only 10.1% of women can make independent decisions about their healthcare, compared to 33.3% of men[1]. This lack of agency often results from traditional gender roles that prioritize male authority in household decision-making.

Cultural and Social Stigma 

Cultural beliefs and social norms significantly impact women’s health-seeking behavior. Many women face stigma related to reproductive health issues, which discourages them from seeking necessary medical attention. Studies reveal that gender bias persists in healthcare settings, with women receiving less attention than men[3]. Furthermore, societal expectations often lead women to prioritize family needs over their own health.

Key Health Issues

A. Nutritional Deficiencies

Malnutrition remains a critical issue for women in India, contributing to various health problems. Poor nutrition is linked to several diseases, including anemia, osteoporosis, and complications during pregnancy. The following chart illustrates common diseases related to specific nutrient deficiencies:

Major Nutritional Deficiencies

Women in India experience a high prevalence of several nutritional deficiencies, including:

-Iron Deficiency: Iron deficiency anaemia is one of the most common nutritional disorders affecting women in India. It is estimated that nearly 50% of women in reproductive age suffer from anaemia due to inadequate iron intake. This deficiency is particularly critical during menstruation, pregnancy, and lactation when iron requirements increase.

– Vitamin B12 Deficiency: Approximately 75% of adults in India are reported to have vitamin B12 deficiency, which is especially pronounced among women. This deficiency can lead to neurological issues and anaemia.

– Folic Acid Deficiency: Folic acid is essential for DNA synthesis and cell division. Women often have inadequate folate intake, which is crucial during pregnancy to prevent neural tube defects (NTDs) in newborns. The recommended dietary allowance (RDA) for folic acid is often unmet, particularly among pregnant women.

– Calcium Deficiency: Calcium is vital for bone health. Many Indian women consume less than the recommended levels of calcium, leading to conditions such as osteoporosis later in life.

– Vitamin D Deficiency: Despite ample sunlight exposure, vitamin D deficiency is widespread due to lifestyle factors and dietary inadequacies. This deficiency can lead to weakened bones and increased risk of fractures.

Diseases Related to Nutritional Deficiencies

The consequences of these deficiencies manifest in various health issues:

1. Anaemia: Iron deficiency anaemia can cause fatigue, weakness, and decreased immunity. In severe cases, it can lead to complications during pregnancy and childbirth.

2. Neurological Disorders: Vitamin B12 deficiency can result in neurological problems such as peripheral neuropathy, cognitive impairment, and mood disorders.

3. Neural Tube Defects: Insufficient folic acid intake during pregnancy increases the risk of NTDs such as spina bifida and anencephaly in infants.

4. Osteoporosis: Long-term calcium and vitamin D deficiencies can lead to osteoporosis, increasing the risk of fractures and other bone-related issues.

5. Poor Pregnancy Outcomes: Nutritional deficiencies can adversely affect maternal health, leading to complications such as preterm birth, low birth weight, and maternal mortality.

Reason behind Nutritional Deficiencies

1.       Poverty- not able to afford fruits, meats, egg and fish or recommended medicine which can overcome nutritional deficiency

2.       Vegetarianism- following strict rules related to religion including fasting and not able to compensate nutritional diet which are mainly link with non-veg such as folic acid, omega fatty acid, vit-B12 etc.

3.       Social-Cultural stigma- norms such as must not eat before husband, eat less, must not eat outside of home

4.       Lack of education- lack of knowledge of own health and need of diet 

Consequences of Nutritional Deficiencies

The impact of nutritional deficiencies extends beyond individual health:

– Intergenerational Effects: Undernourished mothers are likely to give birth to undernourished children, perpetuating a cycle of malnutrition across generations. This cycle affects not only physical health but also cognitive development and educational attainment.

– Economic Burden: Poor nutritional status can lead to increased healthcare costs due to higher rates of illness and disease management. This burden disproportionately affects low-income families who may already struggle with financial constraints.

– Social Implications: Women’s health directly influences family well-being and societal productivity. Malnutrition among women can hinder their ability to participate fully in economic activities and community life.

Addressing Nutritional Deficiencies

Efforts to combat nutritional deficiencies among women in India must focus on several key areas:

1. Education and Awareness: Increasing awareness about the importance of nutrition and dietary diversity is essential. Educational programs targeting women can help them make informed dietary choices.

