Improving Women’s Health and Reproductive Rights in India
Improving women’s health and reproductive rights in India
Poonam Muttreja and Sanghamitra Singh
The COVID-19 pandemic has exacerbated the challenges faced by women across every sphere, from health to economy. In the past year, we have witnessed the beginning of a discourse around the gendered impact of outbreaks and targeted efforts to mitigate them and gain momentum. However, women’s struggle for equity and equality has been a pre-COVID-19 problem prevalent globally. As the Economic Survey 2017-18 aptly stated, “In some sense, once born, the lives of women are improving, but society still appears to want fewer of them to be born”.
Gender disparities have crept into women’s access to health services. Generally, most women receive medical attention only during pregnancy-stemming from India’s patriarchal understanding of women’s role in society. The lack of sufficiently disaggregated data by gender makes it difficult to assess how particular health issues affect women differently from men. For instance, women are more likely to suffer from nutritional deficiencies than men. Adolescent girls are particularly vulnerable to malnutrition because their growth and development is at its peak during these years, while a large number of girls eat the last and the least. Adolescents who become pregnant are at greater risk of various complications since their body is still undergoing development.
Women and girls’ access to health services is determined not merely by their availability, but by a number of contextual and sociocultural factors as well as prejudices, which, more often than not, create an environment that is unfavourable to them and their health needs. According to the fourth National Family Health Survey (NFHS4- 2015-16), more than two-thirds (67 per cent) of women aged 15-49 years report at least one problem for themselves in obtaining medical care when they are sick. More than a third (37 per cent) of women report concerns that no female health provider was
available. Close to 30 per cent of women cite the distance to a health facility and 27 per cent cite transportation as a problem. Other reasons for not accessing health facilities include the absence of a health provider, and non-availability of drugs. One-fourth of women cite money as a problem.
Despite the growing acknowledgement for the need to address women’s sexual and reproductive health needs, women shoulder the responsibility of family planning. Female sterilization accounts for 75 per cent of contraceptive use in India, which is amongst the highest in the world (NFHS4 2015-16). Deep-seated patriarchal norms and false notions of masculinity have fostered the lack of male engagement for centuries. Men often control decision-making regarding contraception and decision of contraception of female partners, which can and does impede contraceptive use as well as increase risk for contraceptive failure. Burdened by the sole responsibility of contraception, women are increasingly resorting to unsafe abortions which has emerged as a proxy for contraception. It is important to note that access to family planning services is likely to have an economic impact for families that extends beyond the reductions in fertility and improvements in health to many other aspects of their lives.
Despite the high prevalence of domestic violence in India, physical and psychological violence against women has not received sufficient attention. Women experience violence in all forms thereby posing a risk for many physical, mental, sexual and reproductive health problems, and in many cases, even suicide. According to NFHS-4, almost 30 per cent of women have experienced physical violence since age 15. There is also a culture of silence and cases of violence are underreported. The roots of such violence can be traced to the attitudes of both women and men towards wife-beating. According to NFHS 4 (2015-16), 52 per cent of women and 42 per cent of men believe that a husband is justified in beating his wife.
The relationship between violence against women and mental illness is yet to be explored adequately. Women and girls experiencing violence need support and services, including counselling, but hesitate to seek help because of feeling ashamed, fear of facing stigma and lacking support from families and communities. Lack of mental health services is also the reason for not seeking help. For India’s health system to be truly responsive to the survivors of violence, mental health services must expanded and counselling support to women should be offered as a priority.
And finally, violence against women can only be transformed by changing entrenched social norms that normalize and justify acts of violence. If the growing incidence of crimes against women is to be checked, societal attitudes and perceptions need to change. For centuries, India’s dominant patriarchal system has given men the right to control women’s lives, by controlling household finances, her mobility, her health issues, and fertility decisions. Indian society needs to stop viewing women’s health as a women’s issue alone. It is as much a men’s issue and a societal issue.
Improving health outcomes for women in India calls for adopting an integrated approach towards managing their health needs, which includes, but is not limited to focus on nutrition, sexual and reproductive health, mental health and communicable and non-communicable diseases. In addition, there needs to be greater emphasis on addressing the social determinants and barriers in accessing health services.
India’s system is well-trained to count how many children are born and how many women die. But knowledge is limited on the morbidity and medical conditions of a majority of women over their life cycle. India’s health system needs to focus on measures that not only prevent maternal deaths but also improve maternal health outcomes. Medical and research institutes can play a critical role in integrated women’s health as a core area of focus in the public health agenda. Greater investments in gender inclusive research on health are needed to promote better understanding of the health
needs of women. The availability of gender disaggregated data on health at various levels will enable more efficient planning and implementation of women’s health interventions and ensure the best quality of care for them.
Moving forward, policy makers and programme implementers need to make sustained efforts, through tailor made strategies to reach out to the more disadvantaged groups in society, particularly socio-economically vulnerable women. India is a young nation with two-thirds of its population below 35 years of age, as per Census 2011. Given the age structure and the large proportion of population in the reproductive age group, higher investments are needed in spacing methods besides focusing on specific sexual and reproductive health strategies for adolescents and youth to address their needs. India has a window of 30 years to capitalize on this opportunity. Now is the best time to push for greater investments in family planning and overall health needs of our young population in order to reap the benefits of this demographic dividend.
And finally, there is need for more public awareness and public discussions on issues of women’s health and well-being. Changing mindsets through behavior change is critical through entertainment education- oriented communication strategies can inspire the audience to observe, learn and imbibe key messages pertaining to health. As more people in the audience inculcate these novel behaviors in their daily lives, social norms across communities will begin to shift – making it possible to create a new and vibrant India where women are treated with dignity, equality and respect.