TOWARDS UNDERSTANDING
WOMEN'S HEALTH:
CRITICAL OVERVEW OF
WOMEN'S STUDIES
Author:LAKSHMI LINGAM

ABSTRACT---A healthy population is considered to be a national resource. Hence, health is a critical component of planning, policy making and programme formulation in the human resource development of the country. Outside the framework of the State, the provision of health care services to the poor and the needy, has always been a zone for philanthropy and charitable work. It has the quality of being apolitical. The paper examines the contribution of Women's Studies towards an understanding of women's health in India and presents the body of knowledge, information and contestations as women's movement trajectory and research trajectory. The areas neglected by feminist research and gender sensitive initiatives are also listed here. The paper attempts to highlight the importance of viewing women's health from the perspective of "gender and health."

Introduction
A healthy population is considered to be a national resource. Hence, health is a critical component of planning, policy making and programme formulation in the human resources development of the country. Outside the framework of the State, the provision of health care services to the poor and needy, has always been a zone for philanthropy and charitable work. It has the quality of being apolitical. However, over the decades, it has been observed that regardless of the approach to reaching health care to people it is inevitable to confront questions of the political economy of health (Jesani, 1998). In simple words, the distinction between the ‘right to health’, as opposed to ‘right to health care’, signifies the difference in the scope of the two. The ‘right to health care’ constitutes the duty of the state to allocate to its members an adequate and fair share of its total resources for health related needs, given the competing claims of different health needs. On the other hand, ‘the right to health’ embodies a broad range of entitlements and access to societal resources, within which access to health care is one. If one were to include the gender lens, to examine the issues of health, it unveils how inequalities that arise from belonging to one sex or the other, can create, maintain or exacerbate exposure to risk factors that endanger health. They can also affect the access to and control of resources, including decision-making and education, which protect and promote health.

The limitations of mainstream research that hitherto remained within the parameters of ‘social engineering’, of improving people’s health seeking behavior; bringing about changes in beliefs and practices that are seen as detrimental to good health etc., had become apparent in the 1970s. The emergence of several people’s struggles, health campaigns and the second wave women’s movement has brought into focus issues of equity, rights and justice, as inextricably linked to people’s health and well being. While analysis of the political economy of health existed among researchers (Banerji, 1982) and groups working for health rights, the critical inclusion of gender perspective had unravelled the structural roots of women’s low health status.

‘Towards Equality’, the Report by the Committee on the Status of Women in India (1974) had revealed crucial aspects on women’s status and health. The International Decade for Women (1975-85) had marked the beginning of a shift in perspective in favour of women. The present paper attempts to closely examine the contribution of women’s studies towards an understanding of women’s health in India. For heuristic purposes, research papers emerging from various disciplines and campaign notes/bulletins/reports that emerge from the movements are all considered as contributing to women’s studies. A close analysis of how women’s health has been articulated by researchers and activists over the past two and half decades, demonstrates the convergence of multiple trajectories. The paper presents the body of knowledge, information and contestations as women’s movement trajectory and research trajectory. The areas neglected by feminist research and gender sensitive initiatives are also listed here. In conclusion, the paper attempts to highlight the importance of viewing women’s health from the perspective of ‘gender and health’.

Women’s Movement Trajectory
a. Violence

The mid-seventies had witnessed the resurgence of the women’s movement in India around the issue of rape. The custodial rapes of women in police stations - Mathura in Maharashtra and Ramizabee in Hyderabad - and the court acquittals of the accused police men had led to wide ranging protests all over the country and the formation of autonomous women’s organisations challenging the legal stipulations and various forms of violence against women.

Behind the grim crime statistics, there are real women and young girls who are maimed, traumatised and silenced by a patriarchal culture and social institutions.

The engagement on the issue of violence had not only meant a critical examination of incidents and events of violence, but also a theoretical understanding of the structural roots of women’s subordination and exploitation. The patriarchal values embedded in legislation, the implementing machinery, state policies and programmes have been unmasked. Wide ranging issues of violence starting from rape, dowry deaths/ murder, sati, female infanticide, female feticide, child sex abuse, sex trafficking, invasive contraceptives, coercive population policies, incidents of ‘acid throwing’, sex scandals, honour killings, to name a few, have been scrutinised. Obviously through all this the multiple manifestations, agencies and sites of violence were unveiled. Apart from the physical aspects of violence, the neglect of the girl child, the gender differentials in access to education, food/nutrition, health care, political participation, training and societal resources are also seen as violence, in other words, violation of women’s human rights.

