Gender-Inequity in Eyecare: Variation by Service Level and Location in North India

Abstract

Background: In the South Asian sub-continent, more than 87% of distance visual impairment is due to

avoidable causes. Women bear a disproportionately large burden of the problem.

Objectives: To perform an eyecare program wide analysis of utilization data, disaggregated by sex, age and

presenting visual acuity, in order to investigate if utilization varied with gender, and if so at what level of

services.

Methods: Retrospective one-year data (July 2016-June 2017), collected as part of a north-Indian eyecare

program was analyzed for sex-based differences. It consisted of rural and urban attendance at vision centers and

camps at primary level, plus walk-in access and cataract operations at rural secondary, and urban tertiary levels.

Results: At primary and secondary levels in rural areas, significantly fewer women than men accessed

vision centers and camps, and received cataract surgery at the secondary hospital, respectively. This trend

was reversed in urban areas, both at primary level, and at tertiary hospital. Cataract surgical patients were

further stratified by pre-operative visual acuity in better eye, and at both levels significantly more women

than men were blind at time of surgery.

Conclusions: Service utilization by women varies significantly and unpredictably within a single eyecare

program. Collection and analysis of sex-disaggregated data is needed at all locations and levels of care, to

determine inequity and plan interventions.