The misery starts for a girl child even before she is born in India. According to the 2011 Census, Haryana had the worst sex ratio with only 861 females to every 1,000 males. Legislation has barely made any effect in stopping female foeticides or in arresting the declining sex ratio in India. The World Bank estimates indicate that compared to 961 women per 1,000 men in 1971, it is reduced to 939 in 2011; it is projected to be 904 in 2021 and 898 in 2031.
Of those fortunate girls who do not get killed in the womb, very few get good nutrition and education. Estimates indicate that for every 100 girls in rural India, only one or two complete class XII. Nearly 40% of girls leave school before completing the fifth standard.
Evidence also suggests that low maternal literacy is related to the poor nutrition status of young children. Poor nutrition, in turn, is the topmost factor for continuation of malnutrition across generations (in their children and so forth). Low birth weight also predisposes the girls to obesity during adolescence.
Not only malnutrition, young girls are increasingly affected by obesity. India has 14.4 million obese children. Several studies suggest that obesity in girls contributes to the early onset of puberty. Also, the latest study in the American Journal of Epidemiology indicates that the early onset of puberty in girls aged between 6-11 years is related to obesity and high glucose levels in mothers. Obesity in pubertal girls may be associated with higher levels male sex hormones such as testosterone and a high risk of adolescent polycystic ovary syndrome (PCOS).
Polycystic ovary syndrome affects nearly 9 to 25% of Indian women. PCOS leads to insulin resistance and therefore increases the risk of diabetes, abnormal cholesterol levels, heart disease, stroke and cancer of the inner lining of the uterus. Adult women suffer from several health risks. For example, indoor air pollution that peculiarly affects Indian women is also the second largest killer with 1.3 million deaths each year.
In 2017, cardiovascular diseases, cancers and injury (self-harm and violence) constituted the top three causes of death in the women in India. Among the 60 years and older, the women outnumber with 1,028 for every 1,000 men (2011 census). Elderly women have poorer health outcomes compared to men, and yet the hospitalisation rates are higher for elderly men. Nearly one in three elderly in India would have lost their spouses; 50% of female elderly are widows who are most vulnerable to disability, illness and are also less likely to avail any healthcare.
Women remain disadvantaged for many reasons throughout their life. This can change through affirmative actions. For instance, women with higher autonomy, are less likely to have a stunted child or poor health outcomes. Access to money and freedom to choose to go to the market or visit a healthcare facility will constitute such autonomy.
A simple measure to make it happen is equal pay for equal work. The government must ensure it if it believes in equality at all.
Besides, financial incentives and subsidies to women, reduced tax, and providing access to education are some measures that the government can take. To implement all these, the government needs major policy overhaul. And we need to involve women in making policies that will have major implications for women. Moreover, girls should be beneficiaries of modern technology, through which tele-education can be imparted. Representation and role models of successful women can help girls work towards realising their dreams. Besides, we need to empower self-help groups that help women in need.
Even as the country rightfully mourns the grievous atrocities against girls and women, we need to introspect — what are the chances for girls to be born, survive and thrive in this country? As the agony of the daughters, wives, sisters and mothers echoes in the minds of the people, attention is needed on several threats a girl faces through her life.
While it is wishful to think that there are easy solutions, the policymakers need to show clear intent and careful planning to implement specific actions with a deeper
perspective. Community participation in the entire process is the key to success. It’s not rhetoric, we need to take action, and soon.
(The writer is an additional professor at the Indian Institute of Public Health, PHFI, Bengaluru)