Engendering Health: The Challenge of Equity

Health scientists have been concerned about health inequity at least since the early part of the nineteenth century, when distinctions between the health status of rich and poor were recognized to be pervasive. Such distinctions are also seen to be causally interactive with other determinants of inequality, such as race and caste. Yet attention to health equity, on the basis of economic class, caste, or race, has not spilled over to an equal extent and to an effective consideration of gender. There is still a need for health professions at large to recognize widespread and profound implications of gender-based inequities in health.

To understand women’s health problems in the third world, one must examine causal factors that go far beyond the biomedical domain, including social, cultural, and economic issues such as poverty, and systematic discrimination, neglect, and abuse. Maternal mortality is an indicator of disparity and inequity between men and women and its extent a sign of women’s place in society and their access to social, health, and nutrition services to economic opportunities. The level of maternal mortality is a sensitive index of the prevailing health conditions and general socioeconomic development of a community. In most developing countries, women of reproductive age (15 to 49 years) constitute a little more than one-fifth of the total population. These women are exposed repeatedly to the risk of pregnancy and childbearing and, under existing socioeconomic conditions and the inadequacy of medical and health facilities, are at great risk of morbidity and mortality from causes related to pregnancy.

This paper examines the causal factors leading to maternal mortality in Andhra Pradesh, India. Secondary data from the National Family and Health Surveys, Andhra Pradesh were used to examine and compare the different variables that directly or indirectly causing maternal deaths. Variables like female literacy, health infrastructure, utilization of maternal health services, total fertility rate, age specific fertility rate and status of women were examined and synthesized. Although the use of these data helps to provide a reasonable picture of women’s health status in Andhra Pradesh, it might underestimate the severity of the problem. Data limitations include questions about the reliability of the available data, as interior rural and difficult to reach areas are common in the state.

The findings show a mixed picture with regard to the causal factors of maternal mortality in Andhra Pradesh. Family planning has reduced the absolute number of maternal deaths but not the maternal mortality ratio, which is the total number of maternal deaths per 100,000 live births. In other words, pregnancy has not become much safer. Available information suggests that the underlying causes reflect the underlying factors leading to maternal deaths, including women’s social status and gender bias, lack of education, and lack of control over fertility and assets. These underlying factors are crucial in the analysis of women’s status as it plays a critical role in creating the ideas around reproductive health, but it must be an integral part of defining interventions to improve reproductive health. Reproductive health demands moving beyond the biomedical model to examine health in its social context, for only when the social determinants, including gender, of health and ill health are understood can interventions be appropriately defined. Central to that analysis are questions of rights, equity, and dignity. There is a need to focus broad safe motherhood programs on maternal mortality reduction, while still maintaining a commitment to improving the overall health and socioeconomic status of women.