What are the preconditions of a healthy infant:

• During pregnancy, the mother must have access to sufficient quality and quantity food including during pregnancy and lactation
• During pregnancy woman and breastfeeding period, the mother must take iron folic acid supplements daily to reduce maternal anaemia and improve pregnancy and lactation outcomes
• During adolescence, girls must be protected against undernutrition and nutritional deficiencies like anaemia through dietary counseling, weekly iron and folic acid supplementation, twice yearly de-worming prophylaxis
• Regular consumption of salt with adequate levels of iodine is required by all pregnant women in order to prevent foetal brain damage associated with iodine deficiency
• Women must avoid early marriage and pregnancy

What this indicates is that at the core of any nutrition program for the infants is actually a program to improve the health outcomes of the mothers. Of course, woman’s health and well-being has its own inherent qualities and every women has a right to good health whether or not she is a mother. However, the point here is that any program that addresses nutritional needs of the children acknowledging it as the building block of the future must start with the women. This pertains not just to health but also to education as significant disparity in nutritional status can be explained by mothers’ education and literacy. Studies have found a significant association between low maternal literacy and poor nutrition status of young children. A healthy and educated mother who enjoys a good social standing is the best guarantee for a healthy child and indeed of development.

India’s Northeast is under a near-constant state of political upheaval, with tensions frequently erupting between locals and the Indian security forces. Manipur has been especially disturbed and has been the face and voice of the turbulence in the region.

What is common across conflict situations is the vulnerability of women to various forms of gender based exploitations- as easy targets of settling scores between warring groups. Whether it is the security forces or the insurgents- humiliation of and violence on women is seen as a potent weapon of war. What is however significant in case of Manipur is the resilience that women have demonstrated, despite their unenviable position.

From Sharmila, the lady who has been fasting for close to a decade now and surviving on forcible nasal administration of fluids, Manorama who was killed in an ‘encounter’, the poignant picture of naked women -these are the most persistent pictures of protest with the women at the forefront. In addition to such stark examples there are numerous instances of women engaged in rallies, demonstrations and other forms of popular protest.

There are also important women’s organizations in the area founded and led by common women. Meira Paibi, for example, is a women’s association and one of the largest grassroots human rights movements in the region. The organization started as ‘Nisha Bandi , ‘an uprising that began around the mid 70’s against the sale and consumption of liquor and intoxicants, leading to successful implementing of prohibition order on sale and consumption of liquor in Manipur. Over time, with the rise of insurgency and counter - insurgency policy in the state, the women started spending nights outside their homes, patrolling the streets and guarding their locality against any surprise attack They took up the “Mira” an improvised bamboo torch and it became the symbol of their movement, and thus lead to what is known as “Meira Paibi Uprising”. (http://e- pao.net/epSubPageExtractor.asp?src=leisure.Essays.Tigress_dont_chicken_out). Organizations like Manipuri Women Gun Survivor’s Network help the survivors of gun violence, to control the use and spread of small arms and to find ways to the community as a means to arrest violent conflict.

The road has not been smooth for these women who have joined these movements- besides the ire of the family there are allegations of alleged links with the insurgent groups. However, the women have been carrying out their activities with a focus on bringing in peace and ensuring protection of rights. They are now, at the same time, symbols of resilience and symbols of a promise of change. Can ‘mainland’ India please stand up to their cause?

Why do you think that women’s groups are so active in Manipur?

How can we as a society respond to the issue of domestic violence? Do we just say that it is a private affair? Or do we take the position that it is a violation of the basic human right of a woman? How can the legal system be empowered to tackle the situation wherein members of a family commit violence against a woman? What about verbal abuse and emotional torture?

While women are victims of domestic violence across the world, what is peculiar about India is the social sanction it enjoys. One who does not protest is considered to be virtuous and women are conditioned to tolerate, allow, even rationalize domestic violence.

