Denial of Healthcare to India’s Women

Mohd Aasif*

Women’s health is a crucial component in the development of a nation. A woman’s poor health has a direct bearing on the health of her children, from infancy to adulthood, and indeed on her entire family as a unit. It is well-established today that if a woman is healthy, and is in a positive frame of mind, the whole family benefits. Can there be a simpler justification for expanding gender representation in the larger society and the political economy of the country and its workforce?

Article 25 of the Universal Declaration of Human Rights endorses health as a basic human right. It lays emphasis on the issues related to the health of women and children. “Everyone has the right to a standard of living adequate for the health and well-being of himself and of his family.”¹ Yet, gender discrimination, at all levels, is a sad reality of our world irrespective of demography and culture even 75 years after the first publication of the Universal Declaration in 1948. It seems we are not even moving in the right direction of bridging the gender gap, particularly in areas like law and justice. The way things are going, it will take 286 years to close gender gaps in legal protection and remove discriminatory laws.²

In India, gender discrimination is attributed to factors like poverty, lack of education, awareness, and deep-rooted feudal-patriarchal mindset in our society. Some of our regressive social customs, beliefs and practices also play a role in the suppression of women.

According to United Nations’ Sustainable Development Goal number 5 (SDG-5) Gender equality, in 2022, India scored 60.32 points on a 0-100 scale. Although India’s ranking sees an improvement over the years, it lags behind its South Asian neighbours such as Nepal (66.18) and Sri Lanka (70.03)³ . The index score signifies a country’s position between the worst and the best or target outcomes on a scale of 0-100.

Discrimination occurs at all levels such as food intake, early age or child marriage, lack of access to educational institutions, and unequal pay at work. This discrimination further expands to the healthcare due to women’s lack of influence in decisionmaking in the family. As an outcome, India is the only large country globally, where more girls die than boys. Girls are

“Gender discrimination, at all levels, is a sad reality of our world irrespective of demography and culture even 75 years after the first publication of the Universal Declaration in 1948.”

also more likely to drop out of school⁴ or die during pregnancy or child birth.

As per WHO, “Maternal death is the death of a woman while pregnant or within 42 days of termination of pregnancy, irrespective of the duration and site of the pregnancy, from any cause related to or aggravated by the pregnancy or its management but not from accidental or incidental causes”⁵ .

to any type of anaemia as against their male counterparts. Unfortunately, India sees a rise in anaemic women in NFHS5 as compared to NFHS-4. Women with anaemia and high Hb concentrations in early pregnancy are associated with an increased risk of developing miscarriage⁶ and risk of maternal and foetal morbidity and mortality⁷ .

A study on Perinatal iron deficiency and neurocognitive development, shows that an anaemic mother gives birth to an unhealthy baby. Maternal anaemia also increases the risk of low birth weight, either due to premature birth or foetal growth restriction, which is associated with delayed neurocognitive development and even psychiatric illness. As iron deficiency inhibits learning as well as motor and emotional development, individuals exposed to perinatal iron deficiency are at high risk for failing to reach educational milestones later in life⁸.

In 2020, the birth rate of India has been estimated at 19.5, whereas the death rate has been estimated at 6.0, according to the sample registration system (SRS) Bulletin May, 2022. The estimate of Infant Mortality rate (IMR) for the year 2020 is 28 deaths per thousand live births. In the same year, the maximum IMR has been reported for Madhya Pradesh (43) and the minimum for Mizoram (3).

“The country has indeed made some steady progress in some areas of gender equality but the fact remains that our challenges are even bigger than our achievements.”

IMR is widely accepted as a crude indicator of the overall health status of a country or a region. Although India has achieved its IMR target, it still needs to achieve its Neonatal Mortality Rate (NMR) and Under 5 Mortality Rate (U5MR) which currently is 22 and 35 respectively.⁹

The major causes of child mortality in India as per the SRS reports (2010-13) are: Prematurity & low birth weight (29.8%), Pneumonia (17.1%), Diarrheal diseases (8.6%), Other non-communicable diseases (8.3%), Birth asphyxia & birth trauma (8.2%), Injuries (4.6%), Congenital anomalies (4.4%), Ill-defined or cause unknown (4.4%), Acute bacterial sepsis and severe infections (3.6%), Fever of unknown origin (2.5%), and all other remaining causes (8.4%)¹⁰.

