Women’s reproductive health and lives

Following is a review of the book The Unheard Scream: Reproductive Health and Women’s Lives in India’, edited by Mohan Rao. It came out in 2004 and is an important political economy text on the question of women’s reproductive health in India. Here it is:

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‘Bharat Mata’, a militant symbol of the nationalism currently being revived by the present establishment, has taken over the country by a storm. Worshipping her is now the proof of one’s loyalty to ‘Akhand Bharat’, and refusal to do so automatically makes one an ‘anti-national’, a criminal, or a ‘Pakistani’. Never mind the masculinized protectionism meted out by the sons of Bharat to this Mata, some view this as a welcome postulation, because after all, respect is being paid to the mothers (and thus assumingly to women).

Feminists, however, find it deeply problematic, and even anti-feminist (John, 2016). They argue that this discourse is an attempt to undermine the questions that they have been raising against the rape culture, state repression, brahminical patriarchy, oppression within family and marriage, neo-liberal onslaught and curtailing of freedoms to love, choose and desire (ibid). The ‘Bharat Mata’, however, does not raise these questions, for she is too content to first be exploited and then ‘saved’ by those very sons of hers. She does not seek justice, as for her, fervent chanting of ‘Bharat Mata ki Jai’ is more than enough!

To counter this celebration of ‘Bharat Mata’ which glosses over the hard realities of gender-based exploitation and oppression, it is imperative that issues, concerns, questions and struggles by millions of women in this country are highlighted. ‘The Unheard Scream: Reproductive Health and Women’s Lives in India’, edited by Mohan Rao and which came out in 2004, does precisely that.

The book, a collection of essays written by thirteen journalists and edited by Mohan Rao, is an honest attempt in documenting the various aspects of women’s health as embedded in their lives. This anthology of writings by journalists is particularly important today, when journalism in India, as also the world over, is visibly losing its depth, commitment and independence to cover the issues of common people. Dreze and Sen (2013) also reported that out of more than five thousand articles appearing on editorial pages of leading English newspapers in last six months of 2012, only about one percent covered health-related issues.

Not only is there a serious dearth of good reportage, the mainstream media now also join the ruling forces in manufacturing consent (Herman and Chomsky, 2010), producing hysteria over trivial issues at the cost of crucial ones and making journalism, the fourth pillar of a democracy, anti-democratic. This book, however, helps restore some faith, if not in the media establishment but at least in the journalists who are writing on issues that matter, one of which is women’s health.

What makes women sick? Like Doyal (1995), if we too were to ask this question, then we would have to adopt the political economy of health framework to situate the question of women’s health in their socio-economic and political contexts (Rao, 2004). This is the main message that the book tries to convey, by looking at multi-level factors intertwining and affecting women’s reproductive health and their lives through stories, data and arguments from the ground.

It is often pointed out that much of the discussion on women’s health is dominated by themes around reproduction, making some critics call it reproductive essentialization of women’s lives (Inhorn, 2006).  Despite this constraining approach, reproductive health services continue to be the only point of contact that most women have with the health system (ibid), and therefore, while sustained efforts must be made to highlight and work on overall (other than reproductive) health needs of women, reproductive health continues to be an important lens to look at women’s health as well as to understand the health system’s responsiveness to gender issues. This book too studies reproductive health so as to ensure both specificity of it as well as to use it as a frame of analysing women’s overall health and well-being, thereby becoming one of the guiding texts in understanding political economy of women’s reproductive health in India.

The book’s introduction poses the central question that keeps recurring as one navigates through the pages: are reproductive rights universally about the woman’s freedom from subjugation by family, community, religion and the State, or can they also be guised as means of population control, disproportionately affecting the oppressed women, thereby, demanding that reproduction be connected with wider socio-economic concerns?

This question is asked at the backdrop of the “Cairo Consensus”, often celebrated as a paradigm shift in the way population, development and reproduction were approached. Rao (2004) problematizes this consensus by showing how seemingly opposed groups, the reproductive rights feminists on one hand, and the World Bank along with population control establishment on the other, decided to be fellow-travellers to merely replace population control with population stabilisation, paying little to no attention to the neo-liberal onslaught on the health of women, particularly of those in developing countries. While a feminist language of reproductive rights was adopted to whitewash the over-population argument, nothing much changed at the grassroots in the following years, as the chapters in the book demonstrate.

One of the most visible violations of the Cairo consensus by the Indian state is what is infamously called the ‘camp’ approach. Menon (2004) reports from inside such camps, which she titles ‘State-of-the-Art Cycle Pumps’, to show how under the garb of sophisticated ‘emancipatory’ rhetoric of the Reproductive and Child Health (RCH) programme, cycle pumps were being used to inflate women’s abdomens for laparoscopic sterilizations!

