Abstract: A healthy population is considered to be a national resource. Hence, health is a critical component of planning, policy making and programme formulation in the human resource development of the country. Outside the framework of the State, the provision of health care services to the poor and the needy, has always been a zone for philanthropy and charitable work. It has the quality of being apolitical. The paper examines the contribution of Women’s Studies towards an understanding of women’s health in India and presents the body of knowledge, information and contestations as women’s movement trajectory and research trajectory. The areas neglected by feminist research and gender sensitive initiatives are also listed here. The paper attempts to highlight the importance of viewing women’s health from the perspective of “gender and health.”
Keywords: women’s health, domestic violence against women, population policy, Family Welfare Planning, sex selective abortions, socio-economic health conditions, women’ movement trajectory, reproductive tract infections
A healthy population is considered to be a national resource. Hence, health is a critical component of planning, policy making and programme formulation in the human resources development of the country. Outside the framework of the State, the provision of health care services to the poor and needy, has always been a zone for philanthropy and charitable work. It has the quality of being apolitical. However, over the decades, it has been observed that regardless of the approach to reaching health care to people it is inevitable to confront questions of the political economy of health (Jesani, 1998). In simple words, the distinction between the ‘right to health’, as opposed to ‘right to health care’, signifies the difference in the scope of the two. The ‘right to health care’ constitutes the duty of the state to allocate to its members an adequate and fair share of its total resources for health related needs, given the competing claims of different health needs. On the other hand, ‘the right to health’ embodies a broad range of entitlements and access to societal resources, within which access to health care is one. If one were to include the gender lens, to examine the issues of health, it unveils how inequalities that arise from belonging to one sex or the other, can create, maintain or exacerbate exposure to risk factors that endanger health. They can also affect the access to and control of resources, including decision-making and education, which protect and promote health.
The limitations of mainstream research that hitherto remained within the parameters of ‘social engineering’, of improving people’s health seeking behavior; bringing about changes in beliefs and practices that are seen as detrimental to good health etc., had become apparent in the 1970s. The emergence of several people’s struggles, health campaigns and the second wave women’s movement has brought into focus issues of equity, rights and justice, as inextricably linked to people’s health and well being. While analysis of the political economy of health existed among researchers (Banerji, 1982) and groups working for health rights, the critical inclusion of gender perspective had unravelled the structural roots of women’s low health status.
‘Towards Equality’, the Report by the Committee on the Status of Women in India (1974) had revealed crucial aspects on women’s status and health. The International Decade for Women (1975-85) had marked the beginning of a shift in perspective in favour of women. The present paper attempts to closely examine the contribution of women’s studies towards an understanding of women’s health in India. For heuristic purposes, research papers emerging from various disciplines and campaign notes/bulletins/reports that emerge from the movements are all considered as contributing to women’s studies. A close analysis of how women’s health has been articulated by researchers and activists over the past two and half decades, demonstrates the convergence of multiple trajectories. The paper presents the body of knowledge, information and contestations as women’s movement trajectory and research trajectory. The areas neglected by feminist research and gender sensitive initiatives are also listed here. In conclusion, the paper attempts to highlight the importance of viewing women’s health from the perspective of ‘gender and health’.
Women’s Movement Trajectory
The mid-seventies had witnessed the resurgence of the women’s movement in India around the issue of rape. The custodial rapes of women in police stations – Mathura in Maharashtra and Ramizabee in Hyderabad – and the court acquittals of the accused police men had led to wide ranging protests all over the country and the formation of autonomous women’s organisations challenging the legal stipulations and various forms of violence against women.
Behind the grim crime statistics, there are real women and young girls who are maimed, traumatised and silenced by a patriarchal culture and social institutions.
The engagement on the issue of violence had not only meant a critical examination of incidents and events of violence, but also a theoretical understanding of the structural roots of women’s subordination and exploitation. The patriarchal values embedded in legislation, the implementing machinery, state policies and programmes have been unmasked. Wide ranging issues of violence starting from rape, dowry deaths/ murder, sati, female infanticide, female feticide, child sex abuse, sex trafficking, invasive contraceptives, coercive population policies, incidents of ‘acid throwing’, sex scandals, honour killings, to name a few, have been scrutinised. Obviously through all this the multiple manifestations, agencies and sites of violence were unveiled. Apart from the physical aspects of violence, the neglect of the girl child, the gender differentials in access to education, food/nutrition, health care, political participation, training and societal resources are also seen as violence, in other words, violation of women’s human rights.
