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Health is an important factor that contributes to human wellbeing and economic growth (Ariana and Naveed). Addressing the gender, class or ethnic disparities that exist in healthcare can contribute to economic gain through the creation of quality human capital and increased levels of savings and investment (Ariana and Naveed). Currently, women in India face a multitude of health problems, which ultimately affect the aggregate economy’s output. The health status of women in India is comprised of multiple measures, which vary by geography, socioeconomic standing and culture (Chatterjee and Paily). To adequately improve the health of women in India multiple dimensions of wellbeing must be analyzed in relation to global health averages and also in comparison to men in India.

Gender bias in access to healthcare
The United Nations ranks India as a middle-income country (United Nations). However, findings from the World Economic Forum indicate that India is one of the worst countries in the world in terms of gender inequality (Raj). The 2011 United Nations Development Report ranks India 132 out of 187 in terms of gender inequality; this measure is determined by numerous factors including maternal mortality rate, adolescent fertility rate, educational achievement and labor force participation rate. Gender inequality in India is exemplified by women’s lower likelihood of being literate, continuing their education and participating in the labor force (Raj). Gender is one of many social determinants of health—which include social, economic, and political factors—that play a major role in the health outcomes of women in India (Balarajan). Therefore, the high level of gender inequality in India negatively impacts the health of women.

The role that gender plays in health care access can be determined by examining resource allocation within the household and public sphere. Gender discrimination begins before birth; females are the most commonly aborted sex in India (Raj). If a female is not aborted, the mother’s pregnancy can be a stressful experience, due to factors such as a family’s preference for a son (Patel). Once born, females are prone to being fed less than boys, especially when there are multiple girls already in the household (Sen). As women mature into adulthood, many of the barriers preventing them from achieving equitable levels of health stem from the low status of women and girls in Indian society, particularly in rural and poverty-affected areas (Raj).

The low status—and subsequent discrimination—of women in India can be attributed to many cultural norms. Societal forces of patriarchy, hierarchy and multigenerational families contribute to Indian gender roles. Males use greater privileges and superior rights to create an unequal society that leaves women with little to no power. This societal structure is exemplified with women’s low participation within India’s national parliament and the labor force (UN). Women are also seen as less valuable to a family due to marriage obligations (Singh). Although technically illegal, Indian society often forces payment of a dowry to the husband’s family (Singh). The increased future financial burden of women creates a power structure that favors males in household creation. Additionally, women are often perceived as being incapable of taking care of parents in old age (Singh).

Taken together, women are often times seen less valuable than men. With lower involvement in the public sphere—as exemplified with the labor and political participation rates—and the stigma of being less valuable within a family, women face a unique form of gender discrimination.

Gender specific inequalities are directly related with health outcomes for women (Raj). Numerous studies have found that the rates of admission to hospitals vary dramatically with gender, with men visiting hospitals more frequently than women (Balarajan). This occurs because women typically have a lower share of household resources and thus utilize healthcare resources to a lesser degree than men (Sen). Furthermore, it has also been found that Indian women frequently underreport illnesses (Balarajan). The underreporting of illness may be contributed to the aforementioned cultural norms and gender expectations within the household. Gender also dramatically influences the use of antenatal care and utilizations of immunizations (Balarajan). A study by Choi in 2006 found that boys are more likely to receive immunizations than girls in rural areas (Choi). This finding has led researchers to believe that the sex of a child leads to different levels of health care being administered in rural areas (Choi). There is also a gender component associated with mobility (Mechakra-Tahiri). Indian women are more likely to have difficulty traveling in public spaces than men, resulting in greater difficulty to access services (Mechakra-Tahri).

