Gender issues in helath nmims 27 07-07Presentation Transcript
Gender Issues in Health Dr. Vibhuti Patel, Director, PGSR & Professor & Head, Department of Economics, SNDT Women’s University, Churchgate, Mumbai-400020. E-mail- [email_address] Phone-91-022-26770227, mobile-9321040048
Alarming Health Status of Women in India
Maternal Mortality, morbidity
Malnutrition, iron deficiency anaemia
Plight of child bride and girl-child labour
Towards Equality report, 1974
Shram Shakti report, 1988
National Perspective Plan for Women
Millennium Development Goals, 2000
National Rural Health Mission, 2005
Critique of Population Policy
India was the first developing nation to adopt family planning policy in 1950.
I FYP (1951-56) – Men targetted
II FYP- barrier methods
III & IV FYPs & interim plans(1961-74)- IUD & male sterilisation, MCH
V FYP (1974-78)- Women targetted
VI FYP(1980-85)- EP drugs,camp approach
VII FYP(1986-1991)- Depo Provera, Net-o-En
VIII FYP(1992-97)- Norplant, A.P.Vaccine
IX FYP (1997-2002)- Cafeteria approach
X Five Year Plan (2002-2009)
Each state to decide its own population policy
Maharashtra - 2 child norm- Amenmdment in Local Self government Act- disqualification provision for an elected representative- having a third child
Panchayat members axed
Tamilnadu- Public Sector Employees penalised
Rajasthan- use of hormone-based contraceptives
Erosion of public health facilities
Charging of user fees
Privatisation of insurance & health services
National Conferences of Women’s Liberation Movement in India
1980-Mumbai Perspective/ critique
1985- Mumbai SD & SP Tests
1988- Patna WDP of Rajasthan ‘Target’
1990-Calicut Women and Health
1993- Tirupati RCH, Coersion
1996- Ranchi Reproductive Rights
Influence of Cairo Declaration (1994)
SAHELI- Delhi, Masum- Pune, FWH- Mumbai
PSM,MFC, IME, JSA
Occupational Health & Safety
Bhopal Gas Carnage, 1984
Shramshakti Report & NPPW 1988
Women in FTZ, FTZ & SEZ
DPAP, Food for Work programme
Energy Expenditure- collection of fuel, fodder, water
Labour processes & labour relations
PRIA, CSE, MFC, ICHRL, VKU, NBA
Tobacco Workers- SEWA
Forest women-Tendu, lac, frogs, snakes, rats
Mental Health Issues
Bhargavi Davar-Bapu Trust for Research on Mind and discourse
Critique of bio-medical Approach
Culture specific counselling
Patriarchal biases in psychiary-victim blaming
Sexual violence, Domestic violence
Mental health of adolescent girls
Demand for Half way homes
Community based approach
Signature campaign against ECT
Environment & Health
Chipko-Fuel, fodder, water
Environment- Medha Patkar & Vandana Shiva
Source: The World’s Women- Trends and Statistics, United Nations, NY, 1995 Regions Women per 100 men Europe & North America 105 Latin America 100 Caribbean 103 Sub Saharan Africa 102 South East Asia 100 Central Asia 104 South Asia 95 India 93
Declining Sex Ratio and Implementation of The Pre Natal Diagnostic Techniques Act
The Census results of 2001 have revealed that with sex ratio of 933 women for 1000 men, India had deficit of 3.5 crore women when it entered the new millennium. Table-1 Demographic Profile Population of India 102.7 crores Males 53.1 crores Females 49.6 crores Deficit of women 3.5 crores Sex ratio 933(W/1000M) Source: Census of India, 2001 .
Pre Natal Diagnostic Techniques Act, 1994
To stop the abuse of advanced scientific techniques for selective elimination of female foetuses through sex -determination, the government of India passed the PNDT Act in 1994. But the techno-docs and the parents desirous of begetting only sons have subverted the act.
PNDTs are part of (new Reproductive Technologies) NRTs based on principle of selection of ‘the desired’ and rejection of ‘the unwanted’.