Women’s movement was engaged in a close scrutiny of questions like ‘Why women are violated or raped?’ ‘What are the different locales of violence?’ ‘Who are the perpetrators of violence?’ ‘How do women perceive violence?’ ‘Why do women endure violence?’ ‘What does violence do to women’s psyche?’ and so on. This has prompted them to examine patriarchal structures, construction of gender, gender relations, social processes and cultural practices. The analysis led the movement to identify the different structures that control women’s bodies, fertility and sexuality. It has become evident that control over women’s bodies, is the bedrock of (a) the caste system – which attempts to regulate sexual relations through marriage practices; and (b) the family – which preserves its honour, izzat, by controlling women’s sexuality.
During the 1980s, some of the women’s groups that campaigned around issues of violence found that support structures were sadly lacking or where they existed, they nurtured patriarchal values. Therefore, they set up alternative shelter homes, provided legal counselling and campaigned for amendments in legislations. Some of the groups conceivably moved on to identify and instill women’s perspective in health issues and campaign against invasive contraceptives and population control policies.
While there are observable changes and increased visibility of women’s issues, the intensity and dimensions of violence against women continue. Women’s groups have recognized the physical, sexual and mental health impacts of violence and incorporated the provision of shelters / short stay homes, counselling and legal aid as part of the services. Systematic research to examine the linkage of gender violence on health is beginning to gain ground.
Studies have established that rapidly growing causes of death such as burns or suicides were not accidents, as officially declared, but domestic violence against women. Physical violence or abuse and the health linkages have attained significance in the recent past, with a WHO report on violence on women as a hidden health burden. The second round of the National Family Health Survey has attempted to capture the quantum of violence that women experience within homes.
A study by Daga, Jejeebhoy, Rajgopal (1998) of Emergency Police Records maintained in a public hospital in Mumbai, strongly argues that more rds than 2/3 of women reporting to Casualty Department may have suffered domestic violence. This may still be the tip of the iceberg. Women approach the health care system with telltale marks of violence. The narrowness of the bio-medical model and the notion that domestic violence is a ‘private’ affair, leave women victims with circumscribed options. The need to modify recording formats, improving the sensitivity of health providers to gender violence has acquired significance in the recent past.
b. Violence, Health & Sexuality
Some of the feminist writings have also attempted to throw light on sexuality and violence. The curious interlocking of love, suspicion, fear and intimate violence, the representation of violence as a marker of love in gender relations, complicate the matter where women are not mere ‘victims’ or ‘survivors’ but also have an agency in a violent relationship.
Violence of various forms and its linkages to various facets of life including health, have often been discussed in the National Conferences of Women’s Movement (Nari Mukti Sangharsh Sammelan). Health sessions are the largest attended and also emerge with fascinating connections that women make. Health sessions discuss range of issues that dwell upon:
• Socio economic conditions that impinge upon livelihood, housing and health
• Poor nutrition, working and living conditions and communicable diseases
• Access to health services, powerlessness vis-à-vis health professionals and biases in the medical system that disregard women’s ability to understand
• Hazardous contraceptives and coercive family planning programme
• Communalism and violence and its effects on the health of women
• Increase in inflation or loss of employment for men, increase in alcoholism among men and domestic violence.
The health session in one of the Conferences that was held in Tirupati, Andhra Pradesh, in 1994, had questioned whether heterosexual relations, which are inherently hierarchal, really natural? Women who could identify with terms like ‘lesbians’ and women who preferred to love women but did not identify with these labels, had a separate session in the Conference. The Conferences in the following years have this theme without fail.
Issues of sexual minorities, sexual orientation and sexual rights have come out of the closet in the late 90’s, though still marginalised and criminalised. The controversies surrounding the film “Fire” that explored lesbian relations and series of violent attacks on organisations working on issues of sexual health and rights, have demonstrated the conservative character of the State and the overall environment in society that is intolerant to all minorities be they sexual, religious or even women. The pressure to abide by the “normal” is so great that there seems to be a total shrinking of the space to even assert for basic human and democratic rights.
