Gender Issues in Work and

Labour Market

BLOCK 4
HEALTH AND GENDER

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Health and Gender
BLOCK INTRODUCTION BLOCK 4

Health and Gender

Block 4 of this Course titled “Health and Gender” comprising two Units which
aims to introduce learners to the intersection of gender and health. Unit 9 of this
Block is “Reproductive Health and Rights”. The objective of the Unit is to
introduce reproductive health and rights to the learners. It talks about the indicators
of Reproductive health and rights and various international conventions to address
the reproductive rights. Finally it briefly states the Reproductive and Child Health
Policy (RCH) in India. The last and final Unit of this Block is “Gender and
Disability”. In this Unit, the author starts asking learners how one feels if we talk
about disability and he defines disability. According to the author of this Unit
there are 26.8 million people with some form of disability according to 2011
Census of India. This accounts to 2.11 % of the total population. Of these, 15
million are men and 11.8 million are women. Thus women constitute just above
44 percent of the population with disabilities in India. These women face various
forms of challenges in their life which are explained elaborately.

Smita M.Patil G.Uma

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 Reproductive Health and
UNIT 9 REPRODUCTIVE HEALTH AND Rights

RIGHTS
Structure
9.1 Introduction
9.2 Objectives
9.3 What is Reproductive Health and Rights?
9.3.1 What is Reproductive Health?
9.3.2 What is Programme of Action for India under RCH Approach?
9.4 Indicators of Reproductive Health
9.5 Reproductive and Child Health policy: A Critiques
9.6 Summing Up
9.7 Key Words
9.8 References
9.9 Unit End Questions

9.1 INTRODUCTION
Reproductive health and rights of every individual are fundamental to the well-
being of the family, community, society and development of a country. The
Programme of Action of the International Conference on Population and
Development at Cairo in the year 1994 defined reproductive health and included
the perspective of individual rights under its definition. The Cairo programme
laid down the purpose of reproductive health is “enhancement of life and personal
relations and not merely to counseling and care related to reproduction and
sexually transmitted disease (WHO, 2015, p. 4). Reproductive and maternal health
are major issues of concern in both developing and the developed worlds and it
impacts women and men differently. For instance, reproductive health and rights
deal with issues of pregnancy, childbirth and individual access to contraception
and safe abortion. These issues become complicated for women when it intersects
with other cultural and social practices. With this background, you will learn
about reproductive health and rights from a gender perspective.

9.2 OBJECTIVES
After studying this Unit, you would be able to:
Know the meaning of Reproductive Health and Rights;
Comprehend the indicators of Reproductive Health and Rights;
Explore about various international conventions and their role in
implementing the Reproductive Rights Approach; and
Explain briefly about the Reproductive and Child Health Policy (RCH) in
India.
Let us begin with reading what is understood by reproductive health and
reproductive rights of an individual.

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Health and Gender
9.3 WHAT IS REPRODUCTIVE HEALTH AND
RIGHTS?
Reproductive rights are also legal rights that give freedom to individual/couple
to take decision with regard to reproduction and reproductive health (Jaiswal
2012). The conceptualization of reproductive health and right can be linked to
the early women’s struggle to demand their right to legal and safe abortion in the
industrialized countries. Later, the concept of women’s reproductive health was
reformulated in the year 1994 at International Conference on Population and
Development (ICPD) popularly known as the Cairo conference. Cairo conference
emphasized that women’s health is socially constructed therefore it is important
to understand reproductive health in the context of individual or couple’s right to
reproductive health. Reproductive health is recognized as human right issues
also.
What is the difference between Reproductive Rights and Reproductive
Health?
The ICPD defines Reproductive Rights in its Chapter 7 as follows:
These rights rest on the recognition of the basic right of all couples and individu-
als to decide freely and responsibly the number, spacing and timing of their
children and to have the information and means to do so, and the right to attain
the highest standard of sexual and reproductive health. It also includes their
right to make decisions concerning reproduction free of discrimination, coer-
cion and violence. UN Population Fund, para. 7.3.; original emphasis, cited in
Jaiswal 2012, p.14)
Reproductive right is a broader framework under which reproductive health was
included and clearly defined. The definition of reproductive health was recognized
by the Fourth World Conference on Women in 1995 known as the Beijing
Declaration and Platform for Action as a human right issue for women.
Reproductive rights may include the following rights for women;
right to legal or safe abortion;
right to birth control;
the right of access quality reproductive health care; and
right to education in order to make reproductive choices (emphasis added,
Amnesty International 2007, in Jaiswal 2012).
9.3.1 What is Reproductive Health?
Reproductive health is defined by the Cairo Program of Action as follows:
Reproductive health is a state of complete physical, mental and social well-being
and not merely the absence of disease or infirmity, in all matters relating to the
reproductive system and to its functions and processes. (cited in Jaiswal 2012)
Reproductive health is defined by the Cairo Program of Action as follows:
Reproductive health is a state of complete physical, mental and social well-being
and not merely the absence of disease or infirmity, in all matters relating to the
reproductive system and to its functions and processes. (cited in Jaiswal 2012)

The definition of reproductive health has implications for both women and men.
The Programme of Action (POA) in ICPD placed reproductive health and rights
110 as follows:
 The right of couple and individuals to decide the number, timing and space Reproductive Health and
Rights
of their children; and to have information and means to do so;
Regulate her fertility through access to information and good health services;
Have access to safe, effective, affordable and acceptable methods of family
planning of their choice for regulation of fertility;
Identification and treatment of Reproductive Tract Infections (RTIs) and
Sexually transmitted diseases among women, prevention and treatment of
RTIs/HIVs:
Remain free of reproductive morbidity (death); and
Bear and raise healthy children.
(Source: Qadeer 1998; Srinivasan et.al 2007; Jaiswal 2012)

During the post-Cairo period specific recommendations were made by various

international conventions to ensure reproductive rights and health of every woman.
Let us list some of the major international conventions which outlined different
measures to ensure reproductive health and rights at the country level.