SP-Index of Son Preference (Excess of sons over daughters/ ideal family size) in Major States in India, 1990. All India-20 W.Bengal U.P. Tamil Nadu Rajasthan Punjab Orissa Maharashtra States 10 14.3 02 27.1 M.P. 01 21.6 12 11.7 Kerala 13 9.2 08 20 Karnataka 03 25 10 14.3 Haryana 07 20.3 06 23 Gujarat 05 23.4 04 24.5 Bihar 09 18 11 13.8 A.P. Rank ISP Rank ISP States
Small Family Norm and Sexist Bias
BIMARU states (Bihar, Madhya Pradesh, Rajasthan, Uttar Pradesh) are at the top of the rank for son preference. Orissa is 5 th in the rank.
unholy alliance between tradition (son-complex) and technology (ultrasound)
Kerala ranks 12 th in the index of son-preference. However the sharp decline in fertility and strong preference for small family norm does raise the possibility of enhanced gender bias.
Women’s Movement on t he neo-classical logic
The law of Law of Demand and Supply does not apply to the complex social forces where patriarchy controls sexuality, fertility and labour of women without any respect to her bodily integrity.
We can’t apply law of DD & SS. In fact, shortage of women in Haryana, Punjab and the BIMARU states have escalated forced abduction and kidnap of girls, forced polyandry, gang rape and child-prostitution.
Attitudes Towards Women’s Health
Social discrimination against women results into systematic neglect of women’s health, from womb to tomb. Female infanticide and female foeticide are widely practiced in BIMARU
(Bihar, MP, Rajasthan
and Uttar Pradesh)
and Gujarat) states.
Juvenile Sex Ratio in Kerala, 2001
The overall sex ratio is favourable to women is Kerala. But, in Kerala also, in the 0-6 age group, the sex ratio was 963, as per 2001 census.
Total 0-6 age-group population of Kerala was 36.5 lakhs. Out of this 18.6 lakhs were male babies and infants and 17.9 lakhs were female babies and infants. Thus, 79760 female babies and infants were missing in 2001 in Kerala.
Increasing Female Literacy & Declining Sex Ratio
In a micro-study of Kolkata, the Census Report observes, “ Out of 141 municipal wards, the percentage of child population has declined in 134 wards since 1991. More importantly, the child sex ratio has declined sharply, from a high of 1011 females per 1000 male children in 1951 to abysmal 923 in 2001. This is the lowest child sex ratio for Kolkata in the last 50 years. A major cause for the decline is ‘sex selective foeticide’”.
Rates of female foeticide have increased along
with the increase in female literacy rates in West Bengal.
60 lakh Missing girls in 2001
As a result of sex-determination and sex-preselection tests leading to selective abortions of female foetuses, sex ratio of the child population has declined to 927 girls for 1000 boys.
Sixty lakh female infants and girls are “missing” due to abuse of amniocentesis, chorion villi Biopsy, sonography, ultrasound and imaging techniques.
Sex pre-selection techniques prevent arrival of female baby at a pre-conception state. Even anti- abortionists use this method to get baby boys, as it does not involve “Blood-bath”.
POPULATION IN THE AGE GROUP 0 TO 6 YEARS IN 2001, INDI
INFANTS AND CHILDREN (ALL) 15.8 CRORES
MALE INFANTS AND CHILDREN 8.2 CRORES
FEMALE INFANTS AND CHILDREN 7.6 CRORES
DEFICIT OF GIRLS 60 LAKHS
SEX RATIO OF CHILD POPULATION 927
Sex ratio (number of women per 1000 men) of Greater Bombay has reduced from 791 in 1991 to 774 in 2001 in spite of rise in its literacy rate. To prevent female infanticide – Tamil Nadu – Cradle baby scheme
Violence and Health Issues of Women Over the Life Cycle
As unborn children, they face covert violence in terms of sex-selection and overt violence in terms of female foeticide after the use of amniocentesis, chorion villai biopsy, sonography, ultrasound and imaging techniques .
IVF (In Vitro Fertilization) clinics for assisted reproduction are approached by infertile couples to produce sons. Doctors are advertising aggressively, “Invest Rs. 500 now, save Rs.50000 later i.e. if you get rid of your daughter now, you will not have to spend money on dowry”.
Discrimination & Dehumanisation
As girls under 5 years of age, women face neglect of medical care and education, sexual abuse and physical violence. As adolescent and adult women in the reproductive age group, they face early marriage, early pregnancy, sexual violence, domestic violence, dowry harassment, infertility, if they fail to produce son, then face desertion/ witch hunt.
The end result is a high maternal mortality. Causes of maternal deaths in our country are haemorrhage, abortion, infection, obstructed labour, eclampsia (blood pressure during pregnancy), sepsis, and anaemia. Proliferation of NRTs should be analysed in this context.
New Reproductive Technologies
NRTs perform 4 types of functions.