The term “Gender-based violence” to understand violence against women and girls, is gaining currency in recent times. The unequal power relationships between women and men created and maintained through patriarchal institutions are addressed to bring about changes in gender relations (Lingam, 2001). The entire culture that creates male roles and identities defined as “masculinity” — aggression, dominance, competitiveness and so on, underlie men’s violence. The recognition and focus on masculinity is seen as an important strategy to make men conscious of gender and challenge gender inequalities and violence against women.
Violence places women at a high level of vulnerability to morbidity and mortality. Pregnancy complications, adverse birth outcomes, HIV infection in non-consensual sex, unwanted pregnancy, unsafe abortion/abortion related injury, gynaecological problems, psychological problems/ fear of sex/ loss of pleasure, low levels of immunity due to increased levels of overall neglect and declines in access to nutrition and health care are some of the outcomes of violence. Empirical evidences from India are getting generated steadily. The National Family Health Survey 1998-99 (NFHS — 2) results underscore the widespread prevalence of domestic violence in India, especially violence perpetuated by husbands against wives. Women’s high level of acceptance of wife-beating has also been revealed by the data (IIPS & ORC Macro, 2000).
c. Invasive Contraceptives
The early eighties spurred two major campaigns in opposition to invasive medical technologies. The first is the campaign seeking a thorough review and withdrawal of NET-EN and Depo Provera (injectable contraceptives) and the second seeking a ban on Amniocentesis (sex detection test) (Nadkarni, et.al. 1998) In response to a Public Interest Litigation (PIL) filed by a group of women from Hyderabad, who objected to the way injectables were being introduced through a camp approach, the court had clamped a ban and called for a review of these. While, the issue keeps coming up with media reports proclaiming the efficacy of these contraceptives and their introduction into the Family Welfare Programme, in reality the injectables are available in a different combination in the open market. Opposition to invasive contraceptives such as injectables, antifertility vaccines, Norplant and the use of quinacrine as a contraceptive, RU 486-abortion pill, has marked various phases of the movement. The literature covering this issue:
• Unravel the mindset that see women’s bodies as expendable
• Deride the increasing medicalisation of women’s bodies
• Demystify the cafeteria approach of the Family Welfare Programme
• question unethical service delivery practices which violate women’s right to information and informed consent; and comment on the economics of promoting provider-friendly contraceptives rather than user-friendly contraceptives (Lingam,1998).
The Ministry of Health attempted to introduce Net-en on a pilot basis in some major hospitals in India. The collective opposition of the women’s movement to these moves of the Government had led to a withdrawal by the Government.
d. Population Policy
The state, through various public policies enters the private realm of childbearing by defining desirable family size and the creation of incentives and disincentives to meet the same. Population policies and family planning targets were seen to directly affect women and alienate them from the health care system.
Much of the literature attempts to establish that ‘women are not wombs alone’; that high infant mortality and poverty contribute to population growth; that women’s acceptance of a small family norm is not dependent on receiving information alone, but also on improving her social status, autonomy and decision – making. A close examination of plan period documents, health policies and programmes, has revealed that women are viewed merely as ‘mothers’. The changing rhetoric in policy documents in the late seventies and eighties has not been adequately reflected in the programmes. Efforts to pass a population policy over the past decades by the state, was systematically thwarted by the women’s movement. The National Population Policy was however, passed by the Government in the parliament without any major opposition, either inside or outside the house, in the year 2000. Over the years, the movement seems to have got dissipated and weakened. Further, the language of the new population policy document resembles in many ways the Reproductive Health Approach strategy. Terms like, ‘participation’, ‘decentralised planning’; ‘empowerment of women’ are generously used in the document. Some viewed the document as ‘women-friendly’. During the years 2000 and 2001 several states like Maharashtra, Gujarat and Madhya Pradesh, have also passed state specific population policies. These are found to be far more targeted and coercive compared to the national policy. (See papers in MFC Bulletin Special Issue on Population. July-October, Issue Nos. 286-89, 2001).
e. Sex Selective Abortions
Among the several pre-natal diagnostic techniques (like sonography and chorionic villi biopsy) that are currently being used for sex detection in India, the indiscriminate use of the Amniocentesis test for sex detection followed by sex selective abortions of female fetuses, had led to a major campaign in 1980s seeking a ban of the test. The Maharashtra Regulation of Use of Prenatal Diagnostic Techniques Act was passed in 1988. The mounting pressure for a central legislation led to the passing of Prenatal Diagnostic Techniques (Regulation and Prevention of Misuse) Act in 1994. Obvious shortcomings like punishing the woman who seeks the test, non-implementation of the legislation, the ‘facility’, being still widely available with more sophisticated technologies and lack of civil society response to play the watchdog function, can be stated as reasons for failure of the goals of the campaign.
