Reproductive Health: A Conceptual Shift or a Matter of Semantics?
Reproduction is a biological process, an outcome of sexual interaction between female and male fertility factors within a species. In the dominant evolutionary paradigm, human beings are considered to be the most evolved and endowed with unique characteristics. Human beings are rational and their sexual desire is not limited to reproduction alone and they have used and expressed their sexual desire in various ways.
In most cultures, women's role in sexual reproduction has been considered a force which has to be either tamed or glorified. Consequently, feminists argue that women's role in reproduction forms the basis for their oppression and is a root cause of their subordination.
Even though the traditions of glorification and subordination of women have a long history, it was only in the middle of this century that the technical potential for manipulating women's fertility was discovered and fertility cycles and hormonal balances became targets for intervention. Western science, true to its reductionist and mechanistic character, has forged ahead to exercise increasing control over women's fertility cycle.
The manner in which the effects of hormones on reproduction and contraception are dealt with in serious scientific journals is a clear indication of the direction of research. The focus is on identifying and addressing molecules like Zona Pellucida and human chorionic gonadotropin (hCG) which have a short but specific role to play in the fertility cycle as opposed to estrogen and progesterone. The director of one of the leading research institutions stated that the future direction for fertility control is to identify the molecules involved either in the reproductive process or the fertility cycle with a very specific function and a very short life but significant viability.
The shift in the focus of fertility research over the past five years coincides with changing guidelines for research on anti-fertility vaccines. The tampering with fertility cycles and the resistance it has met with, from time to time, have forced scientists to change the course of their inquiry and also their language. This has resulted in a change in approach to one of reproductive health slowly but finally.
In this issue Ritu Priya addresses the topic of AIDS and in the last issue Mohan Rao, Padma Prakash and Sathya discuss women's health problems. These articles make it clear that general health status - and not reproductive health - is the root cause of illness and disease among women. The reasons for ill health can be discerned at two levels: the first is the soci-cultural-economic level of women; and the second is state policy, which fails to address the real needs of women.
Reducing this complex reality by equating the health problems of women with reproductive health matters is not just a cosmetic change; it is a classical example of the reductionist approach. Moreover, it is a camouflage to make coercive population policies appear humane. Such an approach will unquestionably reduce women's status to vessels of reproduction.
The World Health Organization (WHO), which runs an MDS control project for the Bombay Municipal Corporation, examined the issues faced by prostitutes and managed to uncover the complexity of their problems even in the sphere of reproductive health. The licensed abortion centre is almost non-functional and the demands to make it work are overlooked. Consequently, women are forced to consult quacks and pay steeply for abortions, both in terms of health and expenditure. Abortion is not the only neglected aspect; this neglect pervades every aspect of their health. One of the officials working on this project says, "We are really concerned about the health of women living within families and having so-called cosy lives. The problems of prostitutes can be laid bare with little effort but it is very difficult to reach out to married women, especially in regard to STDs and AIDS."
The "culture of silence" is all pervasive as is revealed by many researchers and self-help workshops. Rani Bang's discovery that 90 percent of tribal women in her sample had RTIs is one of the most glaring examples. Similarly, in a camp in Vishakhapatnam, Andhra Pradesh, another NGO found a very high incidence of RTIs, while the situation of city-based basti women was even worse. This silence is broken only through self-help, fertility awareness and diaphragm training.
The official health system is responding to the highly structured and complex needs of Indian women by adopting the slogan of reproductive health. This response ignores the socio-cultural and economic conditions, which must be first addressed before catering to the reproductive health needs of women.
This new approach has many drawbacks. It does not take into consideration the state of knowledge in other disciplines, for example, mental health is upset by chemical or hormonal imbalances. The direct correlation between the psychosomatic reactions of the body and the socio-cultural status of women is a well-established fact. The impact of the cultural reality is best demonstrated by the extensive use of sex-determination tests. Son preference and its impact on women is a reality which no legislation can change. Similarly, illiteracy, undernourishment, neglect, and overwork are all part of a woman's reality which impinge even on her reproductive health, and in turn get affected by her reproductive health status.
We would argue that it is a crime to reduce the life of a woman to her reproductive function. This approach also negates women's contributions as labourers and as producers. In doing so, it perpetuates the patriarchal norms in society, while claiming to serve women. It is important to note that national agencies as well as international bodies like the WHO are propagating this approach.
At any rate, even if we accept these narrow terms, is it possible to cater to the reproductive health needs of women? Indian women are at high risk when they have their fourth child but this is not the case for women of the North. In fact, a whole range of the narrowly defined problems of reproductive health can be traced to the period when young girls do not get enough to eat. And these problems will be exacerbated when people have to pay for health services. However the establishment refuses to recognise the short-sightedness of its policies and ignores their interconnectedness.
In order to really address the issue of reproductive health it is necessary not only to bring about changes in the material circumstances of people but to broaden the information and knowledge base of the whole society. It is necessary to re-examine the goals and the direction for acquiring knowledge. The reproduction of human beings is not simply the mating of male and female principals but a much more complex process. Therefore, reproductive health is also not just a matter of catering to the problems of the reproductive system of women's bodies but a window to address the holistic health of the society at large and women in particular.
