AS many as 4 lakh women patients have gone “missing” in 2016 at the All India Institute of Medical Sciences.
An analysis by experts at AIIMS, Indian Statistical Institute, Harvard T H Chan School of Public Health and Prime Minister’s Economic Advisory Council and others has concluded that in 2016, of the patients from Delhi, Haryana, Uttar Pradesh and Bihar who visited the country’s premier medical institute, there were 4,02,722 missing female
patients. These four states contribute to 90% of the OPD (outpatient) load at AIIMS.
The researchers arrived at this number by analysing the sex ratio of patients from these states and comparing it with the population-level sex ratios in those states.
For example, of the total 23.77 lakh outpatient visits, excluding obstetrics and gynaecology patients — since this is
exclusively female — the overall sex ratio was 1.69 male to one female visit. Sex ratios, adjusted for age and hospital department, increased with distance.
The ratio was 1.41 for Delhi, where the facility is located; 1.70 for Haryana, an adjoining state; 1.98 for Uttar Pradesh, a state further away; and 2.37 for Bihar, the state farthest from Delhi.
The sex ratios had a U-shaped relationship with age: 1.93 for 0-18 years, 2.01 for 19-30 years, and 1.75 for 60 years or over compared with 1.43 and 1.40 for the age groups 31-44 and 45-59 years, respectively. In other words, the most skew happens in the younger age segment. “We estimate there were 4,02,722 missing female outpatient visits from these four states which is 49% of the total female outpatient visits for these four states,” the study published in BMJ Open, reported.
The authors, including Shamika Ravi of the Prime Minister’s Economic Advisory Council, concluded that there is: “…gender discrimination in access to healthcare, which was worse for female patients who were in the younger and older age groups, and for those who lived at increasing distances from the hospital.”
This is the first study of its kind that looked at such large numbers of patients from the best known tertiary care institute in the country.
“We need to develop strategies to reach out to women living in distant places as their health may suffer if adequate facilities are not available nearby. This will also have an overall effect of family structure and education of the girl child,” said Randeep Guleria, AIIMS director and a professor in the department of pulmonary medicine and sleep disorders and one of the authors of the study.
Said co-author Ambuj Roy who is professor of cardiology at AIIMS: “Health access discrimination was present across all departments being worst in cardiology. This emphasises that gender sensitivity to health has to be looked beyond maternal and child health since non communicable diseases are the most common cause of morbidity and mortality in both men and women.”
That there is a gap in healthcare access for women has been highlighted through smaller studies in the past — there is data to show that women are mostly organ donors and not recipients. Government data on admissions in neonatal intensive care units in various districts show that many more baby boys are admitted there than is justified by their sex ratio at birth.