TB and women: why gender matters more than ever Premium

Gender disparities in TB care during the pandemic highlight the urgent need for solidarity and action on gender-based issues.

“I was 24 years old when I was diagnosed with MDR-TB. The two-year recovery time, from 2021 to 2023, was when COVID-19 made even the smallest task a logistics nightmare. However, helped by my parents and medical staff, sustained treatment and care was possible,” says Akshata Acharya, an MDR-TB survivor from Maharashtra. “But,” she continues, “it wasn’t logistics or access to treatment and good nutrition that was a challenge; for me, hurdles came in the form of my skin discoloration and becoming physically weak, which made going out an impossible task – it was the mental toll that TB took that eclipsed my life. Negative comments from people about my changed physical appearance, the advice by a grassroots healthcare worker to keep the disease “hidden”, opened my eyes against discrimination and disparities that the disease brings along.”

Ms. Acharya adds: “As an actor, writer and director, TB took away two years of life. But then, I was more fortunate than some other TB patients. I remember a woman who, after being diagnosed with TB, was thrown out from her job (she worked as a house help); also her family abandoned her. TB. I learnt. can be very isolating and more so if you are a woman.”

Sadly, Ms. Acharya’s is not an isolated or stray case of disparities. Gender differences and inequalities play a critical role in how people access and receive TB-related services in the public and private sectors, in India. The Union Health Ministry’s India TB Report 2023 indicates that men are more affected by TB compared to women. This higher risk of men developing TB could be attributed to risk factors including smoking and the use of intravenous drugs. Also, men are more likely to be in occupations that expose them to TB, such as mining, quarrying, metals, and construction industries. However, in India, women face challenges such as under-diagnosis and financial barriers to accessing treatment.

A recently published paper titled: ‘Women and tuberculosis care in India: a scoping review’ notes that while the variables that impacted women in the past, particularly gender roles and norms, seem to be waning over time, they cannot be ignored in the present. The focus that the government of India is placing on gender equity serves as a reminder that these problems are still relevant for TB elimination efforts among women.

The author of the paper Janmejaya Samal explained that studies spanning 20 years (2004 to 2024) were reviewed to understand the changes, if any, around women and TB care in India. “The draft national strategic plan of India for TB 2017–2025 has estimated that about 3 million women would get affected by TB every year, and TB is one of the top 5 leading causes of death among adult women globally,’’ he said. He added that women in India deal with multiple hurdles including stigma-related problems, lack of health-seeking behaviour and poverty, when it comes to accessing diagnosis, treatment, and care for TB. “Normalisation of symptoms, less prioritisation, and the role of caregiver in the family put women in a compromised state and need focused attention. This situation remains unchanged after COVID,’’ added Mr. Samal.

Public health specialist Chapal Mehra notes that at the grassroots level, women have multi-layered problems when it comes to accessing medical care. ”Across India there are multiple cases of women being abandoned when diagnosed with TB; there are cases of symptoms not being attended to and the condition being allowed to worsen; women also are prone to stopping treatment mid-way when they feel that symptoms have waned,” he said.

Speaking about the plight of women who do manage to access diagnosis, and treatment Mr. Mehra said that if society and family do not accept and support women diagnosed with TB, they are unlikely to disclose the condition. “Many suffer, knowing that disclosing the disease would result in a loss of income. The pressure of housework and little social support are the two major hurdles that we often witness. We have also seen that when women lose their partners to TB, families often abandon them and they are also plagued by the fear of passing on the disease to their children,’’ he added.