The issue that requires attention here is the scrambled stand on ‘disability’ in the women’s movement. The legislation purports to regulate the amniocentesis test but not ban it. The Act spells out categories of women who may use the test: (a) those above the age of 35 years could utilize the test to detect Down syndrome, (b)women who have a family history of congenital abnormalities; (c) those who have been exposed to radiation and d) who have experienced repeated abortions. While women’s organisations objected to female fetuses being viewed as ‘unwanted’ ‘they did not object to genetic analysis, which extends the logic to the disabled as ‘unwanted’. The campaign report of the FASDSP states two unresolved dilemmas: (1) allowing the test for genetic analysis and (2) strengthening the power of the state over people. The report notes
|“We have faced the charge of being biased against the disabled–against those suffering from genetic disorders. We ourselves questioned at times our justification in taking such a stand. The fact however remains that in today’s situation of the Indian society, the burden of childcare as such is so much on the family mainly on the woman with a handicapped child and no material resources whatsoever available, the brunt of it all would be faced by the woman of the family. Hence, until we are at least able to make a dent in this society, towards taking collective responsibility of childcare we would have to abide the
The issue of disability and women with disabilities has not received adequate attention from the movement. Protests about large-scale hysterectomies on mentally disabled women inmates of a state-run-home in Shirur (Ahmednagar district), Maharashtra, and debate about the right of the state over the bodies of women under its custody, erupted in 1994 (Rao & Pungalia, 1994). This did not get built into a national campaign.
The issue of female foeticide had acquired significance with the release of the 2001 Census provisional population figures. The 2001 Census data indicates an increase in sex ratio from 927 females per 1000 males in 1991 to 933 in 2001. However, the juvenile sex ratio i.e., the number of girls for every 1000 boys under age 6 years, indicates that the sex ratio has gone down from 945 in 1991 to 927 in 2001. This difference is large, and the sharpest declines in sex ratio for the child population are reported from Himachal Pradesh, Punjab, Haryana, Gujarat, Uttaranchal, Maharashtra and Chandigarh, the areas where abortions of female foetuses are known to be widely practiced ( Parasuraman, 2001). This obviously reflects the rampant use of medical diagnostic techniques for sex detection and selective elimination of female foetuses. Amendments to the Pre-natal Diagnostic Techniques Act and strict implementation, vigilance and the misuse of technology have resurfaced all over again, with Public Interest Litigation filed against the State as a defaulter.
Research in the recent years has not remained the forte of academics in institutions and universities. Participatory approaches to research and the acknowledgement that research is a powerful tool for advocacy had brought in the NGO and the activist groups into the field of research. Market research groups are also major players in health monitoring and evaluation research. Hence, there are several players and several sources of research data. This section would broadly map the major areas of enquiry and the relevant findings, with reference to women’s health.
One of the most significant contributions of Women’s Studies research is the conceptualisation of the household. The household not only as a production, consumption, and a socialisation unit, but one that mediates gender differentials in access to health goods and services. The close scrutiny of the intra household hierarchy, its organising principles and functioning has contributed newer dimensions to the understanding of gender division of work, resources, decision-making, power and autonomy. The intergenerational impact of women’s health and the need to focus on the girl child acquired renewed significance. The evidences point to the following:
• Time allocation studies conclude that women work more than men, their tasks tend to be arduous, and, coupled with low nutritional intake and limited access to health resources, they remain susceptible to illness. Men and male children receive a larger share of food and other resources, compared to women and girl children
• When unwell, women generally neglect their health, or rely more on home remedies, or purchase medicines over the counter
• Women’s ill health is attended to earlier in a nuclear family compared to a joint family. The lack of power and the existence of other women to carry out domestic work explain the neglect in joint households.
• Aged women are neglected in general, but the ones with property are better cared for.
• Most women do not go for all the antenatal checks during pregnancy.
• Infertile women face the threat of desertion.
