Social Issues

Gender roles: Gender roles are tlie roles tliat society assigns to its men and the women based on their gender. Altl~oi~gli gender roles have been changing in the developed countries, traditional gender roles are still dominant in the developing and under developed societies. Tliese roles are influenced by political, economic, cultural, social, religious, ideological and environmental facrors and !nay vary and are changeable over time, as well as from one culture, society arid comniilnity to another. Geinder, Poverty and Health Gender refers to the roles and respo~lsibilities women and men, which are socially of detr:rmined. Gender differences are learned, changeable and vary both within and between cultures. These are socially constructed and determine the position of men and women in the society. Gender has shaped tlie lives of women and men over centuries. In most societies paid work and politics are seen as 'male' and family and household as 'female' responsibilities. Not being a part ofthe mainstream of economic and social life, woliien are marginalised and have received fewer benefits of development. Women do not have equal access to education, skills, employment opportunities, mobility and polii ical r~epresentation. Tliese factors diminish their human development capacities. This has lead to feminisation of poverty both in rich and poor countries indicating ilnec~ual situation in the labour market, social security systems and within households, also affecling the health of women. Following facts summarize the situation: Of the 1.2 billion poor in the world, 70% are women. Most women, nlore so in third world, have no independent inco~ne those who do, have around three and fourtl~s colnparable male salary. of Therr: is also cilltilral devaluation of female gender; work done at home is considered of less value tlian waged work. Also they work longer hours tlian Inen and have pressures on available time and energies linked to sole respolisibilities. Few women hold any real economic or political power. With no decision making ,powertlie access to education, nutrition, health and social services also is poor, ;affectingtheir health directly and indirectly. 'There are twice as many women as Inen who are illiterates. Iron deficiency, anaemia and protein energy malnutrition are more common in wornen. Half a million wornen die ilnnecessarily due to pregnancy related complications, clue to neglect and poor access to liealtli care. In mauy countries men outlive women despite the biological advantage woanen 11 ave. I'he sex ratios are low as Inore females die during childhood and childbearing years clue to gender discrimination in nutrition, health care and social support.

Gender Sensitivity Tlie ilr~balance between tlie two sexes in the society has riot only marginalised women and affected their health, indirectly it has affected tlie whole society with ol'the population not developing to its full potential and hence not about l~alf contributing fully towards the development of the society. Empowerment of women, therefore, is extremely important. Gender awareness and sensitivity in society, particularly among the policy makersand its iniplementers is imperative. All of us need to be aware tliat gender differences exist. We sliould perceive and overcome gender sensitive policies, programmes as well as social and legal these tl~rougl~ justice.

Gender Equality: This refers to the equality of opportunity wherein women slio~~ld equal rights and entitlements to human, social, economic and cultural have development and eq~lal voice in civil and political life. Power-related Concepts Power: The power of an individual refers tlie ability of an individual to control one's destiny. Power is characterized by the following components:

Poverty, Gender and Health

Position in law and access to legal structures and redress. Access to and control over political spaces. Control over labour, inco~ne resources. and Control over access to education and information. Control over physical ~nobility. Control over health.
Gender Equity: This refers to tlie equity of orltcomes and encompasses tlie exercise of equal rights and entitlements which results in outcomes that are fair and just, and wliicl~ enable the women to have the same power as men. Healtli Related Concepts Defil~ition health: According to the World Healtli Organization, healtli is a state of ofcomplete physical, mental and social well being and not merely an absence of disease or infirmity. Health I~iclicators:Health indicators are standardized health measures to study the health s t a t ~ ofsa population. ~

7.3

DETERMINANTS OF GENDER HEALTH

Even thoug11 health is deter~nined a number of factors, some of these have a by specific direct or indirect bearing on gender health. Therefore, tlie deterlninants described below are specifically related to gender health.
Socio-cultural Factors: Socio-cultural factors such as customs and c ~ ~ l t uinfluence re gender health in a significant manner.

(a) Preference for Son: In the Indian society. preference for male child over female child due to which her health is neglected occLlrs due to the following factors:
Patriarchal society: "Preservation" of tlie family name in tlie forthco~iiing generations is a main cause of concern. The Son as a Bread winner: The bias against females in India is related to the fact that "Sons are called upon to provide the income; they are tlie ones who do most of the work in tl.3 fields." in this way solis are looked to as a type of insurance. Thus, it becomes clearer that tlie high value given to males decreases tlie value given to females. Dowry: The practice of dowry is wi lely prevalent even in com~nunities and castes in which it had never been known before. As a result, daughters are considered to be an economic liability.

(b) Early Marriage: in india, traditionally the transition from childhood to adulthood among females has tended to be sudden. This is because marriage, and consequently the onset of sexual activity and fertility occur earlier in india, thrusting the adolescent early into adulthood.

Social lssucs

Tlie average adolescent bride is unlikely to have had a say in the decision about wlio~n when to marry, whether or not to Iiave sexual relations and when to bear or children. On the contrary, society often places strong pressures on young women to prove their fertility, and in many settings bearing sons is the only means by which yoi~ng women can establish social acceptance and economic security in their marital homes. (c) Gender Violence: Gender-based violence both reflects and reinforces inequities between men and women and cornpro~nises health and dignity of the tlie cvomaii. Gender violence is manifested in the form oftlie following social evils such which are widely prevalent in Indian society. Tlie prevailing social evils and tlieir impact on liealth are discussed below: i) Female foeticicle e 4dvanced tecllnologies to detect the sexoftlie child, especially ~~ltrasonograpliy now conveniently available at tlie "clinic next door'', are with the wo~nan's family willi~ig dish out any alnount that is demanded of to 1 hem. The sex of a foetus can be determined within 13 to 14 weeks of pregnancy by trans-vaginal sonography and by 14 to 16 weeks through These methods have rendered sex determination abdominal i~ltrasound. cheap and easy. According to a recent report by tlie United Nations (2hiIdren's Fund, up to 50 million girls and women are missing from India's population as a result of systematic gender discrimination in India leading to adverse sex ratio. Hence, the sex ratio is skewed in favour of males, being 933 females for every 1000 males. Tlie sex ratio has bee11found to be lower for the North western states like Punjab (874), Haryana (86 1 ), FLajasthan (922) as compared to tlie Kerala which has a better sex ratio of 1028 and Tamil Nadu (986). Tlie sex ratio for the girl side is also at a disadvantaged end: 927 girls in the age group of 0 to 6 years for every 1000 boys in that age group.
e

Impact on health: High incidence ofabortions, mostly illegal which endanger tlie woman's health.

i i) Domestic Violence
o

Domestic Violence can be described as when one adult in a relationship misuses power to control another. It is the establishment of control and fear ir-I a relationship through violence and other forms of abuse. Domestic violence can be Psycliological Abuse, Social Abuse, Financial Abuse, Physical Assault or Sexual Assault. Violence can be criminal and includes pllysical assault or injury (hitting, beating, shoving, etc.), sexual abuse (forced sexual activity), or stalking.
llmpact on health: It may result in

(i) (ii)
(iii)

(i)
Dowry
e

Injury Psychological disturbances Unwanted pregnancy Sexually transmitted infections including HIVIAIDS.

