Socialist Health Review 1984 Vol. 1, No. 2, Sep.: Women & Health
Item
- Title
- Socialist Health Review 1984 Vol. 1, No. 2, Sep.: Women & Health
- Date
- September 1984
- Description
-
Is medicine inherently sexist?
Amniocentesis: Misuse of medical technology
Women and the rural energy situation
Health of women in the health industry of witches and witch hunting - extracted text
-
IS MEDiCiAE IAHEREATLY SEK1ST ?
mil 11
AH1AIOCEATESIS :
MISUSE OF MEDICAL TECHAOLOGY
njomEfi aad the rural eaergy situatioa
HEALTH OF (BOMEA IA THE HEALTH’ IADUSTRY
I
OF (BITCHES AAD (BITCH HUATIAG
LD
Yol
1
Number 2
WOMEN & HEALTH
49
EDITORIAL PERSPECTIVE
Padma Prakash
53
IS MEDICINE INHERENTLY SEXIST?
C. Sathyamala
58
WOMEN, HEALTH AND MEDICINE
Barbara Katz Rothman
Working Editors :
65
Amar Jesani,
Manisha Gupte,
Padma Prakash, Ravi Duggal
WOMEN S HEALTH IS WOMEN'S CONCERN
Nirmala Sathe
Editorial Collective :
68
Ramana Dhara, Vimal Balasubramanyam (A P),
Imrana
Quadeer. Sathyamala C (Delhi),
Dhruv Mankad (Karnataka), Binayak Sen,
Mira
Sadgopal
(M P),
Anant
Phadke,
Anium Rajabali, Bharat Patankar, Jean D'Cunha,
Mona Daswam, Srilatha Batliwala (Maharashtra)
Amar Singh Azad (Punjab),
Ajoy Mitra
and Smarajit Jana (West Bengal)
Editorial Correspondence :
Socialist Health Review,
19 June Blossom Society,
60 A, Pali Road, Bandra (West)
Bombay - 400 050
Printed at :
Omega Printers, 316, Dr. S.P. Mukherjee Road,
Belgaum 590 001
RESPONSE
69
AMNIOCENTESIS AND FEMALE FOETICIDE
Vibhuti Patel
72
RURAL ENERGY SITUATION : CONSEQUENCES
FOR WOMEN'S HEALTH
Srilatha Batliwala
78
HEALTH OF WOMEN IN THE 'HEALTH' INDUSTRY
Sujata Gotoskar, Rohini Banaji and Vijay Kanhere
82
THE STUDY OF WOMEN. FOOD AND HEALTH IN
AFRICA
Meredeth Turshen
88
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not necessarily reflect the views of the editors.
REPRINTED
SHR : WOMEN & HEALTH
The first print order of 1500 copies of our second
issue on Women and Health has been sold out. In
response to repeated requests we have reprinted
1000 copies of the issue with financial help from
feminist activists in Bombay.
Send your orders to us or to :
Sona! Shukla, Bhavana Apartments,
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or to
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FORTHCOMING ISSUES
March 1985, Vol I no. 4 : Politics of Population
Control
June 1985,
ol 11 No. 1 : Health and Imperialism
Sept. 1985, Vol 11 No 2 : People in Health Care
Dec. 1985, Vol II No. 3
: Systems of Medicine
'TB and Society' : MFC Annual Meet
The 1985 Annual Meet of the Medico Friend Circle
will focus on 'TB and Society'. The dates of the
Meet are January T1 - 29 1985 and the venue.
Bangalore. For further information contact : Ravi
Narayan, Conver MFC, 326, V Main, I Block,
Koramangala, Bangalore 560 034.
Editorial Perspective
ROOTS OF WOMEN’S ILL HEALTH
Jpower relations mediate all social life and as
such, they not only determine our environment,
but also define the way we reactto it. Our definitions
of health and illness depend on the characteristics
of the society we live in and our location in it. In a
society where commodity production is predominant
as long as an individual can work productively or
rather, as long as that labour is productive to the
capitalist, the individual is considered healthy. There
fore, health services are directed at maintaining this
minimum level of health below which the^generation
of surplus value would fall off (Schatzkin, 1978).
In turn, this defines for the worker, the boundaries
of ill health such that real health needs from the
point of view of quality of life never get expressed.
For, the fulfilment of these health needs would be
contradictory to the needs of capital accumulation.
The patterns of morbidity and mortality express
and reflect this contradiction between real health
needs of the worker and the level of health neces
sary for the generation of surplus value.
How does all this affect women ? As a com
ponent of the labour foce, their needs are subor
dinated to the needs of capital. Further, a woman's
traditional roleis to reproduce and sustain labour
power. This is the necessary function of women in
society-- the maintenance and reproduction of the
labour force, which in turn is necessary for the
reproduction of capital. For a woman, the definition
of health is determined by her ability to perform
these functions. Just as in the workplace, the
worker's health needs are subordinated to the
needs of capital accumulation, women's health
needs are subordinated to the need to maintain
the work force at that level of health required for
the generation of surplus value. Moreover, women
as integral units of the family, are necessary not
only for the reproduction of the working class,
but also for reinforcing the ideological underpin
nings of capitalism, ft/ledical and health services
are designed to keep women qt an optimum level for
the performance of these functions. Thus, the
needs of capitalist accumulation mediating
through partiarchal relations suppress women's
real health needs and their reproductive
freedom.
-..(Vledicine legitimates and rationalises social
attitudes ^nd notions about women (and men)
whether they relate .to their physiology or their social
Socialist Health Review
role. And since women's oppression is justified by
their supposed biological inferiority,{medicine obvi
ously plays a very important role, in substantiating
this myth. Medicine's 'model* of the normal human
being is the upper/middle class male. This makes
all women, by definition 'abnormal'! Menstruation
becomes a disability, child birth an illness. Female
physiology is considered a complication of the
basic male physiology especially with reference to
the reproductive (Rothman, 1979).
Two of the characteristic features of bourgeois
medicine are its clinical paradigm and the dominant
mechanistic model of the human body. This locates
the cause of all ill-health entirely within the body
either as being due to the intervention of an outside
agent or because of the malfunctioning of one or
more 'parts' which comprise the human body. This
means that women's complaints, if they are not
caused by obvious external agents, must lie either
in their 'aberrant' reproductive physiology (so
different from the male) or in their peculiar female
'psyche'. Moreover, the models of 'normality' in
medicine are those that are approved of by dominant
ideology and are useful to bourgeois society. For
women such a model is the ideal image of wife or
mother. Not surprisingly, all health problems of
women are seen in terms of how they might affect
the fulfilment of that role.
Medicine, which is always articulated within a
specific mode of production, contributes to the
reproduction of that mode not only at the ideological
but also at the economic and political levels. Thus
the inappropriateness of medicine for women or its
inaccessibility to the poor or to women is a charac
teristic feature of bourgeois medicine which serves
to maintain and perpetuate the current relations
of production and reproduction.
Any enquiry, discussion or analysis of health
from a radical, marxist perspective must include an
analysis of the women - and - health nexus. At the
same time, no understanding of the women's status,
their oppression and exploitation can be complete
without a clear perception of the political and
ideological roots of women's ill health.
The Women's Health Movement Abroad
In the '60s, the growing disenchantment of
women with institutions and with social norms took
the form of women's liberation movement. This
49
brought women together in consciousness raising
groups where women for the first time began to
exchange personal experiences and make womento-women contacts that had been denied them.
Among other things, this led to the realisation that
their demeaning and dehumanising experience in the
health system were not stray and personal incidents
but the universal experience of all women. This has
over the years generated several analyses of the
medical system and has led to specific actions and
programmes.
a monopoly of the doctors. This led to a strong
movement against hospitalised childbirth in the US.
Groups in many states of the US and in Britain
and Europe set up women's health centres and
self-help clinics as 'alternatives' to the dehumanised
hospital centred medical systems. They provided for
gynaecological examinations, and childbirth faci
lities as well as abortion services. Inevitably they
have come into conflict with power groups and
professional groups, but have survived and prolife
rated nevertheless.
Elizabeth Fee (1970) characterises these in
terms of three forms of social criticism, the liberal
feminist, radical feminist and marxist feminist Liberal
feminist saw their main challenge as being destroy
ing the myth of a biological basis of women's
oppression. They demanded equal pay and equal
opportunity for women but did not seriously challenge
the social and economic hierarchy. They saw the
medical system as reflecting the sexual hierarchy of
society with a male monopoly of the upper levels
and a predominance of women al the menial jobs at
the lower levels. Their solution was centered on
demanding a better representation of women at the
upper levels, but did not question the hierarchical
organisation of health care or of society.
It was mainly this current of feminist thought
which gave rise to a number of significant books
and pamphlets such as Our Bodies Ourselves (from the
Boston Women's Health Book Collective), WitchesMidwives and Nurses and Comphints and Disorders (both
by Barbara Ehrenreich and Deirdre English) and
Vagini! Politics (by E Frankfort). This and other similar
literature has been very influential in rejuvenating
the interest of radical and marxist groups in the
history, nature and ideology of science and medicine.
Radical feminism demanded a fundamental,
restructuring of society, its institutions and values.
Many of these women had participated irT student,
civil rights and anti-war movements. Some had
become disenchanted with left parties and official
marxist view of feminism as being a form of bour
geois protest and with marxist analyses which
appeared to be insufficient to explain women's
situation adequately or provide a satisfactory theore
tical understanding
of the family, reproduction,
sexuality. Radical feminism saw the patriarchal
family as the major and most important oppressive
force in society and a battle of the sexes as being
of more consequence than the class struggle. They
saw revolution as leading to an annihilation of sex
differences. There was an outpouring of radical
feminist analyses of society, of institutions and of
politics in the late '60s and the '70s, all of which
served to expose the operation of paternalist ideology
and the structures of women's oppression in
society.
Radical feminists saw the medical profession
as imitating patriarchal society and were heavily
critical of medical mysticism especially in the area
of gynaecology and obstetrics. They worked to
disseminate information and knowledge about
medicine and specially about women's sexual and
reproductive functions which had for so long been
50
Marxist feminists saw their task as the combi
ning of feminist consciousness with historical dialec
tical method of analysis. They saw patriarchy as both
supporting and strengthening capitalism. At the
same time they saw capitalism as providing the
material condition for the future abolition of sexual
distinction between man's work and women's work,
but the realisation of these conditions being limited
to the extent necessary for the survival of capitalism.
' Capitalism... cannot free itself from dependence on
sexism any more than it can transcend class oppres
sion or the pursuit of private profit at the expense
of the satisfaction of real human needs" (Fee, 1975).
Marxist feminists believe that no one character
istic of the medical system can be analysed in itself,
but must only be seen in relation to the entire social
structure and its institutions, and the economic order
in which it is rooted. Thus, they see the fragmentation
of capitali.-t medicine as a part and consequence of
the ideology of medicine which sees the body in
parts. They are also critical of the sexist bias of
medicine and the emphasis on 'scientific' base which
itself has an inherent class and sex bias. They see
medicine as ignoring the social roots of illness.
Women's Health Issues in India
In India, women's health issues have not emerged
as a major focus of activity or analyses within the
women's movement. Women's groups are of course,
aware of women's inaccessibility to health care
services, the lack of reproductive freedom, sexual
harassment of women patients (and of nurses) and
to a lesser extent the operation of the sexist ideology
in medicine. But this has not led to a comprehensive
theoretical understanding of women's health as a
part of feminist theory. Nor has it generated con
certed action programmes. There have been individual
campaigns, such as the demand for a ban on
estrogen-progesterone drugs for, pregnancy testing
and amniocentesis for sex determination. But while
these, especially the latter, has given rise to signi
ficant debate and action, one cannot say that they
have led to a better perspective of the role of medical
technology in the oppression of women. The reason
for this apparent uninterest in health issues perhaps
lies in the historical and economic roots of the
women's movement in India and needs to be
examined.
This apathy towards heahh issues is even more
significant when one recollects that rape was one of
the earliest issues taken up by the women s move
ment. It would have been logical to suppose that
this would have led to a discussion of broader
questions of female sexuality, a realisation of how
little women knew about their bodies and ultimately,
to a questioning of the male monopoly of the infor
mation about women's bodies, its functioning in
health and illness. This did not happen, although
there was sporadic discussion about such matters as
the 'technical' definition of rape and the relevance
of injuries on a woman's body. Nor was there
significant and sustained effort to provide 'alterna
tive' medical aid to vicitims. Why did this not
happen ? Was it because the medical system and
the definitions promoted by it hold sway even among
those who have little access to it ?
Health issues which would be of concern to
ndian women are generally different from those
which confronted feminists in the West in the late
'60s and early'70s. For instance, by then in most
countries of the West, the major achievements of
medicine which produced visible and noticeable
change had already taken place. The life expectancy
had levelled out and there appeared to be after all,
a maximum limit to human life. Together with this,
the hospital-centred medical system had increasingly
become dehumanised, authoritarian and expensive.
The women's movement could successfully question
the ethos of such a system and its value to women.
In the'70s in India, although the state health
system was weak and inefficient, it was at least able
to bring some relief, especially in acute illness and
during crises. Moreover, by this time several groups,
frustrated and disgusted with both the state systems
and the rapacity of the private practitioners had set
up 'alternative' health programmes in the rural areas.
Socialist Health Review
And many of these had made maternal and child
health programmes their main focus. Undoubtedly,
this brought about positive changes in women's (or
rather maternal) health status. Therefore the women's
movement in India had no immediate and concrete
targets in the area of health The demand for birth
control measures and abortion were two major areas
of activity of the women's health movement in the
West. In India, such measures were, in fact, being
forced on women as part of a determined and
massive family planning programme.
Further, the sex-wise mortality and morbidity
picture in the West was and is quite different from
the Indian. In the US, for instance, women show
lower mortality and morbidity rates and also a greater
frequency of contact with the medical system. Women
there were concerned with countering the criticism
that women were generally, hypochondriac, and in
voicing concern and initiating action about the incre
asing consumption of tranquilisers and painkillers by
women.
What then, are the issues which demand con
cede action, research and discussion in India today?
