Congenital heart defect (CHD) affects a large number of newborns and account for a high proportion of infant mortality worldwide. According to the World Health Organization (WHO) in 2010, an estimated 270 000 deaths during the first 28 days of life were reported due to congenital anomalies globally. According to March of Dimes (MOD) global report on birth defects, 7.9 million births (6% of total births) occur annually worldwide with serious birth defects and 94% of these births occur in the middle- and low-income countries. According to joint WHO and MOD meeting report, birth defects account for 7% of all neonatal mortality and 3.3 million under five deaths.

The prevalence of congenital heart defects in India has been reported as 2.25–5.2/1000 live births compared with 8–10/1000 live births in other parts of the world. This is likely to be an underestimate as an unknown number of cases go unreported, particularly those delivered by unqualified personnel in rural areas where monitoring is inadequate. Parental preference for male children exists in many sections of Indian society, where girls with congenital heart defects are not provided with the same treatment opportunities as boys; this disparity is most apparent in those with lower socioeconomic status and education.

Very often, patients have to travel long distances to metropolitan cities to avail themselves of treatment because specialist care of congenital heart defects in rural India is generally suboptimal due to the lack of pediatric cardiac surgical and interventional facilities. Unlike adult cardiac care, pediatric interventional and surgical care is still in a phase of development and facilities have not been prioritized in many hospitals.

Given the almost equal gender prevalence, it is alarming that relatively fewer girls are brought to the tertiary centres and even fewer are able to get the correct heart disorder treatment. Studies have shown a significant gender gap with the boys outnumbering the girls with only 44% of the girls undergoing required cardiac surgery compared with 70% of the boys

Deep-rooted social prejudices against girls, including the differences in matrimonial prospects even after successful surgical procedures, lack of support from family and relatives for the heart disorder treatment of girls and less conviction among parents of female patients to dedicate their time and resources, compared with those of male patients have been reported as some of the reasons for gender discrimination. The other reasons include concerns about a surgical scar on the chest of the female child, future matrimonial prospects or the fear that surgery might dampen the matrimonial prospects of their child and the need to conceal the illness of the child from relatives and friends.

In conclusion it can be said that the financial incapability is the major factor responsible for a delay in surgery for boys and on the other hand, for girls, the lack of support from relatives is the major factor responsible for this delay. A significant gender bias exists in the acceptance of pediatric cardiac surgical care and a deep-seated social factors and corrective measures are urgently needed to correct this disparity. But abolishing gender bias in child healthcare is a major challenge, especially in India due to gender-biased culture. Corrective actions including the empowerment of women, education of female children, elimination of gender-selective abortions, and discussion at grass root levels about traditional culture and societal norms will go a long way in fighting this social evil.

References:

Congenital anomalies (birth defects) | National Health Portal Of India (nhp.gov.in)

Gender equality in India for children with congenital heart disease: looking for answers | Heart (bmj.com)

Gender bias in cardiovascular healthcare of a tertiary care centre of North India | Heart Asia (bmj.com)