Making TB among women visible

As some of us know, TB most commonly affects the lungs, but it can also affect nearly every other part of the body, such as the lymph nodes, intestines, and the reproductive system. While non-lung or extra-pulmonary TB constitutes 15-25% of all cases diagnosed each year in India, there has been a notable increase in such cases over the years. In fact, in Pune (where I live), extra-pulmonary TB constitutes 40% of the total cases reported in the last four years.

In India, although just by numbers, more men contract TB of the lung, women experience the disease differently, and are often affected by extra-pulmonary TB and, therefore, may not even show the typical symptoms of TB that doctors look for i.e. cough, low-grade fever, and significant weight loss over a short amount of time, along with some others. As a result, finding and treating extra-pulmonary TB remains a challenge in India and I’m sure this is compounded with the challenges that women generally face in accessing healthcare2. Some of these barriers include lack of financial independence, a societal tendency to de-prioritise women’s health, and heavy stigma around the disease, particularly for women. In fact, this stigma is so pervasive that many women hesitate to undergo TB testing for fear of the repercussions if diagnosed. These include fears of divorce, negative impact on their marriage prospects, and the potential for ostracisation or social isolation due to widespread misconceptions that TB is incurable. Coupled with inadequate information among care seekers and frontline workers workers about TB symptoms commonly found in women, these factors lead to missed or delayed diagnosis in women, which keeps them from accessing life-saving treatment on time.

Acknowledging these distinct issues, the government formulated a gender-responsive framework in 2019 to introduce gender-sensitive services across the care cascade. Its recommendations aimed at stakeholders, such as the TB programme, frontline workers, and survivor networks, require immediate attention and implementation. It is the need of the hour to raise awareness about TB in women –symptoms of lung and extra-pulmonary TB - among women, their communities, and health care workers. It is crucial to train ASHAs and ANMs to recognise early signs of the different forms of TB among women for timely referral to nearby health facilities. My engagement with Self-Help Groups (SHGs) in Pune has highlighted the transformative power of these groups in fostering women's empowerment and enhancing their health literacy. Awareness drives leveraging credible and trusted community voices, such as gynaecologists, must be conducted to encourage women to seek care and help destigmatise TB. The role of women’s collectives such as Mahila Arogya Samitis and TB survivor networks is also indispensable in providing counselling support to women and make a difference at the community level.

To successfully eliminate TB from India, we must make our health system not only responsive but also patient-centric and gender-sensitive. We need to acknowledge that TB can manifest and affect individuals differently, based on their biology, social dynamics, and economic standing. Hence, our interventions must be tailored to the unique requirements of patients.

By putting women at the centre of our TB response, we can successfully eliminate TB from India.

This article is authored by Vandana Chavan, member, Rajya Sabha.