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Reasons for Inequalities of Women's Health Care in India

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India- An overview of the Country

India, a country in South East Asia, has the world's second highest population. Out of the one billion people residing in the nation, 120 million of its women live in poverty. The male to female birth ratio is 1.05 males to 1 female. The life expectancy of the average person is sixty-four years of age. They have a literacy rate (people over the age of fifteen that can read and write) of 59.5 percent, with 70.2 percent of males being literate and 48.3 percent of females that are able to read and write ( India's economy is based mainly on traditional village farming, modern agriculture, handicrafts, a wide range of modern industries, and a multitude of support services. It is a patriarchal society, which means that men are the head of societal and familial matters. Women are not thought of as equal to their male counter parts and are expected to be obedient of males. Because of the large, unfavorable shift of power, women face injustices and inequalities in almost every aspect of their lives. A main issue that has always been present and continues to be problematic is the inequalities women must deal with when it comes to health care.

What types of services are available to women when they are pregnant and what types of conditions result from these limited services?

The common belief when it comes to pregnancy is that it is an ordinary part of every woman's life. Even though child birth is an extremely exciting and happy moment for a family, "the mother and child are considered `impure' and `polluting'" (Hussain, 2001). When a woman is pregnant, she is given special treatment in her family, often not expected to do housework and is fed much better, but only if the expected child will be a son. Often, if it is known that the woman will have a daughter, she will still be expected to perform all of her domestic duties, no matter how dangerous it may be for the fetus. Prenatal and post-natal health care are usually not given to a women. Most women, more than 50 percent, give birth to their child in their own homes. The times when she is taken to a hospital is when she will be delivering a male child.

In the article, "Do Women really Have a Voice? Reproductive Behavior and Practices of Two Religious Communities," Sabiha Hussain (2001) tells the story of a woman named Salma. During Salma's last pregnancy, her mother-in-law thought she saw symptoms that indicated that Salma may be pregnant with a boy. Salma was then taken for an ultra sound to verify these thoughts, and once they were sure that she was pregnant with a son, Salma was given a special diet, extra care during her pregnancy and delivery and was even allowed to rest for twenty days after she gave birth.

In another case study, Hussain tells the story of Anita, who was put into an isolated room after her seventh month of pregnancy. When she went into labor, she requested for her mother-in-law to take her to the hospital, but instead her mother-in-law tried to call the dai (midwife). The dai did not arrive in time to assist Anita with her child birth, and as soon as she had the baby, she was left unattended in the room with no one to help clean her or the new born.

During pregnancies, there are some beliefs that families practice. They often prefer "hot" versus "cold" foods during pregnancy, reduced food consumption during pregnancy, son preference, use herbal medicines, home delivery by a traditional birth attendant, exclusion of men from most aspects of childbirth, the role of extended family, confinement after delivery, delayed onset of breast feeding, and perform rituals aimed at warding off the "evil eye" (Choudhry).

In most parts of India, the services available to most pregnant women are only the care they receive from their own families. There are not too many gynecologists or obstetricians available for pregnant women, unless they are extremely wealthy. The estimates nation wide are that only forty to fifty percent of women receive antenatal care (Coonrod). In other states such as Bihar and Rajasthan, maternal health services are given to five to twenty-two percent in rural areas and twenty-one to fifty-one percent in urban areas (Coonrod). Families that traditionally care for the women themselves will make an exception to take her to a professional only if they know that the baby will be a boy. As a result of neglecting the special needs of a pregnant woman, there are often complications during her pregnancy or while she is giving birth. Women are often unable to completely recover from their deliveries and the female babies are not very well taken care of. It is estimated that pregnancy related deaths account for twenty-five percent of mortality in women between the ages of fifteen and twenty-nine. For every one death, twenty more women suffer from other issues that impair their health. In a village called Maharashtra, based on physical exams, ninety-two percent of the women endure at least one genealogical problem (Coonrod).

How does violence and mistreatment of women play a role in the inequality of health-care?

Gender based violence is extremely prevalent throughout the country. "All women, regardless of age, class, caste, and community are vulnerable to domestic violence--marriage, a joint family, education, economic security and social status do not provide any real protection" (Zucker, 2001).

A main factor of violence towards women is dowry murders. Every year, there are about 6,000. Often, when a woman's family does not give the groom a large enough dowry, the bride is murdered. Members of the working class will often save their entire lifetime to make a dowry for their daughter. Instead of being able to spend all of their wages on things that would benefit their health, such as food or clothing, people sacrifice their well -being, just to save enough to give to their daughter's groom (Douglas).

Another main issue is sexual violence. According to the article, "Women and Health: India; The 'Male Factor' in Women's Reproductive Ill-Health," in India,

"every twenty-six minutes, a woman is molested. Every thirty-four minutes, a rape takes place. Every forty-two minutes, a sexual harassment incident occurs. Every forty-three minutes a woman is kidnapped. And every ninety-three minutes a woman is burned to death over a dowry."

Also, women are not safe from harm even from authorities of the law. Police have been known to rape women that are poor or from low castes. Rape within cities and slums is a huge problem. In Bombay, a major city, there was a march against rape because a working



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