Women and Health – An Indian Scenario

Prof. Vibhuti Patel, Director, PGSR & Professor & Head, PG Dept. Of Economics, SNDT Women’s University, Smt. Nathibai Rd, Mumbai-400020 E mail: vibhuti.np@gmail.com mobile-9321040048 Phone-26770227®, 22052970(O) World Health Organisation has defined health as “a state of complete physical, mental and social well-being” which is necessary for leading a productive and fruitful life. Health is a basic human right/ women’s right. Attainment and maintenance of good health depends on women’s access to nutritious food, appropriate medicine to treat illnesses, clean water, safe housing, pollution free environment and health services. Thus, women’s health is determined by the forces working at homes, work-places, society and the state. According to Dr. Amartya Kumar Sen, “Burden of hardship falls disproportionately on women” due to seven types of inequality- mortality (due to gender bias in health care and nutrition), natality (sex selective abortion and female infanticide)), basic facility (education and skill development), special opportunity (higher education and professional training), employment (promotion) and ownership (home, land and property).1 Nutrition- Balanced diet containing carbohydrate, protein, vitamins and minerals make a healthy body and healthy mind. Only 10% of women are fortunate to have the privilege of nutritious diet. Majority of women in our country work more than men and for longer period but eat less, the last and the left over of poor quality of food. Their energy expenditure is not compensated by intake of diet as it is inadequate and lacks in nutrition. India has the highest prevalence of iron deficiency anaemia in the world. 87% of pregnant women, about 68% in the reproductive age group and about 60-70 % of adolescent girls in our country are anaemic.2 This is the major reason for high level of morbidity among Indian women. The Government Organisations (GOs) and Non government Organisations (NGOs) need to make a concerted effort to provide iron rich and vitamin C rich low-cost and locally available foods to women through active nutrition education and change in dietary habits. Common Illnesses- Women specific common illnesses are aches/pains (back, head, stomach, uterine), weakness, fevers, respiratory problems, gastro-intestinal problems, skin, eye, ear problems and reproductive problems such as reproductive tract infection, white discharge, endometriosis. CEHAT3 study reveals that morbidity is much higher among women than men. Middle-aged women have arthritis, menopause related hot flushes and uneasiness4,

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Amartya Sen : “Many Faces of Gender Inequality”, an inauguration Lecture for New Redcliff Institute at Harward University, 24-4-2001. 2 Institute of Health Management- Prevent Anaemia Now, Pachod, Maharashtra, 2002. 3 Sunil Nandaraj, Neha Madhiwalla, Roopashree Sinha and Amar Jesani : Women and Health Care in MumbaiA Study of morbidity, utilisation and expenditure on healthcare by the households of the metropolis, CEHAT, Mumbai, 2001. 4 Iqbal Grewal and Manju Purohit: Women’s Health- A Complete Guide, Gyan Sagar Publications, Delhi, 1999.

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osteoporosis, migraine and swelling of legs. In both, rural as well as urban areas, proportion of physical immobility is higher among elderly women than among elderly men.5 Women are last one to be taken to a doctor and they have the least access to rest, healthy recreation, exercise and sports. All these combined together aggravate the situation and further deteriorate women’s health. Availability of Health-care : Women avail four types of health services. First of all, the majority of women try home remedies, failing which they approach either a homeopath, ayurvedic doctor, unani healer or the allopath. Those who can’t afford private practitioner’s fees go to a trust run clinics/hospitals, government hospitals or Primary health care centres (PHCs) or the health care facilities provided by the non-government organisations. During the last decade, yoga, meditation.6, reiki, aerobics have become extremely popular among the middle and upper class educated women 7, while the poor women approach witch doctors. Population of India Males Females Deficit of women in 2001 Sex ratio (no. of women per 1000 men) Source: Census of India, 2001 Attitude Towards Women’s Health: Social discrimination against women results into systematic neglect of women’s health, from womb to tomb. Female infanticide and female foeticide are widely practiced in BIMARU (Bihar, Madhya Pradesh, Rajasthan and Uttar Pradesh) and DEMARU (Punjab, Haryana, Himachal Pradesh and Gujarat) states.8 As per 2001 census, there were only 933 women per 1000 men and there was a deficit of 3.5 crore women . Sex-ratio is the most favourable to women is Kerala. But , in Kerala also, in the 0-6 age-group , the sex ratio was 963, as per 2001 census. Total 0-6 age-group population of Kerala was 36.5 lakhs. Out of this 18.6 lakhs were male babies and infants and 17.9 lakhs were female babies and infants. Thus, 79760 female babies and infants were missing in 2001 in Kerala. This masculanisation of sex-ratio is as a result of selective abortion of female foetuses after the use of ultra-sound techniques to determine sex of the foetus.9 Sex Ratio of different States of India State
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102.7 crores 53.1 crores 49.6 crores 3.5 crores 933

