(En)gendering Health: A Brief History of Women’s Involvement in Health Issues

Abstract : The question of entitlement – the question of who gets what, why and how of the available resources of the society at any given point of time is at the base of the gender justice and equity issue. The interlinked and interwoven nature of these entitlements with the entire gamut of structurally determined gender relations makes the analysis of the relationship between feminism, health problems, political rights, social issues and economic issues very difficult. This paper traces the history of women’s involvement in health issues from the 1850s to the present day. Many women’s organisations were involved in identifying core issues of health and struggling to establish the basic rights of women.

Keywords: abortion, contraception, health care providers, gender distinction, reproductive health, women’s health, nutritional deficiency, reproductive rights, health movement, sexual liberation, sexual morality, STDs

Women and Rights

The question of entitlement – i.e. the question of who gets what, why and how much of the available resources of the society at any given point of time is at the base of the gender justice and equity issue. The interlinked and interwoven nature of these entitlements with the entire gamut of structurally determined gender positions makes the analysis of the relationship between feminism, health problems, political rights, social and economic issues very difficult. The most problematic of these eras was the latter half of the nineteenth century when women shook off the shackles of centuries of oppression.

The awareness of the discrimination against women in various fields caused them to protest against the oppression. The fight for political equality was one of the areas that women concentrated on. The first treatise in defense of the rights of the women, Mary Wollstonecraft’s A Vindication of the Rights of Women, inspired by the French Revolution, was published as early as 1792 but had to wait for more than five decades to gain prevalence and adequate supporters in the western world. By the 1850s, the word “feminism” had gained universal acceptance and was included in the Oxford English Dictionary.

The women’s agitation to get their right to vote surfaced in Britain as the Suffragette Movement that began in the 1860s and developed into the National Union of Women’s Suffrage Societies in 1872 nearly a century after the Wollstonecraft treatise. The overwhelming attention to political rights subsumed the awakening interest of the feminists in the representation of women’s bodies. Yet the politics of body coverings– the clothing, is an ironic subtext in many a writing by women. The clearer gender distinction between men’s and women’s dress in the 17th, 18th and 19th centuries led to a total inundation of the women in yards of fabric. Scientific sexism and racism sought to keep under wraps the rights of the marginalised, underprivileged women. One of the key concepts in feminist theory, one that underpins the Women’s Movement’s analysis of the subordinate status assigned to the women in the phallocentric culture, is the distinction between biological sex on the one hand and socially constructed gender on the other. This concept involves the recognition that while the sex of the individual depends upon the anatomy, gender is a culturally constructed artifact. As gender is the outcome of cultural and social artifacts, it conditioned responses to the body. Just as the body was kept “under wraps”, the problems of the body too were kept under wraps and could only be whispered behind closed doors.

Social Medicine

All 19th century texts of health have a section called Diseases of Women– diseases that are related to reproductive health that is prioritised over other health related issues. Any study of anatomy or dissection focused more on the woman’s sexual parts and only skimmed her brain. The equation of womannature- body as opposed to man- nurture- culture sought to discriminate and confine the woman. This led to the woman’s sense of dissatisfaction and hatred of her body, an area that women writers of the age investigated. The instances of mental illness, the taboos that prevailed and the harsh treatment meted out to women, who were victims, were subjects explored by many women writers of the time– examples: Charlotte Bronte, Charlotte Perkins Gilman and others. Institutions like St. Mary of Bethlehem Hospital for the insane in London were established as early as 1247 and were incorporated as a Royal Foundation in 1547. The doctors were all male till the 19th century after which women began to join the profession. Mental depression ranging from post partum depression to ante natal depression that raged among women added to problems related to repeated pregnancies and childbirth. The taboos related to contraception and abortion further clouded the issues.

Apart from quinine discovered by the Spaniards in America, iron and digitalis that were specific for diseases like malaria, anemia and heart diseases, medical drugs were not disease- specific. But the dream of medical men to use drugs like magic bullets aimed at the specific cause of the disease was finally a reality only by 1928 when Fleming discovered penicillin at St. Mary’s Hospital, Paddington. Other antibiotics like streptomycin, tetracycline, erythromycin and many others followed. Though antibiotics made a late appearance, England did have an established health service manned by the male doctors with a fair sprinkling of nurses after Florence Nightingale’s intervention in the Crimean War (1853- 56).

By 1842, an attempt had already been made in the field of social medicine, by Edwin Chadwick who first thought in terms of social control of diseases by dealing with their causes so that they were prevented from rising at all. His argument that it was necessary to provide clean drinking water to eliminate typhoid and cholera found favor with the legislators who took several measures for this, including framing laws. Chadwick helped to found the Poor Law Commission that produced a report in 1842, the principal suggestions of which were (a) a municipal water supply for all towns (b) a scientific drainage both in town and country (c) an independent health service with large powers for dealing with those who endangered the lives of others by polluting water and causing other inconveniences and (d) a national service for the internment of the dead for in those days bodies often remained for days without burial. Chadwick’s proposals were the earliest efforts to prevent bad health and had later been complemented by many efforts to maintain good health or rather the idea of positive health which led to the formation of the National Health Service which attempted to take care of the health needs of both the men and the women.

Medical Education for Women

If the idea of having a male doctor to attend or take over the service of the mid–wife was revolutionary in England in the 19th Century, the idea was outrageous to India, Britain’s colony. Indian families did not relish the idea of having male doctors to attend on women because of segregation. Dr. Ida Scudder of Vellore was inspired to go in for a medical education when she saw two young women dying within 24 hours of each other because their families did not allow male doctors to attend on them. Medical education for Indian women came about when medical missions from abroad observed the plight of Indian women. English education was introduced in India as early as 1813 but the education of the Indian women was largely ignored until 1840 when girls’ schools began to function. By the mid century, however, many girls were sent to schools– especially after Lord Dalhousie, the Governor- General of India issued an education despatch in 1854 detailing the need for female education in India. Higher education, especially medical education remained a dream till 1883 when the Universities of Madras, Bombay, Calcutta and Lahore opened their doors to women for medical studies. Western medical training had long been available to Indian males but it was not until 1885 that Lady Dufferin, wife of the Viceroy, established the National Association for supplying Female Medical Aid to the Women of India— otherwise known as the Dufferin Fund. This association provided financial assistance to women willing to be trained as doctors, hospital assistants, nurses and midwives, aided in establishing medical training programs for women and encouraged construction of hospitals and dispensaries. Miss Anne Walker, a domiciled English woman was the first to qualify as doctor from the Mumbai University. Dr. Anandibai Joshi who studied at the Women’s Medical College at Philadelphia was the first Indian woman to qualify in medicine. Kerala was not far behind in women’s education. Mary Poonen Lukose, born in 1886 graduated in medicine in 1915 and was appointed superintendent of the newly constructed 100 bed women’s hospital in Trivandrum in 1916. In 1924, she achieved distinction as the first woman to be made Acting Head of the Medical Department of Travancore State controlling 32 government hospitals, 40 government dispensaries and 20 grant-in-aid private institutions. 95% of the medical corps of the state was then constituted by men. What has to be noted is that the small State of Travancore had by 1915 more than 30 hospitals but even more importantly had introduced allopathic medicine and vaccination in the beginning of the 19th century itself. The indigenous medical systems like Ayurveda, Sidha and Unani flourished, for many people were interested in those systems of medicine.

