Can women achieve equity in healthcare?

Since 1911, the International Women’s Day (IWD) has been celebrated across the world, with more and more organisations, civil society groups and even corporates taking a moment to mark the day. 

This year’s theme of the day is “Together, Let's #AccelerateAction for Gender Equality”. In many spaces, this has been honoured through various means - women empowerment though education, fair practices in the workplace with equal pay for work done and better working conditions, capacity building for women in leadership, and advocating for equity in women in politics. 

With all the great strides we have made in the country with regard to women empowerment and the establishment of laws and policies to safeguard these policies, we must not let health inequity fall by the wayside. 

There has been a lot of focus on empowering women in key decision-making positions in health leadership; through education and mentorship. We have seen many key health leadership positions now being occupied by women in health organisations, ranging from government to development organisations, pharmaceuticals, research and academia. This is truly impressive!

Additionally, big wins have included established maternity leave for a minimum of 90 days; paternity leave of 14 days to support the new mum and baby; a breastfeeding policy to support breastfeeding mums at the workplace, with establishment of breastfeeding rooms and creches for babies at work; and the support for adolescents who get pregnant in school, to stay in school during pregnancy, and to resume school after delivery.

However, one area continues to be left behind - access to healthcare. By default, women are more likely to interact with the health system more often than men. This is simply as a result of their basic biology and the roles this thrusts them into. A quick survey in any multidisciplinary hospital will show that in-patient admission numbers are more likely to be female than male. 

Throughout childhood, the need for healthcare is balanced out among all children. Access to child growth monitoring and vaccination is equal across the divide; and lack of access has nothing to do with gender, but other determinants of health such as socioeconomic status and physical access to care.

As we step into adolescence, the divide begins to show. The female adolescents are more likely to deal with adolescent-related health complications than the males simply because of menstruation-related complications such as menstrual hygiene management issues, dysmenorrhea, menorrhagia, premenstrual dysphoria, endometriosis, adenomyosis and polycystic ovarian syndrome. 

Then the child-bearing age comes around and the females are disproportionately affected by the health burden of bringing forth life. The assumption that pregnancy is a normal biological process has done a lot of harm to women’s health. It has played a huge role in the persistently high burden of maternal and newborn morbidity and mortality, which despite an increase in resources, our progress in addressing it is nought. 

Menopause demonstrates yet another period through which the inequity continues to be perpetrated. Women have had to accept and normalise the menopause syndrome despite the chaos it causes in the woman’s life; coupled with the increased risk of health-related complications. Right up until just about five years ago, nobody spoke about menopause as a health issue in Kenya. In many developing nations, it is yet to even become a topic for consideration. 

Why am I pointing this out? Because of the absolute gender inequality manifested in how we are dealing with these critical health concerns that are affecting one half on the population. Even worse, when you consider that the inequality is spread out throughout the life course of the female. 

Kenya is a country that has, not just a policies, but actual Acts of Parliament, with regard to medical conditions including the Mental Health Act; the Privileges And Immunities (Global Fund To Fight Aids, Tuberculosis And Malaria) Order No. 214 of 2021; the Malaria Prevention Act; the Cancer prevention and Control Act; you name it. 

Yet, the leading cause of death among women of reproductive age has not been accorded the same privileges. These legal instruments compel our decision-makers to appropriately allocate funds to implement these Acts. Therefore, when maternal death is not a cause for concern, enough to actually put in place a legal mechanism to ensure it is not drowned out among other competing priorities, it is very difficult to not look at it from a gender lens and see the glaring gap. 

The same nonchalant attitude translates to how maternity care is funded. Every time I see the costings made with regard to maternity care, I am deeply concerned. How do we choose to treat women responsible for providing us with the next generation with such bare minimum care? How is it that even in private insurance, maternity care is capped at measly figures compared to chronic disease care or cancer care? This modus operandi has been directly adopted by our national social health insurance fund, matching what the private sector has in place, with abominable tariffs for maternal care. 

Let us not even get started with the fact that as a nation, we have accepted that family planning services are considered a privilege, rather than a core health need. I wonder whether this would have been the case had most family planning technologies been male-oriented. 

The fact that our Social Health Insurance makes no mention of adolescent reproductive health care or menopause care speaks for itself. We are still far from equality with regard to healthcare. Female reproductive care cannot be confined to breast and cervical cancer screening. We know that every time we are dealt the hand of ‘Poor medicine for poor people’, it is the women facing the brunt of it, as fair tariffs for these female-specific health conditions that are disregarded. Yet, when young women begin to turn away from child-bearing by opting for permanent sterilisation to avoid the risk of death, we are up in arms.

It cannot be that the commonest surgery in the world, caesarian section, is only carried out in women and yet it is costed at a measly Sh30,000 alongside less risky surgeries that are costed way more. It is the only major surgery where we can dare debate about the qualification of the persons who should be conducting it. I am waiting to see anyone other than a urologist, or at the very least, a general surgeon, touch a prostate. 

As we celebrate the achievements of women in the boardroom, in the c-suite, in the research labs, in Parliament and the deaneries; let us step back and work toward a future where we shall celebrate women in the delivery suites getting fair treatment! 

Dr Bosire is a gynaecologist/obstetrician