Seeing Beyond the Binary: Why Gender Justice Must Be Central to Global Eye Health

“The result of this deeply male-dominated culture is that the male experience, the male perspective, has come to be seen as universal, while the female experience–that of half the global population, after all–is seen as, well, niche.”
― Caroline Criado-Pérez, Invisible Women: Data Bias in a World Designed for Men

The recently published Lancet Commission on Gender and Health delivers a powerful message: achieving true global health equity requires dismantling systemic gender injustice. This comprehensive report, undertaken by a multidisciplinary group of experts, examines the historical, social, political, and economic factors that shape gender and health across the globe. This call to action resonates deeply within the field of eye health, where gendered disparities in access, outcomes, and experiences remain a persistent challenge.

The Commission’s report meticulously outlines how historical, social, and political factors have shaped and continue to shape global health systems. It highlights the problematic conflation of sex and gender, the underrepresentation of women in health leadership, and the need for a more inclusive and equitable approach to policy and practice. These forces contribute to a landscape where women and girls disproportionately bear the burden of visual impairment and blindness. This isn’t simply a matter of biology; it’s a consequence of unequal power relations that limit access to care, perpetuate harmful social norms, and create economic barriers.  Globally, women and girls make up 55% of the 1.1 billion people experiencing vision loss – this is often excused over simplistically because women live longer than men; however, the more nuanced explanation is the systemic inequities for women accessing eye care services, glasses, and cataract surgeries. Yet, policies and programmes often lack an all-round gender-responsive approach that recognises and addresses these specific needs, including health education that explains the need for gender equitable health approaches.

Consider these realities:

• Access to Care: Women and girls often face greater obstacles in accessing eye care services due to financial constraints, geographical limitations, and cultural restrictions on their mobility and decision-making.
• Workforce Representation: The eye health workforce itself often reflects gender imbalances, with fewer women in leadership positions and research roles, impacting the development of gender-responsive solutions.
• Social Norms: Harmful gender norms can discourage men from seeking timely eye care which also prevents them from developing an understanding about why women’s eye health also matters. This contributes to poorer health outcomes for all and a decreased awareness of preventative measures

These disparities have tangible consequences. Unlike many other diseases and health issues, eye health has, for the most part, a simple correction. Uncorrected refractive error can be fixed with a pair of prescription glasses and cataracts can be fixed with a simple 20-minute surgery. Without access to these services the cycle of poverty is perpetuated through limits on educational attainment and an inability to participate in their own, and their communities’, economic productivity.

A Call for Gender-Responsive Action

The Lancet Commission provides a roadmap for change, urging stakeholders to adopt a gender-justice lens in health policies, programmes, and practices. It offers specific recommendations for addressing gender inequality in health systems, promoting gender equality in workplaces, and countering anti-gender movements. The eye health sector can and should consider how to apply this approach with some concrete actions:

1. Prioritise Gender-Disaggregated Data: To truly understand the scope of the problem, we need comprehensive data collection that captures sex, gender identity, and relevant socioeconomic factors. This will allow us to identify the most underserved populations and tailor interventions accordingly.
2. Design Inclusive Programmes: Eye health programmes must be designed to address the specific barriers faced by women and girls, ensuring services are accessible, affordable, and culturally appropriate. This includes training healthcare providers to be sensitive to gender dynamics and addressing issues like transportation and childcare.
3. Increase the Number of Women in Leadership: We need to actively promote women’s leadership within the eye health workforce, creating opportunities for career advancement and mentorship. This will foster a more diverse and equitable field that is better equipped to address the needs of all patients and most importantly, will lead to better health outcomes for all.
4. Challenge Harmful Norms: Eye health interventions should actively challenge harmful gender norms and stereotypes, promote shared decision-making and encourage men to prioritise their own eye health and understanding about why women’s eye health is an equal right.
5. Advocate for Policy Change: We must advocate for policies that ensure equal access to eye care services for all, regardless of gender. This includes pushing for universal health coverage, addressing social determinants of health, and combating discriminatory practices.
6. Counter Anti-Gender Movements: The Commission rightly highlights the growing threat of anti-gender movements. We must actively resist these forces, promote inclusive narratives and defend the rights of all individuals to access quality eye care.

The Lancet Commission on Gender and Health offers a crucial framework for achieving equity and justice in global health. By embracing a gender-responsive approach to eye health, we can break down systemic barriers, improve outcomes, and ensure that everyone has the access to eye health services. It’s time to move beyond good intentions and translate these principles into concrete action, creating a world where gender is no longer a determinant of eye health.

Let’s commit to making gender equity a central pillar in advancing global eye health – for more information, please visit the IAPB Gender Equity Toolkit.

Image credit: In the photograph, a heartwarming scene unfolds, capturing the joy and relief on the faces of a group of women who have just undergone successful cataract surgery. The image is filled with a sense of hope and transformation as their smiles radiate happiness and gratitude./Sanket Parajuli