INDIAN WOMEN HEALTH RELATED ISSUES:

HEALTH INSURANCE AS AN INNOVATIVE TOOL

SUBMITTED AS A PART FULFILLMENT OF THE ‘WOMEN’S STUDIES: AN

INTERDISCIPLINARY PERSPECTIVE’ SIX-WEEK COURSE

SUBMITTED BY:

UMA D. MANDE
COURSE PARTICIPANT
‘WOMEN’S STUDIES: AN INTERDISCIPLINARY PERSPECTIVE’
 INDIAN WOMEN HEALTH RELATED ISSUES

The modern Indian women have come faraway by shedding their inhibitions, as
compared to the past. In the past revolutionary decades, women have proved
themselves and have fought and struggled to achieve equal status in the society.
But, the society still owes them a lot. The sex ratio in India shows that still Indian
women are prejudiced by the society. According to the Census 2001, there are
933 females per 1000 males in India, which is much below the world average of
990 females. The state in India having lowest female ratio is Haryana (861:1000)
and the highest is Kerala (1058:1000).

Biological sex and socially-constructed gender interact to produce differential

risks and vulnerability to ill health, and differences in health-seeking behaviour
and health outcomes for women and men (WHO Report, 2004).

The health of Indian women is in a vulnerable stage in India. It is a major

backdrop in the Indian society. The prevalence of better health care facilities is
still in nascent stage in India.

The health related issues can be broadly studied or overviewed from two
different angles: 1. Health of a urban Indian woman 2. Health of a rural Indian
woman. The work culture, life style and standard of living of a urban Indian
woman is different as compared to the rural Indian woman. Thus, the problems
faced by them are more or less different.

The major health related problems suffered by the Indian women are as follows:

1. Malnutrition, poor health and anaemia (Refer Table 1)

2. Maternal and reproductive health
3. Mental health
4. Other health related issues.

Malnutrition and poor health

Majority women in India suffer from malnutrition and poor health. Generally,
in rural areas, such problems are more rampant. The main causes of
malnutrition and poor health can be enumerated as follows:
• Poverty
• Social stigma or stereotype culture
• Lack of awareness as regards to health
• Mental illness

Poverty is a major reason which leads to poor health in Indian women. Scarcity
of money leads to scarcity in availability of good and hygienic food. The eating
habits greatly depend on the atmosphere we live in. A poor woman is the most
vulnerable section of the society. She has to struggle to earn livelihood and feed
her family. The husband might have bad habits of smoking and drinking and
thus leading to insufficiency of money to buy proper food. She may suffer from
domestic violence, because of the frustration of husband as regards to the
poverty. The problem of poverty is more severe in rural India as compared to
Urban India.

Thus, poverty can lead to many other factors which can hamper the lives of
Indian women.

Our Indian culture is divided in various castes and creeds. There are different
types of traditional values and rituals performed in different castes and creeds.
For example; a muslim woman should wear a ‘burqha’ and should remain in
seclusion’.

These are stereotype cultures also lead to malnutrition and poor health in Indian
women. Generally, many Indian women have the habit of eating food after their
husband and in-laws have eaten food. The woman in the house is the last person
to consume food, thus whatever is left is consumed by her. Sometimes even she
has to compromise with her own diet as there is no food left for her. In some
cultures, there is a practice that the married woman should eat from the left
overs of her husband, it shows her faithfulness and devotion towards her
husband. There are various kinds of fasts which are observed by Indian Women.
They have to stay without food or water for certain number of days. Mostly all
these fasts are performed by women to acquire a good husband and for the long
and healthy lives of their husband. But ironically, the men never observe such
fasts to acquire a good wife or for the long and healthy life of their wife. A widow
is secluded from the society and there are restrictions on her eating habits.
Strangely, such restrictions are not there for a widower.

Proper intake of food is necessary to live a healthy life. But, due to lack of
awareness among women, as regards to the eating habits many Indian women
suffer from malnutrition and poor health. Such problems can be witnessed in
rural as well as urban areas. Mostly, in rural areas women are illiterate thus
there is a lack of knowledge related to health. In urban areas, poor health is a
major problem. Many young girls, crave for ‘zero’ figures, thus resulting into
poor and instable health. The habit of overeating or irregular eating can lead to
obesity and heart problems in women.