Box 2

Article 10(2) of the International Covenant on Economic, Social and

Cultural Rights (ICESCR) writes “special protection should be accorded
to mothers during a reasonable period before and after childbirth” (United
Nations 1996).
Article 12(2) of Convention on the Elimination of Discrimination against
Women (CEDAW) outlines, “State Parties shall ensure to women
appropriate services in connection with pregnancy, confinement and the
post-natal period, granting free services where necessary, as well as
adequate nutrition during pregnancy and lactation” (United Nations, 2979).
General Recommendation No. 24 on Article 12 of CEDAW directs states
to take up the responsibility towards preventing maternal mortality. Article
14(1) of CEWAD recommends the states to take account of the problems
faced by rural women and take appropriate measures to address these
problems.
Millennium Development Goal (MDG) Goal-5- Improving Maternal
Health and Mortality specifies universal access to reproductive health
services by 2015. (cited by Jaiswal 2012, p. 15)

These are international forums in which women’s reproductive rights are specified
and demanded action at the state level to improve the condition of reproductive
and child health in every country. In India, the still majority of women don’t
have access to reproductive health services. We will understand the situation of
maternal health in India when we will read the section on the indicators of
reproductive health and rights.

9.3.2 What is Programme of Action for India under the RCH

approach?
Further, the POA also recommended a set of development goals for bringing a
sustainable and equitable society to implement the Reproductive and Child Health
Policy in India. The development goals include: 111
Health and Gender Sustainable economic development;
Education for girl child;
Promoting gender equity, equality and women’s empowerment;
Reduction in the infant, child and maternal mortality; and
Universal access to reproductive and sexual health services (Source:
Srinivasan et.al 2007).
These POA aims towards building a sustainable society in which the reproductive
health and rights of every individual can be realized in the policy in India which
was formulated on the basis of the POA of ICPD. In the year 1997, government
of India officially adopted the RCH approach and recognized the RCH programme
as the national policy of the government of India. The RCH programme introduced
the target-free approach to family planning and framed the POA for India
accordingly:
Immunization of children and access to contraceptive services by the couples;
Identification, prevention and treatment of RTIs and STDs;
Reproductive health education and services to the adolescent girls and boys;
Identification, prevention and treatment of cervical and uterine cancer for
women who are in the stage of menopause; and
Family planning is an integral part of the RCH programme
These are some of the indicators which were clearly stated in the RCH programme
under the government of India. In rural areas of India, Primary Healthcare Centres
(PHCs) are identified as the core unit to integrate the RCH approach into the
National Health Policies of India. Auxiliary Nurse Midwife (ANM) became the
core agent to provide basic reproductive and child health services in rural areas.
Therefore, the role of ANM was further expanded as counselor, educator, service
provider and coordinators of various other health programmes (Srinivasan et al.
2007, pp. 2931-2932). These are some of the basic concepts of reproductive
health and rights in India. You will be reading more about the reproductive health
indicators in the next section of this Unit.
Check Your Progress Exercise 1
Note: i) Use the space given below to answer the questions.
ii) Compare your answer with the Course material of this unit.
1) Define Reproductive Health.
......................................................................................................................
......................................................................................................................
......................................................................................................................

2) What are the important points on reproductive health placed before IPCD
with regard to Programme of Action (POA)?
......................................................................................................................
......................................................................................................................

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 Reproductive Health and
9.4 INDICATORS OF REPRODUCTIVE HEALTH Rights

The following are the indicators of reproductive health.

Quality of Care: Reproductive rights aim at ensuring universal access to
reproductive health services. The approach of providing care to the clients
became an integral part of the POA. For example, the type of care is provided
to the clients by the service-delivery systems. Continuous counseling, inter-
personal communication and information sharing between the clients and
the service providers became the centre of the quality of care. Imparting
training for the skill development is also emphasized within the POA of
ICPD. According to Sadik (2000) the UNFPA field study of different
countries revealed that there were about 45 countries which imparted training
programme to the service providers to implement the reproductive health
and right approach in their countries.

Gender Relations and Women’s Empowerment: It is one of the indicators

of reproductive health and rights. Many countries took initiative to eliminate
all forms of discrimination against women and efforts were made at the
country level to create a space for gender equality. According to UNFPA
report, out of 114 countries, 98 countries took positive initiative to ensure
gender equality. The positive initiatives include: establishing institutions
and ministry to look into the rights of women and child, facilitating right to
education and health, bringing legal ratification to protect the rights of
women and girl child, protecting women and girl child from harmful
practices of the community. In India, to name a few constructive initiatives
include: laws against sex-selective abortion, Beti Bachao Beti Padhao,
2005 Succession Act, Domestic Violence Act, Sexual Harassment Act 2013,
Verma Committee Report, Right to Education and so on.