After mulling with the issues for some time, the Delhi High Court ruled recently that a woman can also be held liable under the Protection of Women from Domestic Violence Act 2005. The 2005 law focusses on the prohibition of marital aggression, the issue of protection and maintenance orders against husbands and partners who abuse a woman emotionally, physically or economically. This sounds fine on paper, but a one-size-fits-all approach ignores women who need such protection the most. Little thinking has gone into understanding the context in which spousal abuse overwhelmingly occurs in India. The ground realities have been ignored and the implementation aspects left woolly and unprovided for. (http://www.hindu.com/2010/06/17/stories/2010061753321000.htm)

Shailaja Chandra a Secretary of the government of India in her insightful article in the Hindu newspaper rightfully asserts that there is no use having a law that is meant for the whole country when there is no one to implement it. Until full-time and properly oriented protection officers are recruited a more practical way would be to prescribe summary disposal of cases through weekly courts organized at the tehsil or ward level. She also talks in favour on placing incentives on reporting, given that it is one of the least reported offences/ violations. For every case where a protection order is issued, the protection officer and the witnesses should be compensated in recognition of having successfully brought forward the case for intervention. At the village level, the Panchayats as well as the health, education and social welfare fieldworkers and NGOs could be permitted to voluntarily take on the role of protection officials, to be compensated for every case that ends in favour of a battered woman.

These are practical solutions and there is a critical need to take action towards these. What is needed is to get out of official lethargy and get things done.

What can be done to address the issue of domestic violence in India?

Maternal health refers to the health of women during pregnancy, childbirth and the postpartum period. While motherhood is often a positive and fulfilling experience, for too many women it is associated with suffering, ill-health and even death. According to WHO, every day, 1,500 women die from pregnancy- or childbirth-related complications. In 2005, there were an estimated 536, 000 maternal deaths worldwide. Most of these deaths occurred in developing countries, and most were avoidable.

A times of India report (http://timesofindia.indiatimes.com/articleshow/2461713.cms) quoting the Maternal Mortality report compiled by the World Health Organisation (WHO), UNICEF, UNFPA and the World Bank revealed that more women die in India during childbirth than anywhere else in the world. Of the 5.36 lakh women who died during pregnancy or after childbirth in 2005 globally, India accounted for 1.17 lakh. The maternal mortality ratio (MMR) in India is 450 deaths per 100,000 live births.

The newspaper report also says that this finding is consistent with the National Family Health Survey (NFHS-III) that found that women in India lack quality care during pregnancy and childbirth. Almost one in four women (23%), who gave birth in the last eight years, received no antenatal care, ranging from 1% or less in Kerala and Tamil Nadu to 66% in Bihar. At least 40% of pregnant women did not get any antenatal care in Jharkhand, Arunachal Pradesh and Nagaland.

Home births are still common in India - accounting for almost 60% of recent births. NFHS-III found that 37% of deliveries were assisted by a traditional birth attendant, and 16% were delivered by a relative or other untrained person. According to WHO estimates, only 47 percent of the births were attended by skilled health personnel in 2006 ( Source: http://apps.who.int/whosis/database/core/core_select_process.cfm?countries=ind&indicators=BirthsAttended).

While poor maternal health is indicative of many flaws such as poor quality and inadequacy of outreach services, low levels of awareness, early age of marriage and child birth etc, the core of the problem lies in the low social status of women that deprives them of the most basic services and does not prioritize her health and well-being even during such a vulnerable stage as pregnancy and child birth. Unless the social attitudes change, we will continue to have mothers suffering or dying due to entirely preventable causes. Unfortunately, it is still acceptable to us- it is still a low priority.

Why is maternal health such a neglected issue in India?

• A majority of the registered pregnant women did not use the health centres for institutional deliveries. This was particularly so in the States lagging on health and development parameters due to lack of planning in micro birth plan entrusted to the Accredited Social Health Activist (ASHA) and the Auxiliary Nurse Midwives (ANMs)

• Facilities were inadequate and there was a shortage of supporting staff and doctors at the health centres.

• The District Level Household and Facility Survey-III (2007-08) indicated that the percentage of institutional deliveries was 47 against the National Rural Health Mission target of 100 per cent institutional deliveries by 2012.

• More than 50 per cent of pregnant women in seven States and 20 to 50 per cent in nine States did not receive the full dose of iron and folic acid tablets due to delays and shortfalls in supply.

