Friday, April 4, 2014

Women and Health Security

By Raakhee Suryaprakash

“Health security is defined as the provision and maintenance of measures aimed at preserving and protecting the health of the population as well the policy areas in which national security and public health concerns overlap.”
—World Health Organisation (WHO)
What hooked me to this topic was a rather worrying survey. It was conducted by ASSOCHAM (Associated Chamber of Commerce and Industry) and published ahead of International Women’s Day 2014 stating that daily “multi-tasking” is taking a toll on women’s health. 

So basically the very fact that women as able multi-taskers is working against them! And the fact that family and partners conspire to keep women working after a hard day’s work is literally killing them! The sample included 2,800 corporate women employees from 120 companies across 11 broad sectors from Ahmedabad, Bangalore, Chennai, Delhi, Hyderabad, Jaipur, Kolkata, Lucknow, Mumbai, and Pune.

Some friends of mine had recently stated that they no longer look forward to weekends as they work harder and are busier on those days than during the work week! They no longer exclaim, “Thank God it’s Friday!” 

How sad is that ... and in the context of the above statistics how worrying? The concept of leisure is being eradicated from the vocabulary of the working mother especially. “Free time” is hoarded in between endless chores and car-pools and oftentimes eaten away by so-called insignificant items on the ever-present mental to-do list and the “always connected” lifestyle aided and abetted by the “smart” phone! Work-Life balance seems to be compromising the health of women!

The Indian Constitution charges every state with "raising the level of nutrition and the standard of living of its people and the improvement of public health as among its primary duties."  Despite being a destination for Health Tourism access to quality healthcare is a major issue especially rural India. I started researching health stats taking my college research on India’s health security as the starting point. What’s worrying is that nearly a decade down the line health statistics hasn’t improved significantly and in many cases especially with regard to women the situation has worsened. Being polio-free remains our sole significant achievement way back in 2005 and today in 2014!

Many women and girls across the globe remain without access to basic sanitation, which in turn affects their dignity, health, and safety. According to a 2008 estimate more than 122 million Indian households have no toilets, and 33% lack access to latrines – over 50% of the population (638 million) defecate in the open. Consider these in the context of the recent headline “680 million Indian lack the means to meet their essential needs.” Sustainable access to water and sanitation is crucial to enable girls and women to participate in education and employment. E.g., a Tanzanian study shows, reducing the distance to a water source from 30 to 15 minutes increased girl’s school attendance by 12%.

Despite a higher life-expectancy (67 years: 64 years) women in India have a poor quality of life in many ways because India is one of the worst countries in the world in terms of gender inequality (2011 UNDP's Human Development Report ranked India 132 out of 187). India’s alarming sex ratio has an adverse effect on all other statistics. The Gender Chart released in March 2014 by the UN Statistics Division and UN Women shows only 2% of all aid went to gender equality in 2011-2012. Indian maternal mortality rate (MMR) is 212 (per 100000 live births) according to statistics from India’s National Health Profile 2012. MMR is a millennium development goal (MDG) indicator and India’s target for 2015 is 109. According to a Government of India survey (1998-1999) MMR in rural areas is one of the highest in the world and is approximately 132% the number in urban areas. In South Asia as a whole “urban women in the highest wealth quintile are six times as likely to have access to skilled attendance at delivery as rural women in the poorest quintile.” 

Domestic violence – acts of physical, psychological, and sexual violence against women – is currently viewed as a hidden epidemic by the WHO. Economies of nations where domestic violence is prevalent tend to have lower female labour participation rate, in addition to higher medical expenses, and higher rates of disability. On a positive note, a 2005 study found that the incidence of domestic violence against women dropped dramatically with women's ownership of immovable property.

Gender inequity remains the iniquity in the field of health security as well. E.g., women patients with congenital heart disease in India were less likely to be operated on than men because families felt that the scarring from surgery would make the women less marriageable; families failed to seek medical treatment for their daughters because of the stigma associated with negative medical histories; a study in 2011 found out of 100 boys and girls with congenital heart disease, 70 boys would have an operation while only 22 girls will receive similar treatment.

Until access to adequate healthcare and nutrition and gender inequity are addressed health security will continue to be elusive. “Improving the health outcomes can contribute to economic gain through the creation of quality human capital and increased levels of savings and investment.” Proving once and for all Health is Wealth and a nation cannot be secure without being healthy.

Table: Impediments to the well-being of the female – with a South Asian and Indian focus.