Missing women patients: Gender discrimination in access to healthcare


Content from the Brookings Institution India Center is now archived. After seven years of an impactful partnership, as of September 11, 2020, Brookings India is now the Centre for Social and Economic Progress, an independent public policy institution based in India.

Gender discrimination in access to healthcare has not been systematically studied in India or many other developing countries. This is primarily due to a lack of reliable data. In this paper, we use extensive data collected on clinical appointments from a large public-funded tertiary care hospital with a robust hospital information system to study the level and extent of gender discrimination in access to healthcare. We used data on clinical appointments from 2,377,028 outpatients to analyse the likelihood of a male patient visit compared with a female patient visit to the hospital and its variation with respect to distance from the hospital and the age of the patient.

Previous studies on gender discrimination in developing countries have largely focused on the excess mortality of female patients as seen in low population ratios of women to men to explain the issue of missing women. This paper furthers these studies by assessing gender discrimination experienced by women in access to healthcare. There have been a handful of small sample studies on gender bias in access to healthcare in select patient groups or for specific medical conditions; however, this study uses extensive data across a wide spectrum of patient groups and medical conditions to examine the  gender discrimination in access to healthcare.

The objective of the study was to investigate gender discrimination in access to healthcare and its relationship with the patient’s age and distance from the healthcare facility. The observational study was based on outpatient data from the All India Institute of Medical Sciences, a large referral hospital in New Delhi, India.

The researchers used estimates from the logistic regression to compute sex ratios (male/female) of patient visits with respect to distance from the hospital and age. Missing female patients for each state—a measure of the extent of gender discrimination—were computed as the difference in the actual number of female patients who came from each state and the number of female patients that should have visited the hospital had male and female patients come in the same proportion as the sex ratio of the overall population from the 2011 census.

Of 2377028 outpatient visits, excluding obstetrics and gynaecology patients, 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 furthest 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. The study estimates that there were 402,722 missing female outpatient visits from these four states, which is 49% of the total female outpatient visits for these four states.

The study’s findings reveal 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.

Read the Research Paper: Missing female patients: An observational analysis of sex ratio among outpatients in a referral tertiary care public hospital in India