Both the society and the health sector have a very narrow understanding of women’s health, opines Imrana Qadeer.
The tragedy of the World Health Organization (WHO) definition of health is that it is so broad and general that it becomes impractical. Health is seen as the ‘absence of disease’. In fact, there can never be such an ‘absence’. We need to understand health as a collective phenomenon within a public health perspective. In other words, a definition of health has to be dynamic and multi-layered. Health has to be seen through the prism of the various structural components of society, whether it is caste, class, gender, and so on.
Women and mortality
Take mortality levels, for instance. If you compare reproductive mortalities with those related to communicable diseases, you will find that the latter have a much higher load, even among women, when compared to reproductive diseases. In fact, reproductive mortality among women makes for about two per cent of deaths. In other words, the personal circumstances of women and their social backgrounds account for a much higher percentage of deaths among women. Women’s health is clearly much more than their reproductive health. Yet, in India today, we perceive fertility control as still the most critical aspect of our health delivery services. From maternal and child health we have moved to reproductive health, and reproductive health has taken over the National Rural Health Mission (NRHM), which was initially envisaged as approaching health in its totality.
Poor woman’s health
But the interesting aspect is how women, especially poor women, look at themselves and analyse their experiences. Within the international health movement much has been made of the “silence” of women. The idea of health for poor women is very different. It is about whether they have shelter, whether they have tomorrow’s meal, whether their children go to school. That is why it is so crucial for us to understand all the many social aspects that comprise health.
Everywhere women are carrying the double burden, and this gets reflected in health care as well. Since the existence of the household depends on her, a woman will not say that she is unwell until it becomes physically impossible for her to perform. This is partly the result of socialisation. Even when she does speak, the family has other things to do and their responses are invariably delayed and then she is taken to a place that is badly run. So we see the multiplier effect of her secondary status. This maybe a social issue but has a direct health implication.
Just big bucks
What then is the point of access to such health services? If the services are good, the women will come. If not, they will choose a local dai (midwife) to assist them in the delivery at home next time. They are supposed to get cash for accessing these services. That cash, however, comes after the baby is delivered so it doesn’t go into the nutrition of the mother or into ante-natal care, but into transportation and the bribes they sometimes have to pay to get the payments due to them. This shows that cash transfers cannot resolve the problem of women’s health.
Our medical establishment has shifted from being a service within welfare planning, to an instrument of revenue creation. This is what the corporatisation of the medical services has meant. Health services no longer respond to what public health needs. Instead, these days planning for health means asking for, and putting into place, services that are designed to bring in the maximum revenue.