Indian Journal of Health Social Work
(UGC CARE List Journal)
GENDER PERSPECTIVES ON HEALTHCARE ACCESS IN
UNIVERSITIES
Kanti1 & Avantika Singh2
1Research Scholar, Department of Political Science, University of Delhi., 2Assistant Professor,
Department of Political Science, University of Delhi
Correspondence: Avantika Singh, e-mail: asingh@polscience.du.ac.in
ABSTRACT
The paper investigates the gendered patterns in accessing healthcare in university spaces.
Institutions of higher education which are associated with inclusivity and multicultural values
often reproduce barriers that disproportionately affect women students. The study draws on a
structured narrative of secondary literature with thematic synthesis and analyzes empirical case
studies from India and elsewhere through the lenses of structural violence and gender-based
violence. It identifies three interrelated mechanisms through which gendered barriers to healthcare
are produced and sustained i.e. infrastructural invisibility, procedural opacity and normative
normalization. These mechanisms manifest in inadequate menstrual hygiene facilities, limited
transparency in health services and the routinization of gendered norms that render women’s
health needs inconspicuous. The paper argues that barriers or inaccessibility to healthcare in
university spaces may be understood as a form of institutionalized structural violence which is
rooted in gendered relations of power. The notion of gender discrimination and violence reflects
a structural character that is manifested through various norms and institutional practices in
higher education institutions. Various policies in India explicitly recognize the prevalence of such
issues and propose institutional measures which, if effectively implemented, hold significant
potential for addressing and mitigating these challenges.
Keywords: Women and Health, Health & Gender, Sociology of Organizations, Institutions &
Structures, Accessibility, University.
Submitted: 10.01.2026 Revised: 20.02.2026 Accepted: 04.06.2026 Published: 30.07.2026
How to cite this article: Kanti & Singh A. (2026). Gender Perspectives on Healthcare Access
in Universities. Indian Journal of Health Social Work, 8(1), 03-16.
INTRODUCTION
The access to adequate healthcare services
is no longer considered a question of welfare
demand but invoked as a matter of right (WHO,
2023). These services are channeled through
various support systems, largely through
infrastructures which caters to the various
strata of our social system. Such is the case
for the students who are expected to receive
adequate healthcare support having an
enabling environment for their academic growth in higher education institutions yet the
persistence of the cases of absence of basic
amenities or inaccessibility to existing services
suggest the undermining of their dignity and
autonomy. Women students are highly
vulnerable to these infrastructural limitations
as their academic performance and wellbeing
are disproportionately affected than the male
students. These inequality of gendered norms
become part of the institutional structure
which are often manifested in subtle routine
practices, attitudes and institutional
arrangements. Even institutions associated
with values of equality and inclusivity may
reproduce such disparities which often remain
insufficiently examined. A closer engagement
with empirical cases is therefore necessary
to develop a better understanding of the
processes that may contribute to the
sustenance of such vulnerability and
marginality within institutional context.
The broader objective of the study is to
analyze the role of higher education
institutions, specifically universities as an
inclusive institution in shaping gendered
patterns of discrimination and access for
women. The study draws on sociological
perspectives such as symbolic violence
(Bourdieu, 2001; Schubert, 2008; Angeliqa
and Sarwono, 2018), structural violence
(Galtung, 1969; Farmer et al., 2006) and
gender-based violence (Montesanti, 2015).
The reviews of existing literature is guided
by these two interrelated questions (i) what
barriers do women students face in accessing
healthcare services in universities and how
do these barriers relate to their vulnerability
to gender identity? And (ii) In what ways does
limited accessibility reflect broader patterns
of gender discrimination? The analysis is
undertaken to develop a more comprehensive
understanding of the structures of
discrimination and the gendered nature of
inaccessibility. The paper contributes to the
existing literature by conceptualizing
healthcare inaccessibility in university spaces
as a distinct form of institutionalized structural
violence. The study employs narrative review
of literature by operationalizing the tripartite
analytical framework built through the
synthesis of the findings. The first mechanism
of the framework is the infrastructural
invisibility which focuses on how women’s
healthcare needs remain insufficiently
recognized in institutional design. The second
mechanism of procedural opacity highlights
the limited accessibility and transparency of
t he healthcare systems. Normative
normalization is the last mechanism which
captures how gender injustice is
systematically entrenched within the everyday
practices in the institutions. This tripartite
framework facilitates the deeper analysis of
how institutional arrangements shape gender
i nequalities in accessing healthcare in
universities while moving beyond descriptive
accounts of accessibility.