Growth of Women’s Organisations

Practice of allopathic medicine and more concern with woman’s health that emerged by the end of the second and third decade of the 20th century coincided with the establishment of women’s organisations. But foregrounding this was the publication of Bankim Chandra’s Ananda Math (1882) that portrayed revolutionaries sacrificing their lives for the motherland. Bankim’s emotional hymn “Bande Matharam” served to link idealised womanhood with nationalism— thus attempting to place the body in political role. The women however, viewed this representation of the motherland as a call to women to join the political movement— something they desisted.

Between 1917 and 1927 three major organisations emerged in India– the Women’s Indian Association, the National Council of Women in India and the All India Women’s Conference. The more important of the women’s organisations and the most truly Indian of the three was also the last to be formed. The AIWC– All India Women’s Conference met in Poona in January 1927. Delegates to the Conference included a large number of professional educationalists as well as social reformers, women associated with the nationalist movement, the wealthy and the titled. Their specific resolutions stressed the importance of moral and physical education, deplored child marriage and urged special arrangements for educating women doomed to wear purdah. They believed that education should complement gender roles. By 1929 AIWC widened its scope to include all questions of social welfare. They opted to remain apolitical in order to preserve their identity. They traced the role of women historically and maintained that in ancient India, women had equal access to education, political power and wealth.

Child marriage had long been a thorny topic in British India. In 1860, the criminal code set the age of consent for both married and unmarried girls at ten years. The issue reappeared in 1880s and in 1891 the criminal code was amended to raise the age of consent to 12 years. A revival of interest in the age of marriage that happened in the 1920s can be traced to discussions in the League of Nations. In the wake of such interest, the new Sarada bill was to be implemented after the establishment of a select committee. The committee, in order to access public attitude sent out 8000 questionnaires. The women’s organisations promoted the legislation at every stage. They generated propaganda against child marriage, commented on proposed bills, petitioned, met with Joshi committee and lobbied to secure the passing of the Bill. Throughout the country AIWC branches organised meetings at which women’s opinion could be expressed. In their speeches women refused to confine their remarks to child marriage. Many women expressed the view that this was only one of the many customs that crushed their individuality and denied them opportunities for education of mind and body. Enforcing the act was an uphill task for many who practised child marriage. It was difficult to make a change and difficult to obtain a guilty verdict.

In the 1920s and 1930s, women’s organisations demanded educational and medical services for females. Separate institutions were required to deliver these services, for sex segregation norms prevented women from using institutions designed for men. Women leaders wanted new institutions to be staffed by female professionals. As is already stated, medicine was one of the new careers opened to Indian women in the late 19th century. In the early decades of the 20th century demand for women medical professionals grew. The demand came from middle class Indian women who regarded western medicine as modern and scientific. This led to the establishment of a new sector which was mandated to provide medical services for the government employees and the public and to establish clinics, hospitals, dispensaries. Most middle class women sought the services of women doctors. The supply of trained medical women did not equal the demand in those times. By 1929 however 19 men’s medical colleges and schools admitted women and there was one medical college and four medical schools for women alone. Attending men’s medical colleges presented a distinct set of challenges for young women. They faced a number of challenges as they embarked on their careers.

(a) It was difficult for them to combine family life with professional demands. Society had little tolerance for then single woman.

(b) They had to contend with sexual harassment in work places. A case in point is the widely reported case of Dr (Miss) Ahalyabai Samant, the director of the municipal dispensary of Nadiad who was abducted and assaulted by Dr Balabai Harisankar Bhatt ended with Dr Bhatt getting off with a mere fine.

(c) The female doctor received less pay and had to contend with racial and gender discrimination.

Abortion and Social Issues.

The women however prevailed and by sheer grit and determination made themselves a powerful force in the sphere of health. The major problems women and by extension women doctors the world over faced were in the field of contraception and abortion. These issues were moreover part of a wide range of social issues ranging from perspective of social order, concern with overpopulation, solution to social problems, attitude to the concept of family, sexual freedom, sex equality, sexual deviation and/or abstinence, right of fertility control and the overwhelming question of abortion.

In Britain before the 19th century, it was only the middle class who had conservative sexual attitudes, who often attacked the upper class for its behavior. Amongst peasant groups, the young were allowed to express sexual feelings but premarital pregnancy was not encouraged. Contraception of a sort was therefore practised. Chastity was neither the dominant practice nor the ideology. The change in perspective is linked to the social and economic changes that occurred in the early part of the 19th century and influenced life considerably during the middle of the 19th century. This included:

(a) The worsening Economic situation of the working class which resulted in lower standards of morality among working girls.

(b) The changing position of the middle classes which attempted to restrict women. Women were placed on a pedestal and were supposed to embody the virtues of the home and not soil their hands with the evils of the world– an idealisation which led to chastity being greatly valued,

(c) Myths about sexuality; and

(d) Education and middle class virtues which led to the strengthening of conservative attitudes.

The fight for sex equality was thus part of an overall struggle for a changed society. Women argued that restrictions on women’s behavior were designed to support the patriarchal family and ensure safe transfer of property to the next generation. To counteract women’s oppression, they had to make marriage and divorce, personal decisions, while abortion and contraception had to be made available on demand. Although the supporters of Malthus were radical on contraception, they were totally opposed to abortion, while the medical profession was totally opposed both to contraception and abortion in the latter half of the 19th century. However the medical profession did take a more sympathetic view to the plight of women. Most doctors of 1890s were of the view that while illegal abortion was wrong, it was unfair that women should have to shoulder the blame. The church was opposed to birth control as surprisingly were the socialists too.

By the 1920s people became increasingly concerned with the change in sexual morality which had shown definite changes even before the war. However, it was only during the 1920s that the new attitudes became widely discussed. One focal point was the behavior of young people and the growth of a new youth culture with a distinctive style of dress. A new term “flappers” was coined in England to describe those who were assertive, independent and granted “permissive favors” to young men. Sex was no longer a sin to the young. For the first time the problems of sexually transmitted diseases and the need for birth control were hotly debated. By the 1930s the Malthusians had become respectable but the Catholic Church was their major enemy. Moreover some supporters of birth control like Mary Stopes, a member of Malthusian league in the war years, opposed abortion and even feared that the issue might harm her fight for birth control.

The first known call for a change in British abortion laws was from Stella Browne. She proposed a number of reasons for liberalisation in 1915. She argued that:

(a) A reliable contraceptive had not been discovered; so pregnancy might occur even when the greatest care is taken;

(b) The education of young people in sexual matters was only beginning and it was grossly unwise to penalise ignorance; and

(c) The laws left people open to blackmail because of the need for secrecy and the fact that abortion had mainly fallen into the hands of the criminal class.