Thus there is a need of awareness as regards to healthy lifestyles.

Mental health of women largely depends on the socio-economic environment in

which she lives. The major reasons of mental illness can be poverty, domestic
violence, rape, humiliation, lack of social and economic support etc. Thus, it
results into improper intake of food and nutritional supplements, resuting into
malnutrition and poor health.

Maternal and Reproductive Health

Health of a mother is very important for the nourishment and care of the child.
In India in many customs and traditions girls are married at an early age and
thus leading to pregnancies at a young age. India has the highest number of child
marriages in the world. Such girls lack knowledge and awareness as regard to
proper health care facilities and nutritional intake. Thus, resulting into
gynecological complications or death of the child or mother or both.

The reproductive role of a woman, as described by World Health Organization

(WHO) not only includes child bearing and rearing activities but also includes
care and maintenance of the child. The International Conference on Population
and Development (ICPD, Cairo, 1994) and the Fourth World Conference on
Women (FWCW, Beijing, 1995) both clearly emphasized the need to promote
gender equity and equality in reproductive health policies and programs, and to
promote and protect human rights.

The reproductive health of Indian women is very poor due to the beliefs and
cultural practices rampant in India. Due to child marriages and early marriages
reproductive health problem increases.

Lack of awareness as regards to reproductive and sexual health, contraception,

pregnancy and childbirth can lead to poor maternal health.

In India more than a million women suffer from Reproductive Tract

Infections(RTI) accounting for 25% of the RTI between the ages of 15 and 44
(*NACO 2005; Action Aid India, 1997). (*National Aids Control Organisation)

Every year approximately 68000 women in India die due to pregnancy related
issues.

Many Indian women are hesitant to visit male doctors for sexual or reproductive
health related problems.

Thus, the problem remains persistent resulting into severity or death of the
women.

In many stereotype customs and traditions, health related issues are addressed
by some ‘spiritual gurus’ and ‘black magic doers’ and they are preffered over
the professional doctors.

Mental Health

Puberty, Menarche (first menstrual period during puberty), menstrual cycle,

pregnancy, pueperium (state of a woman during childbirth or immediately
thereafter), mothering and menopause are specific health related events in a
woman’s life. These phases if not taken care of properly, can lead to mental
stress, depression or anxiety. The socio-economic culture may fail to develop a
rapport with these phases and thus giving rise to mental health problems in a
woman’s life.

Depression is the most common mental disorder in Indian women. Depression

and anxiety can be due to various reasons as follows:
• Over-burden of work
• Low income or poverty
 • Domestic violence
• Sexual abuse or violence
• Negative life experiences
• Other factors

It has been proven that more women suffer from Dementia in India than men.
According to the India dementia Report, 2010, 36 lakhs Indians who suffer from
dementia, 21 lakhs are women and rest are men. One of the reasons can be better
life expectancy in women as compared to men. Life expectancy at birth of an
Indian woman is 68.1 years as compared to 65.8 in Indian man.

(Dementia is a peculiar disease, which affects the brain; it deteriorates a person’s

intellectual capability. It generally affects older men and women)

Generally many people assume that it is just an ageing problem and avoid
visiting the doctor thus, if not diagnosed on proper time can lead to permanent
mental instability of in severe cases it can lead to death of the person.

Other health-related issues

Apart from the mental, maternal and reproductive health problems there are
many other health related issues which needs attention.

Breast cancer and cervical cancer It is a cancer of cervix – the opening of the
uterus, extending upto the upper end of the vagina) are two most common
cancer-related health problems in Indian women.

A woman in India is believed to be a silent sufferer. Such diseases are not

detected easily, because women don’t come forward to take proper care and
precaution of such health related issues due to social stigmas, hesitation or
shyness. Breast cancer and cervical cancer can be treated, if detected early and
on proper time. Many Indian women die due to late detection of such cancers.

In India approximately, 74,118 women die due ot cervical cancer every year.