The next section of the paper provides a
detailed discussion on the methodology and
theoretical framework of the study. Then the
second section examines the evolution of the
concept of “access” and its meanings. It is
followed by an analysis of empirical case
studies to understand the relationship
between gender and healthcare accessibility
in both India and abroad. Then the fourth
section will discuss the findings of the
empirical case studies of institutional violence
in the light of our theoretical framework. It is
followed by a discussion of the key insights
and limitations emerging from the literature.
The final section reflects on the contemporary
policies on improving healthcare services for
women and their safety in higher education
institutions in India.
METHODOLOGY
The study is primarily based on a structured
narrative review of secondary literature with
thematic synthesis on accessibility, gender violence and healthcare in universities. The
broader objective is to investigate how the
lack of access to essential amenities and
healthcare services in university spaces
disproportionately undermine the well-being
and safety of women students. The paper aims
to develop a comprehensive understanding of
how the denial of basic amenities perpetuate
gender inequality, heighten the risk of violence
which ultimately affect women’s overall
university experience. The experiences of
transgenders or people from other sexualities
(LGBTQ++) were deliberately excluded as the
literature concerning their issues on the
subject would lose their autonomy if situated
within overarching experiences of women.
Although they have been the subject of
violence in a patriarchal system however their
scholarships necessitates an autonomous
treatment as the academic work on women
has already been matured. Therefore the
studies on transgenders and LGBTQ++
experiences of discrimination and gender
violence in university spaces and beyond were
placed in the exclusion criteria.
This paper approaches the topic through a
sociological perspective using the conceptual
understanding of symbolic violence (Schubert
2008), structural violence (Farmer et al.
2006) and gender based violence (Montesanti
2015) as a lens to access the empirical case
studies. The symbolic violence is developed
by Pierre Boudieu (2001). It is understood as
a subtle form of violence where the victims
do not recognize the violence being
perpetrated on them and actively approve the
acts as discussed in works of Angeliqa and
Sarwono (2018) and Schubert (2008). On the
other hand, structural violence was coined by
Johan Galtung (1969) and it refers to the way
social structures restrict the actors
(Individuals, groups or societies) from
realizing their full potential (Farmer et al.
2006) or work to their disadvantage. Farmer
et al. (2006) argue that the entanglement and
interdependence of our social, political and
economic realities enables the formation of
structures which favor certain social groups
while disfavoring others, in effect causing
harm. The intersection of gender with
structural violence is discussed in the work
of Montesanti (2015) who conceptualizes
gender-based violence as encompassing the
gendered dimensions present across multiple
forms of violence. All of these conceptual
perspectives are used to develop a
sociological understanding of the gendered
nature of inaccessibility to healthcare in a
university system.
The study is designed as a theoretically
informed narrative literature review with the
search and selection process outlined to
enhance methodological transparency
(Snyder, 2019). The choice of a narrative
review over a strictly systematic design is
guided by the nature of the inquiry which is
oriented towards interpreting how structures
of power operate through institutional
practices rather than aggregating quantifiable
findings. As Snyder (2019) notes, narrative
reviews can be particularly useful for building
conceptual understanding across diverse
disciplinary perspectives which aligns with the
broader sociological objectives of the present
study. The literature survey was conducted
using keyword-based searches on Google
Scholar with keywords like “healthcare and
university”, “gender violence and university”,
“access in healthcare” on the search
engine.The initial time frame was set to “Since
2024” to find the latest research papers on
the subject and then it was switched to
“anytime” for enhancing the relevance of the
results. After the initial filtration, the second
i teration of the literature survey was
conducted by adding “India” at the end of the
above mentioned keywords in the search title
for the purpose of exploring literature based
on Indian context. The selection of the papers
were made based on the inclusion criteria of the study design which was finalised to include
the concept of “accessibility”, “gender
discrimination”, “gender violence”,
“healthcare” along with the keyword
“university” being used with each of them in
the title itself, sparing few exceptions. The
demography or the “population” of the study
design were primarily university students,
school students, patients or consumers of
healthcare services. Exceptions were made
for the research papers which were empirical
in nature while also providing the conceptual
clarifications on the above mentioned
concepts.
