Research Article

Maithreyi Ravikumar
Lead, Women’s Health, KHPT

Fundamental inequalities in ensuring good health for all, especially vulnerable groups like women and girls, remains a key developmental challenge even in the 21^st century. Girls and women make up one half of the population, but there has been an uneven and inadequate focus on women’s health. Women’s health has been narrowly equated with maternal and reproductive health at the national level, and within the Sustainable Development Goals (SDGs). This exclusive focus on maternal and reproductive health has, no doubt, proven valuable in achieving strong improvements (e.g., 70% reduction in maternal mortality rates between 1990 to 2015 in India.)^[i]  However, it has also resulted in relative neglect of other health conditions which affect women differently or disproportionately, and have therefore received less attention and funding.

Going Beyond Reproductive Health

Comparative analyses across nations of the Global South highlight significant disparities in women’s health outcomes, including lowered gaps in life expectancy between women and men, compared to the Global North. Literature from South Asia has also shown that women face comparatively higher rates of multimorbidity compared to men.[ii] With regards to India specifically, the Demographic Health Survey (DHS) reveals that chronic energy deficiency in women is three times higher than for their counterparts from sub-Saharan Africa, and Indian women generally fare worse in terms of their health status, compared to their counterparts from lower per capita income countries such as Bangladesh and Nepal.[iii] Recent studies based on the National Family Health Survey (NFHS) 5 data has also shown a higher prevalence of chronic conditions such as non-communicable diseases (NCDs) among women in India, in comparison to men, with 512 per 1000 women suffering from a single chronic health condition, and 258 per 1000 women suffering from two or more chronic health conditions.[iv]^,[v] Additionally, there are also substantial and widening within-country geographic variations in women’s health outcomes. These differences have been linked to differences among states in developmental parameters, such as provisions of drinking water, clean cooking fuel, sanitation facilities, and population level characteristics such as literacy, signalling the need for attention to the social determinants of health as well.[vi]

Underrepresentation and Biases in Research and Medicine

At the root of the problem are uninterrogated effects of gendered beliefs and norms within science and society that manifest as systemic barriers to women’s health resulting in disparate health outcomes. This plays out as biases within biomedical research, where women have historically been under-represented―a systematic exclusion that has allowed for the acceptance of the male bodies as the norm for scientific and technological innovations, and the female physiology as the exception, to the detriment of women’s health. Fewer than thirty percent women are represented in industry-sponsored early-phase clinical trials due to legal concerns.[vii] Thus, differences in presentation of illnesses and treatment for men and women are less well understood and remain under-diagnosed. A case in point is cardiovascular diseases that has also been identified as a leading cause of death in women in India.[viii],[ix],[x] Despite being more prone to heart attacks compared to men, women remain under-diagnosed and under-treated, due to atypical symptoms.[xi] Further, women also respond differently to medication due to factors such as hormonal cycles, metabolic rates, immune responses, and fat distribution, which influence the ways in which they absorb, process, and respond to medications.[xii] All of this requires careful consideration within biomedical and clinical research contexts.

Other concerns such as NCDs, autoimmune disorders, anxiety and mood disorders and chronic pain, which affect women disproportionately, and women-specific conditions such as endometriosis and menopause, also remain understudied. Women also report a higher incidence of misdiagnosis within medical set-ups, with at least three of four women in South Asia having experienced a misdiagnosis, and nearly half reporting that their conditions have been dismissed as ‘psychosomatic’ or ‘medically unexplainable’ within medical set-up.[xiii] 

Social Experiences and Gendered Outcomes of Health

Experiences within the healthcare system are compounded by social experiences in everyday life, where sex and gender discrimination affect girls and women from birth. For example, female foeticide has continued despite laws such as the Pre-Conception and Pre-Natal Diagnostic Techniques (PCPNDT) Act in India. Post-birth, experiences of neglect and undernutrition, early school dropout, lack of access to menstrual hygiene products, restrictions on play and physical activity, and systemic and patriarchal barriers to social opportunities and self-actualization, affect adolescent girls’ holistic development. Further, lack of control over reproductive health choices, unequal burden of care work, and exposure to gender-based violence add to the factors that contribute to poor health in women. Evolving challenges, such as climate change and extreme weather conditions, poor air quality and water, food insecurity and changing patterns of vector borne diseases are further set to worsen existing gender disparities in health.[xiv]

Gender norms, cultural values, and societal expectations to uphold family honour traditionally prevent girls and women from seeking help for health. Women routinely fear social stigma, discrimination, and shame for disclosing poor health conditions or disability status, which prevents them from accessing timely medical interventions. Research shows that the lack of social and family support, public attitudes, and community acceptance remain bigger concerns and challenges for women in South Asia and India, when compared to other factors such as lack of resources or adequate health infrastructure.[xv]

Addressing the Gaps in Women’s Health

There is an urgent need to address the scientific biases and the social factors that contribute to inequities in health outcomes for women. An important starting point in this direction is recognizing the differences in the health needs of women, prioritizing their lived experiences, and re-prioritizing health outcomes beyond the myopic focus on maternal and reproductive health centred within national and international goals like the SDGs. Alongside this, it is essential to enrich the data and knowledge on women’s health through deeper, granular clinical research, and qualitative and ethnographic accounts. Both these sets of data contribute to a stronger understanding of how gender and associated intersectionalities, and other social and digital determinants, affect women’s health, along with biological differences.

