Dr Shubhnoor Hazuria
MBBS from GGSMCH, Faridkot.
Worked for women health and hygiene during Swachh Bharat Abhiyaan Internship (3rd prize in the University)
A Health “Not for all”
The recently released results from the first phase of National Family Health Survey (NFHS) point to an overwhelming prevalence of anaemia in almost half of the women. The current Maternal Mortality Rate (MMR) is 130. According to a survey by AIIMS, only 37% of women had access to healthcare as opposed to 67% of men. 43% of women complain of at least one sexual problem. These are not merely numbers that the government or other agencies come up with periodically; bur rather they show that a significant chunk of our population is deprived of something as basic and as essential as health.
The concept of health is extremely vast, with various factors affecting it, but nutrition forms foundation of health. It affects every conceivable aspect of health, from communicable to non-communicable diseases, mental health and reproductive health. It is ironic that the nurturers of the family, women, are often the least nourished in a family. Owing to the unique physiology (menstruation, pregnancy, lactation), women and girls require adequate additional nutrition to lead healthy lives. And yet the nutritional status of women, especially those belonging to lower socio-economic strata, is dismal at best. This can be attributed to a host of factors.
In most cultures, the deep-rooted patriarchy, has led to a preference for male child over the female child. This discrimination manifests at every stage and ultimately leads to disadvantage and deprivation for the girl child. In a family with limited means, the best is reserved for the male child. A survey found that as compared to 68% male children who consumed milk at least thrice a week, only 24% female children consumed the same amount of milk. This environment of deprivation continues well into adulthood. As the girl enters the child bearing age her nutritional needs are all the more important and yet she is deprived of it. Poor nutrition further complicates the pregnancy and adversely affects the unborn child. Anaemia in pregnant women is the leading cause of maternal morbidity and mortality and even causes low birth weight and premature babies. Thus, a vicious cycle is established where even the next generation is a victim of undernourishment. This makes them susceptible to more illnesses that further erodes their nourishment. As a young woman, she is expected of take care of the household while her nutritional needs are still unmet. There have been mammoth efforts on the part of the government to address malnourishment in women (ICDS, POSHAN abhiyaan) but a radical change in the patriarchal mindsets is the need of the hour.
The families are seen to be insensitive to the health requirements of women. Most of the women in rural areas and even in urban areas are dependent on the male relatives to take them to health care facilities. The menfolk give least priority to their health. Therefore, even in sickness women keep on cooking, cleaning, washing etc and their health deteriorates further. Our cinema depicts a dedicated mother and wife offering a hot glass of milk to her son or husband but this kind of warmth is never shown while offering food to a daughter or mother. This needs to be changed. A woman is deified in our society and she being a Devi herself cannot fall ill. So she herself remains in a denial mode. Mere availability of health care facilities does not ensure good health. We have to ensure presence of enabling factors so that the benefit of these facilities reach their target groups.
All our NGOs and the Government machinery targets physical health of women and child but often forget to talk about mental health which is a major component of our well being.
Even WHO recognises that health is multidimensional and includes mental and social health along with physical health while defining health. Malnutrition, neglect in early childhood, suppression of desires, social restrictions, un happy marriages, childhood abuse, domestic violence and a host of other restrictive circumstances women have to confront during their life time, right from before birth till death, leave them mentally scarred. But unlike physical scars, mental scars are not visible, not even to the victim. Thus no efforts are made either by Government or civil society or by the family to address these issues. This results in women going in deep depression, losing their identity and self esteem and in extreme cases committing suicide. Its high time people working for the welfare of women integrate mental wellness in their scheme of things. A woman rescued from the clutches of domestic violence may not be suffering from any physical disease but in all probability she is mentally scarred and needs help.
Availability and accessibility of health care is important not only for women but for society as well because it has direct effect on the well being of the entire population. A physically and mentally healthy woman can be a good nurturer and care taker for the family. But the societal norms formed over the centuries need to be challenged now otherwise the goal of health for all will remain elusive.