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| The Real Glass Ceiling: Why the Right to Health is the Material Basis for Nari Shakti | | | Dr. Manorama Bakshi and Dr. Arjun Kumar | 4/18/2026 10:07:09 PM |
| You cannot build Nari Shakti on political quotas alone, you need health security as the foundation. As India crosses the ₹1.06 lakh crore milestone in health spending and prepares to operationalize the 33 per cent reservation for women, the national conversation is at an inflection point. Yet two of the most consequential policy shifts of our time continue to move on parallel tracks without meeting. Representation is a victory of numbers. Resilience is a victory of survival. We must ask: Can a woman effectively lead a constituency if her own household is anchored in medical debt? Political reservation gives women a seat at the table, but without a Right to Health it does not give them the power to stay there. Women’s health vulnerability is not uniform, empowerment and outcomes differ sharply by caste, tribe and region, and those with greater social independence consistently show better health outcomes, while those from deprived groups face far weaker protection from health shocks.
The blind spot lies in what we call the missing middle, nearly 40 crore Indians who are neither poor enough to qualify for government schemes nor affluent enough to afford private insurance. This space is not gender neutral. In most Indian households, women remain the primary caregivers but the last care seekers. Preventive screenings are delayed, oncology checks are postponed, reproductive care is often sacrificed to protect family savings. India still records close to 47 per cent of health expenditure as out of pocket spending, one of the highest among major economies, and when illness strikes, it is not just a health crisis, it is a financial slide that pushes families out of economic stability. In this silent calculus, women become the shock absorbers of the economy. They absorb risk through deferred care, worsening outcomes and reduced participation in the workforce. By universalizing health insurance as a residency based right, we do not just protect bodies, we protect the economic agency that the reservation framework seeks to unlock.
If the intent of Nari Shakti is to enable women not only to enter institutions of power but to sustain their presence there, then health must be understood not as welfare, but as economic infrastructure. A guaranteed insurance right reduces catastrophic expenditure and stabilizes households. It frees women from the care poverty trap that continues to suppress India’s female labour force participation. It enables women to move from unpaid care roles into productive economic activity, strengthens household resilience and improves overall productivity. In this context, a universal insurance model is not a fiscal drain, it is a high yield macroeconomic multiplier. It creates a labour dividend by releasing women from the constraints of unpaid care and health vulnerability. India’s digital health backbone, with over 60 crore ABHA IDs already active, has already laid the rails for a portable and inclusive social protection system. The infrastructure exists. What is needed now is political will.
India is not starting from scratch. The country has already built significant digital and institutional capacity, and several states have begun to move ahead of the curve. States such as Assam, West Bengal and Punjab are already experimenting with residency based health models, signalling a shift from fragmented schemes toward more universal approaches. This is where the role of the state must evolve, from a fiscal gatekeeper to a caring state that guarantees protection as a right rather than extending it as a benefit. Health entitlements must be decoupled from deprivation and anchored in residency, ensuring that protection follows the citizen rather than the poverty line. At the same time, public health financing must incorporate a gender lens, with at least 30 per cent of health outlays ring fenced for women’s insurance entitlements, protected from mid-year fiscal adjustments and aligned with long term goals of inclusion and equity. Evidence from publicly funded insurance models shows that when design is gender responsive and outreach is targeted, women are as likely as men to be covered, but access ultimately depends on last mile systems that enable awareness and utilisation.
Global experience reinforces that India is on the right path, but speed and alignment will determine outcomes. Countries that have successfully scaled innovation and access have done so by strengthening reimbursement systems, accelerating regulatory approvals and creating market certainty.
India has made progress on several of these fronts, but without a broad based reimbursement framework, a large population does not translate into real access or sustained innovation.
The gap is not in intent, it is in alignment. The path forward lies not in choosing between access and growth, but in recognizing that both reinforce each other when supported by the right policy architecture.
If you want women to lead, you must first ensure they can survive, work and remain economically secure.
Political reservation gives women a voice in governance, but a legally codified Right to Health gives them the strength to exercise that voice. The 2026 election cycle should not just expand representation, it should redefine dignity.
It should mark the shift from subsidising vulnerability to guaranteeing security. The real glass ceiling in India is not the absence of representation, it is the persistence of health insecurity that limits agency and continuity. Break that, and Nari Shakti will not just be visible, it will be unstoppable.
Dr. Manorama Bakshi is Director and Head of Healthcare and Advocacy at Consocia Advisory , Founder /Director Triloki Raj Foundation and a Senior Visiting Fellow at IMPRI.
Dr. Arjun Kumar is Director, IMPRI Impact and Policy Research Institute, New Delhi.
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