It is hardly necessary to point out that women's
health status has been steadily declining. In 1901,
the sex ratio (number of women to 1000 men) was
972 which declined to 930 in 1971. In almost every
age group (except 10 to 14 years) until 34, the age
specific death rates are higher for women. Or in other
words more than half the deaths among women
occur before they are 35. According to one report,
20 per cent of all deaths among women in the age
group 15-34 are because of childbirth and associated
causes (SNDT 1981). However, maternal mortality
is not the major cause of death among women in
that age group. And yet most health programmes
are directed only at reducing maternal mortality
without any alteration of the accessibility of this
group of women to general services.
Women have also been the major focus of
family planning programmes. Most of the measures
proposed and implemented —sterilisation, abortion,
oral contraceptives, copper T, injectables — have
affected women's health significantly, and even
disastrously.
The changing patterns of economic develop
ment have put a heavy burden on women which is
reflected in their health status. In a society where
women hold a lower social status, any situation of
deprivation is bound to affect women adversely.
The marginalisation of farmers, landlessness and
forced migration, temporary and permanent, have
undoubtedly affected women’s health and nutritional
51
brought women together in consciousness raising
groups where women for the first time began to
exchange personal experiences and make womento women contacts that had been denied them.
Among other things, this led to the realisation that
their demeaning and dehumanising experience in the
health system were not stray and personal incidents
but the universal experience of all women. This has
over the years generated several analyses of the
medical system and has led to specific actions and
programmes.
a monopoly of the doctors. This led to a strong
movement against hospitalised childbirth in the US.
Groups in many states of the US and in Britain
and Europe set up women’s health centres and
self-help clinics as 'alternatives' to the dehumanised
hospital- centred medical systems. They provided for
gynaecological examinations, and childbirth faci
lities as well as abortion services. Inevitably they
have come into conflict with power groups and
professional groups, but have survived and prolife
rated nevertheless.
Elizabeth Fee (1970) characterises these in
terms of three forms of social criticism, the liberal
feminist, radical feminist and marxist feminist Liberal
feminist saw their main challenge as being destroy
ing the myth of a biological basis of women's
oppression. They demanded equal pay and equal
opportunity for women but did not seriously challenge
the social and economic hierarchy. They saw the
medical system as reflecting the sexual hierarchy of
society with a male monopoly of the upper levels
and a predominance of women at the menial jobs at
the lower levels. Their solution was centered on
demanding a better representation of women at the
upper levels, but did not question the hierarchical
organisation of health care or of society.
It was mainly this current of feminist thought
which gave rise to a number of significant books
and pamphlets such as Our Bodies Ourselves (from the
Boston Women's Health Book Collective), WitchesMidwives and Nurses and Comphints and Disorders (both
by Barbara Ehrenreich and Deirdre English) and
Vaginil Politics (by E Frankfort). This andothei sim far
literature has been very influential in rejuvenating
the interest of radical and marxist groups in the
history, nature and ideology of science and medicine.
Radical feminism demanded a fundamental,
restructuring of society, its institutions and values.
Many of these women had participated irT student,
civil rights and anti-war movements. Some had
become disenchanted with left parties and official
marxist view of feminism as being a form of bour
geois protest and with marxist analyses which
appeared to be insufficient to explain women's
situation adequately or provide a satisfactory theore
tical understanding
of the family, reproduction,
sexuality. Radical feminism saw the patriarchal
family as the major and most important oppressive
force in society and a battle of the sexes as being
of more consequence than the class struggle. They
saw revolution as leading to an annihilation of sex
differences. There was an outpouring of radical
feminist analyses of society, of institutions and of
politics in the late '60s and the '70s, all of which
served to expose theoperation of paternalistideology
and the structures of women's oppression in
society.
Radical feminists saw the medical profession
as imitating patriarchal society and were heavily
critical of medical mysticism especially in the area
of gynaecology and obstetrics. They worked to
disseminate information and knowledge about
medicine and specially about women's sexual and
reproductive functions which had for so long been
50
Marxist feminists saw their task as the combi
ning of feminist consciousness with historical dialec
tical method of analysis. They saw patriarchy as both
supporting and strengthening capitalism. At the
same time they saw capitalism as providing the
material condition for the future abolition of sexual
distinction between man's work and women's work,
but the realisation of these conditions being limited
to the extent necessary for the survival of capitalism.
’ Capitalism... cannot free itself from dependence on
sexism any more than it can transcend class oppres
sion or the pursuit of private profit at the expense
of the satisfaction of real human needs" (Fee, 1975).
Marxist feminists believe that no one character
istic of the medical system can be analysed in itself,
but must only be seen in relation to the entiresocial
structure and its institutions, and the economic order
in which it is rooted. Thus, they see the fragmentation
of capital!.:t medicine as a part and consequence of
the ideology of medicine which sees the body in
parts. They are also critical of the sexist bias of
medicine and the emphasis on 'scientific' base which
itself has an inherent class and sex bias. They see
medicine as ignoring the social roots of illness.
Women's Health Issues in India
In India, women's health issues have notemerged
as a major focus of activity or analyses within the
women's movement. Women's groups are of course,
aware of women's inaccessibility to health care
services, the lack of reproductive freedom, sexual
harassment of women patients (and of nurses) and
to a lesser extent the operation of the sexist ideology
in medicine. But this has not led to a comprehensive
theoretical understanding of women's health as a
part of feminist theory. Nor has it generated con
certed action programmes. There have been individual
campaigns, such as the demand for a ban on
estrogen-progesterone drugs for/pregnancy testing
and amniocentesis for sex determination. But while
these, especially the latter, has given rise to signi
ficant debate and action, one cannot say that they
have led to a better perspective of the role of medical
technology in the oppression of women. The reason
for this apparent uninterest in health issues perhaps
lies in the historical and economic roots of the
women's movement in India and needs to be
examined.
This apathy towards heahh issues is even more
significant when one recollects that rape was one of
the earliest issues taken up by the women s move
ment. It would have been logical to suppose that
this would have led to a discussion of broader
questions of female sexuality, a realisation of how
little women knew about their bodies and ultimately,
to a questioning of the male monopoly of the infor
mation about women's bodies, its functioning in
health and illness. This did not happen, although
there was sporadic 'discussion about such matters as
the 'technical' definition of rape and the relevance
of injuries on a woman's body. Nor was there
significant and sustained effort to provide 'alterna
tive' medical aid to vicitims. Why did this not
happen ? Was it because the medical system and
the definitions promoted by it hold sway even among
those who have little access to it ?
Health issues which would be of concern to
ndian women are generally different from those
which confronted feminists in the West in the late
'60s and early‘70s. For instance, by then in most
countries of the West, the major achievements of
medicine which produced visible and noticeable
change had already taken place. The life expectancy
had levelled out and there appeared to be after all,
a maximum limit to human life. Together with this,
the hospital-centred medical system had increasingly
become dehumanised, authoritarian and expensive.
The women's movement could successfully question
the ethos of such a system and its value to women.
In the'70s in India, although the state health
system was weak and inefficient, it was at least able
to bring some relief, especially in acute illness and
during crises. Moreover, by this time several groups/
frustrated and disgusted with both the state systems
and the rapacity of the private practitioners had set
up 'alternative' health programmes in the rural areas.
Socialist Health Review
And many of these had made maternal and child
health programmes their main focus. Undoubtedly,
this brought about positive changes in women's (or
rather maternal) health status. Therefore the women's
movement in India had no immediate and concrete
targets in the area of health The demand for birth
control measures and abortion were two major areas
of activity of the women's health movement in the
West. In India, such measures were, in fact, being
forced on women as part of a determined and
massive family planning programme.
Further, the sex-wise mortality and morbidity
picture in the West was and is quite different from
the Indian. In the US, for instance, women show
lower mortality and morbidity rates and also a greater
frequency of contact with the medical system. Women
there were concerned with countering the criticism
that women were generally, hypochondriac, and in
voicing concern and initiating action about the incre
asing consumption of tranquilisers and painkillers by
women.
What then, are the issues which demand concerte action, research and discussion in India today?
It is hardly necessary to point out that women's
health status has been steadily declining. In 1901,
the sex ratio (number of women to 1000 men) was
972 which declined to 930 in 1971. In almost every
age group (except 10 to 14 years) until 34, the age
specific death rates are higher for women. Or in other
words more than half the deaths among women
occur before they are 35. According to one report,
20 per cent of all deaths among women in the age
group 15-34 are because of childbirth and associated
causes (SNDT 1981). However, maternal mortality
is not the major cause of death among women in
that age group. And yet most health programmes
are directed only at reducing maternal mortality
without any alteration of the accessibility of this
group of women to general services.
Women have also been the major focus of
family planning programmes. Most of the measures
proposed and implemented —sterilisation, abortion,
oral contraceptives, copper T, injectables — have
affected women's health significantly, and even
disastrously.
The changing patterns of economic develop
ment have put a heavy burden on women which is
reflected in their health status. In a society where
women hold a lower social status, any situation of
deprivation is bound to affect women adversely.
The marginalisation of farmers, landlessness and
forced migration, temporary and permanent, have
undoubtedly affected women s health and nutritional
51
brought women together in consciousness raising
groups where women for the first time began to
exchange personal experiences and make womento-women contacts that had been denied them.
Among other things, this led to the realisation that
their demeaning and dehumanising experience in the
health system were not stray and personal incidents
but the universal experience of all women. This has
over the years generated several analyses of the
medical system and has led to specific actions and
programmes.
a monopoly of the doctors. This led to a strong
movement against hospitalised childbirth in the US.
Groups in many states of the US and in Britain
and Europe set up women s health centres and
self-help clinics as 'alternatives' to the dehumanised
hospital centred medical systems. They provided for
gynaecological examinations, and childbirth faci
lities as well as abortion services. Inevitably they
have come into conflict with power groups and
professional groups, but have survived and prolife
rated nevertheless.
Elizabeth Fee (1970) characterises these in
terms of three forms of social criticism, the liberal
feminist, radical feminist and marxist feminist Liberal
feminist saw their main challenge as being destroy
ing the myth of a biological basis of women's
oppression. They demanded equal pay and equal
opportunity for women but did not seriously challenge
the social and economic hierarchy. They saw the
medical system as reflecting the sexual hierarchy of
society with a male monopoly of the upper levels
and a predominance of women al the menial jobs at
the lower levels. Their solution was centered on
demanding a better representation of women at the
upper levels, but did not question the hierarchical
organisation of health care or of society.
It was mainly this current of feminist thought
which gave rise to a number of significant books
and pamphlets such as Our Bodies Ourselves (from the
Boston Women's Health Book Collective), WitchasMidwives and Nurses and Comphints and Disorders (both
by Barbara Ehrenreich and Deirdre English) and
Vaginil Politics (by E Frankfort). This and othei similar
literature has been very influential in rejuvenating
the interest of radical and marxist groups in the
history, nature and ideology of science and medicine.
Radical feminism demanded a fundamental,
restructuring of society, its institutions and values.
Many of these women had participated iiT student,
civil rights and anti-war movements. Some had
become disenchanted with left parties and official
marxist view of feminism as being a form of bour
geois protest and with marxist analyses which
appeared to be insufficient to explain women's
situation adequately or provide a satisfactory theore
tical understanding of the family, reproduction,
sexuality. Radical feminism saw the patriarchal
family as the major and most important oppressive
force in society and a battle of the sexes as being
of more consequence than the class struggle. They
saw revolution as leading to an annihilation of sex
differences. There was an outpouring of radical
feminist analyses of society, of institutions and of
politics in the late '60s and the' '70s, all of which
served to expose the operation of paternalist ideology
and the structures of women's oppression in
society.
Radical feminists saw the medical profession
as imitating patriarchal society and were heavily
critical of medical mysticism especially in the area
of gynaecology and obstetrics. They worked to
disseminate information and knowledge about
medicine and specially about women's sexual and
reproductive functions which had for so long been
50
Marxist feminists saw their task as the combi
ning of feminist consciousness with historical dialec
tical method of analysis. They saw patriarchy as both
supporting and strengthening capitalism. At the
same time they saw capitalism as providing the
material condition for the future abolition of sexual
distinction between man's work and women's work,
but the realisation of these conditions being limited
to the extent necessary for the survival of capitalism.
'■Capitalism... cannot free itself from dependence on
sexism any more than it can transcend class oppres
sion or the pursuit of private profit at the expense
of the satisfaction of real human needs" (Fee, 1975).
Marxist feminists believe that no one character
istic of the medical system can be analysed in itself,
but must only be seen in relation to the entire social
structure and its institutions, and the economic order
in which it is rooted. Thus, they see the fragmentation
of capitalist medicine as a part and consequence of
the ideology of medicine which sees the body in
parts. They are also critical of the sexist bias of
medicine and the emphasis on 'scientific' base which
itself has an inherent class and sex bias. They see
medicine as ignoring the social roots of illness.
Women's Health Issues in India
In India, women's health issues have not emerged
as a major focus of activity or analyses within the
women's movement. Women's groups are of course,
aware of women's inaccessibility to health care
services, the lack of reproductive freedom, sexual
harassment of women patients (and of nurses) and
to a lesser extent the operation of the sexist ideology
in medicine. But this has not led to a comprehensive
theoretical understanding of women's health as a
part of feminist theory. Nor has it generated con
certed action programmes. There have been individual
campaigns, such as the demand for a ban on
estrogen-progesterone drugs for( pregnancy testing
and amniocentesis for sex determination. But while
these, especially the latter, has given rise to signi
ficant debate and action, one cannot say that they
have led to a better perspective of the role of medical
technology in the oppression of women. The reason
for this apparent uninterest in health issues perhaps
lies in the historical and economic roots of the
women's movement in India and needs to be
examined.
This apathy towards health issues is even more
significant when one recollects that rape was one of
the earliest issues taken up by the women's move
ment. It would have been logical to suppose that
this would have led to a discussion of broader
questions of female sexuality, a realisation of how
little women knew about their bodies and ultimately,
to a questioning of the male monopoly of the infor
mation about women's bodies, its functioning in
health and illness. This did not happen, although
there was sporadic discussion about such matters as
the •'technical' definition of rape and the relevance
of injuries on a woman's body. Nor was there
significant and sustained effort to provide 'alterna
tive' medical aid to vicitims. Why did this not
happen ? Was it because the medical system and
the definitions promoted by it hold sway even among
those who have little access to it ?
