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India’s TB policy fails to address gender gaps in healthcare. Its Covid-19 response must remedy this

Updated: May 24, 2020

As India and other countries struggle with Covid-19, the gendered aspect of the disease has been almost entirely ignored. Neither is this surprising, nor is it the first time this has happened.

Take the case of tuberculosis, for instance. The fact that far more cases are reported for men than women or non-binary genders supports incorrect ideas that gender has little or no role to play here. Yet, we should remember that instances showing how different genders experiences diseases differently are well-documented. The experience with Covid-19 is unlikely to be different. This begs the question: If experiences of the disease and its accompanying social and economic challenges vary depending on gender, then should the kind of care also not change?

Gendered experiences

For example, experiences globally and in India show that women are more hesitant to report their symptoms, have poorer access to health care, shoulder a heavier burden of running the household, and are at higher risk of malnutrition.

Moreover, trans individuals, non-binaries, and persons with non-heteronormative sexual orientations are less likely to report their condition as they face discrimination and abuse by healthcare authorities, and are often given poor quality care or denied access to it altogether. In cases where they do get healthcare, they fail to complete the course of treatment due to economic constraints.

These conditions are exacerbated for those seeking care for tuberculosis and living with HIV. Members of the trans and LGBTQI communities report higher incidence of HIV and other risk factors. Now, imagine the additional hurdles they would have to face in the context of the Covid-19 pandemic and the stringent lockdown.

Men have their own challenges: they are exposed to more occupational hazards, are often reluctant to discuss or address the devastating emotional and psychological aspects of the disease, and travel and live in migrant communities in larger numbers.

The TB framework

The fundamental question we must ask is: How can we improve gender responsiveness and sensitivity to infectious disease? There are positive learnings from the HIV outbreak, when both equity and human rights were integrated with gender sensitivity, creating trust and high-quality care for the most vulnerable. This is something India could learn from while responding to Covid-19.

Then there are examples to avoid: The Ministry of Health and Family Welfare recently came out with a gender-responsive framework on tuberculosis. Integrating gender and sexual orientation in TB care at the programme level and responding to the needs of all groups through a comprehensive framework is indispensable to defeating the disease.

Accordingly, this framework could have been a game changer in creating gender equity, not just for TB, but the entire health establishment. Sadly, it missed the mark. This, when the Indian government’s ambitious goal is to eradicate TB by 2025.

For starters, the framework excludes health needs and challenges of LGBTQI persons and fails to go beyond the gender binary. It states that tuberculosis affects around 10 million people globally every year, of whom 6.8 million are men and the remaining women. Somewhere in the mix lie the unreported numbers for transpersons and persons of other genders.

Moreover, the committee had insufficient representation from members of all affected communities. How can a framework that aims to be inclusive and gender-responsive be conceptualized without accounting for all gender groups?

Our approach needs to be more fundamental. We need comprehensive and inclusive frameworks to be developed to represent all stakeholders by all stakeholders.

A public discussion

Even today, there are numerous reports of gender discrimination, hesitance to seek care and widespread stigma. If we intend to provide gender sensitive care, the most important step is to initiate an inclusive and public conversation about what it means to genders and communities – whether it be in the case of tuberculosis, Covid-19, or any other disease. One of the ways the government can develop a narrative around gender and health is through public service awareness campaigns.

Next, it must integrate these concepts into India’s care training. The government must provide multi-gender sensitivity training to all health personnel. This is crucial because until the conceptual frameworks change in the minds of those who provide care, it is meaningless.

Further, it must integrate into these policy factors like class, caste, and region. It’s time to take gender equity out of the hands of experts and doctors in ivory towers and consider the lived experiences of those who inhabit numerous gender and sexual orientations.

Any revised framework and future intervention on gender and disease ought to begin, as Mohandas Gandhi said, with the most vulnerable person at the center. If it doesn’t benefit them, then it’s neither inclusive, diverse nor responsive to the needs of all genders.

About the Writers :

Sandhya Krishnan is a wellness and mindfulness coach, TB Survivor, and is associated with Survivors Against TB (SATB), a collective of survivors, advocates and experts working on TB and related comorbidities.

Ashna Ashesh is a lawyer, public health advocate, MDR TB survivor, and is also associated with Survivors Against TB.

(Article as appeared on

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