Anand (2004) too argues that RCH is the same old wine in new bottles, as targets are still present, only they may now be self-generated or undeclared (ibid). In places where this camp approach is not doing the harm, there are other ways to commit medical atrocities, one of which is quinacrine sterilization, known as the “quick fix” method in rural parts of Bengal (Dasgupta, 2004). These hugely popular “injections” were preferred by generations of women, for the method required no surgery or hospitalisation, something that rural poor women usually find hard to afford. Thanks to the official apathy and negligent monitoring mechanisms, a whole racket of “rural practitioners” with international links continued this banned and highly unethical contraceptive trial on women, making their bodies the sites of experiment, “data collection” and control without their consent and adequate disclosure of possible effects, all in the name of providing reproductive choices (ibid).

If we thought this was only a thing of the past, since the book came out a decade earlier, the atrocious death of 13 women and complications in many other in one such ‘camp of wrongs’ in Bilaspur, Chhatisgarh in 2014 reminds us otherwise (Sama et. al, 2014). Even talks to introduce the highly controversial drug Depo Medroxy Progesterone Acetate (DMPA) in the form of injectable in the National Family Planning Programme resurfaced in 2015 (Jan Swasthya Abhiyan et. al, 2015). These recent developments testify that there is no stopping of mutilation of women’s bodies by medical malpractices in the name of family ‘welfare’.

Interventions on women’s bodies take an entirely different form when the attempt is not to control the fertility but to enhance it through assisted reproductive technologies, showing how complex the whole spectrum of reproduction is. Srinivasan (2004) discusses how the Parenthood Dream is packaged and sold by the flourishing fertility industry, flouting ethical norms, coaxing huge sums of money for potentially hazardous treatments on desperate women and playing with cultural aspirations of the couples to produce a commodity, i.e. a baby, for consumption.

That growing commodification and consumerism in neo-liberal times affect women disproportionately is further revealed in the case of Malappuram district of Kerala where the money flowing in from the “Gulf Men” helped the Muslim community of the area to economically progress but also led to increase in teenage marriages and pregnancies and “gulf wife syndrome” among young girls who found it hard to psychologically and emotionally deal with changes in their identities (Basheer, 2004). Discussing migration of male agricultural labourers from North Bihar villages, leaving behind ‘grass widows’, to deal with disease and deprivation all alone, Jha (2004) in his brilliant essay shows how the age-old structures of caste and landlessness collude with neo-liberal assaults of soaring prices and complete withdrawal of State in welfare measures, hitting women the hardest, as always.

But, perhaps one of the most direct assaults of the neo-liberal economic policies that advocate aggressive growth strategy by ‘disciplining’ labour can be seen on women workers. Rajlakhsmi (2004) goes inside two Export Processing Zones (EPZs) to show that unmarried young girls did monotonous work standing for at least eight hours with an additional three hours ‘compulsory over-time’ with no extra pay.  A total of five minutes was allotted for going to the toilet, exceeding which could invite expulsion (ibid). This description alludes to the feminist debate on women and work where women entering the workforce, owing to capitalism, could be seen by some as a step ahead to evade the drudgery and often the violence of households to some extend but the nature and conditions of work, as shown in case of EPZs, as well as devaluation, casualization and sustenance of gendered role even in occupational spaces can be far from empowering.

Discussion on women and work becomes further complicated when it revolves around the theme of sex work, where ‘the range of options available to anyone wanting to take a stand on the issue is confusing’ (Gangoli, 2004:108). The sudden health care attention given to sex worker is only due to the scare of HIV whereby women in sex work are seen as “vectors” but there legitimate health needs remain cruelly unaddressed (ibid). Irrespective of the position, the article urges to listen to the women in the profession and help enlarge the options they can choose from.

Listening to women, lifting the veil of silence, hearing their scream, and thereby acknowledging their voices and issues is the final plea of the book. Chinai (2004) writes about the war-struck, economically stagnant, invaded by drugs and aids, non-existing healthcare and neglected by the ‘mainland’- Nagaland- where ‘even if we (women) shout there is no one to hear’ (ibid). Bhattacharjee (2004) dwells on the sensitive topic of sexual health of adolescents to argue that unless sexuality of the younger persons is demystified and an environment of openness, acceptance and creative and empowering engagement with adolescents is ensured, the ‘politics of silence’ will continue to do more harm than good. Finally, silence around menopause, as captured by Bavadam (2004) throws more questions than answers- is it the medicalization of a natural bodily process which also is deeply linked with socio-cultural aspects that is causing an anxiety over the silence or is it indeed another oppression which invisiblises women’s health problems amidst other oppressions? Only listening to women emphatically can provide answers.

While the book attempts to capture the wide breadth of issues surrounding reproduction, some indispensable ones have been missed out, without which understanding of women’s reproductive health in India is incomplete. One such theme is violence. That violence against women is pervasive, a rallying point of women’s movement for a long time, was reiterated empirically by the National Health and Family Survey – 3 which found that every third woman between the age group of 15 to 49 reported having experienced physical or sexual violence in her life time, with number of women experiencing sexual violence by intimate partners being forty times the number of women who experienced sexual violence by non-intimate partners (Gupta, 2014). This clearly has serious health impacts on women, particularly on their reproductive health, which should have found a place in the book.

