Gender parity is inextricable from the principles on which the Republic of India was founded. In the case of universal suffrage, for example, India is one of the few democracies where women have always had the right to vote as opposed to democracies with a longer history. In the United States of America, the franchise was not provided to women until 1920, a time span exceeding a century since the country ratified its constitution in 1789. In this sense, the principle of equality has been an integral part of the Indian democratic ethos. The Constitution of India not only prohibits any discrimination on the basis of sex, it also guarantees gender equality before the law, equal protection of laws (to take steps for positive discrimination) and provides for humane conditions of work, including maternity relief.
These provisions provided a basis through which structural inequalities that have prevented women from gaining an equal footing in society could be eradicated. Over the years, various laws were enacted and policies adapted to help level the field en masse. However, while the State has played a proactive role by adopting measures that can enable the welfare and betterment of women, the ground realities remain far from desirable. Improvements have been made in various areas, but we still have a long way to go in providing optimum access to facilities, opportunities and conditions that provide women with the means to better their lives.
There are various measures to check how far a country or society has been able to bring about parity for women: sex ratio, access to decision making in households, participation in politics, education and literacy and health care being some of them. The scope of this paper is to report how far the condition of healthcare, employment and access to opportunities for women has changed, for better or worse, over the years.
State Mechanisms for Alleviation
Under Article 14 of the Constitution, citizens are to be provided equality before the law and equal protection of law. While the former prohibits the State from discriminating between two individuals, under the latter the State has been directed to provide special treatment to persons in different social conditions to provide equality amongst all (Mackinnon, 2006). Further, Article 15, which prohibits discrimination on grounds of religion, race, caste, sex or place of birth, has an exception in clause (4) which states that “Nothing in this article shall prevent the State from making any special provision for women and children.” These provisions for positive discrimination act as a bedrock for welfare measures that aim for alleviation of groups that do not enjoy similar privileges in society. To this end, various schemes and programmes have been introduced by the Indian government for the betterment and empowerment of women.
In 2009, the Mother and Child Tracking System (MCTS), an information system for tracking the delivery of services to maternal and child health beneficiaries was launched. The MCTS aimed at improving service delivery planning and outcomes and covered all states in India (Gera et al, 2015). Similarly, Indira Gandhi Matrvita Vandana Yojana (IGMVY), renamed as Pradhan Mantri Matritva Vandana Yojana (PMMVY) in 2017, was introduced in 2010 by the Ministry of Women and Child Development (MWCD) in 53 selected districts. Initially the scheme covered all pregnant and lactating women above 19 years of age and above for first two live births (PIB, 2013). The National Food Securities Act, 2013 mandated that the scheme be brought under the scope of the Act, thus making every pregnant and lactating woman entitled to maternity benefit of not less than INR 6,000. However, it was not until 2017 that the same was implemented. Under the reintroduced scheme of 2017, applicable throughout India, pregnant and lactating women are entitled to the above mentioned maternity benefit—INR 5,000, which will be given in three instalments, provided that certain conditions related to completion of registration of pregnancy and childbirth and vaccination of child are met (MWCD, 2017). However, while the previous scheme covered first two live births, the new scheme covers only the first birth, a change that has been subjected to criticism on the grounds that it will deprive many mothers from receiving the benefits of welfare (Scroll, 2017).
The Rashtriya Mahila Kosh (RMK) was instituted in 1993 for socio-economic improvement of women by providing micro-finance to the poorest women and those without any assets in their name. The RMK acts as a facilitating agency, providing loans through intermediary organisations (IMOs) for income generating activities. The IMOs are provided loans at the rate of 6 per cent simple interest, which in turn extend the loan to self help groups (SHGs) at 14 per cent simple interest.
For adolescent girls, the government introduced the Rajiv Gandhi Scheme for Empowerment of Adolescent Girls (RGSEAG) –SABLA. RSGEAG seeks to enable adolescent girls for self-development and improve their nutrition and health status. For this, the scheme promotes awareness about health, hygiene, nutrition, adolescent reproductive and sexual health and family and child care with the help of Anganwadi Centers (MWCD, 2010).
The above suggests that the State has acted as a benign entity, by implementing various schemes with a view to bring about betterment and empowerment of women. However, it is pertinent to examine what improvements various schemes have actually brought about and whether they end up strengthening and reinforcing the notions and structures that need to be challenged if we truly want women to break free of the stranglehold of patriarchy.
