M.A.3rd Sem, KU-Women's Studies, Paper-4, Unit-III (A Comparative Study of Rural & Urban Women's Health) Class Notes

 By Dr. Farzeen

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Unit III: Comparative Study of Rural and Urban Areas

1. Rural Women’s Health

Rural women’s health in India reflects a complex interaction of socio-economic, cultural, and infrastructural barriers. Despite progress under various government schemes, rural areas continue to face structural inequalities in access to healthcare.

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A. Dependency on Traditional Healers

• In rural areas, especially in remote and hilly regions like Uttarakhand, the first line of treatment often comes from traditional healers, faith-based healers (ojhas, tantriks), or untrained local practitioners (quacks).

• Reasons for dependency:

  • Lack of nearby hospitals or trained doctors.

  • Cultural beliefs in traditional remedies.

  • Low literacy and limited awareness of modern medical benefits.

• Implication: Women delay seeking professional medical help during pregnancy or illness, leading to complications.

📌 Example (Uttarakhand): In villages located above 1500–2000 meters altitude, reaching a Primary Health Centre (PHC) requires walking several kilometers, so traditional healers are preferred in emergencies.

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B. Higher Maternal Mortality due to Delayed Transport Facilities

• Maternal Mortality Ratio (MMR) is significantly higher in rural areas compared to urban regions.

• Causes:

  • Delayed access to transport (ambulance or private vehicle).

  • Lack of emergency obstetric care in nearby health centers.

  • Absence of timely blood transfusion facilities in rural hospitals.

• Three Delays Model (Thaddeus & Maine, 1994):

  1. Delay in recognizing danger signs and deciding to seek care.

  2. Delay in reaching health facility due to poor transport.

  3. Delay in receiving adequate care at the facility.

• Rural women, particularly in Uttarakhand’s mountainous districts (Pithoragarh, Chamoli, Bageshwar), face all three types of delays, leading to preventable maternal deaths.

📊 NFHS-5 Data (2019-21, Uttarakhand): Institutional births in rural areas are lower (≈72%) compared to urban areas (≈90%).

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C. Malnutrition Prevalent due to Low Income and Lack of Awareness

• Malnutrition among rural women is a chronic issue because of:

  • Poverty and limited dietary diversity.

  • Cultural preference for feeding male members first.

  • Seasonal food insecurity in rain-fed agricultural economies.

• Consequences:

  • High prevalence of anemia (iron deficiency).

  • Low Body Mass Index (BMI).

  • Increased risk of complications during pregnancy and childbirth.

• NFHS-5 Data: In Uttarakhand, 32% of women aged 15–49 are anemic, with rural women showing a slightly higher burden compared to urban women.

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D. Low Literacy Rates Affect Health Awareness and Adoption of Schemes

• Literacy is directly linked to health awareness.

• Rural women, particularly in marginalized communities, are less aware of:

  • Maternal health schemes (e.g., Janani Suraksha Yojana, PMMVY).

  • Nutritional programs (POSHAN Abhiyaan, ICDS).

  • Reproductive rights and family planning.

• Low female literacy in rural Uttarakhand (≈74%, lower than urban female literacy of 88%) reduces the ability to demand quality healthcare or understand medical instructions.

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E. Early Marriages and Frequent Pregnancies

• Early marriage remains common in rural India despite legal restrictions (marriage age for girls = 18 years).

• Causes:

  • Poverty, dowry system, and cultural traditions.

  • Lack of higher education facilities in rural areas, leading to early dropout and marriage.

• Health consequences:

  • Adolescent pregnancies → higher maternal and infant mortality.

  • Repeated pregnancies without spacing → nutritional depletion (“maternal depletion syndrome”).

  • Greater risk of cervical cancer and reproductive tract infections.

📊 NFHS-5 Data for Uttarakhand:

• Around 13% of women aged 20–24 were married before 18 years, with rural areas showing higher prevalence.

• Contraceptive prevalence rate is lower in rural districts, contributing to high fertility rates.

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Conclusion

Rural women’s health challenges arise from a combination of socio-economic deprivation, inadequate infrastructure, and cultural practices. While government initiatives like NHM, JSY, JSSK, and POSHAN Abhiyaan have improved access to maternal and child healthcare, the benefits remain unevenly distributed. In Uttarakhand, geographical barriers make the situation more severe, requiring localized solutions such as mobile health units, helicopter ambulance services, and strengthening the role of ASHAs and ANMs in rural outreach.