Despite all the hurdles and setbacks, India, as a developing country has made some progress towards its goal of gender equality, and women’s good health and well-being. The country has indeed made some steady progress in some areas of gender equality but the fact remains that our challenges are even bigger than our achievements. For instance, governments at the Centre and in several states have come up with legislations and schemes to safeguard the women’s rights to health. Maternal Mortality Ratio and Maternal Mortality Rate are the most concerning events in the lives of women. Reducing these rates is a daunting task given the condition of health infrastructure of the developing nations.

Existing Legal Provisions for Women’s Health

Health as a fundamental human right for women has travelled a long way. Starting from the Maternity Benefit Act to the Mental Health and Surrogacy bill (pending in parliament), every legislation has tried to address the needs of the hour. Several welfare schemes have been launched for the benefit of the mother and child at the central and state levels. A glimpse of the existing legal provisions on women’s health is as follows:

Maternity Benefit Act, 1961 and Maternity Benefit (Amendment) Act, 2017

The Maternity Benefit Act (MBA) regulates the employment of women in certain establishments for certain periods before and after childbirth and provides maternity benefits along with other benefits. These Acts entitle a mother to paid leaves for a period of up to 26 weeks. In case a woman is deprived of her maternity benefits or medical bonus or both, the Act gives her the right to appeal in front of the prescribed authority. It gives her a window of sixty days starting from the date on which the order of such deprivation is communicated to her. It also prescribes the punishment for such employers who contravene the provisions.

Medical Termination of Pregnancy Act, 1971 and Medical Termination of Pregnancy (Amendment) Act, 2021

The Bill, at the stage of deliberations, invited controversy and started a debate on prolife or pro-choice stands on the matter of termination of pregnancy. The act provides the legal framework for making medical termination of pregnancies by RMPs and for matters connected with that. The amendment to the principal act increases the time limit for accessing safe and legal abortion series from 20 to 24 weeks (of gestation) in certain circumstances. It removes the limit in case of foetal abnormalities.

The amendment to the principal act has increased the upper gestation limit from 20 to 24 weeks for special categories of women, including survivors of rape, victims of incest and other vulnerable women like differently abled and minors. It also extended MTP services, under the clause of failure of contraceptive, to unmarried women to provide access to safe abortion based on a woman’s choice, irrespective of marital status¹¹.

National Food Security Act, 2013

Food security for an individual ensures her right to life pragmatically. National Food Security Act, 2003 provides that all people at all times get access to the basic food for their active and healthy life. Section 4 of the Act deals with matters concerning pregnant women and lactating mothers including (a) meal, free of charge, during pregnancy and six months after childbirth, through the local Anganwadi; and (b) maternity benefit of not less than rupees six thousand.

The Mental Healthcare Act, 2017

The Act provides for the protection and promotion of the rights of persons with mental illness during the delivery of healthcare in institutions and in the community. The act recognises that every person with mental illness shall have a right to live with dignity. Every person with mental illness shall be protected from cruel, inhuman or degrading treatment in any

“While India’s MMR further declined to 113 in 2016-18, It was the lowest (43) for Kerala for the same period, and the highest (215) for Assam.”

mental health establishment and shall have adequate provisions for wholesome food, sanitation, space and access to articles of personal hygiene, in particular, women’s personal hygiene be adequately addressed by providing access to items that may be required during menstruation.

Drawbacks and Way Ahead

While the statutes mentioned above provide a good cover to women in distress and health emergencies, their implementation is patchy and inadequate to say the least. Besides, inadequate allocation of resources to healthcare infrastructure and services continues to be a cause for concern. The health budget of the Union Government has seen only a marginal rise in the past five years, from 1.2% of its GDP in 2014-15 to 1.8% in 2020- 21. The share of the budget for the National Health Mission (NHM) in the total health budget of the Union Government has also declined from 60.25% in 2018-19 to 52.12% in 2020- 21, adversely affecting the quality of healthcare including reproductive healthcare services¹².

Another cause for concern is that the benefits of the Maternity Benefit Act are limited to the permanent or regular employees of the establishments in the organised sectors. Informal employees or contractual

“The status of healthcare has improved not only because of enhancement in services but also due to better primary education and a relative stability of the economy”

employees of the organised sector as well as unorganised sector remain outside the ambit of the Act¹³.

