Can Fit India movement include women from rural India?

In rural India or for that matter, even in urban India, many do not have the option of a desire to be fit since the emphasis is on survival. Hence, a movement that calls for a ‘Fit India’ can only succeed when it has all its constituents availing of all aspects of a welfare state, including those of better healthcare access.

Now, within this frame, let’s add health of India’s women -- and then comes forth grey areas where the health of women in India receives attention, and that too only during pregnancy. It’s a telling account of our patriarchal make-up. Despite this focus on the reproductive health of our women, we continue to see maternal mortalities and anaemic mothers.

Even the recent schemes and programmes for women, including the Pradhan Mantri Surakshit Matritva Abhiyan focussed on improving the quality and coverage of antenatal care and the Janani Shishi Suraksha Karyakram that worked at minimising out-of-pocket expenses for pregnant women, have not managed to really ensure complete last-mile access for affordable healthcare.

Take the recent case of Lakshmi, a pregnant adivasi woman from Pedabayalu mandal in Visakhapatnam’s tribal area who died after she was forced to walk for around 20 kms to consult a doctor just days before her delivery date.  Lakshmi’s case is not an isolated one, but one that can be unfortunately witnessed in many forgotten pockets of rural India.

A cursory glance at the latest National Health profile that compiles health sector data on demographic, socio-economic, health status, financing indicators, health infrastructure and related human resources corroborates what we already know -- Women still face the brunt of poor health outcomes owing to systemic neglect and negligible last-mile access to healthcare services.

Data on women’s reproductive health in states like West Bengal, Bihar and Uttar Pradesh are proof enough of the apathetic implementation of health policies. The National Health profile states that only around 3 percent of the women in Bihar get full antenatal care while over 70 percent of pregnant women in West Bengal are bereft of access to iron and folic acid tablets.

India is a prime example of how biased social constructs ensure the continuation of women and girls being left out from diverse narratives, be it work or even health! In certain places where access to healthcare is available, gender-based discrimination ensures that women are not free to move as they please. Therefore, their health is never in their own hands! NFHS-4 data (2015-16) shows that only 41 percent of women are allowed by their families to go alone to the market, health centre or outside the community.

Even today, the sheer existence of the stigma surrounding menstruation speaks volumes of the awareness of sexual and reproductive health. Exclusion during “those days of the month” also pushes more women to being anaemic, which further leads to high infant and maternal mortality rates.

A study in The Lancet claimed that only 22 percent of the 15 million abortions happen in medical institutions. In fact, 10 women die everyday due to unsafe abortions. The grim situation is a result of the glaring fact that in rural India, there is only one licensed abortion provider for 2 lakh women!

When the Prime Minister calls for spreading the Fit India movement to all parts of the country, there is a definite need to first unravel all aspects of women’s health that focuses on their lived realities. It also calls for ensuring better collection and reporting of health data, which means there needs to be greater focus on sex disaggregated data on healthcare access and implementation to build better women-oriented health interventions.

This can only happen when there is greater commitment from all quarters starting with awareness creation to improving on-ground coverage of healthcare to ensure last-mile access. When a call for Fit India movement is under way, there can be perhaps no better time to include women in the Fit India narrative in all aspects of a better health movement.

Varsha Pillai is a communications professional interested in gender research. She tweets at @varshapillai.