Context

As India steadily steers its way through the pandemic to safer shores, we must foreground a disease which has been impacting our country for years, and disproportionately affecting women –  tuberculosis.

Toll of TB

• In India, the TB case fatality ratio increased from 17 per cent in 2019 to 20 per cent in 2020.
• According to a joint report (2010-13) of the Registrar General of India and the Centre for Global Health Research, TB was the fifth-leading cause of death among women in the country, accounting for nearly 5 per cent of fatalities in women aged 30–69.

How TB affects women more than men

• Much steeper socio-economic price: While both men and women suffer the consequences of this debilitating disease, women patients pay a much steeper socio-economic price.
• Beyond clinical metrics: From social ostracisation and lack of family support to the negative impact on marital prospects, women absorb the repercussions of TB beyond the clinical metrics.
• Stigma also acts as a strong deterrent when it comes to health-seeking behaviour.
• Fewer women, therefore, get included in the available cascade of care for TB.

Measures by government

• In 2019, the Health Ministry-Central TB Division developed a national framework for a gender-responsive approach to TB in India.
• The document takes cognisance of the challenges faced by women in accessing treatment and offers actionable solutions.
• Gender-responsive policy interventions: In December 2021, a parliamentary conference on ‘Women Winning Against TB’ was organised by the Ministry of Women and Child Development where gender-responsive policy interventions were discussed.
• The Vice-President of India urged states to take proactive steps such as ensuring nutritional support to women and children and the doorstep delivery of TB services, especially for women from socio-economically weaker backgrounds.

Suggestions

1] Highlight the issue at the relevant forum

• One, as elected representatives, we need to come together more to highlight the issue at all relevant forums and spaces.
• These meetings see increased participation of women leaders from all walks of life in the community going forward.

2] Strengthen counselling network

• We need to strengthen counselling networks for women patients and their families.
• Irrespective of where the patient seeks care – public or private sector – build the capacity of healthcare workers to educate the patient’s family about the importance of providing her a supportive environment during the course of her treatment.

3] Nutritional needs

• We need to ensure that the nutritional needs of women are being met.
• Undernutrition is a serious risk factor for TB and research indicates such risks are higher for women.
• It is commendable that the government, through Nikshay Poshan Yojana, has effectively provided a monthly benefit of Rs 500 to enable a nutritious diet for TB patients in the last few years.
• For the 2020 cohort, the total amount paid under NPY via DBT has been over  Rs 200 crore.
• Additionally, we can look to further strengthen inter-departmental coordination, wherein the Public Distribution System can explore appropriate linkages with relevant departments of the MoHFW and even include a protein-rich diet for TB patients.

4] Amplify accurate TB messaging

• At a community level, we must amplify accurate TB messaging and showcase how gender plays a role in determining the course of action on the ground.

Conclusion

These are universal problems that must transcend gender binaries. Only when equitable solutions are offered to vulnerable sections of society will we be able to realise the dream of TB-Mukt Bharat.

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