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Women's Health in India Women's Health in India Women of the World Women of the World WomensWomens HealthHealth inin IndiaIndia By Victoria A. Velkoff and Arjun Adlakha International Programs Center WID/98-3 Issued December 1998 India is one of the few countries in sons (Chatterjee, 1990; Desai, While women in India face many the world where women and men 1994; Horowitz and Kishwar, 1985; serious health concerns, this profile have nearly the same life expect- The World Bank, 1996). All of these focuses on only five key issues: ancy at birth. The fact that the factors exert a negative impact on reproductive health, violence typical female advantage in life the health status of Indian women. against women, nutritional status, expectancy is not seen in India unequal treatment of girls and suggests there are systematic Poor health has repercussions not boys, and HIV/AIDS. Because of problems with women’s health. only for women but also their the wide variation in cultures, Indian women have high mortality families. Women in poor health are religions, and levels of development rates, particularly during childhood more likely to give birth to low- among India’s 25 states and 7 and in their reproductive years. weight infants. They also are less union territories, it is not surprising likely to be able to provide food and that women’s health also varies The health of Indian women is adequate care for their children. greatly from state to state. To give intrinsically linked to their status in Finally, a woman’s health affects the a more detailed picture, data for the society. Research on women’s household economic well-being, as major states will be presented status has found that the contribu- a woman in poor health will be less whenever possible. tions Indian women make to productive in the labor force. families often are overlooked, and instead they are viewed as eco- Figure 1. nomic burdens. There is a strong Percent Distribution of Contraceptive Users by son preference in India, as sons Method: 1992-93 are expected to care for parents as they age. This son preference, along with high dowry costs for daughters, sometimes results in the Female sterilization mistreatment of daughters. Fur- 67% ther, Indian women have low levels of both education and formal labor force participation. They typically have little autonomy, living under Pill the control of first their fathers, then 3% their husbands, and finally their Male sterilization 9% IUD 5% Condom 6% Traditional 11% U.S. Department of Commerce Note: Percentages do not add to 100 due to rounding. Economics and Statistics Administration Source: International Institute for Population Sciences, 1995 BUREAU OF THE CENSUS U.S. Census Bureau, the Official Statistics™ December 10, 1998 2 Women of the World Figure 2. Fertility and Contraceptive Prevalence: 1992-93 Total fertility rate Contraceptive use Urban Rural Illiterate Less than primary Primary High school and above Hindu Muslim Christian Sikh All India 5 4 3 2 1 0 10 20 30 40 50 60 Births per woman Percent of married women using contraceptives Total fertility rates are for the 3 years preceding the survey. Source: International Institute for Population Sciences, 1995 Fertility Intertwined attempt to have a son or two Place of residence, education, and With Women’s Health survive to adulthood. Research religion are strongly related to both has shown that numerous pregnan- fertility and contraceptive use Many of the health problems of cies and closely spaced births (Figure 2). More than half of Indian women are related to or erode a mother’s nutritional status, married women with a high school exacerbated by high levels of which can negatively affect the education or above use contracep- fertility. Overall, fertility has been pregnancy outcome (e.g., prema- tives, compared to only one-third of declining in India; by 1992-93 the ture births, low birth-weight babies) illiterate women. Not surprisingly, total fertility rate was 3.4 (Interna- and also increase the health risk for the total fertility rates for these two tional Institute for Population mothers (Jejeebhoy and Rao, groups are significantly different: 1 Science (IIPS), 1995). However, 1995). Unwanted pregnancies 4.0 children for illiterate women there are large differences in terminated by unsafe abortions compared to 2.2 children for fertility levels by state, education, also have negative consequences women with a high school educa- religion, caste and place of resi- for women’s health. Reducing tion or above. Differentials among dence. Utter Pradesh, the most fertility is an important element in the religious groups also are populous state in India, has a total improving the overall health of pronounced; e.g., Muslims have the fertility rate of over 5 children per Indian women. highest total fertility rate and the woman. On the other hand, Kerala, Increasing