Male-centric medicine affecting women’s health

General Studies Paper 2

Introduction

• Exactly three decades ago, the U.S. National Institutes of Health (NIH) Revitalization Act of 1993 mandated the inclusion of “women and minorities” in clinical trials in a bid to reduce health disparities. Yet, to date, the male model of medicine is thriving, and so is the tendency of treating women as smaller men despite a growing body of research insisting on physiological differences (beyond the reproductive organs) between the sexes. The genetic and epigenetic differences between men and women are also extensively documented.

Generic drugs, trials, mental health

• In India, the “pharmacy of the world”, the gender disparity in clinical trials has even bigger implications, thanks to generic drug production and consumption.
• It has been demonstrated in various studies that women’s bodies respond differently to the components of generic drugs.
• It was clear in clinical trials that nearly one-fifth of medications showed a difference in the active dose between men and women.
• It is not just about treatment but also testing and diagnosis where women have been getting a rough deal.
• The study firmly notes that depression rates and the prevalence of anxiety are higher for women than for men worldwide in general.
• Like depression, cardiac issues are now acknowledged as having a slightly more prevalence in women. Yet, they continue to be diagnosed and treated like ‘lesser men’.
• Study after study demonstrates that women are less likely to receive appropriate medications, diagnostic tests and clinical procedures even in developed countries such as Canada and Sweden.
• The stereotype of the “hysterical woman” continues to haunt women even when they need urgent clinical interventions.

Gaps that can be linked to apathy

• The exclusion of women from clinical trials and research projects addressing sex-agnostic critical illnesses such as cancer and heart disease has resulted in a limited understanding of sex-specific symptoms and responses to treatment.
• When it comes to sex-specific illnesses such as breast or endometrial cancers, polycystic ovarian syndrome, and pregnancy-related issues, there are serious gaps in research that can only be explained by an apathy towards “women’s only” issues.
• United States-based studies show that the funding received for research in migraine, endometriosis and anxiety disorders is much lower in proportion to the burden of these illnesses.
• World Health Organization data from 2017 show that “every day about 808 women die due to complications of pregnancy and childbirth”.
• Pregnant women are further down the ladder of representation in clinical trials and research.

Government Initiative to Ensure Health Facilities to Women

• Health and Wellness Centres: India has about 76,000 health and wellness centres which perform screening of 5 types of health issues; hypertension, diabetes, breast cancer, oral cancer and cervical cancer.
• Adolescent Friendly Health Services Program: Rastriya Kishor Swasthya Karyakram is there where female adolescents are sensitised about their health. The programme also focuses on reaching out all adolescents including Lesbian, Gay, Bisexual, Transgender and Queer (LGBTQ).
• Auxiliary Nurse Midwife: Auxiliary Nurse Midwife, commonly known as ANM, is a village-level female health worker in India who is known as the first contact person between the community and the health services.
• Janani Suraksha Yojana (JSY): Janani Suraksha Yojana (JSY)is a safe motherhood intervention under the National Health Mission (NHM). JSY is a 100% centrally sponsored scheme and it integrates cash assistance with delivery and post-delivery care.
• Pradhan Mantri Matru Vandana Yojana (PMMVY): PMMVY is a scheme for pregnant women and lactating mothers. Is a direct benefit transfer (DBT) scheme under which cash benefits are provided to pregnant women in their bank account directly to meet enhanced nutritional needs and partially compensate for wage loss.

Way forward

• In an equitable world, women would be accepted as an individual category, with race, age and class as subcategories. And an equal amount of time and resources would be spent in finding and providing treatment and health care.
• India’s G-20 presidency may be an opportune time to highlight this issue in alignment with Sustainable Development Goals on women’s health.