By 2020, breast cancer will overtake cervical cancer which is now the most
reported cancer among women in India.

Minister of Tamilnadu State for Health, S. Gandhiselven said that ‘By 2020 it is
expected that breast cancer will overtake cervical cancer at the current rate of
increase in cancer cases. But at the moment cervical cancer tops the list of
cancers detected among Indian women as its symptoms are not easily detected.’

According tp the National Cancer Registry Programme Report on time trends in

cancer incidences rates (1982-2005) of Indian Council of Medical Research
(ICMR) the estimated breast cancer cases in India in 2010 is 90,659 and of
cervical cancer is 1,03,821.

New and innovative lives saving technologies have developed to detect cancer-
related health problems. Breast cancer can be detected through memography
and biopsy. Cervical cancer can be detected through HPV (Human
Papillomavirus) testing.

There is a need to integrate these new technologies with our existing health care
delivery systems.

Barriers faced by Indian women in availability of quality health care services:

• The accessibility to hospitals is a major issue in many sectors and sections

of the society. Primary Healthcare Centers (PHC) are established, but
physical mobility and economic accessibility is lacking greatly.

• There is a shortage of health care personnels, who are professionally

qualified to deal with woman’s health related problems. Ironically, India
has more number of doctors and surgeons than United States, but,
availability and accessibility of these doctors and surgeons is a major
issue.

The government is planning to increase awareness, preventive measures, early

detection and treatment for cancer cases, besides strengthening the health care
delivery systems. During the last 50 years India has developed a large
government health infrastructure with more than 150 medical colleges, 450
district hospitals, 3000 Community Health Centers, 20,000 Primary Health Care
centers and 130,000 Sub-Health Centers.

The Janani Suraksha yajana (JSY) programme has been successful in raising the
number of births that are attended by trained healthcare professionals for poor
women in rural areas.

The employment of Accredited Social Health Activists (ASHA) under national

Rural Health Mission is also on of the pioneering event in development or
woman’s health. The ASHA’s duties include escorting and helping pregnant
women in the health care centers.

Thus, there is an urgent need to spread awareness as regards to detection and

prevention of such health-related issues.

The health delivery systems should be strengthened to provide quality health

care services to Indian women.
 HEALTH INSURANCE AS AN INNOVATIVE TOOL

Health expenditure is a major outgo from an individual’s income and the

monthly income may be insufficient to bear hospitalization expenses. Health
insurance is an ideal mechanism for protecting individual’s earnings by
transferring the risk.

The major features of health insurance can be enumerated as follows:

• Reimbursement of hospitalization expenses.
• Accessibility and availability of better health care services.
• Regular health check-ups
• Creates awareness amongst the individual as regards to the health-care
facilities.

Generally Indian women are dominated by their husband of in-laws for the
household expenditure and use of health-care services. Availment of health
insurance as a mechanism to protect the earnings is also a joint decision made by
the family members. It has been observed that a girl always consults her father
before investing money and a married woman consults her husband before
investing in health insurance policies. The attainment of health insurance
product greatly depends on degree of economic dependence of the women on her
family members.

If we observe such situations with a broader perspective, the economic budget of

the household is maintained by the woman in the family. Thus, she has to
channelise, segregate and divert the income to proper sources.

It is a right of every woman to have access to social security systems. It is a basic

right of a woman, to protect herself from any unforeseen calamities. In this way
it is also possible to secure future of a woman in an environment where family
break-ups, lack of financial support or divorce cases are more.

Health insurance can greatly reduce the economic dependence of women over
their family.

The data pertaining to health insurance indicates that as compared to males, the
number females insured members is less, but the claims which are submitted by
the females insured are proportionately more than claims submitted males.
The data given below indiacates the trends and patterns in the number of male
and female insured and the claims submitted by them:

Insured members, sum insured and number of claims during 2007-08 – by age and
gender.