Contraception and abortion: This is an important area of feminist enquiry

within the domain of reproductive health and rights. In the year 2010, the
development of pills completed its fiftieth years, hence many experts viewed
that the contraceptive pills have impacted gender relations in significant
way. For instance, the development of pills and better contraceptive methods
has increased women’s reproductive choice to avoid unwanted pregnancies
which in turn transforming the maternal health indicators. Unintended
pregnancies may result into abortion that is illegal in many countries. In
developing countries, abortion related complications amount to maternal
deaths when abortions are carried out under illegal and unsafe conditions.
Globally, 13 percent of maternal deaths occur due to unsafe abortion (World
Health Organisation Regional Office for Africa 2010, cited by Lips, 2014).
In case of India, an estimated 1.7 percent of pregnancies end with induced
abortion, between four million and 6 million abortions are done illegally
and around 9 to 16 percent of maternal deaths are due to unsafe abortions
(Centre for reproductive Rights and ARROW 2005, cited in Whittaker 2013).
Therefore, we can say that the development of pills and other contraceptive
methods in some ways has expanded women’s reproductive decision-making
and access to safe contraception. On the contrary, there is not much
development has happened towards men’s access to contraception. Use of
condom and sterilization through vasectomy are the most developed
contraceptive methods for men. However, the effort and approach of the
113
Health and Gender family and the government lack towards involving more men to accept
major responsibility for contraception (Lips 2014). When we talk about
reproductive health and rights, the focus is more towards targeting women
rather involving the men in this process of decision-making. Reproductive
health approach emphasizes the involvement of men in reproductive
decision-making can bring down the gender-based discrimination and
violence against women in family and society. Therefore, Ministry of Health
and Family Welfare, Government of India in its National Population Policy
(2000) emphasized the involvement of men for making contraceptive choices
and make the efforts for utilizing the reproductive and child health services
in India (Singh et.al 2006).

Maternal Health: Maternal health is a significant dimension of reproductive

health. Maternal health risks often increase due to pregnancy, childbirth,
poverty and social practices of early marriage and motherhood. Lips (2014)
lists some of the pregnancy related complications as sever bleeding during
and after childbirth, infections, hypertensions, heart disease, diabetic,
abortion and so on. These complications combined with sever poverty
increases the risks of maternal mortality in developing countries. In
developed countries, the pregnancy related deaths are high among women
who have less access to economic resources and modern medical care. In
both develop and developing countries, maternal mortality is common
among the women belonging to underprivileged groups. Let us read a case
study to understand how women are denied reproductive services in India.

SreejaJaiswal (2012) cites this case study in her article Commercial

Surrogacy in India: An Ethical Assessment of Existing Legal Scenario from
the Perspective of Women’s Autonomy and Reproductive Rights. The case
study is about Shanti Devi’s right to life and reproductive health. She was a BPL
cardholder and belonged to the Scheduled Caste community. In 2008, she carried
a dead foetus in her womb for five days because she was demand medical
treatment from various hospitals and she didn’t have the money to pay the hospital
fees. Finally, the foetus was removed in a government hospital and she was
discharged immediately from the hospital without realizing the condition of her
physical health. She got pregnant again in less than two years and gave birth to a
baby in January 2010 without the assistance of any skilled birth attendant and
died immediately (p. 17). The court asked the State of Haryana to pay the
compensation of INR 2,40,000 to the family of Shanti Devi because it is a form
of violation of her human rights.

The 11th Five Year Plan of India specified its own of the goals as inclusive and
faster growth. This is possible by bringing women and the marginalized sections
of the society to mainstream development in which significant attention is on
reducing the maternal mortality rate in India for which government is committed
to allocate adequate resources for improving maternal health and address obstetric
emergency. In the year 2004-2005, Ministry of Women and Child Development
(MWCD) outlined the mission statement, i.e., “budgeting for gender equity”
(Mahapatro, 2014, p. 313). In India, various institutional mechanisms and policies
are formulated to realize the goal of women’s empowerment. Some significant
policies include: National Health Policy, Common Minimum Programme,
National Rural Health Mission (NRHM) and RCH programme are focused on
women and child health by reducing maternal, infant and child mortality, providing
114
antenatal and post-partum care, making accessible, affordable and appropriate Reproductive Health and
Rights
health services to all with specific emphasis on women and children from
marginalized sections of the society (Mohapatra 2014). In spite of states’ proactive
action and positive discrimination towards women, many poor women in India
still deprive of their basic health rights. There are many stories which tells that
many hardly have any access to family planning and other reproductive services
in India. Let us now read a story.

This is a case about Jaitun vs. Maternity Home, MCD, Jangpura & Ors. In
which the High Court of Delhi directed the Municipal Corporation of Delhi
(MCD) and Government of National Capital Territory of Delhi to INR 50,000
compensation to Fatima. She is a 24 old woman suffering from epilepsy and
was forced to give birth under a tree on a crowded street of New Delhi. She
was denied delivery of her baby by the maternity home in Delhi. The Court
said it is a case of complete failure of the public health system to implement
the programmes and schemes formulated for reducing maternity and neonatal
mortality in India. The Court said: “…...the complete failure of the
implementation of the schemes. With the women not receiving attention and
care in the critical weeks preceding the expected dates of delivery, they were
deprived of accessing minimum health care at either home or at the public
health institutions. ….. It points to the failure of the referral system where a
poor person who is sent to a private hospital cannot be assured of quality and
timely health services. (para. 40). (Refer SreejaJaiswal, p.17-18).
Let us read about the reproductive rights of adolescents.
Reproductive Rights of Adolescent: ICPD clearly states the importance
of reproductive and sexual health of adolescent girls and boys. In many
countries, the discussion on reproductive and sexual health of young
individuals is still considered to be a grey area. Therefore, ICPD put much
emphasis on enabling the young people to make decisions related to
reproduction and their role as parents. The UNFPA field report suggests
that around 55 countries have included adolescent reproductive health in
their National Health Plan and Non-Governmental Organizations (NGOs)
are working in alliance with the various government to provide information
and services related to reproductive health to the young people. The UN
Special Session calls for the following Programme of Action that includes:

“The governments to provide confidential services to address effectively

their reproductive and sexual health needs, respecting their cultural values
and religious beliefs, emphasizing the identity and rights of the young people
themselves. Furthermore, the governments are urged to include at all levels,
as appropriate, of formal and non-formal schooling, education about
population and health issues, including reproductive health issues” (Sadik,
2000, p. 10-11).

9.5 REPRODUCTIVE AND CHILD HEALTH

POLICY: A CRITIQUE
One of the major challenges posed by the international organizations and
advocates of women’s health movements is towards integrating public health
and human rights principles under the comprehensive RCH policy. The main
115
Health and Gender focus of this programme was to transform the conventional family planning
programme into a rights-based approach in which equity and empowerment of
women can be ensured within the public health programme. However, there is a
wider gap between the public health perspective and ensuring rights and equity
of women. Many health programmes often failed to deal with the socio-cultural
and economic condition of the society in which both health care providers and
clients are located. Therefore, in many cases the implementation of reproductive
health and rights agenda became a complex issue.

As Datta and Mishra rightly argued, after six years of India’s commitment to
reproductive and child health policy, still the policy faces a lot of challenges in
terms of understanding the concept of reproductive right. There is a lack of public
understanding in viewing reproductive health in terms of women’s rights. In
India, advocating for reproductive health actually faces challenges for the
following reasons;

Advocating for reproductive health and rights needs a pro-active approach

for implementation.
The concept of reproductive health continues to evoke discomfort among
the women’s group, policy makers, and health practitioners.
Despite the RCH policy promise towards women’s health rights, still the
government remains committed towards the demographic goals.
Concepts like ‘rights’ and ‘health’ have been seen as complex subjects by
policy makers and the programme managers while implementing the RCH
policy in the field.
The concept of bringing child health along with reproductive health to some
extent has been unable to address the issues women as independent of their
maternal role and responsibility.
RCH programme to some extent has the principle of target-driven family
planning approach, as it continues to exclude the single women from the
range of services.
RCH programme is largely an expansion of the existing MCH/FP package
with additional services like termination of pregnancy and, towards
prevention and treatment of reproductive tract infections and sexually
transmitted diseases.
ICPD has limited women’s health to the issues of safe abortion and the
women’s reproductive rights to the extent of making choice over
contraception.
Central concepts like a comprehensive and integrated reproductive and child
health policy remain will define in the programme. For example, at the
level of implementation, the health care providers feel that they are unclear
about how to provide a rights-based health care facility to all the clients
simultaneously (this section is adapted from MA in Gender and Development
Studies).

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 Reproductive Health and
9.6 SUMMING UP Rights

This Unit speaks about the reproductive health and rights of individuals. It
discusses the origin of the concept of reproductive rights in international
conventions. The Units tells us that women’s right to reproductive health is a
matter of human right issue which cannot be ignored in the context of inclusive
development and women’s empowerment. In the last, the unit also provides a
critic of reproductive and child health policy from gender perspective. It aims at
understanding reproductive health in relation to decision-making, choice and
universal access to health services in India.

9.7 KEY WORDS

Human Rights Based Approach: The human rights-based approach focuses on
those who are most marginalized, excluded or discriminated against. This often
requires an analysis of gender norms, different forms of discrimination and power
imbalances to ensure that interventions reach the most marginalized segments of
the population.

Elements of good practices under a human rights-based approach

Programmes identify the realization of human rights as ultimate goals of
development
People are recognized as key actors in their own development, rather than
passive recipients of commodities and services.
Participation is both a means and a goal.
Strategies are empowering, not disempowering.
Both outcomes and processes are monitored and evaluated.
Programmes focus on marginalized and excluded groups.
The development process is locally owned.
Programmes aim to reduce disparities and empower those left behind.
Situation analysis is used to identify immediate, underlying and root causes
of development problems.
Analysis includes all stakeholders, including the capacities of the state as
the main duty-bearer and the role of other non-state actors.
Human Rights standards guide the formulation of measurable goals, targets
and indicators in programming.
National accountability systems need to be strengthened with a view to
ensure independent review of government performance and access to
remedies for aggrieved individuals. 
Strategic partnerships are developed and sustained. 
(http://www.unfpa.org/human-rights-based-approach#sthash.rDiXNHhC.dpuf)

9.8 REFERENCES
Wang, G. and V.K. Pillai (2001). Measurement of Women’s Reproductive Health
and Reproductive Rights: An Analysis of Developing Countries, Social Indicators
117
Health and Gender Research, Vol. 54, No. 1 (Apr., 2001), pp. 17-35, Accessed: 16-03-2016 09:34
UTC.

Qadeer, Imrana (1998). Reproductive Health: A Public Health Perspective,

Economic and Political Weekly, Vol. 33, No. 41 (Oct. 10-16, 1998), pp. 2675-
2684, URL: http://www.jstor.org/

Srinivasan, K. ChanderShekhar and P. Arokiasamy (2007). Reviewing

Reproductive and Child Health Programmes in India. Economic and Political
Weekly, Vol. 42, No. 27/28 (Jul. 14-20, 2007), pp. 2931-2935+2937-2939.