Women’s movement was engaged in a close scrutiny of questions like ‘ Why women are violated or raped?’ ‘What are the different locales of violence?’ ‘Who are the perpetrators of violence?’ ‘How do women perceive violence?’ ‘Why do women endure violence?’ ‘What does violence do to women’s psyche?’ and so on. This has prompted them to examine patriarchal structures, construction of gender, gender relations, social processes and cultural practices. The analysis led the movement to identify the different structures that control women’s bodies, fertility and sexuality. It has become evident that control over women’s bodies, is the bedrock of (a) the caste system - which attempts to regulate sexual relations through marriage practices; and (b) the family - which preserves its honour, izzat, by controlling women’s sexuality.

During the 1980s, some of the women’s groups that campaigned around issues of violence found that support structures were sadly lacking or where they existed, they nurtured patriarchal values. Therefore, they set up alternative shelter homes, provided legal counselling and campaigned for amendments in legislations. Some of the groups conceivably moved on to identify and instill women’s perspective in health issues and campaign against invasive contraceptives and population control policies.

While there are observable changes and increased visibility of women’s issues, the intensity and dimensions of violence against women continue. Women’s groups have recognized the physical, sexual and mental health impacts of violence and incorporated the provision of shelters / short stay homes, counselling and legal aid as part of the services. Systematic research to examine the linkage of gender violence on health is beginning to gain ground.

Studies have established that rapidly growing causes of death such as burns or suicides were not accidents, as officially declared, but domestic violence against women. Physical violence or abuse and the health linkages have attained significance in the recent past, with a WHO report on violence on women as a hidden health burden. The second round of the National Family Health Survey has attempted to capture the quantum of violence that women experience within homes.

A study by Daga, Jejeebhoy, Rajgopal (1998) of Emergency Police Records maintained in a public hospital in Mumbai, strongly argues that more rds than 2/3 of women reporting to Casualty Department may have suffered domestic violence. This may still be the tip of the iceberg. Women approach the health care system with telltale marks of violence. The narrowness of the bio-medical model and the notion that domestic violence is a ‘private’ affair, leave women victims with circumscribed options. The need to modify recording formats, improving the sensitivity of health providers to gender violence has acquired significance in the recent past.

b. Violence, Health & Sexuality
Some of the feminist writings have also attempted to throw light on sexuality and violence. The curious interlocking of love, suspicion, fear and intimate violence, the representation of violence as a marker of love in gender relations, complicate the matter where women are not mere ‘victims’ or ‘survivors’ but also have an agency in a violent relationship.

Violence of various forms and its linkages to various facets of life including health, have often been discussed in the National Conferences of Women’s Movement (NariMuktiSangharshSammelan). Health sessions are the largest attended and also emerge with fascinating connections that women make. Health sessions discuss range of issues that dwell upon:

• Socio economic conditions that impinge upon livelihood, housing and health

• poor nutrition, working and living conditions and communicable diseases

• access to health services, powerlessness vis-à-vis health professionals and biases in the medical system that
disregard women’s ability to understand

• hazardous contraceptives and coercive family planning programme
• communalism and violence and its effects on the health of women

• increase in inflation or loss of employment for men, increase in alcoholism among men and domestic violence.

The health session in one of the Conferences that was held in Tirupati, Andhra Pradesh, in 1994, had questioned whether heterosexual relations, which are inherently hierarchal, really natural? Women who could identify with terms like ‘lesbians’ and women who preferred to love women but did not identify with these labels, had a separate session in the Conference. The Conferences in the following years have this theme without fail.

Issues of sexual minorities, sexual orientation and sexual rights have come out of the closet in the late 90’s, though still marginalised and criminalised. The controversies surrounding the film “Fire” that explored lesbian relations and series of violent attacks on organisations working on issues of sexual health and rights, have demonstrated the conservative character of the State and the overall environment in society that is intolerant to all minorities be they sexual, religious or even women. The pressure to abide by the “normal” is so great that there seems to be a total shrinking of the space to even assert for basic human and democratic rights.

The term “Gender-based violence” to understand violence against women and girls, is gaining currency in recent times. The unequal power relationships between women and men created and maintained through patriarchal institutions are addressed to bring about changes in gender relations (Lingam, 2001). The entire culture that creates male roles and identities defined as “masculinity” — aggression, dominance, competitiveness and so on, underlie men’s violence. The recognition and focus on masculinity is seen as an important strategy to make men conscious of gender and challenge gender inequalities and violence against women.

