What true equality in health care systems look like for women

This article is authored by Abhishek Aggrawal, CEO, Birla Fertility & IVF.

India has made significant progress in women’s health care. The Economic Survey 2025-26 notes that the country’s maternal mortality rate has declined by 86 percent since 1990, compared with a global reduction of 48 percent. Institutional deliveries have increased, primary healthcare has expanded and more women are accessing doctors, diagnostics and treatment.

Female health (Shutterstock)

These achievements deserve recognition. They also provide a strong foundation for the next question: When does access become equality?

A service may be available, but that does not mean every woman can use it. Distance, cost, limited information, family responsibilities and social attitudes can all influence whether she seeks care. Even after reaching a doctor, the journey from symptoms to diagnosis and treatment may not be straightforward.

Access is, therefore, the beginning of equality, not its completion.

The UNFPA’s 2025 State of World Population Report highlights the difference between services being available and people being able to make decisions that reflect their circumstances.

Its survey across 14 countries found that nearly 20% of reproductive-age adults believed they would be unable to have the number of children they desired. Financial limitations had affected or would affect the reproductive goals of 39%, while nearly one in four felt unable to have a child at their preferred time.

These findings broaden the meaning of reproductive health care. Equality is not only about whether a treatment exists. It is also about whether people have reliable information, financial security and the ability to make informed decisions about their health and reproductive goals.

A woman cannot consider an option she does not know exists. She cannot participate meaningfully in a treatment decision if the information is difficult to understand. She cannot continue care if every appointment creates an unmanageable financial or personal burden.

True access must, therefore, include awareness, affordability and informed choice.

Time is one of the least visible costs in women’s health care.

Symptoms such as severe menstrual pain, persistent pelvic pain, unusual bleeding or hormonal concerns are sometimes accepted as a routine part of life. Menopause and sexual health can also remain difficult to discuss openly, even during a clinical consultation.

A global review found that women with endometriosis waited an average of 6.6 years for a diagnosis. Across the studies reviewed, delays ranged from 1.5 to 11.3 years.

A delay of this length can affect education, work, relationships, emotional well-being and reproductive health. It also demonstrates why the number of consultations alone cannot tell us whether health care is working effectively for women.

Earlier diagnosis does not always begin with more complex technology. It often begins with listening closely, recognising patterns and knowing when further investigation or specialist referral is required.

Health care institutions should measure the time between a woman’s first consultation and diagnosis, the number of referrals involved and whether she can begin and continue the recommended treatment. These indicators can show where coordination needs to improve.

Leading a health care organisation has reinforced a simple truth for me: Patients do not experience health care as separate departments. They experience it as time, travel, cost and conversations.

Every repeated test, unconnected referral and additional appointment becomes part of their experience of care. When consultations, imaging, laboratory tests and specialist opinions are not coordinated, a woman may have to begin a new journey at every stage.

Health care must become easier to navigate. Clear referral protocols, coordinated appointments and active follow-up can reduce repeated visits and help more women continue with the care recommended for them.

This is particularly relevant in fertility care. Social expectations around having children continue to place a disproportionate burden on women, even though infertility can involve either partner. Couple-based evaluation should become the natural starting point, allowing doctors to understand the complete clinical picture before recommending the next step.

Reliable communication is equally important. Patients should understand why a test has been recommended, what the results mean, which treatment options are appropriate and what the expected costs may be. Transparent conversations enable people to participate more confidently in decisions about their own health care.

Equality does not mean offering every woman identical care. It means ensuring that every woman can receive care appropriate to her individual clinical needs.

For one woman, that may mean an earlier diagnosis. For another, it may mean access to fertility preservation. For someone else, it may involve treatment for chronic pelvic pain, support during menopause or an appropriate surgical intervention.

Women’s health should also be understood across the life course. Menstrual health, fertility, pregnancy, postpartum recovery, menopause, metabolic health and bone health are not unrelated episodes. Connecting these stages can support prevention, earlier identification of health concerns and more personalised treatment.

Innovation has an important role in this progress. Advances in diagnostics, reproductive medicine, fertility preservation and minimally invasive surgery are expanding what health care can offer. But innovation becomes meaningful only when the right patient can access it at the right time, based on clinical need.

This requires continued investment in infrastructure and specialist expertise beyond the largest metropolitan centres. Geography should not determine whether a woman can reach appropriate care.

Stigma must also be addressed with the same seriousness as infrastructure. When menstruation, fertility, menopause or sexual health cannot be discussed openly, women may enter the health care system later. Respectful, confidential and evidence-led conversations are therefore part of improving health outcomes.

The next stage of progress in women’s health care will not be defined by one institution, treatment or breakthrough. It will be visible in everyday experiences: a symptom taken seriously at the first consultation, a referral that reaches the appropriate specialist, costs explained before treatment, a decision made with reliable information and follow-up that does not depend entirely on a woman’s persistence.

India has made considerable progress in bringing health care within reach of more women. The next step is to ensure that availability consistently translates into informed choice, timely diagnosis, appropriate treatment and better outcomes.

True equality means removing the avoidable barriers between a woman and the care she needs.

That is the standard against which the future of women’s health care should be measured.

(The views expressed are personal)

This article is authored by Abhishek Aggrawal, CEO, Birla Fertility & IVF.