Mainstreaming gender in eye health - way forward

Eye health is a critical aspect of overall well-being, yet it remains a neglected issue, particularly for women and marginalised communities worldwide. The World Health Organization's first World Vision Report reveals that 2.2 billion people worldwide suffer from vision impairment, with one billion cases potentially prevented. The poorest and most vulnerable are disproportionately affected, with 90 per cent of cases occurring in low- and middle-income countries. There are 112 million more females than males who suffer from vision loss, 90 million children suffer from vision loss, and an additional 448 million suffer from refractive error. Most vision loss is preventable, with 90 per cent avoiding or treating with simple solutions. Vision impairment poses a significant financial burden, with an estimated annual global productivity cost of $411 billion.
Further, at least 55 per cent of the world's blind are women, and most 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 Organisation reports that nearly two-thirds of all visually impaired and blind people in the world are women. According to Orbis International Bangladesh's gender-based analysis, women in Bangladesh confront a range of barriers to accessing eye health, particularly rural women who have limited access to eye care services, eye health information, and service availability. They additionally encounter a range of social and economic barriers that prevent them from seeking eye care.
Orbis Bangladesh is implementing a strategy to ensure equal access to eye care for all, regardless of gender, socioeconomic status, location, or cultural background. This strategy aims to improve gender inclusion in eye health programs, raise awareness about inclusive policies, and overcome gender inequity barriers. Orbis has established women-led green vision centres, and trained female health workers stationed in communities by the government and other organisations, to strengthen eye care messaging and refer adults and children to the nearest eye care centres. In addition, Orbis trained its own and partner staff on gender concepts, and partners developed their action plans to mainstream gender in their work and workplace.
The organisation sought input from development partners, eye health leaders, and gender experts on their experiences with gender mainstreaming in development and eye care. To accomplish this, it held a consultative workshop with eye health experts and development partners to gather input on gender mainstreaming in eye care and development efforts. The workshop aims to educate participants on eye health and gender initiatives in Bangladesh, identify barriers encountered by women and girls in accessing eye care, and seek recommendations for overcoming these challenges from gender and eye health specialists.
The gender-based analysis of Orbis Bangladesh revealed that there are structural, economic, social, policy, and practice barriers to delivering and establishing inclusive eye care. The analysis found that women and girls have limited access to eye care due to social and economic conditions that prevent them from making decisions about their mobility. It also found reliance on male family members to accompany them to an eye care facility that prevents them from going to an eye care facility outside a close vicinity, and reliance on male family members to make decisions about their eye care and related spending that causes treatment to be delayed.
The analysis found that socio-cultural beliefs, which prevent women and girls from following treatment guidelines, as well as perceived gender roles frequently contribute to women's inability to hold leadership positions. Individual and societal mindsets shape the decisions to consider women in workplaces and at home. Data show that women get more non-managerial positions at eye care facilities because they are good caregivers, whereas women's perceived gender role at home prevents them from obtaining leadership positions, which also causes male leaders to overlook them in these roles.
Other areas that need to be investigated when conducting a gender-based study were identified by the eye health and gender experts who attended the workshop. The reflections indicate that a more comprehensive national gender-based analysis is required. Also, there is a need for including transgender and disabled people's perspectives in the analysis because they are the most socially marginalised, and their experiences in accessing health or eye care will help remove the range of barriers that the community faces.
The discussants acknowledged that it is necessary to understand the political economy of disempowerment and that people's interests can influence their decision to disempower others or continue the existing process of marginalisation. To address this, the organisation must take affirmative action, such as gender budgeting, changing mindsets, and changing women's gendered roles in eye care facilities. It is also important to sensitise the health care staff on gender concepts and as well as on their roles in tackling the barriers to create equal access to eye care services for the community. For example, the finance team preparing the budget should be sensitised to gender issues so that they can consider allocating funds to prioritise women staff and support eye care for women and girls.
They were of the opinion that there is a need to recognise that women are not a homogeneous group; there is diversity among them; and not all women and girls face equal levels of discrimination. Also, community awareness is required to educate the community about the importance of eye care for women and girls, as well as the forms of deprivation they face when seeking eye care. The facilities should allocate targeted time to provide services to meet the needs of a diverse group of women; for example, garment workers are only available for treatment after 5.00, whereas eye facilities provide services until 5.00 pm. Gender concepts and barriers should be communicated to both men and women. Gender-focused programs should include both men and women, with men playing an important role in removing barriers for women.
The gender experts invited at the consultation put forward different recommendations for mainstreaming gender in eye health. They include constituting a network of eye health organisations, including INGOs, to discuss and initiate the way forward for gender mainstreaming in eye health; conducting a nationally representative gender-based analysis, considering the diverse perspectives of the most marginalised groups; carrying out a national-level policy gap analysis to facilitate the formulation of policies which will make services equally accessible to all communities; and ensuring targeted eye interventions for marginalised groups such as garment workers, sex workers, disabled people, transgender, nomadic population.
Other recommendations were running a community awareness programme that informs the community about the importance of eye care for women; developing tailored interventions for persons with disabilities to tackle their specific problems; engaging men in raising awareness about women's eye health and mainstreaming gender in eye health; and addressing the barriers women health professionals face when working in rural areas because of their gender roles.

Mirza Manbira Sultana is the senior monitoring and evaluation manager, Iqbal Hossain the associate director and Dr Munir Ahmed the country director at Orbis International, Bangladesh. [email protected]