Women and Public Health services in India

Women are at the forefront of the government’s drinking water initiative in the Bihar.

• Recently, reports highlighted the progressive approach of the Bihar government towards empowering women and involve them under various public health schemes ongoing in the state.

• Bihar’s budget 2022-23 focused on the agenda such as Water, Agriculture, health, sanitation and education.
• According to the state government’s visionfor rural development and water availability and sanitation, women play an important role.
• Hence there role was analysed for such public health services in the state.

Status of women and health services in Bihar

• Mortality Rate:
• SRS, 2019: As per Sample Registration Survey (SRS), 2019 estimates, the infant mortality rate in Bihar has been recorded as 29 deaths per 1,000 live births.
  • It is a reduction by three points from the 2018 estimates and is one point better than the national average of 30 deaths per 1,000 live births.
• NFHS-5: Similarly, as per National Family Health Survey (NFHS-5) estimates, mortality rate for children under-5 years of age stands at 56.4 deaths per 1,000 live births.
• The state is one among the least developed and cases reported for infant and maternal mortality was high too.
• Better availability of public health services

• It also indicates better availability of other public health services such as safe water, sanitation, and hygiene.
• Now Bihar has been able to provide tap water to 1.56 crore households out of the targeted 1.72 crore rural households.
• This is a remarkable achievement in the last five years considering the low coverage of 3% with which the State started.
• Bihar has provided the highest number of tap connections in the last few years among all the States in India.

How Bihar has achieved this ‘remarkable change’?

• Structural changes: In programme implementation, structural changes were initiated to divide the responsibility of water provisioning between the Public Health Engineering Department and Panchayati Raj Department.
• The State government has gone for a better service benchmark of water availability to person per day by tapping the available ground water.
• Sustainable source of water: To ensure source sustainability, Bihar launched the Jal-Jeevan-Hariyali Mission for ground water recharge and efficient use of it through changing crop pattern, irrigation methods, large scale plantation and revival of traditional water harvesting and recharge structures.

• Women’s participation: The State Government of Bihar has been experimenting with remarkable success in implementing various initiatives that provide women a chance to come forward to have a democratic dialogue in water provisioning.
• The government has made provisions to include at least three women members in the ward level committees that are formed to manage ward-level piped water schemes across 1,14,691 rural wards in the State.
• Democratic and gender neutral decentralization: There are now more than three lakh women who are a part of these committees.
• Further, more than 25,000 women are also working as pump operators especially in areas where implementation is done by ward implementation and management committee (WIMCs). These women are leading from the front the great turnaround story of drinking water in the State.

What are the Challenges Involved in Gender and Sanitation?

As per the census 2011, more than fifty percent of India’s population defecated in the open, and recent data showed that about 60% of rural households and 89% of urban households have access to toilets.

• Weak Participation and Proxy for men:In practice, the promoters of Swachhta rarely encourage women to participate in water and sanitation committees, which does not guarantee their participation.
  • Further, the age, position in the family, and societal and cultural barriers for females are some of the factors that determine the participation of women in sanitation decision-making.
• Gender-Based Sanitation Insecurity:There is a disproportionate burden faced by women especially shortage of or the non-availability of sanitation facilities that can be also called “Gender-based sanitation insecurity.”
  • The desire for privacy during bathing and defecation is different in the case of girls and women than men.
  • Thus, the non-availability of proper sanitation facilities creates a helpless situation for females and leads to the risk of faucal-orally transmitted diseases, urogenital tract infections, urinary incontinence, and chronic constipation.
• Risks Involved With Open Defecation: Women face threats to their life and feel unsafe while seeking a toilet facility or while going out for open defecation.
  • This leads to the consumption of less food and water by the women to minimize the need to exit the home to use toilets.
  • The risk involved with feeling unsafe while searching a place to go often to the toilet after dark or early in the morning; and dropping out of school at the onset of menstruation due to a lack of safe and private disposal facilities.
• Taboo:Menstrual hygiene education is taboo in India. Women find it difficult to openly ask for sanitary products from a male family member. Women, especially in rural areas, are confined to their homes and depend on male or elderly female household members for procuring sanitary products.

Important initiatives

• Odisha:In Odisha, women and transgender Self-Help Groups (SHGs) have been engaged in the operation and maintenance of treatment facilities in eight cities;
• Jharkhand: In Jharkhand, trained women masons built over 15 lakh toilets in one year, and the state was declared open defecation free (rural) much ahead of the national cut-off date of October 2, 2019.

• The India Sanitation Coalition is committed to looking at these reforms through a gender lens to ensure unintended biases do not creep in.
• UN Committee on Economic, Social and Cultural Rights, Statement on the Right to Sanitation, 2010 was made the right to sanitation is an essential component of the right to an adequate standard of living, enshrined in Article 11 of the International Covenant on Economic, Social and Cultural Rights.

The right to sanitation has been recognised in India at different levels. From the perspective of the Constitution of India, sanitation is a fundamental right. The Supreme Court and different high courts have interpreted the fundamental right to life to include the right to sanitation. However, the contents of the right, related duties and a mechanism to ensure remedies and accountability are yet to be elaborated through a statute. The absence of details in laws has led to the regulation and governance of the sanitation sector in India through policies, programmes and schemes that do not speak the language of rights and do not guarantee any accountability mechanism. Therefore, it is high time that the option of a specific statutory framework on sanitation that is based on the idea of right to sanitation is explored. Such a statutory framework should lay down principles and norms to guide the implementation of sanitation programmes and schemes.