2. Government Initiatives: Programs like “Anaemia Mukt Bharat” aim to reduce anaemia through supplementation and dietary diversification. However, there is a need for more robust implementation strategies that ensure accessibility across different regions.

3. Food Fortification: Fortifying staple foods with essential vitamins and minerals can help address widespread deficiencies effectively. For example, fortifying wheat flour with iron or folic acid could significantly improve women’s nutritional status.

4. Access to Healthcare Services: Improving access to healthcare services for women, particularly in rural areas, is crucial for early diagnosis and management of nutritional deficiencies.

Women are particularly vulnerable due to inadequate dietary intake and socio-economic barriers that limit access to nutritious food.

B. Reproductive Health  

Reproductive health is a critical aspect of women’s health, encompassing a range of issues that affect women’s physical, mental, and social well-being. In India, reproductive health issues are compounded by socio-economic factors, cultural norms, and inadequate healthcare infrastructure. This article delves into the key reproductive health challenges faced by women in India, the underlying causes, and the government’s efforts to address these issues.

Key Reproductive Health Issues

1. Maternal Mortality

India has made significant strides in reducing maternal mortality over the past two decades, yet it still accounts for a substantial proportion of global maternal deaths. The Maternal Mortality Ratio (MMR) has decreased from 556 per 100,000 live births in 1990 to 97 per 100,000 live births in 2018-2020[. However, disparities exist across states; poorer regions such as Uttar Pradesh and Madhya Pradesh report much higher rates of maternal mortality due to factors like inadequate healthcare access and poor socio-economic conditions.

2. Access to Healthcare Service

Access to quality reproductive healthcare remains a challenge for many women in India, particularly in rural areas. The “three delays” model identifies critical barriers: delay in recognizing the need for care, delay in reaching healthcare facilities, and delay in receiving appropriate care once at a facility. These delays are often exacerbated by transportation issues, financial constraints, and lack of awareness about available services.

3. Family Planning and Contraceptive Use

Despite the availability of various contraceptive methods, unmet needs for family planning persist. According to the National Family Health Survey (NFHS), about 13% of married women aged 15-49 have an unmet need for family planning[5]. Cultural stigma surrounding contraception and limited access to information contribute to this issue. Additionally, contraceptive use is often lower among less educated women and those living in rural areas.

4. Reproductive Health Disorders  

Women in India face a high prevalence of reproductive health disorders such as polycystic ovary syndrome (PCOS), endometriosis, and sexually transmitted infections (STIs). Lack of awareness and stigma associated with discussing these conditions often leads to late diagnosis and treatment. For instance, many women do not seek medical help for STIs due to fear of social ostracism.

C. Non-Communicable Diseases (NCDs)

Non-communicable diseases (NCDs) pose a significant health challenge for women in India, with cardiovascular diseases and various cancers leading the burden. These conditions are often underdiagnosed due to limited access to screening and treatment facilities. These diseases are often exacerbated by socio-economic factors, lifestyle choices, and limited access to healthcare.  The increasing prevalence of lifestyle-related diseases necessitates urgent attention from healthcare providers and policymakers.

Cardiovascular Diseases

Cardiovascular diseases (CVDs) are the leading cause of mortality among women in India. According to the World Health Organization (WHO), CVDs account for approximately 27% of all deaths in women aged 30 and above. The increasing prevalence of risk factors such as hypertension, diabetes, obesity, and sedentary lifestyles significantly contributes to this trend.

Risk Factors:

– Hypertension: A major risk factor for heart disease, hypertension affects nearly 25% of Indian women. Factors such as stress, poor diet, and lack of physical activity contribute to its prevalence.

– Diabetes: The rise in diabetes cases among women is alarming, with studies indicating that nearly 10% of Indian women are diabetic. This condition increases the risk of heart disease significantly.

– Obesity: With changing lifestyles and dietary habits, obesity rates have surged. Overweight women are at a higher risk of developing heart-related issues.

Cancer

Cancer is another critical non-communicable disease affecting Indian women. The two most prevalent cancers are breast cancer and cervical cancer.

Breast Cancer

Breast cancer has become the most common cancer among women in India, accounting for approximately 27% of all female cancers. The incidence is particularly high in urban areas, where one in 22 women is likely to develop breast cancer during her lifetime compared to one in 60 in rural areas.

Statistics:

– Every four minutes, an Indian woman is diagnosed with breast cancer.

