“A Four Week Online Certificate Training Course on Healthcare & Gender Equity: Emerging Dimensions, Policies, Impact & Way Forward was organized by the Gender Impact Studies Center (GISC), at the IMPRI Impact and Policy Research Institute, New Delhi and Center for Ethics (CFE), Yenepoya (Deemed to be University), Mangalore from August 28th, 2023 to August 31st, 2023. Inaugurating the session Fiza Mahajan, a visiting researcher at IMPRI, welcomed the speakers and participants to the program with an introduction to the eminent panelists.
Our second speaker for Day 4, Dr. Uma Kulkarni, Professor, MBBS, D.O.M.S, DNB, Yenepoya Medical College, Yenepoya(Deemed to be) University, Mangalore delivered an insightful session on ‘Gender and Reproductive Rights,’ underscoring the significance of recognizing these rights, as they are not only enshrined in the United Nations Human Rights Declaration but also integral to the Indian Constitution. She emphasised that it is the duty of the state to uphold, protect, and fulfil these rights, with particular attention directed towards vulnerable and marginalised groups. Among these groups, women, especially those with multiple vulnerabilities, stand as one of the most discriminated and disadvantaged groups, demanding special consideration and efforts to rectify existing inequities.
Evolution of Human Rights and Gender Rights
The evolution of reproductive rights found its roots in the International Conference on Human Rights in 1968 when the rights of couples were initially addressed. However, the spotlight soon shifted to women’s rights, specifically reproductive rights. This evolution continued with the Declaration of Mexico on Equality of Women in 1975, which emphasised reproductive rights for women. Subsequent milestones included the Vienna Declaration in 1993 and the International Conference on Population and Development in 1994, which played pivotal roles in defining and expanding reproductive rights for women, setting the stage for greater recognition and awareness.
Reproductive rights are fundamental entitlements granted to individuals and couples, ensuring their freedom to make informed decisions regarding the number, timing, and spacing of their children. These rights encompass access to information and the means for responsible family planning, as well as the right to achieve the highest standard of sexual and reproductive health, all while being protected from discrimination, coercion, and violence. These rights are an intrinsic component of human rights documents, reinforcing the principle that individuals and couples have the agency to make choices regarding their reproductive lives.
Reproductive Rights in India
Indian citizens are endowed with several reproductive rights, which include but are not limited to the right to health, life, and liberty. The right to health encompasses various facets, including the availability, accessibility, acceptability, and quality of healthcare services, which extend to essential medicines, contraceptive methods, abortion services, and prevention of sexually transmitted infections.
The right to life underscores the significance of maternal and infant care, with the ultimate goal of reducing maternal and infant mortality, as any failure in this regard would be considered a violation of the right to life of both the mother and her children. It is imperative to establish robust mechanisms that can identify and address the weak points in the healthcare system to prevent such violations.
Non-discrimination and equality rights underscore the necessity of addressing the rampant social discrimination prevalent throughout India, affecting various aspects of life and health. This discrimination, stemming from restrictive gender norms and gender inequalities, is perpetuated not only within the healthcare system but also within the family structure itself. The healthcare system often fails to address gender inequalities adequately and is not inherently gender-responsive, causing direct or indirect discrimination against women with disabilities, sex workers, and individuals belonging to sexual minorities.
The right to education and information empowers individuals, including adolescents, with the knowledge and information essential for understanding reproductive health and the rights guaranteed to them by the constitution. Access to educational information regarding family planning, contraceptives, prevention and treatment of sexually transmitted infections, reproductive morbidities, risks of pregnancy, and methods of contraception for practising safe sex is vital for all individuals, regardless of their marital status. This information should be readily available to all adults and adolescents, ensuring widespread awareness of reproductive rights and health.
