Women and Girls Accessing Eye Health Services – A Struggle

It is evident from most studies that more women (55%) than men suffer from vision impairment or vision loss^[1], mostly living in the low- and middle-income countries (LMIC). This brings my attention to Sustainable Development Goal (SDG) 5 presented by the United Nations – Gender Equality.

More than half the population of people living with vision impairment or vision loss are women and girls. Addressing the gender differences reported in accessing eye care services will contribute substantially to achieving

• WHA Global Eye Health Targets of 40-percentage and 30-percentage point increase in effective coverage of refractive error and cataract surgery respectively, by 2030.
• SDG 5 – eliminating the root causes of discrimination that revolves around women and girls.

In this opinion piece, I have put together my views on how improving access to eye health for women and girls will contribute to achieving gender equality.

Women and Girls are Susceptible to Eye Health Issues than Men and Boys

The gender differences in eye health are due to a range of factors including life expectancy, sex, traditional beliefs, stigma, cost of medical treatments, lack of access and awareness.

Women having the advantage of living life longer than men^[2], bear the brunt of most age-related vision loss causing conditions such as cataract, diabetic retinopathy, macular degeneration, glaucoma etc.  Most eye conditions with mild to severe impact on vision are reported more in women than men^[3] making the gender differences in eye health further significant.

Based on my interaction with several women and girls of the underserved population, it is understood that they do not access eye care services frequently as men and boys do, primarily because they prioritize family over their own well-being. Many had not visited an eye clinic in their entire life owing to which, vision difficulties in women and girls go unnoticed. It is also understood that they do not often report difficulty in vision because of the stigma associated with wearing spectacles and the fear of unacceptability among family members and society. A common misconception among these people had been that a pair of spectacles worn to correct decreased vision is a result of them being visually challenged. This builds distress among younger women on their possibilities of getting married. A certain degree of the issue is also related to them finding spectacles less attractive.

In conditions such as cataract which is one among the leading causes of blindness^[4], and found to be more prevalent in women than men^[5], women might not be able to afford for a surgery due to lack of access to financial resources. They could also be reluctant to ask for help from the family as they prioritize family commitments over their own. This adds further to the global burden of vision loss in women.

The Impact of Vision Loss on Women and Girls

The consequences of vision impairment or blindness is not just on the lives of women and girls but also on others who live with them. This will take a toll on their mental health, social well-being, self-empowerment and quality of life.

Women and girls begin to feel overwhelmed and anxious about their visual status. Complete or partial vision loss causing conditions will leave them wondering about their inability to pay for medical expenses and attend work which could possibly result in depression. Cessation of income flow is also a contributor for increasing poverty. Vision impairment also results in reduced confidence that will resist them from appearing at social gatherings.

The ability to learn (access to quality education) is compromised if decreased vision is left unnoticed in girls thereby contributing to the illiteracy rates.

Poor vision also increases the risk of falls and injuries^[6] which will restrict mobility and increase dependency.

Awareness and Workplace Gender Equality to Achieve SDG 5

Among other actions required to achieve gender equality in eye health, the challenges and barriers mentioned above highlights the pressing need for improved efforts in sensitizing women and girls along with their family members on the impact of vision loss, and the significance of timely intervention.

As we continue to strongly advocate for the gender differences at global forums, it is surprising to find out that gender gaps begin from workplaces^[7] where intensive discussions on addressing these challenges happen. As women have always proven to be better decision makers than men^[8], the existing gaps in women and girls getting access to eye health services will continue to remain unfilled, until workplace gender inequality is addressed.

According to me, taking steps to ensuring more women and girls get access to quality eye health services along with improving gender differences existing in leadership roles at workplaces are critical in achieving the fifth sustainable development goal – gender equality.

^[1] Trends in prevalence of blindness and distance and near vision impairment over 30 years: an analysis for the Global Burden of Disease Study

^[2] World Population Ageing (WPA) 2019 report of the United Nations

^[3] Zetterberg M. Age-related eye disease and gender. Maturitas. 2016 Jan;83:19-26. doi: 10.1016/j.maturitas.2015.10.005. Epub 2015 Oct 23. PMID: 26508081.

^[4] World Report on Vision 2019

^[5] Prasad M, Malhotra S, Kalaivani M, et al Gender differences in blindness, cataract blindness and cataract surgical coverage in India: a systematic review and meta-analysis. British Journal of Ophthalmology 2020;104:220-224.

^[6] Bergen G, Stevens MR, Burns ER. Falls and Fall Injuries Among Adults Aged ≥65 Years — United States, 2014. MMWR Morb Mortal Wkly Rep 2016;65:993–998. DOI: http://dx.doi.org/10.15585/mmwr.mm6537a2external icon.

^[7] World Health Organization. (‎2019)‎. Delivered by women, led by men: a gender and equity analysis of the global health and social workforce. World Health Organization. https://apps.who.int/iris/handle/10665/311322. License: CC BY-NC-SA 3.0 IGO

^[8] Chris Bart & Gregory McQueen, 2013. “Why women make better directors,” International Journal of Business Governance and Ethics, Inderscience Enterprises Ltd, vol. 8(1), pages 93-99.