Around a third of the world’s population live with a vision impairment, half of which are preventable or treatable. Staggeringly, 55% of this burden is carried by women and girls, with cataracts and refractive errors being the most common causes. Additionally, global coverage of spectacles is 10% lower in women than in men.

Vision impairment is therefore both a driver and a product of gender inequality, particularly in low- and middle-income countries.

There is no excuse for this gaping inequity.

Cataracts and refractive errors are easily preventable or treatable with cost-effective interventions, meaning that up to nine out of ten women and girls could avoid vision impairment.

Improving eye health and access to eye care for women and girls will undoubtably advance progress toward multiple Sustainable Development Goals (SDGs), in particular gender equality (SDG 5), good health and well-being (SDG 3), no poverty (SDG 1), reduced inequalities (SDG 10) and decent work and economic growth (SDG 8).

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Moreover, blindness and vision impairment should not be considered in isolation. These conditions are a part of, and intersect with, the growing global burden of non-communicable diseases. Blindness and vision impairment are associated with premature mortality. And progress toward reductions mortality from NCDs (SDG 3.4) through measures such as improved diabetes control, will help to reduce the incidence of vision impairment caused by diabetic retinopathy, for example.

Specifically addressing eye health for women and girls has benefits that extend beyond those experienced by affected individuals. Rather, the potential societal, economic and educational gains are enormous—and multigenerational.

In Rwanda, for example, where it has been estimated that approximately one-third of the population has some form of vision impairment, women are often employed in sorting coffee beans. However, many women experience vision loss in their mid-forties which affects their ability to work and provide for their families. Accepting vision loss as a natural part of ageing and unaware that reading glasses could help to extend their working lives, to compensate for this loss of income, young daughters are pulled out of school to take the place of their mothers in the agricultural workforce.

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With their right to education denied, many of these girls will not reach their full potential, thus limiting their access to pursue career opportunities with higher earnings. Furthermore, they may not attain sufficient health literacy to be able to access appropriate health and eye care, perpetuating the cycle of visual impairment, limited socioeconomic outcomes and detrimental health outcomes.

While the consequences for women, their daughters and their families can be devastating, the solution in such cases is simple. Increase awareness that effective (and low cost) interventions exist, and provide access to women who need them.

Health education (thereby enabling case detection), as well as access to eye care and glasses through community and primary care centres, are among the recommendations included in of the Package of Eye Care Interventions and Primary Eye Care Training Manual from the World Health Organization (WHO). We have seen success in some countries, including Pakistan, where integrated planning for eye care across all levels of the health system, with a focus on strengthening delivery in community and primary care with appropriate referral pathways, combined with strong partnerships and cross-sectoral collaboration, have substantially improved the delivery of eye care over the past 20 years. During this period there has been a notable increase in spectacle coverage; from 15% coverage in people 30 and over in 2004 to 80% coverage in people 50 and over in 2021.

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In the World Report on Vision, the WHO recommends an integrated people-centered eye care (IPEC) approach across a continuum of promotive, preventative, treatment and rehabilitative interventions for an array of eye conditions throughout the life course. While not specifically intended to address the gender gap in global eye health, implementation of four strategies that comprise the IPEC framework: 1) empowering and engaging people and communities; 2) reorienting the model of care; 3) coordinating services within and across sectors; and 4) creating an enabling environment, women and girls with vision impairment will undeniably benefit.

Increased health literacy, targeting underserved populations (especially women and girls), and leveraging technologies (such as mobile phone messaging), in addition to strengthening primary care systems and inclusion of eye care in national universal health coverage programmes come together to ensure improved eye health for all who need it.

A recent policy brief from UN Women “No woman left behind: closing the gender and inclusion gap in eye health” lays out the case for investment in women’s health, including eye health, as a moral imperative, necessary for upholding fundamental human rights of all women. Co-authored by Australian Aid and The Fred Hollows Foundation, the policy brief highlights barriers to inclusive eye care and provides recommendations to all stakeholders for closing the gender gap in eye health. image (8)

Among the barriers are social stigma against women and girls, which can result in marginalisation and in some cases abandonment. The report also brings to attention the paucity of disaggregated baseline data, including by sex, age and socioeconomic status. Without such data, policymakers lack the ability to make informed choices and interventions to reduce the gender gap and to implement effective policies for promoting equitable eye health. A shortfall of effective national programs for eye health was also noted. Placing women in leadership and decision-making roles within governments and health ministries, will ensure that equitable eye health is an attainable goal.

Women must see. And be seen and be heard in positions where they have the empowerment to affect change for raising the profile of and influencing policies that impact women’s lives.

The importance of eye health must not be underestimated. Addressing eye care for women and girls has far-reaching benefits for all of society. Eye health must remain a global priority, leaving no woman behind.

Addressing the Undue Burden of Vision Impairment for Women and Girls

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