Choice-Reproductive Justice

The health of Indian women is intrinsically linked to their status in society. The Indian constitution affirms gender equality, but strong patriarchal traditions persist, with women’s lives shaped by customs that are centuries old. The fact that the typical female advantage in life expectancy is not seen in India suggests a systematic crisis concerning women’s health.A factor that contributes to India’s high maternal mortality rate is the family’s reluctance to seek medical care for pregnancy. Nationwide, only 40-50 percent of women receive any antenatal care. It is estimated that pregnancy-related deaths account for one-quarter of all fatalities among women aged 15 to 29, with well over two-thirds of them considered preventable. For every maternal death in India, an estimated 20 more women suffer from impaired health.Research has shown that numerous pregnancies and closely spaced births erode a mother’s nutritional status, which can negatively affect the pregnancy outcome (e.g. premature births or low birth-weight babies). As a result, mothers can suffer a variety of additional physical and psychosocial health risks.Still more to comeSince 1970, the use of modern contraceptive methods has risen from 10 percent to 40 percent, yet with great variance across India. There have been programs designed to motivate and inform couples, as well as programs aimed at making services more accessible to couples. These represent important tools of government and private sector agencies concerned with improving maternal and child health.India’s long history of activism in the areas of women’s welfare, rights and economic empowerment has placed these topics well within public debate. The government has launched a range of schemes aimed at increasing economic and educational opportunities for women. Such efforts can only compliment initiatives that address the persistent cultural and traditional discrimination that leads to overall abject conditions for women and girls; there remains a reticence to improve choices for women and to accept women’s right to choose methods that she trusts as safe and convenient. Though ongoing efforts continue to improve the lives of women and families insofar as reproductive rights, there is still a long road towards reproductive justice.The fact still remains, however, that female sterilization is the main form of contraception in India; over two thirds of the married women using contraception have been sterilized, which accounts for more than 85 percent of total modern contraception use. Moreover, female sterilization accounts for 90 percent of all sterilizations, attesting to the inequitable burden and responsibility for reproductive carried by women. Meanwhile, traditions that afford women little education about their bodies, or little influence in regards to their reproductive decisions directly undermine any efforts to improve the lot of women in India in any regard.Choice and Quality CareUnwanted pregnancies terminated by unsafe abortions negatively impact women’s health. Increasing access, image and usage of contraceptives are worthwhile goals towards managing fertility thereby improving the overall health of Indian women. While the knowledge of contraceptive methods is nearly universal in India, only 36 percent of married women aged 13 to 49 currently use a modern form of contraception. Compromised quality or inaccessibility of reproductive health services harms women’s health. There is still an unmet need for contraceptives in India despite large increases in the actual number of women using contraceptives and limiting their fertility. Nearly 20 percent of married women in India report a desire to either delay their next birth or have no more children. Most of the unmet need among younger women is for spacing births rather than limiting. This implies a great need for long-term spacing, non-terminal contraceptive methods.Fortunately, there are a plentitude of available options such as Combined or progestin-only pills, DMPA, injectable contraceptive (meant for mid-term spacing), Norplant implants, Intrauterine Devices (IUD’s), condoms, vaginal creams, spermicides and diaphragms. Informing women about the myriad of available choices augments a women’s freedom to choose a method that is best suited to her specific health needs as well as the couples’ consensual reproductive desires. Moreover, education, health care services, job training, as well as improved accessibility reproductive methods and technologies all contribute to an environment where women can make decisions that create a healthy and safe life for herself, her family, and her posterity.