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Unit III: Comparative Study of Rural and Urban Areas

2. Urban Women’s Health

Urban women generally enjoy better healthcare facilities, higher literacy, and awareness compared to their rural counterparts. However, rapid urbanization, lifestyle changes, and socio-economic inequalities create new health challenges unique to urban contexts.

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A. Better Access to Hospitals and Diagnostic Facilities

• Urban areas are better served with:

  • Government hospitals, private clinics, diagnostic centers, and specialty hospitals.

  • Presence of trained gynecologists, obstetricians, and pediatricians.

• Women benefit from:

  • Greater likelihood of institutional deliveries.

  • Availability of emergency obstetric care and blood banks.

  • Access to preventive health check-ups, mammography, Pap smears, etc.

• Uttarakhand context:

  • Cities like Dehradun, Haldwani, Haridwar, and Rudrapur have tertiary hospitals (AIIMS Rishikesh, Doon Medical College).

  • Urban institutional delivery rate is around 90% (NFHS-5), much higher than rural.

📊 NFHS-5 (India, 2019–21):

• Urban institutional births: 94%

• Rural institutional births: 79%

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B. Higher Awareness of Reproductive Rights

• Urban women are more likely to:

  • Use contraception effectively.

  • Access safe abortion services under the MTP Act, 1971 (amended 2021).

  • Demand antenatal and postnatal care.

• Educational advantage: Higher female literacy in cities → greater health-seeking behavior.

• Civil society support: NGOs and women’s organizations in cities actively promote awareness of reproductive rights and menstrual hygiene.

📊 NFHS-5 (Uttarakhand):

• Contraceptive use: Urban – 63%, Rural – 55%.

• Antenatal care (4+ visits): Urban – 83%, Rural – 66%.

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C. Increase in Lifestyle-related Diseases

Urbanization has led to non-communicable diseases (NCDs) emerging as major health threats for women.

• Obesity & Overweight:

  • Sedentary lifestyles and high-calorie diets cause higher BMI levels.

  • NFHS-5: 33% of urban women in Uttarakhand are overweight/obese, compared to 22% in rural areas.

• Diabetes & Hypertension:

  • Urban women show a higher prevalence due to stress, poor diet, and lack of exercise.

• Cardiovascular Diseases:

  • Increasing among middle-aged and working women.

• Reproductive Cancers:

  • Urban women face higher risk of breast and cervical cancer, partly due to lifestyle and delayed childbearing.

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D. Mental Health Issues

Urbanization improves healthcare access but creates psychological burdens:

• Stress & Anxiety: Balancing professional work, domestic responsibilities, and childcare.

• Depression: Rising among urban women due to social isolation, marital conflicts, and lack of family support.

• Workplace Challenges: Gender discrimination, sexual harassment, and job insecurity affect mental health.

• Post-partum Depression: Often reported in urban areas due to nuclear family systems with limited support.

📊 National Mental Health Survey (2016):

• Prevalence of common mental disorders among women in urban India was higher than rural.

• Urban women also face greater reporting and diagnosis, though stigma remains.

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E. Emerging Double Burden of Health

• Urban women experience a double burden:

  • Communicable diseases (like TB, dengue, and reproductive tract infections in urban slums).

  • Non-communicable diseases (obesity, diabetes, hypertension in middle- and upper-class women).

• Urban slum women are especially vulnerable:

  • Poor sanitation, overcrowding, and lack of safe drinking water.

  • Low coverage of maternal health programs compared to wealthier urban women.

• Thus, urban women’s health outcomes are not uniform but stratified by class, income, and location.

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F. Uttarakhand Context

• Urban health advantages:

  • Access to AIIMS Rishikesh and Doon Medical College.

  • Growing private sector hospitals in Dehradun, Haridwar, Haldwani.

• Challenges:

  • Migration from rural hills to urban centers creates slum settlements where women face poor sanitation, unsafe drinking water, and higher risk of communicable diseases.

  • Lifestyle diseases are sharply increasing in middle-class women, especially in Dehradun and Haridwar.

• Policy initiatives:

  • Urban Health Mission (a component of NHM) targets slum women with maternal and child healthcare services.

  • NGO-led interventions for reproductive health awareness in slums of Haridwar and Dehradun.

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Conclusion

Urban women in India and Uttarakhand have better healthcare access, higher literacy, and reproductive health awareness compared to rural women. However, they face new challenges linked to modernization – such as non-communicable diseases, stress, and mental health issues. Importantly, urban health disparities between slum dwellers and middle-class women highlight the need for targeted interventions.