The scope of the research is intentionally
delimited to enable a more focused
engagement with the selected literature.
Expanding the range of empirical studies
without sufficient conceptual integration may
risk producing fragmented insights.
Accordingly, the study emphasises the
interpretive synthesis of existing research to
contribute to a more coherent understanding
of the gendered dimensions of healthcare
access in higher education institutions.
The Concept of “Access” in Healthcare
The concept of ‘access’, despite its frequent
uses in various regulatory or healthcare
policies, had remained mostly undefined or
ambiguous for a long time in academia and
public policy domain (Penchansky and Thomas
1981). The concept of spatiality or distance
to healthcare infrastructures had long been
dominating the understanding of “access” in
public policy (Khan and Bhardwaj 1994; Sibley
and Weiner 2011). However, many studies
attempted to break free from the theoretical
convention either by shifting the attention from
the presence of health facility to its actual
utilisation (Donabedian 1972; Dominic et
al. 2019) or synthesising and thematically
segregating the perspectives provided by the
existing body of literature (MacKinney 2014;
Chapman et al. 2004).
A theoretical exploration by Khan and
Bhardwaj (1994) highlights the spatial
dimensions in the concept of ’”access” along
with the conventional spatial definition. The
authors developed a typology of access model
by taking into account the policy planning
perspective where the ability of the population
to utilise healthcare services was given the
central role in defining the conception of
“access”. The spatial typology refers to the
geographical proximity of the healthcare
services and the non-spatial typology denotes
the differences in accessing or utilising
healthcare services among various social
groups or populations due to socio-economic,
political or psychological barriers etc. Hence,
the study provides a simplistic model for policy
planners to effectively deal with the problem
of “accessibility” by being cognizant of the
multifaceted dimensions of the concept.
However, the inherent bias in the majority of
the studies and policy planning was the
generalising tendency when approaching and
ensuring accessibility for the masses. Hartley
et al. (1994) in their quantitative study
demonstrate how health insurance policy
reforms of the state (Minnesota in United
States), premised on the one-size-fits-all
approach, lead to different health outcomes
across the rural-urban spatiality. Their
findings suggest that rural populations were
at a great disadvantage in terms of low
insurance coverage and high out-of-pocket
expenditures made for getting insured.
However, one interesting case reflected how
the informal networks of altruism partially
offset the impact faced by uninsured rural
residents. The rural physicians altruistically
provided care to most uninsured patients.
Evidently, the top-down policy approaches
mostly miss out on the contextualist factors
which require greater attention to enhance
the accessibility to healthcare services. The
study concludes by providing bottom-up
solutions for effective policy reforms. The conceptual definition of “access” had
undergone many revisions where the objective
of reducing ambiguity led to the search for
central tenets constituting the concept. One
strand of study (Millman 1993) attempted to
shift the definitional focus of access concept
from the availability of health care services
to the outcome obtained from their utilisation.
Dominic et al. (2019) called it the “access
performance” where the adequate delivery of
expected health outcomes are measured.
Under this framework, the unit of analysis is
more inclined to the consumers rather than
the provider of healthcare services. The
concept of “equity” becomes central when the
onus of the analysis is the population (Millman
1993; Chapman et al. 2004). Similarly, the
systematic review of literature on access to
primary health services conducted by
Chapman et al. (2004) teases out an
interesting discussion on access and access
inequality. They deconstruct the concept of
access into four dimensions of ‘availability’ or
supply of health services, ‘utilisation’ in terms
of demand, ‘effectiveness’ as the
appropriateness of available services to cater
to the needs and ‘equity’ indicating the social
justice dimension of the concept. On the
discussion of “access inequality”, they
underscore how certain policy interventions
l ead to ease of access for wealthy or
financially sound patients only whereas the
patients from lower strata are left outside the
purview.