Violence places women at a high level of vulnerability to morbidity and mortality. Pregnancy complications, adverse birth outcomes, HIV infection in non-consensual sex, unwanted pregnancy, unsafe abortion/abortion related injury, gynaecological problems, psychological problems/ fear of sex/ loss of pleasure, low levels of immunity due to increased levels of overall neglect and declines in access to nutrition and health care are some of the outcomes of violence. Empirical evidences from India are getting generated steadily. The National Family Health Survey 1998-99 (NFHS — 2) results underscore the widespread prevalence of domestic violence in India, especially violence perpetuated by husbands against wives. Women’s high level of acceptance of wife-beating has also been revealed by the data (IIPS & ORC Macro, 2000).

c. Invasive Contraceptives
The early eighties spurred two major campaigns in opposition to invasive medical technologies. The first is the campaign seeking a thorough review and withdrawal of NET-EN and DepoProvera (injectable contraceptives) and the second seeking a ban on Amniocentesis (sex detection test) (Nadkarni, et.al. 1998) In response to a Public Interest Litigation (PIL) filed by a group of women from Hyderabad, who objected to the way injectables were being introduced through a camp approach, the court had clamped a ban and called for a review of these. While, the issue keeps coming up with media reports proclaiming the efficacy of these contraceptives and their introduction into the Family Welfare Programme, in reality the injectables are available in a different combination in the open market. Opposition to invasive contraceptives such as injectables, antifertility vaccines, Norplant and the use of quinacrine as a contraceptive, RU 486-abortion pill, has marked various phases of the movement. The literature covering this issue:

• unravel the mindset that see women’s bodies as expendable
• deride the increasing medicalisation of women’s bodies
• demystify the cafeteria approach of the Family Welfare Programme
• question unethical service delivery practices which violate women’s right to information and informed consent; and
comment on the economics of promoting provider-friendly contraceptives rather than user-friendly contraceptives (Lingam,1998).

The Ministry of Health attempted to introduce Net-en on a pilot basis in some major hospitals in India. The collective opposition of the women’s movement to these moves of the Government had led to a withdrawal by the Government.

d. Population Policy
The state, through various public policies enters the private realm of childbearing by defining desirable family size and the creation of incentives and disincentives to meet the same. Population policies and family planning targets were seen to directly affect women and alienate them from the health care system.

Much of the literature attempts to establish that ‘women are not wombs alone’; that high infant mortality and poverty contribute to population growth; that women’s acceptance of a small family norm is not dependent on receiving information alone, but also on improving her social status, autonomy and decision – making. A close examination of plan period documents, health policies and programmes, has revealed that women are viewed merely as ‘mothers’. The changing rhetoric in policy documents in the late seventies and eighties has not been adequately reflected in the programmes. Efforts to pass a population policy over the past decades by the state, was systematically thwarted by the women’s movement. The National Population Policy was however, passed by the Government in the parliament without any major opposition, either inside or outside the house, in the year 2000. Over the years, the movement seems to have got dissipated and weakened. Further, the language of the new population policy document resembles in many ways the Reproductive Health Approach strategy. Terms like, ‘participation’, ‘decentralised planning’; ‘empowerment of women’ are generously used in the document. Some viewed the document as ‘women-friendly’. During the years 2000 and 2001 several states like Maharashtra, Gujarat and Madhya Pradesh, have also passed state specific population policies. These are found to be far more targeted and coercive compared to the national policy. (See papers in MFC Bulletin Special Issue on Population. July-October, Issue Nos. 286-89, 2001).

e. Sex Selective Abortions
Among the several pre-natal diagnostic techniques (like sonography and chorionic villi biopsy) that are currently being used for sex detection in India, the indiscriminate use of the Amniocentesis test for sex detection followed by sex selective abortions of female fetuses, had led to a major campaign in 1980s seeking a ban of the test. The Maharashtra Regulation of Use of Prenatal Diagnostic Techniques Act was passed in 1988. The mounting pressure for a central legislation led to the passing of Prenatal Diagnostic Techniques (Regulation and Prevention of Misuse) Act in 1994. Obvious shortcomings like punishing the woman who seeks the test, non-implementation of the legislation, the ‘facility’, being still widely available with more sophisticated technologies and lack of civil society response to play the watchdog function, can be stated as reasons for failure of the goals of the campaign.

The issue that requires attention here is the scrambled stand on ‘disability’ in the women’s movement. The legislation purports to regulate the amniocentesis test but not ban it. The Act spells out categories of women who may use the test: (a) those above the age of 35 years could utilize the test to detect Down syndrome, (b)women who have a family history of congenital abnormalities; (c) those who have been exposed to radiation and d) who have experienced repeated abortions. While women’s organisations objected to female fetuses being viewed as ‘unwanted’ ‘ they did not object to genetic analysis, which extends the logic to the disabled as ‘unwanted’. The campaign report of the FASDSP states two unresolved dilemmas: (1) allowing the test for genetic analysis and (2) strengthening the power of the state over people. The report notes