Building Gender-Responsive Health Care Systems in India

1. Building Gender-Responsive Health Care Systems in India A health care system is only as strong as the people who run it. Yet, for many female health care professionals, unsafe workplaces, inadequate facilities, and systemic barriers make it harder to provide quality care. A strong health care system must be safe, inclusive, and accessible for all. Gender-responsive infrastructure plays a critical role in ensuring that patients receive dignified care and that health care professionals work in secure environments. Yet, in many health care settings across India, gender disparities in infrastructure continue to create barriers for both those seeking care and those providing it. Without a deliberate shift toward health care infrastructure that is gender equitable and responsive, health care spaces will continue to perpetuate inequities rather than bridging them. Why health care spaces are unsafe for women? Ensuring safe and supportive working conditions is essential not just for the health care providers but also for the patients who depend on them. Female doctors, nurses, and community health workers (CHWs) face everyday hurdles that limit their ability to work with safety and dignity. These barriers, ranging from inadequate amenities to unsafe work environments also make health care less accessible for women patients. Addressing them is critical for a gender-responsive health system. A 2024 survey on Workplace Safety and Security in Indian Health Care Settings revealed that 78.1% of health care professionals reported the absence of separate duty rooms for female staff, including doctors and nurses. The absence of basic amenities is a significant challenge faced by female health care workers as well as female patients. Many female doctors are forced to share overcrowded rooms with little privacy. Nurses and CHWs often work long hours without access to secure rest spaces or changing rooms. Hospital-provided accommodation, where available, is often unsafe or lacks basic facilities. Women are forced to find alternative housing, often at their own expense, or stay in shared dormitories that don’t address their safety or privacy. These challenges discourage many skilled professionals from accepting postings in rural areas and ultimately affecting their career growth.This also affects women patients. Without separate waiting areas, breastfeeding spaces, or private examination rooms, many hesitate to visit health facilities especially for maternal or reproductive care. A 2022 Oxfam India report found that nearly 40% of women felt unsafe or uncomfortable in public health facilities due to lack of privacy.

2. The 2024 survey also highlights 69.5% of respondents reported there were no separate washrooms for women, and more than 79% noted the absence of menstrual hygiene management facilities. Poor sanitation and hygiene facilities add to the challenges faced by female health care workers and patients. Without access to clean toilets and sanitary products, women health care workers are often forced to manage their menstrual hygiene in unhygienic and uncomfortable conditions. Lack of clean, functional toilets also increases the risk of hospital-acquired infections, especially in maternity wards, putting both mothers and newborns at risk. Inadequate sanitation also contributes to concerns about personal safety, particularly in isolated or poorly maintained areas of health care facilities. A recent Indian Medical Association study of 3,885 respondents showed that over 36% of doctors, more women than men, felt “unsafe” or “very unsafe” during night shifts.Security concerns are another set of challenge faced by female health workers. In certain instances, security personnel are not assigned to the maternity wing, and security is prioritized for male administration and clinical staff. This makes the female health care workers vulnerable to frequent attacks and harassment from family members of patients especially during refusal of certain treatments. Nurses and CHWs are especially vulnerable due to their direct and prolonged contact with patients and their work in under-resourced settings, where security measures are weak. These security concerns become worse when there are limited ways to report or act on such incidents.

3. A study focusing on Low reporting of violence against health care workers in India found that approximately 3/4th of the respondents felt there was no formal procedure for reporting verbal abuse or physical violence in the health care settings.India’s Prevention of Sexual Harassment (POSH) Act mandates that every workplace, including hospitals, must have an Internal Complaints Committee. However, most health care facilities lack proper grievance redressal systems making it a challenge for female employees at a health care setting to raise concern about facing any workplace abuse. Other grievance redressal mechanisms for sexual and workplace harassment include the Sexual Harassment Electronic Box (SHe-Box), an online portal for registering sexual harassment complaints and the Grievance Redressal Cell established by the Trained Nurses’ Association of India (TNAI) for registered nurses to file various grievances, including sexual harassment. However, these are not widely used. These gaps have also led to a rise in workplace violence. A survey conducted by the Indian Medical Association highlighted that 75% of doctors had experienced violence at work. Women health care workers often face not just physical and verbal abuse but also sexual harassment and bullying from patients, their families, colleagues, and supervisors. In recent days, the incident at R.G. Kar Medical College and Hospital in Kolkata emphasised the pressing challenges and risks faced by health care professionals. A 31-year-old female postgraduate trainee doctor was murdered in a seminar hall within the hospital premises. The hall, intended as a temporary resting space for overworked doctors, lacked basic security features, such as monitoring, secure entry systems, and private areas for women to access. The absence of gender-sensitive planning and weak enforcement of protective laws make it difficult for female health care workers to do their jobs safely and with dignity. For patients too, these systemic gaps often lead to delayed or avoided care. The cumulative impact of these failures contributes to a culture where workplace violence becomes more likely, rather than an isolated occurrence. Addressing these gaps requires not just infrastructure improvements but a shift in how gender-sensitive care is prioritized in policy and practice. Several countries have successfully integrated gender-sensitive policies into their health care systems from which India can draw valuable lessons.