Women’s groups were the most forthright in the matter of birth control. Radical women were also prime movers of the pressure group for the reform of the abortion law. In 1936, the Abortion Law Reform Association (ALRA) was set up. The greatest victory of ALRA in the 1930s was the trial of Aleck Bourne for it extended the law to cover rape and other factors related to the health of women. The medical profession extended the grounds for therapeutic abortion in suitable cases and hence the abortion laws had to be modified.

The Second World War produced deep-seated social changes in British Society and did much to reduce the social class difference. The position of women in society improved. But in the case of sexual morality it appears that the closing distance between the classes meant that chastity became an ideal pattern of behavior.

Attitudes in western Europe changed in the 1960s with the growth of permissive ideology. By 1962, nearly a third of people were married by civil ceremony. The decline in the practice of religion and change in emphasis meant that the conservative influence of the Church had declined in the 1960s. The change in the nature of the education system, the growth of new radical groups within the middle class, the radical youth, and the development of the “pill” and the strength of the women pressure groups in the political arena led to the passing of the British Abortion Act (1967)

Change in Attitudes: The Interface of Psychoanalysis, Women and the Body

The idea of the mind was a familiar concept to the average European because of transcendental phenomenology. Europe nourished the idea that no object was understandable unless converted to a phenomenon. The idea of the mind as something transcendental was challenged by hermeneutical phenomenology that stated that the mind is contextual. It comes into being in relation to others. The relatedness and the distinction between subject and object inaugurated a new era of the science of the mind. Robert Carter had published in 1843, a theory of hysteria in terms of the unconscious and repressed sexual impulses but was largely ignored. When Freud expressed similar ideas approximately forty years later, he too was ignored for the idea was too conservative for a vast majority of people. Gradually Freud abandoned the popular hypnosis in the treatment of hysteria and developed a talking therapy that he called psychoanalysis. Psychoanalysis became popular with the series of lectures Freud gave at Clark’s University, Massachussetts. Psychoanalysis became a dominant school of thought in both American psychology and psychiatry during the period 1920 to 1950.

Psychoanalysis focuses on the irrational, the functioning of desire, on contradictory ways of experiencing oneself as a subject and behaving as a person. The focus on the unconscious immediately undercuts both the unitary subject and the simple reflectionist view of the essentialist construction of the individual in relation to the social. Freud posited that instincts are sources of continual psychic energy that seeks to discharge and affect mental life and that they have a source, an object and an aim. The source is the body, the aim is to remove bodily excitation and the object is the means by which bodily excitation is removed. Psychoanalytic theory assumes the occurrence of a natural progression through five phases of psychosexual development. This view of a pervasive influence of sexual motivation has been a point of contention since Freud proposed it and it is possible to distinguish at least three groups of critics. One group of critics proposed modifications in Freud’s theory of sexual energy. They suggested other drives as having a pervasive influence on mental life. Jung and Adler were the two major figures of this group of critics. Another group of critics concluded that Freud’s hypothesis of identity motivation needed to be complemented with a theory of ego motivation. This movement began in the late 1930s and some of its major figures were Anna Freud, Hartmann, Erickson, Horney, Sullivan and White. A third group of critics challenged Freud’s theory of sexuality on the grounds of inadequate evidence. This position has been typically those of the theorists unsympathetic to psychoanalysis, such as early feminist critics like Millet, Beauvoir, Freidan and Greer.

In his early work The Interpretation of Dreams, Freud does not remark on the difference in the oedipalisation of the little boy and the little girl. However his cultural norm of subjectivity is centered on the male. By 1925, he argued that feminine sexuality is related to masculine sexuality in terms of negative absence. The obvious problems for feminism in this theory are those of sexist bias, universalism, biological determinism, a historicity and the privileging of the visible. Another problem was the impossibility of a woman in the context to have a satisfactory organisation– the necessary adjustment between the individual and the society–which then leads to questions of adjustment and health. Psychoanalysis sought to present women as seeking men to fulfill and complete them, which according to Erickson was a consequence of their anatomy, their need to protect the unique inner space of the womb which had to be protected and made safe by the male through the institution of the family.

A woman’s different characteristics are produced by her innate narcissism or masochism, a consequence of her anatomy, as most post-Freudian psychoanalytic theory would have it. A reading of Freud would tell her that she has little sense of justice, less capacity for sublimating her instincts and is weaker in her social interests— all of this is no doubt related to the pre-dominance of envy in her mental life. (Freud, 1974.134) If she attempts to resist such a definition and pursue a masculine trajectory, she is perceived as unfeminine and hence unnatural. A woman who refused to conform to social and familial expectations was labeled deviant, abnormal or mentally ill and was prevailed upon by force to fit in with the behavior and attitudes deemed suitable for women. Normality for women was madness.

The readings of Millet and other feminists of Freud’s theory that reduces all behavior to sexual characteristics and the theories of penis envy, narcissism and masochism has been challenged by later feminists like Juliet Mitchell and Jacqueline Ross who argue that Freud does not take sexual identity to be an inborn, biological state and that Freudian psychoanalysis sees sexual identity as an unstable subject position that is culturally and socially constructed in the process of the child’s insertion into human society. Narcissism has been seen by Sara Koffman and Ulrike Prokop, in different contexts, as a representation of female power. Janine Chasseguet Smirgel has argued a cogent case for seeing penis envy as a manifestation of the little girl’s need to establish a sense of her own identity as separate from the mother— a process which for Chasseguet Smirgel is crucial for the later development of the woman’s personality.

In the 1960s, feminism fostered and set the tone for many reforms in relation to health– especially in the sphere of health and education for women. It was from this time that women’s vital role as providers of health care both inside and outside the home was recognised. An appropriate understanding of women’s health presupposed a change in attitudes and values that were discriminatory to women’s health. Women began to have more involvement in the formulation and the planning of their health and health educational needs. Women had more access to and control over income to provide adequate nutrition for themselves and their children and were able to make some headway in this by reducing prevalence of nutritional disorders like anemia. Women’s organisations took more interest and participated more in primary health care activities including traditional medicine. The modern perception that the onus must be on preventive rather than curative measures dates back to the ancient Indian Ayurvedic concepts of maintaining good health.

The establishment of the WHO and the interest shown in the sphere of women’s medical health– especially the appropriate gender-specific indicators for monitoring women’s health could lead, if utilised, to reduction of high morbidity among women, particularly when illnesses are psychosomatic or social or cultural in nature. Occupational health and safety and a focus on risks endangering women’s reproductive capabilities and unborn children were other areas of health explored by the WHO. The impact of new technology on the health and the welfare of the woman were also first explored in the late 1960s.