Sex Ratio- Females per 1000 males

Uday Shankar Mishra: “Health Implications of Ageing”, Medico Friends Circle, Pune, Nov.-Dec. 1999. Prabha Krishnan: Health Care, Earth Care, Interrogating Health and Health Policy in India, Earthcare Books, Mumbai and Calcutta, 1998. p.42 7 Family Medicine in India, Official publication of IMA College of General Practitioners, New Delhi, AprilJune, 1999. 8 Ashish Bose; “Without My Daughter- Killing Fields of the Mind”, The Times of India, 25-4-2001.
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Mridul Eapen and Praveena Kodoth: Demystifying the “High Status” of Women in Kerala, An Attempt to Understand the Contradictions in Social Development, Centre for Development Studies, Kerala, 2001.

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India 933 Andaman & Nicobar Islands 846 Andhra Pradesh 978 Arunachal Pradesh 901 Assam 932 Bihar 921 Chandigarh 773 Chhatisgarh 990 Dadra & Nagar Haveli 811 Daman & Diu 709 Delhi 821 Goa 960 Gujarat 921 Haryana 861 Himachal Pradesh 970 Jammu & Kashmir 900 Jharkhand 941 Karnataka 964 Kerala 1058 Lakshadweep 947 Madyapradesh 920 Maharashtra 922 Manipur 978 Meghalaya 975 Mizoram 938 Nagaland 909 Orissa 972 Pondicherry 1001 Punjab 857 Rajasthan 922 Sikim 875 Tamil Nadu 986 Tripura 950 Uttarpradesh 898 Uttaranchal 964 West Bengal 934 Source: Census of India, 2001. As a result of sex-determination and sex-preselection tests, sex ratio of the child population has declined to 927 girls for 1000 boys. Sixty lakh female infants and girls are “missing” due to sex-selective abortion of female foetuses and pre-conception rejection of daughters. POPULATION IN THE AGE GROUP 0 TO 6 YEARS IN 2001, INDIA INFANTS AND CHILDREN - ALL 15.8 CRORES 3

MALE INFANTS AND CHILDREN FEMALE INFANTS AND CHILDREN DEFICIT OF FEMALE INFANTS AND GIRLS SEX RATIO OF CHILD POPULATION

8.2 CRORES 7.6 CRORES 6 LAKHS 927

. Sex-ratio (number of women per 1000 men) of Greater Bombay has reduced from 791 in 1991 to 774 in 2001 inspite of rise in its literacy rate. POPULATION OF GREATER BOMBAY- Census 2001 YEAR POPULATION SEX – RATIO LITERACY RATE 1991 99 LAKHS 791 84 2001 1 CRORE 19 LAKHS 774 87

To stop female infanticide, the Tamilnadu government introduced ‘Cradle Baby Scheme’ urging parents to leave their unwanted baby girls at cradles provided in hospitals, primary health centres and orphanages and encouraging them to take them back if they changed their minds.10 Negative attitude towards women’s health is the major reason for high levels of perinatal mortality and morbidity including low birth weight babies.11 Vicious Cycles and Poor Women: The vicious cycles of poverty generates the vicious cycle of ill-health. For mother, poverty leads to low intake of food and nutrients, which results in under-nutrition and repeated insults from nutrition related diseases and infections, which affect them in terms of stunted development and growth faltering, hence they have small body size as adults, which impairs productivity; as a result they have low earning capacity. The end result is POVERTY. For a girl child, poverty gives only three options- child labour, child marriage and child prostitution. Poverty coupled with control over women’s sexuality, fertility and labour is manifested in neglect and discrimination of a girl child, she remains a
10

Lalitha Sridhar ( Women’s Feature Service) : India: Killing in Cradle, POPULI- The UNFPA magazine, Vol.28, No.2, September, 2001, pp.10-12. 11 S. Wal and Ruchi Mishra: Encyclopaedia of Health, Nutrition and Family Welfare, Vollume 1, Health and Family Welfare in Developing Countries, Sarup and Sons, New Delhi, 2000. pp.254-255.