– The survival rate is low; over 50% of cases are diagnosed at advanced stages (III and IV), leading to a five-year survival rate of only about 60% compared to 80% in developed countries.

Risk Factors:

– Genetic Predisposition: Family history plays a significant role in breast cancer risk.

– Lifestyle Factors: High-fat diets, lack of physical activity, and late pregnancies contribute to increased risks.

Cervical Cancer

Cervical cancer is the second most common cancer among Indian women, accounting for about 22.86% of all female cancers. It predominantly affects sexually active women and is primarily caused by the Human Papillomavirus (HPV).

Statistics:

– Approximately 97,000 new cases were reported annually.

– Cervical cancer claims the life of one woman every eight minutes in India.

Risk Factors:

– HPV Infection: A significant cause of cervical cancer; vaccination can reduce incidence rates.

– Poor Access to Screening: Rural women often lack access to regular screenings like Pap tests, which are crucial for early detection.

Ovarian Cancer

– Description: Ovarian cancer originates in the ovaries and is known for its vague symptoms, which often lead to late diagnosis. It accounts for about 6.2% of cancers in women.

– Statistics: Though less common than breast and cervical cancers, ovarian cancer has a high mortality rate due to late-stage diagnosis.

Uterine (Endometrial) Cancer

– Description: Uterine cancer typically begins in the lining of the uterus and is more common in postmenopausal women. It is associated with obesity and hormone replacement therapy.

-Statistics: While specific prevalence data is less frequently reported, it remains a significant concern for women’s health.

Oral and Lip Cancer

– Description: This type of cancer affects the mouth and lips, often linked to tobacco use and poor oral hygiene. It represents about 4.3% of all cancers diagnosed in women.

-Statistics: India has one of the highest rates of oral cancer globally, significantly affecting women who use tobacco products.

Colorectal Cancer

– Description: Colorectal cancer affects the colon or rectum and is increasingly being diagnosed among Indian women due to changing dietary patterns and sedentary lifestyles.

– Statistics: While not as prevalent as breast or cervical cancers, its incidence is rising, making awareness and screening essential.

Consequences of NCDs

The impact of NCDs on women’s health extends beyond individual suffering; it poses broader public health challenges:

1. Economic Burden: The treatment costs for NCDs can be substantial, placing financial strain on families and healthcare systems. Women often bear the brunt of this burden due to their lower economic status.

2. Social Implications: Women suffering from chronic illnesses may face social stigma and discrimination, affecting their mental health and quality of life.

3. Intergenerational Effects: Poor maternal health due to NCDs can affect child development and health outcomes, perpetuating cycles of poverty and ill health.

Government Initiatives

The Indian government has recognized the rising burden of NCDs among women and has initiated several programs:

– National Programme for Prevention and Control of Cancer, Diabetes, Cardiovascular Diseases & Stroke (NPCDCS): This program aims to promote awareness about NCDs and improve early detection through screening initiatives.

– Health Promotion Campaigns : Initiatives focusing on lifestyle changes encourage healthy eating habits and physical activity among women.

– Access to Healthcare Services: Efforts are being made to improve access to screening services for cancers and cardiovascular health assessments across rural areas.

 Steps taken by Government of India to improve Women’s Health

The Indian government has implemented several initiatives to address women’s health issues, particularly focusing on maternal and reproductive health, nutrition, and non-communicable diseases (NCDs). Below is a list of key government initiatives, their approximate costs, and performance indicators.

1. Ayushman Bharat – Health and Wellness Centres (AB-HWCs)

– Objective: To provide comprehensive primary healthcare services, including maternal and child health.

– Approximate Cost: The total cost of the Ayushman Bharat scheme is estimated at ₹1,200 crore for the establishment of 1.5 lakh HWCs.

– Performance: As of July 2023, over 160,816 AB-HWCs have been operationalized, significantly increasing access to healthcare services across the country.

 2. Janani Suraksha Yojana (JSY)

– Objective: To reduce maternal and infant mortality by promoting institutional deliveries through cash incentives.

– Approximate Cost: The JSY program has an annual budget of around ₹1,000 crore.

– Performance: The scheme has led to a significant increase in institutional deliveries from 38% in 2005 to over 80% in recent years.

3. Pradhan Mantri Surakshit Matritva Abhiyan (PMSMA)

– Objective: To provide free antenatal care on a fixed day each month to pregnant women.

– Approximate Cost: The estimated budget for PMSMA is around ₹300 crore annually.

