Sex Differences and Gender-Based Inequities in Health in South Asia

This introductory chapter of Part II of the handbook aims to synthesize evidence on sex differences and gender-based inequities in health in five selected South Asian countries: Bangladesh, India, Nepal, Pakistan, and Sri Lanka. The chapter adopts a life cycle approach and examines health outcomes, including mortality, disease and morbidity burden, and other health and well-being indicators as available. The latest quantitative country-level data (comparable across the countries) have been used to describe the sex differences. Additionally, recent (2015–2024) qualitative studies published in English have been synthesized to explain and understand the gender dynamics underlying sex differences. Because of the paucity of data on transgender and intersex groups, the limited information available for transgender persons of all ages is summarized in a single subsection. It is observed that the evidence available is predominantly about the nature and extent of sex differences in health status and outcomes. Most of the studies synthesied use quantitative and, to a smaller extent, mixed methods and are focused on describing and measuring. Sex (male and female) appears as a correlate or predictor of differences in health outcomes. These studies provide a limited understanding of the gendered pathways and mechanisms for the observed male-female differences in health status and outcomes. Few studies engage with the realities of marginalized populations. Intersections of multiple axes of disadvantage or oppression are largely ignored. The chapter concludes with a brief overview of the ways in which the remaining chapters in this section contribute to addressing the vast evidence gaps observed.