The role of gender in South Asia
From
many perspectives women in South Asia find themselves in subordinate positions
to men and are socially, culturally, and economically dependent on them.3 Women
are largely excluded from making decisions, have limited access to and control
over resources, are restricted in their mobility, and are often under threat of
violence from male relatives. Sons are perceived to have economic, social, or
religious utility; daughters are often felt to be an economic liability because
of the dowry system.
We
believe that individual and societal beliefs about and attitudes towards
appropriate gender specific roles, and the choices of individuals and
households on the basis of these factors, mean that women are disadvantaged
with regard to health and health care. There are some instances in which gender
differences hurt men's health—for example, men are more likely to be involved
in road crashes or occupational accidents as they are more likely to be outside
the home or in a workplace than women. However, most of the evidence shows that
gender inequalities have led to a systematic devaluing and neglect of women's
health.
Life cycle of
gender discrimination
Gender
related differences in health status have led to an unbalanced sex ratio for
the past 100 years, which is declining further. An estimated 60-100
million girls are “missing” worldwide, and the imbalanced sex ratios of
South Asian countries contribute a large proportion of this number. In
some parts of the Indian subcontinent the sex ratio has fallen as low as 770
women per 1000 men. Gender discrimination at each stage of the female life
cycle contributes to this imbalance. Sex selective abortions, neglect of girl
children, reproductive mortality, and poor access to health care for girls and
women have all been cited as reasons for this difference .
Sex
selection
Since
the advent of sex selection techniques before conception as well as in utero
diagnosis and selective abortion of female fetuses, prenatal selection of male
embryos has become common. One of the most disturbing aspects of this practice
is that educated women who have frequent exposure to the media are the ones
most likely to seek a sex selective abortionThe most extreme form of sex
selection, female infanticide, has focused international media attention on
certain communities in India .Reports from both the scientific literature
and the local press show that this problem is likely to occur in various
settings.
Neglect
of girls
Less
notorious but more far reaching than infanticide is the so called benign
neglect that girls are subject to at all ages in South Asia. This has led to
gender based health disparities among the population aged under 5 years that
are larger than anywhere else in the world. A girl between her first and fifth
birthday in India or Pakistan has a 30-50% higher chance of dying than a boy. This
neglect may take the form of poor nutrition, lack of
preventive care (specifically immunisation), , and
delays in seeking health care for disease. -
Health
of adolescents
Early marriage
and pregnancy, anaemia, sexual violence, and poor educational opportunities all
contribute to ill health among female adolescents in this region. Adolescents, especially
young women, are disproportionately affected by HIV infection worldwide;
adolescence is also a time when vulnerabilities to injury, including motor
vehicle crashes and suicide, as well as substance abuse, rise. In most
parts of the world men bear the greater burden of violence and; however,
suicide among young women may be more common in South Asia than in other parts
of the world. This, combined with the distressing practice of “dowry
murder,” means that young South Asian women are at a particular risk from
violence. The current demographic trend of a rapidly growing young will
increase the impact of adolescent health issues. Despite this, little attention
has been paid to these conditions in the South Asian context of gender
inequity.
The
risks of reproduction
By
their nature reproductive health hazards are borne by women alone. Poor
outcomes for both mother and child are inevitable for a large proportion of the
population as long as many South Asian mothers are too young, receive minimal
antenatal care, and are malnourished or anaemic during
pregnancy.
Poor
vital registration systems in South Asia pose a challenge to measuring maternal
mortality at the national level. Maternal deaths—most commonly from
haemorrhage, sepsis, and eclampsia—continue to exact a high toll; unsafe
abortions also contribute to deaths from haemorrhage and Home deliveries by
unskilled attendants, a paucity of knowledge of intrapartum danger signs, and
poor transport mechanisms to and lack of appropriate care at health facilities
all contribute to this burden. Women cite economic circumstances and spousal or
familial opposition to delivery in hospital as the most common reasons for
delivery at home. Decisions about seeking care in such emergencies are made
largely by the husband or the elder members of his family., ,
Health
care for women
Women
are less likely to seek appropriate and early care for disease. Yet the
frequency with which such care is required—burden of disease, maternal mortality,
and morbidity aside—and the quality of care provided to women has not been well
documented in South Asia. In the authors' experience, diseases that generally
have an equal prevalence in men and women are found to have affected women
disproportionately in this region. It
remains unclear why South Asian women are more often affected by diseases such
as rheumatic heart disease and hepatitis C virus infection, but it is clearly a
cause for grave concern.
As more
women survive into old age, the role of gender differences among older adults
will become more important. South Asian women experience greater ill health and
a loss of activities of daily living as they age. They are also more vulnerable
because they are likely to be illiterate, unemployed, widowed, and dependent on
others. The combination of perceived ill health and lack of support
mechanisms contributes to a poor quality of life, and public policy to address
the concerns of this group of women will be needed as increasing numbers
survive to old age.
Dealing with
health and gender
Most
gender based health differences in South Asia can be traced back to the same
underlying factors: decreasing fecundity and consequently a preference for
sons, spread of the practice of dowry across most groups in the region, and the
marginalisation of women in agriculture. We believe that all of these factors
are tied to the perceived lack of economic utility of women. Current societal
circumstances make the cost of having a daughter so high that families may be
unwilling to invest scarce resources for their benefit. Similarly, the scarcity
of resources causes society to undervalue women, who, as a rule, are not making
a visible economic contribution. Attempts to address gender disparities must
take into account these underlying issues. However, education and improved
economic circumstances alone are likely to be insufficient to change practices
that have become culturally, socially, and in some cases legally, enshrined.
Programmes and policies aimed at reducing differences at the level of education
and employment between men and women must enshrine gender equity as a core
value. In this respect Sri Lanka might be considered a role model for the rest
of South Asia—minimal gender differences in education and employment levels in
Sri Lanka lead to a life expectancy and healthy life expectancy equivalent to
those of industrialised countries.
In this
sociocultural context, the violation of fundamental human rights, and
especially reproductive rights of women, plays an important part in
perpetuating gender inequity. It is therefore imperative that a rights based
approach be taken across all developmental activities in South Asian countries.
Conclusion
The
life advantage for girls and women that is seen in health statistics in
industrialised countries is blurred in South Asia where gender—based on social,
cultural, and, in some cases, legal constructs and practices—overrides the
biological advantage of being born female. Policy makers, programme managers,
health professionals, and human rights workers in the developing world and
especially in South Asia need to be aware of and responsive to the detrimental
health effects that gender plays throughout the life cycle.
good work
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