Why in the news?
- The United Nations Population Fund (UNFPA) recently said that instead of fixating on the impact of the soaring population in the world, the world should pay attention to women's reproductive rights to shore up demographic resilience.
- This comes after the UN's Sexual and reproductive health agency on 19 April 2023 officially announced that the world population has crossed the eight billion mark. Concerns have also been flagged over the size of the world population, which is expected to peak at around 10.4 billion during the 2080s.
What is Reproductive Health?
- WHO defines reproductive health as where “people are able to have a responsible, satisfying and safe sex life and that they have the capability to reproduce and the freedom to decide if, when and how often to do so”.
- The intrinsic attribute of the definition of reproductive health emphasizes the right of individuals of both genders to be informed about healthy reproductive practice and process, such as, knowledge on safe, effective, affordable and acceptable methods for regulation of fertility, and, men and women’s access to appropriate health care services to enjoy such rights (Sunil & Pillai, 2010).
- But according to Zoya Hasan in the context of Indian society, it is the woman who to a larger extent has Reproductive Slavery.
Socio-cultural Factors that Effect Reproductive Rights & Health of Women in India
Cultural Factors
According to the diffusionist perspective, traditional culture is a barrier to behaviour change, primarily with contraceptive use. Lack of education and the perpetuation of ‘false beliefs’ reinforced by traditional ideas are cited as major obstacles to improved maternal health.
- Patriarchy: Nivedita Menon in ‘Sleeping with Enemy’ exemplifies how ‘through control of sexuality of woman, patriarchy asserts itself public as well as private sphere. Reproductive health belongs to what Sylvia Walby calls Private Patriarchy where the household patriarch controls the ‘sexuality of female’ through reproduction and restriction.
- Religious ideologies: In Hinduism, the Law of Manu says that marriages solemnized only for ‘Progeny’ (Santana) are divine. In Islam, having children is considered an act of worship. These ideologies effectively divest women to avail reproductive health facilities.
- Son Preference: This keeps women to continue childbearing until the desired number of sons is achieved. Madhu Kishwar studying ‘Patriarchy in South Asia’ confirms this social phenomenon
- Inferior status of women: Louis Dumont shows that women in Indian society were given the permanent status of impure relative to men. Leela Dubey confirms it with her study of ‘Seed and Soil’. As she shows in her studies that woman supposedly redeems Pitra-rin (debt to ancestors) by bearing more and more sons.
Structural Factors
According to the study conducted by Commission on Social Determinants of Health (CSDH), the main structural determinants which cause the inequality in access to health facilities are as follows:
- Economic status and education
- India has one of the highest levels of out-of-pocket payments for health care in the world, which imposes a large financial burden on individuals and households. This has been argued to be one of the reasons for lack of proper reproductive health assistance amongst women in India.
- Amartya Sen in ‘The Missing Woman’ presents how economic mobility reduces the total population burden but raises selective reproduction through technology and controlling woman's reproductive health by confining women to household activities and rearing children.
- A household survey from Chandigarh Union Territory comparing coverage of maternal health care showed that among the women studied, only 32% of the women living in urban-slum areas had an institutional delivery, compared to 93% of the non-slum urban women.
- Women living in rural parts of India are considered a vulnerable group in terms of maternal and reproductive health. In rural areas, home births remain the most common practice, with only 29% of the deliveries taking place in a health facility.
- Results from a study based on data from NFHS 5:
- The “unmet need for family planning methods” is highest among the lowest wealth quintile (11.4%) and lowest among the highest wealth quintile (8.6%).
- Use of modern contraceptives also increases with income from 50.7% women in the lowest wealth quintile to 58.7% women in the highest quintile.
- 66.3% women who are employed use a modern contraceptive method, compared with 53.4% women who are not employed.
- Where economic status and levels of schooling were better, teenage childbearing was likely to be nominal.
- Gender
- In India, there is an association between the use of adequate prenatal, delivery and postnatal care and women’s autonomy. The quality of family relationships and type of household is also associated with access to maternal and reproductive health care.
- A study using data from the NFHS 5 showed that women living in joint households were less likely than women living in nuclear households to report the use of contraceptives and less likely to utilize ANC (antenatal care).
- Gender norms have also been shown to influence attitudes toward the use of contraceptives and women’s ability to make decisions on family planning. A qualitative study conducted in the western parts of India showed how women publicly were reluctant to acknowledge awareness and use of modern contraceptives and described the use of contraceptives, other than sterilization, as socially unacceptable.
- Social identities (caste and religion)
- There are also several studies showing that contraceptive use is low among women belonging to ST and SC.
- A study conducted in rural Punjab found that the contraceptive use rate was 61.2% among Muslims, 72.8% among Hindus, and 82.1% among Sikhs. Compared to other religious groups, Muslim women were found to have significantly lower odds of being assisted by a trained birth attendant in a study conducted on data from the NFHS 3.
In conclusion, it can be stated that instead of treating women’s reproductive health as an instrument or means to an end, it needs to be looked at more holistically from a perspective of women’s rights. Datta and Misra (2000) summarises that this objective needs to be fulfilled in two ways:
- Making policymakers understand that gender relations are central to reproductive health and cannot be looked at individually.
- This concept of joint focus needs to be translated into policies that actually enable women - that is, these programmes need to operate on two levels: firstly, address immediate health requirements; secondly, tackle long term issues of gender based power relations.