Jaiswal, S (2012) Commercial Surrogacy in India: An Ethical Assessment of

Existing Legal Scenario from the Perspective of Women’s Autonomy and
Reproductive Rights. Gender, Technology and Development, 16(1), 1-28.

Sadik, Nafis, (2000). Health and Human Rights, Vol. 4 (2), Reproductive and
Sexual Rights pp. 7-15

Singh, A. Ram, F and Ranjan, R. (2006). Couples’ reproductive goals in India

and their policy relevance, Social Change, Vol 36 (2).

Mahapatro, M. (2014). Mainstreaming Gender: Shift from Advocacy to Policy,

Vision, 18(4) 309–315

SAGE Publications, Los Angeles, London, New Delhi, Singapore, Washington

DC, DOI: 10.1177/0972262914551663

9.9 UNIT END QUESTIONS

1) Explain indicators of reproductive health.
2) Explain the criticism of reproductive and child health policy

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 Reproductive Health and
UNIT 10 GENDER AND DISABILITY Rights

Structure
10.1 Introduction
10.2 Objectives
10.3 What is Disability?
10.4 Social Attitudes and Stereotypes
10.5 Disability and Gender
10.6 Marriage and Family Life
10.7 Violence and Abuse
10.8 Physical Access and Mobility
10.9 Education, Training and Employment
10.10 Health Care
10.11 Leisure Activities
10.12 Summing Up
10.13 Key Words
10.14 References
10.15 Unit End Questions

10.1 INTRODUCTION
The earlier Units in this course have sensitized you to the health related
discriminations and inequalities that women experience. In this Unit we will talk
about the experience of disability. Think for a moment about what the word
disability suggests to you. I am sure that most of the thoughts that cross your
mind will be negative; loss, defect, tragedy, curse are some of the words that
come to mind when we talk about disability. Disability challenges our fundamental
notions of reality, the world, culture, and most importantly, our own bodies.
Disability has been historically viewed as a physical or mental limitation affecting
an individual due to which he or she is unable to participate in the life of the
community and society in the same way as non-disabled or so-called ‘normal’
people, Spinal cord injury, cerebral palsy, blindness, deafness and speech
disorders, amputation, mental retardation or intellectual disability, autism, etc.
are some examples of disabling conditions. However, over the past few decades,
scholars and activists have challenged the description of disability as an individual
limitation or defect; they view it as a social issue that is the outcome of social
discrimination and stigmatisation. Persons with disability are to be viewed as
persons in their own right, with the same aspirations, needs and desires as the so
called ‘normal’ or non-disabled people. By considering them as persons with
human rights, society has to take the responsibility to ensure their well-being
and dignity. This Unit will help you to understand disability as an axis of social
discrimination. Specifically, it will discuss how gender affects the experiences
and life chances of persons with disability.
Let us look at the objectives of reading this unit.

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Health and Gender
10.2 OBJECTIVES
After studying this Unit, you would be able to
Define disability;
Discuss social attitudes and stereotypes towards disability;
Explain gender issues in disability; and
Discucss the issues of disability and violence.

10.3 WHAT IS DISABILITY?

Simply put, disability is a state or condition of mind or body that affects an
individual’s functioning and interferes with their ability to participate in the
activities of day to day life. As we have mentioned above, disability is not just an
individual, medical problem, but a social one. For instance, a person may have
lost her ability to see. That is her ‘impairment’. But because the environment
around her makes it difficult and dangerous for blind people to function, she
becomes ‘disabled’ and thus her quality of life suffers. Thus, there is both a
medical as well as social dimension to the issue of disability. Disabled persons
represent the largest minority group in society after women. Disability can affect
a person anytime in the life-span; as health care improves and persons live longer,
the chances of developing an age-related disability increase as one grows older.
Furthermore, accidents and injuries are a major source of injury and disability. It
is rightly said that we are all ‘temporarily able-bodied’. Thus, disability is not
a unique experience of particular individuals labelled as disabled but of each one
of us at some point in our lives.

Disabled persons differ from one another in terms of the type and degree of
disability. Moreover, gender, class, caste, race, ethnicity, sexuality, residence,
and other such social, economic, political and cultural factors determine how
disability is experienced and understood. For instance, in a rural, agricultural
community, the loss of a limb may be seen as a severe disability because it affects
the ability to work in the fields and earn a living. A person with intellectual
disability who can do farm work may not be considered disabled at all, but may
be teased for being a simpleton. But in an urban society, having an intellectual
disability or mental retardation as it is still known in India, may be more of a
problem because so much importance is given to academic performance and
getting into a profession.

But what is a disability and what does it mean to be disabled in the first place?
Disabilities may be present from birth (congenital). For instance, developmental
disabilities like mental retardation and autism are believed to be congenital.
Malnutrition and micronutrient deficiencies may result in disabling conditions
in children in the form of stunted physical and mental growth. Certain kinds of
disabilities are acquired later in life due to accidents, injuries or advancing age,
as mentioned above. A disability may be static such as the loss of limb due to
an amputation; or ‘progressive’ in which a person’s condition may deteriorate
with time. The commonly known disabilities include blindness, deafness,
locomotor disability, mental retardation, cerebral palsy and mental illness.