A survey-based quantitative study by Sibley
and Weiner (2011) compares population’s
perception of access to healthcare across rural
and urban continuum. Their finding unravels
the inequities inherent across multiple
parameters which restricts the population of
certain spatiality i.e. rural or urban from
adequately availing the benefits of healthcare
despite infrastructural presence and wide
coverage of health insurance. An interesting
observation highlighted by the study pertains
to the perception of “unmet healthcare
needs”. The perception of rural population is
determined by economic capability which
extends their threshold of urgency of
accessing healthcare services, in effect,
downplaying the reality of their actual medical
needs. Conclusively, they emphasised the
need to integrate the contextualist
parameters in policy planning rather than
adopting the generalist perspective based on
overall spatial assessment.
Taking a departure from earlier studies,
MacKinney (2014) attempts to streamline the
conception of “access” by dissecting it into
four broad dimensions namely “people, place,
provider and payment” extracted from the
critical review of previous literature
(MacKinney 2014, 1). The dimension of people
emphasises the various individual or collective
factors associated with health providers and
consumers which facilitate or hinder the
accessibility. Similarly, the place dimension
highlights the spatial factors such as
geographical distance, travelling time, urban
or rural setting which affects accessibility. On
the contrary, the provider perspective
considers the number of healthcare
professionals, infrastructure and policies
which influence the quality of healthcare
delivery, in effect, determining accessibility.
The payment perspective focuses on the
economic aspects such as insurance coverage
or out-of-pocket expenditure to measure the
degree of accessibility. Ultimately, the study
proposed a synthesis of many dimensions of
access which were scattered across different
bodies of literature to highlight the
interconnected and dynamic nature of the
concept of access.
Another theoretical strand advanced by some
studies (Carrillo et al. 2011; Millman 1993)
emphasises the elimination of barriers to
healthcare delivery as a measure to
conceptualise “access”. Similarly, the barrier
model developed by Millman (1993) measured barriers across three broad conceptual
frames, namely structural, financial and
personal. While the structural barrier refers
t o the availability, organisation and
transportation of healthcare services, the
financial barrier mostly emphasises the extent
of insurance coverage and public support for
accessing healthcare services. Finally, the
personal barrier parameter covers the
influence of cultural, linguistic, educational or
income criteria on determining access to
healthcare services. Similarly, the barrier
model of Carrillo et al. (2011) examines the
barriers on three parameters namely financial,
structural and cognitive which almost
converges with the understanding provided by
Millman (1993). The financial barriers
parameter mainly focuses on the challenges
and constraints faced by the uninsured
population whereas the structural barriers
highlight the availability of services along
several external factors such as long waiting
time etc. The cognitive barriers are mostly
associated with the personal beliefs and
knowledge as well as the nature of
communication influencing the “patient
provider interaction” (Carrillo et al. 2011,
566).
Employing the extensive critical review of
existing literature, Ricketts and Goldsmith
(2005) attempt to develop a comprehensive
framework of understanding and measuring
access to healthcare services. They
emphasised on the need to acknowledge the
dynamic process inherent in the structures
and resources of health care services and
infrastructure. The appropriate identification
of elements which are static and dynamic is
important for allocating resources judiciously
and yield efficient outcomes. The transition
from “potential access” to “realised access”
is the result of dynamic interaction i.e. the
knowledge exchange and development of
experience in the medical environment,
between the health infrastructure and the
population both providers and consumers of
health services.
Gender and Accessibility in Healthcare Services
machines” installed within the institutional
spaces were largely left unused as the
appropriate information was not disseminated
by the institutions. The challenge of menstrual
health management in Indian educational
institutions, however, extends well beyond
isolated informational lapses. A systematic
review and meta-analysis by van Eijk et
al. (2016) of over 97,000 adolescent girls
across India found that approximately one in
four reported school absenteeism during
menstruation, situating the Kaur and Kaur
findings within a far wider pattern of structural
inadequacy in institutional provisions for
women’s health. Conclusively, the Kaur and
Kaur (2019) study underscores the centrality
of educational institutions in cultivating good
healthy practices among the students as well
as providing institutional support and
infrastructure for the same.
