Just as land is valuable because it is fertile, women too are for the same reasons. And that really sums up the status of women in India and the South Asian region.
A woman's ability to bear innumerable children, mostly boys, is what increases or diminishes a woman's position within the marital home and eventually extends to her position in society. Quite closely connected to this is her sexual autonomy, which remains restricted. It is this control over both property and the sexual control of women that defines male power and authority, and the secondary status of women in both the paternal and matrimonial homes.
The Taj Mahal - one of the eternal symbols of love - is a mausoleum erected by the Mughal Emperor Shah Jahan for his favorite queen, Mumtaz Mahal, who died of complications related to childbirth after having delivered 14 children. Even today, despite leaps in medical research and technology, thousands of women in the country continue to die during childbirth, and, even more tragically, unremembered and mostly unaccounted for. In India every seven minutes a maternal death occurs; more than 75,000 women die each year in India alone. While the maternal mortality ratio over the years has been falling, the rate is too slow, continuing to add to the already enormous statistics.
While inaccessibility to even basic medical facilities is entrenched, social attitudes around the accepted role of women as childbearers - and more specifically of male children - further exacerbates the problem. Governments make and execute laws governing ownership, marriage and divorce, education, inheritance, employment and family leave, and innumerable aspects of life that directly impact the status of females relative to men. And every woman in spite of her educational and social status in society is expected to play this pre-assigned role. While a minuscule minority might be able to exercise their choice of timing, by and large this choice is not available to most women. And the same is true of pre- and post- natal care as well.
Consequently, not only do women go through one pregnancy after the other but most of the time they are unaware of the health hazards for themselves and their children, not to mention the possibilities of infections from their spouses.
The concern surrounding HIV/AIDS in recent years has had the effect of opening the doors to information on other possible infections too. While vulnerability to misinformation continues to engulf women from poorer sections -- many will be deprived of their children and thrown out of their matrimonial homes after having contracted the virus (frequently from their spouses) -- a recent judgment has set a positive precedent in stating that a positive mother cannot be deprived from bringing up her child. More importantly, it might serve to remove stereotypes associated with the virus.
In the throes of poverty and illiteracy most women find themselves married off at a very young age. Even before they are able to understand the real implications of the relationship, these young women are already into their first - if not second or third - pregnancies. At a time when the various state governments struggle over the ethics of sex education in the curriculum of school-going children, many organizations have taken it upon themselves to use sex-education as a tool to empower young girls, women and communities in delaying both marriages and pregnancies.
Kishanganj - an underdeveloped district in the eastern state of Bihar - which lacked even a district hospital until a few years ago, has in more recent months witnessed important attitudinal changes brought on by reproductive and sexual healthcare classes to teenage girls in a madrassa. Consequently, information is all it took for a mother-in-law to get her daughters-in-law operations to prevent further pregnancies. A 16-year-old girl, keen on pursuing her education, aware of the hazards of early childbirth, chose to marry only after she turned eighteen. The census of 2001 had shown this district with the lowest female literacy rate, 18.5 per cent, in India.
Another such initiative has been the formation of the Coalition for Women Deliver, India in October 2007, an effort that would include all current and new players working towards the Millennium Development Goals (MDGs). One of the critical goals is to strengthen local partnerships while addressing high maternal mortality in the country. Why local partnerships? While funds and policy commitments are in place, it is at the level of actual implementation that gaps appear. The problem remains the absence of skilled health workers and medical personnel at the community and district level, further undermining strong policy commitments towards the reduction of maternal deaths.
For years, midwives have been the closest pregnant women got to any kind of structured health care during and after their childbirths. Having woken up to the magnitude of the tragedy of maternal mortality due to the lack of adequate medical support, the government in recent years is focusing on the issue of training auxiliary nurse midwives (ANM). The focus is especially in rural areas, to deal with emergency situations with the support of a functioning health care referral system. Investing in midwives could prove to be the swiftest way of achieving universal access to reproductive health, as well as improve maternal health for most governments.
But the battle is not just restricted to adequate health care during and after childbirth. The preference for the boy child and the second-class treatment of girl children within their paternal homes is a reflection of societal attitudes which only get reinforced as the girl moves in to adulthood. The same patterns are then replicated in the matrimonial homes. From sex selective abortions to engineer a male child, to the manner in which daughters are treated while prioritizing and apportioning resources during the childhood -- these are all manifestations of this mindset.
Considering anemic women are bound to bear anemic children, it is hardly surprising then that seventy percent of children in India in the age group of six to 59 months suffer from it. 63 per cent are in the urban areas and 71.5 percent in the rural areas. Hope comes in the form of a woman who recently pursued a legal battle against her husband and in-laws for forcing her to abort her fetus after an ultrasound test ostensibly showed the fetus to be that of a female.
The Women Deliver Coalition operates as an advocacy group whose primary role is to be a neutral, inclusive pan-India entity to convene diverse groups working in maternal health for regular information sharing. In a path breaking attempt as an India-specific one-stop-shop on maternal health, they will host the creation of a public virtual domain that brings together information at policy and program levels on maternal health and build advocacy platforms across all sectors, especially linking developmental work to media and industry.
In communities where women's rights are on par with men's, women are able to take control of their own fertility and invariably have fewer children on average. Unfortunately, in many cultural contexts and sub-contexts, contraception is socially and morally criminalized, leaving women with very few options of birth control. Girls brought up as equals and eventually vested with choices over their fertility invest more for their children and less on having more children, through their own health paving the way for healthy families. And those families in turn reflect the health of communities they inhabit and societies they build.
