At a recent Planning Commission meeting deliberating the agenda for the September United Nations high-level plenary meeting on the Millennium Development Goals (MDGs), grave misgivings were expressed over the fact that the country's record, specifically on the health-related goals, remains far from satisfactory. Several women's groups at the meeting felt that in recent years the issue of sexual and reproductive health, integral to most of the MDGs, had taken a backseat. Among the eight MDGs, at least six goals and targets refer directly to health care, and one (rural sanitation) is a "non-health determinant" of health care.
Public spending on health care in India is only 0.9 per cent of the GDP, Meenakshi Dutta Ghosh, Advisor, Planning Commission, informed the meeting. "India is not on track on many of the health related parameters and efforts towards realizing these goals clearly need to be accelerated," she said.
Ghosh said that the areas which need urgent attention are: Reducing undernourishment both among adults and children; improving ratio of girls to boys in both primary and secondary education; reducing infant mortality rate; under five mortality rate and maternal mortality rate; and increasing people's access to sanitation.
Whatever may be the response of the Indian government during the September 14-16 UN meeting, women's groups fear that the development agenda could be hijacked for other political issues. Activists like Shivani Bhardwaj of Consult for Women's Land Rights, a network of Indian NGOS working to promote women's rights to natural resources including land, feel the US will try to sideline development issues and focus on the threats posed by international terrorism. "The Indian government should be wary of this and insist on specific issues like women's resource rights, peace and eradication of hunger and poverty," she stresses.
One of the key actions for further implementation of the International Conference on Population and Development (held in Cairo in 1994) goals was that governments should strive to ensure that by 2015 all primary health care and family planning facilities are available to provide, directly or through referral, the widest achievable range of safe and effective family and contraceptive methods.
But this goal is still a long way off for India. According to research, only 23 per cent of the total demand for family planning is being met by married women between the age group of 15-19 years. While abortion is legal in India, in majority of such cases abortion can be life-threatening for women.
States Sudha Tewari, Managing Director of Parivar Seva Sanstha, a Delhi-based reproductive health NGO, India has a total of 25 per cent unwanted fertility and 16 per cent of couples who want to use contraceptive methods are unable to do so because of lack of information. She adds, the burden of poor reproductive health is more in the less developed states of northern India. Indu Capoor, Founder Director of Chetna, a leading health NGO based in Ahmedabad, says to achieve a major and crucial MDG, that of eradicating poverty and hunger, providing universal access to reproductive health care for men and women becomes imperative. Access to these services will give the users fundamental choices that will change the cycle of poverty, she asserts. It will lower fertility rates, slow population growth and open a "demographic window" of opportunity for economic growth and poverty reduction as the ratio of dependants to working-age people declines, says Capoor.
It is critical for the Millennium Summit to realize that sexual and reproductive health are integral for the improvement of maternal and child mortality and this is linked with improved access to food and livelihood resources by women, asserts Bhardwaj. "Women's income poverty and hunger, as well as their low status in the family and community, are central causes to their low maternal health," she observes.
Activists point out that early marriage and early pregnancy continue to pose a challenge to policymakers in India. According to the National Family Health Survey (NFHS)-2000, 13 per cent deaths of females below 24 years are related to pregnancy and childbirth. Repeated pregnancies occur in India due to lack of decision-making and inability to negotiate for contraception. Despite overwhelming emphasis on family planning in public health services, contraceptive use in India continues to be low for women and much lower for males. Contraceptive use rates were 38 per cent higher in urban than in rural areas, says an exhaustive study on `National Profile on Women, Health and Development' undertaken jointly by the Voluntary Health Association of India (VHAI) and WHO in 2000.
Contraception use in Kerala exceeded 55 per cent, above the national average of 45.8, says the study. In states like Delhi, Punjab, Himachal Pradesh and West Bengal, contraceptive rates exceed 40 to 50 per cent while usage in Uttar Pradesh, Orissa, Madhya Pradesh and Bihar was very poor and much below the national average.
There is also concern that policymakers have no concrete strategy to meet the health needs of young Indians. According to Capoor, one-third Indians will be in the 10-24 age group category by 2050. But prevalent socio-cultural norms restrain adolescents from seeking services like abortion or safe sex methods.
Razia Ismail of the Task Force on Women and Women's Coalition for Peace and Development, a Delhi-based NGO, goes a step further saying that the right to health in all its aspects needs to be underlined. "Why just focus on sexual and reproductive health. We need to emphasize on a holistic health approach which incorporates primary health care, nutrition, food security and safe drinking water," she underlines.
The gender need in health care has not been recognized as in all other areas of human development, observes the VHAI study. There is a misunderstanding about "gender" as it is often confused with sex and attributed only to the biological needs of women. It emphasizes the need to look at women's health as a gender issue that recognizes and addresses the sociological roots and power relationships between men and women in a society. "Many of the women's health and reproductive health problems arise from the discrimination prevalent in this power relationship," states the VHAI study, adding, that "peace and justice has to be a very important part of women's health agenda for the future".
But exactly how important is the women's health agenda for the Indian government? Can't say, don't know - is what most women's groups say.