Report of the Comptroller and Auditor General of India, 2009

The Comptroller and Auditor General (CAG) has criticized the National Rural Health Mission (NRHM) for problems in implementation of the Janani Suraksha Yojana – maternity benefit scheme. In its latest report, the CAG pointed out that in addition to the above, the national targets for progress in human development goals and health indicators such as Infant Mortality and Maternal Mortality Rates were fixed by the Ministry of Health and Family Welfare but there was no attempt to ensure that individual State targets matched national targets or that these were achievable.

These are serious allegations considering that NHRM is the flagship program of the government. India is lagging behind in terms of basic indicators of health such as rates of infant and maternal mortality. While increasing institutional deliveries was envisaged as a way to risk mitigation, the fissures in the system ensure that this becomes difficult to achieve. Indeed there is no point in institutional deliveries if the institutions lack basic facilities. There is also a strong lobby that proposes strengthening of the community based systems such as training of the Traditional Birth Attendants (TBA) as a way to ensure safe deliveries. It is also argues that cash transfer is the only motivation that brings women to the institutions that are also ill-equipped to handle complicated cases. The cash transfer also has little meaning in the absence of adequate pre-natal and post natal care and support.

Child birth, one of the most natural human processes is at the crux of development. In order to ensure the safety of mother and infant, it is important to undertake multi-pronged programs to enhance quality and outreach of pre natal and post natal care along with complete immunization, access to adequate and nutritious food, clean water and proper sanitation facilities, etc. This is the minimum basic that we have to ensure for the mothers and their children, failing which no program can address the problems of Infant and maternal mortality.

Any understanding of disability remains incomplete until the gender dimension of the issue is well understood. Given that disability receives little attention from mainstream development agenda, the gender aspects of the issues are often ignore. However, awareness about how disability impacts the lives of men and women differently, can help design programs that are better tuned to the realities of the people that are often markedly different.

For example, National Sample Survey (NSS) 58^th round illustrate that accidents and injuries have some role in around 18 percent of all disabilities. There are, however, major gender differences in the source of such injuries. For males, over 35 percent of these injuries are at the place of work, while for women, the overwhelming proportion – 60 percent - are at home.

There is also a marked difference in intra-household attitudes and community views vis a vis men and women, especially with regard to violence against women with disabilities. This is a subject on which little quantitative research has been done to date in India. However, a 2005 study by an NGO Swabhiman from Orissa indicates that women with disabilities were subject to significant domestic abuse and sexual abuse, and that the situation was sharply worse for women with mental impairments relative to women with other types of disabilities. The findings for rape are the most shocking, with fully one quarter of women with mental disabilities reporting having been raped (with the large majority carried out by family members), and almost 13 percent of women with locomotor, visual and hearing disabilities. In only a small share of cases did the women report the abuse to her family, and in the vast majority of those cases the reaction of the family was either not to listen or to pretend nothing had happened. (Cited in: India: From Commitments to Outcomes, World Bank, 2007)

Similarly, analyzing marriage and widowhood rates, NSS data indicate that women with disabilities have much higher rates of widowhood than women without disabilities in both urban and rural areas – in both cases around four times the non-Women With Disabilities (WWD) rate. Conversely, the proportion of WWD who are currently married is much lower than non-disabled women. The explanation for such differential rates can most likely be found in the common practice of marrying of women with disabilities to men much older than themselves – men who are unable to find more “marketable” brides. (Source: India: from Commitments to Outcomes, World Bank, 2007).

These factors demonstrate that with the same kind and extent of disabilities, men and women often have different life situations that need to be understood and reflected in the programs designed and implemented. In addition, there are other intersectionalities like economic class, education levels etc, that need to be factored in to make the gender aspect of disability clearly spelt out and addressed.

Do the existing policies and programs adequately capture the gender dimension of disability?

Women and children are often in great danger in the place where they should be safest-within their family

At least one out of every three women around the world has been beaten, coerced into sex, or otherwise abused in her lifetime. The abuser is usually someone known to the victim. Yet, while violence against women and girls is a universal problem of epidemic proportions, both the sufferings of the victims often remain invisible. Fear and shame continue to prevent many women from speaking out, and data collected is often insufficient and inconsistent.