1.In Vitro Fertilisation (IVF) and subsequent embryo transfer, GIFT (Gamete Intra Fallopian Transfer), ZIFT and cloning assist reproduction.
2.Contraceptive Technologies prevent conception and birth.
3.Amniocentesis, chorion villai Biopsy, niddling, ultrasound and imaging are used for prenatal diagnosis.
4.Gene technologies play crucial role through genetic manipulation of animal and plant kingdoms.
They are based on the
principles of selection and rejection.
Improvement in Quality of Population
Genomics is “ the science of
improving the human population through controlled breeding, encompasses the elimination of disease, disorder, or undesirable traits, on the one hand, and genetic enhancement on the other. It is pursued by nations through state policies and programmes”.
Sex Ratio among the States with Widespread Use of Sex Determination Tests (O-6 year age group) Source: Census of India, 2001 917 946 Maharashtra 878 928 Gujarat 820 879 Haryana 793 875 Punjab 2001 1991 States
Do Women Have A CHOICE ?
An argument that prenatal diagnostic tests give women a choice to select a child of desired sex is also unacceptable as women's "Choices" are made within the patriarchal compulsions to produce sons.
Women are not taking decision autonomously. Threat of desertion, divorce and ill treatment force them to opt for sex-determination and sex-preselection tests.
Are Indian Women An Endangered Species ?
Can we allow Indian women to be an Endangered Species ? NO.
We will have to change the mindset of doctors and clients, create a socio-cultural milieu that is conducive for girl child’s survival and monitor the activities of commercial minded techno-docs thriving on sexist prejudices. Then only we will be able to halt the process of declining sex ratio resulting into deficit of girls/women.
Slogans of Women’s Rights Movement “ Eliminate Inequality, not Women”. “ Destroy Dowry, not Daughters”. “ Get rid of Domestic violence, not brides”. Say “No” to Sex-determination, Say “Yes” to Empowerment of Women, Say “No” to Sex Discrimination, Say “Yes” to Gender Justice .
Public Interest Litigation on EP combinations, 1986
PIL against long acting contraceptives trials by Saheli-Delhi, TRUE-Vadodara, SSS-Hyderabad- Public hearing in 1990
Maharashtra SD Regulation Act, 1988
Prenatal Diagnostic Techniques (Regulation and Prevention of Misuse) Act, 1994
CEHAT-MASUM- Dr. Sabu George PIL- 1999
PNDT Amendment Act, 2002
Ad. Kamayani x Dr. Malpani case in H. C.
Signature campaign supporting PIL against ECT-Movement Against Shock Treatment
Public Interest Litigation by CEHAT, MASUM, Dr. Sabu
In response to the public interest petition filed by Centre for Inquiry into Health and Allied Themes Mumbai), MASUM and Dr. Sabu George and fought on their behalf by the Lawyers Collective (Delhi); the Supreme Court of India gave a directive on 4-5-2001 to all state governments to make an effective and prompt implementation of the Pre-natal Diagnostics Techniques (Regulation and Prevention of Misuse) Act (enacted in 1994 and brought into operation from 1-1-1996).
The PNDT Amendment Act, 2002
The Pre-natal Diagnostics Techniques (Regulation and Prevention of Misuse) Amendment Act, 2002 received the assent of the President of India on 17-1-2003.
The Act provides “for the prohibition of sex selection, before or after conception, and for regulation of pre-natal diagnostic techniques for the purposes of detecting genetic abnormalities or metabolic disorders or sex-linked disorders and for the prevention of their misuse for sex determination leading to female foeticide and for matters connected therewith or incidental thereto” .
MASUM & MSCW
Another important initiative that has been taken is against any institution or agency whose advertisement or displayed promotional poster or television serial is suggestive of any inviting gestures involving/supporting sex determination.
MASUM, Pune made a complain to the Maharashtra State Women’s Commission against Balaji Telefilms because its top rated television serial’s episode telecast during February 2002 showed a young couple checking the sex of their unborn baby.
Need for Vigilance- The PNDT Rules tighten the Screws
all bodies under PNDT Act namely Genetic Counselling Centre, Genetic Laboratories or Genetic Clinic cannot function unless registered. They have to maintain records and send a complete report in respect of all pre-conception or pregnancy related procedures/ techniques/ tests by 5 th of the following month to the appropriate authorities. Vigilance Committees- Raids
Record of the clinics, sonography machines, public education thro’ mass media, training programme, poster- campaign by the state.