The document discusses various gender issues in health that negatively impact women in India. It summarizes key reports and initiatives on women's health status, critiques population policies, and outlines the alarming declining sex ratio and increasing use of sex-selective abortions. It also summarizes women's rights movements and legal activism aimed at promoting women's health, empowerment, and ending discrimination.

1. 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

2. 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

3. 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

4. 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

5. 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

6. 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 Corporate Responsibility Tobacco Workers- SEWA Forest women-Tendu, lac, frogs, snakes, rats

7. 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 Substabce abuse Media Demand for Half way homes Community based approach Signature campaign against ECT

8. Environment & Health Chipko-Fuel, fodder, water Appiko-Karnataka Junagarh Environment- Medha Patkar & Vandana Shiva Three Dimensions Displacement Worker’s Rights Envionmental Damage

9. 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

10. 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 .

11. 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’.

12. 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

13. 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.

14. 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.

15. 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 DEMARU (Punjab, Haryana, Himachal Pradesh and Gujarat) states.

16. 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.

17. 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.

18. 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”.

19. 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

20. 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”.

21. 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.

22. 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.

23. 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”.

24. 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

25. 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.

26. 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.

27. 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 .

28. Legal Activism 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

29. 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).

30. 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” .

31. 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.

32. 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.

33. THANK YOU DOWN WITH DISCRIMINATION SAY “NO” to FEMALE EXTERMINATION Daughter is not for slaughter Women’s Health Rights are Human Rights