The new psychology of women that emerged in the late seventies and the early eighties of the 20th century meant, in general, a development that took as its base the psychological characteristics that had been fostered in women while they were subordinates. It built on this base, a set of strengths formerly categorised as weaknesses that grew out of women’s new aspiration to be equals. Concepts like autonomy, power, authenticity and self determination were reexamined and re-defined by women. Dichotomies like aggressiveness vs. passivity, leadership vs. affiliativeness and power vs. powerlessness were resolved and transcended. The implication of the arguments raised by Anne Koedt, Mary Jane Sherfy and others was that one could begin to consider the possibility of femaleness as normative while maleness was a derivation. By the mid 1970s many female theoreticians promoted the concept of a woman centered analysis and the view that female experience ought to be the major focus of study and the source of dominant value of culture as a whole.

Women and Their Bodies

The Women’s Health Movement has its origin with the reawakening of feminism in the 1960’s and the 1970’s. Those involved in the movement developed a deeper awareness regarding central issues related to women. Health was identified as one of the core areas demanding urgent and minute attention. Consequently the female body and its care earned prime importance. Those women who were alerted to the necessity of understanding their bodies took up the challenge of spreading the seed of this awakening among others. The year 1969 was important with regard to the Women’s Health Movement. In the U.S.A., Boston area was one of the centers of activity. During a liberation conference twelve women met and talked about their personal experiences with doctors and shared their knowledge about their bodies in a workshop on “Women and their Bodies”. This small group was called “The Doctors’ Group” in the beginning. Their main criticism was leveled at the “condescending, paternalistic, judgmental and non-informative medical system”(Vintage Book of Feminism. 353). The important principles which spurred this movement included the concept of women as informed health consumers who will be instrumental in social change and the idea that women can turn out as their own health experts by discussing health and sexuality with each other, and sharing knowledge. This was imperative because for centuries the medical field had been monopolised by men, women ending up either little informed or misinformed on their own body and its well-being.

The irony inherent in this is that women are truly the health care providers but are refused the information necessary for healthcare. The lack of knowledge regarding health, acts as an impediment, rendering women unable to decide on the correct course of treatment. The Doctors’ Group, which had been formed with the express intention of popularising health information, paved the way for the renowned Boston Women’s Health Book Collective which began in 1970. They brought out a comprehensive course booklet “Women and their Bodies” in 1970. This publication set the issue of women’s health in a new political and social context. This booklet was renamed as Our Bodies Ourselves and published in 1972, while the 1973 edition quickly earned widespread acclaim

Female Sexuality and Lesbianism

Any discussion of the body should deal with sexuality. The 1960’s had been a period of sexual liberation in the West, “ … the rules of sexual relationships were being rewritten …. The Pill had just begun to be widely available, and widely discussed, and thus to a young cosmopolitan cohort of students, it really did appear as if sexual intercourse, together with the Beatles, had been invented in 1964.”(Mary Evans 5) The period was one demanding sexual liberation; sexual restrictions and other taboos associated with women came to an end. Feminism in the 1960’s and the 1970’s was accentuated by the new enthusiasm. Some revolutionary books that appeared during this period were Betty Friedan’s The Feminine Mystique( 1963), Kate Millett’s Sexual Politics (1970) and Germaine Greer’s The Female Eunuch( 1970). While Greer was an advocate of heterosexuality and demanded more equality between the perceived experiences of the sexes, Millett was “advocating a more cautious attitude to heterosexuality, an attitude that was eventually to emerge as explicit lesbianism.” (Mary Evans 10) The new demand was for a female sexual liberation. This direction of contemporary thought gave rise to what was popularly known as the “sisterhood” mentality, calling on women to organise and work together and claim their rights.

In connection with the increasing discussions on female sexuality, lesbianism came to be debated on. Though in the early years, lesbianism was regarded as abnormal behaviour, slowly it came to be understood as a variant form of sexual behaviour. Groups like the Radicalesbians emerged in 1970 and The Furies in 1971. Groups such as these fought to establish Lesbian rights. In countries like the U.S., the lesbian community has contributed towards the advancement of feminism. An article “Compulsory Heterosexuality and Lesbian Existence” by Adrienne Rich advocated resistance against male control and popularised the idea of a “lesbian continuum to include a range of woman identified experience.” This could facilitate greater bonding between women and enable them to comprehend and find solutions to common problems.

The impact of Foucault in feminist sexual politics

The theoretical insights provided by Michel Foucault were central to redefining the feminised central politics. In his book The History of Sexuality Foucault elaborates on sexual identity. He debates on the regulatory and productive potential of power at the level of the body. He concentrates on the effects of power in treating sexuality as the essence of subjective being. His observation that the creation of sexual difference is a mechanism of power where subjects are divided between “the good and the bad, citisens and criminals, the normal and the deviant”(qtd.in Deborah Kerfoot and David Knights.“ Into the Realm of the Fearful: Power, Identity and the Gender Problematic” Power / Gender 83) is of great significance in feminist studies. Subjects are differentiated as men and women, masculine and feminine. The power play and connected discourses arise out of the efforts to safeguard individual sexual identities. In the light of Foucault’s arguments it is easy to understand why the masculine negates the feminine and the normal negates the deviant. Significantly, Foucault exposed the hypocrisy of the Victorian society which sought to repress the biological body.

Foucault’s theory served to empower the feminist sexual politics in the 1980’s. His effort was to bring to the forefront the fallacy of theorising about ‘good’ or ‘bad’ sex. The suggestions he put forth inspired thoughts regarding the importance of subjective experiences. In the feminist scenario, women started discussing the experiences and sexual desires of women themselves rather than envisioning these aspects from the point of view of men. Individual preferences mattered more than any conventional ideology. Foucault is important in feminist studies since his idea of power and of sexual identity could facilitate the possibility of a feminist politics that avoids the binary notions of sexuality of gender essentialism, and the disembodied discourse of deconstruction theory.

Mental Health

While lesbianism which was a very powerful sexual variant came to be accepted in the U.S., other issues related to the sexual and reproductive health of women were given closer attention. Contrary to the traditional medical practice, “feminists redefined women’s health through a holistic model which acknowledged the personal experiences of women and the social, historical, political, cultural, economic, emotional as well as physical determinants of health. This social perspective of health argues that women’s health needs and concerns are entirely incompatible with the conventional medical model which ignores widespread inequalities in society and depends simplistically on morbidity and mortality statistics.”(Feminist Activism in the 1990’s) Women were exhorted to secure control over their bodies. With the increasing consciousness of the female body, sexuality or body politics became the epicenter of discussion and debates in the 1970’s and the ‘80’s. This brought to the forefront thoughts regarding health issues. Organisations were founded to guide women regarding these issues. Centuries of negation and suppression had caused women to pay little, if no attention at all, to their physical and mental health. For a woman to focus on her physical health, it is necessary that she has the proper emotional conditioning. Self-esteem plays a key role in this and “a woman’s sense of self esteem and how she feels about her body, are largely shaped by her personal and family histories — whether as a child and young woman she learned to respect herself and was comfortable with how her body grew and matured or whether she was taunted, humiliated and abused.”(Marion Crook vii) Thus any physical problem can be negotiated only after addressing the emotional problem. Consequently, mental health attains prime importance in any feminist critique. ‘Mental illness’ is very often a product of emotional suppression. Emotional imbalances create a sense of alienation and sadness. The popular psychological standards assigned normalcy to masculine characteristics and an aura of “unpredictable” ness and “mystery” to the feminine. “Femininity is both socially devalued and representative of actual oppression. Women’s lack of assertiveness characterised by this traditional stereotypical femininity coincides with a high state of anxiety and feelings of low self-worth and thus ill health.”(The Psychology of Women’s Health Care 14)

