New DelhiThere are many such things in India that women are deprived of just because of their gender. One of them, it appears, is equal access to life-saving surgery, if data from some major hospitals is anything to go by.
ThePrint accessed data from some of these hospitals for three major surgical specialties that come with significantly higher costs for operation/rehabilitation – cardiothoracic, organ transplant and orthopedic surgery.
The data show that there is a significant gender disparity in favor of men in two specialties: cardiothoracic and transplant surgery. This is even when, say doctors, the chances of a man or woman needing these surgeries are comparable.
While the numbers appear to skew slightly less as we move south, doctors claim that gender differences in surgery are a reflection of social realities, which may differ in different parts of the country.
Overall, there is another trend – organ donors are mostly women. For example, a representative from Delhi’s Max Super Specialty Hospital Saket told ThePrint that seven out of 10 donors were women, while a spokesperson for BLK-Max Super Specialty Hospital pegged the female-to-male ratio at 90:10.
The third feature – orthopedic surgery – has an inverse slant because the incidence of osteoporosis is higher in women. The onset of the disease is also usually earlier in women, hence giving rise to the need for joint replacement surgery.
On gender disparity in cardiothoracic and transplant surgery, medical experts point to some social factors.
“There is an oddity, but we have to accept it without being cynical about the social and economic realities. The bitter truth is that these surgeries cost money and not everyone has health insurance. Hence, the earner always gets priority,” said Dr Harsh Johri, Advisor, Organ Transplantation, and Renal Transplant, Senior Consultant at Sir Ganga Ram Hospital, Delhi, at the National Organ Transplantation and Tissue Organization (NOTTO).
He further said that whenever it comes to donors, it is usually the women of the family who come forward. “For various reasons it is usually the wife who is the giver. The number of husbands who came forward to donate used to be very few but now it has become more respectable.
The proportion of women who have undergone surgery has also improved over time, according to Dr Johri, who has attributed the advent of the NGO sector willing to fund complex surgeries, easier access to assistance under the Prime Minister’s National Relief Fund, and increased health. given credit. insurance coverage.
“Earlier, about 10 per cent of the organ recipients were women. This number is now around 20-25 per cent.”
Wide gender disparity in surgery
According to a spokesperson for Max Saket, 80 percent of all organ transplants are performed on men. However, in 70 per cent of such surgeries, the donor is a woman.
“Even 20 per cent of the women who are being transplanted will have a female donor,” a hospital representative said on condition of anonymity. For cardiac surgery, the ratio of in-hospital surgery is 65:35 in favor of men, although there is no difference in the incidence of heart diseases.
Max Saket’s representative said that for joint and hip replacement surgery, the ratio is reversed, 60:40 (female to male). “That’s because women tend to have more orthopedic problems.”
At BLK Max Hospital, statistics follow similar broad trends.
“Organ transplants are taking place in the ratio of 70:30 for men and women and the donation ratio is 10:90. In 30 per cent of cases where women are the recipients, in most cases the donor is also a woman. The joint and hip replacement surgery ratio is 65 (female): 35 (men),” said the hospital spokesperson.
For every three cardiac surgeries performed in the hospital, two surgeries are performed on a man. “Women tend to have similar or more complex cardiac problems, yet the numbers stack up disproportionately. In addition, their heart surgery often becomes more complicated because of their smaller-caliber arteries,” the spokesperson said.
Data from Delhi’s Indraprastha Apollo Hospital in the last financial year shows that of the total cardiovascular surgeries performed at the hospital, 66 per cent were for men and 34 per cent for women.
Among those who underwent kidney transplants, 76 percent were men and 23 percent were women. For liver transplants performed during this period, 62 percent were for men and 38 percent for women.
Here too orthopedic surgery presented a different picture. Of all knee replacement surgeries, 25 percent are performed on men and 75 percent on women. For hip replacement surgery, 58 percent were performed on men and 42 percent on women.
Another exception is transplant surgery involving autopsy, where the gender slant is not very clear.
Dr. Kunal Sarkar, Chief Cardiac Surgeon and Senior Vice President, Medica Superspecialty Hospital, Kolkata, told ThePrint that out of 250 cardiac transplants performed there, the gender divide in favor of men is around 65:55.
Unlike liver and kidney transplants, where most transplants involve living donors, heart transplants typically involve autopsies.
‘Differences in the mental system’
When asked about the gender gap in surgery, Dr Vanitha Arora, consultant cardiologist at Apollo, told ThePrint that she attributed it partly to “the mental set-up of women” and how they view their health. ordained.
He said that while some heart diseases are more common in men, there are others which are more common in women.
“But in my own practice I see every day that if I ask a person to do a procedure, nine out of 10 will come back for it. The greater the urgency on the part of the family, the more willing the patient himself is.” But if I say the same thing to a woman, eight out of 10 people won’t do it. They will say ‘I’ll be fine, it’s just gas’,” Dr. Arora said.
Furthermore, she said, families did not place equal importance on women’s health. “Even at the family level, spending money on a woman’s health is looked down upon.”
It is worth noting that a 2016 paper published in the journal Heart Asia (which ceased publication in 2019) pointed to gender bias towards children in the health-seeking behavior of families in North India.
The study involved pediatric patients referred for free cardiovascular treatment at a center under the School Health Program. Of the 519 children studied, only 37.6 percent were girls, despite a nearly gender equal prevalence of congenital heart disease among children.
Territorial division?
When it comes to transplant and cardiac surgery, the gender gap in South India is less than in the northern part of the country, claim doctors.
“There is definitely a south-north gap,” said Dr Ravichand C Siddhachari, head of transplant at KIMS Hospital in Hyderabad.
“In this part of the country, there are a lot of examples of sons or brothers coming forward to donate kidneys, so I would say only 30-35 percent of my donors are women,” she told ThePrint. Told. “But one also has to understand that once the rules have been tightened, only the spouse or children are considered ‘first degree’ relatives, so that if a wife comes forward, the committee (which approves the living donor transplant). It’s usually easier to get approval from.”
In the case of liver transplant patients, Dr Siddhachari said that in his practice, around 60-65 per cent of recipients were male, but the main reason was alcohol consumption.
“One needs to understand that alcohol use is much higher in men and it is still a significant contributor to our burden of liver diseases,” he said.
However, it appears that some of the attitudes troubling women in the North also exist elsewhere.
Dr Praveen K Verma, head of the department of cardiac surgery at Amrita Institute of Medical Sciences and Research Center in Ernakulam, Kerala, said only about 25 per cent of his patients undergoing coronary artery bypass grafting are women.
“Generally in our practice we see that women opt for surgery much later than men, for a variety of reasons, including their attitude of ‘family comes first’. But it is difficult for us to say whether women We are missing out on surgery because we only see the tip of the iceberg. We see people who actually go through the surgery,” he said.
(Edited by Aswari Singh)
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