New Delhi: Health, as a concept, goes much beyond medical science. Good health and well-being are outcomes of a range of non-medical factors which impact people through the course of their lives. Some of these prominent ‘social determinants of health’, which can deeply influence health seeking behaviour, health equity, include income and social protection, education, early childhood development, non-discrimination, social inclusion and access to affordable and quality health services. Gender inequalities in these social determinants of health, which have persisted for centuries, are at the core of health inequities for women and girls across the globe, including India.
By definition, gender refers to socially constructed roles, behaviours and attributes considered ‘appropriate’ for men and women. These are determined by power structures in society. While gender inequality across every sphere is not unique to any country, in the Indian context, it has manifested into patriarchal norms and harmful practices such as son preference, sex selection and child marriage.
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Child marriages not only undervalue the girl child and deprive them of childhood but are also detrimental to their health and well-being. Child marriages impact girls through their lives increasing their susceptibility to early pregnancies, unsafe abortions, maternal mortality, poor health and nutrition status of both the teenage mother and the child. Poverty, lack of education, safety concerns and control over sexuality are additional factors that perpetuate the practice. Child marriages have widespread acceptance among several communities, which view them as a solution to ‘protect’ and ‘secure’ the future of their girls. Families are motivated out of a sense of acting in the ‘best interests’ of their girls. It is therefore not surprising that child marriages have continued to prevail despite existing laws (such as the legal marriageable age of 18 for girls and 21 for boys) having been in place for over four decades. Despite large scale programmatic efforts to spread awareness on the adverse outcomes of child marriages, the last five years have witnessed a marginal decline (from 27 per cent in 2015-16 to 23 per cent in 2019-21), as is evident from the last two rounds of the National Family Health Survey conducted by the Ministry of Health and Family Welfare, Government of India. The need to end child marriages assumes greater significance in the context of the COVID-19 pandemic. Several reports and anecdotal evidence suggest that many young girls may never return to schools as a result of COVID-induced school closures and being married off and forced to shun any plans to pursue higher education and employment opportunities.
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In a recent turn of events, the Prohibition of Child Marriage (Amendment) Bill, 2021, which seeks to raise the age of legal marriage for women from 18 to 21, was sent to a Parliamentary Standing Committee for further deliberation on 22nd December 2021. While legal enactment is necessary, our challenge is also to change perspectives around child marriages at the community level and to do so bearing in mind the societal factors and pressures which lead communities to make such decisions. Our response to child marriages, therefore, cannot rely on the use of legal instruments alone. Instead, we need a more holistic approach that includes empowering girls and their families with the right knowledge and means to understand why the practice is more of a problem than a solution.
As we look ahead, existing policies and strategies need to be more responsive to their health and well-being across the life course. Addressing the social determinants of health, which impact women and girls differentially will require a “health in all policies” approach. We need to optimise investments in women’s and girls’ health. This can be done through:
1. Increased investments in secondary school education for girls and there is a direct correlation between education and delay in age at marriage. Allowing girls to complete their education, especially upto senior secondary level will also give them the opportunity of being financially independent.
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2. Include Comprehensive Sexuality Education (CSE) in the school curriculum and for out-of-school adolescents. Adolescents need access to CSE to build their knowledge, attitudes, skills and values that will enable them to take charge of their health and well-being in addition to normalising conversations around sexual and reproductive health (SRH) issues.
3. Ensure universal access to family planning and SRH services: Improving family planning and SRH service delivery has enormous benefits like prevention of unwanted and teenage pregnancies, unsafe abortions and lower infant and maternal mortality rates.
4. Invest in gender equality initiatives that promote equitable gender norms. This will not only empower girls from a very young age to take charge of their lives and decisions but also sensitise young boys on gender issues.
As we celebrate the National Girl Child day today, we must acknowledge the extraordinary contributions of women and girls to families, societies, economies and nations. Going forward, the needs of women and girls must be inherent to all aspects of decision-making. This will require action by ministries of health, both alone and in collaboration with other ministries, private sector and civil society organisations.
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(Written by Sanghamitra Singh, Senior Manager, Knowledge Management and Partnerships, Population Foundation of India.)
Disclaimer: The opinions expressed within this article are the personal opinions of the author. The facts and opinions appearing in the article do not reflect the views of NDTV and NDTV does not assume any responsibility or liability for the same.
NDTV – Dettol have been working towards a clean and healthy India since 2014 via the Banega Swachh India initiative, which is helmed by Campaign Ambassador Amitabh Bachchan. The campaign aims to highlight the inter-dependency of humans and the environment, and of humans on one another with the focus on One Health, One Planet, One Future – Leaving No One Behind. It stresses on the need to take care of, and consider, everyone’s health in India – especially vulnerable communities – the LGBTQ population, indigenous people, India’s different tribes, ethnic and linguistic minorities, people with disabilities, migrants, geographically remote populations, gender and sexual minorities. In wake of the current COVID-19 pandemic, the need for WASH (Water, Sanitation and Hygiene) is reaffirmed as handwashing is one of the ways to prevent Coronavirus infection and other diseases. The campaign will continue to raise awareness on the same along with focussing on the importance of nutrition and healthcare for women and children, fight malnutrition, mental wellbeing, self care, science and health, adolescent health & gender awareness. Along with the health of people, the campaign has realised the need to also take care of the health of the eco-system. Our environment is fragile due to human activity, which is not only over-exploiting available resources, but also generating immense pollution as a result of using and extracting those resources. The imbalance has also led to immense biodiversity loss that has caused one of the biggest threats to human survival – climate change. It has now been described as a “code red for humanity.” The campaign will continue to cover issues like air pollution, waste management, plastic ban, manual scavenging and sanitation workers and menstrual hygiene. Banega Swasth India will also be taking forward the dream of Swasth Bharat, the campaign feels that only a Swachh or clean India where toilets are used and open defecation free (ODF) status achieved as part of the Swachh Bharat Abhiyan launched by Prime Minister Narendra Modi in 2014, can eradicate diseases like diahorrea and the country can become a Swasth or healthy India.