CASTE AND GENDER FROM HEALTH PERSPECTIVE

I am very happy and grateful to All India Council of Christian Women for having given me this opportunity to share with you my ideas on caste and gender from health perspective.

The perspective (issue) of health is always central to women's lives. It's implications on women's lives needs to be considered seriously. The alarming decline on the number of women in the country is directly related to its health care system. Being agents of change, it is imperative for us to develop a perspective on health which gives greater control and choices for women, and we need to work towards the realization of this goal.

The main focus of my sharing is how to make health an instrument of social change and a means to empower women. Many of the ideas that I present here are taken from the different experiments done by the Foundations for Research in Community Health in Maharashtra . You may be aware of these experiments and their results that have given women a space and power. It is all the more important that we reflect together reinforced in our ideology of community health, specially women's health and very specially Dalit women's health. Because traditionally, culturally it is much engraved in the minds of the society that women are lower to men eg. Tulsidas in his Ramayana expressed his contempt to women when he wrote, “The drum, the village fool, the Shudras (Dalits), animals, women, all these are fit to be beaten by a rod as thick as a thumb”. Which reflect that women were equal in intelligent to animals and fools, then one can imagine what is the fight of Dalit women?

Health is a subject that involves a wide spectrum of human activities related to socio-cultural and economic development. Generally we think of a mystified, curative medicine when we talk of a health system. The economic processes of globalisation and privatization in the world order made health and sickness into marketable commodities. They have exploited the poor, specially women, impoverished the middle class and increased human suffering. We need to search for an alternative approach to health and medical care. Health should be taken away from the hands of governments and multi-national and given back to people who could reconstruct its concepts with a wholistic understanding of the human well-being.

The WHO Concept of Health for All by 2000 AD has unfortunately failed to achieve its goal. This is due to its narrow disease centered approach, sponsored by western capitalism and technology. The governments of the member countries were supposed to take initiative in ‘delivering' health services and people were mere recipients. Because of its failure to produce results, now the private sector is coming aggressively promoting their market-oriented health concepts. This has resulted in a form of a new health hazard – indebtedness – of the poor which is next only to the problem of dowry.

Until the middle ages in Europe and to a large extent even in India, women specially dalit women played the role of healers, provided contraceptives, conducted deliveries, offered detections to bring down fevers and pains, and coundled people in their mental distress. They had techniques and methods handed down from generation to generation. They knew personally the individuals, the families, the communities whom they treated. With the gradual professionalisation of medicine during the 11 th Century (the Church playing an important role in this process), and the collusion between male surgeons and the state, the medical practice passed to male hands. During the colonial era the hegemony of western science and medicine spread to other parts of the world further marginalizing traditional systems of medicine practiced by women. In other words the powerful western domination recognized the power of medicine in the indigenous practices, took over that power, transformed it from an art or skill to an economic commodity to be sold in the market. ‘Healing was female when it was a neighbourly service and personal relationships. But when it became a commodity and a source of wealth in itself, it became a male enterprise' (Gupta 2000).

Ancient India had women who had the knowledge of birth processes. Dalit women were mid-wives. As mid-wives they knew how to conduct deliveries, how to get the foetus in right position, how to induce abortion and how to cure the problems of menstrual cycle. Most of their knowledge came from their own experiences as mothers and also from the accumulated knowledge over generations. The European invasion tore apart this cultural fabric in our country, and undermined the cosmo-centric practice of traditional medicine and beliefs. It discredited many of the cultural practices as ‘witch craft', ‘primitive irrationalism' and ‘magic' in order to promote its universalistic western medicine. Some of the indigenous practices like Ayurveda and Herbal medicines managed to survive the onslaught of western medicine. But this situation is again changing. They are now getting more and more institutionalized, (as the big pharmaceutical companies have started manufacturing them and marketing them for profits.) Our audio-visual media are full of these ads. (Example: Ayurveda Concepts). Thus healing became a male centered technological profession pushing the women and their skills to cure, to its periphery.

The reality is still stark when we actually see the status of women's health in the country. I am giving you only a few examples, as you are already familiar with this reality.

It is really shocking to hear that more than 2700 women die every day from the disease of tuberculosis in India . T.B. claims the number of deaths as equal to maternal mortality in the country. Only one third of the women came for treatment as compared to men. Women are more affected by the psychological problems of T.B. than men. More women find the T.B. clinics time inconvenient, as they have to take care of the family chores or work in the field. Most women depend on the public transport system to access health services. The stigma of T.B. affects more women than men and reduces the chances of them getting married. Many of the gynaelogical problems and RTI of women are directly related to the status of women within the households. Women are denied privacy to perform necessary functions such as bathing and toileting particularly at the time of menstrual cycle. Genital infections are often related to lack of clean water, lack of sanitary textiles, delivery procedures often conducted in unhygienic environments and transmission of sexual diseases which they receive from their husbands. A stress-free environment, according to several studies, would reduce disorders related to conception, pregnancy and child-bearing. Environmental degradation and deforestation have affected women directly as they have to walk many more miles to gather food, fodder and fuel. Studies in Bihar , Punjab and Gujarat (Sarin 1989) show that such long marches of women are related to their poor intake of food which then leads to anemia and other health related complications e.g. Dalit women suffer from circle-cells.