Health issues which would be of concern to
'ndian women are generally different from those
which confronted feminists in the West in the late
'60s and early'70s. For instance, by then in most
countries of the West, the major achievements of
medicine which produced visible and noticeable
change had already taken place. The life expectancy
had levelled out and there appeared to be after all,
a maximum limit to human life. Together with this,
the hospital-centred medical system had increasingly
become dehumanised, authoritarian and expensive.
The women's movement could successfully question
the ethos of such a system and its value to women.
In the'70s in India, although the state health
system was weak and inefficient, it was at least able
to bring some relief, especially in acute illness and
during crises. Moreover, by this time several groups,
frustrated and disgusted with both the state systems
and the rapacity of the private practitioners had set
up 'alternative' health programmes in the rural areas.
Socialist Health Review
And many of these had made maternal and child
health programmes their main focus. Undoubtedly,
this brought about positive changes in women's (or
rather maternal) health status. Therefore the women's
movement in India had no immediate and concrete
targets in the area of health The demand for birth
control measures and abortion were two major areas
of activity of the women's health movement in the
West. In India, such measures were, in fact, being
forced on women as part of a determined and
massive family planning programme.
Further, the sex-wise mortality and morbidity
picture in the West was and is quite different from
the Indian. In the US, for instance, women show
lower mortality and morbidity rates and also a greater
frequency of contact with’the medical system. Women
there were concerned with countering the criticism
that women were generally, hypochondriac, and in
voicing concern and initiating action about the incre
asing consumption of tranquilisers and painkillers by
women.
What then, are the issues which demand con
cede action, research and discussion in India today?
It is hardly necessary to point out that women's
health status has been steadily declining. In 1901,
the sex ratio (number of women to 1000 men) was
972 which declined to 930 in 1971. In almost every
age group (except 10 to 14 years) until 34, the age
specific death rates are higher for women. Or in other
words more than half the deaths among women
occur before they are 35. According to one report,
20 per cent of all deaths among women in the age
group 15-34 are because of childbirth and associated
causes (SNDT 1981). However, maternal mortality
is not the major cause of death among women in
that age group. And yet most health programmes
are directed only at reducing maternal mortality
without any alteration of the accessibility of this
group ol women to general services.
Women have also been the major focus of
family planning programmes. Most of the measures
proposed and implemented —sterilisation, abortion,
oral contraceptives, copper T, injectables — have
affected women's health significantly, and even
disastrously.
The changing patterns of economic develop
ment have put a heavy burden on women which is
reflected in their health status. In a society where
women hold a lower social status, any situation of
depiivation is bound to affect women adversely.
The marginalisation of farmers, landlessness and
forced migration, temporary and permanent, have
undoubtedly affected women s health and nutritional
51
status. The groVvth of the small and the cottage
industries sector has depended heavily on female
labour. And most of these do not coma under the
purview of any kind of safety legislation. Therefore,
women have, in the last decade become exposed
to new kind of health hazards. Added to this is the
fact that women risk their lives in the performance
of domestic labour. According to Rajni Kothari a
woman spends approximately 73,000 hours on an
average in the kitchen, most of which are environ
mentally harmful and unsafe (Raj and Patel, 1982).
The number of 'workers' among women is
estimated to be only 20.01 per cent. But the Census
definition of 'work' does not include cooking,
collecting firewood, fetching water, etc. activities
which take up half theenergy expenditure of women.
At the same time adult women eat consistently
less than men and also much less than the recom
mended calorific allowances, which are themselves
based on somewhat questionable assumptions.
According to a recent survey carried out by the
National Institute of Nutrition, Hyderabad, 60 per
ceht of the rural population is anaemic, most of
this group being women. Malnutrition is not only
aggravated by diseases but renders women more
prone to illness. Ironically enough, although women
suffer from illness more or at least as often as men,
they seek help less often.
There is little.hard-core data available to support
any analysis of women's health status. And this
itself is a telling comment on how unimportant
women's health is. Nevertheless, there is sufficient
evidence — experiences, persona^observations—that
women's health status presents an apalling, dismay
ing and deteriorating picture. In this, the second
issue of SHR, we examine a few facets of this picture.
Sathyamala discusses the sexist ideology of
medicine and its operation in the past and currently.
She convincingly shows that the sexist ideology is
so closely integrated with the theory and practice of
medicine that it is difficult even to identify it, let
alone accept it.
Our next offering is an article by Barbara Katz
Rothman, reproduced from the book Women: A
feminist perspective edited by Jo Freeman (1979)
giving a slightly different theoretical explanation of
the sexist bias. She sees sexism in medicine as a
component of the mechanistic, positivist bourgeois
medicine and calls for a critical examination of the
medical mode of women's bodies and health.
52
Nirmala Sathe provides an overview of health
issues in the women's movement in India.
Srilatha Batliwala writes on the energy-healthnutrition nexus with reference to women. This paper
gives credence to the fact that the gap between
expenditure for energy and intake of calories is large
for women than for men. These data and the accomp
anying analyses gave for the first time, ( when itwas
tirst presented) hard core information and statistics
about some aspects of women s health status.
Meredeth Turshen's article is an extract from a
book Third World Medicine and Social Change ( editied
by John Morgan and published by Lanham ) which
is just out. It analyses the nutrition-health complex
with reference to women in Africa. It looks at the
health situation of women from the perspective of
Africa's changing economy. It seeks to show the
linkages between political and economic measuies,
changes in cropping patterns, food imports, interna
tional loans and changes in land tenure, women's
nutritional and health status.
Misuse of medical technology is at times, a
sore topic of discussion. The use of amniocen
tesis for sex determination, aroused great deal of
discussion a year ago. It was in fact, one of the few
issues that women's groups took up all over the
country and pressed for a ban on such tests being
used indiscriminately. Vibhuti Patel concisely traces
the major features of this debate and highlights the
misuse of such medical technology which more often
than not leads to female foeticide.
How healthy are workers in the drug industry?
A large number of women are employed in the
pharmaceutical industry , but there are few studies
of their health status. Sujata
Gotoskar, Rohini
Banaji and Vijay Kanhere report a case-study of
women workers manufacturing vasodilators. A drug
such as this is prescribed to produce a definite
physiological change in those who need it. What
happens to normal women who have to breath in
the powder day-in and day-out? This study, high
lights the need to gather more information of the
hazards women face at work places.
We wind up this issue with a review and report
of 'health' problem which is currently facing the
Kashtakari Sanghatana working among the adivasis
in Dahanu in Maharashtra. And this is the torture
of women bhutalis' (witches). The Sanghatana
has attempted in this paper to locate the issue-in a
socio-economic perspective. Who is the witch? Why
(Contd on Page 51)
IS MEDICINE INHERENTLY SEXIST ?
c sathyamaia
During the last twenty years, many feminists, activists and researchers have been taking a doser look at
medicine. There is voluminous and irrefutable evidence that the medicine of the 19th and early 20th centuries
incorporated and reinforced the sexist ideology in society. But does sexism operate in and through current
medical practice in India? The author argues, that the teaching and practice of medicine here is strongly
influenced by what happens in the West With extensive i Hustrations from popular textbooks and journals
she shows how sexism in medicine operates just as strongly now as it did a hundred years ago. Additionally,
campaigns such as the one promoting breast feeding continue to use outmoded and demeaning stereotype for
women. This article is based on a paper written for the Medico Friend Circle's Annual Conference held
in 1983, which focussed on 'Prejudice against women in the medical system.'
j^/£edicine has played and continues to play a
powerful role as a reinforcer and perpetuator
of sexist ideology. It has the dubious distinction of
shifting justification for sexism from religion to bio
medicine, thereby taking it out of the realm of preju
dice and putting it within the confines of'scientific'
objectivity. The interpretations medicine offers are
basically to legitimise the discrimination of women
and their continued oppression under the guise of
biological determinism.
The period of rapid industrialisation in the West
witnessed the growth of the monopoly of the white
middle-class male over medicine. This period also saw
the emergence of new social norms which specified
roles on the basis of sex and class. The upper-class
women were expected to lead a sedentary life of
enforced leisure with nothing more taxing than
embroidery to keep them occupied, whereas the
working-class women were forced to lead a life of
hard physical labour. Although it was the working
class women who were subjected to a host of ill
nesses, (a result of nutritional deficiencies and poor
working and livingconditions )itwasthe upper-class
women whom, medicine considered as inherently
sick. "It was the . wealth .extracted in that harsh
outside world that enabled a man to afford a totally
leisured wife. She was the social ornament that
proved a man's success, her idleness, her delicacy,
her child-like ignorance of 'reality' gave a man the
'class' that money alone could not provide". (Ehrenreich and English, 1973).
The combined effects of enforced leisure,
confinement and boredom led to the emergence of
the cult of 'female invalidism' among the upper
class women. To the medical men the 'sick' women
of the upper classes were a godsend. Here was a
patient, who was ill without being 'diseased', in
obvious need of the ministrations of a medical man
(like himself), compliant enough to obey every one
of the doctor's demands, and wealthy enough to
afford the prolonged treatment --- an ideal patient
as it were. "As a businessman, the doctor had a
direct interest in a social role ».for women that
encouraged them to be sick; as a doctor he had an
obligation to find the causes of female complaints.
The result was that as a scientist he ended up pro
posing medical theories that were actually justifica
tions of women's social roles". (Ehrenreich and
English, 1973). The popular medical theory proposed
was that women's inherent weakness rested on the
physiological law of 'conservation of energy'. Each
person had a fixed supply of vital energy and the
different organs had to compete with each other for
their share. Since a woman's life was centred around
her reproductive organs it meant that these organs
developed at the expense of all the other organs.
The result of such distribution of energy left the
woman strong enough to bear children, but weak
in every other way. This theory implied that the
woman could never be physically or intellectually
superior to a man who did not lose out his energy
on reproductive functions. As a further development
of the theory, it was postulated that the ovaries were
central to the woman’s being. The ovaries determined
the personality traits of the woman and these could
range from irritability to insanity. In textbooks and in
actual medical practice, doctors found
uterine
and ovarian problems behind every female complaint
be they headaches, sofe throat or tuberculosis.
Although all these could be dismissed as part of
the deep medical ignorance of the times, it did not
prevent the medical profession from carrying out
treatment which were specifically designed to alter
female behaviour. Treatment for female invalidism
included isolation,/ prolonged rest, clitorectomy and
ovariotomy. Ehrenreich and English point out that
this was in effect a surveillance system through
53
Socialist Health Review
5
which the doctors could detect the first signs of
rebelliousness and could interpret them as symptoms
of disease, and hence, curable.
But the theories and medications could not be
applied to
working-class women.
They had
neither the time nor the money to indulge in female
invalidism and their labour was essential for the
growth of capital. Medical theory came up with an
explanation based on racial differences : These
women (mostly blacks and immigrants from Europe)
were congenitally inferiorto the white Anglo-Saxon
protestants in that they had smaller brains, larger
muscles and a host of inherited social traits. They
were considered to be free from uterine diseases and
were supposed to have robust healthy babies. Alth
ough these working-class women were not sick'they
were 'sickening' to other classes. They bred disease
and were the reservoir of infection. The danger of
coming in contact with working-class women was
especially great for upper classes for they often
worked as maids in the homes of the upper class
and as prostitutes. Thus medical theory proposed
two separate biological reasons to explain and justify
the social roles of these two classes.
Sexism in Current Medical Practice
It could be argued that all this took place in the
distant past at a time when the scientific founda
tion of medicine was still being laid and that the
content of medicine itself has changed since then.
Such an argument would be valid only if it was
possible to prove that the later devlopments in
medicine were not influenced by sexist prejudices.
But a review of medical literature reveals that sexism
is still dominant in the interaction between'medicine'
women, and medicine still continues to rationalise
and to dictate social norms to women.
It would have been difficult to substantiate these
statements had they been made say, twenty years
ago, because then the ultimate pronouncements on
woman's 'nature' still came from the doctors. But the
militant feminist movement in the west has
been powerful enough to draw.the attention of
academicians to.provide the much-needed data. The
following quotes are taken from studies conducted
in US and in England and are relevant to India
as well, for the teaching and practice of medicine
is not very different and students follow
the same textbooks. Doctors continue to view
women patients as hysterical, irrational and incapa
ble of making decisions. "......... women's illnesses
are psychosomatic until proven otherwise".
"Following traditional linguistic convention,
patients in most medical school lectures are referred
54
’primary dysmenorrhoea is dis
missed as being psychogenic,
although it affects 50 percent
of women*
to exclusively by the male pronoun 'he'. There is,
however a notable exception: in discussing a hypoth
etical patient whose disease is of psychogenic origin,
the lecturer often automatically uses 'she'. For it is
widely taught, both explicitly and implicitly, that
women patients (when they receive notice at all)
have uninteresting illnesses are unreliable historians
and are beset by sucn emotionality that their sympto
ms are unlikely to reflect 'real' disease."
" Woman as compared to men are more likely
to have their depression treated by drugs than to be
helped to overcome the causes of their distress".
( Howell, 1974 )
Work up by physicians in response to five com
mon complaints in a sample of 1.04 men and women52married couples — were evaluated by chart audit.
For the total group of complaints, back pain, head
ache, dizziness, chest pain and fatigue, the physicians'
work ups were significantly more extensive for men
than they were for women. These data tend to
suoportthe argument that male physicianstake medi
cal illness more seriously in men than in women.
( Armitage et al, 1979 )
Most complaints which are termed women’s
complaints (because they refer to their reproductive
tracts) are often dismissed as being of purely psy
chogenic origin. Primary dysmenorrhoea is one such
gynaecological complaint which though it affects
about 50 per cent of women, is considered partly
or wholly psychogenic. This is inspite of the fact
that the origin of pain is still unknown.
