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The notion of women's health in India is evaluated in this case study. The Indian constitution stipulates that all citizens have access to free healthcare. As a result, all government hospitals are expected to provide free healthcare to patients. Every district headquarters in most states has at least one public hospital where all services, from diagnostic to medicine, are provided for free. Nonetheless, the private healthcare sector provides the majority of medical services in the country, with individuals paying healthcare expenses out of cash rather than having insurance cover the costs. The health-seeking behaviour of Indians is compromised due to the fears regarding privacy and also the judgmental attitudes of the healthcare providers, which apparently prevent young people and some women from seeking out the needed services(Santhya and Jejeebhoy 21). Three key social determinants of health that are a priority for Indian women are stress, employment, and addiction. The paper will further discuss the three factors about women's sexual and reproductive health. Also, the paper critiques the means for providing primary health care, and as well analyses how social and economic policies in India have affected women’s health.
Overview of Sexual and Reproductive Health in India
According to scholars, denial of sexual and reproductive rights and health is both a cause and consequence of gender inequality (IPPF, 9). The connection between poverty and gender inequality has far-reaching implications for the reproductive and sexual health and rights of both girls and women (Davis, Schensul and Verma 484). It translates to considerable gaps in capability and opportunity. Also, it leads to massive vulnerability to gender-related poor health, gender and sexual-based violence, harmful practices that are considered traditional and also disproportionate rising of care work that is unpaid (IPPF, 9).
Gender norms in most countries, including India, disproportionately limit girl’s and women’s control over reproductive and sexual health and rights. Besides, the lack of access to sexual and reproductive rights and health is likely to heighten the currently existing inequalities in gender. This has implications that girls lack access to education primarily due to gender norms that advocate for early marriage and childbearing at a tender age for girls (Banerjee, Andersen and Aich 37). Such norms in the society not only impact on the individual lives of girls but as well carry on systemic inequalities in gender where girls’ education is less valued as compared to boys education. Sexual and reproductive health and rights are significant aspects for the empowerment of girls and women, and for the advancement of gender equality. With this, girls and women, in general, realise their rights as well as access to health services.
Reproductive and sexual health rights mean the right for all people despite their gender, age, and other characteristics, to decide on what they want regarding their own reproduction and sexuality, as long as they respect the rights of other people(Griffin 1). This entails the right to access to information and services meant to support the choices made and also strengthen reproductive and sexual health. Nonetheless, women in most developing nations often lack the right to both knowledge and control over their experience in sexuality and reproduction. This lack of control among Indian women is characterised by lack of access to health services, lack of or inadequate education about their bodies and on contraception, and also lack of rights to choose what they want(Davis, Schensul and Verma 484). Such lack of reproductive rights presents a serious issue in health, considering the fact that the right of a woman to plan the number of children she wants, and when she wants them is central to the quality of her life experience. As explained by Barot, since the mother's health and her newborns are closely connected, their care should also be linked (p. 1). The well-being of the child cannot be therefore entirely addressed if the mother is not granted the right to make her own sound choices.
In the modern world, many unwed teenagers become pregnant each year, and the solution given is often outdated. The teenagers, i.e., girls are told to ‘say no' as they wait until they are married. Nonetheless, it is evident that this ‘solution’ does not work, and as such, education and empowerment remain the two most feasible options. It is evident that in most nations, schoolgirls who become pregnant are expected to drop out of school, and the number of new mothers who return to school is relatively low (IPPF, 17).
In rural India, young women have limited knowledge and agency about sexual and reproductive health (Banerjee, Andersen and Aich 38). According to these researchers, agency denotes the potential to exercise choices via personal competence to control life matters, i.e., decision-making, a sense of self-worth, freedom of movement, and also access to healthcare resources (Banerjee, Andersen and Aich 38). Also, women, mainly teenage girls in rural India have limited understanding of reproductive and sexual health matters. Therefore, it is justifiable to conclude that the women in the country are not empowered or educated enough in issues of their reproductive health, and as such, they cannot make informed decisions about the same.
