According to the WHO In 2011, an estimated 8.7 million people fell ill with tuberculosis and 1.4 million people died from it, including 0.5 million women, making TB one of the top three causes of death for women aged 15 to 44 worldwide. “Although the ratio of males to females affected by TB in the pre-puberty and childhood ages is almost equal, this changes significantly in adulthood, and we find almost 4 men per 1 woman affected with TB,” according to Dr Sarabjit Chadha, Project Director at the International Union Against Tuberculosis and Lung Disease (The Union), India. Dr Chadha attributes this to “access related issues considering that women in the rural settings do not have a similar health seeking behavior as men. Also, issues of poverty and malnutrition are more relevant in case of women because of gender inequality.”
Thus although women may be equally likely to develop this infectious disease, they are less likely to access a health care service. In India, much of society is patriarchal. In a household where the man controls resources of the family or where the woman is engrossed in the everyday chores of life, women tend to seek medical care much later than men. “There are households where women cannot leave their home without the authorisation from the husband. These women miss the opportunity of visiting health camps that they would otherwise go to” says Nazeema Nasir Sheikh, a Community Health Worker working in one of the slums in Mumbai.
This delay in accessing healthcare services causes TB in women to reach a stage more severe than that of men when they are first diagnosed. This is also true for female children who are treated at cheaper traditional healers rather than the more expensive private practitioners to whom their brothers would be taken to.
In a study done on the analysis of the gender aspects of TB in the slums of Delhi it was found that a high level of stigma occurs among TB patients, particularly in women. While women fear loss of employment, rejection and blame for bringing the disease, men being self-employed fear loss of wages. The stigma associated with TB worsens the likelihood for the girl to seek medical care and find out whether she has got TB. Many female TB patients are rejected by their spouses and sent back to their childhood homes with the blame that they had ‘picked up’ the disease from their hometown. They are not allowed to stay in their husband’s house till they get better. Those who are unmarried, succumb to their illness as the family keeps the condition hushed up, and do not seek adequate treatment for fear of the society coming to know that she has the disease. Very often this also decreases her prospects of getting a suitable husband for marriage, as people usually refuse to get married to young girls who have had TB labelling them as ‘sick’.
TB doubles the chances of a pregnant woman of having a premature or low-birth-weight baby and high chances of infant death. Pregnant women with HIV and active TB face higher risks of maternal mortality. “We advise women not to get pregnant while they are on TB treatment. This we advise for a number of reasons: One, they are too weak to undergo a pregnancy. Two, the drug dosages for the treatment of TB are very high and three, to avoid drug resistance. However, many women continue to get pregnant”, says Dr. Rashid Vasi, the Chest Specialist at the Holy Family Hospital in Bandra, Mumbai.
Apart from bearing the burden of being a TB patient herself, caretakers of TB patients also suffer an equal if not more burdensome life. A TB patient in the house often means that the person’s utensils are not shared and that his or her clothes are washed daily and separately. Any contact of care with the TB patient, whether male or female, has to be endured by the mother, wife, sister or daughter of the house. Many a times she is the only caretaker who balances her life between the sick and the healthy in the household. Due to stigma, the support of her extended family perishes, people no longer visit and volunteer to help around the house with the fear of contracting the disease themselves. The woman is left alone to fend for her partner and children. If the TB patient happens to be her spouse, his lack of wages due to absence from work or loss of job adds on to her burdens and she is then required to work. Female children often abandon their education to take care of younger children or other ailing members who have TB.
According to Dr. Chadha, “We need to target women more specifically. Right now our activities are actually not gender specific. We do not take cultural issues into consideration in devising any interventions”. He suggests that the program should intensify case finding and create awareness among women, bring services to their doorstep rather than expect them to come out and travel long distances to access health services.
How far have we gone to reach out to the poor and underserved women of India? Does Tuberculosis need to be seen through a different lens where women are concerned? Perhaps, yes. TB programs need to focus on greater access and reduce delay in diagnosis and treatment. The TB program can be part of the Maternal and Child Programme advocating together to screen, prevent and treat TB and HIV and to eliminate the stigma attached, making more women-friendly policies and programming.
Carolyn Kavita Tauro
Citizen News Service - CNS
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