Dowry is the payment in cash orland kind by the bride's family to tlie . bridegl-oom's family along with the giving away ofthe bride. Dowry originated in upper caste families as the wedding gift to the bride from her family. The dowry was la~.er given to help with marriage expenses and became a form of insurance il-I the case that her in-laws mistreated her. Although the dowry was legally ~II-oliibited 1961, it continues to be highly institutionalized. The groom often in demands a dowry consisting of a large sum of money, farm animals, furniture,

and electronics. The practice of dowry abuse is rising in India. The most severe is "bride burning", the burning of women whose dowries were not considered sufficient by their husband or in-laws. Most of these incidents are reported as accidental burns in the kitchen or are disguised as suicide. In 2005, the National Crime Records Bureau recorded a dowry death every 77 minutes and the ni~rnber bride burning cases totaled to 7026. of Impact on health: It leads to (i) Injuries which maylmay not result in death (ii) Psychological disturbances. iv) Sexual Harassment, Pornography and Rape As in other countries, sexual Harassment, pornography and rape are crimes faced by women in India. Victims of rape are often reluctant to report because ofthe stigma attached to the crime. Similarly, pornography contributes to violence against women by sending out the message to men that women elljoy being beaten, abused and raped. A total of 18359 cases of rape and 9984 cases of sexi~al harassment were reported in 2005.
Impact on health: The following consequences may occur:

Poverty, Gender and Health

(i) Injuries (ii) Unwanted pregnancy (iii) Psychological disturbances (iv) Sexually transmitted infections including HIVIAIDS. v) Prostitution Prostitution is a rampant social problem in India. Growing poverty, increasing urbanization, and industrialization, migration, and widespread unemployment, breaking LIPofjoint family system, etc. are also responsible for the prevalence and perpetuation of the prostitution. A survey conducted by Indian Health Organization of a red light area of Bombay shows that 20% of the one lakh prostiti~tes children. are
Impact on health: The following consequences may occur:

(i)

Unwanted pregnancy

(ii) Sexually transmitted infec\ions including HIVIAIDS. vi) Child Marriage Child marriages are a common phenomenon even today and the bride is very much younger to the bridegroom.
Impact on health: The following consequences may occur:
#

(i) Early pregnancy which may result to higher mortality. (ii) Higher chances of repeated pregnancies which impairs maternal health. Socio-economic Factors: Socio-economic factors have always been known to influence health. These factors include: (a) Educational level: 'The low'educational status of majority of Indian women results in a negative impact on their health in the following ways: Ignorance towards health and health related issues Poor treatment seeking behaviour. Lack of power in decisions related to one's heaIth. Poor income generating prospects - mostly restricted to housework and low paying jobs.

o c i r l Issues

(b) Socio-economic status: purchasing power, standard of living: As mentioned abovla, poor financial conditions ofthe Indian woman results in a dissatisfactory health status.

( c ) t3ccupation: Occupation of the woman affects her health by:

Women engaged in unskilled operations often have to work for long hours and under unsatisfactory conditions. Women working inside homes are most exposed to the dangers of indoor pollution.
a

Pvle~ltal sexual harassment of women at the work place affects their and mental we1 I being.

Environmental Determinants: Here we are using the concept of "external" or "macro environment" to which a persoil is exposed. It includes:

(a) Sanilation: In villages, women have to walk for long distances to collect water and carry it back to their homes. This leads to early development ofjoint-related and spinal problems.
'

(b) Enviironmental pollution: As mentioned above exposure to indoor pollution pre-disposes a woman to lung disorders such as Chronic Obstructive Pulmonary disease and lung cancer.
Health Services: The quality of health services have a bearing on health in terms of:

(a) Availlability: Lack of availability of health services for women in rural areas, especially in the difficult to access areas leads to a considerable impairment of health.
1)

Acce:rsibilityand IJtilization: Even though women targeted health services may be available in an are:a, these services may not provide actual benefit due

Lack of facilities for physioal mobility (transpurt) available to women. Lack of awareness about availability of health services. Lack of power in seeking health care for oneself.

Based upon your knovvledge about the determinants of gender health, enl.~merate factors wliicli have an impact upon the health of women in the your areia.

FIELATIONSHIP BETWEEN GENDER, POWER - blND HEALTH 7.4

As mentioned above, an individual's gender determines the power at one's disposition wiiicl~ turn has an impact on certain factors influencing health. In a developing in country like India, gender inequality which is largely prevalent has an adverse effect on health a.j depicted below:

Gender

I,
I

, "

gad
winner

1
I I

Female

(--w 1 Household I
responsibilities

Child bearer

( - ' r
power

winner

M
Less education, socio-economic status Poor decision making power
rUUl dLLGSb L cUlU U L I I I ~ L I U I ~ U

Figure 7.1: Relationship between Gender, Power and Health

Factors influencing health ~ e t t eeducation and r socio-economic status

I[

I
Health Outcome Disparity in Health

Poverty,'Gender and Health

1'
8

More decision making power Better access to and

of health facilities

7.5

GENDER-RELATED HEALTH, SOCIOECONOMIC AND POWER ASSESSMENT INDICATORS

171e indicators which are discussed below are used to measure health and the socioeconomic related factors of males and females and to study their disparity in each gender and also for comparison in different areas.

