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EDITORIAL
Year : 2020  |  Volume : 64  |  Issue : 4  |  Page : 325-327  

Inequality in health and social status for women in India – A long-standing bane


1 Advisory Board Member of Indian Journal of Public Health; Vice President, Public Health Foundation of India, Gurgaon, Haryana, India
2 Additional Professor, Indian Institute of Public Health Delhi, Public Health Foundation of India, Gurgaon, Haryana, India

Date of Submission23-Oct-2020
Date of Decision27-Oct-2020
Date of Acceptance28-Oct-2020
Date of Web Publication11-Dec-2020

Correspondence Address:
Sanjay Zodpey
Advisory Board Member of Indian Journal of Public Health; Vice President, Public Health Foundation of India, Gurgaon, Haryana
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijph.IJPH_1312_20

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How to cite this article:
Zodpey S, Negandhi P. Inequality in health and social status for women in India – A long-standing bane. Indian J Public Health 2020;64:325-7

How to cite this URL:
Zodpey S, Negandhi P. Inequality in health and social status for women in India – A long-standing bane. Indian J Public Health [serial online] 2020 [cited 2021 Jan 24];64:325-7. Available from: https://www.ijph.in/text.asp?2020/64/4/325/303091



Over the years, women in India have been victims of extreme social, cultural, and developmental adaptations. In the ancient period, many women across various Indian States were compulsorily made to follow several social traditions and restrictions, thereby victimizing them in a largely patriarchal society. Practices such as female feticide, female infanticide, dowry, domestic violence, acid throwing, and taboo on widow remarriage were rampant. These retrogressive practices have declined with time but are yet to see a complete root out. On a positive note, there have been incidents where a few Indian women have shone, nationally as well as internationally. They have brought laurels to the country across fields such as sports, art, culture and cinema, space and technology, and politics.

Yet, when it comes to equality between men and women, as a country, India is still struggling. Gender inequalities between Indian men and women have been observed to exist right from the time they are born. India's sex ratio at birth (number of females per 1000 males) has always been favorable toward the males. In 1901, the census reported a sex ratio of 972 females per 1000 males at birth.[1] This figure deteriorated in the subsequent decades, until it reached an all-time low at 927 females per 1000 males during the 1991 census, only to increase again slowly. In 2011, the ratio was 943 females per 1000 males.[1] This suggests some improvement in the efforts at bridging the gender gap, albeit slow moving.

Another noteworthy fact is that these gaps as well as programmatic efforts toward parity are very variable across the Indian States. While the states such as Kerala and Puducherry reported a sex ratio favoring the females (1084 and 1037 per 1000 males, respectively), in census 2011, Delhi with a ratio of 868, Haryana – 879, Jammu and Kashmir – 889, and Punjab – 895 have been the worst.[2] Other variations are seen with respect to socioeconomic class, caste, etc. Furthermore, for some other basic indicators, differences are observed among women across different castes and socioeconomic groups; a recently released UN report stated that an average Dalit woman in India dies 14.6 years earlier than an upper caste woman.[3] Women from upper socioeconomic classes generally tend to have more accessibility toward basic services and better opportunities at honing their skills as against those from lower socioeconomic groups.

At a global level also, India has been faring rather poorly. World Economic Forum's Gender Gap global report of 2019 published country ranks on various factors related to gender disparities such as education, health, and employment. India's global ranking was 112, being one of the bottom five countries, and faring worse than the previous year, when its rank was 108.[4] India fared poorly, particularly in women's health and survival (rank 150) and economic participation by women (rank 149).[4]

With fewer females across the country, the opportunities they have access to are also limited. This has been customary among communities and societies for decades. While a selected few women in the country are adequately exposed to equal opportunities as men in various developmental fields, most women, especially in the rural areas of India, are subjected to poor social development and deteriorating health, both being interlinked. The proportion of literate females as per the census 2011 was 65.46%, as against 82.14% literate males. This indicator was even worse for rural females (58.75%). Fortunately, the gender gap for literacy showed an improvement from 24.8% in 1991 to 16.7% in 2011.[5] More recent data (2018) from the World Bank showed a marginal improvement in literacy rates, according to which adult male literacy rates were 82.37% and 65.79% for adult females.[6] The Indian economy has also been less favorable toward women, with a wage gap between men and women despite a substantial proportion of women being engaged in the labor force across various sectors.[7]

