M. A. 2nd Semester Complete Syllabus

 

PAPER 4 – WOMEN AND HEALTH

M.A. 2nd Semester – Complete Class Notes


UNIT I: WOMEN’S HEALTH ISSUES – PAST AND PRESENT SPHERES

1. Introduction to Women’s Health

Meaning and Scope of Women’s Health

Women’s health refers to the comprehensive physical, mental, reproductive, and social well‑being of women across the life cycle. The World Health Organization defines health as a state of complete physical, mental, and social well‑being, not merely the absence of disease. Feminist health scholarship expands this definition by emphasizing gender relations, power structures, and women’s lived experiences in shaping health outcomes.

Women’s health differs from general health because women experience:

  • Unique reproductive functions (menstruation, pregnancy, menopause)

  • Gendered social roles (care work, restricted mobility)

  • Structural inequalities (nutrition, education, access to care)

Thus, women’s health is both biological and socio‑political.

DESCRIPTIVE FORMAT


Introduction to Women’s Health: Meaning and Scope

Women’s health is a multidimensional concept encompassing the physical, mental, reproductive, and social well-being of women throughout their life cycle—from childhood and adolescence to reproductive years and old age. The World Health Organization defines health as “a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity,” emphasizing that health extends beyond biological functioning to broader social conditions (WHO, 1948).

Feminist health scholarship expands this understanding by highlighting that women’s health is profoundly shaped by gender relations, power hierarchies, and social structures that influence women’s access to resources, autonomy, and healthcare. Scholars argue that health outcomes cannot be understood solely through biological differences between sexes but must be situated within the context of gendered inequalities embedded in family, community, and institutional systems (Bird & Rieker, 2008; Gideon, 2016).

Women’s health differs from general or male-norm health frameworks because women experience distinct biological processes such as menstruation, pregnancy, childbirth, and menopause, which require specific healthcare attention across the life course. At the same time, women’s health is shaped by gendered social roles, including unpaid care work, domestic responsibilities, and restrictions on mobility and decision-making, which often limit their ability to seek timely healthcare. Structural inequalities—such as unequal nutrition, lower educational opportunities, poverty, and limited access to medical services—further contribute to gender disparities in health outcomes, particularly in low- and middle-income contexts.

Therefore, women’s health is not merely a biological condition but a socio-political phenomenon shaped by the interaction of physiology, social norms, economic structures, and power relations. Understanding women’s health requires an integrated gender-sensitive framework that recognizes both biological specificity and structural inequality in shaping women’s well-being across the life cycle (Gideon, 2016; Sen & Östlin, 2008).R

References

Bird, C. E., & Rieker, P. P. (2008). Gender and Health: The Effects of Constrained Choices and Social Policies. Cambridge University Press.

Gideon, J. (Ed.). (2016). Handbook on Gender and Health. Edward Elgar.

Sen, G., & Östlin, P. (2008). Gender Inequity in Health: Why It Exists and How We Can Change It. WHO.

World Health Organization. (1948). Constitution of the World Health Organization.


2. Gender and Health: Key Concepts and Frameworks

Sex vs Gender

  • Sex: Biological differences (chromosomes, hormones, reproductive organs)

  • Gender: Socially constructed roles, norms, and expectations assigned to women and men

Health research shows that gender norms influence:

  • Exposure to risks

  • Health‑seeking behavior

  • Access to healthcare

  • Control over resources and decision‑making

For example, women may delay treatment due to household responsibilities or lack of autonomy.

Major Frameworks in Women’s Health

(1) Biomedical Model

The biomedical model views health primarily in terms of biological disease processes. In women’s health, this model historically focused on:

  • Reproduction and fertility

  • Pregnancy and childbirth

  • Hormonal functions

Critique: Feminist scholars argue that this model reduces women to reproductive bodies and ignores social determinants such as poverty, violence, and discrimination (Bird & Rieker, 2008).

(2) Social Determinants of Health Framework

This framework emphasizes that health outcomes are shaped by social and economic conditions such as:

  • Education

  • Income

  • Nutrition

  • Sanitation

  • Gender inequality

Women often experience worse determinants due to patriarchy, leading to poorer health outcomes. For example, gendered food distribution contributes to anemia among women in South Asia (Sen & Östlin, WHO gender report).