Furthermore, the right to enjoy the benefits of scientific progress encompasses access to advances in sexual and reproductive healthcare, including medication for abortion, infertility management, assisted reproductive techniques, and HIV/AIDS treatment. The state must take proactive steps to prevent the misuse and harm that can arise from technological advancements in healthcare.
The right to privacy and the right to marriage and family life are essential components of reproductive rights. These rights acknowledge the ability to exercise reproductive choices, including the decision to procreate or abstain from procreation. It is crucial to recognize a woman’s right to privacy, dignity, and bodily integrity, and to ensure that no restrictions are placed on the exercise of reproductive choices, such as a woman’s right to refuse participation in sexual activity or insist on the use of contraceptive methods. However, it is essential to acknowledge the influence of multiple social and economic factors that can determine whether a woman can express her opinions, desires, and needs concerning her reproductive choices.
Reproductive Rights in Practice
In India, there are several legislative efforts aimed at ensuring reproductive rights. The Maternity Benefit (Amendment) Act of 2017 provides maternity benefits to mothers who have given birth, including earned leave. However, a significant challenge arises as most women work in the unorganised sector, where this act is not applicable. Thus, a substantial portion of women cannot benefit from this legislation, highlighting the need to bridge gaps in implementation.
Child marriage is another complex issue with far-reaching implications. Child brides often lack negotiating power in sexual and reproductive matters and are more vulnerable to violence. They are more likely to have children at a young age and face higher risks of maternal mortality and morbidity.
Challenges in the realm of reproductive rights can be categorised into medical, sociocultural, and health systems or policy issues. India’s public health system, often underfunded and overburdened, struggles to meet the growing demand for healthcare services. The infrastructure is often subpar, with a shortage of healthcare professionals and a lack of modern facilities. The high cost of hospitalisation is frequently unaffordable for many people, especially those in low-income groups, resulting in financial strain that can lead to poverty. To address these issues, there is an urgent need to expand and strengthen public health facilities and allocate more resources to meet the increasing demand.
The Rashtriya Swasthya Bima Yojana (RSBY)
The Rashtriya Swasthya Bima Yojana (RSBY) is a state-funded insurance scheme, introduced in 2008, targets families living below the poverty line. It allows five members of such families to access this scheme with the aim of reducing the out-of-pocket expenses incurred during hospitalisation. However, the RSBY faces certain limitations, such as being underfunded and providing insufficient coverage. For instance, the scheme allocates only Rs. 4,500 to private hospitals to cover the costs of a C-section delivery. This amount often falls short of the actual expenses, leading private hospitals to demand additional payments from patients’ families. Consequently, the goal of reducing out-of-pocket expenses remains unfulfilled in many cases, leaving families with financial burdens that can be difficult to bear.
Status of Maternal Health
In the domain of maternal health, India faces significant challenges that demand attention. The lack of access to emergency obstetric care and skilled assistance during childbirth is a pressing concern. Many families are compelled to travel long distances under challenging conditions due to the shortage of ambulances or other transportation facilities. In addition, the healthcare infrastructure often lacks the necessary equipment and suffers from shortages of drugs and blood banks available to women in need.
Postnatal care services are often inadequate, and there is a dearth of accessible and safe abortion services. Overall, there is a lack of accountability for essential and emergency care provided to pregnant women and new mothers. These challenges in maternal health reflect the urgency of addressing critical healthcare disparities and ensuring the well-being of mothers and infants in India.
In summary, Dr. Uma Kulkarni’s session shed light on the complex interplay of gender and reproductive rights, emphasising the importance of recognizing and protecting these rights, especially for marginalised and vulnerable groups. The historical evolution of human rights and the challenges in implementing reproductive rights in India were discussed, underlining the need for comprehensive and equitable healthcare solutions. The various challenges that persist, including inadequacies in public health infrastructure and the limitations of insurance schemes, emphasise the ongoing efforts required to secure reproductive rights and maternal health in the country.
Acknowledgement: Aasthaba Jadeja is a research intern at IMPRI.