I I

Health Indicators: Health ilidicators are used to directly measure the health status of an individual. The followilig ilidicators are discussed below:

I)

Expectation of Life at Birth

(a) Definition: Life expectancy at birth is the average number of years that will be lived by those born alive into a population ifthe current age specific mortality rates exist. (b) Significance: An increase in expectation of life indicates an improvement in the health status.
/

I I
1.

2)

Sex Ratio
(a) Definition: It is defined as the number of females per 1000 males. (b) Significance: Adverse sex ratio is a strong indicator of gender bias and societal problelns such as female foeticide, dowry deaths, etc.

3)

Maternal Mortality Ratio

(a) Definition: It is defined as death of a woman while pregnant or within 42 days of termination of pregnancy, irrespective of the duration and site of

pregnancy from any cause aggravated by the pregnancy or its management but not from accidental or incidental causes.

(b) Significance: It is an indicator of the underlying health status of the wornen and the availability and utilization of maternal health care. Table 7.5 shows that the maternal mortality ratio is higher in India (having a medium HDI) in comparison to Argentina (which has a higher HDI) and Congo (having a low HDI). The higher maternal mortality in India as compared to that of Congo could be attributed to socio-cultural factors such as early marriage, early and repeated pregnancies, etc.
Infant Mortality Rate (a) Definition: It is defined as the number of deaths of infants (under 1 year of age) in a given year per 1000 live births. (b) Significance: It is an indicator of infant rearing practices and care rendered to the female infant. Child Mortality Rate (a) Definition: It is defined as the number of deaths in children under 5 years of age per 1000 live births. (b) Significance: This also indicates the health care and rearing of the female child. Per cent of Children Less than 5 Years who are Underweight (a) Definition: This refers to the proportion of children less than 5 years of age who are underweight. (b) Significance: The nutritional needs of the female child often tends to be compromised due to bias towards the female in sxiety. Total Fertility Rate per Woman 15-49 (a) Definition: Total fertility rate represents the average number of children a woman would have if she were to pass through her reproductive years bearing children at the same rates as the women now in each age group. (b) Significance: High total fertility rate has an adverse impact on maternal health. Table 7.2 shows that the total fertility rate is higher for rural females compared to urban females and is higher in poor women as compared to the rich in India. In Table 7.5, it may be noted that the total fertility rate is highest for the country with the lowest HDI. Age-Specific Fertility Rate per 1000 Women, 15-19 (a) ]Definition: It is defined as the number of live births in a year to 1000 women in the age group of 15 to 19 years. (b) Significance: Teenage pregnancy is considered to be a high risk pregnancy ~vllicl~ turn has a negative effect on women's health. Table 7.3 denotes in that the age specific fertility rate is much higher in poor women as c:ompared to rich women. Percentage of Live Births Attended by Skilled Health Personnel\ (a) Ilefinition: This refersto the number of deliveries conductgd by a skilled bii-th attendant (who could be an accredited health professiohal- such as a midwife, doctor or nurse) per 100 live births during the specified period. ~(b)Significance: It indicates the availability of health care in a community. The wide disparity in the percentage of skilled health personnel attended live births is shown in Table 7.2 and Table 7.3.
..-

10) Modern Contraceptive Prevalence Rate (a) Definition: Modem contraceptive prevalence rate is tlie propol-tion of women of reproductive age of 15 to 49 years who are using (or whose partner is using) a modern contraceptive neth hod at a given point in timc. Tlie modern contraceptive methods include: female and male steriliz :1 t 'loll, intrauterine devices (IUDs), hormonal methods (oral pi1 Is, injectables). condoms. (b) Significance: It indicates tlie provision and utilization of health carc services. 'The contraceptive prevalence rate is much higher in urban tlin~l rural areas (Table 7.2), rich than poor (Table 7.3) and in lion-tribals than tribals (Table 7.4). I I) Unmet Need for Family Planning, Limiting and Spacing (a) Definition: Noni~se contraception alnong women who would like to of regulate their fertility, measured as tlie proportion of currently married women of reproductive age not using co~itraceptio~i wishing either to but childbearing after postpone tlie next wanted birth or to prevent u~iwanted having achieved their desired number of children. (b) Significance: This also indicates tlie availability and utilization offanlily planning services in an area. Tlie unmet need is liiglier among poor women as compared to tlie ricli (7'able 7.3).

Poverty, Gender and Health

12) Number of Women who Completed 3 ANC Visits

(a) Definition: It is defined as tlie percentage of women who have obtained tlil-ee ANC visits from a skilled health personnel as a percentage of live births in a given time period. (b) Significance: It is an indicator of tlie availability and utilization of maternal health care services. I n Table 7.4, it can be seen tliat the number of women who completed 3 ANC visits is higher for lion-tribal women as compared to tribal women. 13) Percentage of Women with Anemia (a) Definition: It is defined as tlie proportion of women in the reproductive age group having a hemoglobin level of less than 1 1 g % . (b) Significance: It reflects upon the nutritional status of women and also pertaining to tlie availability and utilization of health services in terms ofIron folic acid supplementation. Table 7.4 displays tliat a higher percent oftribaI women are anaemic compared to lion-tribal women. Socio-economic Indicators: These indicators do not directly measure health but point towards tlie socio-economic factors which influence health.
1)

Educational Level Related Indicators: These include:

a a
.

Literacy Rate: Proportion of persons literate (having the ability to read and write) above the age of 7 years. Gross Enrolment Ratio: 'l'lie Gross Enrolment Ratio can be defined as of percentage of projected Pop~~lation School age children in age groups 7- 18 Years with that of actual no. of children attending school. Net Priniary School Attendance: Proportion of primary school children enrolled who are actually attending at least 70 % oftlie classes during a given year.

Social Issues

2)

Worlk Participation Indicators Iiabour Force Participation Rate: The Labour Force Participation Rate (LFPR) is defined as the number of persons in the labour force per 1000 persons. Persons categorized as working (employed) and also those who are seeking or available for work (unemployed) together constitute labour force. Work Force Participation Rate: Persons who were engaged in any economic activity constitute work force. The number of persons e:mployed per 1000 persons is called Work Force Participation Rate (WFPR). 1Jnemployment Rate: Unemployment rate is defined as the number of persons unemployed per 1000 persons in the labour force. Persons who owing to lack of work has not worked but either sought through e:mployment exchanges, intermediaries, making applications to prospective employers were considered as unemployed.