(3) Feminist Health Perspective

The feminist approach critiques male‑centric medicine and highlights:

  • Bodily autonomy

  • Reproductive rights

  • Gender bias in healthcare

  • Women’s experiential knowledge

It emphasizes that women’s health cannot be understood without examining power relations and structural inequality (Gideon, 2016).

DESCRIPTIVE FORMAT


Gender and Health: Key Concepts and Frameworks

Understanding women’s health requires a gender-sensitive analytical framework that distinguishes between biological sex and socially constructed gender roles. The term sex refers to biological differences between females and males, including chromosomes, hormonal profiles, and reproductive anatomy. In contrast, gender denotes the socially constructed roles, norms, expectations, and power relations that societies assign to women and men. While sex shapes biological health needs, gender structures the social conditions under which health risks are experienced and healthcare is accessed (Sen & Östlin, 2008).

Health research demonstrates that gender norms significantly influence patterns of exposure to health risks, health-seeking behavior, access to healthcare services, and control over resources and decision-making. Women often face constraints on mobility, financial autonomy, and time due to domestic responsibilities and caregiving roles, which may delay or prevent timely medical treatment. Thus, gender inequality becomes a major social determinant of health disparities between women and men.

Within gender and health scholarship, several conceptual frameworks have been developed to understand women’s health more comprehensively.

Biomedical Model

The biomedical model conceptualizes health primarily in terms of biological processes, pathology, and medical treatment. Historically, women’s health within this framework has been narrowly associated with reproductive functions, particularly fertility, pregnancy, childbirth, and hormonal regulation. Medical knowledge and research often treated the male body as the norm and women mainly as reproductive subjects.

Feminist scholars critique this approach for reducing women’s health to reproductive biology and neglecting broader social determinants such as poverty, gender-based violence, labor burdens, and discrimination in healthcare access. Bird and Rieker (2008) argue that biomedical perspectives overlook how constrained social choices and gendered life conditions shape women’s health outcomes across the life course.

Social Determinants of Health Framework

The social determinants of health framework expands the understanding of health beyond biology by emphasizing the role of socioeconomic and environmental conditions. Factors such as education, income, nutrition, sanitation, housing, and social status significantly shape health outcomes. Gender inequality operates within each of these determinants, often placing women at a structural disadvantage.

In many societies, patriarchal norms restrict women’s access to education, employment, food, and healthcare, resulting in poorer nutritional status and higher disease burden. For instance, gender-biased intra-household food distribution in South Asia contributes to widespread anemia among women despite overall household food availability (Sen & Östlin, 2008). This framework thus demonstrates that women’s health disparities arise from systemic social inequality rather than individual biological vulnerability.

Feminist Health Perspective

The feminist health perspective provides a critical analysis of gender bias in medical knowledge, healthcare systems, and health policy. It challenges male-centric medical models and emphasizes women’s bodily autonomy, reproductive rights, and experiential knowledge of health and illness. Feminist scholars argue that women’s health cannot be fully understood without examining power relations embedded in patriarchy, class hierarchy, and institutional structures.

This perspective highlights issues such as gender bias in diagnosis and treatment, medicalization of women’s bodies, lack of attention to women’s mental health and violence-related health effects, and exclusion of women from clinical research. Gideon (2016) emphasizes that women’s health outcomes reflect structural inequalities in resources, autonomy, and social status, making gender a central determinant of health.

In sum, gender and health scholarship demonstrates that women’s health is shaped by the interaction of biological processes and gendered social structures. A comprehensive understanding therefore requires moving beyond biomedical reductionism toward integrated frameworks that incorporate social determinants and feminist analysis of power and inequality.

References

Bird, C. E., & Rieker, P. P. (2008). Gender and Health: The Effects of Constrained Choices and Social Policies. Cambridge University Press.

Gideon, J. (Ed.). (2016). Handbook on Gender and Health. Edward Elgar.

Sen, G., & Östlin, P. (2008). Gender Inequity in Health: Why It Exists and How We Can Change It. WHO.