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malnourished girl, early marriage makes her pregnant, she is an impoverished mother who produces low birth weight baby,12 if the baby is female, she faces discrimination, repeated pregnancies/ deliveries to get son results in maternal mortality i.e. DEATH.13 Miserable profile of reproductive health of Indian women is due to octopus clutches of early marriage and pregnancy, high prevalence of reproductive tract infection, ignorance, high infant mortality rate, no control over fertility and sexuality, anaemia, no control over contraception and repeated pregnancies. As per UNICEF, in 1995, there were 453 maternal deaths per 100000 births in India. Nutritional needs of lactating mothers demand urgent attention. Violence and Health Issues of Women Over the Life Cycle: As unborn children, they face covert violence in terms of sex-selection and overt violence in terms of female foeticide after the use of amniocentesis, chorion villai biopsy, sonography, ultrasound, imaging techniques.14 IVF (In Vitro Fertilization) clinics for assisted reproduction are approached by infertile couples to produce sons. Doctors are advertising aggressively, “Invest Rs. 500 now, save Rs.50000 later i.e. if you get rid of your daughter now, you will not have to spend money on dowry. CAUSES OF MATERNAL DEATHS IN 1993 IN RURAL INDIA DIRECT OBSTETRIC CAUSES PERCENTAGE HAEMORRHAGE 22.6 ABORTION 11.7 INFECTION 12.5 OBSTRUCTED LABOUR 5.5 ECLAMPSIA (blood pressure) 12.8 OTHER DIRECT CAUSES 14.6 INDIRECT OBSTETRIC CAUSES ANAEMIA 20.3 Source: Registrar General, India As girls under 5 years of age, women face neglect of medical care and education, sexual abuse and physical violence. As adolescent and adult women in the reproductive age-group, they face early marriage, early pregnancy, sexual violence, domestic violence, dowry harassment, infertility, if they fail to produce son, then face desertion, witch hunt. The end result is a high maternal mortality. Causes of maternal deaths in our country are haemorrhage, abortion, infection, obstructed labour, eclampsia (blood pressure during pregnancy), sepsis, and anaemia. STATES
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MATERNAL MORTALITY RATE (MMR) MATERNAL DEATHS PER 100000 BIRTHS

K. Rameshwar Sharma : When the Baby Weighs Low- On Low Birth Weight and How to Remedy it’, Health Action, Vol. 14, No.12, December 2001. pp.18-19. 13 ARROW for Change, Women’s Gender Perspectives in Health Policies and Programmes, Malaysia, Kuala Lumpur, Vol. 7, No 1, 2001. 14 Vibhuti Patel ”Girl Child: An Endangered Species?”, in Viney Kripal (ed) The Girl Child in 20th Century Indian Literature, Sterling Publications Pvt. Ltd., New Delhi, 1992. p.9.

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ANDHRA PRADESH ASSAM BIHAR GUJARAT HARYANA HIMACHAL PRADESH KARNATAKA KERALA MADHYA PRADESH MAHARASHTRA ORISSA PUNJAB RAJASTHAN TAMIL NADU UTTAR PRADESH WEST BENGAL ALL INDIA Source: UNICEF, 1995.

436 534 470 389 436 456 450 87 711 336 738 369 550 376 624 389 453

Escalating number of cases of domestic violence, dowry deaths and bride burning has motivated Bombay Municipal Corporation (BMC) run K.B. Bhabha Municipal General Hospital to collaborate with an NGO, CEHAT to launch a project Dilaasa (means reassurance) to provide social and psychological support to women facing domestic violence. On March 8, 2002, the process will begin to replicate this model in all BMC run hospitals in the Greater Bombay. Sexual harassment at work-place should be treated as an occupational health hazard as it causes damage to both physical and mental health of women. Even women in the medical profession- right from medical students to other women health workers face this problem.15 Home and Work Conditions Affecting Women’s Health: Pollution of air and water, noise pollution and chemicalisation of environment affect everybody. Scarcity of fuel-wood, fodder, water and herbs as a result of deforestation has taken heavy toll of women’s health. Rural and tribal women have to walk for miles for these basic survival needs of human beings and domestic animals. Floods create deaths, destruction and epidemics. Desertification in the western India has accentuated women’s survival struggles, as they have to depend on adhoc public works programmes. Global warming has resulted in resurgence of older epidemics such as cholera, typhoid, malaria, dengue, and haemorrhagic fever. Burgeoning sex-trade have made 2 million sex-workers potential carriers of HIV, STD, AIDS. Moreover, women in

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Thelma Narayan: “Gender and Power Issues in Medical Education Consultation on Gender and Medical Education, Understanding Needs for Gender Sensitisation, Critiquing Content and Method of Medical Education- Developing Long Term Strategies for Intervention, organised by Achutha Menon Centre for Health Science Studies in collaboration with CEHAT, at SNDT Women’s University, Bombay, 0n 31-1-2002.