3)

Human Development Index (HDI): HDI is a composite index measuring average achievement of a country in three basic dimensions of human development -

(i) A long and healthy lifeas measured by life expectancy at birth. (ii) Knowledge as measured by adult literacy rate and gross enrolment ratio. (iii) A decent standard of living as measured by GDP (Gross Domestic Product) per capita in purchasing power parity terms in terms of U.S. tlollars. The value of HDI ranges from 0 being the lowest value to 1 as the highest value. The health of the woman varies from one country to another with a different HDI. (See Table 7.4) From the table it can be inferred that countries with ,s low HDI manifest a higher fertility, which in turn has an adverse impact on maternal health. The life expectancy for females is higher in countries with high HDI. Also, Socio demographic characteristics such as sex ratio and mean age at marriage and less in India as compared to Congo which has a lower HDI; this may be related to spcio-cultural factors and religious norms.The secondary school enrolment for girls is much less as compared to primary enrolment in India and Congo which indicates that girls are made to drop out of school earlier so as to take up household responsibilities.
Power Assessment-related Indicators: The power related indicators are used to assess the power available to an individual.

1)

Gencler-Related Development Index (GDI): GDI is a composite index measuring average achievement in the three basic dimensions captured in the human development index -a long and healthy life, knowledge and a decent standard of living -adjusted to account for inequalities between men and wom1:n. Gender Empowerment Measure (GEM): GEM is an indicator which focuses upon opportunities available to women rather than their capabilities. The foIlo\wingvariables are taken into consideration:

2)

E'olitical participation and decision-making power, as measured by women's and men's percentage shares of parliamentary seats. Economic participation and decision-making power, as measured by two indicators: women's and men's percentage shares of positions as legislators, senior officials and managers and women's and men's percentage shares of p-ofessional and technical positions.

Power over economic resources, as measured by women's and men's estimated earned income (PPP US$) 3) Gender ~ ~ u a l i Index (GEI): The index of gender equality measuring the ty attainments in human development indicators for females as a proportion of that of males. Other Women Empowerment Related Indicators (a) Percentage of Parliament seats held by women. (b) Currently married women who usually participate in household decisions. (c) Per cent of ever married women who have experiences spousal violence. Activity 2 Draw a linkage chart between gender, power and health for your area as represented i n the section above.

Poverty, Gender and

Health

I
I

4)

7.6

GENDER HEALTH DISPARITY' ACC DEMOGRAPHIC SITUATION

Disparity in socio-economic and health indicators between males and females in India (Table 7.1) In Table 7.1 it is evident that the socio-economic indicators of women are lagging behind that of men in India. Although the life expectancy of females at birth is more than that of men (Females: 66.9 versus Males: 63.9)' if this is compared with the difference in life expectancy at birth between males and females in Argentina (females 74.3 versus Males 67.1) which is a country with high HDI, it is more than that of India. The bias towards females is seen in tlie adverse sex ratio and higher infant, under-five child mortality rates and higher proportion of malnutrition in - females. Disparity in health and empowerm ent indicators of women across rural and urban India a able 7.2)

From Table 7.2, it can be observed that urban women have better indicators as compared to rural women. The fertility rates dre reported to be higher for rural women. Also a low availability and utilization of maternal and child health services in rural areas is evident from tlie lower contraceptive prevalence rate and lesser proportion of deliveries conducted. Disparity in health' indicators of women according to wealth in India (Table 7.3) Women from tlie richest quilltile enjoy much better health as compared to women from tlie poorer classes of society. The fertility rates are higher for poorer women who also report lower contraceptive prevalence rate, lesser proportion of deliveries conducted and a higher un~net need of contraception.

Social Issues

Disparity in health status between tribal and non-tribal women in state of Jhairkha~id(Table 7.4) A higher number of tribal women are illiterate and more number of them are working as compared to non-tribal women. Tribal women project better health indicators. Global comparison of (a) selected health indicators for females (b) selected socio-ecoi~omicand power related indicator (Table 7.5)

On comparing countries with varying Human Development Indices (HDls), Argentina whicli has a higher HDl as cornpared.to India and Congo shows better health indicators. Socio-economic indicators such as literacy rate and gross enrolment rate for school!; are directly proportional to the HDI, that is Argentina has higher literacy rates. rate and el~rolment
Comparison of education level and health status of women in Bihar and Kerala (Table 7.6 ) According to National Planning Comlnission Report of 2001, gender equality index for Kerala and lowest for Bihar. Therefore, as seen in Table 7.5, Kerala reports better socio-econ om ic and health indicators. TABILES: Table 7.1: Disparity in socio-economic and health indicators between males and females: India

1 Socio-economic indicators Literacy Rare (%) (2001 )

Mules

Females

Pl.i~lli~l.y school enrol~nent ratio, gross. ( 1 998-2002) % of net priniary school attendance, ( 1996-2003)

I I
I

80

Work icorceparticipation rate (u,pban) Unemr)lovm~:nt (urban) rate

12.9I 8.0 7.5 23.4

I
I

8.7
11.6

[ Mean ilge at marriage

Health indic:~ tors

18.7

Life expectar~cy birth at (200 1)

I Sex ratio (2001)

Child mortality rate
,
/ '

933 70.3 23.2

45

I
72.2 25.3 49
.

Source: UNFPA CountG~rofile 2005, NSSO-55Ihround.

Table 7.2 :Disparity in health and empowerment indicators of women across rural and urban India
Males
Total fertility rate per woman ,15-49 Age-specific fertility rate per 1000 Women, 15-19 Deliveries attended by skilled attendants percent Modern contraceptive prevalence rate for women, 15-49 Percent Currently married who usually participate in household decisions Percent of ever married women who have experienced spousal violence 2I3

Poverty, Gender and Health

Females
3.1 121 33.5 39.9

68
73.3 512

'\

61.4

48.5

30.4

40.2

Source: UNFPA Country Profile 2005 and NFHS-3. Table 7.3 :Disparity in health indicators of women according to wealth in India
Poorest quintile
Total fertility rate per woman, 15-49 Age-specific fertility rate per 1000 Women, 15-19 Deliveries attended by skilled attendants percent Modern contraceptive prevalence rate for women 15-49 per cent Unmet need for family planning, limiting per cent Unmet need for family planning, $pacing per cent
, -

\Richest quintile
2.1 45 84.4 51.2

4.1 135 16.4 39.9

10.4

6.1

9.4
I

5.9

Source: UNDP Report 2005.