Ecological degradation induced by rapid industrialization is another health hazard for the rural and urban poor population. The mechanisms of rehabilitation and safety measures till date, have not yielded desirable effects. Such eco-stresses have changed relationships between women and land, production and technology. It has marginalized women, threatened their means of survival, and capitalized the natural resources which were earlier common for all. Landless people dependant on common property resources, forest dependent households, and fisher folk dependent on the sea and the ocean are some of the examples where people use resources offered by the environment. It is not surprising that these same groups suffer from a higher rate of mortality and morbidity in the country.

The new reproductive technologies target women with the message that they can be free from the burden of child bearing. They promise power for women to control their reproduction. Studies have proved that these technologies made a large number of women mere consumers of these technologies by paying a heavy price in terms of financial costs, adverse effects on health, loss of bodily integrity and autonomy, and severe mental disorders. It is frightening to read that an unborn female fetus aborted from its mother can itself becomes a mother by donating its millions of egg cells for various human cloning experiments. Very soon we will be confronted with the development of human species, reproduced a sexually. Are we prepared to meet these situations? Do our women know what kind of future is waiting for them?

How do we change this situation and regenerate once again women's confidence and power in the health field? Our search for an alternative in this problem situation finds some hope in the ICSSR/ICMR Report “Health for All”: An Alternative Strategy, 1981. It has provided us a wholistic concept of health. It goes beyond the limited understanding of health as diseases and treatment. It defines health as the overall development in fields such as nutrition, education, water, sanitation, communication, livelihood, housing and environment. The mental aspect of health is seen more as the fulfillment of social, cultural, moral and spiritual functions of individuals and communities, rather than just treatment of psychological problems. It is addressing an integrated form of health and medical care ranging from life style, diet, community living, family relationships, folk and herbal remedies, to the use of allopathic treatment for specific situations and conditions.

According to J.P. Naik and Prof. V. Ramalingaswami, health is primarily a function of individuals, families and communities. If the health care can be differentiated and graded in a manner between those requiring social skills and those requiring technological skills and facilities, based on epidemiological considerations, about 70 percent of all medical care can be given by women health workers in the social context of families and neighbourhood. Another 15 percent can be achieved by a higher-level trained women para-medical sahayoginis at 5000 population level of and at 1,00,000 population level in talukas/blocks. This leaves only a small percentage that requires a super special health care and facilities at district/city level. The present Panchayatraj system provides these socio-political conditions to organize such as comprehensive people's own health and medical service. The advantages of such a people-centered health care system are:

1. It is personalized, easily accessible and provided at a low cost.
2. There is a social control and monitoring.
3. The health personnel belong to the local places and therefore no question of transfers.
4. It promotes indigenous health care practices as well, thus keeping the traditional knowledge alive and active.
5. It improves the self-image of women, empowering them with scientific skills and techniques.
6. It encourages cooperation of the community in developing infrastructures in the village with decentralized decision-making.
7. It ensures prevention and early detection of common diseases.
8. It offers high-level job satisfaction for the health personnel and village functionaries.
9. It increases the employment opportunities for women.

Such a health system should function in close relationship with Panchayatraj. The widespread demonstration of such a new approach to health and medical care as a people centered/women centered approach will definitely give development to people, and power to women.

It is interesting to note that at present the government is spending Rs. 670 per capita per annum on health care. The community health care system in turn can provide a better health care to all with half of this expenditure, which would also include free service to those below poverty line.

In the end how do we summaries the empowerment of women in and through the health care system? According to me it could be done only through the restoration of healing power to women which has been taken away from them. As much h as health is a central issue, in the lives of women as said in the beginning, women are also central actors in providing health and medical care. To achieve this goal, what skills would women need? Several experiments in training women as primary health providers have shown very positive results in the empowerment of women. Women have learned the skills to speak confidently in front of leaders and other men folk. (They have laid open the misdemeanors of public officials to the people.)

Organizing collective water management in the area has been another achievement of women. Their vigorous health education to other women has controlled the spread of epidemics. Several local women have been master trainers in training other women in the neighbourhood. They have independently organized community meetings to discuss issues related to gender discrimination, rural technology, sexually transmitted diseases, HIV, and addiction to gutka and alcohol. They have successfully initiated the self reliance of communities and the withdrawal of parent NGOs.

The utilization of PHC services has increased in village communities through changes in the attitude of village women. Village Information Centres have been established in some villages of Maharashtra where trained women operate these centers. Any enquiries of the villagers are responded to within 10-15 days. New information received is discussed by village women and men in meetings.

We could make a long list of indicators of women's empowerment in the health care area. When health is seen beyond treatment of diseases and as an integral component of village/community development including water, nutrition, sanitation, transport, communication and sustainable livelihood, there are plenty of opportunities for women to get empowered. All we need to do is to develop their potentials and create/seek opportunities of women's expression. We too are women. Our own species are endangered. Wake up sisters! We are responsible to make health for all a reality.

- Sr. Lilly Francis

Issues

Discuss and Make a list of indicators of women's empowerment in the health care area.

When health is seen beyond treatment of diseases and as an integral component of village/community development including water, nutrition, sanitation, transport, communication and sustainable livelihood? Discuss the opportunity for women to get empowered specially the Dalit women.