The focus of my group’s Global Health Research Documentary was barriers to care for Indian women. We were able to speak to the Public Health Research Insitute of India’s (PHRII)  Founder and Director Dr. Purnima Madhivanan as well as PHRII Research Physician Dr. Kiranmayee Muralidhar. Both women were able to give us insight into the social obstacles that prevent Indian women from receiving adequate and timely healthcare. The gendered expectations of women to be homemakers who deferred to their husbands and in-laws, as well as women’s inability to travel freely alone are major obstacles that relate not to the Indian healthcare system but rather the social system.  

​

In the documentary, Dr. Madhivanan poignantly notes that “women keep the household running.” One common theme I learned throughout my stay in India is that women are expected to tend to the household and cook fresh meals throughout the day. This means that when a woman needs medical attention, she is hesitant to leave due to the integral nature she plays in the home structure. Dr. Madhivanan notes that this hesitancy translates into women seeking medical care when their situation has become more serious, which often leads to women needing more extensive care, or passing away because of the severity of the medical concern.  

​

Even if a woman is willing to leave her home for the time necessary to receive care, it is not ultimately her decision but rather that of her husband and inlaws. Arun and Prabhu found that of women who opted not to participate in a maternal public health intervention, a staggering 81.1 percent refrained from doing so due to a lack of support from their husbands or families in general (2023). Dr. Madhivanan and Dr. Kiran also discussed the limitations to women’s abilities to make their own medical decisions. Dr. Kiran even raised the point that many women are subject to divorce if they are diagnosed with cervical cancer. This lack of support, and at times ostracization, from their families when attempting to seek medical care can push women away from taking care of their health. 

A third aspect of Indian social life that serves as a barrier to Indian women receiving care is the reality that women are not often permitted to travel alone. Dr. Madhivanan discusses how this means that seeking healthcare does not only negatively impact the home structurally, but financially in the loss of two people’s daily wages. Thus, even if women are not being charged by the medical facility, they are still paying for their care in other ways that their household may not be able to afford.  

​

Understanding the importance of gender roles in the ways women navigate the medical system is paramount if there should be an attempt to decrease barriers to care. Although the creation of traveling programs that can access women at home decreases the structural barriers of their necessity in the household and the difficulties they face traveling, it appears the main solution should target the ways in which the family system thinks about and thus approaches women’s care. Culturally competent program that target this relationship between family attitudes and women’s health can be the difference between women dying because they are being pulled away from care and women thriving because they are being pushed towards it.  

​

Arun, A., & Prabhu, M. P. (2023, May 19). Social Determinants of Health in rural Indian Women & Effects on Intervention Participation. BMC public health. https://pubmed.ncbi.nlm.nih.gov/37208651/