, ..
I

Table 7.4: Disparity in health status between Tribal and Non-tribal women in state of Jharkhand

Illiterate (per cent) Percent of women working Number of women who completed 3 ANC visits Percent currently using any method of contraception Percent ofwomen with anemia .

Source: NFHS-2.

Social Issues

The lable given below displays the disparity in women's health across countries with different Human development Indices (HDls).

Table 7.5: (A) Global comparison of (a) selected health indicators for females
Llfe Expectancy at birth Under-five Child Mortality Rate Maternal Mortali~ Rate Total Fertility Rate per Woman 15-49

HIV Prevalence
(%)

High Hum~an Dev~elopmlent Argentina Medium Human Devt:lopmt:nt India Low Human Development Congo

Source: UNFPA Cotl,dry Profile 2005.

(B) Gllobal C:omparisonof selected socio-economic and power related indicators Illiteracy Rate, Primary School Mean age at Per cent of Enrolment, Gross ' Marriage, Female Population 15 Per cent ofSchoo1 and Over, Female Age Population, Female Seats in Parliament Held by Women Per cent

49.7

I13

510

'

629

6.3

Medium Human Development lnd ia Low Human Development Congo Sourc'e: UN.FPA Country Pro$le 2005. Table '7.6: A comparison of education level and health status of women in Bihar and Kerala

High Human Develfopment Argentina

I
Indicators of Women's Education Female literacy 2001 Primary school enrolment
1999-2C0 - -

Bihar

Kerala _

Indicator's for Women's Health Mean age at marriage Total fertility Percentage of women with anemia Maternal mortality Infant niortality for girls Source: NFHs-2 and Census, 2001

Activity 3

Poverty, Gender and Health

Analyze the disparity in gender health for your area with respect to the economic conditions.
L ..................................................................................................................... ..................................................................................................................... ..................................................................................................................... ..................................................................................................................... .........\...1.................................... ;........................................................... .....,. .....................................................................................................................
/
/

7.7

WOMEN EMPOWERMENT

Definition

Women empowerlnent is a process that brings about significant changes in women which enables them to control their own destiny.
Dimensions of Empowerment

Tlie dimensions of empowerment may be manifested at the domestic (or household level), comlnunity level as well as in broader areas such as regional/national level in the following areas:
/

I)

Socio-economic: Ensure women's access to employment, ownership of assets and lands, access to credit, access to and control of family resources and assistance to women in difficult circumstances. Bringing about a colnmitlnent to education of girls. Socio-cultural: Shift in patriarchal norms (Such as preference for male child), ensure participation of worneri in social networks. Also includes participation in doliiestic decision making such as ability to make child bearing decisions, use contraception,control over marriage timing and community mobilization for shifts in marriage and kinship systems. Legal: Includes fostering knowledge for legal rights and protection against crime. Political: Empowerment of women with rights for political decision making. Health: Ensure availability and accessibility of underprivileged women, i.e., the least educated, the poorest quintile, rural and tribal women. It also focuses upon the mental dimension of health by means of enhancing a sense of self esteem, self efficacy and psychological well being in women.
\

2)

3)

4)

5)

7.8

GOVERNMENT INITIATIVES FOR WOMEN EMPOWERMENT

i) Swayamsidha: This scheme came into being as a result of merging of the two earlier scliemes of Indira MahilaYojana and Mahila Samriddhi Yojana.

Tlie objectives of this scheme is to develop empowered women who will (a) demand their rights from family, community and government; (b) have increased access to, and control over, material, social and political resources;
\

Social Issues

have enhanced awareness and improve4 skills; and

,

(d) be able to raise issues ofcommon conc n through mobilization and networking The activities under this sclierne include:
\

31:

(a) Establishment of self-reliant women's ~ ~ l f - ~ e l ~ ~ r o according to (SI-IGs) u ~ s soc 10-economic status tind felt-needs. (b) Federating and networking strong pressure groups for women's empowerment/ rights. (c) Creiition of confidence and awareness among members of SHGs regarding women's status, health, nutrition, education, sanitation and hygiene, legal rights, economic uplifiment and other social, economic and political issues. (d) Encouraging savings habit in rural women and their control over economic resources. Improying access of wornen to micro-credit and involvement of women in local level planning. ii) S'wadhar: This scheme has been framed for women in difficult circumstances. The objectives of this scheme are: (a) To provide primary need of shelter, food, clothing and care to the marginalized womenlgirls living in difficult circumstances who are without any social and economic support. counselling to s ~ ~ c l i women. (b) To provide emotional s~~ppc~rtand To arrange fpr specific clinical, legal and other support for such womenlgirls in need .by linking and networking with other organizatiorls in both Government and Non-Government sector on case to case basis. The target group beneficiaries of the sclieme include women without any social and econc)micsupport and those disowned by their families such as: (a) 'Widows. (b) 'Women prisoners released from jail. (c) \Nornt:n survivors of natural disaster. (d) Imraffil:ked womenlgirls rescued or rlylaway from brothels or other places or \vomen/girl victims of sexual crimes.
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(e) \Yomen victims o terrorisr/exfrernis violence. f ( f ) Rllentally challenged women (except for the psychotic categories who require care in specialized enviroriinent in mental hospitals). Viomen with HIVIAIDS deserted.by.their family or women who have lost their husband due to HIVIAIDS. iii) Scheme for Short Stay Home for Women and Girls This sc:hema answers the need for providing short stay homes for women and girls in difficulties and those working outside their hometown. Shelter is given to the following categories o F women: (a) Those who are being forced into prostitution. (b) Those tleserted by their famxies due to marital discord or those who escaped away from their families due to mentallphysical torture, etc. Those who have been sexually assaulted and are facing the problem of re.-ad-justment the family or society. in

iv) Stree Shakti The scheme was launched during 2000-01 in tlie state of Karnataka. It has the followi~ig objectives:
1)

Poverty, Gender and Health

2)
3)
4)
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To strengthen the process of economic development of rural women. To form one lakh Self Help Women croups based on thrift and credit principles wliioli builds self reliance. To create self confidence in rural women by involving them in income generating activities thus contributing to poverty alleviation. To provide opportunities to the members of the groups to avail the benefits of their departmental schemes by converging the services of various departments . , and lending institutions to ensure women's access to credit financing.

