Exploring the Links between Health Sector Reforms & Reproductive Health & Rights

At this meeting, findings were presented from a two-year research project examining the implications of health sector reforms for reproductive health services in India. The purpose of the project is to provide information on how to shape reforms that seek to effectively promote reproductive rights and health and gender equity. This report covers district-level research studies conducted in Tamil Nadu which examine the implications of reforms for reproductive health services for health systems, users, and providers.

This study aims to:

1. identify the gaps in the conceptualisation and implementation of the integrated RCH programme in Tamil Nadu. Specifically it: examines the structure of the primary health care system in its ability to provide quality reproductive health services; and assesses provider's understanding of reproductive health and rights.
2. explore whether the RCH programme has improved women's access to quality reproductive health care. Specifically it looks at: women's access to and utilisation of reproductive health services; and women's perceptions on quality of reproductive health services.
3. examine the implications of the RCH programme for gender equity and reproductive rights. Specifically it examines: the gender context of women's decisions to seek reproductive health care; and the provider's understanding of women's social vulnerability to reproductive health.

The findings of the study are presented thematically within sections that address: a) a women's perceptions of reproductive health needs and their experiences with seeking health care; b) structural constraints at the primary health care level; and c) provider's perceptions of the RCH programme and constraints in delivering quality reproductive health care. Of the 30 districts in the state, the study was conducted in the two pilot districts selected for the RCH sub-programme - Madurai and Theni with qualitative and the quantitative components.

The study points out a number of vulnerabilities experienced by women. One of them is female infanticide for reasons of a "dowry." There is a belief that the daughter takes the wealth away from the home while the son brings in wealth. Women belive that “excessive heat” (soodu), either from within the body or due to prolonged exposure to sun is a cause of their reproductive symptoms.

According to the report, regardless of their socio-economic status, 60% of women tend to use private health facilities, as compared to the remaining who use government facilities. In cases of reproductive and general morbidities, only when women perceive themselves to be very sick do they think of going to a health facility or provider. And "women often do not see their reproductive symptoms a significant problem for which they need to seek medical care."

In conclusion the report states that "there was a fatalism in the approach that women had, to the discrimination they suffered from non-co-operative husbands, or the situation of their lives owing to lack of choice in marriage. Male violence was socially sanctioned and rarely questioned. Drinking liquor and perpetrating violence on women in the family has become a part of their lives. Reproductive health problems largely remain relatively less addressed while pregnancy and childbirth are the issues that seem to get attention both for women and the primary heath care system."

Click here for the full report.For further information contact: change@genderhealth.org