The systemic invisibility of women’s midlife health Premium

The invisibility of women’s midlife health is embedded in the way medicine diagnoses and treats disease.

India’s focus on women’s health during their child-bearing ages has been one of its most significant public health achievements. The Maternal Mortality Ratio (MMR) has fallen from 362 per 1,00,000 live births in 2000 to about 80 per 1,00,000 in 2023. Through the National Rural Health Mission and subsequently, the overarching National Health Mission (NHM), several initiatives expanding institutional deliveries, skilled birth attendants, better antenatal and post natal care have enabled these outcomes. This work is still ongoing, since access to safe pregnancy, childbirth and reproductive autonomy is highly variable across the country. 

However, women’s health does not conclude when childbearing years pass. The decades that follow, when autoimmune conditions emerge, perimenopause begins, cardiovascular risk and cancer incidence increase, receive far less structured attention. In policy, practice and perception, these years remain largely invisible.

As India’s disease burden shifts to the increasing prevalence of Non-Communicable Diseases (NCDs), women in their 30s and 40s are experiencing higher rates of chronic diseases, such as hypertension and thyroid disorders, with 106 per 1,000 women reporting at least one NCD compared to 65 per 1,000 men.

The invisibility of women’s midlife health is embedded in the way medicine diagnoses and treats disease. For example, women experience heart attacks differently from men, with symptoms such as fatigue, nausea, anxiety or back pain rather than the classic chest pressure or pain. When the widely communicated default symptom profile is male, women’s emergencies are likely to be misread or detected late. Some midlife conditions that are more prevalent among women, such as autoimmune disorders, frequently present as generic symptoms like fatigue, cognitive fog, and diffuse pain, and are therefore not often investigated clinically. Historically, conditions that affect women differently and disproportionately have received less research attention and therapeutic innovation. The speculum, used widely in gynaecological examinations, has not evolved since it was first invented in the 19th century.

These blind spots extend to the design of objects and spaces in everyday life. Women are biomechanically different from men, carrying their centre of mass lower in the body. Yet chairs and desks at the workplace, protective equipment and rehabilitation devices are designed around a male default. In addition, the social realities of women delaying medical help, prioritising family responsibilities, and dismissing early symptoms further reinforce this invisibility, resulting in late diagnoses and more complex treatment.

Addressing these invisible aspects of women’s health needs a shift from focusing narrowly on specific stages to adopting a life-course approach, which recognises the impact of early exposures, lifestyle factors and social determinants over time. India has been laying the foundation for a life-course approach by extending Health and Wellness Centres beyond maternal services to include prevention and management of chronic diseases. Population-based screening for breast and cervical cancers by the NHM is a step towards recognising the health risks that emerge in midlife. Broadening the program to include conditions such as anaemia and autoimmune disorders along with greater awareness of the symptoms could significantly strengthen early detection and care for women. However, the promise of these programmes will depend on the deployment of sufficient frontline capacity and resources.