In the last couple of years, women’s position improved quite a lot in various socioeconomic indicators. Women are moving ahead on the yardsticks of education and awareness as well. While a vast majority of rural women had very little to no access to healthcare in the past, now they are receiving primary level treatment and medical advice from their local health centers and community hospitals.
Every day a large number of women are reaching out to their local healthcare workers for primary level health care. However, the scenario is completely different when it comes to higher levels of healthcare. At the lower-level facilities, there is a predominance of female attendees but, as the level goes up, the female predominance reduces in a linear fashion. Many rural women are unable to leave their localities to receive specialized treatment. Just like the levels of education, women’s presence/ access start to decrease after the primary level on the way up to secondary and tertiary levels, an analysis of the government’s latest health bulletin for 2016 found.
Experts said that although women’s social position has improved a lot compared to the past, a vast majority of the rural women are still somewhat homebound. As the community clinics are located nearby their houses, they are being able to go there by themselves. However, most of these women have to be accompanied by their husbands/ sons or other relatives to go far away from home for treatment. As women have the sole responsibility to take care of children and do all the household chores, they cannot make enough time for themselves to go to another area/city for higher cost, and possibly time-consuming levels of treatment. As a result, they have to settle for the primary treatment available in their community clinics even when they need a higher level of medical care. Most of the community clinics do not even have any certified doctor, leaving the well-being of rural women solely in the hands of community health providers.
As per the data of the 2016 health bulletin, about 60.42 percent of the patients admitted in the primary level public health care organizations in 2015 were female and 39.58 percent male. In the primary level community clinics, the ratio between female and male patients is 63.1 vs 41.12 percent. However, in the next levels of healthcare, the scenario is reversed, having a male predominance.
In the upazila health centers, female patients constituted 58.44 percent of the total attendees and men 41.12 percent. In the secondary level, which involves the district hospitals, the presence of female patients is significantly lesser than the previous levels. While female patients’ attendance has decreased to 54.06 percent, male patients’ presence increased to 45.94 percent. However, the gender gap is most visible at the tertiary level, which involves the medical college hospitals. Against the 50.81 percent male attendance, the presence of female patients is 46.19 percent. In the specialized hospitals, the presence of female patients is 46.05 percent and the male patient is 53.95 percent.
According to the Directorate General of Health Services (DGHS) data, on an average 1,718 patients visit the outdoor service division of the government medical college hospitals every day. The number is 606 in district level hospitals, 197 in upazila hospitals, 43 in union sub-centers or Health and Family Welfare Centers, and 32 in the community clinics.
Khushi Kabir, one of the leading women’s rights activists in the country, said, “Not only the rural women, many city women are reluctant to visit doctors and/or going to the hospital alone. Even many educated women display the similar tendency. Many women do not go for higher levels of treatment in fear of its cost. In the rural areas, women do not want to leave their families behind to receive treatment in hospitals far away from their homes. Besides, often the men of the family do not take the women's sickness seriously. There is a strong element of neglect and indifference when it comes to caring for women's health.” The high-level hospitals are not adequately women-friendly, she added. She also advised the government to take necessary steps to make the hospitals more women friendly.
President of the National Health Movement and the former president of Bangladesh Medical Association (BMA), Dr. Rashid E Mahbub, said, “Most women are still dependent on the earnings of their husbands or other family members. As a result, they have to depend on others’ opinion when it comes to treatment. This is the same reason why they have to be accompanied by someone else to visit the healthcare centers far away from home. In most cases, their access to healthcare is strictly limited to the local community clinics and other primary level health care centers.” He also said, “Men usually do not visit the primary level health care centers much. They can go to the upazila, district or higher levels of hospitals whenever they want. On the other hand, women have comparatively lesser access to the secondary and tertiary level hospitals. Along with increasing familial and social awareness, the government should increase medical facilities for women in the higher level hospitals.”
According to experts, women’s healthcare is still a less-prioritized issue in our country. Attention is generally given to maternal health, but it largely circles around the wellbeing of the child. The prenatal care and treatment a woman receives generally stops a few days within the birth of the child. The child’s health becomes the priority, while the mother’s condition is largely overlooked. However, postpartum care is no less important that prenatal care. After giving birth, women can contact a wide range of physical and mental diseases. Maternal care should be considered as a lifelong requirement for a mother, the experts stressed. The Bangladesh representative of international organization Engender Health and director of the Mayer Hashi project, Dr. Abu Jamil Faisal, said, “The existing maternal healthcare service in Bangladesh is highly inadequate. It should be extended to include advance healthcare. Many women in our country develop serious life-debilitating conditions such as fistula, prolapsed uterus, permanent hypertension, etc., during childbirth. Fistula and prolapsed uterus severely decrease the quality of life of the affected woman. However, the treatment facilities for these conditions are not available at the primary level healthcare centers.”
A report of Ubinig, a communitybased and community-led research and advocacy organization, said that women consist 80 percent of the 4 million workers in the RMG sector. Most of these women came to the cities from impoverished rural families. They are deprived of hygienic residential and other facilities. As a result, they contact various types of diseases. Many RMG workers do not have a hygienic environment in their workplaces either. With their meager salary and long working hours, they can neither afford proper treatment nor make enough time to visit the hospitals.