Investing in Women’s Health: A Step Towards Gender Equality | Suranjita Ray

The World Economic Forum (WEF) 2023 at Davos makes a strong pitch to overcome several challenges to achieve gender equality by 2030 as targeted in Sustainable Development Goals (SDGs). The WEF Global Gender Gap Index for 2022 highlights the increasing gender gap in economic participation and opportunity, educational attainment, health and survival and political empowerment. The meeting at Davos noted that many of these gaps are preventable. The dialogue outlined that a healthier world for women would be possible through multilateral collaboration of private sectors with the policymakers. The need to prioritise an increased investment in women’s health became a common concern.

Ayushman Bharat Yojna/Pradhan Mantri Jan Arogya Yojna, the world’s largest universal national health protection scheme for the poor families in India was highlighted at the WEF by Smriti Zubin Irani, Minister of Women and Child Development. She stated that this scheme has seen 120 million women being examined for cervical and breast cancer. Similarly, Swachh Bharat Abhiyan was acknowledged as a positive step in improving health conditions of women by building private toilets to ensure hygiene and sanitation. The increase in the duration of leave from 12 weeks to 26 weeks for female employees under the Maternity Benefit Amendment Act is also an important policy decision to secure women’s health.

While the government’s official reports claim that the benefits of several schemes in India such as National Food Security Act, Pradhan Mantri Awas Yojna, Janani Suraksha Yojna, Pradhan Mantri Ujjwala Yojna and Pradhan Mantri Matru Vandana Yojna have empowered women across the country, the ground reality reveals that most women live in poor health conditions as they are discriminated, marginalized, and deprived of basic health care facilities and treatment. Despite the measures to address maternal and reproductive health problems, a large number of women continue to die during pregnancy and childbirth due to lack of prenatal (before birth) and postpartum (after birth) health care facilities. Though it is important to develop research and basic facilities in health care, most women are unable to access and afford the available services due to extreme poverty, increasing gender inequalities, deprivation and discriminations. In fact, preventable health conditions are the cause of deaths of millions of women, children, and adolescents, every year (World Bank).

Experiences at the Ground 

It is disturbing that India ranks lowest on health and survival (the sex ratio at birth and healthy life expectancy) in the Global Gender Gap Index for 2022. Despite the launch of the Anaemia Mukt Bharat (anaemia-free India) strategy to reduce anaemia amongst the vulnerable age groups such as women, children and adolescents, the National Family Health Survey -5 (2019-21) finds that 59.1 percent adolescent girls, and 57.2 percent non-pregnant women and 52.2 percent pregnant women in the age group of 15-49 years, are anaemic. Between the two rounds of survey in 2015-16 and 2019-21, anaemia rates have increased from 53.1 per cent to 57 per cent in women (15-49 years) and from 58.6 per cent to 67.1 per cent in children (6 to 59 months). There is an increase in anaemia of 1.8 per cent in pregnant women from 50.4 per cent to 52.2 per cent. Studies suggest that it is important to invest in an enhanced understanding of the varied causes behind this increase in anaemia (Gupta and Seth, 2022: 11). Despite huge number of Maternal and Child Health and Nutrition Programmes/Schemes under various Ministries and Departments, hunger and malnutrition persist.

The irony is that more than half the women and adolescent girls are malnourished and anaemic due to menstruation, pregnancy, and lactation.

Though the constitutional responsibility of the state to secure ‘right to food’ has gained significance through the National Food Security Act in 2013, every year large number of children die of hunger and even when they do not die of acute starvation, tens of millions of children go to sleep hungry. We are far behind the target of the National Nutrition Mission and National Nutrition Strategy worked out for all 640 districts by NITI Ayog as Prime Minister’s Overarching Scheme for Holistic Nourishment (POSHAN) Abhiyan which aimed at Kuposhan Mukt Bharat (malnutrition-free India) by 2022. Though the proportion of stunted children in the age group 0-6 years has declined from 38.4 per cent in 2015-16 to 35.5 per cent in 2019-21, we still have a third of the children who are stunted/malnourished. During the last few years India’s rank has not improved in the Global Hunger Index. It dropped from 94 among 107 countries in 2020 to 101 among 116 countries in 2021 to 107 among 121 countries in 2022.