"One gains little conviction in relation to most
of the literature (regarding dysmenorrhoea) especially
in respect of management. To illustrate an extreme,
one recent study advises physicians not to trust
empiric diagnoses of dysfunctional dysmenorrhoea,
but to inspect the peritoneal cavity by culdoscope
and to expect often to find free (menstrual ?) blood
as the cause of the pain. Actually, one is finally driven
to the conclusion that theories concerning intrinsic
dysmenorrhoea in early menstruation are as conflic
ting as are countless methods and medications which
are claimed as being helpful. Hardly, a day or a
medical journal, goes by which does not offer a new
near-panacea whose rationale conflicts with many
others, it reflects more essentially the psycho
somatic ineffectiveness of the proscribing
physician, and in general the results are not
superior to our sage advices at the beginning
of the century" (Jones).
The psychogenic theory of primary dysmenorrhoea however is very definite : "It is generally
acknowledged that this condition, is much more
frequent in the highstrung, nervous or neurotic
female than in her stabler sister." (Lennane and
Lennane 1973).
"Faulty outlook leading to an exaggeration of
minor discomfort .... may even be an excuse to
avoid doing something that is disliked''. Or more
simply, "The pain is always secondary to an emo
tional problem." (Lennane and Lennane 1973).
In refuting these theories Jean Lennane and
John Lennane have this to say : "There is no valid
basis for this attitude. These authors are not referring
merely to the effect that the personality of the patient
may have on the amount of suffering or complaints
occurring in any organic illness, but are implying or
directly stating, that the patients* faulty outlook is
causing the condition.
"If the pain is the result of 'faulty outlook' one
would expect it to start at the t;me of the initial
psychic shock (menarche), and not two to four years
later. The pain is dependent on the occurrence of
ovulation and is reliably and usually completely
removed by suppression of ovulation (92 percent
of severe'cases in one study) Perhaps the few who
do not respond to ovulation suppression might be
psychologically disturbed, but in practice, psycho
somatic study and psychometric tests do not confirm
this hypothesis. Scientific supporting evidence is
completely absent e. g. a prospective study of
pubescent girls, or of menstruating girls who were
not yet ovulating. Evidence when offered, is scanty.
'A dysmenorrhoic mother usually has
a
dysmenorrhoic daughter' which, if true (no statis
tical confirmation is offered), would more usually be
taken to indicate a hereditary factor.
"The attitude to treatment mayalso be unusual..
'very little can be done for the patient who prefers to
use menstrual symptoms as a monthly refuge from
responsibility and effort'. The patient with visceral
colic is treated with rest and relief of pain; the
patient who persists in having severe dysmenorrhoea
may be denied both." (Lennane and Lennane, 1973).
The following quote also shows how women's
gynaecological complaints are seen as unimportant
and not worthy of medical attention. ''Majority of
the women in our country are housewives. In most
Socialist Health Review
"Mistaken and misleading beliefs
about female sexuality conti
nued.to dominate medical
theories until the late 70s*
of the other countries women do as much office
work as men and in addition do the duties of house
wives. Thus Indian women have more 'spare time'.
Since majority of them have no other activities or
hobbies and do not do any reading (being unedu
cated) they spend most of their spare time
concentrating on their vaginal discharge".
(emphasis ours) (Kapoor, 1976). The underlying
attitude that will be encouraged in general practi
tioners is self-evident.lt is also significant that
leucorrhoea (vaginal white discharge) is the only
common gynec problem discussed in the book.
In fact, it is not too farfetched to say that almost
every second gynaecological complaint is viewed
with suspicion as being fictitious and just a figment
of the imagination. Here is what Lennane and
Lennane say with regard to nausea of pregnancy :
"A well-defined clinical entity occurring in 75 to 88
per cent of pregnant women. The exact cause
remains unknown. The condition is nevertheless
commonly held to be partly or wholly psychogenic
again without any scientific supporting evidence.
Few will deny that the psychogenic factor is of
prime importance, and it is probable that many
adjustments demanded of the newly-pregnant
woman impose a mild condition of stress coupled
with an irrationally exaggerated fear of the obstetric
hazards confronting her, especially that of producing
an abnormal child. Classified with the neuroses,
(nausea of pregnancy) may indicate resentment,
ambivalence and inadequacy in women ill-prepared
for motherhood "......... " Nearly all pregnant women
see a doctor and to classify up to 88 per cent of
patients with a particular organic condition (preg
nancy) as neurotic is unusual in the extreme" . . .
"its severity in multiple pregnancy and hydatidiform
mole contradict the neurosis theory, unless it is
postulated that the patient can subconsciously and
definitely diagnose these conditions as early as the
fourth week" (Lennane and Lennane, 1973).
Female sexuality has always been a source of
concern in all patriarchal societies. Medical theories
of the late 19th and early 20th century drew a rigid
distinction between reproductivity and sexuality. It
was believed that the development of reproductive
powers and of the maternal instincts could only taka
place when sexuality itself was suppressed. Women
55
were told (by medical theoreticians) that sexual
feelings were ‘unnatural, unwomanly pathological
and probably detrimental to the supreme function of
reproduction".
These
beliefs
continued
to dominate medical theories till as late as
the 'seventies, even after Master's and Johnsons
findings had revolutionised the understanding of
female sexuality. According toScully and Bart(1973)
who reviewed 27 general gynaecological textbooks
published in the US from 1943 to 1972 : "... examina
tion of gynaecological textbooks, one of the primary
professional socialisation agents for practitioners in
the field, revealed a persistent bias towards a greater
concern with the patient s husband than with the
patient herself. Women are consistently described as
anatomically destined to be happy. So gynaecology
appeals to be another of the forces committed to
maintaining traditional sex role stereotypes, in the
interest of men and from a male perspective."
In the textbooks published between 1963-72:
Eight (of the textbooks) continued to state, cont
rary to Master's and Johnson s findings, that the male
sex drive was stronger and six still maintained that
procreation was the major function of sex for the
female. Two said that most women were 'frigid' and
another stated that one-third were sexually unrespon
sive.......... when they (the book) deal with the
subject (sex. role) the traditional female sex role is
preferred. Thus Jeffcoatestates 'An important feature
of sex desire in the man is the urge to dominate
the women and subjugate her to his will; in the
women, acquiescence to the masterful takes a high
place'. In 1971 we read:'the traits that com
pose the core of the female personality are
feminine narcissism, masochism and passivity '. . .
A 1970 text states,'The frequency of intercourse
depends entirely upon the male sex drive. The bride
should be advised to allow her husband's sex
drive to set their pace and she should attempt to
gear hers satisfactorily to his. If she finds, after se
veral months or years that this is not possible, she
be advised to consult her physician as soon as she
realises there is a real problem*. The gynaecologist's
self-image as helpful to women combined with un
believable condescension is epitomised in this remark :
"If like all human beings he (the gynaecologist) is
made in the image of the Almighty and if he is kind,
then his kindness and concern for his patient may
provide her with a glimpse of God's image."
Medical attitudes have changed little in spite
of the criticisms which have been the outcome
of the feminist movement. A recent example is the
breast feeding campaign which has merely incorpo
rated the new attitude of society towards women,
56
*<Jhe advocates of the breast
feeding, campaign reinforce the
idea of the main role of women
being to reproduce and nourish
at the cost of self"
but has not changed its fundamental sexist ideology.
For many years the infant formula companies
had peddled breast milk substitutes as an expression
of mother's love They had played upon the image of
women as sex objects who in order to be desirable
had to be depilated, deodorised, and have well-sha
ped and firm breasts. The counter propoganda (of
the breast feeding campaign) tries to allay the fears
of the mother about the shape of her breast by
leassuring her that breast feeding will, in fact, make
her more shapely.
"Contrary to the old wives's tales that nursing
makes breasts sag (age and gravity do that), breast
feeding actually helps women to get their bodies
back in shape after childbirth. It helps the uterus
return to its pre-pregnancy condition and facilitates
Loss of excess weight gained during pregnancy. It
promotes a deep feeling of warmth and attachment
between mother and baby, and many women
report the physical sensations of breast feeding are
pleasurable" (UNICEF, 1981). The issue is not whe
ther the technical content of the quote is correct or
not, but that the images it uses and reinforces are
as sexist as 'organised' commercial advertisement.
The advocates of this campaign also reinforce the
idea of the main role of women as being to repro
duce and to nourish at the cost of self.
Lactation offers the opportunity of giving 'self.'
to feed an infant, instead of feeding through the
medium of the substitute glass bottle, rubber nipple
and compounded baby formula. To thisend success
ful lactation is indeed, a worthy and noble goal for
the physician to inspire" (Applebaum, 1970). And
further,
"The remarkable ability of poor women to
breast feed their babies for prolonged periods is
the most redeeming feature in an otherwise bleak
nutritional status of many developing countries”
(Gopalan, quoted UNICEF)
Conclusions
A woman is by definition 'emotional'. For long
it was believed that a woman's emotions were con
trolled by her womb and a disturbance in the womb
led to a hysterical state. Modern thinking has
reversed this understanding. It is believed now that
emotions acting through hypothalamus effect men
strual function considerably.
The process of professionalisation includes
learning attitudes about work, about relations with
colleagues and about patients or clients. In medicne
these attituides are strongly coloured by a demean
ing regard for women. For, after all, such attitudes
about women are pervasive in society and more
over the medical profession has been virtually a
male monopoly. This may be disputed in India
since the majority of gynaecologists here are women.
Unfortunately, they too have imbibed the sexist
values in society. We are all products of our cultural
expectations-— and our culture devalues women.
The answer does not lie in doing away with
gynaecologists. The more mature way would be :
(i) to recognise inadequacies that exist in our
knowledge and be more open and receptive to
women's personal experiences; (ii) to redirect
research priorities and focus on problems that
women consider as important; (iii) to end the medical
monopoly of knowledge about women's physiology,
their illnesses. Only then can we hope that medicine
will serve those who need it most.
References
Applebaum, R. M. The modern management of successful
breast feeding in Paediatric Clinics of North America, 17:1
1
(Coold from Page 52)
doeswitch-hunting take place with greater frequency
during certain seasons? There are no simple answers.
This article looks at the entire complex fabric of the
adivasi's way of life, the status of women, and how
factors such as deforestation, modern diseases,
increasing unemployment and impoverishment
and a deterioration and disappearance of trbial
knowledge of medicine may be generating a set of
circumstances which could perpetuate and streng
then the belief in the bhutalis and thus lead to
increasing persecution of women. We especially ask
readers to respond to this article.
Our focus throughout the issue is on women
as consumers of health care. Women also comprise
a large proportion of the providers of health care
and we hope to devote a^seperate issue to the topic
sometime. We hope you find this glimpse of the
many health issues which
concerrn
women,
insteresting.
padma prakash
References
1.
Fee, Elizabeth. Women ahd Health care : A comparison of
theories International Journal of Health Services 5 (3) 347-415
1975.
2.
Raj, Maiteyi and Patel, Vibhuti. An Indian Perspective on
Housework (They quote Rashmi Mayor's study)
3.
See article on Women, Health and Medicine : A feminist per
spective By Katz in this issue.
4.
Schatzkin, Arthur. Health and Labour power International
Journal of Health Services 8 (2) : 213-234, 1976
5.
SNDT Women's Studies Unit. Women in India 1981
February, 1S$70.
2.
Armitage, Schneiderman, Bass. Abstract of article : Respo
nse of physicians to Medical complaints in men and women
JAMA 241; 2186-2187, 179.
3
Burns, Janice. The medical system as a source of sexist
ideology. Paper presented at the Women's Studies Seminar
on Women and Health, New Zealand, 1978.
4
Ehrenreich, Barbara and English Deidre, Complaints and
Disorders— -The Sexual Politics of sickness. Glass Mountian
Pamphlet.
5
'
6
Howell Mary C. What medical schools teach about women.
The New England Journal of medicine 304-307 pp. 1974.
Llewellyn Jones, Derek, Fundamentals of
INAUGURAL ISSUE SOLD OUT!
The first issue of SHR has been sold out !
New subscribers will receive four issues
beginning with this issue (September
1 984) only.
Obstetrics and
Gynaecology. Vol. 1 ahd 11 ELBS.
'*
Lennane. K. J. Alleged psychogenic disorders in women—
a nossible manifestation of sexual prejudice. The New
£ng, nd Journal of Median* 238; 288-292, 1973.
g
Scully, Diana and Bart, Pauline. A funny thing happened
to the orifice : women in gynaecology textbooks.
on the way u - __ ___ _____
Journal of Sociology 78: 1040-1050, 1973.
American --------
9
UNICEF. Questions and answers on infant feeding. April 1981.
1O.
UNICEF Information 1981.
Forthchoming issues will highlight :
WORK AND HEALTH
-
December 1984
POLITICS OF POPULATION - March 1985
HEALTH AND IMPERIALISM - June 1985
Book your copies nowl
Social^ Health Review
57
WOMEN, HEALTH AND MEDICINE
barbara katz rothman
Until pregnancy and childbirth were defined as medical events, midwifery was in no sense a branch, area
or interest of medicine as a profession. The expansion of scientific medicine converted norma p Ys,ca
changes of pregnancy and others into medical problems devoid of their larger socio- emotional content, e
displacement of the midwife by the male obstetrician resulted not from any ideological struggle or scientific
advancement but from the control that physicians exercised through their professional associations- The treat
ment of the body as a machine and the lesser functional importance assigned to women constituted a basis for
exercising the overt social control over women through the surgical removal of her various sexual organs
and by creating physical deformities in her. The author argues that the alternative to the mechanical model of
taking the female system as a complication of so-called biological stability of the non-cycling male, is to take
the female as working norm for the female system.
This article is reproduced from "Women: A feminist perspective" by Joe Freeman (Ed), Mayfield
Publishing Co. 1979.
omen are not only people : woman is a subject
one can study, even specialize in within medi
cine. Obstetricians and gynecologists are medicine's
and perhaps society's generally recognized "experts"
on the subject of women, especially women's
bodies: our health, reproductive functioning, and
sexuality.1 Obstetrics is the branch of medicine con
cerning the care of women during pregnancy, labor,
and the time surrounding childbirth,2 similar in some
ways to midwifery. Gynecology is the "science of
the diseases of women, especially those affecting
the sex organs."3 There is no comparable "science"
of the study of men, their diseases and/or reproduc
tive functions. An attempt by urologists in 1819
to develop an "andrology" specialty came to
nothing.’