The book is also conspicuously silent on issues of mental health which have both direct and indirect association with women’s reproductive health. History is full of examples of how reproductive wrongs have been committed on women with mental illnesses or disabilities in the name of ‘disciplining’ them or ‘maintaining hygiene’ and sometimes without any reasons at all.

The book also does not discuss the reproductive health, as well as the overall health of the lesbian, bisexual, Trans and queer (LBTQ) women. Written in early 2000s, when the discourse as well as the movement around queer rights had perhaps not as strongly emerged in India as it is today, the book could have at least attempted to problematize the heteronormativity as well as sexism rampant in the health system which further marginalises identities that are variant from the norm.

No one book can do justice to the full spectrum of issues in women’s health, which are diverse, complicated, yet extremely important. Even though some topics such as mental health, violence against women and health issues of LBTQ women are neglected, The Unheard Scream: Reproductive Health and Women’s Lives in India does a remarkable job in highlighting women’s health needs and their neglect in India. Ideally, there should have been more policy discussion and action related to these concerns, and much more research and action related to women’s health. That this is one of the few books paying careful attention to women’s health is the real tragedy.

 

 

References

Anand, A(2004): Safe Motherhood, Unsafe Deliveries in Rao, M. (Ed.). (2004). The unheard scream: reproductive health and women’s lives in India. Zubaan.

Basheer, K P M.(2004): The Gulf Wife Syndrome in Rao, M. (Ed.). (2004). The unheard scream: reproductive health and women’s lives in India. Zubaan.

Bavadam, L.(2004): The Silent Transition: Indian Women and Menopause in Rao, M. (Ed.). (2004). The unheard scream: reproductive health and women’s lives in India. Zubaan.

Bhattacharjee, S. (2004): The Politics of Silence: Introducing sex education in India in Rao, M. (Ed.). (2004). The unheard scream: reproductive health and women’s lives in India. Zubaan.

Chinai, R.(2004): Even If We Shout There is No One to Hear: Reproductive Health Issues among Marginalized Population of Nagaland in Rao, M. (Ed.). (2004). The unheard scream: reproductive health and women’s lives in India. Zubaan.

Dasgupta, R. (2004): Quick-fix Medical Ethics: Quinacrine Sterlization and the Ethics of Contraceptive Trials in Rao, M. (Ed.). (2004). The unheard scream: reproductive health and women’s lives in India. Zubaan.

Doyal, L. (1995): What Makes Women Sick: Gender and Political Economy of Health. Macmillan.

Drèze, J., & Sen, A. (2013). An uncertain glory: India and its contradictions. Princeton University Press.

Gangoli, G.(2004): Women as Vectors: Health and the Rights of Sex Workers in India in Rao, M. (Ed.). (2004). The unheard scream: reproductive health and women’s lives in India. Zubaan.

Gupta, A. (2014). Reporting and incidence of violence against women in India. Available at: http://riceinstitute.org/wordpress/wp-content/uploads/downloads/2014/10/Reporting-and-incidence-of-violence-against-women-in-India-working-paper-final.pdf (accessed on 6th April, 2016).

Herman, E. S., & Chomsky, N. (2010). Manufacturing consent: The political economy of the mass media. Random House.

Jan Swasthya Abhiyan et al. (2015): Statement protesting approval to introduce Injectable contraceptives in the national family planning programme, Kafila. Available at: http://kafila.org/2015/09/24/a-statement-protesting-approval-to-introduce-injectable-contraceptives-in-the-national-family-planning-programme/ (accessed on 6th April, 2016).

 Jha, D.K. (2004): Grass Widows of Bihar in Rao, M. (Ed.). (2004). The unheard scream: reproductive health and women’s lives in India. Zubaan.

John, M. E. (2016): Feminism, Freedom and Bharat Mata. Public Lecture Delivered in Jawaharlal Nehru University. Available at: https://www.youtube.com/watch?v=iVo8msMZWKI.

Menon, S. (2004): State-of-the-Art Cycle Pumps in Rao, M. (Ed.). (2004). The unheard scream: reproductive health and women’s lives in India. Zubaan.

Rajalaxmi, T.K.(2004): For a Few Dollars More: Women in Export Processing Zones in Rao, M. (Ed.). (2004). The unheard scream: reproductive health and women’s lives in India. Zubaan.

Rao, M (2004): Cairo and After: Flip Flops on Population Policy in Rao, M. (Ed.). (2004). The unheard scream: reproductive health and women’s lives in India. Zubaan.

Sama et al. (2014): Camp of Wrongs: Mourning afterwards- Fact Finding Report on Sterilization deaths in Bilaspur. Available at: http://sites.hampshire.edu/popdev/files/2015/02/camp-of-wrongs.pdf (accessed on 6th April, 2016).

Srinivasan, S.(2004): Selling Parenthood Dream in Rao, M. (Ed.). (2004). The unheard scream: reproductive health and women’s lives in India. Zubaan.