Problems with India’s current healthcare system
India’s current health care system is strained in terms of the number of healthcare professionals including doctors and nurses (Rao). The current health care system is highly concentrated in urban areas (Rao). This results in many individuals in rural areas seeking care from unqualified providers with varying results (Rao). It has also been found that many individuals who claim to be physicians actually lack formal training (Rao). Nearly 25 percent of physicians classified as allopathic providers actually had no medical training; this phenomenon varies geographically (Rao). Women are negatively affected by the geographic bias within implementation of the current healthcare system in India (Rao). Of all health workers in the country, nearly two thirds are men (Rao). This especially affects rural areas where it has been found that out of all doctors, only 6 percent are women (Rao). This translates into approximately .5 female allopathic physicians per 10000 individuals in rural areas (Rao). A disparity in access to maternal care between rural and urban populations is one of the ramifications of a highly concentrated urban medical system (Adamson). It has been estimated that maternal mortality in rural areas is approximately 132 percent the number of maternal mortalities in urban areas. The Indian government has taken steps to alleviate some of the current gender inequalities (Doshi and Gandhi). In 1992, the government of India established the National Commission for Women (Doshi and Gandhi). The commission was meant to address many of the inequalities women face, specifically rape, family and guardianship (Doshi and Gandhi). However, the slow pace of the judicial system and the aforementioned cultural norms has prevented the full adoption of policies meant to promote equality between men and women (Doshi and Gandhi).

Malnutrition and morbidity
Nutrition plays a major role in and individual’s overall health; psychological and physical health status is often dramatically impacted by the presence of malnutrition (Tarozzi). India currently has one of the highest rates of malnourished women among developing countries (Jose and Navaneetham). A study in 2000 found that nearly 70 percent of non-pregnant women and 75 percent of pregnant women were anemic in terms of iron-deficiency, a common One of the main drivers of malnutrition is gender specific selection of the distribution of food resources (Tarozzi). Current studies in India have found the nutritional intake of early adolescents to be approximately equal (Tarozzi). However, the rate of malnutrition increases for women as they enter adulthood (Jose and Navaneetham). Furthermore, Jose et al found that malnutrition increased for ever-married women compared to non-married women (Jose and Navaneetham). Maternal malnutrition has been associated with an increased risk of maternal mortality and also child birth defects (Jose and Navaneetham). Addressing the problem of malnutrition would lead to beneficial outcomes for women and children.

HIV/AIDS
As of July 2005, women represent approximately 40 percent of the HIV/AIDS cases in India (Doshi and Gandhi). The number of infections is rising in many locations in India; the rise can be attributed to cultural norms, lack of education, and lack of access to contraceptives such as condoms (Doshi and Gandhi). The government public health system does not provide adequate measures such as free HIV testing, only further worsening the problem (Pallikadavath et al). Cultural aspects also increase the prevalence of HIV infection. The insistence of a woman for a man to use a condom could imply promiscuity on her part, and thus may hamper the usage of protective barriers during sex (Pallikadavath et al). Furthermore, one of the primary methods of contraception among women has historically been sterilization, which does not protect against the transmission of HIV (Steinbrook). The current mortality rate of HIV/AIDS is higher for women than it is for men (Pallikadavathet al). As with other forms of women’s health in India the reason for the disparity is multidimensional. Due to higher rates of illiteracy and economic dependence on men, women are less likely to be taken to a hospital or receive medical care for health needs in comparison to men (Pallikadavath et al). This creates a greater risk for women to suffer from complications associated with HIV (Pallikadavath et al). There is also evidence to suggest that the presence of HIV/AIDS infection in a woman could result in lower or no marriage prospects, which creates greater stigma for women suffering from HIV/AIDS.

Breast cancer
India is facing a growing cancer epidemic, with a large increase in the number of women having breast cancer (Shetty). By the year 2020 nearly 70 percent of the world’s cancer cases will come from developing countries, with a fifth of those cases coming from India (Shetty). Much of the sudden increase in breast cancer cases is attributed to the rise in Westernization of the country. This includes, but is not limited to, westernized diet, greater urban concentrations of women, and later child bearing (Shetty). Additionally, problems with India’s health care infrastructure prevent adequate screenings and access for women, ultimately leading to lower health outcomes compared to more developed countries (Thorat). As of 2012, India has a shortage of trained medical oncologists and cancer centers, which only further strains the health care system (Shetty).