The above case studies highlight how the
notion of accessibility becomes unfavourable
for some when intersected with gender
identities. The disadvantageous tilt towards
women even in the so-called inclusive
institutions like universities points towards an
alarming situation of vulnerability and
marginality of the weaker gender. These
phenomena are so implicit and inconspicuous
in our everyday experiences that they hardly
become the subject of resistance.
Higher Education Institutions as a Site of
Institutionalized Gender-Based Violence
Higher education institutions frequently
function as arenas where gendered power
relations are reproduced despite their stated
commitment to inclusivity, equity and
progressive values. This section examines
universities as sites of institutionalized
gender-based violence (GBV) and
demonstrates how the structural mechanisms
that sustain such violence also create and
perpetuate barriers to healthcare access for
women students. The contextualization of
theoretical perspectives on GBV in the light
of empirical evidence from university settings
reveals that inaccessibility to healthcare is not
merely a service delivery gap but a
manifestation of structural and symbolic
violence embedded in institutional norms and
everyday practices.
The theoretical traditions in the studies of
gender-based violence have mostly relied on
the analysis of structures inherent in gendered
relations of power. A seminal work titled
Theorizing Patriarchy (1991) by Sylvia Walby
critically analyzes the three grand ideological
traditions in feminist approaches. She
critiques the liberal, Marxist and radical
feminist frameworks for their limitations in
providing a systematic analytical theory for
analyzing gender violence and the underlying
influence of the social structure. These
limitations can be improved with inclusion of
more recent approaches. This structural
perspective closely aligns with Pierre
Bourdieu’s concept of symbolic violence
(2001) where subordinated social groups
become participatory to their own domination
and normalize the system (Angeliqa &
Sarwono, 2018; Schuber, 2008) and Johan
Galtung’s theory of structural violence (1969)
which refers to the way social structures
systematically restrict the actors (Individuals,
groups or societies) from realizing their full
potential and put them in “harm’s way”
(Farmer et al. 2006) or work to their
disadvantage. The intersection of gender with
structural violence is discussed in the work
of Montesanti (2015). Gender-based violence
i s understood as a broad category to
“recognize the gendered elements in nearly
all forms of violence against women and girls,
whether it is perpetrated through sexual
violence or through other means” (Montesanti,
2015, p.1). These frameworks help capture
the dynamic processes and practices through
which gender relations of power manifests
and function within institutional context.
A more concrete manifestation of such institutionalized violence would become
fathomable with closer examination of various
empirical studies conducted in educational
institutions across India and other countries.
Kiguwa et al. (2015) conducted a qualitative
study of South African higher education
institutions and highlighted how the cases of
sexual harassment are normalized in
heteronormative institutional cultures where
the blame is largely attributed to women for
their presence, behaviour or dressing choices
thereby legitimizing inappropriate conduct as
routine. Similar dynamics are often observed
in universities where gendered norms often
shift responsibility onto female students.
Symbolic violence theory is employed by
Angeliqa and Sarwono (2018) to demonstrate
the inescapability of patriarchal subordination
of women even in the position of authority
and power. It reflects that power relations of
gender cannot easily be offset despite women
occupying the leadership roles in inclusive
institutions like universities. Furthermore,
Mutinta’s study (2022) in South African public
universities lists out several risk factors that
leads to heightened vulnerability of women
to gender-based violence. These include
enrolment in male-dominated disciplines,
younger age, romantic partnership, limited
financial resources and proximity to campus
housing whose intersection or individual
effects can cause greater difficulties in
utilizing campus health services.