Further, data must inform public spending on women’s health. An analysis undertaken in 2022 on the National Institutes of Health (NIH) funding shows a skew in funding patterns towards health conditions that disproportionately affect men such as substance use and HIV/AIDS, rather than conditions that disproportionately affect women, such as migraines, headaches, endometritis and anxiety disorders, irrespective of the size of the disease burden.[xvi]

This skew in investment can also be seen in the nature of programmes prioritized for women’s health, which can be improved through gender budgeting practices for health. For example, while a large number of programmes such as the Janani Suraksha Yojna, Surakshit Matritva Aashwasan and Pradhan Mantri Surakshit Matritva Abhiyan have been implemented in India to improve maternal and child outcomes, other chronic conditions that affect women have not received a concurrent specific focus.[xvii] Although these other conditions are meant to be addressed through the Ayushman Bharat scheme and Ayushman Arogya Mandirs for Universal health Coverage (UHC), the gender-insensitive design of these provisions do not adequately account for the gendered differences in healthcare needs, access and treatment, and other social determinants that affect women’s health outcomes. Consequently, women are less likely to receive timely support for serious health risks apart from those associated with maternal health. Addressing these systemic gaps will require paying attention to factors such as social mechanisms which prevent women from reaching practitioners and health centres.

Other areas that require attention are pharmaceutical policies and weak occupational safety policies, differential needs of gender non-conforming populations, and support, protection, and capacity building for the highly feminized cadre of frontline health workers.[xviii] Additionally, there is a need to integrate science and technology, medical and clinical education with social science curricula that can provide medical, clinical and technology experts with an understanding of intersectionality and gender.

Overall, there is a need to urgently centre women’s lived experiences and perspectives in health, for research design, policy reform, and infrastructure and care services enhancement. It is imperative that we move away from an overtly generalized and normative medical-clinical approach towards a comprehensive understanding women’s health as a social phenomenon influenced by biosocial and environmental factors.

Acknowledgements

I sincerely thank Mohan H. L., Ketaki Nagaraju, Dipty Nawal, Sanghamitra Savadatti and Prarthana B. S., for their invaluable inputs for strengthening this article.

References

[i] Ghosh A, Ghosh R. (2020). Maternal health care in India: A reflection of 10 years of National Health Mission on the Indian maternal health scenario. Sexual & Reproductive Healthcare, 25:100530.

[ii] Jafree, S.R. (2020). The Sociology of South Asian Women’s Health. Switzerland: Springer

[iii] Banerjee, D., and Kayal, T.K. (2024). An analysis of inequality in physical health status of women in India: 2015‒2021. Global Health Journal, 8, 4, 213-221. Doi: 10.1016/j.glohj.2024.11.003

[iv] Singh, S.K., Chauhan, K. & Puri, P. (2023). Chronic non-communicable disease burden among reproductive-age women in India: evidence from recent demographic and health survey. BMC Women’s Health 23, 20. https://doi.org/10.1186/s12905-023-02171-z

[v] Dolui, M., Sarkar, S., Hossain, M., and Manna, H. (2023). Demographic and socioeconomic correlates of multimorbidity due to non-communicable diseases among adult men in India: Evidence from the nationally representative survey (NFHS-5). Clinical Epidemiology and Global Health, 23. Doi: 10.1016/j.cegh.2023.101376

[vi] Banerjee, D., and Kayal, T.K. (2024). An analysis of inequality in physical health status of women in India: 2015‒2021. Global Health Journal, 8, 4, 213-221. Doi: 10.1016/j.glohj.2024.11.003

[vii] Singh, K., and Swarup, R. (March 08, 2025). Women are poorly represented in clinical trials. That’s problematic. Nature India. https://www.nature.com/articles/d44151-025-00036-y#ref-CR1

[viii] See Bill & Melinda Gates Foundation and National Institute of Health. (2023). Women’s Health Innovation Opportunity Map 2023: 50 High-Return Opportunities to Advance Global Women’s Health R&D. Retrieved from https://cambercollective.com/wp-content/uploads/2025/01/Womens-Health-RD-Opportunity-Map-2023.pdf

[ix] Kiran,G., et al. (2020). Escalating ischemic heart disease burden among women in India: Insights from GBD, NCDRisC and NFHS reports, American Journal of Preventive Cardiology,2. Doi: 10.1016/j.ajpc.2020.100035

[x] Short, S.E., and Zacher, M. (2022). Women’s Health: Population Patterns and Social Determinants. Annual Review of Sociology, 48:277–98. Doi: 10.1146/annurev-soc-030320-034200

[xi] IANS. (October 25, 2023). In clusive research: Women left out of drug research, clinical trials. ET Healthworld.com. https://health.economictimes.indiatimes.com/news/industry/inclusive-research-women-left-out-of-drug-research-clinical-trials/104685037

[xii] See Singh and Swarup, 2025.

[xiii] See Jafree, 2020

[xiv] Sorensen, C., et al. (2018). Climate change and women’s health: Impacts and opportunities in India. GeoHealth, 2,

283–297. https://doi.org/10.1029/2018GH000163

[xv] See Jafree, 2020

[xvi] Smith, K. (May 03, 2023). Women’s health research lacks funding -these charts show how. Nature. https://www.nature.com/immersive/d41586-023-01475-2/index.html

[xvii] See Singh et al, 2023

[xviii] See Jafree, 2020