New Delhi, July 17: The gender gap in healthcare spending is increasing in India, and even educated and wealthy households spend less on women's health than on men's, scientists have reported.
Demographers and other experts have documented for over a century how Indians discriminate against girls in healthcare and general well-being. New research now suggests that this gender disparity is amplified in adults and has increased over time.
An analysis from two nationwide surveys seven years apart has found that gender gaps in the sampled households' healthcare expenditures rose from 8 per cent to 15 per cent for short-term illnesses and from 25 per cent to 37 per cent for long-term illnesses.
As significant as that increase over time, the scientists say, is their finding that education, wealth and place of residence (urban or rural) appear to account for just 48 per cent of the gap in healthcare expenditure.
More than half the gap appears to stem from an unexplained bias against spending on the health needs of women.
"Both (findings) - the sizes of the gaps and their increases between two points in time - are striking and surprising," said Nandita Saikia, an assistant professor at the school of social sciences in Jawaharlal Nehru University who led the research.
"One would expect things to improve over time - we don't see evidence of that."
Saikia and her colleagues set out to investigate a silent and shameful trend that had been documented, among others, by the authors of India's 1901 population census.
"There is no doubt that, as a rule, she (a girl) receives less attention than would be bestowed upon a son.... She is less warmly clad.... She is probably not so well fed as a boy would be.... When ill, her parents are not likely to make the same strenuous efforts to ensure her recovery," they wrote in 1901.
Over the past three decades, study after study from various parts of India have captured gender discrimination in health: parents consult doctors sooner and more often for boys than girls; parents immunise boys more than girls; sons are better breastfed than daughters; parents whose boys are hospitalised are more likely to borrow or sell their assets than parents whose girls are hospitalised.
But most previous studies did not explore the socio-economic factors that might influence such behaviour.
The new research examined healthcare expenditure data from about 41,000 households in 2005 and 42,000 households in 2012, captured in surveys conducted jointly by the University of Maryland in the US and the National Council of Applied Economic Research, New Delhi.
The researchers analysed the prevalence of illnesses among men and women and household spending patterns on short-term illnesses such as fever, cough or diarrhoea, and on major illnesses such as cataracts, tuberculosis, diabetes, high blood pressure and cancers.
Both short-term and major illnesses were more prevalent among women compared with men in 2005 as well as 2012, a finding that is in line with global observations of higher morbidity among women although women have higher longevity.
"The greater prevalence of illness among women should translate into higher healthcare expenditure for women, but we see the opposite in both the years," said Jayanta Kumar Bora, a researcher at the Public Health Foundation of India, New Delhi.
A quantified analysis of the contributions of socio-economic factors such as education, wealth and place of residence suggests that they explain only 48 per cent of the gap in health spending.
Saikia, Bora, and Moradhvaj, a research scholar at the JNU, have just published the results of their analysis in the journal PLOS One.
"More than half the gap appears to be driven by the notion that women's health is not as important as men's health," said Saikia.
"It is possible that men's health is seen as important because in many households they are the primary breadwinners."
She added: "But while women contribute significantly to a household's well-being, their contribution - whether through the chores they do at home or the care and emotional support they provide to their children and older members of the household - remains un-quantified. This is sad and unfortunate."