The State of Women’s Health
The last two decades have seen improvements in the areas of maternal mortality rate (MMR), female infant mortality rate (FIMR) and female death rate (FDR). For instance, while in 1990 MMR (defined as the number of maternal deaths per 100,000 live births due to causes related to pregnancy or within 42 days of termination of pregnancy) stood at 556, in 2015 it had been brought down to 174, a reduction by more than half (WHO, 2015). Further improvements were recorded in 2016, as MMR further declined to 130 in 2016 (Kumar, Korff and Sudhir, 2018). Significant variations can be seen across the country, with Kerala, Maharashtra and Tamil Nadu having a consistently low MMR through the past two decades—in 2016, these three states had MMRs of 46, 61 and 66 respectively. On the other hand, poorly performing states in this regard are Assam with a MMR of 237 followed by Rajasthan at 199 and Odisha at 180 (Ibid). Further, while India’s MMR was better than that of Nepal (258) and almost the same as Myanmar and Pakistan (178), other neighbouring countries fared much better. Bhutan has brought down its MMR from 945 in 1990 to 148 in 2015, while Sri Lanka and China presently have MMR rates of 30 and 27 respectively (Ibid). This, however, has to be seen in light of both India’s larger population – especially when compared to Bhutan and Sri Lanka – and spatial variations.
FIMR (defined as number of infant deaths below the age of 1 per 1,000 deaths) has also improved during the last decade. While FIMR in 2004 was 58, in 2015 it had declined to 39. However, the decrease in FIMR has been accompanied with an increase in gender gap. In 2013, when FIMR was higher than that of 2015, the gender gap (male infant mortality rate: female infant mortality rate) was one point, (42:43), while in 2015 it increased to four points (35:39) (Kumar, Korff and Sudhir, 2018).
As data from the Central Bureau of Health Intelligence (CBHI) shows, there is a wide disparity in FIMR across different states. Bihar, Uttar Pradesh, Haryana, Odisha and Madhya Pradesh have performed poorly in this regard, with FIMRs of 48 to 50, much higher than the national average of 39 (Fig 1.).
The nutritional status of women is a key determinant of maternal mortality, infant health and infant mortality ratio. Most significantly, it has been found that women with anaemia have higher chances of post-partum haemorrhage, giving birth to underweight children and perinatal deaths (Nair et al, 2016). In 2016, out of 614 million women of reproductive age (15-49 years) affected worldwide by anaemia, India has the largest number, with more than half of all its women of reproductive age suffering from the ailment (WHO, 2016).
It is clear that while India has made improvements across various indicators, while compared to other countries, performance is still subpar. Presently, the country still lags far behind in the areas of maternal health and nutrition for women. One of the reasons for insufficient improvement is India’s low public healthcare expenditure, which has remained constant at approximately 1.3 per cent between 2008 and 2015. While it marginally improved to 1.4 per cent in 2016-17, the change is negligible when compared to world average public health expenditure of 6 per cent (Rao, 2018). It is pertinent that India boosts its public healthcare expenditure to improve its performance across the above mentioned indicators. Studies have shown that an increase of 10 per cent public spending on health decreases average probability of death by about 2 per cent, mainly for the elderly and women (Farahani, Subramanian and Canning, 2010).
Aparajita Gogoi, Executive Director at Centre for Catalyzing Change, speaking with G’nY notes, “63 per cent of total health spending in India is out of pocket expenditure, a major cause for pushing people into poverty, especially those belonging to the poorer sections of society. Public spending on healthcare needs to be at least 2.5 per cent of GDP and it needs to focus on recruitment and retention of doctors and nurses while increasing midwifery managed inpatient services in healthcare facilities. Infrastructure funding needs a boost and allocations need to be made to ensure quality of care in maternal facilities. Private facilities need to be brought in if universal coverage for maternal services is to be achieved.”
Education and Access to Economic Opportunities
Literacy in India has steadily grown. While in 1951, the combined literacy rate was 18.32 per cent, it had grown to 72.98 per cent in 2011 (MoSPI, 2017). Similarly, while female literacy rate (FLR) stood at a mere 8.9 per cent in 1951, it had grown to 64.6 per cent in 2011 (ibid). However, India is still far behind the world FLR by 15 percentage points (Kumar, Korff and Sudhir, 2018).
