4 lakh ‘missing’ women, AIIMS documents gender gap in health access

Doctors from AIIMS and Harvard TH Chan School of Public Health looked at the gender breakup of OPD patients in AIIMS in 2016 to estimate “missing” female patients

In the first such documentation of “missing” female patients in the outpatient department of the All India Institute of Medical Sciences, Delhi, doctors have estimated that 4 lakh women did not reach the country’s premier medical institute in 2016.

The proportion of women declines sharply with increase in distance as the doctors analysed the male female breakup of patients from Uttar Pradesh, Bihar Delhi and Haryana. Patients from these four states make up 90% of the OPD load in AIIMS.

“We found gender discrimination in access to healthcare, which was worse for female patients who were in the younger and older age groups, and for those who lived at increasing distances from the hospital”

“Of 2377028 outpatient visits, excluding obstetrics and gynaecology patients, the overall sex ratio was 1.69 male to one female visit. Sex ratios, adjusted for age and hospital department, increased with distance. The ratio was 1.41 for Delhi, where the facility is located; 1.70 for Haryana, an adjoining state; 1.98 for Uttar Pradesh, a state further away; and 2.37 for Bihar, the state furthest from Delhi. The sex ratios had a U-shaped relationship with age: 1.93 for 0–18 years, 2.01 for 19–30 years, and 1.75 for 60 years or over compared with 1.43 and 1.40 for the age groups 31–44 and 45–59 years, respectively. We estimate there were 402 722 missing female outpatient visits from these four states, which is 49% of the total female outpatient visits for these four states,” the study concluded.

The authors of the paper published in BMJ Open included Dr Randeep Guleria, director AIIMS and professor of pulmonary medicine, Dr Ambuj Roy, professor of Cardiology, Shamika Ravi, member of the prime minister’s economic advisory council and Dr S V Subramanian of the Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health.

Missing female patients for each state—a measure of the extent of gender discrimination—was computed as the difference in the actual number of female patients who came from each state and the number of female patients that should have visited the hospital had male and female patients come in the same proportion as the sex ratio of the overall population from the 2011 census.

The authors reported: “We found gender discrimination in access to healthcare, which was worse for female patients who were in the younger and older age groups, and for those who lived at increasing distances from the hospital.”