One of the factors that triggers mental instability in women is the abusive relationship they find themselves in. Bonnie Burstow in her book Radical Feminist Therapy, quotes L. Walker’s “Cycle of Violence”: “ In the cycle, tension building leads to violence; the ‘violence phase’ is followed by ‘a honeymoon period’ in which the man is mortified, apologises, promises to do better, and ostensibly is believed and forgiven. The honeymoon phase is followed by a further tension building phase and that phase by further violence. And so the cycle continues, with the honeymoon periods characteristically becoming progressively shorter and the violence and the tension building phases becoming progressively larger.” (Burstow 149). Due to a variety of personal and social pressures, very often the woman continues in the abusive relationship, deliberately hoodwinking herself and others. It is however, imperative that in such cases, the woman is made aware of her position and given professional advice. Suppression of the extremities of an abusive relationship results in acute mental stress and trauma. In countries like India, economic dependency along with social and familial pressures trap women in abusive relationships, both physical and mental, forcing them to hide their anguish.

Mental health is also influenced by stress. Significant sources of stress include major life events — break up of marriage, death of one’s spouse, diseases in the family and such other instances. These events might destroy a person’s ability to cope with and function effectively. Women who face financial hardship experience tremendous stress. At the same time traumatic events such as rape might also spark off tension and anxiety at a dangerous level. Male violence towards women is an important issue that demands public attention – women organise against this internationally. In many cases, women who undergo extreme sexual violence experience a loss of self and self-esteem following the shock inflicted on them. When there is a continuous period of traumatic stress, it becomes chronic, lessening the individual’s ability to do any kind of constructive work. Such cases require careful counselling so that the victim can be gently brought back to a normal level of existence. There are numerous crisis centers and support groups all over the world which extend valuable help to such victims. Mental health centres had assumed importance during the 1960’s and ‘70’s; consequently Women and Psychiatry groups came to be formed in the early 1970’s. The journal Feminism and Psychology was begun in 1992. The focus during this period was on violence. In the 1980’s health promotion was identified as an important factor to be put into actual practice. Close studies of the issues related to health revealed that the causes of ill health include poverty, poor housing, unemployment and social disadvantages. Feminist therapy or counselling has been suggested as an ideal solution for the innate feeling of unhappiness in women. Feminist therapy emerged in the wake of the women’s movement. The mental health establishment which was viewed as patriarchal was deemed unable to impart the required counselling. The prevalent mental health system came under acerbic attack for being “a particularly misogynous and oppressive substructure.”(Burstow. ix) The research carried out by Inge Broverman “indicated that both male and female clinicians identify ‘socially competent adult’ with ‘socially competent man’ and see women as socially competent only when not acting like a competent adult.” (Burstow. ix)

Phyllis Chessler’s study of women and madness successfully established how the patriarchally structured psychiatric system subjugated women. She accused the existing trends of psychiatry for creating sex role stereotypes and exposed the actual danger which awaited women whose efforts to stay feminine would jeopardise their well-being and destroy their identity. Chessler’s and Broverman’s studies spurred new feminist approaches regarding therapy. Counselling ought to make women more aware of their problems and the oppressions they faced. Therapy can provide alternatives to deal with health issues.

The Focus on the Body

The socially accepted notions of femininity thus function as a snare since these prove to be hostile to women’s health and related concerns. “Femininity has a social meaning which transcends simply being a woman …. Women need to be feminine and have feminine qualities in order to avoid being pathologised, and paradoxically femininity itself is a pathologised concept.” (The Psychology of Women’s Health Care. 10) This is borne out by the fact that all physical changes of a woman from the period of puberty to menopause are considered pathological. Women’s bodies have become sites for medical experimentation. An aura of sickness has come to be associated with the woman’s body. Technological intervention had shorn the female body of individuality.A new awareness had to be instilled in women regarding their body behavior. Menstruation, pregnancy, childbirth, menopause, ageing were all to be regarded as natural phenomena rather than instances of ill health. Pre-Menstrual Syndrome is now considered as one of the debilitating factors as far as women are concerned. There are many explanations for this phenomenon. Coming under one of the new reproductive illnesses, medical experts and researchers have offered a variety of explanations for this so-called disease. It is true that many women experience premenstrual discomfort, which is characterised by headaches, irritability, nervousness, fatigue, crying spells, and depression with no logical reason. Menstrual cramps are also experienced. Although premenstrual symptoms and discomfort during menstruation were once thought to be of psychological origin, research now indicates that hormonal and chemical changes are responsible. However, the hormone responsible for the disorders has so far not been identified but a wide range of drugs are prescribed to treat the syndrome. This cannot be justified because there is no conclusive proof that pre-menstrual behavior patterns have any influence over the performance of women or their psychology. Jane Ussher argues convincingly that PMS is a political category that ties women to their biology and provides reductionist and reactionary explanations for women’s discontent or distress. She says that the feelings of women who suffer from PMS are not necessarily rooted in biology. She adds that the negative framing and defamation of the female body which links it with unhappiness, does not allow women to express discontent except through the body. Biology should not be elevated to the status of the sole site of misery, turning unhappiness into illness. Thus a natural body phenomenon has come to be treated as a disease and the woman becomes a victim of her own biological self which overpowers her and weakens her.

Similarly pregnancy and childbirth are also viewed as states of ill health in need of medical intervention. Feminists have been constantly fighting against the medicalisation of the natural phenomena of pregnancy and childbirth. The exit of the traditional midwife and the entry of the male physician has in a way snatched the reins from the hands of women, regarding their individual freedom and private experiences. Women are demanding more choices and cooperation from the medical professionals and this has become an area where women can hope to stay in control of their health. It is true that some deliveries may become emergencies, but this does not justify the fact that normal deliveries should also be considered as cases demanding the interference of medical personnel. When a woman faces the event of childbirth all by herself with none other than the doctor beside her, she might be consumed by a feeling of depression and anxiety. Therefore this mental condition of women should not be seen as pathological.