Statewise, 11 out of 35 states and UTs fell below the all India FLR, while nine states were well above the world FLR—Kerala at 92 per cent followed by Mizoram at 89.3, Goa at 84.7 per cent and Tripura at 82.7 per cent. Among UTs, Lakshwadeep had FLR of 87.9, followed by Andaman and Nicobar and Puducherry at FLRs of 82.4 and 80.9 respectively. The states with the poorest performance were Bihar with an FLR of 51.5 per cent, Rajasthan at 52 per cent, Jharkhand at 55.4 per cent and Jammu and Kashmir at 56.4 per cent (ibid).
Workforce participation rate (WPR) for women in India also remains far from desirable and from 2001 to 2011, not many changes occurred in the trends. In 2001, 28.7 per cent rural women and 14.0 urban women were engaged in the workforce. By 2011, negligible improvements were made for urban women, as the participation rate increased merely to 14.7 per cent, while for rural women it fell to 24.8 per cent (MoSPI, 2017). There are wide gaps between combined female and combined male participation rate – currently, the latter stands at 53.3 per cent, while the former is merely 25.51 per cent (Fig. 2). While India performs poorly when compared to the world average WPR for women of 50.2 per cent, its performance when compared to neighbouring countries is not satisfactory either. Pakistan and Afghanistan with a female WPR of 25 and 16 per cent respectively are the only two countries faring worse than India. Nepal, Myanmar, Bhutan, China and Bangladesh on the other hand have female WPR of 80 per cent, 75 per cent, 67 per cent, 64 per cent and 57 per cent respectively (Kumar, Korff and Sudhir, 2018). Not only is the WPR ratio between men and women in India skewed, but there is also the existence of a wage gap. The difference is presently of INR 120 per day between male and female salaried workers and between INR 50 to 80 for casual workers (Ibid.).
There is undoubtedly an urgent need to engage women in the formal economy to harness the full potential of India’s combined workforce and provide a boost to the Indian economy. Presently, India has a lower share of women’s contribution to GDP (17 per cent) than the global average of 37 per cent. A ‘full-potential’ analysis suggested that if global female WPR is at par with male WPR, it would add up to USD 28 trillion to global GDP in 2025. India stood to gain significantly from this, adding USD 2.9 to its annual GDP (McKinsey, 2015).
Women Policy challenges
While the State seeks to act as a benign entity, in line with the mandates of the Constitution and has over the years framed numerous policies to ensure better access to facilities and opportunities for women, structural problems viz. the prevalent outlooks in society that influence the manner in which a policy is shaped can often act as an impediment.
The RGSEAC, for example, focuses on providing training and increasing awareness among adolescent girls on issues pertaining to sexual healthcare and family nutrition. However, family structures and patriarchy often preclude women from meeting their nutritional needs – it is often the case that the nutritional needs of the ‘men of the house’ or that of the male child’s are prioritised. In cases such as these, it is essential that men too are made aware of the nutritional needs of women.
Gogoi points out that doing so needs moving beyond relying on government schemes, “Women and girls eating last is just one of the many manifestations of existing gender norms. To challenge this, we need to involve men in schemes and policies for spreading awareness on nutrition and healthcare. If an adolescent boy sees men ensuring that nutritional or other needs are being met, he will consider this a norm and practice the same. If he sees women eating the last and the least, the chances of him perpetuating the same practice are high.”
Undoubtedly, the State mechanisms in India and the provisions of the Constitution have fostered the development of a policy framework meant to bring in greater inclusion and equality. However, there are large gaps that still need to be filled to ensure that women have greater access to healthcare, education and economic opportunities. Inadequate financing in the healthcare sector and notions of predefined roles for women can often prove inimical to achieving parity.
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Gera R., Muthusamy N., Bahulekar A., Sharma A., Singh P., Sekhar A., and Singh V., 2015. An in-depth assessment of India’s Mother and Child Tracking System (MCTS) in Rajasthan and Uttar Pradesh, BMC Health Services Research, 15 (315)
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Scroll Staff, 2017. Cabinet clears changes to maternity benefit scheme, now applicable for only firstborns, Scroll, May 18
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__________, 2016. Global Nutrition Reports: Nourishing the SDGs, Available at: https://bit.ly/2Km0exp