the use of contracep- lowest contraceptive use (IIPS, which has relatively high levels of 1995). female education and autonomy, tives is one way to reduce fertility. has a total fertility rate under 2. While the knowledge of family Despite a large increase in the planning is nearly universal in India, number of women using contracep- High levels of infant mortality only 36 percent of married women tives and limiting their fertility, there combined with the strong son aged 13 to 49 currently use mod- is still unmet need for contracep- preference motivate women to bear ern contraception (IIPS, 1995). tives in India.2 Nearly 20 percent high numbers of children in an Female sterilization is the main form of contraception; over two- thirds of the married women using 2 Women who either do not want any more 1 The total fertility rate is the number of contraception have been sterilized children or want to wait 2 or more years children a woman could expect to bear in her before having another child, but are not lifetime given the prevailing age-specific (Figure 1). currently using contraception, are said to fertility rates. have an unmet need for family planning. U.S. Census Bureau, the Official Statistics™ December 10, 1998 Women of the World 3 Figure 3. Total Fertility Rate and Maternal Mortality Ratio by Major State: 1993 Orissa Madhya Pradesh Uttar Pradesh Rajasthan Assam Bihar Karnataka Andhra Pradesh Haryana West Bengal Gujarat Tamil Nadu Punjab Maharashtra Kerala 6 5 4 3 2 1 0 100 200 300 400 500 600 700 800 Births per womam Maternal mortality ratio* *The maternal mortality ratio is the number of deaths from pregnancy-related causes per 100,000 live births. Note: Data for the state of Jammu and Kashmir are unavailable. Source: UNICEF, 1995 and India Registrar General, 1996a of married women in India either estimate that India’s maternal Few Pregnant Women want to delay their next birth or mortality ratio is lower than ratios Receive Prenatal Care have no more children (IIPS, 1995). for Bangladesh and Nepal but Most of the unmet need among higher than those for Pakistan and The most recent National Family younger women is for spacing Sri Lanka (WHO, 1996). The level Health Survey (NFHS) was con- births rather than limiting them. of maternal mortality varies greatly ducted in 1992-93; it found that in This implies that methods other by state, with Kerala having the the 4 years preceding the survey, than female sterilization, the lowest ratio (87) and two states 37 percent of all pregnant women method strongly promoted by (Madhya Pradesh and Orissa) in India received no prenatal care India’s family planning program, having ratios over 700 (Figure 3) during their pregnancies (IIPS, need to be considered. (UNICEF, 1995). This differential 1995). The proportion receiving no maternal mortality is most likely care varied greatly by educational Over 100,000 Indian related to differences in the socio- level and place of residence. economic status of women and Nearly half of illiterate women Women Die Each Year From received no care compared to just Pregnancy-Related Causes access to health care services among the states. 13 percent of literate women. Maternal mortality and morbidity Women in rural areas were much are two health concerns that are The high levels of maternal mortal- less likely to receive prenatal care related to high levels of fertility. ity are especially distressing than women in urban areas (42 India has a high maternal mortality because the majority of these percent and 18 percent, respec- ratio—approximately 453 deaths deaths could be prevented if tively). per 100,000 births in 1993.3 This women had adequate health services (either proper prenatal Most women who did not receive ratio is 57 times the ratio in the health care during pregnancy said United States. The World Health care or referral to appropriate health care facilities) (Jejeebhoy they did not because they thought it Organization (WHO) and United was unnecessary (IIPS, 1995). Nations Children’s Fund (UNICEF) and Rao, 1995). In fact, the leading contributor to high maternal mortal- Thus, there is a definite need to ity ratios in India is lack of access educate women about the impor- 3 The maternal mortality ratio is the number of to health care (The World Bank, tance of health care for ensuring deaths from pregnancy-related causes per 1996). healthy pregnancies and safe 100,000 live births. U.S. Census Bureau, the Official Statistics™ December 10, 1998 4 Women of the World childbirths. Another reason for the While health care is important, mortality. Studies have found that low levels of prenatal care is lack of there are several other factors that between 50 and 90 percent of all adequate health care centers. It is influence maternal mortality and pregnant women in India suffer currently estimated that 16 percent health.
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