Health issues of women need different approach

With this year’s World Population Day’s theme being reproductive health and gender equality essential for achieving sustainable development, the focus has once again shifted towards the need for women’s reproductive health. Surveys have shown how lack of knowledge among women on sex, contraception, pregnancy, and abortion has been affecting their reproductive health orientation.

A reproductive health orientation means that people have the ability to reproduce as well as to regulate their fertility; women are able to undergo pregnancy and childbirth safely and that the outcome of pregnancy is successful in terms of both maternal and child health and well-being. Reproductive health is affected by a variety of socio-cultural and biological factors and the quality of the delivery system. A woman-based approach to reproductive health is the one which responds to the needs of adult women and adolescent girls.

Even after four decades of the inception of the family planning programme, nothing much has been observed in terms of the population growth rate, which continues to grow at over 2% per year. Currently, almost 18 million people are added to India’s population annually, under which 40% of the population comprises children under 14.

Gender gaps

Life expectancy has now reached 61 years, up from about 44 in 1960; and the crude death rate has fallen dramatically from 27 per 1000 population at the time of Independence in 1947 to 9.8 per 1000 (1991). In Kerala, which has the longest life expectancy, males live for 67.2 years while it is 72.4 for females.

In Uttar Pradesh, which has lowest life expectancies in the nation, there is a reversal of the gender pattern: while males can expect to live a total of 57.1 years, female life expectancy is only 52.8.

Gender disparity is the biggest roadblock in unequal access to healthcare. Women’s unequal access to resources, be it healthcare or education, is a reality. Despite being active economically, the work of a majority of rural Indian women goes largely unrecognised and poorly remunerated. They earn lower wages including lower cash-to-kind ratio than what is awarded to men.

When it comes to households, women have little decision-making authority and freedom of movement. Many behavioral norms further reinforce women’s lack of freedom of movement, self-confidence and their acceptance of self-denial including in matters relating to health-seeking and food intake. Violence against women and rape and are all part of women’s lives. Women’s poor reproductive health in India can be attributed to various socio-cultural and biological factors.

Thus, efforts to improve women’s education are fundamental, be it raising enrollment and attendance rates of girls in school, reducing the drop-out rate, or enhancing women’s income autonomy.

Major concerns

India’s Family Welfare Program basically focuses on achieving demographic targets by increasing contraceptive prevalence and notably female sterilisation. However, the Indian family planning program also evolved through a number of stages. It has changed its focus. In the early years, the programme was laid with loads of caution and its impact was hardly felt.

Then during 1965- 75, the programme was strengthened by integrating family planning with maternal and child health services was introduced. It was also during that decade, that abortion was legalised. Despite all these, India’s maternal mortality ratio is estimated at 555 per 100,000 live births, about fifty times higher than that of many industrialised nations and six times as high as that of neighboring Sri Lanka.

The following sub-sections highlight major concerns in the area of reproductive health:

a) Focus to be laid on reproductive morbidity and maternal health

b) Improving access to safe abortion

c) Information on sexually transmitted diseases

d) Improved quality of the reproductive system

(The writer is Founder, Gramin Healthcare)