– Performance: The program has successfully provided antenatal care to millions of women since its launch in 2016, although challenges remain in reaching rural populations [3][4].

4. Janani Shishu Suraksha Karyakram (JSSK)

– Objective: To eliminate out-of-pocket expenses for pregnant women and sick infants by providing free delivery services and transport.

– Approximate Cost: The annual budget for JSSK is approximately ₹600 crore.

– Performance: The initiative has improved access to essential maternal healthcare services, contributing to reduced maternal mortality rates.

5. Pradhan Mantri Matru Vandana Yojana (PMMVY)

– Objective: To provide cash benefits to pregnant women for enhanced nutrition and compensation for wage loss during pregnancy.

– Approximate Cost: The scheme has a budget allocation of around ₹2,500 crore annually.

– Performance: PMMVY has benefited millions of women by providing direct cash transfers, thus improving maternal nutrition.

6. National Free Drugs Initiative

– Objective: To provide essential medicines free of cost at public health facilities.

– Approximate Cost: Varies by state; overall funding is part of the National Health Mission budget.

– Performance: This initiative aims to improve access to necessary medications for women suffering from chronic diseases.

7. Labour Room Quality Improvement Initiative (LaQshya)

– Objective: To enhance the quality of care in labor rooms and maternity operation theaters.

– Approximate Cost: The initiative’s funding is included within the broader National Health Mission budget.

– Performance: LaQshya aims to ensure that women receive respectful and quality care during childbirth, contributing to improved maternal health outcomes.

• • National Free Drugs Initiative: States/UTs are supported to provide essential drugs based on the level of public health facilities free of cost to all who access these facilities.
  • Free Diagnostics Initiatives. (FDI): Under the initiative, support provided to States/UTs to provide a set of essential diagnostics (14 tests at Sub Centre/ Health and Wellness Centre level, 63 tests at PHC/ PHC-HWC level, 97 tests at CHC level, 111 tests at SDH level and 134 tests at DH level) at various levels of care, free of cost.
  • National Ambulance Services (NAS) –  Under the NHM, technical and financial support is provided for emergency medical services in States/UTs through a functional National Ambulance Service (NAS) network linked with a centralised toll-free number 108/102.
  • National Mobile Medical Units (NMMU) – are supported to facilitate access to public health care at the doorstep particularly to people living in remote, difficult, under-served and unreached areas to provide primary care services.
  • Surakshit Matritva Aashwasan (SUMAN) provides assured, dignified, respectful and quality healthcare at no cost and zero tolerance for denial of services for every woman and newborn visiting public health facilities to end all preventable maternal and newborn deaths.
  • Janani Suraksha Yojana (JSY), a demand promotion and conditional cash transfer scheme for promoting institutional delivery.
  • Under Janani Shishu Suraksha Karyakram (JSSK), every pregnant woman is entitled to free delivery, including caesarean section, in public health institutions along with the provision of free transport, diagnostics, medicines, blood, other consumables & diet.
  • Pradhan Mantri Surakshit Matritva Abhiyan (PMSMA) provides pregnant women a fixed day, free of cost assured and quality antenatal check up by a Specialist/Medical Officer on the 9th day of every month.
  • LaQshya improves the quality of care in labour room and maternity operation theatres to ensure that pregnant women receive respectful and quality care during delivery and immediate post-partum.
  • Functionalization of First Referral Units (FRUs) by ensuring manpower, blood storage units, referral linkages to improve the access to quality of care for pregnant women
  • Outreach camps are provisioned for improving the reach of health care services especially in tribal and hard to reach areas. This platform is used to increase the awareness for the Maternal & Child health services, community mobilization as well as to track high risk pregnancies.
  • IEC/BCC campaigns: One of the key focus areas of Maternal Health is to generate demand through Information Education & Communication (IEC), Inter-personal Communication (IPC) and Behaviour Change Communication (BCC) activities.

Despite these initiatives, challenges remain in implementation and outreach, particularly in rural areas where healthcare infrastructure is lacking.

Addressing women’s health issues in India requires a multifaceted approach that tackles the underlying socio-economic determinants of health. By improving access to education, addressing cultural stigmas, and enhancing healthcare infrastructure, India can make significant strides toward ensuring better health outcomes for women. Continued government efforts combined with community engagement will be vital in overcoming the barriers that currently limit women’s access to essential healthcare services.

Sources: PIB; CSEP Report