Menopause is another stage a woman has to pass through – a stage which also has drawn attention to the female body. The medical field views this as a period when women suffer a general deterioration of health and complain of various physical and mental disorders. Menopausal complaints, like PMS and PND, cannot be regarded as a general complaint, applicable to all women. The psychological complaints during this period, if any, can be attributed to the behavior of society and the treatment meted out to women. A community which pathologises menopause as well as the negative ideas associated with ageing contributes towards the depression experienced by women during this period. Negative effects of menopause can be reduced by maintaining a healthy diet, eliminating caffeine and alcohol, reducing sugar and salt intake, stopping smoking and taking vitamin supplements. Exercise helps increase conversion of androgens to estrogens and can help relieve menopausal symptoms. How women view menopause may also affect symptoms. Traditionally in our culture, menopause has been viewed negatively, as a period of fluctuating hormones that weakens women. For many women, there is only a fractional discomfort during menopause, and some find renewed energy and enthusiasm after menopause.

Reproductive Rights

Women’s efforts to control their own reproductive systems have been an important part of the Women’s Rights Movement since the mid-19th century. The right to use contraceptives, the decision to plan their family and the choice of abortion had to be necessarily provided for women. Women must be provided the option to select the time to become mothers. The greatest controversy in this respect has been regarding the legality of abortions, whether a woman can be given the right to terminate her pregnancy or not. Abortion was illegal in the United States until 1973. Abortion has become one of the most intense and antagonistic moral and philosophical issues of the late 20th century. Modern medical techniques have made induced abortions simpler and less dangerous. But in the United States, the debate over abortion has led to legal battles in the courts, in the Congress of the United States and state legislatures.

On one side are individuals who favor a woman’s reproductive rights, including the right to choose to have an abortion. On the other side are those who oppose abortion except in extreme circumstances, as when the mother’s life would be threatened by carrying a pregnancy to the full term. The former group holds that the foetus is not yet a human being and thus has no legal rights. The woman bearing the foetus can decide whether to continue her pregnancy or abort it. The other group believes that the foetus is a living thing and hence deserves legal rights.

Considerable hostility surrounds the abortion debate due to medical vagueness regarding the status of the foetus, as well as social, political and religious reasons. Many women are worried about allowing the government to decide the options open to them – they fear this might lead to interference in their reproductive rights. Many religions forbid or restrict this practice. Abortion was considered illegal in most countries until the 19th century. In the 20th century, however, many nations began to relax their laws against abortion. The former Union of Soviet Socialist Republics (USSR) legalised abortion in 1920, followed by Japan in 1948, and several Eastern European countries in the 1950s. In the 1960s and 1970s, much of Europe and Asia, along with Canada and the United States, legalised abortion. In India family planning programmes have legalised abortions and in 1971 the Parliament passed the Medical Termination of Pregnancy Act to make abortions legal. In 1975 the Indian Government made rules and regulations regarding abortions so that abortions would be done only legally. Abortion facilities are available everywhere in India now. However, the problem in India is the increasing case of female feticide which is still prevalent. The introduction of amniocentesis has made it easy for identifying the foetus and eliminating it in case it is a female. This is largely triggered by other social evils like dowry which make the girl child a burden and hence unwanted.

In the United States, the legalisation of abortion began in 1966 when the state of Mississippi passed a law permitting abortion in cases of rape. In the following four years, other states allowed abortion when for instance a pregnancy threatens a woman’s health, the foetus has serious abnormalities, or the pregnancy is the result of incest. In 1976 the Supreme Court recognised the right of pregnant girls under the age of 18, known as mature minors, to have abortions. There are other restrictions regulating who pays for abortions, where abortions are performed, and what information is provided to women seeking abortions. In the year 1977, the Supreme Court allowed the states to limit the government assistance for health care in cases where the abortions were elective. Funding for abortions, considered medically necessary, was also restricted by the Supreme Court . There were many cases related to abortion fought in the courts of the United States of America. In 1996 the Congress of the United States enacted a bill banning the practice of abortions. President Clinton vetoed the law because it failed to permit use of the procedure when a foetus displays severe abnormalities or when a pregnancy threatened a woman’s health or her life. Many states have since passed laws banning use of the procedure.

Since the Supreme Court ruling that legalised abortion in 1973, the antiabortion campaigners have worked continuously to reverse the decision. They have consistently requested state and federal officials to place restrictions on women seeking abortions or on individuals providing abortions. They have also held protests directed at clinics that perform abortions, and, in some cases, have protested against and obstructed patients at such clinics. In May 1994 the Freedom of Access to Clinic Entrances Act was passed, which made it a federal crime to use force , or physical obstruction to injure, intimidate or interfere with reproductive health care providers and their patients.

More than two decades since the Supreme Court first upheld a woman’s right to abortion, the debate whether abortion is ethical and legal, continues in the United States. Although supporters of abortion and those against it still are at war, a growing number of individuals expect that discussing the issue taking into consideration other related aspects might put an end to the debate. In Britain, the National Abortion Campaign is the largest and most successful organisation in favour of abortion. It was founded in 1975 and works tirelessly to spread awareness among women regarding health and related matters topics. When there are pro-choice centres on the one hand, there are anti-abortion groups which function to protect the rights of the unborn child. The NAC’s objective is to provide women, irrespective of their social, economic and cultural background, access to safe and free abortion on request .

The Euro-centered perspective of women’s movements which was followed by the women’s movements in India underwent drastic changes as time went on. For a long time the women’s movements stood for the interests of the intellectual, upper-middle class Indian womanhood. It was only by the 1990’s that the movement became a strongly felt presence among those whose lot required betterment. The movement then became truly of the people. Such people’s movements like the visible and very vocal eco-movement are undoubtedly for the betterment of the country. The health movement too is beginning to gain momentum. Women were traditionally accepted as health care providers. Their involvement with health issues can lead to the betterment of health in home and in society. When rural women who are often distanced both physically and financially from the best of hospitals are educated, they can even save lives. A case in point is the decrease in the number of deaths caused by diahorrea, one of the major causes of infant mortality. The education women were given about the need to provide fluids with the appropriate ratio of sugar and salt considerably reduced the high incidence of death. The health education of women will thus lead to better health for all.

It has now been accepted that women’s health can be an index for the measurement of the overall progress that has been brought about by the health services of a country. This is because of the extra burden that women carry in health and development matters. Although women experience the same pressing problems like, lack of access to resources, underemployment or unemployment, lack of training opportunities, they are almost always the most severely affected. They are the last to be given resources, to be listened to and consulted about their own needs, to be beneficiaries of health and development schemes. The fact that women’s well-being has a powerful impact on society is now being recognised as an important index to measuring a people’s state of health

Support groups and Health Centers for Women:

Looking at the world scenario in general, the ‘70’s, ‘80’s and ‘90’s saw the mushrooming of a number of centers and support groups for women all over the world. Important among these are the National Women’s Health Network which began work in 1976, the Combahee River Collective, a black feminist group founded in Boston in 1974 and, ROW (Rights of Women) established in 1975. Women-controlled health centers emerged as alternatives to conventional medical centers and there emerged many self help groups who taught cervical self exam, and provided abortion services. These centers gave prime importance to the client and her needs. There were also various support groups dealing with infertility, menopause, pre-menstrual problems and such aspects. The new womencentred organisations were insistent that whatever be the issue, the primary importance was to be given to the client and her well-being.