Reproductive health
The lack of maternal health contributes to future economic disparities for mothers and their children. Poor maternal health often affects a child’s health in adverse ways and also decreases a woman’s ability to produce in economic activities (Pathak et al). Therefore, numerous national health programs such as the National Rural Health Mission (NRHM) and the Family Welfare Program have been created to address the maternal health care needs of women across India (Pathak et al). Although India has witnessed dramatic growth over the last two decades, maternal mortality remains stubbornly high in comparison to many developing nations (Pathak et al). As a nation, India contributed nearly 20 percent of all maternal deaths worldwide between 1992 and 2006 (Pathak et al). The primary reasons for the high levels of maternal mortality are directly related to socioeconomic conditions and cultural constraints limiting access to care (Pathak et al). However, it should be noted that maternal mortality is not identical across all of India or even a particular state; urban areas often have lower overall maternal mortality due to the availability of adequate medical resources (Pathak et al). For example, states with higher literacy and growth rates tend to have greater maternal health and also lower infant mortality (Pathak et al).

Reproductive rights
India legalized abortions through legislation in the early 1970’s (Grimes et al). However, access remains limited to cities. Less than 20 percent of health care centers are able to provide the necessary services for an abortion. The current lack of access is attributed to a shortage of physicians and lack of equipment to perform the procedure (Grimes et al). The most common sex that is aborted in India is female (Raj). Women who are highly educated and had a first-born female child are the most likely to abort a female (Raj). The act of sex-selective abortion has contributed to a skewed male to female ratio. As of the 2011 census, the sex ratio among children aged 0-6 continued a long trend towards more males (Tarozzi). The preference for sons over daughters in India is rooted in social, economic and religious reasons (Singh). Women are often believed to be of a lower value in society due to their non-breadwinner status (Tarozzi). Financial support, old age security, property inheritance, dowry and beliefs surrounding religious duties all contribute to the preference of sons over daughters (Singh). One of the main reasons behind the preference of sons is the potential burden of having to find grooms for daughters (Singh). Families of women in India often have to pay a dowry and all expenses related to marriage in order to marry off a daughter, which increases the cost associated with having a daughter (Singh).

Cardiovascular Health
Cardiovascular disease is a major contributor to female mortality in India (Chow and Patel). Women have higher mortality rates relating to cardiovascular disease than men in India because of differential access to health care between the sexes (Chow and Patel). One reason for the differing rates of access stems from social and cultural norms that prevent women from accessing appropriate care (Sivasubramanian). For example, it was found that among patients with congenital heart disease, women were less likely to be operated on than men because families felt that the scarring from surgery would make the women less marriageable (Pednekar et al). Furthermore it was found that families failed to seek medical treatment for their daughters because of the stigma associated with negative medical histories. A study conducted by Pednekar et al in 2011 found that out of 100 boys and girls with congenital heart disease, 70 boys would have an operation while only 22 girls will receive similar treatment. The primary driver of this difference is due to cultural standards that give women little leverage in the selection of their partner. Elder family members must find suitable husbands for young females in the households. If women are known to have adverse previous medical histories, their ability to find a partner is significantly reduced. This difference leads to diverging health outcomes for men and women (Pednekar et al).