Recently, autism and learning disabilities like dyslexia have also become more
120 familiar.
In legal documents and policy statements, disability is defined in terms of what Gender and Disability
qualifies for public assistance. In India, the Rights of Persons with Disabilities
Act (2016) identifies 21 disabilities as compared to the earlier Persons with
Disabilities Act (1995) which identified only seven categories.

Persons with disabilities are the most neglected and disempowered section of
the population. Due to their marginalised status, they are denied the fundamental
civil, political, social and economic rights that are guaranteed to all citizens in a
democracy. The plight of women with disabilities is even worse, since they have
to face the double oppression of gender and disability. Indeed not only are
they a socially invisible category but their plight is worse than both men with
disabilities and other non-disabled women. A disabled girl child is considered as
a curse upon the family and often ill-treated and abused.

According to the Census of India (2011) 26.8 million persons have some form of
disability in India accounting for 2.11 % of the total population. Of these, 15
million are men and 11.8 million are women. Thus, women constitute just above
44 percent of the persons with disabilities in India. This is believed to be a
conservative figure as the Census took into account only a limited number of
disabilities .Using a wider definition of disability which includes conditions like
diabetes and cardiovascular disease, the World Health Organisation (WHO)
estimates that 6%-10% of the population suffers from identifiable physical or
mental disability. That comes to over 70 million persons in India. It should be
noted that estimates of the total number of persons with disabilities in a country
vary depending on the definition of disability used, degree of impairment, survey
methodology including use of scientific instruments for identification and
measurement of the disabling conditions. Wars and conflict, HIV/AIDS, industrial
injuries, and road accidents are increasing the number of disabled persons. As
mentioned earlier, enhanced life expectancy has increased manifold the incidence
of old age-related, chronic disease induced disabilities worldwide as well.

10.4 SOCIAL ATTITUDES AND STEREOTYPES

Historically, persons with disabilities have always been regarded with a mixture
of fear, horror and disdain, almost as if they were sub-human. They have been
portrayed as freaks, helpless victims and a lifelong burden for family and society.
Even in religion and mythology, negative traits have been attributed with form
of deformity, be it Manthara, the hunchback in the Ramayana or Shakuni, the
“lame” of the Mahabharata. Indeed, the law of karma decreed that being disabled
was a punishment for past misdeeds. Such constructions of the disabled by the
non-disabled leads to the marginalisation and disempowerment of a whole
population group. At the same time, such negative stereotypes are internalised
by the disabled people themselves. This leads to passivity, dependency, isolation,
low self-esteem, and a complete loss of initiative. Pity, segregation, discrimination,
and stigmatisation became normalised in the management of persons with
disabilities.
In India, the dominant attitude towards persons with disability is that of pity.
This reflects in social policies which are based upon charity and welfare. Medical
rehabilitation including distribution of assistive aids and appliances such as braces,
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Health and Gender crutches, hearing aids etc., special schools, vocational training in low-end
occupations and sheltered employment have been the pillars of state policy for
the disabled right from the colonial period. Furthermore, they have never been
regarded as a politically significant group and hence their issues and concerns
have not been taken up seriously by the political class. As many of them are
hidden away from public view and denied access to education and social
experiences, they have not been able to come together in a big way and make
their presence felt in public life.
Things began to change marginally after 1981 (International Year of Disabled
Persons) when the issue of disability was opened up at the national level. The
changing international climate focussing on human rights and empowerment of
marginal groups impelled the government to make some policy changes such as
reservations in educational institutions and employment. But real progress in the
form of concrete legislation to deliver the promise of equality of opportunity and
social justice only came in 1995 with the passage of the Persons with Disabilities
(Equal Opportunities and full Participation) Act. Other legislation soon followed.
One of the historic international policy documents in recent times was the United
Nations Convention for the Rights of Persons with Disability (2006) which was
also signed by India in 2007. This signalled the introduction of a view of disability
as a human right and development issue rather than simply a matter of charity
and welfare. The Rights of Persons with Disabilities Act (2016) which has now
replaced the 1995 Act, is in line with this view. Several disability rights groups
and NGOs have emerged in recent times and disability related issues are being
increasingly included in the curricula of educational institutions.
Check Your Progress Exercises 1
1) Define disability.
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2) Explain social attitudes and stereotypes with regard to disability.

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We will now look into interface between disability and gender.

10.5 DISABILITY AND GENDER

The plight of women with disabilities as earlier mentioned is far worse than that
of men, as they suffer on account of being a woman in a male-dominated society,
and disabled in a world which considers the healthy, able body as ‘ideal’. How a
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person with a disability experiences the condition and is perceived by others is Gender and Disability
largely dependent on whether s/he is male or female. For instance, Michelle
Fine and Adrienne Asch point out that women with disabilities experience ‘sexism
without the pedestal’ (1988, p.1) ,i.e. they are doubly disadvantaged. Not only
do they experience disability- linked discrimination but they experience sexism
and are denied the consideration and social status that non-disabled women may
claim as wives and mothers. Men with disabilities also experience a similar assault
on their masculinity and may be shamed or bullied as ‘not being man enough’ or
dependents and burdens upon the family. This can be very bruising and damaging
to their self-respect, as traditionally, men are expected to be the providers and
decision makers of the family.

