Eliminating gender gaps key to better public health

Updated: Sep 10, 2020 3:35 PM

India has done very well in addressing the gender gap on some fronts, like literacy, malnutrition, etc. But significant gaps remain on other fronts, especially in health. These need to be tackled urgently, not just for health outcomes, but also for realising Sustainable Development Goals

gender gaps, public health, Gender Gap global report, female foeticide, World Economic Forum, Anaemia, IMR, healthcare, health newsGender disparity in India is a hard reality. (Representational image: Reuters)

By Sanjay Zodpey & Preeti Negandhi

At a global level, India’s recent performance with respect to gender has been dismal. The World Economic Forum’s Gender Gap global report of 2019 published country ranks on various parameters related to gender disparities such as political empowerment, education, health, employment, etc. In this report, India was placed among the bottom 5 with a global ranking of 112, a drop of 4 ranks since 2018. India fared poorly, particularly in women’s health and survival (rank 150) and economic participation by women (rank 149).

Gender disparity in India is a hard reality. This inequality commences at birth. India’s sex ratio at birth (number of females per 1000 males) has always been favourable towards the males. Census of 1901 reported a sex ratio of 972 females per 1000 males at birth. Over the next few decades, the ratio consistently showed a declining trend, with a nadir at 927 during the 1991 Census. This was the period when female foeticide was extensive, mostly being conducted illegally. This was followed by a slow rise in the sex ratio following the advent of the Pre-Conception and Pre-Natal Diagnostic Techniques Act (1994), eventually leading to a sex ratio of 943 females per 1000 males in 2011.

The sex ratio trend over the past century suggests that the interventions targeted at bridging the gender gap have been proceeding sluggishly. Besides, these disparities exist differently across different States within the country. Southern states and UTs such as Kerala and Puducherry reported a sex ratio tilting towards the females (1084 and 1037 per 1000 males, respectively), as per the latest Census report. The worst-performing states/UTs have been those in North India (Delhi – 868, Haryana – 879, Jammu and Kashmir – 889 and Punjab – 895). Daman & Diu was the worst UT (618), followed by Dadra and Nagar Haveli (774).

With fewer females present across the country, the opportunities they get tend to be limited. The proportion of literate females in India in 2017-18 was a mere 64.6%, as compared to 81.5% among males. This gender gap in literacy (16.9%) only improved marginally, from the previous gap of 18.5% in 2014. Yet, from primary to tertiary education, the share of women attending classes is larger than that of men. Economic opportunities are also limited for Indian women, with a considerable gap between men and women in labour force participation rate (LFPR). As per the Periodic Labour Force Survey (2018), the LFPR among women ranged from 5% to 31% across all working age groups, whereas this range was much higher for the males in labour force (22% to 99%). A lower rate of women working during their reproductive age might have led to these estimates. Additionally, the survey also reported that the average salaries of female casual and regular wage workers were generally between 60% and 80% of the salaries of male workers, both in rural and urban areas. In 2015-16, the unemployment rates for working Indian females and males were 5.8% and 3%, respectively. Another analysis of unemployment data of NSSO (National Sample Survey Organization) showed that the proportions of male and female medical graduates that were not in the workforce in 2011-12 were 16.3% and 25.7%, respectively. The analysis further showed that among the working population in the health sector, more than 58% of all health workers are males.

Not too long ago, gender differences were also extensive in health and nutrition. During the National Family Health Survey (NFHS) 2005-06, the proportion of fully immunised boys and girls was 45.3% and 41.5%, respectively, suggesting that girls were slightly more disadvantaged in their access to full immunisation. Also, young girls tended to be slightly more underweight (weight-for-age) in comparison to boys (43.1% versus 41.9% respectively). Among adults, gender disparities in health existed with 33% married women being too thin as per Body Mass Index values, as against 28% men. Anaemia was also observed to be more prevalent among females (56.2%) than males (24.3%)..

With time, these proportions and rates seem to be changing, albeit gradually. More recent, nationally-representative data suggest that the gap in immunisation rates is reducing. NFHS-4 of 2015-16 reported an almost equal immunisation coverage for boys and girls (62.3% and 62.5%, respectively). The malnutrition rates have in fact reversed, with more boys being undernourished as compared to girls. With regards to literacy rates, too, the gender gap has shown improvement from 24.8% in 1991 to 16.7% in 2018. With targeted interventions and schemes in place, focussed efforts are being undertaken to improve women’s indicators significantly. Yet, some indicators need further attention. For instance, the infant mortality rates (IMR) for boys and girls (32 and 34 per 1000 live births, respectively, in 2017), and under-5 child mortality rate (35.8 for boys and 37.3 for girls – 2018). Both these crucial health indicators suggest the existence of gender disparity, although diminishing. Also, anaemia rates have not changed much over a decade (53% among women and 23% among men in 2015-16).

These highlights are only the tip of the iceberg. Women in India have been living in a largely patriarchal society. With time, women have become habituated to the fact that their male counterparts would receive the majority share with respect to basic amenities like food, education, healthcare, to larger aspects such as status in society, property, inherited wealth, etc. Intake of small quantities of food, intake of poor quality food, poor educational background with scarce access to knowledge about health and healthcare, inability to take decisions about healthcare seeking for self, insufficient acquaintance with the outside world, and other such mores have taken a toll on the overall health and social well-being of women in our society. National reports have highlighted that the higher the educational status of the mother in the family, the better is her decision-making capability for the healthcare of her children, including the girl child, resulting in improvement of the status of their health indicators. In the mid-1900s, Jyotirao Phule and Savitribai Phule together toiled unwaveringly to bring about major reforms in the form of education for women in Pune, addressing practices such as prohibition of widow remarriages, and worked for general women empowerment. Their persistent efforts brought these social issues, among many others, to light. Today, while India has made advancement on multiple fronts, gender disparity through traditions such as dowry, child marriage, women subjugation continues in different parts of the country. Although multiple social, development and health organizations, within and outside India, are investing in reducing these problems, it is extremely crucial that families and communities across various levels of social groups, classes and customs proactively come forward and bring about a sweeping change in their behaviour towards women across all age groups, and support their attempts at equality and empowerment.

India is committed to achieving gender equality among all its citizens. This can be achieved through a rigorous and unrelenting momentum towards alleviating gender disparity. UN agencies and other global partners aim to implement Sustainable Development Goal 5—achieve gender equality and empower all women and girls, to ensure an end to discrimination against women and girls globally. India has initiated a dialogue on gender neutral laws and empowerment of women, and SDG 5 aims at supplementing this with a structured and sustained gender approach in its policies and schemes. Through empowerment, Indian women would be able to surpass their sufferings. Women’s empowerment and gender equality are cross-cutting prerequisites to achieve other related SDGs such as poverty and hunger alleviation, education, health, economic growth, etc. The theme for International Women’s Day 2020 (8th March 2020)—An equal world is an enabled world—is also in alignment with this spirit of bridging the gender gap and empowering women. With this, we hope to relieve the women of our nation from the vices attached to gender inequality.

(Zodpey is vice president, Public Health Foundation of India, and Negandhi, is additional professor, Indian Institute of Public Health, Delhi Views are personal.)

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