Life Style Issues

The choices made by individual persons about their lifestyles determine the nature of their diseases. Smoking, too much alcohol, too little exercise and using drugs combined with dietary and other factors put people at the risk of poor health and premature death. A number of countries have attempted to regulate alcohol and tobacco promotion by issuing statutory warning and by levying high taxes on these products. Educational campaigns against the use of tobacco and alcohol have helped the cause of health care. There are evident connections between improving lifestyle of the people and the number of noncommunicable diseases they seem to face. If infections and parasitic diseases and malnutrition plague developing countries, lung cancer, heart diseases and cirrhosis of the liver are diseases that haunt developed countries. These trends have great significance for women’s health.

Earlier, women had lagged behind men in alcohol consumption and smoking. Studies have revealed that only 5 to 7 percent of the women smoke in developed countries. However in certain developing countries like Swaziland, 72 % of adult woman smoke. There is an alarming increase in the percentage of young women who smoke. The need for educating young women to avoid health destroying addictive behavior is the need of the hour. If cardiovascular diseases and lung cancer had at one time never claimed female victims, with the increase of women who smoke, the statistics show an alarming increase in the death toll due to tobacco use. The scale of the threat that smoking poses to women’s health has received surprisingly little attention. A recent study revealed that women smokers have higher rates of cervical cancer. A comprehensive culture specific programme tailored to meet the local situation, containing three key elements of protection, education and support may go a long way to slow down the enthusiasm of young women for tobacco consumption.

Research has confirmed that women are more sensitive than men to alcohol effects. Due to a biochemical difference in the stomach lining, women absorb more of the alcohol she drinks into her blood stream. This greater psychological vulnerability added to socio- economic changes and the increasing stress on women accounts partly for the increasing number of women who are addicted to alcohol. Society is harder on women who are addicted to alcohol and this results in their being totally isolated while guilt may result in a total loss of respect. Women drinkers are less likely than men to seek treatment or get into a self-help group. Family life and marriage become casualties in this context, for the husband of a woman drinker is more likely to leave her. Alcoholism in women is a problem that could be aggravated by urbanisation for fewer social controls operate in an urban scenario. Even if women themselves do not drink, women are affected by the increasing consumption of alcohol as much violence against women is associated with alcohol.

Though drugs have the power to reduce pain and treat diseases, they are also used by people to experience pleasure. The escape offered by the psychotropic or mood altering drugs treads the fine line of drug abuse or addiction. As this fine line is not always clear, there are particular consequences for women’s health. Psychotropic drugs that are the main concern of the medical companies that sponsor campaigns are minor tranquilisers that have sedative effect on the brain. A study in Europe in the 70s found that the proportion of women who used anti- anxiety sedative drugs far outstripped men. The minor tranquilisers prescribed or those that women used, could produce severe effects when compared with alcohol, to pregnant women particularly. The tranquillisers prevent women from solving problems that make them turn to drugs in the first place, for drugs help them to mask the misery and prevent expression of misery that would have a psychotherapeutic effect. The reaction of women while coping with anxiety, stress and anger are not welcomed by society for they are not expected to express their emotions at all. Instead, their problems are medicalised and soon they begin to feel that they cannot cope without drugs. Dependence on drugs is the result.

The various preventive measures suggested by health personnel include calling the attention of the public to drug abuse, providing information about the problem, approaching policy-makers and politicians and encouraging publicity about the extent of the problem and the need for appropriate services.

Disease and Disability:

“While for both the sexes, coping with disabilities can be difficult, to be female and disabled in our society is a double drawback” (Jo Campling, 1979.2). Statistics reveal that one person in every 10 has a significant disability. Probably more than half of them are women. This is because women live longer and experience the disabilities associated with old age. Certain disabling diseases like multiple sclerosis and anemia strike women more often than men. Several of the causes of disability are because of nutritional deficiencies. Accidents in the house or at the workplace or on the road are major causes of disabilities as are preventable childhood diseases such as poliomyelitis and measles. The impact of disability on women range from total isolation and abandonment to the limited opportunities available for girls with disabilities. Many disabled women feel that while disabled men are taught to fend for themselves, women are not encouraged to do so. A woman with a disability has to be twice as qualified to get employment. Disabled women are frequently victims of rape and violence. Disability causes a poor self-image for the woman. Multiplication of self-help initiatives, the establishment of the Disabled People International and the setting up of developmental training programmes for disabled women may help them to acquire greater self esteem.

Just as the disabled among women suffer more both physically and psychologically than men, women struck with diseases suffer more than their male counterparts. Often, women do not enjoy the same medical care that the male members of the family do. This may be determined by their economic status too, for the kind of attention that the wage earner claims in matters medical is not available to the home maker. Screening techniques ranging from mobile X-ray units to C.T.scanners are now available on request. Yet, it is a fact that even educated women often hesitate to make use of these facilities. They would rather wait and see if the symptoms would disappear. Choices regarding treatments too rest on the authoritative figure of the family, thereby considerably lessening the power of the woman to determine the kind of treatment she would like to follow. In certain kinds of diseases women are at the mercy of social and religious beliefs.

Despite the social and economic aspects of women’s health, their reproductive function continues to be a major issue. The World Development Report of 1993 proposed a new composite measure called the Disability Adjusted Life Year or DALY as a generic indicator usable everywhere to help set up health policy priorities. This would facilitate comparison between countries and standardise the way decisions are made in the health sector. The leading causes of DALYs lost among women aged between 15 and 44 in developing countries were found to be related to childbirth, tuberculosis and sexually transmitted diseases. It was found that the leading cause of death among women in developing countries is cancer of the uterine cervix. According to a recent study, cervical cancer can be caused by infection with certain strains of human papilloma virus, a sexually transmitted pathogen. Genetic causes have also been established. All these affect the reproductive status of women.

The incidence of breast cancer is something that women dread because of medical, social and psychological reasons. In the mid 1970s, women were educated to detect the presence of lumps in breasts, a possible indication of breast cancer. The issues surrounding the treatment of breast cancer were addressed by a number of feminists activists, particularly the journalist, Rose Kusher. The preponderance of surgery for all who approached a medical doctor, following minimal indication, was opposed by Kusher who argued that breast surgeries should be performed as a two step procedure. One positive result that emerged was the increased awareness of the existence of non-surgical treatments. Yet, more than the availability of medical treatment is the feeling of loss and bewilderment that seem to plague the sufferers. The very medical treatment that would cure them also brings into focus various taboos and social barriers that women are subconsciously aware of. The trauma associated with breast cancer is clearly influenced by the cultural emphasis on breasts as objects of male sexual interest and pleasure, one of the major reasons why women tend to shy away from surgery. Surgical treatment could also lead to the society’s negation and cruelty. The feeling of being out of control of one’s life when subsumed by intense competition, one of the direct results of the market economy brought in by globalisation, is further heightened by the loss of the support systems that women had hitherto enjoyed. An even more distressing aspect is the attitude of society. On auspicious occasions, such women get the short shrift from even their closest relatives. In India, in conservative circles, persons afflicted with diseases are kept under wraps and not permitted to take part in rituals. It is important to educate people to give up such outdated attitudes and practices, and provide those stricken by diseases with support as part of a comprehensive health care system. The existence of support groups will certainly help to reinforce the woman’s decision to get professional health care and minimise the trauma of affliction. The support group system can bolster the will power of the patient and equip her to face the disease and ultimately to conquer it. It will also help her to overcome the morbid curiosity of society and the taboos enforced by it.