As mentioned earlier, the 2011 Census estimates that there are over eleven million
women with disabilities in India constituting about 4% of the population. Some
researches estimate that there are over 35 million women with disabilities in
India. (Bacquer and Sharma, 1997). Others put the figure at 20 million. 98% of
the disabled are illiterate: less than 1% can avail healthcare and rehabilitation
services (ActionAid, 2003, p. 15). But these statistics are only the tip of the
iceberg when it comes to gauging the level of neglect, isolation, stigma and
deprivation that characterise their lives. The majority of women with disabilities
in India suffer the triple discrimination of being female, being disabled and
being poor. Let us discuss some of the aspects of discrimination that these women
experience.

10.6 MARRIAGE AND FAMILY LIFE

A disabled woman is considered incapable of fulfilling the normative feminine
roles of homemaker, wife and mother. Then, she also does not fit the stereotype
of the normal woman in terms of physical appearance. Since women embody
family honour, disabled girls are kept hidden at home by families and denied
basic rights to mobility, education, and employment. They are less likely to be
given in marriage than disabled men. The capacity of women with disabilities to
be sexual partners, homemakers and mothers is questioned and doubted. They
are not considered capable of performing household chores efficiently, having
meaningful sexual relationships or producing and rearing healthy children. Under
these circumstances, they may be married off to older already married or men in
poor health. In short, women with disabilities do not have the same options of
marriage and motherhood as non-disabled women. Being nurturing and caring
are important aspects of female identity and cultural expectations of ‘proper’
womanhood, but women with disabilities are themselves in need of care. Thus,
they are not regarded as complete women.

10.7 VIOLENCE AND ABUSE

Being powerless, isolated and anonymous, women with disabilities are extremely
vulnerable to abuse and violence. In addition, help in activities of daily living
like dressing, eating, and other bodily activities makes them more vulnerable to
abuse both at home and in institutions. She will be less able to defend herself in
a risky situation because she may not be able to run or shout for help. Then,
persons with developmental disabilities may be too trusting of others and hence
may be easier to trick, bribe or coerce. They may not understand differences
between ‘good touch’ and ‘bad touch’. Many cases are known of mentally or 123
Health and Gender intellectually disabled girls and women who are sexually abused by people
responsible for their safety and care because they are sure that the victim will not
be able to report what has happened to her, and the abuser can escape scot-free.
Persons with speech and hearing difficulties may have limited communication
skills to report abuse. Furthermore, since disabled persons are often taught to be
obedient, passive, and to control their behaviour, this may make them easy victims.

10.8 PHYSICAL ACCESS AND MOBILITY

Women in general in our country find it difficult to move freely from one place
to another for work or leisure. So we can well imagine the condition of women
with disability. Poor public transport, bad roads or no roads, lack of proper lighting
and safety on the streets all make it very difficult for women with disabilities to
move from one place to another without assistance or help. You may have seen
women with disabilities in public places facing great hardships because the built
environment (roads,buildings,toilets etc.) are so difficult for them to negotiate.
Conditions in public buses and the railways are also very unfavourable for persons
with disability in general and women in particular. Lack of proper toilet facilities
is a major problem. Public toilets are filthy and unhygienic and usually at ground
level (Indian style toilet) making it very difficult for loco-motor disabled women
who often get around by crawling on all fours. Many women with disabilities
have narrated their experiences of not eating food or even drinking water for
long periods while they are out of the house for fear that they may need to use
the toilet. This has a bad effect on their health. Due to these difficulties in moving
from place to place, families often prefer to keep their disabled daughters confined
in the four walls of the home. Many such girls never get the opportunity to interact
with the outside world; go to school, make friends or visit relatives or neighbours.
This leads to feelings of depression, isolation and worthlessness.

10.9 EDUCATION, TRAININGAND EMPLOYMENT

Many disabled girls never go to school. There is a lot of social stigma attached to
their condition and families may want to hide them from the eyes of the world
for fear of bringing a bad name on the family and affecting the marriage chances
of other girls in the family. Special schools or vocational centres that are equipped
to deal with their needs are usually only found in urban centres and travelling
daily to these centres becomes a burden on the family. Lack of hostel facilities
and proper care if such hostels exist further worsens the problem. Many families
consider their disabled daughters to be unfit for education and are unwilling to
invest any money for the purpose because the girls are already considered a
burden. Needless to say women with disabilities also find it very hard to secure
employment because of their lack of education and training. This poses a serious
problem for their futures especially after their parents die leaving them without
financial support or independence.

10.10 HEALTH CARE

Girls and women with disabilities may suffer from several health problems which
may be related to their disability and which may require prolonged and costly
medical care, rehabilitation, occupational therapy, physiotherapy, special diets
etc. Assistive devices like hearing aids for the deaf, wheelchairs or artificial
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limbs for those with loco-motor disabilities may prove prohibitively expensive Gender and Disability
for poor families. Women find it very humiliating when they go for health check-
ups because health professionals often treat them in an insensitive and callous
way. Many women neglect their health because they do not want to burden their
families more and consider themselves worthless. Health is directly related to
nutrition and a good quality of life. Many women with disability also suffering
from poverty and neglect, do not get adequate nutrition, fresh air, exercise and a
wholesome atmosphere in which they can be healthy.