Implementation of maternity oriented schemes also remains a challenge for the state governments. A study by CEDAW (Convention on Elimination of all forms of Discrimination against Women) notes that the Matru Vandana Yojana (Maternity Benefit Program), 2017 —meant to support lactating mothers and pregnant women by compensating them for loss of wages during their pregnancy — has been able to reach less than a third of the eligible beneficiaries¹⁴. Further, the benefit is restricted to only the living child, thereby, excluding a large number of pregnant women in the country.¹⁵

Government bodies need to constantly monitor such pitfalls and work on them while learning from our mistakes and good practices. Further, eligibility conditions stipulated for availing the benefits of the Matru Vandana Yojana (reproductive health services) should also be made easier and more approachable.

Although India has performed well in reducing the Maternal Mortality Ratio and IMR over the years. Maternal Mortality Ratio (MMR) in India was exceptionally high in 1990 with 556 women dying during child birth per one lakh live births against a global MMR of 385. In the next two decades, the MMR in the country has declined to 167 (2011-13) against a global MMR of 216 (2015), according to the Ministry of Health and Family Welfare. Yet, A wide gap among the states of India continues to be a cause for concern. While India’s MMR further declined to 113 in 2016-18, It was the lowest (43) for Kerala for the same period, and the highest (215) for Assam.

It is heartening to see a positive change in at least some of the health indicators of SDGs in India even though we still have to cover a lot of ground. The status of healthcare has improved not only because of enhancement in services but also due to better primary education and a relative stability of the economy. On the flip side, the situation continues to be dismal in the more backward states of Northern and Eastern India and even worsening in some places. For a quantum change in the status of women and their healthcare, however, the ratio of female-to-male labour force participation rate and seats held by women in national parliament and state assemblies also need to show a perceptible improvement. India’s backward states also need to learn from the experiences of our own better performing states which have shown remarkable success in areas of women’s health and overall wellbeing.

Endnotes

• UNSD. Department of Economic and Social Affairs Statistics. UNSD. Retrieved Oct 21, 2023, from https://bit.ly/3S1aIYc
• Hasan, Z. (2023). Gender Inequality in South Asia: Tracing Impediments to SDG 5 of UN Sustainable Development Goals.
• UNICEF. Gender equality. unicef for every child. Retrieved November 15, 2023, from https://bit.ly/4aHOnWU
• GoI. (2022, November). Census Of India. Census Digital Library. Retrieved November 21, 2023, from https://bit.ly/48CcTad
• Díaz-López, A., Ribot, B., Basora, J., & Arija, V. (2021). High and low haemoglobin levels in early pregnancy are associated to a higher risk of miscarriage: a populationbased cohort study. Nutrients, 13(5), 1578.
• Shah, T., Khaskheli, M. S., Ansari, S., Lakhan, H., Shaikh, F., Zardari, A. A., ... & Shar, A. H. (2022). Gestational Anemia and its effects on neonatal outcome, in the population of Hyderabad, Sindh, Pakistan. Saudi journal of biological sciences, 29(1), 83-87.
• Radlowski, E. C., & Johnson, R. W. (2013). Perinatal iron deficiency and neurocognitive development. Frontiers in human neuroscience, 7, 585.
• GoI. (2022, May 25). India - SAMPLE REGISTRATION SYSTEM (SRS)-BULLETIN 2020 VOLUME 55-I. Census of India. Retrieved November 12, 2023, from https://bit.ly/3NNTmf4
• GoI. National Health Mission. NHM. Retrieved November 11, 2023, from https://bit.ly/48bGBmC
• . CHAKRABARTY, S. (2023, October 15). Why are abortion laws in the spotlight again? The Hindu. Retrieved November 15, 2023, from https://bit.ly/41OxdD5
• NHRC. (2021). Women’s Rights in India. National Human Rights Commission. Retrieved October 25, 2023, from https://bit.ly/41Fcfq4
• Lal, N. (2016, August 21). The New Maternity Benefits Act Disregards Women in the Unorganised Sector. The Wire. Retrieved November 21, 2023, from https://bit.ly/3RJ1JJP
• Chandra, J. (2019, November 19). Maternity scheme reaches only onethird of beneficiaries. The Hindu. Retrieved December 1, 2023, from https://bit.ly/4aCNpLH
• Supra note 11.
• . Supra note 11.
• Supra note 4.

 

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