Mental health
Mental health consists of a broad scope of measurements of mental well being including depression, stress and measurements of self worth. Numerous factors affect the prevalence of mental health disorders among women in India (Nayak). Older age, low educational attainment, fewer children in the home, lack of paid employmentand excessive spousal alcohol use increase the risk for mental health disorders among women in India (Nayak). There is also evidence to suggest that disadvantages associated with gender increase the risk for mental health disorders (Nayak). Women who find it acceptable for men to use violence against female partners may view themselves as less valuable than men (Nayak). In turn, this may lead women to seek out fewer avenues of healthcare inhibiting their ability to cope with various mental disorders (Nayak). One of the most common disorders that disproportionately affect women in low-income countries is depression (WHO). Indian women suffer from depression at higher rates than Indian men (Pereira et al). Indian women who are faced with greater degrees of poverty and gender disadvantage show a higher rate of depression (Pereira et al). The difficulties associated with interpersonal relationships—most often marital relationships—and economic disparities have been cited as the main social drivers of depression (Pereira et al). Furthermore, it was found that Indian women typically describe the somatic symptoms rather than the emotional and psychological stressors that trigger the symptoms of depression (Pereira et al). This often makes it difficult to accurately assess depression among women in India in light of no admonition of depression (Periera et al). Gender plays a major role in postnatal depression among Indian women (Patel). Mothers are often blamed for the birth of a female child (Patel). Furthermore, women who already have a female child often face additional pressures to have male children that add to their overall stress level (Patel). Women in India have a lower onset of schizophrenia than men (Loganathan). However, women and men differ in the associated stigmas they must face (Loganathan). While men tend to suffer from occupational functioning, while women suffer in their marital functioning (Loganathan). The time of onset also plays a role in the stigmatization of schizophrenia (Loganathan). Women tend to be diagnosed with schizophrenia later in life, often times following the birth of their children (Loganathan). The children are often removed from the care of the ill mother, which may cause further distress (Loganathan).

Suicide
The suicide rate in India is five times higher than the rate for the developed world. Women in India have a higher rate of suicide compared to men in India (Shahmanesh). The most common reasons cited for suicide directly relate to depression, anxiety, gender disadvantageand violence (Shahmanesh). Many of the high rates of suicide found across India and much of south Asia have been correlated with gender disadvantage (Shahmanesh). Gender disadvantage is often expressed through violence (Shahmanesh). The suicide rate is particularly high among female sex workers in India, who face numerous forms of discrimination for their gender and line of work. (Shahmanesh).

Domestic Violence
Domestic violence is a major problem in India. Domestic violence—acts of physical, psychological, and sexual violence against women—is found across the world and is currently viewed as a hidden epidemic by the World Health Organization (Kimuna). The effects of domestic violence go beyond the victim; generational and economic effects influence entire societies. Economies of countries where domestic violence is prevalent tend to have lower female labor participation rate, in addition to higher medical expenses and higher rates of disability. The prevalence of domestic violence in India is associated with the cultural norms of patriarchy, hierarchy, and multigenerational families. Patriarchal domination occurs when males use superior rights, privileges and power to create a social order that gives women and men differential gender roles. The resultant power structure leaves women as powerless targets of domestic violence. Men use domestic violence as a way of controlling behavior (Kimuna). In a response to the 2005-2006 India National Family Health Survey III, 31 percent of all women reported having been the victims of physical violence in the 12 months preceding the survey. However, the actual number of victims may be much higher. Women who are victimized by domestic violence may underreport or fail to report instances of domestic violence. This may be due to a sense of shame or embarrassment stemming from cultural norms associated with women being subservient to their husbands. Furthermore, underreporting by women may occur in order to protect family honor. A 2012 study conducted by Kimuna, using data from the 2005-2006 India National Family Health Survey III, found that domestic violence rates vary across numerous sociological, geographical and economic measures. The study found that the poorest women faired worst among middle and high-income women. Researchers believe that the reason for higher rates of domestic violence come from greater familial pressures resulting from poverty. Additionally the study found that women who were part of the labor force faced greater domestic violence. According to the researchers, working women may be upsetting the patriarchal power system within Indian households. Men may feel threatened by the earning potential and independence of women and react violently to shift the gender power structure back in their favor. One of the largest factors associated with domestic violence against women was the prevalence of alcohol use by men within the households.