• Neglect of girl children is linked to the number of girl children.
• Women endure aches and pains.
• Women expend high levels of energy on basic survival tasks like fetching drinking water, firewood in rural areas and rations in urban areas.
b. Work Related Health
A major contribution of Women’s Studies and the feminist health movement is the recognition that ‘women’s work’ encompasses not only paid work but also unpaid family labour and household chores. The Shram Shakti report (1988) systematically documented the various facets of women’s work, vulnerability, poor implementation of legislations and health hazards. The evidences range on several issues:
At the work place health hazards include exposure to chemical and other polluting elements and physical injuries caused by the type of work (like lifting heavy loads), work environments (dark, suffocating environments) and work schedules (long hours without break). The different health hazards associated with different industries have been well documented.
• Attention has also been focused on the health hazards associated with unpaid family labour including domestic work. Health problems arising from domestic chores like cooking, fetching firewood, and tending to children, which are not considered as “work”, even by women themselves, include body aches and pains, respiratory problems, cuts and burns and exhaustion.
• A five-year prospective epidemiological study (Ray et al, 1995) of chronic obstructive pulmonary disease in rural Tamil Nadu, observed that prevalence rate was 33/1000 with a significant higher prevalence of 40.8/1000 for males and 25.5/1000 for females. Smoking and exposure to indoor pollution, because of cooking fuels, are seen as major contributing factors for males and females, respectively. A hospital based prospective study that specifically focused on women exposed to domestic smoke and the various respiratory diseases that they present, observed chronic obstructive pulmonary disease, cor pulmonale, pulmonary tuberculosis and bronchial asthma (Bhat and Sujit, 1997). An urban slum study by Dutt et.al,(1996) has revealed that women exposed to biofuels were more liable to have increased respiratory illnesses and reduced pulmonary functions than women using kerosene or liquid petroleum gas (LPG). The types of fuel used and average monthly incomes are closely related. Women from the low-income households are exposed to high levels of domestic pollution. A study on rural population in Tamil Nadu, observed that majority of the people affected by chronic respiratory diseases belonged to scheduled castes, had low levels of education and income (Karamarkar, 1991). This study obviously indicates the manner in which socio economic conditions mediate vulnerability to infections and diseases, and affect men and women differentially.
• The relationship between women’s occupation and their reproductive health outcomes has not adequately attracted the attention of the women’s health movement and feminist researchers. While the association is plausible, in terms of reproductive problems including menstrual disorders, chromosomal and gene defects, abortions, cancer, malformation, low birth weight, infertility and premature menopause; empirical evidences have not bared out the relationship.
• Work has great impact on the psychology of women. Adverse work conditions lead to depression, anxiety, sleeplessness, and stress. Sexual abuse at the work place is another cause of mental disorders. Though acknowledged and possibly addressed at a micro level, mental health has gained little focus at the struggle and advocacy level.
• The main problem in dealing with health issues related to domestic work and work in the informal sectors is that laws addressing issues of occupational health do not include these two sectors, where most women are occupied. The solution is therefore not a legislative one but one that challenges social, political and economic inequalities.
• Since poverty is linked negatively to several health indicators, women’s employment is assumed to improve the household child survival. However, micro level evidences indicate that in the absence of support structures, working women of the poorer classes neglect their health, show higher levels of nutritional deficiency and drop out of the work force, to recuperate (Shatrugna, 1993; Khan et.al.1991).
c. Reproductive Choices
The Earth Summit on Environment, the Cairo Conference on Population and Development, the Beijing Conference on Women, Peace and Development are the milestones in the 1990s, which positioned women’s reproductive rights,
reproductive freedom and empowerment for improvements in several development indicators. Changes in the Family Welfare Programme took place with official announcement of withdrawals of incentives, disincentives and targets, in April 1996, and the heralding of the Reproductive and Child Health Programme. Despite the changes in rhetoric, the ground realities of women’s health inform the following:
From a typical health service delivery perspective, women’s low acceptance of contraception, spacing the first birth and between births, and delay in accepting the small family norm are viewed as a failure of official communication or as women’s ignorance. However, the feminist perspective informs us that women’s procreation is set within the ideological context of patriarchal family, culture and property relations. In a culture, where daughters are given less education, married young, attain status within the marital family only through fertility and male sons, the issues of spacing the first birth between births and adopting a small family norm, need to be addressed not merely at the level of providing information or services to women.
