Over the past three decades, South Asia has significantly improved maternal health indicators. Nonetheless, the national policies are yet to acknowledge that women’s health is not limited to maternal health. Addressing women’s health requires us to negotiate with a broader spectrum of factors affecting women and girls, one of which is healthcare.
Healthcare providers often overlook the gender-specific needs of women, leading to poor care-seeking experiences, particularly among those facing intersecting social vulnerabilities such as caste, class, religion, or ethnicity. Additionally, the way the healthcare system treats women’s bodies closely mirrors the gendered construction of womanhood, manifested as overmedicalization of women’s health issues and erosion of their agency.
In this piece, we discuss the manifestations of gendered social norms and discriminatory attitudes perpetuated in women’s healthcare. Drawing on empirical data from South Asia, we argue for the creation of equitable and transformative healthcare systems.
Women globally report experiences of their health concerns being dismissed or minimized by healthcare providers. This phenomenon, viewed as a form of medical gaslighting, is particularly evident with reports of pain, often labelled as exaggerated. Conditions causing chronic pain, such as endometriosis and fibromyalgia, are frequently misdiagnosed or undertreated in women. One of the contributors is the cultural belief that women can endure pain since they routinely experience it during menstruation or childbirth. In many South Asian cultures, particularly in rural settings, this expectation is pervasive, discouraging women from even seeking healthcare.
Adolescent girls in South Asia have considerably lower access to contraception and sexual health services than their male peers do. With as little as one in five girls using modern contraceptives, this gap exacerbates the challenges young women face in managing sexual health. Many South Asian cultures deem women’s sexuality outside the institution of marriage as sinful. Healthcare providers, influenced by these norms, judge and attribute promiscuity to unmarried women who seek contraceptive services, abortion, or treatment for sexually transmitted infections (STI). In abortion care, some providers cite conscientious objection – a refusal to offer services based on personal moral beliefs, which essentially stems from a lack of understanding of women’s healthcare needs from a human rights perspective. These cultural taboos surrounding sexuality and fear of judgment discourage women from seeking timely care. The discrimination faced by women and girls also extends to poor access to information about protection from pregnancies and infections, leaving them, particularly the younger and/or unmarried, vulnerable to higher risks of unintended pregnancies, unsafe abortions, and untreated STIs.
Feminist scholars have long pointed out the issue of over-medicalization of women’s bodies, evident in how physiological processes such as menstruation, pregnancy, and menopause are often constructed. The phenomenon of treating these as medical conditions requiring intervention, is uniquely gendered. For instance, menopause is sometimes medicalized and treated with unnecessary hormone therapy with potential adverse effects, due to its portrayal as a deficiency that needs to be managed. Contrary to this, age-related changes in men, such as decreasing testosterone levels, are often framed as natural or even marketed as an opportunity for enhancement.This disparity in gaze reinforces that women’s bodies are inherently problematic and in need of control. Such pathologizing of women’s health not only reinforces gendered power imbalances stripping women of medical agency but also leads to the normalization of surgical procedures like caesarean sections (CS), and tubal ligations.
The CS rates in any region should not exceed 10-15% of the total childbirths. However, recent data on CS from India, Bangladesh, Pakistan, Sri Lanka, Nepal and Bhutan clearly exceed this range. Decision-making around CS is complex, and often obstetricians are the primary decision-makers. Women may decide to have elective CS as a more convenient option due to the fear of labour pain or perceived vaginal birth complications. Healthcare providers are known to nudge or even coerce women and families towards CS due to higher confidence in performing CS as opposed to assisted vaginal birth, greater convenience in scheduling births, and lower chances of litigation. Institutions may incentivize providers to perform more CS because of the higher costs involved in surgical procedures.
The family welfare interventions of several South Asian nations are highly skewed towards women, and place a disproportionate burden of birth control on them. Female sterilization, a permanent birth control method with potential complications such as menstrual cycle changes and future risk of hysterectomies, is widely used in almost all the South Asian nations with the exception of Bhutan. In comparison, male sterilization which is a reversible procedure with fewer side effects has abysmally low rates. Given the significant proportion of women undergoing sterilization with these risks, it is clear that not all of them are making informed decisions, as indicated by the high proportion of sterilization regret reported from these settings.
A notable volume of research from South Asia has reported high levels of disrespect and abuse during institutionalized childbirth, particularly in public healthcare settings, in the form of verbal and physical abuse, non-consented procedures, non-dignified and poor quality without ensuring privacy and confidentiality, and neglect. Women from lower-income groups, rural areas, lower castes and minority communities are more likely to encounter such dehumanizing and neglectful behaviours. It is important to note that these are not isolated issues resulting from faulty individual attitudes. The abusive environment is the result of deficiencies in the public healthcare system – poor infrastructure, undertrained and overworked providers – and deeply rooted gender biases.
Building on these empirical instances, we argue that the healthcare system’s gendered construction of women’s bodies facilitates the trivialization of their experiences, and the stripping of their agency, often subjecting them to invasive procedures without proper consideration. Hence, there is a clear need to reorient these systems to be equitable and transformative so that they can effectively address the healthcare needs of women. A key starting point is the incorporation of gender sensitivity in medical education. Apart from isolated efforts, the current medical curricula in these countries lack a gender-sensitive approach, limiting the potential of future healthcare providers.
Finally, it is time to consider a paradigmatic shift from the prevalent technocratic to a humanistic model of childbirth. Unlike the technocratic model that treats childbirth as a medical condition that needs fixing, the humanistic model recognizes it as a natural process requiring compassionate care. Such a shift could pave the way for upholding the rights and well-being of women during childbirth, one of the most foundational processes of humanity.
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