How Marital Status Affects Cataract Surgery Rates: An Exploration into Discrimination
In the sphere of eye care, particularly cataracts in developing countries, it is no secret that women face additional challenges in receiving treatment. Cataracts is the leading cause of visual impairments globally and women and girls make up 64.5% of the global cataract population.
Unlike rates of femicide, as mentioned in a previous story in this series, the data on the number of women living with cataracts, both married and unmarried, and rural and urban, is well documented in various studies.
A 2019 study by the International Journal of Environmental Research and Public Health was conducted to explore the theory that women living without a spouse are less likely to receive treatment for their cataracts. The study consisted of responses from Nigeria and Sri Lanka. Results showed that in Nigeria, the group of unmarried, predominately widowed, women made up 19% of the general population yet were 56% of the population that suffered from cataracts. Similar findings were seen in Sri Lanka as the group counted as 18% of the general population but 54% of the cataract population.
Unmarried women living in rural areas experienced the worst access to cataract services in Nigeria compared to married, urban men. These women had a cataract surgical covered (CSC) of just 25.2% compared to the men whose CSC was 80%. Again, results mirrored Sri Lankan findings with unmarried rural women’s CSC at 69.5% compared to married, urban men at 100%.
The comparison between unmarried rural women and married urban men is not an entirely fair contrast. It’s important to note that unmarried rural men faced low CSC levels however they accounted for a much smaller number of the study, at 2% in Nigeria and 3% in Sri Lanka versus women at 14% and 15%. The study states that to ensure gender equity is achieved in situations similar to this, rural unmarried women should make up over half of the patients receiving cataract surgery. The study explores the idea that women, particularly older women in poor rural settings, face ‘overt and unconscious bias’ within their households and communities which negatively effect their right to health and healthcare.
A separate study, conducted in 1995 in Malawi, showed that women who were either divorced or widowed were actually more likely to receive treatment for their cataracts than married women. It seemed that when married, a women’s right to health was considerably lower than when unmarried. In the case of the unmarried women, their primary caregivers and support came from siblings or children, suggesting that the care received from non-spouse relations was more beneficial for their eye health, and perhaps overall health. As marriage is the primary social relationship for many adults, it is assumed that there are high levels of support within that relationship but this suggests that is not always the case.
Though this Malawi study is useful in shedding light on the importance of multiple support systems to support those, particularly women, living with cataracts, the data is not conclusive nor is it found in other studies. A survey of blind people in Nigeria from 2017 showed that 53% of women blind from cataracts were unmarried. This contrasts the Malawi-based theory that unmarried women are more likely to receive treatment for their cataracts, and shows that is it more or less equal to married women, with only a 6% difference.
A large factor in the low undertaking of cataract surgery amongst both men and women from poorer, rural areas is a lack of awareness about cataracts itself. Though the data on the relationship between marriage and cataract care is important to have documented, focussing on it may not be the most beneficial aspect in moving forward.
To move forward and achieve the goal of gender equity within eye care, improving both awareness and accessibility to cataract services is crucial. The Tej Kohli & Ruit Foundation is aware of this and continues to work with #The3As in mind: awareness, accessibility and affordability. By improving all three amongst communities where cataract rates are disproportionately high, our foundation hopes to reduce the amount of cataract blindness around the globe for women and men of all ages, marital status and location.
This story is part of the series, An Exploration into Discrimination, by the Tej Kohli & Ruit Foundation.
