The Issues

Gender equity in eye health fact sheet

Key facts

Of the 1.1 billion people with vision loss, of whom 609 million are female (55%)¹
Globally, Between 1990 and 2020, the prevalence of mild and moderate and severe vision impairment increased in women¹
Women are 12% more likely to have vision loss compared to men¹
In some settings, the higher rates of vision loss experienced by women is socially determined
- After adjusting for demographic differences, there are 108 women with blindness for every 100 men. The persistent gender difference suggests that, in some settings, the greater vision loss experienced by women is socially determined.¹

The recent Lancet commission² reported:

Projections to 2050 predict the proportion of women with vision loss will increase¹
The number of women living with moderate and severe vision impairment is greater than men in all regions. After adjusting for age, the prevalence remains greater in women in all regions except central and southern sub-Saharan Africa.¹

The higher prevalence of vision impairment and blindness in women is attributed to a number of factors, including a longer lifespan, increased risk of developing some eye conditions that can lead to vision impairment and blindness (e.g., age-related macular degeneration, trachomatous trichiasis and cataract) and social inequity contributing to reduced access to care and other inequities.¹

The eye health sector has not achieved gender parity, with only 28.3% of eye health organisations boards held by women

A recent systematic review found in India found women have a 35% higher odds of being blind compared to men.³

The number of women living with moderate and severe vision impairment is greater than men all regions of the world.¹
A higher prevalence of trachomatous trichiasis is observed in women,⁴ in within many countries, inequity in access to, and use of, cataract services.⁵

Inability for women to travel for eye care services has been cited as a barrier to access,^6,7 where cost barriers are more likely to be reported by rural dwellers.⁸
Low levels of health literacy, rural habitation, older age, and female gender is associated with low awareness of eye conditions can contribute to reduced access to eye care services.⁹

A recent systematic review found women in India have a 69% higher odds of blindness due to cataracts compared to men, and the odds of receiving cataract surgery are 27% less likely compared to men.³
Inequality in cataract blindness and services has been demonstrated within counties, where women who were illiterate and rural dwelling had the highest prevalence of cataract blindness.¹⁰
When examining the effective cataract surgical coverage in each Global Burden of Disease super-region, the Lancet Commission reported that women frequently have a lower effective cataract surgical coverage than men.²

Women also experience poorer outcomes following cataract surgery. A recent systematic review in Southern India reported that women experienced 40% higher odds of visual impairment (<20/60 to ≤ 20/400) following cataract surgery compared to men.¹¹

Gender inequality is observed amongst children requiring bilateral cataract surgery, where access to surgery by girls is lower in some low-income countries across several regions.¹²

The Lancet commission reported on interventions that reduced gender inequity. An intervention included trained rural community volunteers promoting eye services in low- and middle-income countries to women.¹³ Another intervention examined the effect of free access to cataract testing and low-cost surgery for five years. This intervention reduced the gender disparity in willingness to pay at follow-up five years later.¹⁴

The eye health sector has not achieved gender parity, with only 28.3% of eye health organisations boards held by women. Ethnic minority women hold the fewest leadership positions, including the senior management, board position, CEO and chair.¹⁵

References

Bourne R, Steinmetz JD, Flaxman S, Briant PS, Taylor HR, Resnikoff S, et al. Trends in prevalence of blindness and distance and near vision impairment over 30 years: an analysis for the Global Burden of Disease Study. The Lancet Global Health. 2021 Feb 1;9(2):e130–43. Accessed via the IAPB Vision Atlas (https://IAPB.org/learn/vision-atlas)
Burton MJ, Ramke J, Marques AP, Bourne RRA, Congdon N, Jones I, et al. The Lancet Global Health Commission on Global Eye Health: vision beyond 2020. The Lancet Global Health. 2021 Apr;9(4):e489–551.
Prasad M, Malhotra S, Kalaivani M, Vashist P, Gupta SK. Gender differences in blindness, cataract blindness and cataract surgical coverage in India: a systematic review and meta-analysis. Br J Ophthalmol. 2020 Feb;104(2):220–4.
Cromwell EA, Courtright P, King JD, Rotondo LA, Ngondi J, Emerson PM. The excess burden of trachomatous trichiasis in women: a systematic review and meta-analysis. Trans R Soc Trop Med Hyg. 2009 Oct;103(10):985–92.
Ramke J, Zwi AB, Palagyi A, Blignault I, Gilbert CE. Equity and Blindness: Closing Evidence Gaps to Support Universal Eye Health. Ophthalmic Epidemiol. 2015;22(5):297–307.
Gurung R. Cataract surgical outcome and gender-specific barriers to cataract services in Tilganga Eye Centre and its outreach microsurgical eye clinics in Nepal. Community Eye Health. 2007;20(61):14–5.
Upadhyay MP. Rethinking eye care: from exclusion to equity. Nepalese Journal of Ophthalmology. 2010;2(1):1–2.
Abubakar T, Gudlavalleti MVS, Sivasubramaniam S, Gilbert CE, Abdull MM, Imam AU. Coverage of Hospital-based Cataract Surgery and Barriers to the Uptake of Surgery among Cataract Blind Persons in Nigeria: The Nigeria National Blindness and Visual Impairment Survey. Ophthalmic Epidemiology. 2012 Apr 1;19(2):58–66.
Shrestha MK, Guo CW, Maharjan N, Gurung R, Ruit S. Health literacy of common ocular diseases in Nepal. BMC Ophthalmology. 2014 Jan 8;14(1):2.
Ramke J, Zwi AB, Lee AC, Blignault I, Gilbert CE. Inequality in cataract blindness and services: moving beyond unidimensional analyses of social position. British Journal of Ophthalmology. 2017 Apr 1;101(4):395–400.
Vijaya L, George R, A R, Raju P, Arvind H, Baskaran M, et al. Outcomes of cataract surgery in a rural and urban south Indian population. Indian Journal of Ophthalmology. 2010 Jun;58(3):223–8.
Gilbert CE, Lepvrier-Chomette N. Gender Inequalities in Surgery for Bilateral Cataract among Children in Low-Income Countries: A Systematic Review. Ophthalmology. 2016 Jun 1;123(6):1245–51.
Mercer GD, Lyons P, Bassett K. Interventions to improve gender equity in eye care in low-middle income countries: A systematic review. Ophthalmic Epidemiol. 2019 Jun;26(3):189–99.
Baruwa E, Tzu J, Congdon N, He M, Frick KD. Reversal in gender valuations of cataract surgery after the implementation of free screening and low-priced high-quality surgery in a rural population of southern China. Ophthalmic Epidemiol. 2008 Apr;15(2):99–104.
Yashadhana A, Zhang JH, Yasmin S, Morjaria P, Holland P, Faal H, et al. Action needed to improve equity and diversity in global eye health leadership. Eye. 2020 Jun 1;34(6):1051–4. Accessed via the IAPB Vision Atlas (https://IAPB.org/learn/vision-atlas)