A UNICEF study carried out across various nations and cultures (including India) has established close correlation between domestic violence and suicide in India. Suicide is 12 times as likely to have been attempted by a woman who has been abused than by one who has not. In a more focused study undertaken by UNICEF in Uttar Pradesh, up to 45% of married men acknowledged physically abusing their wives. (Source: http://www.unicef-irc.org/publications/pdf/digest6e.pdf). Another UN study in India, indicates that 14 wives are murdered by their husbands’ family every day. (Source: http://www.un.org/events/tenstories/06/story.asp?storyID=1800).

A World Bank report estimated that violence against women was as serious a cause of death and incapacity among women of reproductive age as cancer, and a greater cause of ill-health, than traffic accidents and malaria combined.

Most police, prosecutors, magistrates, judges and doctors adhere to traditional values that support the family as an institution and the dominance of the male party within it. Given this, there is a great deal of reluctance to ‘criminalize’ wife battering. There is a sense that domestic violence is a crime between those who are linked by bonds of intimacy. The question of intimacy, i.e. whether wife-battering should be treated as an ordinary crime or whether there should be an emphasis on counseling and mediation, poses a major dilemma for policy makers.

Women’s organizations have provided leadership in boosting the visibility of violence against women; giving victim-survivors a voice; providing support to victims of violence; and forcing governments and the international community to take action. From local, collective action, women have transformed their struggle against violence into a global campaign. However, much remains to be done. It is a social problem that happens behind the closed doors. And yet, the most critical challenge is to open the doors and develop a mechanism for strong negative sanction. It is important to bring together the important stakeholders- the police, the law makers, the state and the civil society on a common platform to articulate a shared vision to protect women from violence and empower her to take action. Once that is clear, the message of zero tolerance has to be articulated across all levels of enforcement. The message is loud and clear- it is no longer personal.

What actions should be taken to combat domestic violence?

• Even though India has legally abolished the institution of dowry, more than 5,000 women are killed annually by their husbands and in-laws. An average of five women in a day are burned, and many more cases go unreported.

• In Bangladesh, it is estimated that there are over 200 acid attacks each year.

• More than 50 countries allow marriage at 16 or below with parental consent. Early marriage leads to childhood/ teenage pregnancy, and can expose the girl to HIV/AIDS and other sexually transmitted diseases.

• In several countries in the world including , women are killed in order to uphold the “honour” of the family.

Source: Innocenti Digest, 2000, UNICEF

Gender Based Violence against women is a manifestation of historically unequal power relations between men and women.

Women are inflicted to the various forms of gender based violence across age- from prior to birth till old age. Pre-birth, the unborn baby is at risk of sex-selective abortion. Their mothers are vulnerable to battering during pregnancy that impacts their birth outcomes. During infancy, the infants are vulnerable to female infanticide and other physical abuse. During girlhood, there are risks of being married as a child and of female genital mutilation in addition to physical, sexual and psychological abuse. The girls are also at risk of incest, child prostitution and pornography.

During adolescence, there is an increased risk of trafficking for commercial sexual exploitation and/ labour, courtship violence (e.g. acid throwing and date rape) etc. Adulthood is characterized by coerced sex, sexual abuse in the workplace, rape, sexual harassment, forced prostitution and pornography, trafficking in women, partner violence, marital rape, dowry abuse and murders, partner homicide, psychological abuse, etc.

Among elderly women, there are incidences of forced “suicide” or homicide of widows for economic reasons; physical and psychological abuse. In many rural areas, elderly women are killed, often with social sanction, on the suspicion of practicing witchcraft.

Gender based violence is one of the most pervasive of human rights violations. Violence against women is present in every country, cutting across boundaries of culture, class, education, income, ethnicity and age. Even though most societies proscribe violence against women, the reality is that violations against women’s human rights are often sanctioned under the garb of cultural practices and norms, or through misinterpretation of religious tenets. Moreover, when the violation takes place within the home, as is very often the case, the abuse is effectively condoned by the tacit silence and the passivity displayed by the state and the law-enforcing machinery. (http://www.unicef-irc.org/publications/pdf/digest6e.pdf).