At its simplest, we can think of a medical spe
cialty as arising out of pre-existing needs. People
have heart attacks : the medical specialty of card
iology develops. Or the amount of knowledge
generated in a field grows so enormously that
no one person can hope to master it all: physicians
"carve out" their own areas of specialization. Incre
asing knowledge about cancer thus led to the
specialty of oncology, and subspecialities within
oncology.
But the development of a medical specialty is
not necessarily the creation of a key for an already
existing lock. Medical "needs" do not necessarily
predate the specialty, even though the specialty is
presumably organized to meet those needs. This
has been made quite clear in the work of Thomas
Szaz on the relatively recent expansion of medicine
into such "social problem" areas as alcoholism,
gambling and suicide.5 Medicine doesn't have the
"cures" for these problems but by defining them in
medical terms, as sickness, the physician gains
58
political control over the societal response: punish
ment becomes "treatment ', desired or not, success
ful or not. Similarly, medical control over childbirth,
lactation, menopause, and other women's health
issues was not based on superior ability to deal with
these concerns.
The case of Jacoba Felice de Almania, a
woman tried for the illegal practice of medicine in
1322 illustrates this point. In her defense Jacoba
Felice de Almania had witnesses who testified that
she never charged unless she cured, and that her
cures were successful where other "legal" (male)
practitioners had failed. However, since she had
not attended a medical school (medical schools
being closed to womer ) she was not licensed to pra
ctice medicine. That she saw women who did not
want to go to a male practitioner, that she was
successful did not matter. "Efficacy of treatment
was not the criteria for determining who was or was
not a legitimate medical practitioner, but the educa
tional requirements and membership in the faculty
of an organized group were the most important
factors. 11 In essence, what professional control
over medicine says is, "We may not be able to help
you, but we are the only ones qualified to try."
Vern Bullough, in his analysis of the develop
ment of medicine as a profession, writes that during
the middle ages, "One obvious group outside of
the control of the university physician was the mid
wife, but during the period under study the univer
sity physician generally ignored this whole area of
medicine. Midwives might or might not be quali
fied, but this was not a matter of -public concern
(emphasis added)".7 More accurately, one might
state not that physicians ignored this "area of
medicine," but that midwifery and its concerns
we/e outside of medicine, just as matters that were
undoubtedly of concern to women existed outside
o t ie public concern. Until pregnancy and childirt were defined as medical events, midwifery was
in no sense a branch, area, or interest of medicine
as a profession.
Medical expansion into the area of childbirth
began before the development of asepsis, surgical
techniques, anesthesia; any of what we now con
sider the contributions of obstetrics. And yet, even
without the technology, by the beginning of the
nineteenth century medicine had begun the redefini
tion of childbirth from a family or religous event to
a medical one, needing medical presence for its
safe conduct.8
Midwives treated childbirth in the larger con
text of women's lives. Midwives did not and do
not deliver babies. They teach women how to
give birth.Brack hascalled the role of midwife "total"
—she helped in the socialization of the mother to
her new status, both as teacher and as role model.
"The midwife's relation to the woman was both
diffuse and affective, while the physician role
demanded specificity and affective neutrality".9
Midwives taught how to birth babies, how to nurse
them, how to care for the babies and for the
mother's own body. Physicians deliver babies and
move on. The physician "isolated the laboring
woman and her delivery of the infant from the rest
of the childbearing experience, and defined it as a
medical and surgical event which required speciali
zed knowledge."10 As one modern nurse—midwife
has said of obstetrics residents : "They want us to
stay with the woman in labor and just call them
when she's ready to deliver. To them, that's the
whole thing."
At the time that physicians were taking over
control of childbirth, it is virtually unarguable that
the non-interventionist, supportive techniques of
the midwives were safer for both the birthing woman
and her baby. The physicians' approaches included
bleeding to "syncope" (until the woman fainted),
tobacco infusion enemas, frequent non-sterile
examinations, and other surgical and chemical
interventions?1 In the 1910's and 20's, as American
physicians successfully ousted midwives, the mid
wives' safety records remained better than the
physicians. In Newark a midwifery program in i91416 achieved maternal mortality rates as low as 1.7
Der thousand, while in Boston, where midwives
were banned, the rates were 6.5 per i000. Similarly,
infant mortality rates in Newark were 8 5 per 1000
contrasted with 37.4 in Boston.'^ In Washington,
as the percentage of births reported by midwives
shrank from 50 percent in 1903 to 15 percent in
Socialist Health Review
"... midwifery and its concerns were
outside of medicine, just as matters
that were undoubtedly of concern
to women existed outside of the
public concern".
1912, infant mortality in the first day, first week,
and first month of life all increased. New York's
dwindling corps of midwives did significantly better
than did New York doctors in preventing both
stillbirths and post—partum infection.13
The physician's separation of the "delivery" of
the baby from its larger socio-emotional context has
its roots as far back as Rene Descartes concept of
mind-body dualism. To Descartes, the body was a
machine whose structure and operation falls within
the province of human knowledge, as distinguished
from the mind which God alone can know. Though
even the Hippocratic principles state that the mind
and body should be considered together, "Experience
shows that most physicians . . . irrespective of their
professional activites and philosophical views on the
nature of the mind, behave in practice as if they
were still Cartesian dualists. Their conservative att
itudes are largely a matter of practical convenience." 11
The medical models used for convenience are
that diseases are the bad-guys which the good-guy
medications can take care of; that the body breaks
down and needs repair; that repair can be done in
the hospital like a car in the shop; and that once
' fixed." the person can be returned to the commu
nity. The earliest models were largely mechanical;
later models worked more with chemistry; and newer
more sophisticated medical writing describes computer-like programming; but the basic points remain
the same. It was a useful model when dealing with
the problems facing medicine at the turn of the
century : primarily bacterial and viral disease-causing
agents and simple accidents and trauma. It has never
worked well for understanding the problems that
women face in dealing with doctors, including the
experience of childbirth. While midwifery was learned
by apprentice, doctors were instructed in the use of
forceps, as well as techniques of normal delivery,
by "book learning," by discussion, the use of wooden
models, and infrequently by watching another doctor
at work. Wertz, in her study of the development of
obstetrics, has pointed out that "By regarding the
female body as a machine, European doctors found
that they could measure the birth canal and predict
whether or not the child could pass through.'15
Stories of women delivering while their doctors
scrubbed for a Caesarian section were told, probably
59
... the female gonads were removed
not when women were “loo female*
that is, too passive or dependent, but
when women were too masculineassertive' aggressive, unruly.
with much relish, and similar stories continue to be
part of the lore of midwifery. Among the stories
midwives tell each other are the tales of women who
were told that they could never deliver vaginally,
and then went on to have normal births of over
sized babies.
In the nineteenth and early twentieth centuries
midwives and physicians were in direct competition
for patients, and not only for their fees. Newer, more
clinically oriented medical training demanded "teach
ing material," so that aven the immigrant and poor
women were desired as patients. 1,1 The displacement
of the midwife by the male obstetrician can be better
understood in terms of this competition than as an
ideological struggle or as "scientific advancement."
Physicians, unlike the unorganized, disenfranchised
midwives, had access to the power of the state
through their professional associations. They were
thus able to control licensing legislation, in state
after state restricting the midwife's sphere of activity
and imposing legal sanctions against her.17
The legislative changes were backed up by the
attempt to win public disapproval for midwifery and
support for obstetrics. Physicians accused midwives
of ignorance and incompetence, and attacked
midwifery practices as "meddlesome." Rather than
upgrading the midwives and teaching the skills
physicians thought necessary, the profession of
medicine refused to train women either as midwives
or as physicians. Is Physicians argued repeatedly that
medicine was the appropriate profession to handle
birth because "normal pregnancy and parturition are
exceptions and to consider them to be normal
physiologic conditions was a fallacy." ly Childbirth
became redefined as a medical rather than a social
event, and the roles and care surrounding it were
reorganized to suit medical needs.-0
Once professional dominance was established in
the area of childbirth, obstetrics rapidly expanded into
the relatively more sophisticated area of gynecology.
The great obstetricians of the nineteenth century
were invariably gynecologists 21 (and of course all
men). Among other effects, this linking of obstetrics
and gynecology further reinforced the obstetrical
Orientation toward pathology.
CO
One of the earliest uses of the developing held
of gynecology was the overt social control of women
through surgical removal of various of
s^a‘
organs. Surgical removal of the clitoris (clitondectomy) or less dramatically, its foreskin (c.rcumcis.on)
and removal of the ovaries (oopherectomy or castra
tion) wem used to check women's "mental disorders.
The first gynecologist to do a clitoridectomy was an
Englishman, in 1858. 22 In England, the procedure was
harshly criticised, and not repeated by others after the
death of the originator in 1860. In America, however.
clitoridectomies were done regularly from the late
1960's through till at least >904 2; and then spora
dically until as recently as the late l940's. 21 The
procedure was used to terminate sexual desire or
sexual behavior something deemed pathological in
women. Circumcisions were done on women of all
ages to stop masturbation up until at least 1937.2’
More widespread than clitoridectomies or
circumcisions were oopherectomies for psychologi- cal "disorders". Interestingly the female gonads
were removed not when women were "too female"
— i.e., too passive or dependent, but when women
were too masculine—assertive, aggressive, "unruly.'
Oopherectomies for "psychiatric" reasons were done
in America between 1872 and 1946. 21 (By the
1940’s perfrontal lobotomies were gaining accept
ance as psychosurgery.)
The developing medical control of women was
not limited to extreme cures for psychiatric problems.
The physical health and stability of even the most
well-adjusted, lady-like women was questioned.'
Simply by virtue of gender, women were (and are)
subject to illness labeling.
One explanation for women's vulnerability to
illness labeling lies in the functionalist approach to
the sociology of health. Talcott Parsons has pointed
out that it is a functional requirement of any social
system that there be a basic level of health of its
members.27 Any definition of illness that is too
enien' would disqualify too many people front
fulfilling their functions and would impose severe
strains on the social system. System changes,
such as war can make changes in standards
of health and illness generally set for members.
If heZ t Hn n ° lndlVidUal lCVel as we"' ^ndards
of health and illness being related to social demands,
a mi d headache w.ll excuse a student from attendng class, but not from taking final exams A ,
g,
extension of this is that the less valued a’person or
group's contribution to society th.
person
are labeled ill.
socie'y. the more easily they
Women are not always seen
members of society,
oeonip h
•S
Y/ as
as people
doing
t
functl
0nal,
important'
•things. This has historically and cross—culturally
been especially true of the women of the upper
classes in patriarchal societies, where it is a mark of
status for a man to be able to afford to keep a wife
who is not performing any useful function. A clear,
if horrifying example of this is the traditional Chinese
practice of foot-binding. By crippling girls, men
were able to show that they could afford to have
wives and daughters who do nothing. It is a parti
cularly disturbing example of conspicuous consump
tion. But we do not have to turn to faraway places
to see women defined as useless. In Ehrenreich
-and English's historical analysis of the woman
patient Complaints and Disorders, they speak of the
late nineteenth and early twentieth century 'lady of
leisure." "She was the social ornament that proved
a man's success; her idleness, her delicacy, her
childlike ignorance of 'reality’ gave a man the 'class'
that money alone could not provide."-s
The practice of creating physical deformity in
women can be seen in our history as well. A woman
researcher who studied menstrual problems among
college women between 1890 and 1920 found that
women In the earlier period probably were some
what incapacitated by menstruation, just as the
gynecologists of the day were claiming. However,
she did not attribute the menstrual problems to
women's "inherent disabilities" or "overgrowth of
the intellect" as d;d the male physicians. She related
it to dress styles. Women in the 1890's carried some
fifteen pounds of skirts and petticoats, hanging
from a tightly corseted waist. As skirts got lighter
and waists were allowed to be larger, menstruation
ceased to be the problem it had been.-u In the
interest of science, women might try the experiment
of buckling themselves into a painfully small belt
and hanging a fifteen pound weight from it. One
might expect weakness, fatigue, shortness of
breath, even fainting: all the physical symptoms of
women's "inherent" disability. And consider further
the effects of bleeding as a treatment for the problem.
It follows from Parson s analysis that in addi
tion to actually creating physical disability (the
bound feet of the Chinese, the deforming corsetry
of our own histrory), women were more easily
defined as sick when they were not seen as functional
social members. At the same time in our history that
the upper class women were "delicate", "sickly'
and "frail," the working class women were well
enough to perform the physical labor of housework,
both their own and the upper classes as well as to
work in the factories and fields. Because "...how
ever sick or tired working class women might have
been, they certainly did not have the time or money
Socialist Health Review
to support a cult of invalidism. Employers gave no
time off for pregnancy or recovery from childbirth,
much less for menstrual periods, though the wives
of these same employers often retired to bed on all
these occasions. '::n The working class women w,ere
seen as strong and healthy, and for them, pregnancy,
menstruation, and menopause were not allowed to
be incapacitating.
These two themes : the treatment of the
body as a machine, and the lesser functional
importance assigned to women, still account
for much of the medical treatment of women.
Contemporary physicians do not usually speak
of the normal female reproductive function as
diseases The exception, to be discussed below, is
menopause. The other specifically female reproduc
tive functions—menstruation, pregnancy, childbirth,
and lactation—are regularly asserted in medical texts
to be normal and healthy phenomena. However,
these statements are made within the context of
teaching the medical "management," "care,"
''supervision," and "treatment" of each of these
'conditions."
Understood in limited mechanical terms, each of
these normal female conditions or happenings is a
complication, stress on an otherwise normal system.
Medicine has fared no better than any other discip
line in arriving at a working model of women that
does not take men as the comparative norm.
