Imagine two patients walk into a primary health centre in the same week. Both describe chest tightness, breathlessness, and shortness of breath. One is a 54-year-old man. He is sent for an ECG within the hour, a troponin test is ordered, and he is referred to a cardiologist within a matter of hours. The other is a 54-year-old woman. She is told it is likely stress, perhaps early menopause. She is advised to rest and sent home. While the symptoms were the same, the outcome was not. The difference? Gender.
This is not a hypothetical scenario confined to one clinic. It is a repeating pattern across Indian healthcare, and it sits at the centre of a new framework from the World Economic Forum and McKinsey Health Institute, which finds that a third of the global gender gap in health outcomes comes not from biology or underfunding, but from care delivery itself.
The Problem
An expert panel of 99 cardiologists from the SHAKTI Expert Group concluded that ischemic heart disease remains underdiagnosed and undertreated among Indian women compared with men. In part, this is because women typically present with heart disease a decade later than men. It is often with symptoms like fatigue, nausea, or back pain that get misattributed to stress or menopause rather than being recognised as cardiac. The picture is similar for maternal health. India’s Sample Registration System found that 88 women died of maternal causes for every 100,000 live births in 2023, translating to roughly 22,500 deaths in a single year. Haemorrhage and hypertensive disorders together account for around 40% of those deaths, many of which are preventable with earlier monitoring. For maternal mental health, multiple meta-analyses estimate that roughly 20-25% of Indian mothers experience postpartum depression, yet screening for it remains informal and largely absent from routine antenatal and postnatal visits.
While these three are very different conditions, there is something that unifies the problem: the medical knowledge to catch these problems early already exists. The system that reliably puts that knowledge in front of women is missing. More troublingly, there is often a lack of willingness of healthcare workers to take women seriously when they present. Research consistently shows that women’s pain and symptoms are more likely to be attributed to anxiety, stress, or emotional causes than the same symptoms in men. And this is so prevalent that there is a name for it: the “Yentl syndrome”. It was found that women received equal cardiac investigation only once they proved they were as sick as a man.
What’s going on?
Part of the answer is research bias. Decades of cardiovascular research, in India and High-income countries, was done using data extracted from men. This is why diagnostic criteria still favour male-pattern symptoms over the more atypical presentation common in women. The SHAKTI panel noted that the lack of gender-specific data has meant coronary disease was long treated as a man’s condition by default, leaving frontline healthcare workers with neither the training nor the tools to recognise it quickly in women.
Another reason could be fragmentation. A woman who develops preeclampsia during pregnancy is handed off from her obstetrician at delivery, often with no one tracking her sharply elevated lifetime cardiovascular risk afterward. A radiologist reading a mammogram has no standard way of flagging incidental findings linked to heart disease. A new mother showing signs of depression may be seen only by an obstetric team with no working relationship with psychiatry. Each handoff is a point where a woman can simply disappear from the system.
And another part of the problem is stigma and self-neglect, especially around mental health. Postpartum depression is still widely dismissed in many Indian households as a passing mood rather than a medical condition. This means women underreport it and providers rarely ask about it. If you combine that with a culture in which women routinely defer their own checkups until after a husband’s surgery or a child’s exam, the result is a population that enters the healthcare system late. If at all.
What needs to change now?
The encouraging part is that many of the solutions are already within reach. They do not require new infrastructure or expensive technology. In many cases, they simply require making better use of existing systems.
A woman who comes for breast cancer screening, for example, could also be screened for cardiovascular risk factors during the same visit. Similarly, postpartum cardiovascular monitoring does not always need a cardiologist. India’s vast network of ASHA workers and nurses already reach women where they live and have the potential to identify problems long before they become emergencies.
The same principle applies to mental health. Too often, screening for perinatal depression depends on whether an individual provider thinks to ask. Making it a routine part of antenatal and postnatal care would ensure that fewer women fall through the cracks. Kerala’s Amma Manasu programme has already shown that this can be done.
Ultimately, none of this is about inventing new medicine. It is about making sure that the right questions are asked, that warning signs are recognised early, and that women are connected to care before a crisis occurs.
Closing this gap is not about blaming individual clinicians, most of whom are doing their best within a system that often makes equitable care difficult. It is about recognising, as physicians, public health researchers, and now global health economists have all independently concluded, that closing this gap is both a matter of basic equity and one of the more cost-effective investments available to Indian healthcare today.
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