How Gender Influences Health: Understanding Inequities in Care and Outcomes

Gender shapes health in ways that often go unnoticed. From who eats first at the dinner table to who decides when a sick person sees a doctor, deeply held norms influence the body, mind, and lifespan of every person – but rarely with equal consequence. For women in particular, these patterns translate into measurable disparities in nutrition, disease burden, mental health, and even survival itself. Understanding how gender operates as a social determinant of health is essential to closing these gaps.

Gender norms and how they shape health 🔗

Gender norms are the unwritten rules a society teaches about how men and women should behave, what they should value, and what they are entitled to. These norms are absorbed in childhood and reinforced through families, schools, workplaces, religion, and media. They become so familiar that they appear natural – yet they decide who gets the larger share of food, who is allowed to step out of the home for a check-up, and whose pain is taken seriously.

The World Health Organization recognises gender as one of the key social determinants of health, acting alongside income, caste, and education. When norms restrict women’s movement, decision-making, or income, they directly limit access to care. When norms place men under pressure to appear tough and self-reliant, they delay help-seeking for mental health concerns and chronic disease. Both sides experience harm, but the consequences for women are typically more severe because the norms intersect with broader inequalities of power and resources.

Limited access to health services 🔗

Across much of South Asia, women cannot easily decide when or where to seek care. A woman may need a husband’s permission to visit a clinic, a mother-in-law’s approval to spend money on medicines, or a male relative to accompany her on public transport. These restrictions delay diagnosis and treatment, especially for conditions considered private – gynaecological problems, mental health concerns, or sexually transmitted infections. A qualitative study in rural Odisha found that women postponed visits for anaemia testing and iron supplements because their household duties left no time, and because travelling alone to a health centre was socially discouraged.

Increased risk of disease 🔗

Gender norms also raise exposure to specific health risks. Indoor cooking on biomass stoves places women at higher risk of respiratory illness. Early marriage and frequent pregnancies increase the chance of maternal complications and cervical cancer. The expectation that women eat last and least within the household means that even when food is available, their share is smaller. The result is a population of women who carry a heavier disease burden than men despite often having longer life expectancy on paper.

Socio-cultural barriers to women’s health 🔗

The pathway between gender norms and poor health passes through a set of concrete socio-cultural barriers. These barriers are not isolated problems – they reinforce one another, creating a cycle that is hard to break without targeted intervention.

Malnutrition and the “eat last” custom 🔗

In many Indian households, women serve meals to men and children first and eat whatever remains. Over years, this practice contributes to chronic undernutrition. The latest National Family Health Survey (NFHS-5) recorded that 57 percent of women of reproductive age in India are anaemic, compared with about 25 percent of men in the same age range. Anaemia prevalence is highest among women from Scheduled Caste, Scheduled Tribe, and rural households, showing how gender disadvantage compounds with caste and class.

Anaemia is not just a number on a haemoglobin report. It increases fatigue, lowers work capacity, raises the risk of complications during pregnancy and childbirth, and contributes to low-birth-weight babies – passing the disadvantage to the next generation.

Overwork and the double burden 🔗

Women in India typically perform paid or subsistence work and then return home to unpaid cooking, cleaning, child care, and elder care. Economists call this the double burden. Amartya Sen has described it as an “accumulation of labour” rather than a fair “division of labour,” noting that household work is wrongly classified as a low-energy sedentary activity when in fact it involves long hours of physically demanding tasks. This continuous workload leaves little time for rest, exercise, preventive check-ups, or even adequate sleep – each of which has direct health consequences.

Lack of education and health literacy 🔗

Girls who are pulled out of school early lose more than academic credentials. They lose exposure to information about nutrition, menstruation, contraception, and disease prevention. They are less able to read medicine labels, understand a doctor’s instructions, or assert their needs in a clinical setting. Female literacy in India still trails male literacy by a significant margin, and the gap widens in rural and tribal areas. Education is one of the strongest predictors of maternal and child health outcomes; every additional year of schooling lowers the risk of early marriage, early pregnancy, and infant mortality.

Violence against women 🔗

Violence is both a public health crisis and a driver of other health problems. According to NFHS-5 data, about 32 percent of ever-married women aged 18-49 in India reported experiencing domestic violence in the previous twelve months, with physical violence being the most common form. The consequences extend far beyond visible injuries – survivors show higher rates of anaemia, hypertension, depression, anxiety, unintended pregnancy, and reduced ability to seek healthcare because of fear and economic dependency.

