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John A. Hovanesian
They are mothers, daughters and grandmothers, and they share one health factor in common: Around the world, two out of every three people who are blind from preventable causes are women.
“It’s really a story of women, and women in development and women in poverty,” Ken Bassett, MD, PhD, program director for Seva Canada, said. “It differs, of course, but the general themes are that women use services less than men.”
Ending the gender health divide has been the focus of programs and initiatives across the globe, as experts discover new ways to deliver ocular care to women. Work on the issue has been ongoing for a number of years.
In 2003, a Canadian research initiative gave funding to establish a working relationship between epidemiologists, anthropologists and ophthalmologists to tackle the issue of gender disparity in blindness at four sites. Those sites – The Community Ophthalmology Program, Lumbini Eye Hospital, Bhairahawa, Nepal; Lions Aravind Institute of Community Ophthalmology, Madurai, India; Al Noor Magrabi Foundation, Cairo, Egypt; and the Kilimanjaro Centre for Community Ophthalmology, Moshi, Tanzania – have employed numerous ways to effect change.
Since the inception of the programs, the sites have pioneered gender-specific services, and efforts have been met with continued success, according to officials. One program in Nepal has even reversed the eye care ratio of treatment, with 55% of cataract patients now being women, Dr. Bassett said.
Next year, the theme of World Sight Day, organized by the International Agency for the Prevention of Blindness, will be gender equity, according to Suzanne Gilbert, PhD, MPH, director of Seva Foundation’s Center for Innovation in Eye Care.
She said the topic needs continued attention; while many programs addressing the disparity have been successful in reducing the number of women with blindness, advances are still needed.
“These are real people suffering from blindness. They are not numbers. They are individuals. They have a place they live, they have a gender, they have a family, and we need to be sure that we’re recognizing more of the whole person and making sure that we’re helping them overcome barriers to care,” Dr. Gilbert said.
Dr. Bassett and colleagues published a meta-analysis in Ophthalmic Epidemiology in 2001 that tabulated the published population-based surveys of blindness on a country-by-country basis. They found that, globally, women had a higher rate of blindness than men, with an overall age-adjusted odds ratio of blind women to men at 1.43.
“We didn’t suspect it,” Dr. Bassett said in a telephone interview with Ocular Surgery News. “There were inklings of it. We didn’t think it would be as strong or as consistent. That became startling that it was almost universal.”
The researchers also found that almost all types of preventable and treatable blinding conditions affect more women than men, many of whom are over the age of 50 years and 90% of whom live in developing countries.
Biological differences do not appear to account for the overall higher prevalence of blindness among women, researchers found. The reasons for the disparity are complex and include age, economic status and social status. Those reasons ultimately contribute to fewer women than men seeking surgery and eye care, Dr. Bassett said.
“The reason that they have surgery less is somewhat complicated, but it really is to do with living in patriarchal societies where they don’t have control over finances and decision making,” he said. “Their health needs are a relatively low priority.”
After these findings were published, interest in the topic grew, and the Canadian government funded a gender and blindness meeting in Tanzania in 2002. That meeting led to the development of the international collaboration between leading ophthalmic outreach programs, the World Health Organizations and support for research and programs worldwide.
| || |Three generations of women
at the Sadguru Netra Chikitsalaya Eye Hospital in Chitrakoot, Madhya Pradesh, India. According to officials, two out of every three people around the world who are blind are women.
Image: Harris B
Paul Courtright, DrPH, who is co-director at the Kilimanjaro Centre for Community Ophthalmology, took part in the study with Dr. Bassett. He said finding a difference in eye care by gender was the easy part of their research.
“The tough part was figuring out ways to reverse that trend,” Dr. Courtright said in an interview with OSN. “Most programs are not thinking about women — they’re just thinking about people in general. When we looked into this, we realized that those programs were really addressing men rather than addressing women because they were using traditional methods of information and health partnerships.”
Dr. Bassett said gender-specific programs that address women’s needs – including social and familial – have been successful in many developing nations. He said the eye care model in countries such as Nepal focus on the local level, training local women as community outreach workers. Those women, who are sometimes already leaders in their communities, often have no background in medicine. They act as liaisons between women and health care providers, helping to educate and inform women about health care services, he said.
“It’s not necessarily the women who had surgery or an eye problem, but they’re women we would train, bring together for meetings and then support in acting in this kind of community advocacy role,” Dr. Bassett said.
Training people in their home countries to deliver care to their fellow citizens, as well as training women to help educate women, appears to be one of the most effective ways of delivering eye care in many communities, he said. It is especially effective in countries where women’s access to outside sources and information is limited because of religious or cultural reasons.
An example of the effectiveness of women educating women at the professional level is Elizabeth Kishiki, according to Dr. Courtright. Ms. Kishiki, a Tanzanian educator, had no prior knowledge of ophthalmology when she was hired at the Kilimanjaro Centre for Community Ophthalmology.
In the 4 years since she was hired and trained as the childhood blindness and low vision coordinator at the center, Ms. Kishiki has helped to highlight the role of professional women in reducing blindness throughout eastern Africa, Dr. Courtright said.
He said women such as Ms. Kishiki will help reduce the gender disparity of blindness by playing vital roles at the national and international level.
“People are now requesting her to help them set up networks and programs,” Dr. Courtright said. “Her results show themselves as being a successful program. Someone like her can hopefully lead the way in more [places] than just Tanzania.”
For more information:
- Ken Bassett, MD, PhD, can be reached at University of British Columbia, 2176 Health Sciences Mall, Vancouver, BC, Canada, V6T 1Z3; e-mail: firstname.lastname@example.org.
- Paul Courtright, DrPH, can be reached at Kilimanjaro Centre for Community Ophthalmology, P.O. Box 2254, Moshi, Tanzania; e-mail: email@example.com.
- Suzanne Gilbert, PhD, MPH, can be reached at 1786 Fifth St., Berkeley, CA 94710; 510-845-7382; e-mail: firstname.lastname@example.org.
- Abou-Gareeb I, Lewallen S, Bassett K, Courtright P. Gender and blindness: a meta-analysis of population-based prevalence surveys. Ophthalmic Epidemiol. 2001;8(1):39-56.
- Erin L. Boyle is an OSN Staff Writer who covers all aspects of ophthalmology.