We recently started a conversation with 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 on the current state of access to women’s vision. This was an important topic before the global pandemic of Covid-19 and will continue to have great consequences going forward, as funding for other health issues may potentially be required. Our conversation continues below.
VII: In your research work, you’ve focused on children in low- and middle-income countries. From that research, were there any key insights you observed when it comes to the treatment of boys’ vision vs. girls’ vision?
CG: A colleague and I undertook a systematic review of published studies, which provided the first evidence that children undergoing surgery for bilateral cataract in Asian countries were more likely to be boys rather than girls, despite there being no gender differences in the incidence. In other regions, such as the Middle East, there were also differences, but these were less pronounced. Other studies show in Asian countries, girls are more likely to present late for cataract surgery, which is likely to affect the outcome of management.
There are several possible explanations from other sectors of health, one being that in some societies parents perceive their boys to be sick/have a health problem earlier in the course of the condition than they do for girls. I expect this reflects deep-seated anxieties about the need to ensure the health and functioning of the future “bread earners.” We are currently planning an in-depth study in India where we will explore possible reasons for this gender difference.
VII: UN Women estimates that only 31% of the data required to monitor progress for women and girls are available today. What data will ensure we understand this population?
CG: There are two main sources of important and complementary data: population-based and facility-based.
Population-based data are very important, as they indicate the size of the problem and who has already accessed services. Most surveys of blindness and visual impairment present these findings by gender. However, more nuanced data are needed, and we are currently determining the best way to identify marginalized groups. This is likely to entail using tools such as the Equity Tool or analyzing the data using a combination of variables. As an example, in Nigeria we found that non-literate, rural women comprised 32% of all cataract blind adults, and this group were almost five times more likely to be blind as literate, urban men. we must undertake similar analyses for refractive errors and spectacle correction.
Facility-based data are also important, and two sets of data are required:
The proportion of people by gender who access the facility with an eye condition which needs treatment.
The proportion of males and females who subsequently undergo treatment. This will tells us who gets to the facility, and once there, who actually does or does not undergo treatment. Although this data is often collected, the total number of people accessing services is usually reported, and not data by gender.
Together these sources can provide important information of where the “leaks” or “bottlenecks” are in the system – from community to undergoing treatment – and the size of the leaks.
VII: What advice would you give to advocates for women’s vision?
CG: I think different audiences require different approaches. For example, policymakers are more likely to be persuaded by economic arguments, such as the greater productivity afforded by good sight and the costs that would be avoided by good sight (such as for social care and fewer fractures from falls).
Other groups may be more easily influenced using a human rights approach – explaining that men and women have an equal right to eye care services. Community leaders may need other arguments, such as the vitally important role women of all ages play in families, communities and society. We must stress that all will suffer if women cannot see well.
Additional arguments, which apply equally to men and women, are the considerable benefits of good sight, including maintaining independence (less need for care by other family members or social care), less anxiety and depression, fewer falls and fractures, and for those who drive cars, fewer car crashes.
I think the state of women’s vision will only change substantially in low- and middle-income countries once a high proportion of women and girls become better educated, have greater access to information, and gain more independence and control over their own lives, including their own healthcare.