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A roadmap for progress

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A roadmap for progress

Monday, 12 August 2019 | Ajoy Khandheria

Despite the launch of many schemes, major concerns in the area of women’s reproductive health remain. We need to stand up for their rights

With this year’s World Population Day being on the theme of reproductive health and gender equality, which is essential to achieve the UN-mandated sustainable development goals, the focus has once again shifted towards the need to women’s sexual and reproductive health. Numerous surveys have shown how women lack knowledge on sex, contraception, pregnancy and abortion. The lack of it has been affecting their reproductive health.

Reproductive health implies that apart from the absence of disease or infirmity, people have the ability to reproduce, to regulate their fertility; women must be able to undergo pregnancy and childbirth safely and that the outcome of pregnancy must be successful in terms of both maternal and child health and well-being. Reproductive health is affected due to a number of socio-cultural and biological factors as also the quality of healthcare delivery system. A woman-based approach to reproductive health is one which responds to the needs of adult women and adolescent girls.

Current scenario: Even after four decades since the inception of family planning programmes, nothing much has changed in terms of population growth rate, which continues to grow at over two per cent per year. Currently, almost 18 million people are added to India’s population annually, of which, 40 per cent comprises children under the age of 14.

Life expectancy has now reached 61 years — up from about 44 in 1960. And crude death rate has fallen dramatically from 27 per 1,000 population at the time of independence in 1947 to 9.8 per 1,000 (1991). In Kerala, which registered the longest life-expectancy, the average life span among males is 67.2 years and for females it is 72.4. Whereas in Uttar Pradesh, which ranks among those States with the lowest life expectancies, there is a reversal of the gender pattern: While males are expected to live a total of 57.1 years, female life expectancy is only 52.8.

Gender disparity is the biggest roadblock towards equal access to healthcare. Unequal access to resources for women — be it in healthcare or education — is the harsh reality. Even economically, despite a majority of the rural women in India being active, their work largely goes unrecognised. They are poorly remunerated, too. Where women work, they earn lower wages, including lower cash-to-kind ratio than those that are awarded to men. 

When it comes to household, women have little decision-making power and freedom of movement. Many behavioural 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 have almost become part of their lives. Poor reproductive health among women can be attributed to various socio-cultural and biological factors. Thus, efforts to improve their education are fundamental — be it raising the enrolment and attendance rates of girls in school, reducing drop-out rates or enhancing their income autonomy.

Loopholes in the reproductive health programmes:

India’s family welfare programmes are basically focussed on achieving demographic targets by increasing contraceptive prevalence and notably, female sterilisation. However, Indian family planning schemes have also evolved through a number of stages. It has changed its focus. In the early years, the programme came with loads of caution and its impact was hardly felt. Then during 1960s, it was strengthened with the integration of family planning with maternal and child health services. It was also during this decade that abortion was legalised. Despite all these efforts, India’s maternal mortality ratio is estimated at 555 per 100,000 live births, which is about 50 times higher than that of many industrialised nations and six times higher than our neighboring country, Sri Lanka. 

The following sub-sections highlight major concerns in the area of reproductive health: Focus must be on reproductive morbidity and maternal health; improving access to safe abortion; more should be done to spread information regarding sexually transmitted diseases; ensure the provision of comprehensive sexuality education; eliminate coercive practices and safeguard women’s informed consent and decision-making in sexual and reproductive health care contexts and improve the quality of reproductive system.

(The writer is founder of Gramin Healthcare)

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