Reducing gender disparities in blindness: A global perspective

Fort Lauderdale, FL-Gender disparities in diagnosis and treatment of conditions causing blindness are apparent in numerous parts of the world and start at an early age. Service utilization is the key factor when looking at these gender inequities in developing countries, said Paul Courtright, PhD, co-director of the Kilimanjaro Centre for Community Ophthalmology, Moshi, United Republic of Tanzania. He spoke during a symposium on socioeconomic disparities in access to and use of eye care.

Since few hospitals in the developing world report data disaggregated by gender, according to Dr. Courtright, population-based studies of data such as cataract surgery patterns are used instead. They show that in every setting around the developing world, women have much lower utilization rates for cataract surgery compared with men. Some studies also show that women are less likely to have an IOL implanted and are more likely to be blind, rather than visually impaired, when they come in for surgery.

Underutilization of health services in developing countries is due to factors such as women’s reluctance to assume the “sick” role and seek hospital-based care, their lack of decision-making authority in the family, inexperience at traveling outside of their communities, and fear-often justifiable-of the outcome of care, he said.

Gender disparity also is evident among children. In numerous settings, boys are twice as likely as girls to receive treatment for developmental or congenital cataract and are brought in for surgery earlier, when favorable outcomes are more likely, Dr. Courtright said. Boys also are more likely to be brought back to a clinic or hospital for follow-up care, such as for glasses or low-vision devices.

“We have multiple problems that we’re only starting to recognize in developing countries, and this is an area that we need to spend a considerable amount of time and energy to address,” Dr. Courtright said.

He also stressed the need for more data on existing and emerging conditions.

“In every setting, unless we understand our populations, and that frankly means adopting qualitative research methods, we’re not going to be able to understand why people utilize our services and why they don’t utilize our services,” he said. “Tick boxes that ask people the barriers to cataract surgery are useless. You have to get into communities and you have to understand communities to expect them to open up to you.”

A broader geographic reach also is critical, as data are lacking or extremely limited from certain regions of the globe.

Dr. Courtright urged his colleagues to apply what is learned from their studies.

“We need to use this data for advocacy for improved eye care in developing countries,” he concluded. “Improving equity means reducing blindness.”