The widespread underreporting of cases of
violence is also a critical aspect of
institutionalized gender-based violence in
university spaces. Multiple barriers have been
consistently reported and documented in
various studies which underscores risks such
as shame, stigma, fear of retaliation by
perpetrators and institutional pressure for
preserving the reputation of the organization
(Kiguwa et al., 2015; Ahmed, 2015; Rennison
& Addington, 2014). Kiguwa et al. (2015)
documented that many offensive and
aggressive behaviors are normalized and are
hardly considered as violence by the victims
whereas universities may actively discourage
formal complaints to safeguard their public
image. Over time, it is hardened into a culture
of silence which may have direct and profound
implications for women’s access to healthcare
services. It induces the same fear and stigma
that prevent women students from reporting
experiences of harassment or violence while
also subtly acting as an everyday deterrence
for claiming institutional support for timely
healthcare services. Recent empirical
evidence from Indian universities validates this
hypothetical correlation. A cross-sectional
study among medical undergraduates was
conducted by Choudhary et al. (2025) in a
North Indian tertiary care institution and
reported that women students experienced
significantly higher levels of gender-based
discrimination in hostel facilities and
healthcare services resulting in heightened
mental distress and potential reluctance to
access healthcare services in campus
f acilities. Similar observations were
documented by Ramya et al. in their study in
Coimbatore in 2024. They noted that more
than 62% female college students experienced
unmet menstrual practice needs with many
citing embarrassment, lack of privacy and
i nadequate institutional support as key
barriers which aligns with the larger
normalization narrative observed in gender
based violence literature. Nayak et al.
(2025)’s study on college women in rural
Odisha reinforces this perspective as they
highlight the persistent dissatisfaction with
menstrual hygiene infrastructure and state
supplied products alongside a tendency
toward silence rather than complaint due to
fear of judgement and institutional inertia.
These findings collectively illustrate how
procedural opacity and normative
normalization operate across both violence
redressal and healthcare domains. Women students often internalize the notion that their
specific health needs particularly those related
to menstruation or reproductive health are
private matters or secondary to academic
priorities just as they learn to downplay
experience of harassment.
DISCUSSION
Gender-based violence is a broad conceptual
category that encompasses other forms of
violence such as physical, emotional and
sexual while simultaneously delineated from
them (Mutinta, 2022). The concept largely
reflects the structural character of various
expressions of violence premised on
inequalities embedded in gendered power
relations. The concept largely reflects the
structural character of various expressions of
violence premised on inequalities embedded
in gendered relations of power. The denial of
healthcare services and their associated
barriers may be understood as implicating
concerns of human rights and dignity.
Furthermore, the routinisation or normative
normalization of these deficiencies
disproportionately creates hurdles for women
who often occupy a disadvantaged position
within these power relations. Hence this paper
attempts to extend the understanding of
gender-based violence to include the denial
or perpetuation of structural barriers to
accessing basic healthcare services.
The assessment of the existing literature
highlights several nuances while also
indicating limitations in the frameworks
employed. Classical approaches to gender
based violence reveal a methodological
limitation in earlier studies where the focus
of analysis has largely been on rape often
overlooking more subtle forms of violence
(Walby, 1991). Emerging studies draw
attention to less visible forms such as stalking
(Rennison and Addington, 2014) and symbolic
violence where acts of violence may not be
recognized as such (Angeliqa and Sarwono,
2018). These limitations indicate the need for
greater conceptual clarity as legal definitions
of violence often leave important ambiguities
unresolved. Moreover the definition of
institutional settings such as colleges requires
clearer specification to appropriately situate
experiences of violence and victimization.
Much of the existing literature is also
dominated by intimate partner violence
although this is not necessarily the most
prevalent form of gender-based violence
experienced by women (Rennisonn and
Addington, 2014). A notable limitation in
empirical research is the limited inclusion of
men despite some studies indicating the
presence of male victimization (Kiguwa et al.,
2015).
The findings of the review can be analytically
organized through three interrelated
dimensions of institutionalized structural
violence i.e. infrastructural invisibility,
procedural opacity and normative
normalization. These dimensions provide a
more precise understanding of how gendered
barriers to healthcare access are produced
and sustained within university settings. It has
been noted that despite the availability of
healthcare facilities, a range of structural
barriers (infrastructural invisibility) continues
to affect access within university systems.
