Tuberculosis (TB) remains one of the world’s deadliest infectious diseases, continuing to pose a major public health challenge despite decades of global control efforts. According to the World Health Organisation (WHO), TB is among the top 10 causes of death worldwide and the leading cause of death from a single infectious agent, claiming over 12 lakh lives and affecting more than 1 crore people in 2024 alone.
India continues to bear the largest share of the global TB burden. WHO estimates show that nearly one in every four new TB cases worldwide occurs in India. Other high-burden countries include Indonesia, Philippines, China, Pakistan, Nigeria, Democratic Republic of the Congo and Bangladesh, which together account for a large proportion of the world’s cases.
While TB affects people across all age groups and genders, its impact is not always the same. Globally, men account for the majority of cases - about 54 per cent in 2024, followed by women at 35 per cent and children and adolescents at 11 per cent. However, research increasingly shows that women often face unique challenges related to TB.
A 2023 review highlighted the social and psychological burden faced by women with TB, noting that “the social stigma and anxiety associated with tuberculosis may have a much more significant negative impact on women's health behaviours than men.”
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On World TB Day, we spoke to Dr Benhur Joel Shadrach, Consultant in Pulmonology and Sleep Medicine at Rela Hospital in Chennai, to understand how tuberculosis impacts women differently.
Why is tuberculosis diagnosis often delayed in women?
Dr Shadrach said that tuberculosis in women presents a unique set of diagnostic, social and clinical challenges that are often different from those experienced by men. Although the biological progression of the disease may be similar, women frequently take longer to receive a diagnosis due to health system barriers, societal expectations and their roles as primary caregivers.
“India alone contributes nearly a quarter of the global tuberculosis burden, which makes targeted interventions for women particularly important,” he explained.
According to Dr Shadrach, early symptoms such as persistent cough, unexplained weight loss, fatigue and daytime sleepiness are often overlooked or misattributed to everyday stress and household responsibilities. As a result, many women delay seeking medical help until the illness becomes more severe.
“In many households, women tend to prioritise family responsibilities over their own health,” he said. “Domestic duties, childcare responsibilities and limited financial independence often delay access to timely medical care.”
The role of stigma and social barriers
Dr Shadrach noted that stigma surrounding tuberculosis continues to be a major barrier, particularly for women. Fear, misinformation and social judgment often discourage individuals from seeking early diagnosis or openly discussing their symptoms.
“A tuberculosis diagnosis can still carry significant social consequences for women,” he said. “Concerns about marriage prospects, employment opportunities and social standing often lead many to hide symptoms or delay seeking treatment.”
In communities where a woman’s identity is closely tied to her role within the family, the diagnosis may even result in social isolation. Dr Shadrach pointed out that fear of gossip or negative labelling sometimes leads women to seek informal care or postpone medical consultation, which can worsen the disease and increase the risk of transmission within families.
Pregnancy and the need for stronger public health interventions
Pregnancy can further complicate the diagnosis and management of tuberculosis. Dr Shadrach explained that the disease during pregnancy may increase the risk of complications such as miscarriage, preterm birth, low birth weight and maternal health problems.
“The physiological changes that occur during pregnancy can sometimes mask or mimic symptoms of tuberculosis, making early detection more challenging,” he said.
To address these challenges, he emphasised the importance of strengthening public health interventions that specifically support women. Integrating tuberculosis screening into routine maternal healthcare, improving access to rapid diagnostic tools, increasing community awareness and strengthening social support systems can help improve early detection and treatment outcomes.
“When health systems, social support and community awareness work together, we can significantly reduce the burden of tuberculosis among women while improving both public health outcomes and gender equity,” he added.
This story is done in collaboration with First Check, which is the health journalism vertical of DataLEADS
