In India, women’s health is not determined by biology alone-it is deeply shaped by the family they are born into, the household they marry into, and the cultural norms that govern their daily lives. Despite significant economic growth, India continues to struggle with gender inequality that directly impacts women’s access to nutrition, healthcare, and social opportunities. Understanding how family dynamics influence women’s health is essential for healthcare professionals, policymakers, and communities working toward gender equality.
Table of Contents
- The patriarchal structure and its impact on women’s health
- Gender inequality indices reveal the extent of the problem
- Nutritional disparities within families
- The anaemia crisis among Indian women
- Intergenerational effects of malnutrition
- Limited decision-making power in healthcare
- The role of mothers-in-law in health decisions
- Gender gaps in healthcare utilisation
- Barriers beyond cost
- The double burden of unpaid work
- Path forward: Addressing family dynamics for better health
- Education and economic empowerment
- Healthcare system responses
- The nursing profession’s role
The patriarchal structure and its impact on women’s health
India’s deeply rooted patriarchal society creates a cycle of deprivation that affects women from birth through old age. Patriarchal norms influence household dynamics, institutions, and policy-making, resulting in systematic disadvantages for women across generations. These social structures dictate that male members deserve priority in resource allocation-whether it is food, education, or healthcare.
Traditional customs are so deeply embedded that women often subconsciously believe their male counterparts deserve larger and better shares of household resources. This internalised bias means women’s health takes a backseat over time. They are frequently not empowered to make decisions or seek healthcare independently, which further worsens their health outcomes.
Gender inequality indices reveal the extent of the problem
India’s global ranking on gender inequality measures has been concerning, particularly in women’s health and survival indicators. The sex ratio at birth has historically favoured males, reflecting deep-seated preferences for sons that begin even before birth. While selected women in urban areas have gained equal opportunities, the majority-especially in rural regions-face poor social development and deteriorating health.
Nutritional disparities within families
One of the most visible manifestations of gender bias occurs at the dining table. In many Indian households, women eat last-after serving their husbands, children, and in-laws. This practice leaves them with insufficient and less nutritious food.
Research in rural Odisha found that intra-household food allocation favours men, in-laws, and children, with women serving family members first and often being left with little food. This systematic nutritional neglect has severe consequences.
The anaemia crisis among Indian women
Anaemia prevalence among Indian women stands at approximately 57%, placing most states in the severe category. Only Kerala, at around 39.4%, falls outside this classification. The National Family Health Survey data shows an increase in anaemia among adolescent girls between survey rounds, indicating the problem may be worsening rather than improving.
Females are significantly more disadvantaged in terms of anaemia compared to males, with the gap widening as children reach adolescence. This is directly linked to son preference, early marriage, and biased food distribution within households. When boys are given more nutritious food because they are viewed as future breadwinners, girls’ nutritional needs remain unmet.
Intergenerational effects of malnutrition
The consequences extend beyond individual women. Undernourished mothers are more likely to deliver low-birth-weight babies, perpetuating a cycle of malnutrition across generations. These children face higher risks of stunting, wasting, low immunity, and other health complications. India accounts for nearly one-third of the global burden of undernutrition, and women’s nutritional status is a critical factor.
Limited decision-making power in healthcare
Women’s autonomy in healthcare decisions is severely restricted within Indian family structures. Data from the National Family Health Survey reveals that only 12% of women aged 15-49 make decisions about their own healthcare, compared to 34% of men in the same age group. This stark disparity highlights how cultural norms limit women’s agency over their own bodies and well-being.
The National Family Health Survey measures women’s autonomy across four domains: decisions about their own healthcare, large household purchases, how to spend the husband’s earnings, and visits to family or relatives. Women who score higher on autonomy measures consistently show better utilisation of maternal healthcare services.
The role of mothers-in-law in health decisions
In patrilocal societies where young brides move into their husband’s family home, mothers-in-law often wield significant influence over daughters-in-law’s health decisions. Research in Uttar Pradesh found that young married women living with mothers-in-law had fewer close peers, which reduced their utilisation of reproductive health services.
There is often a misalignment of fertility preferences between women and their mothers-in-law, particularly around son preference. Studies found that mothers-in-law wanted significantly more sons for their daughters-in-law than what the younger women wanted for themselves. This power dynamic directly affects women’s reproductive autonomy and access to family planning services.
