(cntd.)

In India the most significant turnaround strategy was in mid 80's with the Seventh Plan, which started a move towards equality and empowerment of women. The Eighth Plan marked a further shift towards the empowerment of women emphasizing women as equal partners in the development process. The Govt. of India ushered in the new millenium by declaring the year 2001 as 'Women's Empowerment Year' to focus our vision in the new century of a nation where women are equal partners. However, health empowerment still remains a distinctive problem for Indian women as exemplified by the health statistics. The employment of women is one of the main objective of India's Ninth Plan and enhancing women's capacity, correcting gender imbalances, especially in health, nutrition and education and promoting greater participation in economical and political decision making processes. At present, the National Policy for Empowerment of Women is being finalised by the Department, which would describe strategies and action points to bridge the gap between equal de-jure status and unequal de-facto position of women in the country.

Current perspective reflects a worldview of health, having important social, economic and ramifications and is much more than a mere medical issue and not just confined to biological factors and medical intervention. The Empowerment Approach to women's health is based on the health differences arising from the unequal power relationship between the sexes.

The Empowerment Approach in health has to move beyond describing men and women's health in isolation and bring into its analysis the male / female differentials, exposure to risk, access to benefits of technology and health care, rights and responsibilities and the control exercised by people over their lives. The gender empowerment approach, while not excluding the biological factor, has to account for critical roles with social, cultural factors. Women’s empowerment has to be seen in a "relational context" e.g. obstacles to women’s empowerment cannot be understood without a clear vision of the relationships, roles, responsibilities and inequalities between men and women.. Empowerment is not something which can be bestowed upon people - rather women need to be agents of their own empowerment. Others can help to create conditions favourable and support processes that work in this direction. There are many dimensions to women’s empowerment including personal, collective, national and global as well as economic, social and political. It is also important to ground specific understandings of empowerment in day to day context realizing that the reality of women’s lives differs from place to place.

The subject of health education, particularly sex education still evokes strong emotions. Sexual education has never been supported at a satisfactory level. Poland is the only country to make "Preparation for Family Life" a compulsory school subject in 1986. There is a need to promote health education for all, as an integral part of formal and informal education system.

Factors of life states that multiple burdens of womanhood are too great. Male and female roles in many cultures are deeply rooted in tradition and are often perpetuated by the attitudes of both men and women. If these roles are to change, men and women must both agree that change is desirable and then, they must decide together how responsibilities can be redistributed. Women cannot fully exercise choices unless men's life patterns also change. The concept of paternity leave, flexi-work schedules, recording of unpaid work are necessary in making them visible on the social screen of society. The sexual division of labour within the household and labour markets, exposes men and women to varying health risk. Women's multiple roles are modelled and defined by the social values and attitudes both within and outside the family and also gives rise to differentials in access to resources and health care. Gender differentials in access to and control over resources, such as money, time and transport and differences in men and women's decision making powers within the family affect women's access to health services. Women may be allowed to decide on seeking medical care for the children but may need husband's/elders permission to seek medical services. Restrictions on women's physical mobility makes it imperative for women to be accompanied by a male member. In fact in exercising real power or decision making authority women are a distinct minority throughout the world.

In all societies economic policies such as those that enslave women, in low wage jobs under dangerous conditions and development strategies like those that take land out of subsistence farming and put in cash crops, have a profound effect on the health status of women and their families. The primary challenge to health rights stems from poverty and under-development. Education, vocational training and self-employment initiatives will provide women the access to markets, technology and trade. Mothers, many of whom are single heads of households, are burdened not only with economic problems, but also with the problems of civil conflict and environmental degradation. They are often ignored by the male dominated health and social services and the social and economic systems. Even within the family, disparities exist because of social, cultural bias, for example preference for a son may lead to daughters being given less food and education. The girl child is also expected to do more work and consequently, girls are often ill-prepared to marry and bear child, which they do before they are physically, sociologically and financially equipped to take on the responsibility. Often, premature marriages begin the vicious circle of malnutrition where under-weight mothers have under-weight babies, who are at a risk of suffering from nutrition and educational deprivation.

Amartya Sen rightly remarked that 'freedom to make decisions about fertility, is the cornerstone for women's empowerment'. He observed in 1994 that "central to reducing birth rates ... is a close connection between women's well being and their power to make their own decisions and bring about changes in the fertility pattern..... Reduction in birth rates are typically associated with the improvement in women's status and their ability to make their voices heard - often the result of expanded opportunities for schooling and political activity".

Throughout history, women have risked their life and health to terminate unwanted pregnancies. If contraceptives are available, women will use them as their first choice. When no preventive means are available, abortion becomes the solution. Even where contraceptives are available, abortion is needed for back up services, as conditions change, contraceptives fail and human relations break. Therefore, the right to regulate one's fertility is often restricted. In reality, the freedom of reproductive choice is an illusion in many societies where women are subordinated and the possibility of challenging the authority of husband is extremely limited. The laws and regulations on contraception and abortion, insufficient reproductive health services and lack of decision making powers, are the obstacles for exercising a free choice. The contradiction between policies and population practice, between religious beliefs and social necessity leads to the inequality in reproductive options and in access to health services.

Develop Comprehensive National Strategies and Policies regarding Women's Health

 

Devise and Implement Preventive Programmes regarding Women's Health:

 

 

Develop and Implement Social Welfare and Health Insurance Systems to ensure sufficient funding for Women's Health Care Services:

Improve access to Specialist and Women-Friendly medical treatment.

Improve Quality of Life and Health of Menopausal and Older Women:

It is time for men of India - leaders, teachers, policy makers and administrators to stand up against the dehumanisation of half of the population. There is nothing in India's diversity of traditions, cultures or values, which supports it. India's new direction in the population programme will certainly help to create a culture of respect for women. Workers in reproductive health deserve respect as professionals and all the support services including good training and supervision should be given to them. Abandoning target-oriented approach should not imply loss of focus or direction. Good standards for quality of care and results should be measured in maternal and child survival and in healthier and smaller families. Women need to be the central reference point in deciding and implementing health policies. The rectification of many social and economic perceptions can go a long way in ushering an era of women determining their own fate. It is obvious that economic equality, access to education and reproductive freedom are of great importance to women's health and wellbeing. They are convinced that equal terms in work and family will improve health and wellbeing of women, men and children, of entire family and ultimately, the whole society.

A concerted effort to change societal attitudes, elimination of all forms of biases, prejudices and discrimination, active participation of women in all spheres of life, incorporation of gender perspective in policies and plans, gender auditing and finally, making women 'visible' and being 'heard' at family, regional, national and international platform – should be the focus of female empowerment.