However, the government claims that the report is misinformation as multidimensional nature of hunger captured by measuring 4 variables such as undernourishment, child stunting, child wasting and child mortality, reflects children’s health status and cannot represent the entire population. The report is also criticised as it defines hunger in terms of variables beyond the lack of food and ignores the successful implementation of free distribution of food under Pradhan Mantri Garib Kalyan Yojana (Mishra, 2022: 13; Gulati, 2022:13). On the contrary, several experts find the data on child malnutrition and mortality as an important indicator of the nutrition level of the whole population as malnutrition that sets in children cannot be reversed in adulthood. Malnutrition is a persistent problem and even if it is named as Global Nutrition Index, India’s rank does not change. These data raise important concerns that contest the systematised understandings of hunger in terms of production, distribution and availability of food. The process of being starved does not start with the biological collapse but a decline in the socio-economic conditions. The multi-dimensional problem of hunger and its experiences need to be explained in terms of their continuity. Providing free food grains to 80 crore poor people is certainly an important step but it will not resolve the problem of malnutrition. It is disappointing that the budget allocation in 2023 for education and nutrition are stagnant. And the allocation of grants for Mid-Day Meals has been reduced by 9 per cent. India is far away from the SDGs target to end hunger by 2030.

Health: A Comprehensive State of Well-being

As health is a comprehensive state of physical, mental and social well-being rather than mere absence of disease (WHO), women’s health have to address discriminations against women in the social and economic structures of society. While it is important to draw strength from the dialogue at WEF, the challenge is to address a fundamental aspect of gender inequality by making the voices of the marginalized and disadvantaged woman heard. The socio-cultural norms defined by patriarchal families contribute to the multiple inequalities and hierarchies that remain relevant despite rapid socio-economic and political transformations that strengthen modern democratic and egalitarian relations. Therefore, it is important to bring structural changes in the family, education institutions and society that can prevent gender discriminations in food, nutrition, health check-up and treatment.

The detonating prejudices against women results in deterioration of their physical and mental health. Negligence of women’s health aggravates due to patriarchal attitudes and behaviour. The caste-based division of labour reinforces gender discrimination as several Dalit women continue to earn their living as manual scavengers, a dehumanising practice that persists till date. Alongside building toilets it is pertinent to have plans for cleaning these toilets. The uneasiness with the findings of empirical researches on the everyday struggles faced by women compels us to have a deeper understanding of women’s health. Despite the moral commitments of the state towards gender justice, the patriarchal practices fuels and deepens inequalities. While the health care system has to be gender sensitive, it is equally important to educate men and women regarding gender health equality.

Women have been affected disproportionally due to greater vulnerability to processes of deprivation and inequalities. Increasing female infanticide and practices to discriminate girl child after birth, early marriage, lack of education and deprivation to access quality health care services are endorsed due to the patriarchal practices. While several campaigns such as Beti Bachao Beti Padhao, Save the Girl Child, and scholarship programmes for single girl child, Mid-Day Meals and Integrated Child Development Schemes have contributed immensely towards increasing enrolment, the data on dropout rates suggest maximum number of girls’ dropout at the secondary level, in particular after attaining puberty at the age group of 12-14.

With growing consciousness against gender discrimination and oppression, it became important to underscore several concerns which were either missing or received inadequate attention for long. Transcending the boundaries of conventional debate, women’s health besides maternal and reproductive health need to be prioritised as several non-communicable diseases are also a major threat to life of women. Investing in women’s health is important. However, investment in women’s health should not be an end in itself. It should be a means to a more sustainable, equitable, unbiased, unprejudiced, and just society. Interventions to significantly reduce the vulnerability of women to discriminations is an essential step that will lead to protecting and promoting women’s health in more ways than one. We have a long way to go to create conditions for securing access to education, nutrition, immunisation and better sanitation for promoting women’s health.

(Author: Suranjita Ray Teaches Political Science in Daulat Ram College, University of Delhi. She can be contacted at suranjitaray_66[at]yahoo.co.in)

References

• Gupta, Soumya and Payal Seth (2022): ‘Cracking Our Anaemia Mystery’ in The Indian Express page 11, 14 September.
• Mishra, Udit (2022): ‘Reading India’s Hunger Score’ in The Indian Express page 13, 18 October
• Gulati, Ashok (2022): ‘Getting Nutrition Wrong’ in The Indian Express page 13, 31 October