(a) Women living below poverty line (b) Women landless agricultural labourers (c) Women belonging to SCISTs (d) Families havingeither alcoholics, drug addicts or physically disabled persons. Socio-cultural
a)

Welfare schemes for the girl child

i)

Balika Samriddhi Yojana :Balika Samriddhi Yojana is a 100% Centrally Sponsored Scheme. Its objectives include: (i)To change negative family and community attitudes towards the girl child at birth and towards her mother. (ii)To improve enrolment and retention of girl children in schools. (iii)To raise the age at marriage of girls. (iv) To assist the girl to undertake income generating activities. htt~:l/wcd.nic.inl-bsytop. Balika Samriddlii Yojana The will cover girl children in families below the poverty line (BPL) as defined by tlie Governrnent of India, in rural and urban areas, who are born on or after 15 August, 1997. They are entitles to the following benefits:

1. A post-birth grant amount of Rs.5001-. 2. She willtiecome entitled to annual scholarships as under for each successfully completed year of schooling:
CLASS
1-111

AMOUNT OF ANNUAL SCHOLARSHIP Rs.3001- per annum for each class Rs.5001- per annum Rs.6001- per annum Rs.7001- per annum for each class Rs.800;- per annum Rs.l,OOO/- per annum for each classhtt~://wcd.nic.in/bsytor,
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IV VI-VII VIII

IX-X

ii)

Cradle Baby Scheme: Cradle Baby Scheme has been launched by the government of Tamil Nadu in 1992. Under this scheme, cradle beds are provided for at places like hospitals, primary health centers and maternity homes for . abandonment of female infants by the biological parents. Tlie infant is then sent to a rehabilitation home. Apni Beti Apna Dhan Scheme: This programme has been launched by the Government of Haryana. Tlie ABAD sclleme entitles the mother of a newlyborn girl-child to an amount of Rs 500 and an Indira Vikas Patra (IVP) of Rs

iii)

Social Issues

2,500 in favour of the child. The IVP is encashable only after1 8 years, i.e. after the baby becomes an adult. On maturity, the IVP amount becomes Rs 25,000. The monetary incentives offered to mothers and girl children, available under the scheme, have not only improved the respectability of both the mother and girl child but promoted small family norm and anti-child marriage campaign acceptable among ignorant and financially poorer families. b) IEduc~ationalSchemes i)
SanvaSiksha Abihyan: This is a holistic and convergent scheme with thrust on com~nunity participation, aims to bring all children in school and aims to provide elementary education to all children by 201 0. The programme has a special ~ O C Uon educational needs of girls, scheduled castes and scheduled tribe. :~ District Primary Education Programme: This program has been launched in districts with 1041' female literacy. Under this program, 1 1,000 new formal schools and over 4 1,000 alternative schools have been established and as Inany as 4,500 anganwadis have been strengthened.

ii)

LEG;AL

i) Constitutional Provisions a Iirticlt: 14-equal rights and opportunities on men and women in the political, economic and social spheres. Article 15_(3)-enables state to make affirmative discrimination in favour of women. citizens.
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,Article 39- providing men and women equally the right to means of livelihood and equal pay for equal work. ,4rticle 42 -humane condition of work and materpity relief.

ii) N:ation:alPolicy fo The goal of'this Policy is to bring about the advancement, development and empoTwerment of women. The Policy will be widely disseminated so as to encourage active participation of allstakeholders for achieving its goals. Specifically,the objectives of this Policy include (1) Creating an environment through positive economic and social policies for full

(2) The dtl-jure and de-facto enjoyment of all human rights and fundamental fireedom by women on equal basis with men in all spheres - political, economic, slocial, cultural and civil.

(4) Equal access to women to health care, quality education at all levels, career and ~~ocational guidance, employment, equal remuneration, occupational health and silfety, social security and public offrce, etc. against women.
(6) Changing societal attitudes and community practices by active participation and involvement of both men and women.

(7) (8)

Mainstrea~ning gender perspective in tlie development process. a Elinii~iatio~idiscrimination and all forms ofviolence against women and the of

Poverty, Gender sad Health

I society, particularly women's

organizations. iii) National Commission for Women The Govemnient of India has set up a National Commission for Women to monitor violations oftlie rights of women enshrined in our Constitution and the law.

ii) Legislative Measures

1)

Domestic Violelice Act 2005. at Work Place B i l l 2007. Dowry Proliibition Act 1961. Medical Termination o f Pregnancy Act 197 1.

3) 4)

6)
7)

lmmoral Trafficking (Prevention) Act 1986.

Pre-natal Diagnostic Technique (Regulation and Prevention o f Measure) Act Child Marriage Restraint Act 1976. The Indecent Representation o f women (Prohibition Act) 1986.
'

8)
9)

1) Domestic Violence Act 2005

The Domestic Violence Act o f 2005 is primarily meant to provide protection to the wife or female live-in partner from violence at the hands o f the husband or male live-in partner or his relatives, tlie law also extends i t s protection to women who are sisters, widows or mothers. Domestic violence under tlie act includes actual abuse or tlie threat o f abuse whether physical, sexual, verbal, emotional or economic. Harassnie~lt way o f unlawful dowry demands to the woman or her relatives would by also be covered under this definition. The office i s punishable with a non-bailable imprisonment for a term which may be up to one year or imposition of fine o f more than Rs 20,000 or both. 2) Protection of women against sexual harassment at Work Place Bill 2007 l'his Act provides for protection o f women against sexual harassment at the workplace. I t also covers the unorganized sector as well as other places o f confinement sucli as police station, courts, juvenile homes and prisons. 3) Dowry Prohibition Act 1961 According to this law, i f a groom or his family is found to be taking dowry, lie shall be pu~iishable wit11 i~nprison~nent a term which shall not be less than five years, and for with the fine which sllall not be less than fifteen thousnnd rupees or tlie amount o f the value o f sucli dowry, whichever is more. Ifthe groom or his family have been found to be demanding dowry, then he sllall be punishable with imprisonment for a term wliich shall not be less than six months but which may extend to two years and with tine whicli may extend to ten thousand rupees.
,

4) Medical Termination of Pregnancy Act 1971 This Act was legislated with the aim to curb the menace o f illegal abortion. The Act provides for the termination o f certain pregnancies by registered medical practitioners. The reasons for which a woman may seek abortion under the MTP Act are as follows:

Social Issues

i)
ii:~

Piliere a pregnant woman has a serious medical disease and continuation of PI-egnancy could endanger lier life. Mrlierethe continuation of pregnancy could lead to substantial risk to the newborn leading to serious physical/mental lialidicaps. Pregnancy resulting of rape.

iii)

iv) Conditions where {lie socio-economic status oftlie mother (family) hampers the progress of a healthy pregnancy arid the birth of a healthy child. v) Failure of Contraceptive Device irrespective of the method used (natural ~nr:thods/barrier metliods/liormonal methods). , /

TI- is condition is a unique feature oftlie Indian Law. 41 the pregna~icies be 1 call terminated using tliis criterion. A woman can seek for an MTP at ally governmental institution or at any institution which has been licensed to provide MTP services.
5) The Commission of Sati Prevention Act 1987
This Aci: was passed to provide for the Inore effective prevention of tlie co~nmissio~i of ,suti. According to this Act if any person cornmits sati,whoever abets the cotnmission'of sucli sati,either direcily or indirectly, shall be punishable with death or imprisonment for life and shall also be liable to fine. onlyone case ofSuti was repo+ted from Rajasthan in 2005.
6) Immoral Trafficking (Prevention) Act 1986

This Act provides for protection of women from trafficking. Any person who keeps or manages, or acts or assists in tlie keeping or management of, a brothel shall be for punishable on first conviction with rigorous i~iiprisonment a term of not less than one year and not more than three years and also with fine which may extend to two thousand rupeesand in tlie event ofAsecond or subsequent conviction, with rigorous , i~nprison~nent a term of not for than two years and not more than five years and also with fine which may exte~# to two thousand rupees. A total of 5908 cases have beer1 apprehended under tliis Act in the year 2005.

1 4

7) ]?re-natal Diagnostic ~ e c h n i ~ u e (Regulation and Prevention of Measure) Act (11994)

This Act provides for tlie regulation of tlie use of prg-natal diagiiostic techniques for the purpose of detecting genetic or nietabolic disorders for the prevention of the misuse of sucli techniques for the purpose of pre-natal sex determination leading to female foeticide. Before conducting any prenatal diagnostic procedure, the medical practitione:r must obtain a written consent from the pregnant woman in a local language that she understands. Prenatal tests may be performed in various specified circuriistaelces. including risk of clironioso~nal abnormalities in the case ofwomen over 115. and genetic diseases evident in tlie family history of the couple. Any doctor who performs a pre-natal test for sex determination or any woman seeking such a-service is liable for i~i~prisonmeiit a term which may extend to three years and for with fine wliicli may extend to ten thousand rupees and on any subsequent conviction, which may extend to five years and with fine which may extend to with impris,o~iment fifty thousand rupees. 8) Cl'lild Marriage' Restraint Act 1976 This Act is ,an Act to restraint the sole~nnization child marriages. Any adult male of a who rnarrie:~ minor or any person found to be conducting child marriage is liable for imprisonment up to 3 months and imposition of fine.,
9) Th~eIndecent Representation of Women (Prohibition Act) 1986

'This Act prc~hibits indecent representation of w o ~ n ethrough advertisements or in ~i publications, writings, paintings, figures or in any other mander. The penalty for

violation oftliis act on first conviction entails imprisonment ofeither description for a term which may extend to two years, and with fine which may extend to two thousand rupees, and in the event of a second or subsequent conviction with imprisonment for term of not less than six months but which may extend to five years and also with a fine not less than ten thousand rupees but which may extend to one lakh rupees.
Political

Poverty, Gender and Health

i) Panchayati Raj Institutions: As many as one million women have actively entered political life in India through the Panchayati Raj Institutions. ii) 73rd and 74th Constitutional Amendment Acts: These guarantee that all local elected bodies reserve one-third of their seats for women which has resulted in the vast majority of local women - most of them illiterate and poor - have come to occupy these seats, enhancing the election of increasing numbers of women at the district, provincial and national levels.
Health

i) Kishori Shakti Yojana: This scheme has been introduced under the aegis of the Integrated Child Development Services Scheme (ICDS). The broad objectives.of the Scheme are to improve the nutritional, health and development status of adolescent girls, promote awareness of health, hygiene, nutrition and family care, link them to opportunities for learning life skills, going back to school, help them gain a better understanding of their social environment and take initiatives to become productive members of the society. ii) Adolescent Girls Scheme: Includes two sub schemes:

Sub Sclreme I: Girl to Girl Approaclr: Under the Girl to Girl Approach (SubScheme I), all adolescent girls in the age group of 1 1- 15 years belonging to families in rural areas are eligible for receiving services. These services include hands on learning experience at the anganwadi centres for a period of six months. Under this Scheme, 12 girls are identified in every anganwadi village in a year. Sub Scheme 11 :Balika Mandal Programme: The Balika Mandal (Sub Scheme 11), is designed for the girls in the age group of 11-18 years. In each block, ten per cent of the anganwadi centres implementing Scheme-I (i.e., Girl to Girl Approach) are selected to serve as "Balika Mandals ". The existing anganwadi centres are used for the activities of Balika Mandal. The Balika Mhndal programme is drawn up in a participative manner keeping the interests and skills of girls in mind with a view to ensure that the enrolled girls actively participate and these girls take maximum benefit out of it. On an average, an adolescent girl participates in the activities of Balika Mandal for a period of six months. Each Balika Mandal caters to about 40 adolescent girls in a year and the activity componen?include learning through sharing experiences, training of vocational and agro-based skills and household related appropriate technology. In addition to providing appropriate envi~onment learn, supplementary nutrition is also provided to the adolescent girls to enrolled in Balika Mandals.
iii) Jannni Suraksha Yojana (JSY) Janani Suraksha Yojana (JSY) is a safe motherhood scheme launched under the National Rural Health Mission. This scheme benefits: 1) All pregnant women seeking antenatal care from government health facilities in states with low institutional deliveries which include Uttar Pradesh, Uttaranchal, Bihar, Jharkhand, Madhya Pradesh, Chhattisgarh, Assam, Rajasthan, Orissa and Jammu and Kashmir (also known as low performing states).

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Social Issues

2)

All pregnant women below the poverty line in High performing states. For wolnen u p to two live births.
All wolnen belonging to the scheduled caste and schedule tribe category in both high performing and low performing states.

