Mind the gap: Gender differences in walkability, transportation and physical activity in urban India

Introduction: Insufficient physical activity (PA) is a key contributor for premature mortality in low- and middle-income countries (LMICs). Despite the well-documented health benefits of PA, few women achieve the recommended levels of PA. The global average of inactivity among women is higher at 31.7% compared to 23.4% for inactive men. The gender gap in PA participation is wider in India where estimates indicate that 44% women are insufficiently active, compared to 25% men. Methods: This cross-sectional study was conducted in the city of Chennai, India. Participants (N = 370) were recruited from 155 wards stratified by neighborhood walkability and socio-economic status. The adapted Neighborhood Environment Walkability Scale for India (NEWS-India) was used to assess built environment perceptions on density, land-use mix, street infrastructure, aesthetics, traffic and crime safety. Travel and leisure PA were recorded using the International Physical Activity Questionnaire-Long Form (IPAQ-LF). Study protocols were based on recommendations of the International Physical activity and the Environment Network (IPEN; www.ipenproject.org) and previously used in studies in Brazil, Colombia, and Nigeria. Results: A greater number of women reported achieving weekly PA levels from travel-related activities (n = 54, 16.0%) compared to men (n = 33, 9.8%). In contrast, a higher percentage of men (n = 75, 22.3%) met weekly PA recommendations during leisure-time compared to women (n = 54, 16.1%). Street connectivity (aOR = 3.2, CI = 1.3, 8.0) and land-use mix access (aOR = 3.7, CI = 1.4, 8.2) significantly increased odds of travel PA among women. Conclusions: Low engagement in leisure PA among women can be linked to prevailing socio-cultural norms that constrain women's mobility and hinder their participation in PA. Aspects of gender equity in transportation planning are closely linked with citywide indicators of liveability, sustainability and resilience in LMICs like India. Public health practitioners must address gender-specific barriers to increase PA among women through context-specific group exercise programs, peer support and guidance that emphasize the importance of PA.