For example, while menstruation is no longer
viewed as a disease, it is seen as a complication in
the female system contrasted to the reputed biologic
stability of the supposedly noncycling male. 31 As
recently as 1961 the American Journal of Obstetrics
and Gynecology was still referring to women's
"inherent disabilities" in explanations of men$Xrvc<
tion :
Women are known to suffer at least some
inconvenience during certain phases of the
reproductive cycle, and often with consider
able mental and physical distress. Woman's .
awareness of her inherent disabilities is
thought to create added mental and in turn
physical changes in the total body response,
and there result problems that concern the
physician who must deal with them. 32
Research on contraception displays the same
mechanistic biases. The claim has been made that
contraceptive research has concentrated on the
female rather than the male because of the sheer
number of potentially vulnerable links in the female
chain of reproductive events.3; Reproduction is
61
’"Reproduction is dealt with not as
u complicated organic process, but
as a series of discrete points, like
stations on an assembly line, with
more for female than for male’.
clearly a more complicated process for the female
than the male. While we might claim that it is safer
to intefrere in a simpler process, medicine has tended
to view the number of points in the female reprodu
ctive process as distinct entities. Reproduction is
dealt with not as a complicated organic p'oeess but
as a series of discrete points, like stations on an
assembly line, with more for female than for male.
The alternative to taking the female system as a
complication of the ''basic" or "simpler" male system
is of course to take female as the working norm. In
this approach, a pregnant woman is compared only
to pregnant women, a lactating breast compared
only to other lactating breasts. Pregnancy, lactation,
etc. are accepted not only as nominally healthy
variations, but as truly normal states. To take the
example of pregnancy, women are pregnant; it's
not something they "have" or "catch" or even
"contain". Pregnancy involves physical change; they
are not, as medical texts frequently call them,
"symptoms" of pregnancy. Pregnancy is not a
disease; its changes are no more "symptoms" than
the growth spurt or development of pubic hair are
"symptomatic" of puberty. There may be diseases
or complications of pregnancy, but the pregnancy
itself is neither disease nor complication.
In contrast, the working model of pregnancy
that medicine has arrived at is that a pregnant
woman is a woman with an insulated parasitic
capsule growing inside. The pregnancy, while
physically located within the woman, is still seen as
"external" to her, not a part of her. The capsule
within has been seen as virtually omniscient and
omnipotent, reaching out and taking what it needs
from the mother-host, at her expense if necessary
while protected from all that is bad or harmful.
The pregnancy, in this medical model, is almost
entirely a mechanical event in the mother. She
differs from the nonpregnant only in the presence
of this thing .growing inside her. Difference other
than the mechanical are accordingly seen as
symptoms to be treated, so that the woman can be
kept as "normal" as possible through the "stress"
of the pregnancy. Pregnancy is not necessarily in
herently unhealthy in this model, but it is frequently
associated with changes other than the growth of
the uterus and its contents, and these changes are
seen as unhealthy. For example, haemoglobin (iron)
is lower in pregnant women than nonpregnant,
making pregnant women appear (by non-pregnant
standards) anemic. They are then treated for this
anemia with iron supplements. Water retention, or
edema, is greater in pregnant women than nonpregnant, and they are treated with limits placed on
their salt intake and with diuretics. Pregnant women
tend to gain weight over that accounted for by the
fetus, placenta and amniotic fluid. They are treated
for this weight gain with strict diets, sometimes even
with "diet pills". And knowing that these changes
are likely to occur in pregnant women, American
doctors have tried to treat all pregnant women with
iron supplements, limits on salt and calorie intake,
and many with diuretics, in the name of "preventive
medicine".
What is particularly important to note is that
these "treatments" of entirely normal phenomena
are frequently not perceived by the medical profession
as interventions or disruptions. Rather, the physician
sees himself as assisting nature, restoring the
woman to normality. Bogden, in her study of the
development of obstetrics, reports that an 1800‘s
non-interventionist physician, as opposed to a
"regular" physician, would give a laboring woman
a catheter, some castor oil or milk of magnesia, bleed
her a pint or so, administer ergot, use poultices to
blister her, and "Any of these therapies would be
administered in the interests of setting the parturient
up for an easier, less painful labor and delivery, while
still holding to the belief that the physician was letting
nature take its course." 31 Wertz says that currently
medicine has redefined "natural childbirth " in
response to consumer demand for it to include any
of the following techniques : spinal or epidural anes
thesia, inhalation anesthesia in the second stage of
labor, forceps, epesiotomy, induced labor. 35 Each
of these techniques increases the risk of childbirth
for mothers and babies. 33 Under the .title "Normal
Delivery," an obstetric teaching film purports to
show "the use of various drugs and procedures used
to facilitate normal delivery." Another "Normal
Delivery" film is 'a demonstration of a normal,
spontaneous delivery: including a paracervical block,'
epesiotomy . . . . "
*
The use of estrogens provides an even better
example of how medicine views the body as a
machine that can be “run" or "managed" without
bemg changed. Estrogens are female hormones; in
medicme they are seen as femininty in a jar. In the
widely selling Femmin Forever, Dr. Robert A. Wilson,
af7/ic model of the body as a
machine, which can be regulated,
controlled, and 'managed* by
medical treatments, is not working.
'feminity* or physical *fenialeness'
is not something that comes in a jar
. and can be manipulated*.
pushing "estrogen replacement the rapy" for all
menopausal women, callsestrogen levels as detected
by examination of cells from the vagina, a woman's
"femininity index. 4 As estrogen levels naturally drop
off after menopause a women is according to Dr.
Wilson, losing her "femininity. Interestingly, estrogen
levels are also quite low while a woman is breast
feeding, something not usually socially linked to a
"loss of femininity."
Menopause remains the one normal female
process that is so overtly referred to as a "disease4, in
the medical literature. To some physicians, menopause
is a deficiency disease, and the use of estrogen restor
ing the woman to her "normal" condition. Here we
must reconsider the question of women's functional
importance in the social system. Middle-aged house
wives have been called the last of the "lady of
leisure/4 having outlived their social usefulness as
wife-mothers, and having been allowed no alterna
tives. While oopherectomies and clitorectomies are
no longer being done on upper class women as
they were a hundred years ago, to "cure" all kinds
of dubious "ills,44 older women are having hysterec
tomies, (surgical removal of the uterus) at alarming
rates. Much more typical of modern medicine,
however, is the use of chemical rather than surgical
"therapy." Because the social changes and demands
for readjustment of middle age roughly coincide with
the time of menopause, menopause becomes the
"illness44 for which women can be treated.
Estrogens have been used in virtually. every
stage of the female reproductive cycle, and usually
with the argument that they return the woman to
normal or are a "natural" treatment. Estrogens are
usedin puberty, to keep girls from getting "unnatu
rally" tall; to treat painful menstruation; as contrace
ption, supposedly mimicing pregnancy; as a chemical
abortion in the ''morning after'4 pill; to replace supp
osedly missing hormones and thus to prevent misca
rriages; to dry up milk and return women to "normal"
nonlactating state and in menopause to return women
to the "normal44 cycling state. For all the claims of
normality and "natural" treatment, at this writing
approximately half of these uses of estrogens have
Socialist Health Review
been shown to cause cancer. The use of estrogens
in pregnancy was the first to be proven carcinogenic:
daughters of women who had taken estrogens
(notably DES, a particular synthetic estrogen) are at
risk for the development of a rare cancer of the
vagina 40 The sequential birth control pill was taken
off the market as the danger of cancer of the lining
of the uterus (endometrial cancer) become known, '
and similarly estrogens taken in menopause have
been shown to increase the risk of endometrial
cancer by as much as fourteen times after seven
years of use. 21
The model of the body as a machine, which can
be regulated, controlled, and "managed" by medical
treatments, is not working. "Femininity" or physical
"femaleness" is not something that comes in a jar
and can be manipulated.
Nor are women accepting the relegation to
secondary functional importance, as wives and
mothers of men. In rejecting the viewpoint that we
bear men's children for them, we are reclaiming our
bodies. When pregnancy is seen not as the presence
of a (man's) fetus in a woman, but as a condition of
the woman herself, attitudes toward contraception,
infertility, abortion, and childbirth all change. When
pregnancy is perceived as a condition of the
•woman then abortion, for example, is primarily a
response to that condition.
The women's health movement has grown as an
important part of the women's liberation movement.
In some of its work, the movement has been geared
toward consumerism within medicine, seeking better
medical care and a wide range of services for
women. While better trained, more knowledgeable
and more humane physicians are a high priority, what
the self-help and lay midwifery groups are doing
goes much deeper than that. I believe that these
women are reconstructing the pre-obstetrics and
gynecology model of women's health. They are
redefining women's health in fundamentally women's
terms.
Women's self-help groups and clinics are teach
ing women how to examine their own bodies, not
in the never-ending search for pathology in which
physicians are trained, but to learn more about
health. Medical technology and physicians are
clearly useful in treating illness, but do we really
want physicians to be "treating" health? It is entirely
possible for a woman to fit herself .for a diaphragm,
do a pap smear and a breast examination (all with
help and instruction if she needs it) and never
adopt the "patient" role. It is also possible for a
woman to go through a pregnancy and birth her
63
.
i
baby with good, knowledgeable, caring help, but
without becoming a "patient” under the "super
vision" of a physician.
Redefining normality within the context of the
female reproductive sytstem will take time. We
have all been imbued with the medical model of
women's bodies and health and it is hard to work
past that. Redefining women in women's terms is
not a problem unique to health. It is an esential
feminist issue.
References
Diana Scuhy and Pauline Barr, "A Funny Thing Happened on
the Way to the Orifice : Women in Gynecology Textbooks,"
American Journal of Sociology. 78 (1971). 1045-1050.
2 . Gould Medical Dictionary, 3r d Ed. (New York: McGraw-Hill,
1972). p. 1056.
• 3 Gould Medical Dictionary, p. 658.
4
G. J. Barker Benfield, The Horrors of the Half-Known Life
(New York : Harper and Row, 1976) p. 88
5
Thomas Szasz The Theology of medicine (New York : Harpe
Colophon. 1 977).
6
Vern Bullough, The Development of Medicine as a Profession
(New York and Switzerland : Barger 1956)
7
Bullough, p. 102.
8
Janet Carlisle Bogdan, "Nineteenth Century Childbirth; its
Context and Meaning,” paper presented at the third Berk
shire Conference on the History of Women. June 9-11
1
9
1976, p. 2
Datha Clapper Brack, "The Displacement of the Midwife :
Male Domination in a Formerly Female Occupation”,
10
11
12
unpublished, 1976, p. 4.
Brack. "The Displacement of the Midwife,” p. 5
Bogdan. "Nineteenth Century Childbirth."
Frances E. Kobrin. "The American Midwife Controversy:
A Crisis in Professionalization." Bulletin of the History of
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
Medicine (1166), p. 355.
Kobrin. "The American Midwife Controversy," p. 355.
Rene Dubos, Man, Medicine and Environment (New York: New
American Library. 1968), p. 79.
Dorothy C. Wertz, "Childbirth as a Controlled workspace: From
Midwifery to Obstetrics," paper presented at the 71st Annual
Meeting of the American Sociological Association, 1976, p 5.
Barbara Ehrenreich and Deirdre English Witches, Midwives
and Nurses (Old Westbury, N. Y. : Feminist Press, 1973), p. 33
Brack, "The Displacement of the Midwife".
Bogdan, "Nineteenth Century Childbirth", p. 8
Kobrin, "The American Midwife Controversy," p. 353.
Brack, The Displacement of the Midwife," p. 1.
Barker-Benfield, The Horrors of the Half-Known Life ,p. 83.
Ibid., p. 120.
Barker-Benfield, The Horrors of the Half-Known Life,p.‘\20.
Ehrenreich and English, Complaints and Disorders (Old West
bury. N.Y.: Feminist Press. 1973).
Barker-Benfield. The Horrors of The Hall-Known Life, p. 120.
Ibid,, p. 121.
Talcott Parsons, "Definitions of Health and Illness in Light of
American Value Systems," in Jaco, Patients. Physicians and
Illnesses (New York : Free Press, 1958)
2a.- Ehrenreich and English, Complaints and Disorders, p. 16.
29 \fern Bullough and Martha Voght, "Women, Menstruation and
Nincyjnth-Century Medicine," paper presented at the 45th
annual meeting of the American Association for the History
of Medicine, 1972.
64
30
31
32
Complaints and Disorders, p. 47.
Ehrenreich and English,
Cycles (They Have Them Too, You
Estelle Ramey, "Men's
Know)." Ms. (1972). 8-14 .
Milton Abramson and John R. Torghete, American Journal of
Obstetrics and Gynecology (1961), p. 223.
Sheldon Segal, "Contraceptive Research : A Male Chauvinist
33
Plot ?*', Family Planning Perspectives (July 1972).
Janet Carlisle Bogdan, "Nineteenth Century Childbirth : The
34
Politics of Reality," paper presented at the 71st annual meet
ing of the American Sociological Association, 1976, p. 11.
Wertz, "Childbirth as a Controlled Workspace", p. 15.
35
Doris Haire. The Cultural Warping of Childbirth Hillside, (N. J.
36
International Childbirth Education Association. 1972).
Educational Materials for Obstetrics and Gynecology, American
37
College of Obstetrics and Gynecology. 1974.
Robert A. Wilson. Feminine Forever (New York : Pocket
38
Books. 1 968).
39 John Bunker, "Surgical Manpower", New England Journal of
40
41
42
Medicine (January 15, 1970).
Arthur Herbst. J. Ulfelder and D.C. Poskanzer, "Adenocar
cinoma of the Vagina”, New England Journal of Medicine.
(April 22, 1971), pp. 871-81.
Barbara Seaman and Gideon Seaman, M.D., Women and the
Crisis in Sex Hormones (New York : Hawson Associate’s
Publishers. Inc.. 1977). p. 78.
Harry Ziel and William Finkla, "Estrogzn
Replacement
Therapy," New England Journal of Medicine (Dacembsr 4.
1975).
Books in Print
Rational Drug Therapy : The Arogya Dakshata
Mandal, 1913 Sadashiv Peth, Pune 411 030 is to
publish in August, 1984 a booklet highlighting
recent advances in the treatment of common dieases,
rational approach to treatment, side effects of drugs,
clinical diagnosis of common diseases etc. This is\
meant to act as a physician's desk reference for uayto-day practice. For further information write to
Dr. A R. Patwardhan at the above address.