10.11 LEISURE ACTIVITIES

As mentioned earlier, girls and women with disability are often confined within
the house because of stigma, shame and practical considerations like mobility
issues. This gives them little opportunity to socialise with their peers, make friends,
attend family events, religious ceremonies etc. This further isolate them and makes
their lives dull and drab. As earlier mentioned, our public spaces are not at all
accessible for persons with disabilities. Leisure activities like going out for a
meal or for a film become potentially embarrassing and humiliating encounters.
A woman with a disability may have to be physically carried because there is no
lift or ramp; or made to sit at a distance from her companions because there is
not adequate space for her wheelchair.
Thus we see that women with disabilities face violations of their rights at every
level. They are considered a financial burden and social liability by their families;
they are denied opportunities to move outside the home, and have access to
education; they are viewed as asexual, helpless and dependant; their vulnerability
to physical, sexual and emotional abuse is enormous; their aspirations for marriage
and parenthood often denied; they grow up isolated and neglected within the
walls of home or special institutions with no hope of a normal life.

Although a rights-based approach has entered the disability rights movement,

the specific concerns of women with disabilities have not yet found a place neither
in the government policies and programmes nor in the voluntary sector. Ironically
or expectedly, the disabled rights movement all over the world including India is
male dominated. It may even be blatantly sexist. Even within the women’s
movement, women with disabilities rarely figured as a distinct group in
international covenants. However, the Beijing declaration in 1995, Platform for
Action, specifies women with disabilities as a particularly vulnerable group
with little access to information on their fundamental rights. This is a serious
lacuna, which needs to be rectified at various levels. One of the most important
features of The United Nations Convention on the Rights of Persons with
Disabilities, which was passed by the General Assembly in 2006, is the
incorporation of a separate article on women with disabilities. Being a signatory
to this Convention, the Indian state is henceforth duty bound to incorporate a
gender perspective in all its policies and programmes in the disability sector.
The new disability Act does make reference to women particularly with regard
to access to sexual and reproductive health care, however there remains much to
be done on the ground to ensure that women with disabilities access their rights.

10.12 SUMMING UP
Disability is a universal human condition and we are all only ‘temporarily able
bodied’. The notion of disability as a tragedy or medical anomaly has been 125
Health and Gender challenged by scholars who view it as a social as well as biological condition.
Discriminatory social attitudes and denial of basic rights to persons with disability
has made them weak, powerless and isolated throughout history. The condition
of women with disability has been particularly difficult and they have faced
discrimination and marginalization in all aspects of life; from marriage and family
life to mobility, education, employment, health care and leisure. However, the
new rights based approaches and international policies that have been introduced
over the past few years have created greater awareness about their condition.
Rigorous research and life-writing by women with disabilities has contributed to
our knowledge and understanding. Disability has also become a topic of interest
in popular cinema. All these developments will hopefully lead to better
understanding of the situation and concrete action on the ground through enabling
policies and laws for ensuring that all people with disabilities get the opportunity
to lead fulfilling lives.

Disclaimer/ This Unit has been adapted and modified from the Unit ‘Disability
and Feminism’ (MWG001, Unit 5 (Block 5) prepared for the MAWGS programme
of SOGDS authored by Renu Addlakha and Shubhangi Vaidya

10.13 KEY WORDS

Census of India : The Indian Census is the largest single source
of a variety of statistical information on
different characteristics of the people of
India. With a history of more than 130 years,
this reliable, time tested exercise has been
bringing out a veritable wealth of statistics
every 10 years, beginning from 1872 when
the first census was conducted in India non-
synchronously in different parts. To scholars
and researchers in demography, economics,
anthropology, sociology, statistics and many
other disciplines, the Indian Census has been
a fascinating source of data. The rich
diversity of the people of India is truly
brought out by the decennial census which
has become one of the tools to understand
and study India. The responsibility of
conducting the decennial Census rests with
the Office of the Registrar General and
Census Commissioner, India under Ministry
of Home Affairs, Government of India. The
Census Act was enacted in 1948 to provide
for the scheme of conducting population
census with duties and responsibilities of
census officers. The Government of India
decided in May 1949 to initiate steps for
developing systematic collection of statistics
on the size of population, its growth, etc.,
and established an organisation in the
Ministry of Home Affairs under Registrar
General and ex-Officio Census
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 Commissioner, India. This organisation was Gender and Disability
made responsible for generating data on
population statistics including Vital Statistics
and Census. Later, this office was also
entrusted with the responsibility of
implementation of Registration of Births and
Deaths Act, 1969 in the country.
(www.censusofindia.gov.in)

10.14 REFERENCES
Action Aid. 2003. Just People–Nothing Special, Nothing Unusual. Bangalore:
Books for Change.

Additional title in Useful Readings:

Addlakha, Renu (2013) Disability Studies in India. Delhi: Routledge

Bacquer, A.& Sharma, A. (1997). Disability: Challenges vs Responses. New

Delhi: Concerned Action Now.

Begum, Nasa (1992). Disabled Women and the Feminist Agenda. Feminist Review,
40(1), 70-84.

Chib,Malini (2012) One Little Finger New Delhi: Sage Publications.

Fine, M. & Asch Adrienne ( 1988). Introduction: Beyond Pedestals. In M. Fine

and A. Asch (Eds). Women with Disabilities: Essays in Psychology, Culture and
Politics ( pp. 1-37). Philadelphia; Temple University Press.

Gupta, Shivani (2014) No Looking Back New Delhi: Rupa Publications Census
of India,2011 Data on Disability downloaded from http://
www.languageinindia.com/jan2014/disabilityinindia2011data.pdf
Ghai,Anita (2015) Rethinking Disability in India Routledge.

10.15 UNIT END QUESTIONS

1) Explain the issues of gender in disability in detail.
2) Explain the problems of disabled women with regard to marriage and family
life ..
3) Explain the significance of access to education and employment for disabled
women.

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