3. Feminist Critiques of Biomedical Models

Feminist scholars identify several biases in traditional medicine:

(a) Medicalization of Women’s Bodies

Natural processes like menstruation, menopause, and childbirth are treated as medical problems requiring control and intervention. This shifts authority from women to medical institutions (Riessman, feminist sociology of health).

(b) Reproductive Reductionism

Women historically viewed primarily as mothers. Health programs prioritized fertility control rather than overall well‑being, especially in population policies in developing countries (Hartmann, reproductive politics literature).

(c) Gender Bias in Diagnosis and Treatment

Research shows women’s pain and symptoms are often dismissed or misdiagnosed, especially cardiovascular disease. Clinical trials historically excluded women, leading to male‑norm medical standards (Gideon, 2016).

(d) Neglect of Social Context

Biomedical approaches ignore violence, poverty, and workload—major determinants of women’s health (WHO gender and health framework).

DESCRIPTIVE FORMAT


Feminist Critiques of Biomedical Models

Feminist scholarship has critically examined the traditional biomedical model of health, arguing that it reflects gender bias in both medical knowledge and healthcare practice. The biomedical approach conceptualizes health primarily in terms of biological pathology and medical intervention, often neglecting the social, cultural, and political dimensions of women’s health. Feminist scholars identify several key biases within this model that have historically shaped women’s healthcare in unequal and restrictive ways.

One major critique concerns the medicalization of women’s bodies, whereby natural physiological processes such as menstruation, pregnancy, childbirth, and menopause are framed as medical problems requiring surveillance and intervention. This process shifts authority over women’s bodies from women themselves to medical professionals and institutions. Riessman argues that medicalization transforms normal female life processes into conditions requiring expert management, thereby reducing women’s bodily autonomy and reinforcing dependence on medical systems. Feminist analyses emphasize that such medical control often marginalizes women’s experiential knowledge of their own bodies and health.

A second critique is reproductive reductionism, the tendency to define women primarily through their reproductive functions. Historically, women’s health policies and medical research have focused predominantly on fertility, contraception, and childbirth, often neglecting broader aspects of women’s physical and mental well-being. In many developing countries, population control programs prioritized fertility regulation over women’s health rights, targeting women’s bodies as instruments of demographic policy. Hartmann’s analysis of reproductive politics demonstrates how global population agendas frequently subordinated women’s autonomy and health to state-driven fertility reduction goals. This narrow reproductive focus ignored women’s nutritional needs, occupational health risks, and mental health concerns.

Feminist scholars also highlight gender bias in diagnosis and treatment within biomedical practice. Medical research and clinical trials historically used male bodies as the normative standard, resulting in diagnostic criteria and treatment protocols that do not adequately reflect women’s symptoms or disease patterns. Consequently, women’s pain and health complaints are more likely to be dismissed, misinterpreted, or attributed to psychological causes. This bias is particularly evident in cardiovascular disease, where women’s symptoms often differ from male patterns and are therefore underdiagnosed or treated late. Gideon (2016) notes that the exclusion of women from biomedical research has produced male-centered medical knowledge that inadequately serves women’s health needs.

Another central feminist critique concerns the neglect of social context in biomedical approaches. By focusing narrowly on biological disease mechanisms, the biomedical model overlooks structural determinants such as poverty, gender-based violence, heavy workloads, and limited autonomy that profoundly shape women’s health outcomes. The World Health Organization gender and health framework emphasizes that women’s health risks are deeply embedded in social inequalities, including discrimination in resource allocation, restricted access to healthcare, and exposure to violence. Feminist public health research therefore argues that women’s health cannot be understood or improved without addressing these structural conditions.

In sum, feminist critiques demonstrate that the biomedical model is insufficient for understanding women’s health because it reduces women to biological and reproductive bodies, marginalizes their lived experiences, and ignores social determinants of health. Feminist perspectives call for a more holistic, gender-sensitive health framework that integrates biological processes with social context, power relations, and women’s autonomy in healthcare decision-making.

References

Gideon, J. (Ed.). (2016). Handbook on Gender and Health. Edward Elgar.

Hartmann, B. (1995). Reproductive Rights and Wrongs: The Global Politics of Population Control. South End Press.

Riessman, C. K. (1983). Women and Medicalization: A New Perspective. Social Policy.

