In our most recent blog, we discussed the need to broaden the definition of access when it comes to vision care. We must reinvent the topic to encompass access to information, technology and methods of care. In addition, we will need to ensure that all who need access receive it – that includes women and girls who sometimes face barriers that prevent them from getting the vision care services they need.
In a two-part series on vision access for women, we recently interviewed Dr. Clare Gilbert, Professor of International Eye Health in the International Centre for Eye Health (ICEH) at the London School of Hygiene and Tropical Medicine, to get her thoughts on the current state of women’s vision. Gilbert is also a founding member of the Vision Impact Institute’s Advisory Board.
VII: Research from IAPB suggests that women are still 1.3 times more likely to be blind than men, meaning 55% of the visually impaired are women. Why is this the case?
CG: There are two broad reasons why women are more likely to be blind than men:
Women are more likely to develop some eye diseases, such as cataract and age-related macular degeneration, at a higher rate than men. Reasons for this are not fully understood but may reflect different exposure to risk factors across their lifetime than men, such as UV light. There may also be genetic or hormonal influences, but this is still not clear. In many countries, women also live longer than men and are more likely to develop blinding eye diseases associated with ageing.
The second, and probably most important, is that females are less likely to access eye care when they have a problem, particularly in low-income countries. There are several explanations:
Women are more likely to consider their own health needs to be less important than the needs of other family members.
In many countries, men are the head of the household, and they make the decisions about how household resources are used. Women often lack agency to be able to make demands.
For cultural reasons, in some places, men receive preferential treatment. In many societies, they are still seen as the main “bread-winners,” and it’s more important that they are healthy and can work.
In some countries, women in the workplace are expected to have a certain “look” which influences what they are expected to wear, including wearing eyeglasses.
In other communities, women are not permitted to travel alone, or they fear doing so. In fact, older women who are widowed face particular challenges, as they lack financial support and have to negotiate an escort.
VII: From time to time, we will hear stories of women who face stigma in their work or personal life as a result of wearing glasses. How have you seen this issue manifest itself in your work?
CG: I have seen this in studies of refractive errors among schoolchildren in India, where girls who wear spectacles are considered to be disabled and less likely to get married. Their parents are unwilling for them to wear spectacles. However, in two studies I have participated in, girls were more likely to wear their spectacles than boys – maybe because they are culturally less rebellious!
VII: What implications does this have for communities? What are the solutions?
CG: Women with impaired vision are less likely to contribute to, or participate in, household activities, including shopping, food preparation, small-scale farming and caring for grandchildren. This can lead to opportunity costs for their own children. Deep-seated cultural factors will take time to change, but these should change as women become better educated and have greater health literacy.
Eye care providers are not always aware of the differences in access challenges between men and women. This needs to change, and differences in access need to be monitored and addressed.
Possible solutions ideally should come from those affected, through good quality qualitative and participatory research. Very practical solutions could include providing transport, using women who have had successful treatment as informal counsellors, and having different pricing scales for men and women. In many cases, communities where the affected women live are not considered potential providers of solutions. Influential community leaders could encourage other members to accompany women to the hospital or even provide transport. It is well known that when free eye camps are held in poor communities, elderly women predominantly show up on their own. This implies that lack of access is not because they do not want to see better, but because of all the social and economic challenges they face.
VII: What can eye care professionals, parents and other advocates do to ensure that these stigmas are broken?
CG: I think there are several possible approaches. There’s a great need for health education, so that people understand what refractive errors are and the benefits of wearing spectacles. One-to-one counselling is also important, to explain to the parents of girls that their lives will greatly improve if they wear their spectacles, and that they are more likely to achieve at school. Female role models are also important, and well-known personalities can become ambassadors and serve as role models for a younger generation that must see well to be successful.
We continue the conversation with Dr. Gilbert in Part 2 of discussion. Join us here.