Age in Male Female

years
No. of Sum No. of No. of Sum No. of
members insured claims members insured claims
Less than 97278 926 8818 90055 666 8969
one year
1-5 759990 4757 46074 638665 4044 30907
6-15 1384808 7718 46059 1135013 6475 28828
16-25 2112014 15678 67815 1633498 11081 77875
26-40 4026058 37752 152563 3085837 24396 185385
41-60 2983681 28364 202128 2684142 23785 194876
61-65 411416 4086 48963 268342 2508 34664
66-70 234412 2352 38461 143172 1359 23754
70 & 265630 1886 37598 120939 1089 21689
above
Total 12275287 103519 648479 9799663 75403 606947
(Courtesy: Tariff Advisory Committee)
The figures of sum insured indicate rupees in crores.

The Employees State Insurance Act, 1948 was the first to include woman in the
health insurance segment. Under ESI Act, 1948, it provides protection to the
employees against loss of wages due to inability to work due to sickness,
maternity and death due to employment injury.

It covered the women employees who were working under organized sector.

ESI Act, 1948 was the first step towards the development and awareness of
health insurance among the Indian women.

About 95% of work-force in India is working in unorganized sector of economy

and large section of this population live Below Poverty Line (BPL). Thus there is
a strong need to develop a social security system for this segment of population.

Poor women are the most vulnerable sections of the society. They have to share
the burden of family expenditure as well as they have to perform the daily
domestic work.

There are initiatives taken by NGOs and Central Government to curb with the
problem of the poor women residing in rural areas.

SEWA (Self Employed Women’s Association) have initiated to protect poor

women from financial burdens arising out of high medical costs and other risks.
Their sickness, maternity needs, widowhood etc., is covered under the scheme.
The scheme is linked with a saving scheme.

The overall experience of SEWA’s health insurance has been encouraging and it
has received full support from the women.

It has helped to spread the awareness of health care amenities among the poor
women.

Apart from SEWA, other NGOs like AKHSI (Aga Khan Health Services in
North Gujarat, Nav-sarjan in Gujarat and Sewagram medical college in
MAharashtra have also provided medical assurance (insurance + assistance) to
women in different areas.

Thus, it can be concluded that health insurance is a emerging innovative tool to

develop the awareness of quality health care services in India.

_______________________________________________
Table – 1 Prevalence of anaemia among women-States
Percentage of women with :
Moderate
State Mild anaemia anaemia Severe anaemia Total
1 2 3 4 5
Andhra Pradesh 39.0 20.6 3.3 62.9
Arunachal Pradesh 36.6 12.5 1.6 50.6
Assam 44.8 21.2 3.4 69.5
Bihar 50.5 15.9 1.0 67.4
Chhatisgarh 39.9 15.7 1.9 57.5
Delhi 35.2 8.8 0.2 44.3
Goa 29.6 7.8 0.6 38.0
Gujarat 36.2 16.5 2.6 55.3
Haryana 37.6 16.7 1.7 56.1
Himachal Pradesh 31.6 10.5 1.2 43.3
Jammu & Kashmir 37.3 13.1 1.6 52.1
Jharkhand 49.6 18.6 1.3 69.5
Karnataka 34.4 15.1 2.0 51.5
Kerala 25.8 6.5 0.5 32.8
Madhya Pradesh 40.8 14.1 1.0 56.0
Maharashtra 32.8 13.9 1.7 48.4
Manipur 30.1 5.1 0.5 35.7
Meghalaya 32.8 12.6 1.8 47.2
Mizoram 29.1 8.8 0.7 38.6
Nagaland .. .. .. ..
Orissa 44.9 14.9 1.5 61.2
Punjab 26.2 10.4 1.4 38.0
Rajasthan 35.2 15.4 2.5 53.1
Sikkim 42.1 16.2 1.7 60.0
Tamil Nadu 37.4 13.6 2.2 53.2
Tripura 49.0 14.8 1.3 65.1
Uttarakhand 40.4 13.3 1.5 55.2
Uttar Pradesh 35.1 13.2 1.6 49.9
West Bengal 45.8 16.4 1.0 63.2
India 38.6 15.0 1.9 55.3
Source: National Family Health Survey - III, 2005-06
.. : Not Available
Note: The haemoglobin levels are adjusted for altitude of the enumeration area and smoking
when calculating the degree of aneamia. Total includes women with missing information , who
are not shown separately.