World Health Organization. (2009). Women and Health: Today’s Evidence, Tomorrow’s Agenda.


4. Reproductive and Sexual Health

Reproductive health refers to a state of complete physical, mental, and social well‑being in all matters relating to the reproductive system (ICPD, 1994).

(a) Menstruation

Menstruation is a biological process but heavily shaped by culture and stigma. In many societies, menstruating women face restrictions in mobility, diet, worship, and education. Lack of menstrual hygiene facilities contributes to school absenteeism among adolescent girls in India (UNICEF, menstrual hygiene reports).

Menstrual stigma affects:

  • Self‑esteem

  • Participation in public life

  • Health practices


(b) Contraception

Contraception includes methods to prevent pregnancy: barrier, hormonal, intrauterine, and sterilization. Globally and in India, women bear the disproportionate burden of contraception, particularly sterilization.

Feminist concerns include:

  • Coercive sterilization programs

  • Limited male participation

  • Lack of informed consent

  • Side‑effect burden on women

Population control programs in the Global South historically targeted poor women rather than addressing structural inequality (Gideon, 2016).


(c) Abortion

Safe abortion is recognized as a reproductive right essential to women’s autonomy and health. Unsafe abortion remains a major cause of maternal mortality worldwide (WHO abortion guidelines).

Barriers include:

  • Social stigma (especially for unmarried women)

  • Provider refusal

  • Legal restrictions

  • Cost and access barriers

Thus, legal availability does not always ensure practical access.


(d) Menopause

Menopause is a natural transition marking the end of reproductive capacity. Biomedical approaches often frame it as hormonal deficiency requiring treatment, whereas feminist perspectives emphasize:

  • Normalization of aging

  • Psychosocial experiences

  • Cultural meanings of womanhood beyond reproduction

Menopause remains under‑researched in developing countries, reflecting reproductive bias in women’s health priorities (WHO ageing and women’s health literature).


5. Reproductive Rights and Reproductive Justice

Reproductive Rights

Recognized internationally at the ICPD (1994), reproductive rights include:

  • Right to decide number and spacing of children

  • Access to contraception and safe abortion

  • Safe pregnancy and childbirth

  • Freedom from coercion and violence

These rights link health with human rights and gender equality.


Reproductive Justice Framework

Developed by women of color activists, reproductive justice expands rights to include social conditions necessary for exercising those rights.

It includes:

  • Right to have children

  • Right not to have children

  • Right to raise children in safe environments

This framework highlights intersections of gender, class, caste, and race in reproductive health inequalities (Ross & Solinger, reproductive justice theory).


6. Family Planning Policies and Feminist Critiques

Population Control Approach

Post‑1950s population policies in many countries, including India, focused on reducing fertility through:

  • Sterilization targets

  • Incentives/disincentives

  • Female‑centered contraception

Women’s bodies became instruments of demographic goals rather than subjects of rights.


Feminist Critique

Scholars argue that population control policies:

  • Ignored women’s health and consent

  • Targeted poor and marginalized women

  • Reinforced gender inequality

  • Neglected male responsibility

Thus, fertility reduction overshadowed reproductive autonomy (Gideon, 2016; Hartmann).


Shift to Reproductive Health Approach

After ICPD (1994), policy shifted toward:

  • Client‑centered services

  • Informed choice

  • Integrated maternal health

  • Rights‑based approach

However, implementation gaps remain in many health systems.


2. Reproductive and Sexual Health

Menstruation

  • Biological process often surrounded by stigma

  • Cultural taboos: impurity, restrictions, silence

  • Consequences: poor menstrual hygiene, school absenteeism

  • Need for menstrual dignity and education

Contraception

  • Methods: barrier, hormonal, IUCD, sterilization

  • Gender imbalance: women bear burden

  • Issues: coercive sterilization, lack of informed consent

  • Male responsibility often absent

Abortion

  • Part of reproductive rights

  • Unsafe abortion → maternal mortality

  • Social stigma for unmarried women

  • Legal access vs practical barriers

Menopause

  • Natural life transition

  • Medicalization vs empowerment debate

  • Neglected area in health policy

  • Associated issues: osteoporosis, depression, hormonal changes


3. Reproductive Rights and Justice

Reproductive Rights

Right to:

  • Decide number and spacing of children

  • Access contraception and abortion

  • Safe pregnancy and childbirth

  • Freedom from coercion

Reproductive Justice Framework

Integrates:

  • Social justice

  • Human rights

  • Structural inequality

Key principles:

  • Bodily autonomy

  • Parenting in safe environments

  • Freedom from forced sterilization


4. Family Planning Policies and Critiques

Population Control Approach (India historical)

  • Target‑based sterilization

  • Focus on fertility reduction

  • Women‑centered interventions

Feminist Critique

  • Women treated as demographic tools

  • Neglect of health and consent

  • Coercion of poor and marginalized women

Shift to Reproductive Health Approach

  • Client‑centered services

  • Choice‑based contraception

  • Integrated maternal health


UNIT II: GOVERNMENT INITIATIVES IN HEALTH FACILITIES, RIGHTS & JUSTICE

1. Maternal and Child Health (MCH)

Concept and Importance

Maternal and Child Health (MCH) refers to promotive, preventive, curative, and rehabilitative healthcare services provided to women during pregnancy, childbirth, and the postnatal period, and to children during early life. MCH is a core indicator of public health development and gender equality because maternal and infant outcomes reflect women’s nutrition, status, and access to healthcare.

According to WHO, improving maternal health is essential to achieving gender equity and sustainable development because most maternal deaths are preventable with timely care.


Components of MCH

(a) Antenatal Care (ANC)

WHO recommends at least 8 antenatal contacts during pregnancy to ensure:

  • Monitoring of fetal growth

  • Detection of complications

  • Nutritional supplementation (iron–folic acid)

  • Tetanus immunization

  • Counseling on danger signs and birth preparedness

ANC improves maternal and neonatal survival by early risk detection (WHO antenatal care guidelines).


(b) Skilled Birth Attendance

Skilled birth attendants (doctors, nurses, midwives) reduce risks during delivery through:

  • Sterile techniques

  • Management of complications

  • Emergency referral

Evidence shows that skilled attendance significantly lowers maternal mortality (WHO Safe Motherhood Initiative).


(c) Postnatal Care (PNC)

The first 48 hours after childbirth are the most critical for maternal and neonatal survival. Postnatal care includes:

  • Monitoring hemorrhage and infection

  • Breastfeeding support

  • Mental health screening

  • Newborn care

However, postnatal services are often neglected in health systems, especially in rural areas (UNICEF maternal health reports).


2. Safe Motherhood

Safe Motherhood Concept

The Safe Motherhood Initiative (WHO, 1987) aims to ensure that all women receive care needed to be safe and healthy throughout pregnancy and childbirth.

Safe motherhood requires:

  • Skilled care during pregnancy and birth

  • Emergency obstetric services

  • Postnatal care

  • Reproductive health services


Antenatal Care and Nutrition

Maternal nutrition and anemia prevention are central to safe motherhood. Iron deficiency anemia increases risks of hemorrhage, preterm birth, and maternal death. WHO estimates that anemia contributes to about 20% of maternal deaths globally.


Birth Preparedness and Complication Readiness

Women and families should plan for:

  • Skilled birth location

  • Transport

  • Emergency funds

  • Blood donors

Lack of preparedness contributes to delays in seeking care (Thaddeus & Maine Three‑Delays Model).


3. Maternal Mortality and Public Health Infrastructure

Maternal Mortality: Definition

Maternal mortality refers to death of a woman during pregnancy or within 42 days of termination due to pregnancy‑related causes (WHO definition).

Maternal Mortality Ratio (MMR) reflects health system performance and women’s status.


Medical Causes of Maternal Death

WHO identifies major causes:

  • Hemorrhage

  • Hypertensive disorders (eclampsia)

  • Sepsis

  • Unsafe abortion

  • Obstructed labor

  • Anemia (indirect cause)

Most deaths occur in low‑resource settings and are preventable with timely obstetric care.


Social Determinants of Maternal Mortality

Feminist public health research highlights structural causes:

  • Early marriage and adolescent pregnancy

  • Malnutrition and anemia

  • Poverty and illiteracy

  • Gender discrimination in healthcare access

  • Low decision‑making power

Thus maternal mortality is both a medical and social injustice issue (Gideon, Gender & Health).


