Women as Healthcare Gatekeepers: Gendered Dimensions of Health Decision-Making in Tribal Communities of Northeast India

Abstract

This paper examines the critical role of women as healthcare gatekeepers within tribal communities in Northeast India, with a specific focus on Tripura. Through a comprehensive mixed-methods research design incorporating sophisticated statistical modeling, we analyze how women's decision-making authority in family healthcare creates measurable positive health outcomes despite structural limitations. Data from 427 households across 12 tribal villages reveals that households where women have primary healthcare decision-making authority demonstrate significantly better health indicators, including higher vaccination rates (OR=2.37, p<0.001), improved maternal health outcomes (β=0.41, p<0.01), and more consistent utilization of available healthcare services (χ²=18.42, p<0.001). Our hierarchical regression and structural equation models indicate that women's education level and economic empowerment serve as significant mediating factors in this relationship. Applying multiple theoretical frameworks including feminist standpoint theory, capabilities approach, and social ecological models, we demonstrate how women's healthcare gatekeeping represents a domain-specific exercise of agency within traditionally constrained gender systems. These findings suggest that targeted policy interventions should focus on enhancing women's decision-making authority while simultaneously addressing broader socioeconomic factors to improve community health outcomes in resource-limited settings.