Closing the gender divide in eye health

According to the World Health Organization's (WHO's) first World Vision Report, more than a quarter of the world's population - 2.2 billion people worldwide - suffer from vision impairment, of which one billion cases could have been prevented or are yet to be addressed. Unless urgent investment and innovation in eye care are made, this figure is expected to rise by 60 per cent to nearly 1.8 billion people by 2050.

The poorest and most vulnerable people in society are disproportionately affected by blindness. About 90 per cent of all cases of global vision loss occur in low- and middle-income countries, where access to eye care is limited. There are 112 million more females than males who suffer from vision loss. Besides 90 million children suffer from vision loss and an additional 448 million suffer from refractive errors. However, most of the vision loss is preventable. About 90 per cent of vision loss cases, or approximately 1 billion cases, can be avoided or treated with simple solutions such as a 30-minute cataract operation, antibiotics, or a pair of glasses. Vision impairment poses an enormous global financial burden, with the annual global productivity losses estimated to be US$ 411 billion. Vision loss can affect people of all ages. However, most people with vision impairment and blindness are over the age of 50 years. (WHO 2023)

Further, at least 55 per cent of the world's blind are women, and most of them live in low- and middle-income countries. Eye diseases such as cataracts and macular degeneration are diagnosed more often in women than in men. The Women's Eye Health Organization reports that nearly two-thirds of all visually impaired and blind people in the world are women.

The age-standardised prevalence of blindness in Bangladesh is 1.53 per cent, or 750,000 blind people, with cataracts accounting for roughly 80 per cent of the cases. Around 6 million people, including 1.3 million children, have uncorrected refractive errors. The primary causes of visual impairment in Bangladesh are refractive errors (18.9 per cent) and cataracts (73.4 per cent) while the main causes of persistent visual impairment in the country are an inadequate referral system, a lack of access to glasses, a lack of primary eye care facilities or vision centres, and a lack of compliance with eyewear. Furthermore, geographic barriers, poverty, sociocultural norms, and a lack of awareness prevent people in rural areas from getting access to eye care (National Blindness Survey 2011).

Why gender equity in eye health matters

According to WHO estimates for 2023, women make up about 55 per cent of all blind people, which means 112 million more women than men are blind. There are many factors which contribute to this gender gap, including the fact that women have longer life expectancies than men, meaning that more women are in age groups where there is a higher risk of developing an eye condition that could result in blindness. As a result, women are 1.3 times more likely than men to be blind or have vision problems. In addition, some eye conditions are more common in women than in men. In some nations, women have less access to eye care services than men do. According to Ackland, P. et al. (2017), this is caused by a variety of socioeconomic and cultural factors.

According to a cross-sectional survey conducted in 2013, the female population and the rural population had higher rates of blindness in Bangladesh, as it lacks adequate community-based eye care facilities (IAPB 2022). Women have less access to eye care facilities, which are typically located at the district level, due to social restrictions on their mobility and the reliance on male family members for health care decisions and finances (Orbis 2023).

Given these contexts, Orbis International recognises that blindness is a gender issue and remains committed to addressing equity and access to in eye health.

The Orbis Approach - prioritising women, girls and vulnerable groups

The Orbis strategy places a particular emphasis on gender and is committed to ensuring that men and women have equal access to eye care. In this context, Orbis Bangladesh has been working to strengthen the mainstreaming of gender into all eye health programs. The primary objective of this approach is to provide eye care services that are inclusive of people regardless of their gender, socio-economic status, where they reside, or their cultural backgrounds. In addition, this strategy has sensitized Orbis staff and partners to the role gender equality plays in improving access to health care and the importance of inclusive policies in our society and workplaces. Orbis remains keen on improving programming that is gender-responsive and addressing gender inequity barriers to improve eye health services for all.

High-impact gender equity initiatives in eye health

Orbis Bangladesh set up five women-led green vision centres in Chandpur, Baniachang, and Rangpur to prioritise gender-responsive programming. As a first step, Orbis, alongside partners in the eye health sector, conducted a gender-based analysis to determine the barriers women and girls face in accessing services. Orbis International has developed a brief online gender concept training programme for all its employees, while Orbis Bangladesh made the training programme available to partner staff by uploading it to the Cybersight platform, where they could enrol and complete the training. The gender concept training for partners included the development of an action plan for gender mainstreaming with clear milestones that would be accomplished by the end of 2023. Following the training, partners began to reform various committees that were not functioning. The partners are also reviewing their current policies to provide a more sensitive work environment for their female employees and a more welcoming environment for their female patients. Orbis Bangladesh continues to solicit opinions and feedback from gender experts, women, girls, and community members on how to improve the delivery of eye programmes. Designing and implementing gender equality eye health programmes is imperative to addressing structural barriers that prevent women and girls from seeking eye care. Despite the uncertainties, the participation of partners in training, action plan development, and execution has been very encouraging. We have seen partners lead and take affirmative action to retain their female vision technicians and reap the positive results in the increased uptake of women, girls, and community members accessing services at the vision centres.

Sustaining eye health outcomes and impact for women, girls, and children

Gender is not a cross-cutting issue at Orbis; rather, it is integrated into our overall programme approach. We envision an Orbis in which people's diverse perspectives and needs are celebrated and embraced. Equity is central to our organisational culture, and our work contributes to transformational change for women and girls. We uplift and improve opportunities for women professionals in the ophthalmic community by identifying and addressing barriers that limit women's progress and by collaborating with partners who share the same gender priorities and vision to effect systemic change. We are committed to ensuring that women and girls are central to defining, designing, and delivering eye health programmes that reflect their unique needs, skills, and lives. Finally, as we continue striving to deliver eye health programmes that are accessible to all, women's health perceptions and behaviours will shift, creating a more enabling environment for women and girls, particularly the most marginalised women and girls, to access eye care.

- Mirza Manbira Sultana is the senior monitoring and evaluation manager and Dr. Munir Ahmed the country director at Orbis International, Bangladesh Country Office while Dr. Doris Macharia is the senior vice president of global programs at Orbis headquarters