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prostitution may suffer from T.B., other STDs, malnutrition, malaria and skin diseases.16 At present, there is an evidence of rising HIV rates among young married women who are infected by their husbands. Data from 7 cities in India of ante- natal clinics reveals that HIVAIDS prevalence rates among pregnant women are 2% to 3.5 % in Mumbai and 1% in Hyderabad, Banglore and Chennai.17 Modern lifestyle and environment has increased breast and uterine18 cancer among Indian women. Techniques meant for detecting cancer (e.g. self-examination of breast and papsmere) are rarely used by women. As a result, detection of cancer and its treatment at earlier stage becomes impossible. All types of fruits are cornered by liquor industry and alcoholism is aggressively promoted among the toiling poor. As a result, men don’t contribute for daily necessity of the households. Women have to shoulder major burden of household expenditure. Use of biofuels- wood, dung, crop residue resulting into indoor air-pollution takes away the lives of 5 lakh women annually.19 Women and Mental Health: The most neglected area concerning women has been her mental health. Social workers and psychiatrists are approached by husbands to issue “mentally unfit” certificates so that they can flash them in a court of law to demand divorce. Relatives do not want to keep mentally ill women in the family.20 Even after their recovery, they have to languish in the mental asylum. There is a need for half- way- homes where mentally ill women can work for few hours under the supervision of couple of professionals and then go home in the evening. Psychotherapy, mutual and group counselling should be promoted. Shock therapy and chemical treatment should be avoided as it cabbagifies women in distress.

16

Gracy Fernandes and Cecily Stewart Ray: Raids, Rescue, Rehabilitation, The Story of Mumbai Brothel Raids –of 1996-2000, The College of Social Work, Nirmala Niketan, Mumbai, 1991.p.75.

17

Sameera Khan: “The Indian Women: Confronting HIV/AIDS”, SANKALP, The Newsletter of the International AIDS Vaccine Initiative in India, Nov.-Dec. 2001.p.7. 18 S. Wal and Ruchi Mishra; op.cit., pp. 27-30. 19 Sarla Gopalan and Mira Shiva: National Profile on Women’s Health and Development, Voluntary Health Association of India and World Health Organisation, Delhi, 2000, p213. 20 The Times of India, 26-1-2002.

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60% 50% 40% 30% 20% 10% 0% RGI 1997 Rural Urban Total

% of women who received * ante-natal check-up by health professionals, Nurses- 49.2 Percentage of Institutional Deliveries in India -1994 * Home Visit by health worker during pregnancy –21% Health-care Facilities for Women: As women are * Tetanus Toxoid coverage not as individuals perceived as mothers, of Pregnant women –53.8% in their own right, they are covered under MCH (mother and Prophylaxis coverage among MCH child programme). Even *Anaemia does not cover majority of Indian women. Only 49.2 % ofwomen pregnant women received pregnant total –50.5 %

ante-natal check-up by health professionals. Health workers visited only 21% of pregnant Source: 53.8% and women. Tetanus toxoid coverage of pregnant women was IIPS, 1995. Anaemia prophylaxis

• • •

% of % -53.8% Anemia Prophylaxis coverage among pregnant women-50.5%

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coverage among pregnant women was 50.5%. 21 Majority of Indian women are left with no choice than to deliver at home.22 Every 5000 population has an auxiliary nurse midwife (ANM) with responsibility to attend childbirth. Only negligible parts of home-births are attended by ANMs. 23 Institutional deliveries constituted only 22 % of total deliveries at the national level. Urban areas were better covered: 55 percent as against a very megre 18% in rural areas.24 New Reproductive Technologies (NRTs) and Women: NRTs perform 4 types of functions. In Vitro Fertilisation and subsequent embryo transfer, GIFT (Gamete Intra Fallopian Transfer), ZIFT and cloning assist reproduction.25 Contraceptive Technologies prevent conception and birth. Amniocentesis, chorion villai Biopsy, niddling, ultrasound are used for prenatal diagnosis.26Feotal cells are collected by the technique of amniocentesis and CVB. Gene technologies play crucial role through genetic manipulation of animal and plant kingdoms.27 Genomics is “ the science of improving the human population through controlled breeding, encompasses the elimination of disease, disorder, or undesirable traits, on the one hand, and genetic enhancement on the other. It is pursued by nations through state policies and programmes”.28 It is important to examine scientific, social, juridical, ethical, economic and health consequences of the NRTs. NRTs have made women’s bodies site for scientific experimentations. Current Use of Contraceptive Methods: Majority of population in our country is not using any contraceptive methods for birth control. Female sterilisation is most widely prevalent method of contraception. Usage of Pill, Intra Uterine Device (IUD) and male sterilisation is 2% for each of the three. Condom use constitutes only 3% of the total. 29 Current use of Contraceptive Methods Pill Intra Uterine Device Condom Male Sterilisation Female Sterilisation
21 22