Research studies observe that women acknowledge the need for contraception and limiting the number of pregnancies. Women are aware of sterilisation in remote tribal and rural villages. However, their utilisation of family planning services (especially those relating to contraception) is low. This will not change quantitatively unless the circumstances within which fertility decisions are made (or not made) change. Women’s low decision-making power in the early ages of marriage, their poor health leading to miscarriages, social pressures against contraception before completion of the desired family size, general son-preference, secondary infertility due to reproductive tract infections, and so on, are barriers to the use of contraception or limiting family size (Khan and Singh, 1987; Khan, et.al., 1985; Ravindran, 1993). Therefore, in the Indian context, the concept of ‘choice’ is not limited to availability of contraceptives. The exercise of choices does not emerge from the control over their fertility alone, but control over their sexuality and life situation (Lingam, 1995).
Studies drive home the point that liberalisation of law has not significantly increased the ratio of legally induced abortions or reduced abortion-related mortality (Jesani and Iyer, 1993). The use of abortion as a method of family planning, with a high proportion of women seeking abortion in the second trimester, points to women’s lack of decision-making power within sexual relationships and their dissatisfaction with the existing contraceptive choices (Dixon-Mueller, 1993; Karkal,1991). Studies on women’s perceptions of abortion, abortion services and sex selective abortions point to the complex web of pressures from the family, service delivery providers and women’s vulnerability within a context of double standards pertaining to pregnancy ‘outside wedlock’ (Gupte, Bandewar and Pisal, 1997). Studies on gynecological morbidities, reveal that women suffer reproductive tract infections (RTIs) and sexually transmitted infections (STIs) in silence because of the shame, guilt, fear and stigma associated with these illnesses. Due to the high premium on chastity, sexual fidelity, monogamy and the honour of family closely tied to her sexual character, women are reluctant to draw attention to their bodies. Paucity of women doctors in the rural areas compounds the problem. Women endure these infections as ‘part of their lot’. Women’s vulnerability and the lack of power to say ‘no’ to unprotected sex, if her partner is infected, is the hard reality. Heterosexual intercourse appears to be the single most common mode of transmission of HIV. It is predicted that the number of women and children with HIV will outnumber men. The gender concerns of HIV have been taken up by NGOs but the women’s movement has remained largely distanced from this issue.
Several studies have been undertaken both quantitative and qualitative, to understand sexual behaviour of Indian men and women, adolescents, college going students, truck drivers, etc. The issues of sex education, dealing with male and female sexuality emerge as major areas for intervention. Typically however, interventions underplay the power relations that exist in gender relations and focus on education and condom use. A recent review of studies on sexuality and sexual behaviour unveil the biases in the conceptualisation of studies on sexuality. The authors point out that only very few studies attempt to connect sexuality with factors other than biology, health and disease (Chandiramani, Kapadia, Khanna & Misra, 2001).
Neglected Areas of Research
A broad list of areas for further enquiry is listed here. The list is obviously not exhaustive.
• The top causes of mortality for women in the reproductive age group from 1981-1994, compiled by the Registrar General of India places Tuberculosis as the leading cause of death for women in the reproductive ages, though this has been declining over this period. Subsequently new causes of death such as suicide, heart attack, burns and cancer have emerged and are steadily gaining in incidence. A close examination at the micro level to understand the social circumstances that contribute to these outcomes is necessary.
• Studies in the field of heart disease, cancers, osteoporosis, diabetes, hypertension, tuberculosis, the domain of research by medical people, are completely left out by women’s studies. A recent review by Gopal & Lingam (2001) of select research in these fields indicate lower prevalence rates for women for several communicable and noncommunicable diseases, but however, do not adequately explain whether this is a biological advantage or a methodological problem. Further, answers to the following questions are poorly lacking:
• How does class, caste, and gender variables intervene, interact, and contribute (as risk or protective factors) to morbidities and differences in prevalence rates?
• What are the intra-class variations in men’s and women’s morbidities?
• What are the inter-class variations in women’s morbidities?
• What are the factors that influence women’s experience of illness, perceptions of disease, and the social etiology of disease and access to health care?
