On the bustling streets of India, cows stroll and street food wafts through piles of fruit. The people are hospitable and friendly, mirroring the vibrancy they've created in the country.
Despite the beauty and strengths of India and its people, the shadow of misogyny threatens the lives and health of its women. I spoke to Public Health Research Institute of India (PHRII) founder and Director Dr. Purnima Madhivanan about how the gender roles women perform leave them in a position where they do not adequately care for their own health. When she faced the opportunity to start her own health center, she created PHRII with the intention of combating the inequity in women's healthcare.
Often in the United States, when we speak about culture and health, the conversation focuses on sedentary lifestyles and the presence of food deserts. In speaking with Dr. Kiran and Dr. Madhivanan, I grew a deeper understanding of the way cultured gender norms impact women's willingness and ability to adequately care for their health. Dr. Madhivanan expressed that women are not always able to move freely. Women are not allowed to travel alone and must take permission from their families to seek care. In this case, their family consists of their husband and/or his own family, as it is customary to move in with the husband's parents following marriage. Traveling to the hospital or clinic may become an issue if a woman’s husband is unwilling to consent or unable to accompany her. Dr. Madhivanan also noted that these concerns are exacerbated among rural women. If the nearest health center is hours away, then traveling there may result in the lost wages of both wife and husband.
A woman having to travel long distances is not only a concern of lost wages, but also household care. Indian women are expected to homemake: prepare fresh meals, keep the home clean, and watch over the children. In the case that a woman must travel to a health facility, the question “Who will take care of the house?” arises. Women are viewed as the caretakers, a view so deeply entrenched that they often eat meals last, eat less healthier options than their families, and neglect their health to prevent any lapses on their ability to caretake.
The culture impacts unmarried women– and men– as well. In India, it is not socially acceptable for medical professionals to ask a woman if she is sexually active, so HPV and cervical cancer screenings are geared towards married women. This presents an issue for sexually active men and women as oropharyngeal, anal, and penile cancers can also result from high risk strains of HPV (Gillison, Chaturvedi, Lowy 2008). Although vaccination seems an easy enough solution ,PHRII Lab Research Assistant Anisa S.K.explained how parents are often unwilling to give their young children the vaccine. This is due to beliefs they will become promiscuous because they are not afraid of contracting an STI.
My understanding of the barriers women face when it comes to receiving healthcare in India have changed massively. Westerners often make the mistake of pitying foreign women or idealizing them as innately stronger. In reality, they're people born into different circumstances and cultural values. In speaking with Dr. Madhivanan, I was able to begin thinking of the intricacies of preserving culture while improving equity within a society.
One thing that stood out to me was the fact that women have to take permission from their families to seek care. While this might sound unimaginable in an individualistic society like the United States, in a family centered society such as India, this wouldn't even require a second thought. When I often think of barriers to care, I think of structural issues within the medical system itself that dismisses patient concerns or renders them inadequate care. According to the CDC, compared to their White counterparts, pregnancy based problems kill three times more Black women. Even a wealthy celebrity such as Serena Williams almost passed away after childbirth (Lockhart 2018)! In India, however, many barriers to care are within the microcosm of the family system. One cannot educate doctors enough to convince a woman’s family to allow her to seek medical care.
In order to address the cultural barriers that stop women from accessing adequate health care, the government must step in to enact changes to the culture. During the immunology lecture, Dr. Anil Bilimale showed government flyers depicting the importance of vaccines and spoke about how the public campaign was so influential it became a part of common colloquial speech. Similarly, in the United States, we know phrases such as "An apple a day keeps the doctor away.” Adapting the pro-vaccine rhetoric to include regular check ups would greatly aid the fight for equity in healthcare. Another beneficial idea would be to create support systems that alleviate households when women are gone for extended periods of time. Just like the asha program wherein local women are tasked with ensuring that the community receives adequate healthcare, a program can be instituted where other community women contribute to households when the usual homemaker is absent for a time.
Sources
Centers for Disease Control and Prevention. (2023, April 3). Working together to reduce Black Maternal Mortality. Centers for Disease Control and Prevention. https://www.cdc.gov/healthequity/features/maternal-mortality/index.html#:~:text=Recognizing%20urgent%20maternal%20warning%20signs,prevent%20many%20pregnancy%2Drelated%20deaths.&text=Black%20women%20are%20three%20times,related%20cause%20than%20White%20women
Gillison, M. L., Chaturvedi, A. K., & Lowy, D. R. (2008, November 15). HPV prophylactic vaccines and the potential prevention of noncervical cancers in both men and women. Cancer. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6264789/
Lockhart, P. R. (2018, January 11). What Serena Williams’s scary childbirth story says about medical treatment of black women. Vox. https://www.vox.com/identities/2018/1/11/16879984/serena-williams-childbirth-scare-black-women
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