The Indian government’s draft National Health Policy 2015 is radical in terms of its analysis of the failures of the past. It fails, however, to translate this admission to policy prescriptions that will be gender transformative. In so far as addressing gender inequality in healthcare, the policy frames gender as an area for action under “Nirbhaya nari” (translated as fear-free woman), a program that covers sex determination and sexual violence, and which calls for these issues to be tackled through legal measures, timely health sector responses, and by working with young men.
The draft policy does identify gender inequality as one factor that renders women vulnerable, and calls for addressing the social determinants of health with a view to improving reproductive and child health. The policy also devotes sections to the reduction of maternal mortality, women’s health, and gender mainstreaming (ensuring that the consequences of policies on women is considered and integrated into the planning and implementation process), by making public hospitals more women friendly and training staff to be gender sensitive. While acknowledging that “women’s health issues and concerns go far beyond maternal health,” in its action points, the policy perpetuates the conceptualization of women as mothers or as victims of violence.
In doing so, the policy yet again situates women’s roles within the patriarchal norms: either as mothers of children—giving birth to children in need of “Janani Suraksha” (a scheme that offers women conditional cash transfers for institutional delivery)—or as victims of violence and acid attacks in need of social protection. The need to mainstream gender as a cross cutting agenda gets short shrift, for the policy fails to identify gender as an axis of vulnerability within the social determinants of health.
If the policy accepted that women’s health issues extend beyond maternal health, it could address inequalities in health and healthcare in all forms, and recognize that tackling gender based inequalities is a means to achieving the government’s health goals across the spectrum. For example, the policy is silent on the need to specifically address the issue of infectious diseases in women—and the implications of emerging infectious diseases, such as the H1NI flu virus, for pregnant women are well known.
Furthermore, the policy does not address the various problems associated with the prevention, diagnosis, and treatment of non-communicable diseases in women. The predominant risk factors for NCDs are known to vary between men and women in India. Owing to a combination of gender and socio-cultural factors, important risk factors among men are smoking and alcohol consumption, while among women it is low levels of physical activity. Women are less likely to have access to healthcare resources in general, but this is particularly an issue for NCDs.
The Indian government does use affirmative action (positive discrimination) as a policy tool to correct inequalities in access to education and employment opportunities for marginalized groups. But this draft policy fails to use the same tool to benefit women, who are the largest group for whom gaps in healthcare access and provision have not been bridged.
Fiscal allocations can address these gaps in innovative and imaginative ways. For example, should there be a differential but enhanced insurance coverage for girls and women to meet their healthcare needs, or reduced fares for girls and women to travel to healthcare facilities? We need policies like these, which could be transformative in addressing women’s strategic needs, enhance the value the state places on them, and enable them to meet their healthcare needs more effectively.
Mala Ramanathan is a faculty member and professor at the Achutha Menon Centre for Health Science Studies, SCTIMST, Trivandrum.
Views expressed are solely of the author and do not represent those of the institution.
Competing interests: None declared.