2% 2% 3% 2% 34 %

International Institute of Population Sciences, Bombay, 1995. Kalyani Menon Sen and A.K. Shivakumar: Women in India- How Free? How Equal? Report Commissioned by the United Nations Resident Coordinator in India, New Delhi, 2001. p.37. 23 Shyam Ashtekar: Health and Health Care Systems- Observations From China, Philippines and Thailand & Reflections on India, Bharat Vaidyak Sanstha, Nasik, p.128. 24 Registrar General of India, 1997. 25 Tarala D. Nandedkar and Medha S. Rajadhyaksha: Brave New Generation, Vistas in Biotechnology, CSIR, Department of Biotechnology, Government of India, 1995. 26 Vibhuti Patel: Sex Selection, in Routledge International Encyclopedia of Women- Global Women’s Issues and Knowledge, Vol.4, 2000.pp.1818-1819. 27 Jyotsana Agnihotri Gupta: New Reproductive Technologies- Women’s Health and Autonomy, Freedom or Dependency? Indo Dutch Studies in Development Alternatives-25, Sage Publications, New Delhi, 2000. 28 Chee Heng Leng “Genomics and Health: Ethical, Legal and Social Implications for Developing Countries”, Issues in Medical Ethics, Bombay, Vol.X, No. 1, Jan.- March, 2002, pp.146-149. 29 National Family Health Survey, 1998-99.

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Any Traditional Method/Other method Not Using Any Method

5% 52 %

Source ; National Family Health Survey, 1998-99. Contraceptives targeted at women, with serious side effects are quinacrine, Net-en, Norplant, Depo-Provera, anti fertility vaccine, RU 486. Side effects of long acting hormonal contraceptives are menstrual disturbance, circulatory and cardio-vascular problems, thyroid, chest-pain, giddiness, migraine, increased risk of cancer and infertility. 30Aggressively promoted HRT (Hormone Replacement Therapy) i.e. oestrogen therapy for menopausal women has generated opposition as several studies have shown that HRT has carcinogenic implications for women.31 Modus operandi of contraceptive research in the Asian countries treats coloured women as raw material for experimentation for eugenics. Women resort to abortion when faced with unwanted pregnancy due to failure of contraceptives or due to non-utilisation of contraceptive methods. As per UNICEF, 1993, about 50 lakh abortions are performed under the health services network while 45 lakh by the illegal practitioners/quacks. 10% of all maternal deaths are due to unsafe abortion, which result into haemorrhage, infection, incomplete evacuation, cervical lacerations, uterine perforations, thromboembolism32 and anaesthetic complications. Population Policy The focus of health programme should change from a population control approach of reducing numbers to an approach that is gender sensitive and responsive to the reproductive health needs of women/ men. Women groups have raised hue and cry against sexist, racist and class biases of the population control policy, which perceives uterus of coloured women as a danger zone. They have opposed genetic and reproductive engineering, which reduce women to reproductive organs and allow women being used as experimental subjects by science, industry and the state.33 They believe that instead of abusing reproductive biology, responsible reproduction is an answer to overpopulation and infertility. Any coercion, be it through force, incentives or disincentives in the name of population stabilisation should be rejected. Instead enabling women to have access to education, resources, employment, income, social security and safe environment at work and at home are precondition to small family norm. Reproductive Rights of Women which guarantee women healthy life, safe motherhood, autonomy in decision-making about when, how many and at what interval to have children are a central axis around which a discourse on population policy should revolve. Several groups have prepared manuals to assist women leaders to reach out to poor illiterate women and teach them about fertility and infertility, giving them knowledge of their anatomy, to teach women to use fertility awareness as a

30

Chayanika, Kamakshi, Swatija: We and Our Fertility, Research Centre for Women’s Studies, SNDT Women’s University, Bombay, 1990. 31 Sherril Sellman: “Osteoporosis- the bone of contention”, Drug Disease Doctor, Quarterly Journal on Rational Drug and Therapy, Drug Action Forum, Kolkata, Vol.14, No. 2, April, 2001. 32 IPPF Medical Bulletin, International Planned Parenthood Federation, London, Vol. 35, No. 5, October 2001. 33 Feminist International Network of Resistance to Reproductive and Genetic Engineering (FINRRAGE)UBINIG-Policy Research for Development Alternative- DECLARATION OF COMILLA, Bangladesh, 1989.