The health sector of most developing nations such as India should establish a unified approach to reproductive and sexual health. In order to attain safe reproductive health for women, various aspects ought to be considered or addressed. These components include access to contraception, education, awareness, and access to safe abortion. Besides, Stover, Hardee, and Ganatra explain that individuals and health systems have a considerable role to play in safeguarding reproductive health. Among the interventions include family planning, adolescent sexual and reproductive health, address the problem of unsafe abortion, and lastly discourage violence against women (Stover, Hardee and Ganatra 115). These interventions are different from other health interventions as the motivation for their use is not necessarily bound by better health but instead entails social and cultural norms.
Three Key Social Determinants of Health for Women in India
Social determinants of health entail the conditions in which in which individuals are born, grown, work, live, and also age, and they play a huge role in determining the health of the population under consideration. Such social determinants are associated with potential repercussions emanating from poor health, for instance, high cost of treatment and morbidity. Various social determinants of health are reported in India, and they include lack of social support, social exclusion, stress, employment, and addiction. This section focuses on three key determinants namely stress, addiction, and job, with particular emphasis on how they impact on health.
Stress is described as a reaction or response to change, and as such, it could either be positive or negative and affects both the body and the mind. Stress stimulates the production of hormones like adrenaline that consequently speed up rate of heartbeat, accelerates metabolism rate, and also prepares the body for emergency, regardless of whether a chance for action is presented(Wilkinson and Marmot 12). Stress is harmful to individuals as it can, for instance, damage a promising academic session by maiming the joy associated with learning and also impacting on the general health of the scholar or student, thus compromising performance.
As explained by Schneiderman, Ironson, and Siegel, stressors significantly influence our sense of well-being, mood, traits as well as health (607). It is essential to understand that acute stress responses in young individuals who are healthy could be adaptive and typically do not denote a problem in health. However, for sick or older individuals, the long-term impacts of such predisposing factors to stress can be detrimental to health(Schneiderman, Ironson and Siegel 607). Some features of a particular situation are linked to high levels of stress responses. Such include the severity or intensity of the stressor as well as the controllability of the specific stressor. Besides, life events like humiliation, loss, and danger are associated with increased depressions as well as generalised anxiety. It is also pertinent to note that stress-related outcomes vary depending on environmental or personal factors(Schneiderman, Ironson and Siegel 701).
The history of the idea of stress and its connection to disease processes dates back to the nineteenth century. Research has established that there exists a significant link between pathophysiological processes and the emergence of chronic illnesses (Vitetta, Anton and Cortizo 494). According to some scholars, the modern-day world is considered the age of stress and anxiety.
There are numerous causes of stress (stressors) in the modern world. The most common ones are examinations (for students), parental expectations, grief, and homesickness especially for students studying and living away from home, conflicts with intimate partners (relationships), as well as thinking about the future. Other causes include work, money, and the economy. Besides, most people cite personal health and the health of their family as a significant cause of stress.
In Indian women, stress has been cited as one of the most significant social determinants of health. In this sense, it is essential to prioritise women’s health and also be committed to ensuring that factors that cause detrimental health in women are adequately addressed. When the health of women is prioritised, it becomes possible to achieve the fourth and fifth goals of the Millennium Development Program(Baheiraei, Bakouei and Mohammadi 119). Stress has been considered an environmental influence, which is conceptualised as endemic stress, on the health of women in India. The stress is caused by physical and social determinants of deprivation, lack of fundamental resources, few role opportunities as well as oppressive cultural factors or norms. There is a direct correlation between these factors and the health status of women in India. As had been explained earlier, Indian women are denied sexual and reproductive health rights, and this significantly impacts their quality of life and decisions. When stress is left unchecked, it could lead to numerous health complications such as heart diseases, diabetes, obesity, and hypertension. Besides, chronic stress is associated with high levels of anxiety that consequently makes an individual have low self-esteem.