The Three‑Delays Model

Proposed by Thaddeus & Maine (1994), maternal deaths occur due to:

  1. Delay in deciding to seek care (lack of awareness, gender norms)

  2. Delay in reaching healthcare facility (distance, transport)

  3. Delay in receiving adequate care (poor infrastructure, staff shortage)

This model links maternal mortality to health systems and social barriers.


4. Institutional Births vs Traditional Birth Attendants (TBAs)

Institutional Births

Institutional delivery refers to childbirth in health facilities with skilled professionals. Governments promote institutional births to reduce maternal and neonatal mortality.

Benefits:

  • Emergency obstetric care

  • Surgical interventions (C‑section)

  • Blood transfusion

  • Infection control

Evidence shows institutional delivery reduces maternal deaths when quality care exists (WHO maternal health evidence).


Limitations and Feminist Critique

Research shows women may face:

  • Disrespectful maternity care

  • Verbal abuse

  • Non‑consensual procedures

  • Over‑medicalization

Feminist scholars argue that institutionalization without respectful care can reproduce violence within health systems (Bohren et al., WHO respectful maternity care studies).


Traditional Birth Attendants (Dais)

Traditional birth attendants provide culturally familiar childbirth support in communities.

Strengths:

  • Trust and emotional support

  • Cultural sensitivity

  • Accessibility in rural areas

Limitations:

  • Lack of emergency obstetric skills

  • Limited infection control

WHO recommends integrating trained TBAs into referral systems rather than replacing them entirely.


5. Mental Health and Gender

Gender Differences in Mental Health

Women have higher prevalence of:

  • Depression

  • Anxiety disorders

  • Trauma‑related disorders

WHO gender and mental health studies attribute this to:

  • Gender discrimination

  • Poverty

  • Care burden

  • Limited autonomy

  • Exposure to violence

Mental health is thus shaped by gendered social roles, not biology alone.


Gendered Stressors in Women’s Lives

Key stress factors include:

  • Domestic workload and unpaid care

  • Economic dependence

  • Marital conflict

  • Reproductive pressures

  • Social restrictions

These chronic stressors increase vulnerability to mental illness (APA Gender & Stress research).


6. Violence Against Women and Mental Health

Domestic Violence and Mental Health

WHO multi‑country studies show intimate partner violence leads to:

  • Depression

  • PTSD

  • Anxiety

  • Substance abuse

  • Suicide attempts

Violence is a major determinant of women’s mental and physical health.


Sexual Violence and Trauma

Sexual abuse has long‑term impacts:

  • Chronic pain

  • Reproductive disorders

  • Fear and stigma

  • Social isolation

Trauma affects both psychological and reproductive health outcomes (WHO violence and health reports).


Structural and Emotional Violence

Beyond physical abuse, women face:

  • Dowry harassment

  • Emotional abuse

  • Control of mobility

  • Economic deprivation

Feminist theory conceptualizes these as structural violence embedded in patriarchy, affecting mental well‑being (Gideon, 2016).


7. Government Initiatives in Maternal and Mental Health (India Context)

Maternal Health Programs

Key initiatives include:

  • Janani Suraksha Yojana (institutional delivery incentives)

  • Janani Shishu Suraksha Karyakram (free maternal services)

  • Pradhan Mantri Matru Vandana Yojana (maternity benefit)

These aim to reduce maternal mortality and improve access to care (Government of India MCH programs).


Mental Health Initiatives

  • National Mental Health Programme

  • District Mental Health Programme

  • Maternal mental health integration in reproductive services

However, gender‑sensitive mental healthcare remains limited in practice.


UNIT III: NUTRITION AND ANAEMIA

1. Gender, Nutrition and Health: Conceptual Overview

Nutrition is a fundamental determinant of women’s health across the life cycle—from childhood and adolescence to pregnancy, lactation, and old age. Feminist public health research shows that women’s nutritional status is shaped not only by biological needs but by gendered power relations within households and societies.

According to WHO and FAO nutrition frameworks, women in South Asia experience disproportionately high levels of undernutrition and anemia due to gender discrimination in food access, workload, and healthcare.