The Mandal also publishes a monthly informa
tion sheet the Pune Journal of Continuing Health Educa
tion which is designed to 'present scientific informa
tion and opinion to the medical profession to
stimulate
thought and further invistigation.'
Subscription rate : Rs. 10 a year.
Book News
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. _ Health
.
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women, Finally
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Available for reference at the Centre for Education
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"WOMEN'S HEALTH IS WOMEN'S CONCERN"
A Brief Overview of Health Issues in the Women's Movement
nirmala sathe
Women's health status is closely linked to their social status. Even though the ’ideal' woman is supposed
to look weak and delicate, she has to be able to perform all the domestic tasks necessary for the sustenance of
the family. Her major role in society is that of a reproductive machine. The feminist movement aims at uniting
women to raise their voices against the oppression of these stereotypes. Logically then, health issues
concerning women must form an integral part of the women's movement. Why has the movement been generelly
apathetic to health issues? The author, a feminist-activist, briefly reviews the sporadic activities
concerning women's health and strongly urges that women's health issues should preferably be taken
up by women s groups.
II of us have a right to good health. The right to
health means not only the right to be free from
disease, but also to enjoy physical, mental and
emotional well-being. Health cannot be separated
from political, cultural or economic systems in which
we are living. It cannot be isolated from the roles
we are playing and the status we have in society.
My grandmother often used to tell us ''Beti, a
woman cannot afford sickness. If she does fall sick
then she can't complain, but has to bear her illness
silently ; for who will tolerate a sick-slave?''. Many
of us have experienced this truth in our own lives or
through those of our mothers, grandmothers.
Although it is true that in economically poor
classes even the men do not get proper medical aid
in sickness, it is the women who are the more neg
lected group. In fact, even among the economically
better off, where it is possible for women to afford
good care and proper food, they are found to be
weak, or rather not as healthy as they could be.
This is because of cultural influences. According to
the ideal image of women perpetuated in society, a
woman is supposed to be weak and delicate. A
'strong' woman thus becomes, in a sense, the victim
of cultural norms. Women are traditionally supposed
to eat only after the rest of the family members have
eaten and then only what has been left over, even
though in poor families it is hardly ever sufficient to
keep body and soul together. It will not be an
exaggeration to say that she ever gets sufficient rest
only on her deathbed.
Menstruation, pregnancy, childbirth, breast
feeding, menopause, all these are considered to
be 'women's issues'. In a way society at large has
nothing to do with them, because women are not
equal members of the society and therefore, com
plaints about these are treated as, 'psychological' or
as 'women's sickness' and are not given the serious
Socialist Health Review
consideration they deserve. Doctors and medical
professionals produced in this male-dominated
society are taught to either close their eyes and ears
to such complaints or to immediately connect all
women's complaints to their reproductive system. A
woman is looked upon as a mere reproductive
machine rather than as a human being. Politically
also, it is the world-wide phenomenon, that all
drives for population control or population increase,
breast-feeding or the baby foods campaign have
treated women as reproductive machines. Nowhere
have these issues been treated in a manner where
women's 'health' is given central importance.
In order to understand the location of women's
health-issues in the context of feminist movements,
it is necessary to broadly define feminism and the
feminist movement. Feminism is a new concept in
India, a concept not yet well-accepted or understood
by the people at large. Broadly speaking one can
say that feminism deals with all the aspects of a
woman's life and her role in society - - male domi
nated society. Feminists are interested in changing
a hierarchical society and in creating a society
where everybody is equal. In today's society, women
are at the bottom of the hierarchical structure. In any
class, caste or race, whatever their status, women
among them are always at the bottom.
No doubt women of the upper classes have
more facilities and opportunities than the lower
class males, but in their own class they are the
least important. Not only that, but because they are
women any man from any class can express his
superiority as a male member of the patriarchal
society. One example is rape.
So the main role of the feminist movement is
to unite women to raise their voices against their
oppression in a male-dominated society. In her
family life, work place, place of education and in all
65
“irrespective of educational status,
caste or class background, women
share the same (health) experience
and feelings of inferiority because
of their physiology*
the aspects of her life, women have a lower status
than men. In our health systems too, the status of
women is only as a reproductive machine.
In India, we cannot say that there exists any
mass feminist movement. But at the same time it is
a fact that there are several women's groups--femi
nist groups--who are jnvolved in activities in various
areas of women's oppression such as rape, wife
beating, legal reforms and so on. Their activities
range from cultural activities to agitational morchas
and'helping' individual women in distress to fight
for their rights and the common cause.
But none of these groups have as yet taken
health'as the prime issue and worked on it. Many
of them have touched on one or the other aspect of
the issue at some point of time. But there has been
no consistency shown regarding the health issues of
women. This is because cf various reasons which
are rooted in our outlook (such as the cultural and
social stigma attached to the discussion of women's
problems about their bodies.) Many feminists have
inhibitions which do not allow them to freely dis
cuss these issues among themselves.
Some groups have made an attempt to raise
their voices against oppression through medical
systems. For instance, the Women's Centre in
Bombay held a meeting with other feminist groups to
discuss the effects of "amniocentesis" as a sex
determination test, which gave rise to demands and
concerted action in Bombay. Two of these demands
were : (1) Amniocentesis facilities should be allo
wed only in research instituions with proper mach
inery and control; (2) The government and the
medical profession should be brought under pressure
to abolish pre-natal sex-determination. It was
pointed out that unless and until major social up
heaval takes place regarding the* status of women
in society, female babies will continue to be
murdered. (See article on Amniocentesis.)
Recently, another meeting was held by the
Women's Centre to discuss the issue of Depo-provera, the controversial injectable contraceptive.
Womens magazines - feminist ones such as Baija
(in Marathi) and Manushi (in Hindi and English)
66
have given importance to the health and reproduc
tive activity of women by bringing out special issues
on the subject. Baija's special issue was on women
and health in which the whole proplem had been
discussed from the feminist point of view.
Organisations which are working in health such as
the People's Science Movement, Medico Friend Circle,
(MFC) have also touched on the women's health
problems. The Lok Vidnyan Sanghatana, Maharashtra,
had prepared an exhibition on women and health
which received a tremendous
response from
various women's groups as well as others working
among the toiling masses. This wasthefirst attempt
made to discuss the woman's body and her health,
reproduction and social biases about it. The exhibi
tion was taken to many villages and it was a thrilling
experience to find that women are able to relate to
one another while discussing their experiences
about their bodies from menstruation to menopause.
They were all encouraged by the fact that as women,
irrespective of educational status, caste or class
background, they have gone through the same
experiences and feelings of inferiority because of
their physiology. The explanations we had received
were shrouded in myth and the actual scientific
explanation of the various functions that a woman's
body has to perform had been denied us.
The exhibition criticises the social outlook and
stigmas attached to the female -sex in society
and superstitions about women's bodies and child
bearing especially with regard to producing male
children. Mainly the posters about sex-determination
and about fertility, entitled "Who is responsible
for not getting a child ? ' have made a great impact
and have very positively put forward the view that
a woman is not wholly. nor mainly responsible.
The exhibition emphatically argues that a woman
is not merely a reproductive machine. In adivasi
areas as well as urban areas like Bombay, Nasik,
Pune, Miraj the exhibition attracted large numbers
WOmen and OnlytO
women. It is only in this situation that women can
wnmTph'SHXhibiti°n WaS Sh°Wn
Zr .
°k‘ ,he'lr Pr°blems- “ very intp rtant to realise that women can relate only toother
women when it comes to health and theh bodies
because only women ran
i
Annthpr'c nr^ki
.
tru,y understand one
anomer s problems
foot
although sincerely interested 33
aCtiV*tS'
the problems, are not able to " U"ddrstand,n9
ment or even a group around
° m ° m0V6
y up around the subject.
“Women's groups should take prime
responsibility about women's health
issues. Other organisations in
health can help in a number
ways... *
At Anand the MFC held an annual meeting
in 1983 where many women were called from
various groups which were interested in women and
health. Majority of the women, who were educated
and were working in one or other organisation found
it difficult to discuss their problems in the meeting
when men were present as even with the desire and
sincerity to ^understand the problems, male partici
pants were unable to understand the intense
emotional severity of the problem. At the session
where only women were present, there was a live
discussion and a free exchange of experiences.
or the lack of it. In all phases of our lives, we face
difficulties and become the victims of health care
system. As potential mothers, as mothers, as house
wives, as consumers in order to keep ourselves in
accordance with the beauty norms of the society,
women are either neglected or misguided by the
health care system. To raise our voices against this,
women's groups should start (and are actually start
ing) to organise around health issue’s. Only this
can lead to a strong and united fight against all
sorts of oppression in male-dominated society.
Here I do not intend to devalue the male-acti
vists, who are really helping to raise the voice of
women against the medical oppression of women.
MFC activists have brought out various articles
and debates on the problem. Peoples Science Move
ment groups have made attempts to make people
aware through health exhibitions, the posters and
pamphlets on Anaemia. In both the organisations,
it is mainly women activists with the help of male
activists who have worked very hard for it.
1
;i
We can conclude that women's organisations
should take prime responsibility about the women's
health issues, and other organisations in the health
area can help them in a number of ways. With this
mutual co-operation, one can hope for a strong
women's health movement.
The Women's Centre in Bombay is planning to
start some health activities. They will be mainly
(1) Educational - making women aware of their body
and its functions, to help them to tackle the social
prejudices and superstitions and to create a healthy
outlook about themselves; (2) Preventive ; and (3)
Curative - With the help of sympathetic medical
proffesionals to help women in preventing and curing
health disorders.
Most of us have very little control over the health
care system, ver/ little say in the decisions as to
what kind of health care is available to us. Women
perhaps are most affected by the health care system
Socialist Health Review
67
it Many of us have been and are, actively involved tn its activities
including its journal the MFC bulletin. The idea of a journal Ife
RESPONSE
Why Don't We Organise
Sir : It is a happy development that a forum for
debating and defending a radical perspective on
health care has come into existence. If the first issue
is any guide I have no doubt that the forum is going
to bean instrument of immense value to socialist
.activism in the health sphere. Wish you all success !
May I share an idea here regarding what I think
is an essential requisite for continuity and accounta
bility in this effort. If the persons interested organise
themselves into a society (maybe, Indian society for
Socialist Health Care - IS$HC) itgives us an identity,
a shared cause for loyalty, and, no less important, a
firm ground from which to influence, to bargain, and
to relate to other organisations, agencies and govern
ments. Further if the society has at least one Annual
Conference it will provide us the much needed
person-to-person interaction for enhancing enthusi
asm and exchanging ideas.
SHR came from these MFC
members not with a sectarian
motivation of providing any 'alternative- to the MFC and its
bulletin but to help focus and sharpen the debate amongst the
radicals working in health and in turn, widen the basis of radical
medical work and of marxist political praxis.
The MFC is a decade old and has helped to radicalise many
health workers. We feel it is still relevant and all radical activists
experiencing a need for such organisation should join the MFC
and be part of the process of radicalisation started by it.
For further information about MFC contact :
Ravi Narayan, Convener
326, Vth Main, 1st Block
Koramangala, Bangalore-560 034
Protest Against Marxist Male Chauvinism
Dear comrades : I am writing to lodge a strong
protest against Dhruv Mankad's reference to our
joint article (Health Care in a Revolutionary Frame
work : Possibilities for an Alternative Praxis, SHR 11)
as 'Binayak Sen's article' in his editorial perspective
(page 3, SHR 1:1).
(Contd. on page 71)
I would suggest two streams of membership :
Members—persons qualified and directly enga
ged in health care, irrespective of their position in
the health personnel hierarchy. This includes health
visitors, nurses, auxiliary health workers, dentists,
pharmacists, physicians, surgeons etc. The other
stream of membership will be that of Associate
Members for all those interested in socialist health
care but not directly engaged in health care. This
includes teachers, lawyers, politicians, engineers
etc., practically anybody from the public.
Dr. N. Janakiramaiah
Asst. Professor of Psychiatry,
Mental Health & Neuro Sciences,
National Institute of
Bangalore 560029
MANUSHI
A Journal AboutWomen And Society
Brought out by a group of women in New Delhi
More Than A Magazine - A Cause
*•**
:o:
WORKING EDITOR'S REPLY : We share your viewpoint that
radical activists working in the field of health or interested
in it, need person-to-person interaction for enhancing enthusiasm
and exchanging ideas.
But we feel that it would be a terrible mistake to form a sepa
rate organisation of socialists interested in health issues. That
will be the best way to isolate socialists from the wider move
ment on health issues. In fact, not marxists but other radicals
were the people who gave meaning to radical medical practice
while some socialists have only very recently started questioning
the official communist view of health i.e. (i) merely more equitable
distribution of.medical care and (ii) the content of medicine and
medical practice as being value free. Therefore no comprehensive
marxist understanding of health and health care exists. Genuine
(undogmatic and scientific) marxist theory and practice in health
can develop only as an outcome of our interaction and work
with wider stratas of radical activists.
Fortunately in India,
a broad radical thought current
does exist — the Medico Friend Circle, and many of us are part of
68
fo:
Brings you
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different parts of the subcontinent, among
different communities castes, classes
News about women's organised struggles
Interviews, lifesketches
Film reviews
Women in history
Fiction, poetry, artwork
Letters from readers
And much more
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^d*
AMNIOCENTESIS AND FEMALE FOETICIDE
Misuse of Medical Technology
vibhuti patel
Murder of the female child is nut new in India. This practice still continues, only the methods of commiting such murder have changed. Such practices reflect society s attitude towards the female sex. The
patriarchal male-dominated system has evolved modern methods to perpetuate women's oppression in today's
socip-economic system. The author analyses the reasons for the popularity of one such modern medical method,
amniocentesis, as a pre-natal sex determination test and argues that it is meant to exterminate women and
perpetuate their oppression, she also emphasises the need to fight sexist abuse of this medical technique.