These include factors such as long waiting
times, transportation challenges, multiple
locations for tests and specialists, limited
telephone access to providers, restricted
operating hours and multi-step care processes
(Carrillo et al., 2011) along with the lack of
i nformation dissemination (procedural
opacity) by universities regarding available
services (Kaur and Kaur, 2019; Ramya et al.,
2024) and the unavailability of medical
personnel. The implications of these barriers
for women students have been discussed in
the literature reviewed.
The gendered nature of discrimination within
universities manifests in subtle and symbolic forms in everyday interactions. Despite being
associated with inclusivity and academic
advancement, institutions of higher education
may reproduce gendered disparities with
women often disproportionately affected. The
case studies examined in this paper indicate
that such patterns are embedded within
i nstitutional norms. These embedded
normative assumptions are reflected in
practices, attitudes and institutional
arrangements that may favour one gender
over another. The resulting power relations
are often asymmetrical and hierarchical. A
closer examination of underlying institutional
dynamics are critical for probing adequate
measures for their redressal.
Policy Perspectives: Reflections on Current Indian Policies
Recent policy frameworks in India
demonstrate a growing recognition of the need
to address gendered barriers to healthcare
access within higher educational institutions
(HEIs). The University Grants Commission’s
(UGC) ‘Guidelines on Basic Facilities and
Amenities for a Safe, Secure Environment for
Women and Women Cell’ (2022) represents
a key national mandate. These guidelines
outline a comprehensive set of measures
across infrastructural, administrative and
awareness domains. They recommend the
provision of gender-sensitive infrastructure
including clean and well-maintained separate
restrooms with sanitary vending and disposal
facilities, 24-hour primary healthcare centres
with ambulance services, professional
counselling services and regular health
awareness and check-up camps. They also
emphasize gender sensitisation programmes,
zero tolerance towards sexual harassment,
mechanisms for anonymous complaints and
periodic reporting to regulatory authorities.
Complementary to this, the ‘National
Education Policy’ (NEP) 2020 establishes a
Gender Inclusion Fund to support equitable
access for women and transgender students
while longstanding Menstrual Hygiene Scheme
(MHS, 2011) and ‘Rashtriya Kishor Swasthya
Karyakram’ (RKSK, 2014) under the ‘National
Health Mission’ continue to target adolescent
and young women through subsidized pads
and awareness programmes. In 2025, the UGC
further reinforced these efforts through
campaigns such as ‘Swasth Nari, Sashakt
Parivar Abhiyaan’ and advisories promoting
campus-level integration of Ayushman Bharat
services. A landmark Supreme Court ruling
i n February 2026 Dr. Jaya Thakur vs
Government of India declaring menstrual
health a fundamental right under Article 21
has extended these obligations and
strengthened the existing mandates for
functional infrastructure across educational
spaces and strengthened the policy impetus
for HEIs.
Despite these progressive mandates,
empirical evidence reveals persistent gaps
between policy intent and institutional practice
and underscores the structural violence
embedded in university healthcare systems.
Recent studies such as Ramya et al. (2024)
and Nayak et al. (2025) document that over
60% of college women in Coimbatore and
Odisha still experience unmet menstrual
practice needs with vending machines
frequently unused due to inadequate
i nformation dissemination and poor
maintenance. These findings illustrate the
t hree interrelated dimensions of
institutionalized structural violence identified
in this paper. Infrastructural invisibility
persists as primary health centres and hygiene
facilities remain under-equipped or poorly
located particularly in rural and semi-urban
campuses. Procedural opacity is evident in the
l imited transparency around grievance
redressal through Women Cells and unclear
pathways for accessing emergency care or
menstrual products. Normative normalization
further entrenches these barriers as gendered norms lead to underreporting of health-related
vulnerabilities and one-size-fits-all
approaches that overlook intersectional
factors of caste, class and region disparities
(Mahapatro et al., 2021).
Interestingly, UGC ‘Guidelines on Basic
Facilities and Amenities for a Safe, Secure
Environment for Women and Women Cell’
(2022) comprehensively corresponds to our
framework of institutional structural violence
and moves towards the positive direction in
addressing them. Their emphasis on
dedicated infrastructure such as healthcare
centres, sanitation facilities and counselling
services reflects the recognition of gaps that
correspond to infrastructural invisibility.