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means of family planning and to use natural family planning as an entry point to women’s health and development.34 Scientifically accurate books for sex-education and fertility awareness are now available. 35 Sex education for women becomes meaningful only when it is linked with assertiveness training. Girls and women who are unable to handle gender based power relations end up as victims even after receiving thorough physiological, anatomical, scientific and medical details of sex-education.36 Women, Health and Law : Medical Termination of Pregnancy (MTP) Act (1972) stipulates that only trained doctors are eligible to conduct abortion in registered abortion clinics. Prenatal diagnostic Techniques Act (1994) prevents the use of ante natal sex determination tests for selective abortion of female foetuses. CEHAT has filed a petition in the Supreme Court of India for effective implementation of the Act as well as to expand the scope of the Act to cover sex-preselection (pre-conception) techniques in its purview. Women’s groups in Delhi and Hyderabad have jointly filed a petition in the Supreme Court of India against human trails of injectible contraceptives.37 . The Lawyers Collective HIV/AIDS Unit helps many infected women who are abandoned by their families after the death of AIDS afflicted spouse, denied rights to marital home and custody of their children.38 For sensitive handling of medico legal dimensions of sexual violence- rape, molestation, assault, dying declaration of the women victims of poisoning, burns and attempted suicide, the doctors, nurses, other health care workers and special executive magistrates need to be trained, as evidences of medical examination play important role during the court proceedings and the final judgement. Women’s organisations have prepared an exhaustive code of conduct for the doctors, police, lawyers, special executive magistrates and social workers for recording of dying declaration.39 Medical kit for examination of victims of sexual violence has been prepared by CEHAT.40 There is a need for medical kit for examination of women under-trials whose death occurs in police custody or jail to ascertain the nature of torture. Conclusion

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Mahila Samooh: Fertility Awareness, published by Jagori, Delhi, 1995. Tarala D. Nandedkar and Medha Rajadhyaksha: Reaching Womanhood, National Book Trust, India, 1999. 36 Sabala and Krnti: Na Shariram Nadhi- My Body is Mine, edited by Dr. Mira Sadgopal, Bombay, 1995. 37 Documentation on Women and Health, Section on Contraceptives, Streevani Documentation Centre, Pune, 1991-1994., 38 Lawyers Collective: Study of Cases Involving 130 Clients From May 1998-May 2001”, Bombay, September, 2001. 39 Sakhya, College of Social Work, Nirmala Niketan, Bombay, February, 2002. 40 Lalita D’souza: Medical Kit for examination of Sexual Violence, CEHAT, 1997.

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Gender divide in the access of health care and health cost is so sharp that women have to access informal providers and informal care. Gender audit in health should be done on the basis of identifying issues for reorientation at each stage of women’s life cycle and focussing on the problems of each age group of women. Dr. Veena Shatrughna states, “ While writing a book on Women and Health, we found that almost every illness could be ripped apart from the point of view of being woman. The medical system is premised on the assumption that there is a family which is caring. Women really struggle to fit into this framework. Women never have that kind of support . Every illness has specific implications and consequences of being women. Looking at gender is seeing how women negotiate in this hostile environment.” 41 To address the problems concerning women’s health, a holistic life span approach is needed.42 Women as growing human beings, home-makers, workers, mothers and elderly citizens face different types of health related issues. Women’s health is determined by the material reality generated by socio-economic, cultural forces as well as gender relations based on subordination of women. It is important to make men aware about women specific health needs. Improvement in women’s health is a precondition for development of her family. For an effective public education on the above-mentioned issues, charismatic personalities should teach the “Women and health” module. How to engender medical education? This question needs to be addressed. There is also, a need for gender sensitive books for the health practitioners.

41 42

Veena Shatrughna: Cnsultation on Gender and Medical Education, op.cit. 2001. Nisha Gupta: Social and Gender Perspectives in Women’s Health, Health for the Millions, Vol.27, No.3, May- June 2001, pp.11-12.

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