Just as land is valuable because it
is fertile, women too are for the same reasons. And that really sums
up the status of women in India and the South Asian region.

A woman’s ability
to bear innumerable children, mostly boys, is what increases
or diminishes a woman’s position within the marital home and eventually extends
to her position in society. Quite closely connected to this is her sexual
autonomy, which remains restricted. It is
this control over both property and the sexual control of women that
defines male power and authority, and the secondary status of women in both the paternal and matrimonial homes.

The Taj Mahal – one of the eternal
symbols of love – is a mausoleum erected by the Mughal Emperor Shah
Jahan for his favorite queen, Mumtaz Mahal, who died of complications
related to childbirth after having delivered 14 children. Even today,
despite leaps in medical research and technology, thousands of women
in the country continue to die during childbirth, and, even more tragically,
unremembered and mostly unaccounted for. In India
every seven minutes a
maternal death occurs;  more than 75,000 women die each year
in India alone. While the maternal mortality ratio over the years has
been falling, the rate is too slow, continuing to add to the already enormous
statistics.

While inaccessibility to even basic
medical facilities is entrenched, social attitudes around the accepted role of
women as childbearers – and more specifically of male children – further exacerbates the problem. Governments make and execute laws
governing ownership, marriage and divorce, education, inheritance, employment
and family leave, and innumerable aspects of life that directly impact
the status of females relative to men. And every woman in spite of her
educational and social status in society is expected to play this pre-assigned
role. While a minuscule minority might be able to exercise their choice
of timing, by and large
this choice is not available to most women. And the same is true of pre- and
post- natal care as well.

Consequently, not only do women go through
one pregnancy after the other but most of the time they are unaware
of the health hazards for themselves and their children, not to mention
the possibilities of infections from their spouses.

The concern surrounding HIV/AIDS
in recent years has had the effect of opening the doors to information
on other possible infections too. While vulnerability to misinformation
continues to engulf women from
poorer sections — many will be deprived of their children and thrown
out of their matrimonial homes after having contracted the virus (frequently
from their spouses) — a recent
judgment has set
a positive precedent in stating that a positive mother cannot be deprived
from bringing up her child. More importantly, it might serve to remove
stereotypes associated with the virus.

In the throes of poverty and illiteracy
most women find themselves married off at a very young age. Even
before they are able to understand the real implications of the relationship, these young women are already into their first – if not second or third – pregnancies. At
a time when the various state governments struggle over the ethics of
sex education in the curriculum of school-going children, many organizations
have taken it upon themselves to use sex-education as a tool to empower young girls,
women and communities in delaying both marriages and pregnancies.

Kishanganj
– an underdeveloped district in the eastern state of Bihar – which lacked
even a district hospital until a few years ago, has in more recent months
witnessed important attitudinal changes brought on by reproductive and sexual
healthcare classes to
teenage girls in a madrassa. Consequently, information is all it took
for a mother-in-law to get her daughters-in-law operations to prevent further
pregnancies.  A 16-year-old girl, keen on pursuing her education,
aware of the hazards of early childbirth, chose to marry only after
she turned eighteen. The census of 2001 had shown this district with
the lowest female literacy rate, 18.5 per cent, in India.

Another such initiative has been the formation of the Coalition for Women Deliver,
India in October 2007, an effort that would include all current and new players working
towards the Millennium Development Goals (MDGs). One of the critical
goals is to strengthen local partnerships while addressing high maternal
mortality in the country. Why local partnerships? While funds
and policy commitments are in place, it is at the level of actual implementation
that gaps appear.  The problem remains the absence of skilled health
workers and medical personnel at the community and district level, further
undermining strong policy commitments towards the reduction of maternal
deaths.

For years, midwives have been the closest
pregnant women got to any kind of structured health care during and
after their childbirths. Having woken up to the magnitude of the tragedy
of maternal mortality due to the lack of adequate medical support, the
government in recent years is focusing
on the issue of training auxiliary nurse midwives (ANM). The focus is especially
in rural areas, to deal with emergency situations with the
support of a functioning health care referral system. Investing in midwives could prove to be the swiftest way of achieving universal access to
reproductive health, as well as improve maternal health for most governments.

But the battle is not just restricted
to adequate health care during and after childbirth. The preference
for the boy child and the second-class treatment of girl children within
their paternal homes is a reflection
of societal attitudes which only get reinforced as the girl moves in
to adulthood. The same patterns are then replicated in the matrimonial
homes. From sex selective abortions to engineer a male child, to the
manner in which daughters are treated while prioritizing and apportioning
resources during the childhood — these are all manifestations of this mindset.

Considering anemic women are bound to bear anemic children, it is
hardly surprising then that seventy
percent of children in
India in the age group of six to 59 months suffer from it. 63
per cent are in the urban areas and 71.5 percent in the rural areas. Hope
comes in the form of a woman who recently pursued a legal battle against
her husband and in-laws for forcing her to abort
her fetus after an ultrasound
test ostensibly showed the fetus to be that of a female.

The Women Deliver Coalition operates
as an advocacy group whose primary role is to be a neutral, inclusive pan-India
entity to convene diverse groups working in maternal health for regular
information sharing. In a path breaking attempt as an India-specific
one-stop-shop on maternal health, they will host the creation of a public
virtual domain that brings together information at policy and program
levels on maternal health and build advocacy platforms across all sectors,
especially linking developmental work to media and industry.

In communities where women’s rights
are on par with men’s, women are able to take control of their own fertility
and invariably have fewer children on average. Unfortunately, in
many cultural contexts and sub-contexts, contraception is socially and
morally criminalized, leaving women with very few options of birth control.
Girls brought up as equals and eventually vested with choices over their
fertility invest more for their children and less on having more children, through their own health paving the way for healthy families.
And those families in turn reflect the health of communities they inhabit and
societies they build.