“Deeply rooted gender inequality” has failed women's access to healthcare, says the Human Development Report for the district for 2009. A telling pointed made by the HDR commissioned under the Gandhigram University for the period from 2003-07 revealed the extent to which snapped reproductive rights of women has triggered a vicious cycle of poverty of health.
Multiple pregnancies, preference for sons, inability to take a stance against the family, and underlying patriarchal social mores – have impacted on the health of women, including maternal mortality, infant mortaility, low birth weight, ante-natal anaemia among others .
The Still Birth Rate of Nagapattinam, according to 2003 figures of the Department of Health was 16.7, higher than the State average of 15.5. However, in comparison to districts such as Trichy(19.4); Madurai(18.8); Perambalur(21.2); Pudukottai(20.8); and Theni (19.9), Nagapattinam was still lower; yet long way to touch Chennai(3.0) and Kanyakumari(6.6) Within the district, 2007 figures reveal that Kizhvelur block had the higher SBR average of 25.05.
Infant Mortality Rates stood at 30.2, marginally higher than State average of 30.1. The HDR observed that among the blocks highest IMR was at Thirumarugal(28.07) and lowest at Kuthalam(16.20); but relatively urbanized Mayiladuthurai(22.26) and Nagapattinam(22.33) had recorded higher IMR, suggesting that presence of private healthcare has not made tangible contribution, the report said.
The Maternal Mortality Rate average was 1.47 for the five-year period. In 2003, MMR for Nagapattinam (1.23) and for Tamil Nadu (0.9).
According to Dr.Jhansi Rani, Assistant Surgeon, Thirukadayur PHC, every woman suffers from antenatal anemia, and it is rooted in the fact that they are yet to reclaim their reproductive rights – to make the choice for pregnancy. Despite the NHRM providing for iron injections, the fact that every pregnant woman suffers from chronic antenatal anemia has PHCs running out of stocks. “Most often, we buy injections to ensure the women get them. Also, they will have to be pushed by VHNs to visit the PHC for the injections,” says Dr.Jhansi.
However, a proper coordination between anganwadi workers responsible for door-to-door nutrition and the PHCs can address the problem of anemia.“The balwadi workers are expected to be aware of the number of pregnancies and deliveries in their area, but most often they are clueless,” says Dr.Jhansi.
Preference for sons and failure to beget sons, and familial pressure has stripped women of any say in their health.
The HDR reveals that Sirkazhi had a whopping 70.50 percent of anemic pregnant women in 2004; and the district percentage in 2007 was 37.25 with highest in Keezhvelur (52.40).
Institutional interventions have failed in the face of a society steeped in patriarchal moorings. “How does one retrieve women's agency over their own bodies and choices, when husbands and in-laws have usurped that right,” asks Vanaja, a womens' rights activist. Early marriage is a key issue.
In a largely fishing community-setup, convincing families even for tubectomies is an ordeal by itself. Vasectomy, despite its simplicity and no-hospital stay has no takers, says Dr.Jhansi.
Institutional deliveries have increased to 89.20 percent. However, they do not reflect emancipation for women, when decision making does not reside with them. It is not just access to health care, but the ability to make an informed choice and decision that plays a vital role in women's health, say doctors and womens' rights activists.