2. Gendered Patterns in Food Distribution

Intra‑Household Food Allocation

In many patriarchal households, food distribution follows a hierarchy:

  • Adult men eat first

  • Boys prioritized over girls

  • Women eat last and least

This pattern reflects women’s lower status and internalized norms of sacrifice. Studies in South Asia show women consume fewer calories and less protein despite higher workloads (Sen, gender and cooperative conflicts; FAO gender and nutrition reports).


Cultural Norms and Food Taboos

Women’s nutrition is affected by beliefs such as:

  • Pregnant women should eat less to ensure small babies

  • Certain nutritious foods are “hot” or “impure” in pregnancy

  • Menstruating women avoid milk or protein foods

These taboos reduce nutrient intake during periods of increased need.


Consequences for Women’s Health

Gendered food deprivation leads to:

  • Chronic energy deficiency

  • Low Body Mass Index (BMI)

  • Micronutrient deficiencies

  • High anemia prevalence

Undernourished mothers are more likely to experience complications and give birth to low‑birth‑weight infants (WHO maternal nutrition evidence).


3. Anaemia in Women

Definition and Types

Anemia is a condition in which hemoglobin levels are below normal, reducing oxygen‑carrying capacity of blood. WHO defines anemia in non‑pregnant women as Hb < 12 g/dl and in pregnant women as Hb < 11 g/dl.

The most common type among women is iron‑deficiency anemia, though folate and vitamin B12 deficiencies also occur.


Causes of Anaemia in Women

Biological Factors

  • Menstrual blood loss

  • Pregnancy iron demands

  • Repeated pregnancies

  • Lactation

Nutritional Factors

  • Low intake of iron‑rich foods

  • Poor dietary diversity

  • Vegetarian diets without supplementation

Gendered Social Factors

  • Women eating last

  • Poverty and food insecurity

  • Heavy physical labor

  • Early marriage and adolescent pregnancy

Thus anemia is both a nutritional and gender inequality issue (WHO global anemia reports; UNICEF India nutrition data).


Health Consequences of Anaemia

Anemia affects women’s health and productivity through:

  • Fatigue and weakness

  • Reduced work capacity

  • Increased infection risk

  • Maternal mortality risk

  • Preterm birth and low birth weight

WHO estimates anemia contributes significantly to maternal deaths globally, especially in low‑income settings.


4. Childhood Nutrition and the Girl Child

Gender Discrimination in Child Feeding

Studies in South Asia show girls often receive:

  • Shorter breastfeeding duration

  • Delayed complementary feeding

  • Less protein and micronutrient foods

  • Lower healthcare access

This reflects son preference and perceived lower value of daughters (UNICEF gender and child nutrition reports).


Malnutrition Among Girls

Forms of malnutrition include:

  • Stunting (chronic undernutrition)

  • Wasting (acute undernutrition)

  • Underweight

  • Micronutrient deficiencies

Malnourished girls often become malnourished mothers, perpetuating intergenerational cycles of poor health (UNICEF life‑cycle nutrition framework).


Intergenerational Cycle of Malnutrition

Undernourished adolescent girl → underweight mother → low birth weight baby → stunted child → malnourished adult woman

Breaking this cycle requires improving girls’ nutrition before pregnancy (WHO adolescent nutrition strategy).


5. Policy Interventions and Nutrition Schemes (India)

Integrated Child Development Services (ICDS)

Launched in 1975, ICDS is India’s flagship early childhood and maternal nutrition program.

Services

  • Supplementary nutrition

  • Growth monitoring

  • Immunization linkage

  • Health check‑ups

  • Nutrition and health education

  • Preschool education

ICDS targets pregnant women, lactating mothers, and children under six through Anganwadi centres (Government of India ICDS guidelines).


POSHAN Abhiyaan (National Nutrition Mission)

Launched in 2018, POSHAN Abhiyaan aims to reduce malnutrition through convergence across ministries and technology‑based monitoring.

Objectives

  • Reduce stunting

  • Reduce underweight

  • Reduce anemia among women and children

  • Improve maternal nutrition

It promotes behavior change, dietary diversity, and community participation (Ministry of Women & Child Development reports).


