Bias sharpest among young girls; cervical cancer one of the biggest killers of women in India.
WHEN THE Indian Statistical Institute, New Delhi, studied cancer patients in Odisha in 2014, the findings were stark. While average expenditure on treatment for a male patient was Rs 1.16 lakh, the mean treatment expenditure for a female patient was considerably lower, at Rs 83,626. Also, not surprisingly, they found that women patients reach tertiary care hospitals when the cancer is at a much more advanced stage in comparison to male patients.
Doctors at India’s largest cancer care institute, the Tata Memorial Hospital (TMH) in Mumbai, concur. For every two males, there is one female diagnosed with cancer in the general population, according to statistics. But for every three or four male patients, only one female reaches the hospital. “The gender bias starts there,” observes Dr Shripad Banavali, head of medical and pediatric oncology at Tata Memorial.
Even as Indians grapple with the ever more common incidence of cancer, in cancer-care shelter homes, stories of abandonment of women patients abound. In a room at the Ghadge Maharaj Dharamshala in Dadar, central Mumbai, six members of the Shaikh family occupy a room, having migrated from a village near Patna in 2016 for daughter Parveen Khatoon Shaikh’s treatment. Parveen, 26, has breast cancer. Her husband, an auto rickshaw driver in Delhi, abandoned her soon after the diagnosis. Her father Mohammed Iqbal is physically challenged. Son Shahanawaz, 7, is curled up in a corner. “My life would have been different if my husband was around,” says Parveen. Married off at the age of 15, she was diagnosed with breast cancer five years later, in 2010. Once she informed her husband over the phone, he never returned to the village to meet her. He changed his telephone number. Her parents-in-law broke off all contact too. Her father has since supported her by loaning money from other villagers.
Parveen needs six chemotherapy cycles, each costing Rs 17,000. Iqbal has Rs 200 in his pocket, but is limping from one charity to another, hopeful. When her cancer relapsed in 2016, she received a call from her husband. “He told me I should commit suicide.” The repeated trips to Mumbai and the toll of the treatment have meant that Shahnawaz has never been to school.
Saurabh Rai, a research scholar in public health, says rural households in India still debate whether a woman patient has to be treated at all, for cancer or any other disease. In urban areas, gender disparity remains, though parents are generally more willing to invest time and money on daughters. “Discrimination is highest against married women because they rely on parents-in-law for finances,” says Rai. Dr Sudeep Gupta, secretary of the Women Cancer Initiative, says poor women in government hospitals have neither a source of income nor bank accounts. A research report by Dr Banavali and his colleagues also found the number of men completing cancer treatment higher than among women patients.
To illustrate, in India, 1.5 lakh women are diagnosed with breast cancer each year, with a 45 per cent fatality rate. In Western countries, the fatality is only 25 per cent. “Cancer hits a woman badly — hair loss, cosmetic disfigurement, weakness and loss of livelihood are just a few,” Dr Gupta says. The Women Cancer Initiative has seen that about 20 per cent of the women it aids have no family support at all.
If women cancer patients suffer discrimination, the bias is sharper among young girls. “Parents fear about their daughter’s marriage if an organ has to be removed. We don’t hear them asking the same question for a son,” says Dr Banavali. It’s little wonder, then, that gender bias is most commonly witnessed in treatment for retinoblastoma, a cancer that affects children’s eyes, and in bone cancer, where amputation is common.
In May, a two-year-old girl with retinoblastoma from rural Maharashtra passed away at TMH after her father refused to remove her eye. “We see a 95 per cent cure rate if we just remove the eye. The parents were counselled over multiple sessions but they were worried about her marriage in the future,” says Dr Girish Chinnaswamy, paediatric oncologist.
About 75-100 children with retinoblastoma come to TMH every year, of which 40 per cent require removal of an eye. “A boy’s parents are more willing to amputate or remove the organ because of the general belief that a boy will earn for the family later,” says Dr Chinnaswamy. In general, TMH’s paediatric department data from 2010 till 2017 (August) shows that admission of boys for cancer treatment is twice that of girls — 7,859 boys as opposed to 3,873 girls. Refusing treatment and subsequent abandonment were higher in girls. Over seven years, 6.89 per cent girls (267) dropped out of cancer treatment from TMH, compared to 4.7 per cent boys (377).
In addition, women are also more susceptible to certain kinds of cancers. Dr Pankaj Chaturvedi, cancer surgeon and anti-tobacco activist, says rising alcohol consumption and smoking among urban women and continuing tobacco chewing among rural women are alarming. “In Jharkhand and Chhattisgarh, chewing tobacco is in fact higher among women than among men,” he says. Women consuming tobacco have a higher risk of cancer than men, due to a biological predisposition. Cervical cancer, one of the biggest killers of women in India, requires awareness programmes to sensitise women. “Access to private toilets can help reduce cervical cancer,” says Chaturvedi.
At the Dr Ernest Borges Memorial Home, Dadar, Sana Khan (name changed on request) is hopeful that she’ll get married. The 26-year-old Kanpur resident suffers from bone cancer and has been undergoing chemotherapy for the last two years. Fours years ago, she was engaged to a man who works in Saudi Arabia. “When I was diagnosed, I thought he would be my biggest strength,” she says. “But he broke the engagement four months after I told him.” Khan has an MA degree but has not worked. Her father and mother shuffle between Kanpur and Mumbai to look after her. Her hairline is already receding. But once her chemotherapy ends, she wants to work. “And marry, perhaps,” she says, grabbing the edge of her dupatta that slips a bit, revealing a balding scalp.