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Unit III: Comparative Study of Rural and Urban Areas

3. Special Reference to Uttarakhand

Women’s health in Uttarakhand reflects the dual reality of mountainous rural hardship and emerging urban lifestyle challenges. The state’s unique geography, socio-economic conditions, and migration patterns shape distinct health outcomes for women.

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A. Geographical Challenges: Hilly Terrain and Access to Hospitals

• Around 86% of Uttarakhand is mountainous, which creates difficult terrain, scattered settlements, and transport barriers.

• Challenges:

  • Villages located in high-altitude districts like Chamoli, Pithoragarh, Bageshwar often lack all-weather roads.

  • Women in labor face delays in reaching health facilities (sometimes 6–8 hours of travel).

  • Limited availability of specialists (gynecologists, anesthetists) in hilly districts.

• Health consequences:

  • Higher maternal mortality in remote districts.

  • Dependence on traditional healers due to poor accessibility.

• Government response:

  • 108 Emergency Ambulance Service introduced to provide quicker transport.

  • Mobile Medical Units (MMUs) deployed in hilly districts.

📊 NFHS-5 Data (Uttarakhand, 2019–21):

• Institutional births: Rural – 72% | Urban – 90%

• Antenatal care (4+ visits): Rural – 66% | Urban – 83%

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B. Migration Issue: Feminization of Agriculture & Household Burden

• Large-scale male out-migration from hill districts to cities for jobs.

• Consequences for women:

  • Women left behind manage agriculture, household, and caregiving roles.

  • Double burden increases physical and mental stress.

  • Lower time availability to seek healthcare.

• Social impact:

  • Women-headed households are rising, but with limited financial autonomy.

  • Mental health burden due to loneliness, overwork, and lack of support.

📌 Data point: According to Uttarakhand Migration Commission (2017), nearly 3,000 villages face heavy out-migration, leaving women as primary caretakers of land and family.

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C. High Prevalence of Anemia in Women

• Anemia is one of the most common health problems among women in Uttarakhand.

• Causes:

  • Nutritional deficiencies (iron, folic acid, vitamin B12).

  • Workload from agriculture and household chores.

  • Early marriage and repeated pregnancies.

• NFHS-5 Uttarakhand:

  • 32% of women (15–49 years) are anemic.

  • Rural prevalence is slightly higher than urban.

• Implications:

  • Weak immunity, fatigue, reduced productivity.

  • High risk during pregnancy → low birth weight babies, maternal complications.

• Policy response:

  • Anemia Mukt Bharat campaign under POSHAN Abhiyaan provides IFA (Iron-Folic Acid) tablets to adolescent girls and pregnant women.

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D. Maternal Healthcare Issues: Deaths due to Delay

• In hilly regions, maternal mortality is linked to “Three Delays”:

  1. Delay in recognizing complications.

  2. Delay in reaching health facilities.

  3. Delay in receiving treatment at understaffed hospitals.

• Example: Pregnant women from remote villages in Chamoli or Uttarkashi often cannot reach district hospitals in time.

• NFHS-5 Uttarakhand Data:

  • Mothers receiving full antenatal care: Rural – 17% | Urban – 30%.

  • Delivery assisted by skilled personnel is lower in rural compared to urban.

• Emergency referral systems are improving, but lack of blood banks and surgical specialists in CHCs/PHCs still contributes to preventable maternal deaths.

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E. Positive Aspects: Women’s Agency and Community Participation

Despite challenges, Uttarakhand also presents success stories in women’s health:

• Self-Help Groups (SHGs) & Mahila Mandals:

  • Active in spreading awareness about nutrition, sanitation, and maternal care.

  • Women play a strong role in grassroots governance (Panchayati Raj institutions).

• ASHA & ANM workers:

  • Act as a lifeline for maternal and child healthcare in remote villages.

  • Provide immunization, antenatal counseling, and escort services for institutional deliveries.

• 108 Ambulance Service:

  • Widely acknowledged as a lifesaving initiative in mountainous terrain.

• NGO initiatives:

  • E.g., Himalayan Institute Hospital Trust (HIHT) in Dehradun runs rural outreach programs for maternal and child health.

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Conclusion

Women’s health in Uttarakhand is shaped by geography, migration, and socio-economic realities.

• Negative aspects: Difficult access to hospitals, anemia, high maternal deaths in remote districts, workload from migration.

• Positive aspects: Strong community participation through SHGs and health workers, innovative government schemes like 108 ambulance service.

• Way forward: Focus on decentralized health infrastructure, special schemes for hilly districts, and women-centric nutrition and mental health programs to bridge rural-urban disparities in the state.

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