Violence is rarely treated as a clinical issue in routine practice. Yet a woman who arrives with recurrent headaches, chronic pelvic pain, or repeated miscarriages may be carrying the unspoken weight of an abusive relationship. Addressing this requires training health workers to ask, listen, and refer without judgement.

The current health scenario for women 🔗

The health status of women in India shows both progress and persistent gaps. Maternal mortality has fallen sharply – the Sample Registration System now places the Maternal Mortality Ratio at 88 per 100,000 live births, down from nearly 400 in the late 1990s. Institutional deliveries have crossed 89 percent. Sex ratio at birth has improved modestly, and the total fertility rate has dipped below replacement level.

Yet the picture remains uneven. Five Empowered Action Group states – Uttar Pradesh, Bihar, Madhya Pradesh, Rajasthan, and Odisha – continue to account for a disproportionate share of maternal deaths. Anaemia has actually risen slightly since the previous NFHS round. Cervical and breast cancers are detected late because screening coverage is poor. Mental health concerns among women remain largely unaddressed, in part because seeking psychiatric help carries social stigma. The WHO has noted that harmful gender norms and the low prioritisation of women’s rights remain major barriers to further progress.

Amartya Sen’s seven types of inequality 🔗

Amartya Sen, in his 2001 address at the Radcliffe Institute, offered a framework that remains one of the clearest ways to organise the many faces of gender disadvantage. Each type carries direct or indirect consequences for health.

Mortality inequality. In several countries, including parts of India and China, women die at higher rates than expected relative to men because of inadequate nutrition and healthcare. The phenomenon of “missing women” that Sen highlighted decades ago has not fully disappeared.

Natality inequality. Preference for sons leads to sex-selective abortion and skewed sex ratios at birth. Although India’s sex ratio at birth has improved, several northern states still show significant deficits, with long-term demographic and social consequences.

Basic facility inequality. Even where survival rates are comparable, girls and women receive less of the basic facilities a society provides – schooling, sanitation, transport, safe public spaces. Each of these gaps translates into a health gap.

Special opportunity inequality. Higher education, professional training, and skill development reach fewer women. Without these opportunities, women cannot enter better-paid occupations or gain the economic independence that protects health.

Professional inequality. Women are concentrated in lower-paid jobs, informal sector work, and unprotected employment. Even within the health workforce itself, women dominate the lower tiers – nurses, ASHAs, anganwadi workers – while men hold most senior administrative and specialist roles.

Ownership inequality. Property, land, and productive assets are rarely held by women. Without ownership, a woman has limited bargaining power within the household and limited recourse when relationships turn abusive. Both reduce her ability to make decisions about her own healthcare.

Household inequality. The division of work, food, and rest within the home is profoundly unequal. As Sen pointed out, this is not a fair division of labour but an accumulation of it on women’s shoulders, with consequences for nutrition, fatigue, mental health, and access to leisure.

Moving towards gender-responsive health systems 🔗

Closing the gender gap in health requires more than building clinics. It requires confronting the norms that decide who uses them. Practical steps include training health workers in gender-sensitive communication, integrating violence screening into primary care, expanding cash transfer schemes that incentivise institutional delivery and girls’ schooling, ensuring frontline workers like ASHAs are adequately paid and protected, and collecting health data disaggregated by sex so that disparities become visible. Policy frameworks such as the National Health Mission and Mission Shakti acknowledge these links, but implementation remains uneven across states.

Equally important is recognising that gender is not only about women. Men’s health suffers from norms around stoicism, risk-taking, and reluctance to seek mental health support. Transgender and non-binary people face exclusion from most health programmes designed around a binary model. A truly gender-responsive system must address all of these dimensions.

What do you think? Which gender norm in your own community do you think has the greatest influence on women’s health, and what would it take to change it? Can you identify one of Sen’s seven types of inequality at work in households you know?

References

1. https://www.who.int/health-topics/gender
2. https://pubmed.ncbi.nlm.nih.gov/33636419/
3. https://main.mohfw.gov.in/sites/default/files/NFHS-5_Phase-II_0.pdf
4. https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0281015
5. https://pubmed.ncbi.nlm.nih.gov/37717950/
6. https://link.springer.com/article/10.1186/s12982-025-00973-0
7. https://www.dataforindia.com/maternal-mortality/
8. https://www.who.int/news-room/fact-sheets/detail/maternal-mortality
9. https://www.sas.upenn.edu/~dludden/MANY%20FACES%20OF%20GENDER%20INEQUALITY.htm
10. https://www.nhm.gov.in/