In India, women's health issues have prevailed across a span of centuries. Taj Mahal, one of the most admired world heritage sites, was built by the Mughal emperor Shah Jahan in the early 1600s in the memory of his wife, Mumtaz Mahal, after her death during childbirth.[8] Indian history has been witness to many such maternal deaths since, most of which were preventable and should have been averted with timely intervention and appropriate management. The number of deaths has gone down with time, however, not to the extent that is scientifically and socially acceptable. In 1990, when the Millennium Development Goals were laid down, India's maternal mortality ratio (MMR) was 556 per 100,000 live births, considerably higher than the global MMR of 385.[9] In 2005, when the National Rural Health Mission was launched by the Ministry of Health and Family Welfare (MoHFW), Government of India, the MMR of the country stood at 254 per 100,000 live births.[10] With targeted interventions and schemes in place, efforts were focused on improving women's health and lowering the maternal death rates significantly. With reporting mechanisms and verbal autopsies being strengthened, the number of deaths reported showed an artifactual increase for a short period, followed by a streamlining of the rates. A decade later, in 2015, the rates declined to 158 per 100,000 live births.[11] In the latest Sample Registration Survey report of 2017, MMR of India stands at 122 per 100,000 live births.[12] Despite all the concerted efforts of MoHFW in trying to save the lives of our mothers, the struggle to reach the Sustainable Development Goals global target of <70 maternal deaths per 100,000 live births continues.

Besides mortality, Indian women face multiple health issues contributing to their ill health. Anemia and undernutrition in these groups have been prevalent for a long time. As per the National Family Health Survey (NFHS)-4 (2015–2016), the proportion of non-pregnant anemic women (Hb <12.0 g/dl) in the age group of 15–49 years is 53.2%. Furthermore, more than 50% of pregnant women in the same age group have been reported to be anemic (Hb <11.0 g/dl).[13] What is noteworthy is that despite a substantial proportion of urban and rural women suffering from this basic preventable medical condition, only 30.3% of pregnant mothers reported consuming iron tablets as prescribed, and a meager 21% of mothers reported having received full antenatal care.[13] In addition, underweight combined with stunting and wasting leads to undernourished women who are more likely to give birth to undernourished babies, perpetuating an intergenerational cycle of malnutrition, with the birth of a girl child.[14] NFHS-4 reports 22.9% of women in the age group of 15–49 years with a body mass index of <18.5 kg/m2).[13]

Other illnesses common among women include the growing burden of breast cancer, menstrual problems, and mental health. Breast cancer is the number one cancer among females in India, with an age-adjusted rate of 25.8 per 100,000 women.[15] Problems related to menstruation and menopause further add to women's woes. The reported incidences of menstrual issues such as menorrhagia, leukorrhea, endometriosis, and polycystic ovarian disorder have only been increasing with time. More recently, mental health issues such as depression (due to various domestic causes and/or other health issues) have also surfaced among Indian females. The National Mental Health Survey of 2015–2016[16] reported a female predominance for depressive disorders (at the time of survey [females vs. males – 3.0% vs. 2.4%] and lifetime [females vs. males – 5.7% vs. 4.8%]). Differences in access to health care and the power to seek health-care remain major factors influencing these illnesses. It is observed that the average inpatient health-care expenditure is 1.5 times higher for Indian males as compared to Indian females. One of the reasons for poor access to health care among women as cited in the study was the fact that more than 70% of Indian women were engaged in unpaid household chores and caregiving, which are noneconomic activities, thereby underestimating the relative importance of their health.[17]

Gender inequality is a scourge, existing even today in India. Women in India have lived and continue to live in a deep-rooted patriarchal society. Traditional social customs are entrenched in Indian families to such an extent that women subconsciously believe that their male counterparts deserve to get a bigger and better share with respect to food, education, property, access to health care, etc. As a result, their own health takes a backseat with time. They are not empowered to take decisions and seek health care, further worsening their health. Multiple efforts, at national and global levels, continue to be directed toward women empowerment, addressing their health problems as well as other sociocultural issues. However, until and unless families and communities proactively take it upon themselves to change their attitude toward women's status in the community, this will only be an illusion. To turn this illusion into reality, we need a rigorous and sustained push toward gender equality and empower women to care for their health as much as they care for the health of their loved ones. In keeping with this thought, the world celebrated International Women's Day on March 8, 2020, with the theme – an equal world is an enabled world. The aim is to have a world where women are enabled as much as their male equivalents in decision-making, accessing appropriate resources for management of their health and social problems, thus leading good quality lives.



