Introduction
India's healthcare architecture exhibits structural gaps that disproportionately fall on women due to intra-household deprioritisation, socio-economic vulnerability, and inadequate female-specific medical infrastructure. While the Supreme Court has interpreted health as integral to the right to life under Article 21, assessing whether elevating this to an explicit constitutional entitlement can resolve systemic gender disparities requires examining both legal accountability and ground-level implementation bottlenecks.
Gendered Deficits in the Healthcare System
Women encounter distinct structural hurdles across preventive, diagnostic, and curative healthcare due to socio-cultural and supply-side limitations:
- Nutritional and Preventive Screening Gaps: According to NFHS-5, 57% of women aged 15–49 are anaemic. Preventive screening remains negligible, with only 1.9% of women screened for cervical cancer and 0.9% for breast cancer.
- Financial Burden and Delayed Care: Out-of-pocket expenditure (OOPE) accounts for 39.4% of total health expenditure (NHA 2021-22). Non-earning or financially dependent women face acute intra-household deprioritisation, delaying critical medical intervention.
- Severe Specialist Deficits: Rural Community Health Centres (CHCs) suffer from a shortfall exceeding 70% in obstetricians and gynaecologists (Rural Health Statistics), severely restricting maternal and reproductive healthcare in rural areas.
Can an Explicit Constitutional Right to Health Bridge the Gap?
While the judiciary recognised emergency healthcare within Article 21 in Paschim Banga Khet Mazdoor Samity (1996), an express constitutional right offers distinct advantages:
- Enforceable Legal Accountability: It establishes justiciable rights against denial of emergency obstetric, maternal, and reproductive care in both public and empanelled private facilities.
- Mandated Public Expenditure: Constitutional backing creates legal pressure to elevate public healthcare expenditure toward the National Health Policy target of 2.5% of GDP (currently at 1.84%).
However, constitutionalisation alone is not a panacea due to practical limitations:
- Capacity and Supply Bottlenecks: Fundamental rights cannot instantaneously build secondary healthcare infrastructure, train obstetricians, or eliminate deep-seated rural shortages.
- Implementation and Provider Friction: As witnessed during strikes against Rajasthan's Right to Health Act (2023), mandates on private providers without predictable reimbursement mechanisms can lead to operational resistance and service disruptions.
Suitable Alternatives to Bridge the Divide
- Statutory Health Spending and Gender Budgeting: Enact statutory mandates ensuring public health spending reaches 2.5% of GDP, with ring-fenced allocations for female-specific health services and diagnostics.
- Universalised Primary Care and Screening: Expand Ayushman Arogya Mandirs to institutionalise routine non-communicable disease (NCD) screenings, universal cervical and breast cancer checks, and comprehensive anaemia management.
- Dedicated Midwifery and Frontline Health Cadres: Scale up Midwifery-Led Care Units (MLCUs) to ease the burden on specialist doctors, while regularising and adequately remunerating ASHA workers to ensure reliable community outreach.
- Unconditional Maternity Protection: Remove parity restrictions under the Pradhan Mantri Matru Vandana Yojana (PMMVY) to guarantee universal nutritional and wage support for all pregnancies.
Conclusion
Bridging the gender gap in healthcare requires moving beyond declaratory legal guarantees to creating accessible, well-funded physical infrastructure. Institutionalising gender-responsive primary healthcare, expanding female clinical cadres, and assuring predictable public financing are the most practical measures to secure equitable health outcomes for women.