Gender gaps in healthcare utilisation
Even when healthcare is available and affordable, gender disparities persist. Research on India’s public health insurance programmes documented significant gender gaps in hospital utilisation. Strikingly, these disparities exist despite substantial programme expansion and are driven partly by households allocating fewer resources to female healthcare.
A study on Rajasthan’s health insurance programme revealed that lowering costs may not reduce disparities because men benefit as much as-or more than-women from subsidised care. This means gender-neutral policies that simply expand access are insufficient. Without interventions specifically targeting women, public healthcare spending effectively becomes pro-male.
Barriers beyond cost
Families with limited resources often prioritise healthcare for male members, leaving women and girls with inadequate care. This disparity becomes more pronounced as healthcare costs rise. Cultural expectations that women should prioritise family needs over their own health lead to delayed or neglected treatment. Social stigma around certain health issues-particularly reproductive health-prevents women from seeking timely medical help.
The double burden of unpaid work
Women face a double burden of work outside the home and completing the majority of unpaid domestic labour. This leaves them with limited time and energy to prioritise their own health and nutrition. A survey in a factory in North India found that 90% of women workers’ health problems and absenteeism were linked to skipping breakfast-they were too busy completing household chores and caring for family members before leaving home.
Many women reported having no other option, believing that their gender and family roles made them solely responsible for caregiving. This normalisation of self-sacrifice has profound implications for women’s physical and mental health.
Path forward: Addressing family dynamics for better health
Improving women’s health requires addressing the family and social context in which health decisions are made. Addressing discriminatory social norms-including harmful practices like child marriage and gender-biased sex selection-is essential. Engaging men and boys, particularly in their formative years, to promote positive masculinity and gender-equal values can help shift household dynamics.
Education and economic empowerment
Women’s education is strongly linked to better health outcomes. Girls who study longer have fewer children, are more likely to delay marriage, and find employment. The proportion of women with their own bank accounts has increased significantly, and mobile phone ownership combined with banking access creates building blocks for empowerment.
Research by Nobel Laureate Esther Duflo shows that women who control financial resources tend to prioritise nutrition and child well-being. However, workforce entry alone is insufficient-what matters are secure, fairly paid jobs that give women genuine economic independence.
Healthcare system responses
Health programmes need to move beyond gender-neutral approaches. Gender-targeted strategies are needed to improve healthcare for women, including information campaigns that specifically reach women, female-friendly transport services, outreach by village health workers, and additional insurance benefits earmarked for females.
Local female political representation has been shown to modestly reduce healthcare disparities. Exposure to female leaders in government can reduce bias in perceptions of women and increase investments in female health.
The nursing profession’s role
Nurses are uniquely positioned to address these issues. They interact with families during critical health moments-pregnancy, childbirth, childhood illness, and chronic disease management. Understanding how family dynamics affect women’s health helps nurses provide culturally sensitive care, identify women at risk of neglect, advocate for female patients within family settings, and educate families about the importance of women’s nutrition and healthcare.
Community health workers like ASHAs (Accredited Social Health Activists) serve as bridges between health systems and families. Training these workers to navigate complex household dynamics-including the influence of mothers-in-law-can improve women’s access to services.
What do you think? How can healthcare providers effectively challenge deeply ingrained family hierarchies that harm women’s health without alienating the families they serve? What strategies have you observed that successfully shift household dynamics toward greater gender equality in health decisions?
References
- https://www.nature.com/articles/s44294-024-00044-w
- https://journals.lww.com/ijph/fulltext/2020/64040/inequality_in_health_and_social_status_for_women.1.aspx
- https://www.sciencedirect.com/science/article/pii/S0899900721000216
- https://www.drishtiias.com/daily-updates/daily-news-editorials/women-and-nutrition
- https://pmc.ncbi.nlm.nih.gov/articles/PMC10052428/
- https://www.smilefoundationindia.org/blog/womens-nutrition-in-india-a-closer-look/
- https://www.capedindia.org/unmasking-gender-disparities-in-women-health/
- https://pmc.ncbi.nlm.nih.gov/articles/PMC7725295/
- https://www.theigc.org/blogs/gender-equality/women-and-health-india
- https://www.bu.edu/gdp/2022/09/15/mothers-in-law-friends-and-husbands-leveraging-social-connections-to-improve-womens-reproductive-autonomy-in-india/
- https://development.asia/insight/women-left-behind-gender-disparities-health-insurance-utilization-india
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- https://pmc.ncbi.nlm.nih.gov/articles/PMC12322238/
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