Women and diabetes

Women are victims of gender bias in accessing diabetes treatment, as they have little autonomy even on decisions about their own health.

I believe the recent World Diabetes Day (November 14) made a considerable contribution in raising the profile of a serious global health concern. This day is celebrated every year to spread awareness on the increasing number of people being affected by diabetes and to emphasize the importance of prevention and treatment. The theme this year was: ‘Women and diabetes—our right to a healthy future’.

The number of people with diabetes is increasing globally. According to the World Health Organization (WHO), worldwide, around 8.5 percent of adults aged 18 and over are currently living with elevated blood sugar levels. Diabetes is the ninth leading cause of death in women, and one in 10 women has it.

Diabetes is increasingly becoming a public health problem in Nepal, too. There is marked countrywide variation in its burden: with as few as 1 percent people affected in rural areas, compared with up to 19 percent in cities. Our changing lifestyle, with many of us eating more processed foods that contain high levels of sugar, salt and fat, as well as sugar-sweetened drinks, make us prone to diabetes. 

At the same time, our level of physical activity is declining and there is low level of diagnosis and treatment of diabetes. Growing obesity, malnutrition and tobacco abuse are other important risk factors. Unfortunately, lack of sex-disaggregated data has resulted in an incomplete picture of women with diabetic conditions in Nepal.

Double burden 

A woman with diabetes can face a number of serious health-related problems, including heart disease, complications in pregnancy and depression. Diabetes is a serious and neglected threat to the health of both mother and child. The problem is heightened in developing countries where access to maternal care is limited. Worldwide, one in seven live births is affected by gestational diabetes.

Diabetic Nepalis face a number of challenges: lack of awareness, ignorance about diabetes management, late diagnosis, absence of appropriate medical infrastructure, high cost of treatment, lack of government support, among others. This is particularly problematic for women due to constricted gender roles, socio-economic inequalities and lack of power of women in our traditional society. 

For instance, owing to patriarchal mindset, women are normally expected to pay more attention to the health of the men and children in the family, and in the process, they might ignore their own diabetic status. Young women with diabetes are often discriminated against when it comes to marriage and pregnancy due to lack of education and awareness. Moreover, women are often victims of gender bias in accessing diabetes treatment and care, as they have less power and autonomy than men even when making decisions about their own health. 

We in Nepal need more advocacy and research on integrated, gender-focused policies to address the need for girls and women living with diabetes. Empowering them with necessary knowledge and investing in them will strengthen their capacity to manage their diabetes and safeguard their health. 

Collective effort 

Diabetes can be prevented and controlled through a combination of lifestyle changes and medication. Since early detection and prompt treatment can greatly reduce the burden of diabetes and its complications, screening for it is an appropriate prevention strategy under certain conditions. Especially in a developing country like Nepal, population-based screening combined with simplified diagnostic evaluation and follow-up may greatly enhance awareness of the seriousness of diabetes and its complications.

However, with the limited number of health workers in Nepal, it is not feasible to rely on them alone to manage health needs of the population, particularly to manage the growing burden due to diabetes. One of the effective strategies for managing diabetes is task-shifting, which is endorsed by the WHO. This can involve laying health workers, for instance, Female Community Health Volunteers (FCHVs), for screening and brief behavioral interventions.

Preventing and treating diabetes will be important to achieve the third Sustainable Development Goal (SDG 3), as set out in the United Nations Sustainable Development agenda approved in 2015. The goal is to reduce premature mortality from non-communicable diseases by a third by 2030. In order to achieve this, all sectors of the society, including the government, employers, educators, the private sector, civil society, and individuals themselves, need to work together to halt the rising trend of diabetes and improve the lives of those living with the disease.

The author is a Ph.D. scholar in Public Health at Aarhus University, Denmark