• Women suffer from a range of gynecological illnesses such as menstrual problems, reproductive tract infections, STDs, etc. Many of these illnesses may have long-term consequences such as infertility or cancer. A recent review by Garimella and Ramanathan (2001) point out that while substantial amount of research covering areas of reproductive morbidity and the risk factors associated with them are there, gaping holes on a number of issues pertaining to gender power relations that come in the way of spousal communication, decision making, treatment seeking, every day experience of living with the morbidities and so on, are evident.
• Risky sexual practices among males contribute to cancer among women. Poor genital hygiene, multiple sex partners and lack of use of condoms by male partners place women at risk. Breast cancer accounts for 20% of all female cancers in India. Due to lack of awareness and education, most women present themselves to the medical system with advanced disease.
• A study by Stein et al, (1996) observes that 9% men and 11% women who had low birth weights, short birth lengths, or small head circumferences at birth, had developed Coronary Heart Disease (CHD) in adulthood. This study subscribes
to the hypothesis that an individual’s health is programmed at the formative stage in the uterus. This reiterates the feminist concern of addressing women’s health from childhood, since it has an intergenerational impact.
• Research in the field of breast feeding and infant feeding practices is dominated by (a) medical researchers interested in child survival issues and (b) demographers interested in the relationship of breastfeeding to natural infecundity/post partum amenorrhea (PPA). Studies indicate that the practice of breast-feeding is inversely related to women’s education and employment. A few papers highlight the need to provide support structures for working women to facilitate the continuation of breastfeeding. However, women’s studies researchers have not adequately examined this area.
• Almost a decade of NGO initiatives in building women’s empowerment through various entry points like education, health, income generating programmes, self-help groups and micro-credit, have been witnessed. Attempts have to be made to generate participatory methods and tools to assess the linkages of women’s empowerment to several health and development indicators at the micro level.
Gender Sensitive Initiatives
The fallout of the discussions on health among women’s groups has led to the development of
• Educational materials about the body in a participatory, culture sensitive idiom. ‘Body mapping’ and ‘body literacy’ in the way of fertility awareness, male sexuality and reproductive health are now seen as intrinsic parts of empowerment processes.
• Workshops on male sexuality and the construction of male identity are also organised.
• Attempts to document women’s traditional knowledge of home and herbal remedies have been undertaken, as an alternative to the hegemony of allopathic model. However, these have remained on the periphery.
• Strengthening the health functionaries of the Government and NGO sector through training in gender issues.
• Developing medical kits and formats to facilitate the recording of violence against women.
• Mainstreaming women-centered health care in public hospitals.
• Developing life skills education manuals for women and adolescents.
The present paper has attempted to map the major areas of struggles and research evidences that throw light on women’s health. The health arena constitutes number of players each engaging at different levels with the ‘system’. The feminist discourse deals with the issue of health within the broader structural roots of patriarchy and patriarchic institutions. It provides a powerful tool to explain women’s health situation. However, from the standpoint of making a difference to women’s health through research and developing programmatic interventions, gender analysis frameworks facilitate a lot of clarity. A critical enquiry of the following areas will provide rich insights into gender differentials in terms of exposure, risk factors, morbidity, outcomes, perceptions and health seeking behaviour:
• Identification of the patterns of illness – who gets ill, when and where?
• What is/are the risk factors that contribute(s) to ill health for different groups of men and women?
• How are men and women’s responses to illness influenced by gender roles, values and norms?
• What are the consequences to everyday life and well-being?
• What are the perceptions of men and women about ill health and morbidity?
• How is their health seeking behaviour shaped by these perceptions and gender roles, values and norms?
Future research with enhanced gender sensitivity only can fill this void and make a difference to women’s health.
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LAKSHMI LINGAM: Reader in the Women’s Studies Unit, Tata Institute of Social Sciences, Mumbai, India. Co-ordinator, Centre for Health Studies, TISS and the General Secretary for the Indian Association for Women’s Studies for 2000 – 2002.Her doctoral research, ‘Women’s Roles in the Production and Reproduction Spheres of Wet and Dry Villages of East Godavari District, Andhra Pradesh’ was at the Indian Institute of Technology, Mumbai. Published papers on the subjects, women-headed households, girl child, sex-selective abortions, reproductive rights, occupational health, women’s health, migration and development. She had been widely acclaimed for her book
Understanding Women’s Health Issues : A Reader (1988) published by KALI for women, New Delhi.