Given this, it is important to address the issue at all levels of society and its institutions. One of the first steps is to recognize that while making laws is an important first step, enforcement will remain the crux of the problem unless it is backed up by strong negative social sanction. Sensitizing the enforcement agencies about the issue is another critical issue that the state and the civil society has to deal with.

What measures can be taken to ensure that the law is enforced effectively?

• Essentially all (99%) of the half a million maternal deaths every year occur in developing countries.
• Breast cancer is the leading cancer killer among women aged 20–59 years in high-income countries.
• Globally, cardiovascular disease, often thought to be a “male” problem, is the leading killer of women.
• Tobacco use is a growing threat among young women,
• Mortality rates during pregnancy and childbirth remain high in developing countries.

Source: WHO, 2009

Despite considerable progress in the past decades, societies continue to fail to meet the health care needs of women at key moments of their lives, particularly in their adolescent years and in older age. Given this, there is an urgent action both within the health sector and beyond to improve the health and lives of girls and women, from birth to older age.

The distinct roles and behaviors of men and women in a given culture, dictated by that culture’s gender norms and values, give rise to gender differences. Gender norms and values, however, also give rise to gender inequalities - that is, differences between men and women which systematically empower one group to the detriment of the other. The fact that, throughout the world, women on average have lower cash incomes than men is an example of a gender inequality.

Both gender differences and gender inequalities can give rise to inequities between men and women in health status and access to health care. For example: women cannot receive needed health care because norms in her community prevent her from traveling alone to a clinic, or showing her to a male doctor. Again, a married woman is often at risk of HIV because society is tolerant of her husband’s promiscuity. In each of these cases, gender norms and values, and resulting behaviours, are negatively affecting health. In fact, the gender picture in a given time and place can be one of the major obstacles - sometimes the single most important obstacle - standing between men and women and the achievement of well-being.

Thus, social factors combine to create a lower quality of life for women. Unequal access to information, care and basic health practices further increases the health risks for women. It is therefore crucial to increase awareness of the role of gender norms, values, and inequality in perpetuating disease, disability, and death, and to promote societal change with a view to eliminating gender as a barrier to good health.

How can gender and health be better reflected in actions to promote health seeking behaviour?

• First, certain regions of South Asia, particularly a band running through Pakistan and northern India, consistently have among the worst indicators of gender disparity in the world
• Second, the variations in gender disparity within India are as large as those across countries.
• Third, there is no correlation between average income and gender disparity in the sample, either across nations or within India.
• Girls are significantly less likely to receive treatment for common childhood illnesses in South Asia
• The female disadvantage in educational enrollment for ages 11 to 15 is high in South Asia much like the disadvantage in western and central African countries

Gender disparity in South Asia, World Bank, 1998

Yes, the data is more than a decade old. But the worst part is that not much has changed since then. A recently published UNDP Asia Pacific Human Development Report reiterated the same points. Women from South Asia continue to lag behind the world average in terms of literacy rates and labour force participation and have higher rates of Maternal Mortality and malnutrition prevalence. The proportion of women in labour force is 36 percent, compared to 60percent in Sub- Saharan Africa. China and India together account for nearly a 100 million missing women estimated to have died from discriminatory treatment in healthcare, nutrition access or neglect or because they were never born as female fetuses are aborted.

Given that South Asia accounts for almost a quarter of world’s population and within the region India accounts for 73 percent of the population, the magnitude of the problem can be well-understood.

This also reiterates the much repeated contention that high GDP does not automatically deliver human development. It needs more focused and deliberate public policy interventions. On the other hand, estimates suggest that if the work participation rate of women in improved, the GDP gets a 2-4 percent boost in countries like India.

The present scenario looks bleak and disappointing. We are talking of half the population of the country- a country with a woman as the President and another woman as the most important leader of the ruling party and also listed as one of the most powerful women in the world. While these are realities, the reality that the more things change, the more they remain the same seems to be the case here.

We also seem to know the answers, improved access to basic services like health, education and nutrition, increased empowerment at the grass root level, enhanced socio –political representation. However, we are so poor at delivering that changes are far too little.

How can the status of women in South Asia change?