 
   References Top

1.
Ministry of Statistics and Programme Implementation. Sex Ratio of Population By Census (1901 To 2011) New Delhi: MoSPI, GoI; 2015. Available from: http://www.mospi.gov.in/sex-ratio-population-census-1901-2011-1. [Last accessed on 2020 Apr 21].  Back to cited text no. 1
    
2.
[email protected] Census 2011. 2020. Available from: https://www.census2011.co.in/states.php. [Last accessed on 2020 Apr 21].  Back to cited text no. 2
    
3.
UN Women. Turning Promises into Action: Gender Equality in the 2030 Agenda for Sustainable Development; 2018. Available from: https://www.unwomen.org/en/digital-library/publications/2018/2/gender-equality-in-the-2030-agenda-for-sustainable-development-2018. [Last accessed on 2020 May 04].  Back to cited text no. 3
    
4.
The Hindu Business Line. India's Gender Gap Widens, Slips 4 Places in WEF Survey. New Delhi: The Hindu; 17 December 2019. Available from: https://www.thehindubusinessline.com/economy/india-slips-to-112th-place-on-gender-gap/article30329051.ece. [Last accessed on 2020 Apr 21].  Back to cited text no. 4
    
5.
Social Statistics Division, Central Statistics Office, Ministry of Statistics and Programme Implementation. Women and Men in India. New Delhi: Ministry of Statistics and Programme Implementation; March 2019. Available from: http://www.mospi.gov.in/sites/default/files/reports_and_publication/statistical_publication/social_statistics/Chapter_3.pdf. [Last accessed on 2020 Apr 2020].  Back to cited text no. 5
    
6.
The World Bank. Literacy Rate. 2019. Available from: https://data.worldbank.org/indicator/SE.ADT.LITR.FE.ZS?locations=IN. [Last accessed on 2020 May 03].  Back to cited text no. 6
    
7.
Jindal School of International Affairs. The Economic Dimensions of Gender Inequality in India. 2020. Available from: http://www.jsia.edu.in/the-economic-dimensions-of-gender-inequality-in-india-2/. [Last accessed on 2020 Apr 24].  Back to cited text no. 7
    
8.
Wikipedia. Taj Mahal. 2020. Available from: https://en.wikipedia.org/wiki/Taj_Mahal. [Last accessed 2020 Apr 21].  Back to cited text no. 8
    
9.
World Health Organization. Trends in Maternal Mortality: 1990 to 2015. Geneva: World Health Organization; 2015. Available from: https://apps.who.int/iris/bitstream/handle/10665/193994/WHO_RHR_15.23_eng.pdf; jsessionid=BBE2 EB1FC8EFBE3E77D1AE336CD5ED90?sequence=1. [Last accessed on 2020 Apr 20].  Back to cited text no. 9
    
10.
Registrar General of India. Special Bulletin on Maternal Mortality in India 2004-06. 2009. Available from: http://censusindia.gov.in/Vital_Statistics/SRS_Bulletins/MMR-Bulletin-April-2009.pdf. [Last accessed on 2020 Apr 19].  Back to cited text no. 10
    
11.
World Health Organization. Maternal Mortality 2000-2017. Geneva: World Health Organization; 2019. Available from: https://www.who.int/gho/maternal_health/countries/ind.pdf. [Last accessed on 2020 Apr 20].  Back to cited text no. 11
    
12.
Office of Registrar General, India. Special Bulletin on Maternal Mortality in India 2015-17. New Delhi: Ministry of Home Affairs; 2019. Available from: http://censusindia.gov.in/vital_statistics/SRS_Bulletins/MMR_Bulletin-2015-17.pdf. [Last accessed on 2020 Apr 21].  Back to cited text no. 12
    
13.
International Institute of Population Sciences. National Family Health Survey (NFHS-4). New Delhi: MoHFW; 2016. Available from: http://rchiips.org/NFHS/pdf/NFHS4/India.pdf. [Last accessed on 2020 Apr 21].  Back to cited text no. 13
    
14.
UNICEF. Women's Nutrition. New Delhi: UNICEF; 2020. Available from: https://www.unicef.org/india/what-we-do/womens-nutrition. [Last accessed on 2020 Apr 20].  Back to cited text no. 14
    
15.
Malvia S, Bagadi SA, Dubey US, Saxena S. Epidemiology of breast cancer in Indian women. Asia Pac J Clin Oncol 2017;13:289-95. Available from: https://www.ncbi.nlm.nih.gov/pubmed/28181405. [Last accessed on 2020 Apr 22].  Back to cited text no. 15
    
16.
Murthy SR. National Mental Health Survey of India 2015-2016. Indian J Psychiatry 2017;59:21-6. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5419008/#.[Last accessed on 2020 Apr 22].  Back to cited text no. 16
    
17.
Moradhvaj, Saikia N. Gender disparities in health care expenditures and financing strategies (HCFS) for inpatient care in India. SSM Popul Health 2019;9:100372. Available from: https://www.ncbi.nlm.nih.gov/pubmed/31998823. [Last accessed on 2020 Apr 22].  Back to cited text no. 17
    




 

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