In most instances, individuals turn to drugs, alcohol, as well as tobacco and consequently suffer from their abuse. Nonetheless, there is the need to understand that use is determined or influenced by the larger social setting. Some parts of India, particularly the slums, are characterised by high levels of poverty, and this provides a suitable social context for the abuse of drugs; hence addiction. According to Wilkinson and Marmot, people start alcohol, drugs, and tobacco use in efforts to numb the pain associated with desperate social and economic conditions (24). Drug use is considered a response to breakdown in the social setting or order, and it is an essential factor in causing deterioration in inequalities in health in India. Users find a false mirage of escape from stress and adversity as in reality, their issues are worsened.
Until recently, the problem of alcohol and substance use was viewed as predominantly male phenomenon. However, much attention in the last few decades has been directed to female drug use as well as its associated consequences in women (Lal, Deb and Kedia 275). As further explained by Lal, Deb and Kedia, the relative amount of different drugs used by females is dependent on the region they inhabit (281). For instance, in “wet” culture nations such as the US, alcohol use by women has considerably high social acceptance, but for other drugs, women remain a minority. However, in “dry” culture states such as India, alcohol consumption rate is relatively less as compared to that of the west.
Addition emanating from drug use (and or abuse) is detrimental to women’s sexual and reproductive health. In most parts of the world, HIV epidemic has been feminised, and considering the role played by drugs in spreading the disease, focus on women and substance abuse has turned out to be extremely necessary(Lal, Deb and Kedia 282). In order to address the problem of sexual and reproductive health among women in India, it is pertinent that policymakers consider the issue of addiction and how it leads to poor health.
Higher unemployment rates are associated with more diseases and also premature death (Wilkinson and Marmot 20). In areas where unemployment is widespread, health is at risk. In India for instance, there is high level of poverty and unemployment, and with this, women and their families suffer a significantly higher risk of premature death. As explained by Pawar, Mohan and Bansal, it is pertinent to improve the health or urban residents, especially those living in slum areas such as the slums of Surat City, India (607).
The health impacts of unemployment are connected not only to psychological effects but also the financial issues, i.e., debt it brings (Wilkinson and Marmot 20). Women in India are from different socio-economic backgrounds, and in most cases, they are neglected or marginalised regarding gender discrimination in regard to primary healthcare (Mehrotra and Chand 1). However, the research by Mehrotra and Chand concludes that when women rise in economic status, they tend to gin considerable social standing not only in the family but also in the village, and as such, they have a greater say (9), for instance in matters of sexual and reproductive health.
Critique of How Primary Healthcare is Addressed in India
Primary healthcare is an essential and fundamental strategy that remains the backbone of delivery of health service. Primary healthcare entails the day-to-day care necessary to safeguard, maintain, and also restore the health of the population in any given nation. As explained by Pandve and Pandve, India was one of the first nations to acknowledge the benefits of primary healthcare approach. Long before the Declaration of Alma-Ata, the country had put in place a fundamental healthcare model that was founded on the principle that being unable to pay for health services should not prevent people from accessing the services (Pandve and Pandve 126). In this light, it is evident that India has for a long time been committed to provision of healthcare services to its citizens. The decision to avail such free services to all citizens is a move to ensure the country fares well in health indicators and measures.
Besides, after the 1978 establishment of the Alma-Ata Declaration, there was a launch of the facet of health for all by the year 2000. The declaration aimed at providing primary medical care within the context of health services that are integrated (Pandve and Pandve 126). Nonetheless, over the years, the concept of integrated primary health has failed in India, and this has to a large extent been linked with the inability to support service delivery. The government pays small amounts of money to multiple providers of primary healthcare. The problem with this policy is that monitoring turns out to be extremely difficult. Such downfalls can be addressed by ensuring there is use of technology by all physicians, as this will see to it that patient records are centrally stored, which further imply that audits will be easy to carry out regardless of the place or time.