1
I

3)
4)

C w h assistance is given to the benejiciaries as follows:

(a) Fclr institutional deliveries

Rural (in rupees)

Low performing states

14~1

Urban (in jupees) ' 1200

tligh performing states

700

600

(b) Home deliveries: 111LPS and HPS States, BPL pregnant women, aged 19 years and above, preferring to deliver at llo~ne entitled to cash assistance of is Rs. 5001- per delivery.
Mataram Scheme: The scheme is available under Public Private iv) Va~nde Partnership with the involvement of Federation of Obstetric and Gy~lecological Society of India and Private health facilities. The aim of the scherne is to reduce the maternal mortality and morbidity of tlie pregnant women by providing free allrenatal and postnatal check, counselling on nutrition, breastfeeding, spacing of birth, etc. by utilizi~lg vast resources available in tlie private sector. the

iv) National Population Policy: The Government of India launched the National Pojpulation Policy in 2000 which has the followir~gco~nponents directed towards improvement in maternal health of underprivileged wornen: (a) Convergmg service delivery at village level (b) Empowering women for improved health and nutrition. (c) Meeting the uri~net need for contraception. (d) Undertaking special intervelitions for special groups such asurban slums, tribal,communities, adolescents, hill areapopulatio~is displaced and and migraht populations. (e) Collaboration withNon-governmental organizations for better reproductive health care delivery. , vi) Reproductive and Child Health Programme II Thr: secclnd phase of the Reproductive and Child Health Programme I1 was launched in the year 2005. The Maternal Health Programme which is a component of tlie Reproductive and Child Health Programme aims at reducing maternal mortality to less than 100 by the 20 10. The major interventions include: .(a) Essential obstetric care intends to provide the basic maternity services to all pregnant women. (b) Strengthen the emergency Obstetric Care Services and make the FRUs (First Referral Units) operational. (c) Provide 24 hours delivery services at PHCs/CHCs. (d) Provision of ambulance services in case of referral. (e) Provision of safe abortion services.
(f) Develop a special cadre of community level Skilled Birth Attendants
.

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(SBAs).

7.9

NGOs WORKING FOR WOMEN IN INDIA

Poverty, Gender and , Health

Following are the NGOs, which are working in the area o f woman empowerment in Ii~dia. Joint Women's Programme - NGOs Delhi CSIRS, 14 Jungpura B, Muthura National Council of Women In India Poona Medical Foundation, Ruby Hall, Clinic, 40 Sassoon, PO Box No. 70, Pune-4 1I00 Committee on the Portrayal of Women in the Media 4 Bhagwzndas Road, New Delhi- I 10001 India

(
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Centre for Women's Development Studies The Library 25, Bhai ~ ising], Marg, Gole Market r New Delhi 1 I000 I. (Institute of Social Studies Trust M-l Kanchenjunga 18 Barakhamba Road, New Delhi- l I000 1 India

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National Coinmission of Women 4, Deen Dayal Upadhaya Marg New Delhi-I10002

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The YWCA of India- NGOs Delhi 10, Sansad Marg, New Delhi- l10001. All lndia Coordinaking Forum of the AdivasiIIndigenous Peoples (AICAIP) K - 14 (First Floor);Grten Park
c.,+---:--LYCW n-IL:i V UnUi. ~ xr I n CAlCll31VI1, UCllll- 1 I I

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r ~ i v e r s e ~ o m for Diversity en A -60 tlauz Khas New Delhi- I 10016. 1

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Kali For Women B 118 Hauz Khas, l st Fl New Delhi-l10016. Centre for Social Research E.82, Saket New Delhi-110017 Social Work and ~ e s e a r c h Centre: Network for Self-reliance of the rural poor Tilonia-305 816, Ajiner, Rajasthan, India. Center for Health Education, Training and Nutrition Awareness, (CHETNA) Lilavatiben Lalbhai's Bungalow Civil Camp Road, Shahibaug-380004 Ahmedabad, Gujarat, India Maitreyi 7, Maniiki, Makarand Society r Veer ~ i v a r k aMarg, Mahim Mumbai-4000 16

Wornen's Foundation L 1-4 Hnuz Khas Enclave New Delhi- 1100 I6

Centre for Women's Development Studies B-43 Panscheel Enclave New Delhi-I10017 SEWA (women and work) Reception Centre Opp. Victoria Garden Ellisbridge Ahmedabad-380 00 1
I The Women's Centre of India

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Nehru Road, Vokola Santa Cruz, Mumbai-400 005 Akshara - A Women's Resource Centre Neelambari 501, Road no. 86 Off Gokhale Road Dadar, West, Mumbai-400028 Working Women's Forum 55 Bhimsena-Garden Road
r

Center for Informal Education and Development Studies No.7, Balaji Layout Wheeler Road Extension Bangalore460 084 -

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Stre lakha (Feminist Publisher) 16, Southern Avenue Kolkata-700 026

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Sanhita Gender Resource centre 89B, Raja Basanta Roy Road

U Iloor Trivandrum

Social Issues

7.10 -- SUMMARY
It is evident that the status of women in India is yet at a disadvantage as compared to Inen and also in contrast to women belonging to developed countries. The efforts by the government as well empowerment of women by means of co~icerted as voluntary agencies will gr, a long way in enhancing the status of women on whom the healtlt of her Wire family depends.

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1.

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SELF-ASSESSMENT QUESTIONS
Which factors influence the preference of son in Indian society?

State the difference between gender equality and gender equity. How does early marriage affect women's health? What is gender violence? Name the different forms of gender violence which are prevalent and their influence on gender health. Define the indices: (i) Hurnan Development Index (HDI) (ii) Gender related Development Index (GDI) (iii) Gender Equality Index (GEI). How does the health of women in lndia differ from that of women in other parts of tlifecountry and the world? Outline the salient features of the disparity between health of men and women iy India. ,

2.

3.
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5.

6.
7.

IFURTHER READINGS
I

Park. K. 2007. Textbook of Preventive and Social Medicine, 19th Edifion. Bhanot Publishers, Jabalpur. Kishore, J. 2006. National Health Programmes of India, 6 t k ~ d ( New Delhi: , Centllry Publications. Unite:d Nations Development Report, 2006. United Nations Population Fund Country Report, 2005.