Similarly, the requirement for information
dissemination, grievance mechanism and
institutional reporting indicates the presence
of procedural opacity in accessing services
and support systems. The focus on gender
sensitisation and the explicit acknowledgment
of a “culture of silence” and masculinized
norms highlight the role of normative
normalization in sustaining unequal power
relations.
CONCLUSION
The persisting issue of gender-based violence
is a multivarious phenomenon which extends
beyond the superficial interpretation of
empirical cases and demands critical
engagement with intersections and
contestations of broader socio-political
processes. A structural understanding of
gender violence helps explain how
perceptions, attitudes and practices adopted
by various actors reflect gendered patterns
of power asymmetry which are embedded in
the social norms. With the growing body of
literature, the concept of violence now extends
beyond its physical characteristics and
includes subtle and everyday practices and
hence seeps into the seemingly inconspicuous
experiences such as infrastructural
deficiencies within university spaces. The
denial of basic amenities such as healthcare
services may therefore constitute concerns of
rights and dignity to women students whose
medical needs are expected to be fulfilled
timely.
This paper argues that gendered patterns of
inaccessibility in availing healthcare services
within university spaces constitute a distinct
form of institutionalized structural violence.
Various barriers to accessing essential
healthcare especially for women students with
menstrual, reproductive and mental health
needs are not isolated service deficiencies but
emerge systematically through three
interrelated mechanisms of infrastructural
invisibility, procedural opacity and normative
normalization. The power dynamics of gender
relations seeps into the structure and culture
of higher education institutions which
reproduces asymmetrical power relations that
disproportionately disadvantage women
students. The synthesis of the empirical
findings extends the argument beyond
descriptive accounts of accessibility to
highlight how seemingly neutral institutional
arrangements systematically constrain the
autonomy, wellbeing and academic
participation of women students. The paper
contributes a novel theoretical perspective by
conceptualizing healthcare denial in higher
education as a specific instantiation of
structural violence which lies at the
intersection of gender-based violence, health
policy and institutional scholarship. The
empirical evidential aspect of the paper
integrates recent India oriented studies that
provide fresh quantitative and qualitative
insights into the lived realities of women
students. The study also attempts to
contribute to the policy domain by bringing
into focus the potential implementation gap
that might escape scrutiny. The growing
progressive frameworks such as the UGC
Guidelines on Basic Facilities and Amenities for a Safe, Secure Environment for Women
(2023), the National Education Policy (NEP)
2020’s Gender Inclusion Fund and the
Supreme Court’s 2026 recognition of
menstrual health as a fundamental right under
Article 21 represent important normative
advances but does not guarantee the
mechanisms for their effective translation into
practice which demands effective
enforcement, intersectional design and
accountability structures that explicitly
address infrastructural, procedural and
normative barriers.
The acknowledged limitations of the present
study opens scope for future research. The
methodological design is based on the
narrative literature review with the scope of
analysis deliberately delimited to focus
primarily on women students to maintain
analytical coherence. However the framework
could be expanded to include the experiences
of LGBTQ++ community for further research.
Individuals or students belonging to
transgender, non-binary and queer individuals
face compounded forms of discrimination even
in university healthcare settings. The cases
may range from misguided facilities and
hostile provider attitudes to the complete
absence of gender affirming care which
intersect with the same mechanisms identified
here but manifest in distinct and often more
acute ways. A more robust and generalizable
empirical evidence base could be established
by employing mixed methods designs
i ncluding longitudinal tracing of health
outcomes, participatory action research with
student collectives and comparative analyses
across public and private institutions.
ACKNOWLEDGEMENTS
The authors acknowledge the use of ChatGPT
5.3, which was employed to enhance sentence
construction and improve the overall structure
of the manuscript. The conceptualization, core
arguments, and content of the paper,
however, are entirely original and remain the
sole intellectual contribution of the authors.
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Conflict of interest: None
Role of funding source: None
ISSN: 2582-1393 (Online)