Another aspect relating to addressing primary health care is about the 2002 National Health Policy. The policy sets out a substantial sectoral share of allotment out of the overall health spending to primary healthcare (Pandve and Pandve 127). However, it is pertinent to note that even with massive allocation to the primary healthcare, the issue of accountability remains central. Therefore, the government of India should ensure that administrators and managers in primary healthcare centres are accountable when it comes to utilising funds allocated to their organisations.
Analysis of How the Social and Economic Policies in India have Impacted Women’s Health
India has diverse range of cultures, religions, languages, and ethnicities. Fundamentally, this acts as a source of strength and richness, but in some instances, cultural influences cause challenges regarding managing illnesses that are common. Therefore, it is pertinent that multiple factors be considered in efforts to provide quality healthcare. The policies established in the country are associated with considerable impacts on the health of women.
One of the policies put in place in the country is the empowerment of women. Empowerment can be briefly defined as control over making own decisions. In other words, it can be viewed as the ability to come up with strategic choices as well as be in control of the resources necessary for the achievement of the sought after outcomes. It is pertinent to note that such empowerment of women is viewed in terms of skills and educational development for the attainment of improved quality of life. This policy, therefore, is linked with improving the quality of life of women in India. For instance, women are granted abilities and rights to make decisions about and also control their body, implying that there will be more positive health results(Osypuk, Joshi and Geronimo 149).
Lack of women empowerment in India is due to various factors. Among them include the Indian society that is by nature patriarchal, constrained movement of women, limited employment opportunities, and also limited engagement in social, political, and social endeavours (483). Economic policies such as employment opportunities also impact women’s health. According to Davis, Schensul, and Verma, women have limited control over financial decisions in most Indian communities. Indian women are less involved in main economic choices, and as such, they find it difficult to access such services as contraceptives and safe abortions(Davis, Schensul and Verma 492).
Other policies include liberalisation and globalisation, and they have impacted on women’s health in the patriarchal Indian culture(Davis, Schensul and Verma 493). Globalisation is viewed as a tool to better women’s conditions as it has offered women increased economic freedoms as well as better status in the society. The globalisation and liberalisation policies adopted in the country have enabled women to grow economically, and as such, they are better placed to make decisions on their health.
Critique of Health Strategies used to enhance Women’s Health
Governments have been committed to improving the health of women to conform to the pledges made in major international summits. The underlying goal is to reduce maternal mortality. A significant strategy in most nations is the use of family planning and maternal healthcare. Other strategies put in place by states include increasing enrolment rates for young girls in schools and also participation of women in important field such as politics. With such engagement, women have become empowered to make independent choices regarding their bodies, and as such, an improvement in women’s health.
The strategy of health financing has also been utilised by governments to address challenges in access to quality care. When governments fund such programs, women find it possible and easy to access health services as healthcare is made fundamental and patients are treated for free. Besides, there is the need to ensure that primary healthcare centres are operational and well-funded in order to ensure that women in poor regions can access health services.
This paper has identified sexual and reproductive health as a significant women’s health issue in India. The country has a considerably high rate of fertility, a young age of marriage for girls, as well as high rates of sexually transmitted infections amongst the youth. Globally, women suffer from a lack of rights to reproduction and sexual health. The paper identified three key social determinants of women’s health, namely stresses, employment, and addiction, and asserted that the factors should be adequately addressed to ensure women in India enjoy quality healthcare services.
There is the understanding that the government provides health services in primary healthcare centres in India for free. However, the integrated primary health has failed in India due to the inability to support service delivery. The paper has noted that use of modern technology where medical records will be centrally stored is a suitable solution to the problem. Further social and economic policies in India have been noted to impact women’s health, either positively or negatively. The paper has concluded by assessing the health strategies used in ensuring that Indian women have commendable health, with the acknowledgment of women empowerment and funding of health services in primary healthcare centres.
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