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Published in Health Action, Vol. 13 (9), pp 18-19, 2000.


Manoj Choudhary and Shelley Saha The dynamics that leads to inequities in health for woman are derived from the generally low status that a women have - legally, economically and socially, from the imbalance of power relationship which limits womans choices and inability to protect their own health from societys indifference to the abuse and neglect. Gender inequities begin at birth and sometimes even before birth. Gender bias in health care system A wide range of studies provide evidence of under utilisation of health services by women. A health system concentrating on fulfilling the population control targets set by the government, inaccessible primary health care centres and indifferent biased doctors, unaffordability, improper timing, work, and lack of faith and privacy in the health facilities serve to keep women away from the reach of safe health care. Modern medicine has retained the age-old belief that most women are irrational and hysterical and their genuine health problems are often dismissed as psychosomatic. Besides not according enough seriousness to womens health problems, it only views womens health only in terms of motherhood and not womanhood. But still the Maternal Health Programmes cannot prevent mothers from dying and suffering from pregnancy related morbidity. Bias against women persists in our national health programmes too. Women's illnesses would be further neglected and aggravated due to the decrease in budget allocation on health, introduction of user fees and the dependence on the private sector. What needs to be done Although lots of alternative strategies are being developed in various parts of the country to provide health services, these strategies remain confined in the project areas. Many of these efforts are not self-sustaining. There is a need to document these efforts and thrash out mechanisms to mainstream these strategies by taking into consideration the diversity of our country. Mainly three aspects determine the health of a population: health services, policies and social norms. Therefore all these three aspects needs to be taken into consideration. Health services: For improving health services especially for women the following efforts should be taken: Ensure availability of need-based, affordable, accessible, acceptable health services for women, through the primary health care system. Identify critical areas of health needs for women. Train health care providers to make them responsive to womens individual, social, cultural and medical needs, and help the women to make voluntary, coercion-free decisions about their own health. Undertake training of local medical practitioners to ensure that they are skilled and sensitive while treating patients, especially females. Develop indicators for continuos monitoring of services to access quality of care including womens involvement and participation. Organise awareness raising programme for women in the community on issues like anaemia in women and its socio-cultural context, malnutrition, equity for women, importance of educating girl child, menstruation and personal hygiene. Involve decision-makers (husbands and mother-in-laws) at every possible level. Form village level health committees. They can identify the health concerns of the community people, especially of women. Monthly meeting could be held with the health workers like ANMs, MPWs, PHC doctors, where identified health problems could be addressed. These health committees

along with the members of the Gram Panchayat can act as pressure groups, so as to make all levels of health functionaries accountable to the community. Establish community outreach programme by health organisations Locally recruited health workers can be trained to diagnose and treat common ailments suffered by women. For this, there is a need to formulate guidelines for the health workers for early detection and management of minor aliments at the village level. If this could be done, many problems faced by women in accessing health care can be solved. The financial sustainability of the health services could be improved by integrating services, and by making use of community-based services, social marketing and costrecovery schemes. Ensure male participation: promote male responsibility and enhance the involvement of men, as most of times they are the decision-makers. Male involvement in womens health can be attained by a. Training male health workers in order to get cooperation from the male members of the family regarding womens health b. Creating awareness among men about their role in promoting equality for women. c. Forming small local-level mens group and involving them in the campaign that addresses womens issues. Many of the existing IEC (Information, Education, and Communication) materials are not sensitive to womens needs. Listen to what women have to say about health and what they would like to know about it, rather than simply transferring information to them. Develop culturally appropriate women sensitive and specific IEC material, which would take into account issues regarding womens health. Policies: While framing policies and programmes, the policy makers should respect of womens rights as individuals. Create conducive environment that would to allow women to exercise their rights. Frame policies which would ensure access of women to relevant education, health and resources through skill development The health policies and programmes should change the focus from a population control approach of just reducing numbers to a more comprehensive approach, which is sensitive to the needs of women. Male contraceptives need to be promoted. Provide women with more choices, free from coercion and discrimination Involve women in health policy and planning as well as its implementation and evaluation. Advocate for greater and rational allocation of resources to programmes that effectively address the health needs of women. Ensure that discriminations against women are identified and strategies are formulated to eliminate all forms of violence against women. Social norms: Health care is a part of the broader social process and therefore, shaped by it. Poor womens health is the direct result of her unequal status in society, especially where there are different standards for women and men. Unless discriminatory practices against women are eliminated, any amount of health service provision to women would make little difference in health status of women. Address the issue of gender discrimination against women in all aspects and stages of her life. Nutrition: Nutrition Programmes of the government had been unsuccessful and will remain unsuccessful till the society understands the need of providing proper nutrition to its women. Nutrition education programme should be conducted to make people understand the need of proper nutrition, use of low-cost locally available foods, and the nutrition requirements in various stages of womens life. Education: It is one of the most important means of empowering women. Special attention needs to be given for the education of the girl child, in order to decrease drop out of girl child from schools. Utilisation of health services: In our society, women do not avail health services until she is unable to shoulder her responsibilities. But by then it becomes too late. Society should be made to understand that if the health problems are treated early, life of the woman as well as cost of treatment can be saved.

Address adolescent needs: In our society girls are married early due to social reasons. A low social and economic status of women and girls and their high rates of illiteracy and ignorance about sex and reproductive physiology make them particularly vulnerable to various health problems like unwanted pregnancy, illegal abortion. Trained members from the village level health committees can interact with young girls and boys in the community and provide them with required skills and knowledge. Communication fairs (melas) can be organised during village festivals. Specific issues related to women like domestic violence, alcoholism, early marriage and how all these affects womens health can be addressed through this in a non-threatening manner. Womens group (Mahila mandals) should be given information about Panchayati Raj, functioning of a Gram Panchayat, its role, rights and responsibilities towards the village. A link could then be established between these groups and panchayat members. This would enhance womens issues being raised in the Gram panchayat meetings. Health for women in our country will continue to elude till they have equal access to resources and to the fruits of development. This, in turn, means addressing inequitable gender relationships, and the underlying inequalities that currently stand in the way of womens access to quality health care. (Manoj Choudhary is a demographer in Institute of Health Management, Pachod, and Shelley is a researcher in Centre for Enquiry into Health and Allied Themes CEHAT)