Anaemia Mukt Bharat Strategy

A national initiative to reduce anemia across life stages through:

  • Iron–folic acid supplementation

  • Deworming

  • Nutrition education

  • Fortified foods

  • Testing and treatment

It recognizes women and adolescent girls as priority groups (Government of India anemia strategy).


6. Challenges in Nutrition Programs

Despite policies, gender nutrition gaps persist due to:

  • Poor implementation quality

  • Inadequate food quantity/quality in ICDS

  • Social norms restricting women’s diet

  • Poverty and food insecurity

  • Lack of nutrition awareness

Feminist policy analysis argues that nutrition programs often treat women only as mothers rather than individuals with independent nutritional rights (Gideon, Gender & Health).


7. Gender, Workload and Energy Expenditure

Women in rural and low‑income households perform heavy labor:

  • Agricultural work

  • Water and fuel collection

  • Domestic work

  • Childcare

Yet their calorie intake is often lower than men’s. This imbalance causes chronic energy deficiency and anemia (FAO gender and agriculture nutrition studies).


8. Feminist Perspective on Nutrition and Health

Feminist scholars highlight that women’s malnutrition is not merely food scarcity but structural inequality:

  • Patriarchal food distribution

  • Economic dependence

  • Lack of bodily autonomy

  • Maternal‑centric nutrition policies

Thus improving women’s nutrition requires:

  • Gender equality in food access

  • Women’s income control

  • Education and empowerment

  • Rights‑based nutrition policies


9. Summary

Unit‑III shows that women’s nutrition and anemia are deeply gendered phenomena shaped by household hierarchy, poverty, cultural norms, and policy gaps. Malnutrition begins in girlhood and continues across the life cycle, affecting maternal and child health. Addressing women’s nutrition requires structural gender transformation alongside health interventions.


UNIT IV: WOMEN, HEALTHCARE SYSTEMS AND RIGHTS: WOMEN, HEALTHCARE SYSTEMS AND RIGHTS

1. Gender‑Based Violence and Health

Health Sector Role:

  • Screening victims

  • Medical care

  • Documentation

  • Referral to legal support

Barriers:

  • Victim blaming

  • Lack of privacy

  • Poor training


2. Healthcare Responses and Medico‑Legal Protocols

Key Principles:

  • Consent‑based examination

  • Confidentiality

  • Trauma‑informed care

  • Evidence preservation

Problems:

  • Two‑finger test (now banned)

  • Police dominance over consent

  • Delayed reporting


3. Access, Affordability and Quality of Care

Access Barriers

  • Distance

  • Cost

  • Gender norms

  • Mobility restrictions

Affordability Issues

  • Out‑of‑pocket expenditure

  • Informal payments

Quality Concerns

  • Negligence

  • Discrimination (caste, class)

  • Lack of female providers


4. Gender Bias in Medical Research and Practice

Examples:

  • Drugs tested mainly on men

  • Heart disease misdiagnosed in women

  • Pain complaints dismissed

Consequences:

  • Wrong treatment

  • Delayed diagnosis


5. Health Insurance and State Schemes

Janani Suraksha Yojana (JSY)

  • Cash incentives for institutional delivery

  • Target: reduce maternal mortality

Other Maternal Schemes

  • Free delivery services

  • Transport support

  • Nutrition supplements

Limitations:

  • Incentive‑driven institutionalization

  • Quality gaps remain


6. Movements, Activism and Futures

Women’s Health Movements

Focus areas:

  • Reproductive rights

  • Anti‑sterilization abuse

  • Maternal mortality accountability

  • Menstrual dignity

Feminist Reimagining of Healthcare

Principles:

  • Rights‑based approach

  • Community participation

  • Respectful care

  • Bodily autonomy

  • Intersectionality

Future Directions

  • Gender‑sensitive health policy

  • Inclusive research

  • Mental health integration

  • Violence‑responsive healthcare

  • Universal health coverage


CONCLUSION

Women’s health is not merely biological but deeply social and political. Gender inequality, violence, nutrition discrimination, and structural barriers shape women’s health outcomes. A feminist, rights‑based, and intersectional approach is essential for equitable healthcare systems.

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