Amongst many sexually transmitted diseases, the incidence of the AIDS epidemic could erase whatever progress made in women’s health over the past decade. Statistics reveal that the number of HIV positive women will soon surpass that of men. It is clear that AIDS is putting additional burden on women in their role as health care providers. STDs can contribute to blindness, brain damage, pelvic inflammations, spontaneous abortions, ectopic pregnancies and cervical cancer. Like all other health issues, the drawing up of an education and prevention programme that is appropriate to the public is as important as providing information, support and counselling to the infected.

Women and Nutrition

Even granted the severe limitation of low income, many groups fare far worse than they should because of culturally determined practices, particularly regarding diet. It is impossible to chronicle the many permutations of counter-productive food taboos which fall most heavily on those least likely to tolerate them- i.e. children, women and lactating mothers. In countries like Peru, Indonesia and Malaysia, fish is withheld from children for fear that it may make them sick. Eggs are linked with illness in India, Lebanon and Syria. It is linked with mental retardation in East Africa, with late speech development in Korea and licentiousness in various countries. In West Africa, eggs are kept away from children on the grounds that they will come to expect luxuries and grow up to be thieves. In some tropical countries, papaya and similar fruits are thought to cause worms in children. The children may develop xerophthalmia and suffer permanent blindness from the resultant avitaminosis A.

Apart from these taboos, nutritional deficiency underlies women’s deaths to a greater extent than male deaths. The lower nutritional status among women is, according to a recent study conducted in India, due to greater morbidity. When clearly analyzed, it was further discovered that nutritional deficiency was one of the most important among the health problems of women. Though milk intake was high even among low income groups, the intake of milk and milk products by women was less than 20 grams per day. Women’s consumption of green vegetables was much less than that of cereals and pulses. The quality and the quantity of food women consumed were comparatively inferior and lesser than that of the male members of the household. In the case of families without adequate income or larger landholdings the food intake of women was extremely poor. Women were, moreover, culturally bound to eat only after the men had had their food. Often they had to be content with leftovers. The case of old women was even worse for their nutrition was hardly ever taken into account. Far from being given vitamin and nutritional supplements, they were often denied a balanced diet under the erroneous belief that they do not require any further nutrition.

Nutritional deficiency among women include also anemia owing to iron deficiency and calcium deficiency that manifests itself as osteoporosis among older women. Among young adults nutritional deficiency may well be the result of self induced starvation with a view to remain slender. Extreme dietary restrictions may lead to anorexia nervosa or bulimia, which were basically ‘culture bound’ syndromes in the West. With globalisation and the expansion of the beauty industry, these hitherto culture bound syndromes occur in urban areas all over the world.

Increase in per capita income and a greater amount of money spend on food may at times lead to impoverishment rather than improvement of nutrition. In India, food preference has gone from home polished rice and wheat to commercially polished grains or flour. A great deal of vitamins and protein may be lost by these refinements of the natural food grains. The “Coco Colonisation” of the world shows how rapidly cultural changes can occur. In India, more costly but less nutritious substitutes have replaced the abundant greens, fruits and legumes. In virtually all countries, there is a rapid increase of consumption of sweets, soft drinks and other junk.

With the advent of the 90’s women are seen to be given enough exposure to health related issues so that they are educated on their bodies, illnesses and treatments available. They have been sufficiently warned against the indiscrete prescription of drugs by physicians and given available information regarding alternative medicine. Among the organisations formed in recent years the Universal Health Care Action Network (UHCAN) formed in 1992 is significant. It brings together diverse groups and activists working for comprehensive healthcare. NAWHO founded in 1993 aimed at eliminating health disparities for Asian women and families in America. The new demands of women’s organisations are that reproductive health care must include maternity care, family planning, abortion facilities, infertility treatment, care for sexually transmitted diseases, and such others. Education has contributed a great deal towards empowering women and making them aware of their rights. The present day concerns of women are gathering information regarding diseases such as breast cancer, reproductive and sexual health, mental health, osteoporosis, smoking, immunisation and sexual violence. In the United States, there are many organisations providing information regarding specific women’s diseases. The organisations have also expressed genuine concern over the immense influx of women-targeted health and medical technologies.

Towards a Health Policy for Women

If women’s health issues are to be treated fairly and effectively, one has to stress the necessity of a practical health policy. What is most important is that the policy makers should realise that the health problems of women cannot be uniform. The various health issues identified have differing dimensions in different countries. A certain issue has to be dealt with in its particular context. In India, the National Health Policy 2001 recognises the catalytic role of empowered women in improving the overall health standards of the community. This underscores the fact that women are the actual health care providers. Proper practical education is imperative in this regard. It is important that the government take steps to prevent infanticide, pre-natal sex selection and immoral trafficking of girls. In developing countries, easy access to basic health care facilities should be made available. Ensuring proper nutrition and health care is a major responsibility of the government since in countries like India the girl child is the subject of neglect and disregard. Meeting a number of necessities like the adequate provision of clean drinking water, sanitation and ensuring the systematic performance of the public distribution system must rank high in the government agenda. Given the right choices and in the presence of an ideal infrastructure, women will surely make the right decisions for themselves and their families. If sufficiently educated in matters of health and hygiene, women can bring about substantial improvement in the community health standards.

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JAYASREE RAMAKRISHNAN NAIR : Freelance writer and translator. Has published many articles and translated many works including four plays of Shakespeare into Malayalam. Interested in Shakespeare Studies, Translation Studies and Women’s Studies. Her doctoral work was on the ‘Translations of Shakespeare’s Plays into Malayalam.’

R. HEMA NAIR. Teaches English at the N.S.S. College for Women, Neeramankara, Thiruvananthapuram. Her doctoral work was on Doris Lessing. A regular contributor to research journals. Interested in Women’s Studies.

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Freelance writer and translator. Has published many articles and translated many works including four plays of Shakespeare into Malayalam. Interested in Shakespeare Studies, Translation Studies and Women’s Studies. Her doctoral work was on the ‘Translations of Shakespeare’s Plays into Malayalam.’R. HEMA NAIR. Teaches English at the N.S.S. College for Women, Neeramankara, Thiruvananthapuram. Her doctoral work was on Doris Lessing. A regular contributor to research journals. Interested in Women’s Studies.

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