First World Suffering

Kerala’s women conquered primary healthcare problems before much of India even saw a problem. So, why aren’t they celebrating?

Imagine a time in India when the crisis in women’s health has moved from life-threatening to lifestyle. Imagine a place where women are seeking so much hospital care that experts are beginning to worry about over-medicalisation. Imagine a predicament when a state government has to rethink it healthcare policy for women because major targets have been long achieved.

Welcome to Kerala, India’s pocket-size first world state. Well, almost. (Developed countries would still be outraged by its maternal mortality rate and degree of anaemia among women.)

Emerging women’s health problems in Kerala belong to an era that the rest of India hasn’t made it to yet.

Kochi-based Centre for Socio-economic and Environmental Studies (CSES) recently released a working paper titled ‘Health of Women in Kerala: Current Status and Emerging Issues’. It reads nothing like any health report on India so far.

Says N Ajit Kumar, director of CSES, “As a result of sustained emphasis in Kerala on the social sector, especially on education and health, we have reached a stage where women are facing second-generation health problems.”

The study calls for the state government to look beyond reproductive healthcare and at women’s health concerns arising from old age, obesity and mental stress. The study was conducted by Kumar and D Radha Devi, a visiting fellow at CSES.

‘Priorities, approaches and strategies set at the national level may not be appropriate for Kerala. Therefore, moving in the same pattern as other states based on the conventional strategies for health improvement may not be advisable or adequate for Kerala,’ says the study.

Why? One instance.

In Kerala, 99 per cent of the deliveries are done in hospitals. In comparison, in India overall, institutional deliveries constitute 39 per cent only.

Strangely enough, Kerala has now gone the other extreme and is now facing the problem of over-medicalisation of deliveries.

‘The caesarian section rate in Kerala is more than three times the national rate and is much higher than the maximum justifiable rate of 15 per cent recommended by the World Health Organisation.’ The medical risk involved in a caesarian section is higher. A higher dependence on private hospitals and their profit motive push up the caesarian rate.

‘The one-child norm is cited as another reason… in such a situation, the child and the mother are very precious and the doctor does not have much elbow space. It is reported that in some cases, caesarian section is performed on demand from the family so that the delivery occurs at an auspicious time.’ The more surprising reason why Malayali women are over-medicalised is that they, unlike the stereotypical Indian mentality, are over-sensitive to medical problems.

KP Aravindan, professor of pathology at Calicut Medical College, explains why: “The most important contribution of the Communist Party in Kerala was breaching the psychological barrier of poverty. This made people believe in a better future… They flocked to hospitals. The birth rate came down and each child became precious… It was actually girl’s schooling that made all the difference.”

But while Kerala might look like an over-achiever compared to India’s record on reproductive healthcare, it remains largely unprepared for emerging health problems.

For Kerala’s Health and Social Welfare Secretary Usha Titus, health problems emerging from women living longer and lifestyle changes reflected in consumption of processed foods and lack of exercise are uppermost on the women’s health agenda. “We need to make women more aware of their bodies,” says Titus.

The study also finds that obesity is much higher among women in Kerala when compared to its incidence among Indian women in general. It is also more common among women than men in the state and the difference too is more marked in Kerala than in the rest of India. And, of course, the crisis in mental health. Women in Kerala experience higher degrees of mental stress.

This is another of Kerala’s dichotomies. Says Aravindan, “Neither great success in health and education nor the political radicalisation has been accompanied by a more liberal sexual outlook. The psychological grip of patriarchy is still strong. Even the most fervent Left radicals have a Victorian sense of morality. This has resulted in denial of physical and emotional space to women commensurate with other achievements. I think this is an important cause for stress and mental illness.”

With women living longer, they are more likely to spend more years in poor health with problems such as hypertension and diabetes.

A study warns that more than two-thirds of elderly women in the state are financially dependent, making them soft targets for abuse: ‘Data on elder abuse is not easy to obtain, as parents would not usually talk ill of their children irrespective of the sufferings they endure. Qualitative studies are required to develop further understanding on the different dimensions of elder abuse.’

So while women’s health in India has become synonymous with reproductive healthcare, the Kerala experience has, perhaps, for the first time taken women’s healthcare in India beyond the concerns of motherhood.

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Pallavi Polanki