Amniocentesis, a scientific technique that was
supposed to be used mainly to detect genetic
deformities has become very popular in India for
detection of the sex of a foetus. For that 15-20 ml
of amniotic fluid is taken from the womb by prick
ing foetus membrane with the help of a special
kind of needle. After separating foetal cell from the
amniotic fluid, a chromosomal analysis is conducted
on it. This test helps in detecting several genetic
disorders like mongolism, defects of neurotube in
the foetus, retarded muscular growth, 'Rh' incom
patibility. haemophilia and other types of abnormal
babies. This test should be conducted on women
above 40 years because there are higher chances
of mongoloid children produced by such women.
In some cases, a sex determination test is required
to identify sex-specific deformities such as haemo
philia, retarded muscular growth which mainly
affect males.
Limitations of Amniocentesis
----- test
---- can give
_
This
95-97% accurate results.
Thus it is not totally reliable. In Harkisandas Hospital
and Pearl Centre, Bombay, where this test is con
ducted on thousands of women, it was noted that
the test had affected foetus adversely to 1% of the
total number of cases. Thus the test may lead to
spontaneous abortions or premature delivery, dislo
cation of the hips, respiratory complications, needle
puncture marks on the baby (Chhachhi 8 Sathya-
maia, 1983).
The test is conducted after completion of 16
weeks of pregnancy and within a week the findings
are available. In our country, the facility of amniocen
tesis is available only in big cities like Bombay,
Delhi, Chandigarh etc., hence patients from villages
and small towns get the results by post; that takes
one more week. By the time they decide to abort
the foetus, it is over 18 weeks old. Abortion
at such a late stage is quite harmful for the mother.
Popularity of the Test
The amniocentesis tests became popular in the
last three years though earlier they were conducted
Socialist Health Review
in the government hospitals on an experimental
basis. Now these tests are conducted for sex deter
mination and thereafter extermination of female
foetus through abortions, in private clinics and
hospitals and government hospitals in many cities of
India like Bombay, Delhi, Amritsar, Chandigarh,
Baroda, Ahmedabad, Kanpur, Meerut etc. This
perverse use of modern technology is encouraged
and boosted by money-minded private practitioners
who are out to make a woman, "a male-child
producing machine ". As per the most conservative
estimate made by a research team of Women's Centre,
Bombay, based on their survey of six hospitals and
clinics, in Bombay alone 10 women per day undergo
test This survey also revealed the hypocrisy of
"non-violent", "vegetarian", "anti-abortion" ma
nagement of the city's reputed hospital - Harkisandas
Hospital, that conducts ante-natal sex-determination
test Their handout declares the test as "humane and
beneficial". The hospital has out-patient facilities
and there is such a great rush for the test that one
has to book one month in advance. As the manage
ment does not support abortion, they recommend
women to various other hospitals and clinics and ask
them to bring back the female foetuses after abortion
to them for further "RESEARCH". (Abraham &
Sonal, 1 983).
In other countries, this test is very expensive
and is under strict governmental control, while in
our country this test can be done at between Rs. 80
to Rs. 500. Hence not only upper class people, but
even working class people can easily avail this
facility. A survey of several slums in Bombay
showed that many women had undergone the test
and after knowing thatthe sex of foetus was female,
had undergone abortion in the 18th or 19th week of
pregnancy. Their argument was it is better to spend
Rs. 80 or even Rs 800 now than give birth to a
female baby and spend thousands of rupees for her
marriage when she grows up.
Controversy Around Amniocentesis
Three years back a controversy around Amnio
centesis started as a resulj of several investigative
69
1941
1951
1961
319
361
439
164
186
226
155
945
reports published in popular magazines like India
Todays Eves Weekly, Sunday and other regional
-’nnrv>-»n° Journals. One estimate that shocked every-
175
213
acaaemicians ana activists was: between 1978 and
1983, around 78000 female foetuses were aborted
after sex determination test in our country. (TOI
June. 1982).
nmem and pupate
oners involved
in this lucrative trade, justify the sex determination
test as measure for population control. Women have
always been worst target for family planning policies.
Harmful effects of pregnancy test, contraceptive pills,
anti-pregnancy injections, camps for mass-sterilisa
tion of women with their unhygenic atmosphere
are always overlooked by the enthusiasts of family
planning policy. Most of population control research
is conducted on women without giving any consi
deration to the harm caused by the research to the
women concerned. Advocates for population con
trol will continue cashing in on socio-cultural values
that trest the birth-of a daughter in the family as a
great calamity and* perpetuate modern method of
massacaring female foetuses on a massive scale.
India has a legacy of killing female children
(dudhapiti) by putting opium on the mother's nipple
or by putting the afterbirth over the child's face or by
illtrealing daughters. (Clark, 1983). These days also
female members of the family get inferior treatment
as far as food, medication and education is concer
ned (Research uniton Women's Studies. 1981). When
they grow up, there is further harassment for dowry.
"Then, is it not desirable that she dies rather than be
illtreated?" ask many social scientists. In Dharma
Kumar s (EPW, June, 1983) words : ''Is it really
better to be born and 'left to die' than to be killed as
foetus? Does the birth of lakhs or even millions of
unwanted girls improve the status of women?".
But what can be the long-term implications if
such a trend continues ? Will it not aggravate the
already disturbed sex-ratio ? There has been con
tinuous decline in female/male sex-ratio between
1901 and 1971. Between 1971 and 1981 there was
slight increase, but it still continues to be adverse
for women.
Demographic Profile of India (in millions)
1901 -1981
1981
684
353
331
946
941
930
935
Year
1901
19.11
1921
1931
70
Male
Total
Female
Total No. of
Fopula - Popula - Population women per
tion
tion
1000 men
i e. sex ratio.
121
238
117
972
252
128
124
964
251
128
123
955
279
143
136
950-
Source : Census Report, 1981, Series 1, Paper 1.
Here too, economists have their reply ready i.e.
law of demand and supply. If supply of women is
reduce, their status will be enhanced. Scarcity of
women will increase their value (Bardhan, 1982).
According to this logic, women will not be burnt alive
because of dowry problem as they will not be easily
replaceable commodity. But here the economists
forget the socio-cultural milieu in which women have
to live. The society that treats a woman as a mere
sex-object will not treat women in a more 'humane'
way if they are scarce in supply. On the contrary
there will be increased incidences of rape, abduction
and forced polyandry. In U. P, Haryana, Raiasthan
and Punjab among certain communities, sex-ratio is
extremely adverse for women. There a wife is shared
by 'a set of brothers' (or some times even by patrilateral parallel cousins) (Dube, 1983\
To think that it is better to kill female foetuses
than giving birth to unwanted female children, is
very fatalistic. By this logic it is better to kill the
poor rather than let them suffer poverty and
deprivation. How horrifying !
Another argument is that in cases where women
have one or more daughters, they should be
allowed to have amniocentesis done so that they
can plan a 'balanced family' by having sons. Instead
of going on producing femalj children in the hope
of getting a male child, it is better for the family's and
the country's welfare that they abort the female
foetus and have small and balanced families with
daughters and sons. This concept of 'balanced family'
also has a sexist bias. Would a couple with one or
more sons undergo amniocentesis to get rid of male
foetus and have a daughter for balancing their
family ? No. never !
This rrenzy of having a 'balanced family- !~At
what cost ? How many abortions (between 16 to 18
weeks) can a woman bear without jeopardising her
health ?
J
Time and again it is stated that women themsel
ves enthusiastically go fOr the test Ouf Qf
ffge
will. It is a question of women'**
u' •
a,e these ehetoes mM.
a
■»
have „o sect.,
<■««
taunted, even deserted by their hush"
harassed’
if they fail to do so. Thus thei^-rh
S
'n’laWS
s their choices' depend on
,he fear of society. It is true that feminists
world have always demanded -the riaht nf, /
to control their own bodies/fertility and choTe
whether or not to have child/children and havl
facilities or free, legal and safer abortions "
While understanding these issues in the third world
context we must see it in the background of the role
of imperialism and racism that aims at the control of
•coloured populations". Thus: "It is all too easy for
population control advocates to heartily endorse
women s rights at the same time diverting attention
from the real causes of the population problem.
Lack of food, economic security, clean drinking
water and safe clinical facilities, have led to a situa
tion where a woman has to have 6.2 children to
have at least one surviving male child. These are
the roots of the population problem, not merely the
'desire to have a male child'" (Chhachhi, and
Sathyamala, 1983).
Meetings called by Women's Centre (Bombay)
and various women's organisations in Delhi, discus
sed this problem at length- and three positions
emerged. 1. Total ban on amniocentesis tests;
2. Support to amniocentesis tests; and 3. Amniocen
tesis tests to be allowed under strict governmental
control and only for detecting genetic abnormalities.
Most of the women's organisations feel that the
3rd position is most advantageous even if one ac
cepts the fact that illegally, the tests will be cond
ucted by unscrupulous people. To avoid this,
women's organisations and other socially conscious
groups will have to act as watch dogs.
The issue of amniocentesis once again shatters
the myth of neutrality of science and technology.
Hence, the necessity of linking science technology
with socio-economic and cultural reality. Class, racist and sexist biases of the ruling elites have crossed
all boundaries of human dignity and decency by
making savage use of science. Even in China after
10 years of 'cultural revolution' and 'socialist think
ing' sex determination test for female extermmation
are largely prevalent afterthe government s campaign
^one-chifd-family began (Sunday, 1983). Chinese
couples willy-nilly accept a system of one-chihdfamily but the child has to be a ma e. This shows
how adaptive the system of patriarchy
suorsmemacy Is. Il can asiahlish and
™
,oo,s
am.lodsc, social
and even post-capitalists,
consistently.
1.
2.
(Contd. from page 68)
I am unable to understand the thought process
behind the omission of my name. Does Dhruv Mankao
assume that because I am married to Binayak Sen,
my contribution to a joint production is subsistence
( —negligible^ zero ) ? I would be grateful if he
could clarify what lies behind this e.g. of marxist
male chauvinism - for we can only begin to advance
towards correct action from correct analysis.
May I congratulate you on an excellently produ
ced first issue ?
Ilina Sen
Dalli Rajhara
DHRUV MANKAD REPLIES:
I tender my sincere apology to Ilina Sen for not mentioning
her name in the editorial perspective while referring to a joint
article by her and Binayak Sen. The error occurred due to the fact
that before writing the perspective, I had not seen the actual
article referred to above. I knew about the contents only from
discussions with Binayak at Calcutta and later with Anant Phadkc. •
Manisha Gupte Awasthi, Padma Prakash, Amar Jcsani at Pune. '
Till I saw the article in print in SHR, I was under the honest
impression that it was indeed written by Binayak only. This is
what lies behind " this e.g. of Marxist Male chauvinism”.
Despite this apology, I do wish to stale that Ilina Sen's
■protest' is petty and unprincipled. She has thrown wild allegations
'of Marxist male chauvinism’ on my part without first giving me a
chance to explain. This kind of immature reasoning based on mere
presumptions - that too, incorrect ones, would lead us neither to
correct analysis nor to correct action but only to bickerings and
quarrels.
I am restraining myself in my reply with the intention not to
extend this issue any further. I hope in future, such errors are
avoided <ind if and when they do occur the reactions thereto are
References
. cnnal • "Amniocentesis - Sex Determination
Abraham Amu and Sonal . Amn
Tests". Women's centre
An£f (he Ma|o
Balasubramanyan,
Utopia", Economic and
Bardhan, Pranab: "Little Girls and Death in India", Economic
and Political Weekly, Bombay, September 4, 1981,
4. Census Repot, 1981, Serios 1, paper 1, Government of India
Delhi.
5. Chachhi, Amrita and C. Sathyamala : -'Sex Determination
Tests : A Technology Which Will Eliminate Women", Median
Friend Circle Bulletin. Pune, November, 1981.
6. Clark, Alice : "Limitations on Female life chances in Rural
Central Gujarat", The Indian Economic and Social History
Review, March, 1981. Delhi,
7. Dube, Leela : "Misadventures in Amniocentesis", Economic
and Political Weekly, Bombay, Feb. 1 983, pp-279-280
8. Dube, Leela : "Amniocentesis Debate Continued", Economic
and Political Weekly, Bombay, Sept. 1983, pp. 1633-1636’
9. Jeffery, Roger and Patricia Jeffery . "Female Infanticide and
Amniocentesis", Economic and Political-Weekly. Bombay,April,
1983, pp-645-656
10.
Research Unit on Women's Studies : Women in India, SNDT
Womens University, Bombay,
11.
Kumar, Dharma : "Male Utopias or Nightmare", Economic
and Political Weekly. Bombay, Jan. 1984,
12.
Kumar, Dharma : "Amniocentesis Again" Economic and
Political Weekly, Bombay, June. 1983,
13.
Sunday, May 8-14, 1983.
. 14. Times of India, Editorial on Amniocentesis, June, 1932.
3.
Bombay, Oct. 23.
more responsible.
WORKING EDITORS' REPLY : The omission was our fault
rather than Dhruv’s, because we wore responsible for checking
the final proofs and wore of course aware of the joint authorship.
We regret the inadvertant slip.
1981.
71
Socialist Health Review
RURAL ENERGY SITUATION
Consequences for Women's Health
srilatha batliwala
This article examines the interrelationship between women s work, the growing scarcity of energy resources
for survival, and its impact on women's health and nutrition. Women contribute 53 per cent of the human energy
required for survival tasks. And yet they eat far less than they require. Women's calorific intake is about 100
calories (per woman per day) less than they expend whereas men show an 800-calorie intake surnlus. The article
raises some very important questions with regard to women's work, their food intake, access to health care and
women's morbidity patterns and examines the energy - health - nutrition syndrone. This is based on a paper
presented at the Conference on 'Women and Poverty' in Calcutta, 1983
^^orland's Medical Dictionary defines the word
syndrome as "a combination of symptoms resultfrom a single cause or so commonly occurring
together as to constitute a distinct.............. entity".
It is hard to find a more apt definition of energy,
health and nutrition and their relationship to poverty.
It may be felt that poverty has an impact on the
health and nutrition of all the poor, regardless of
age and sex. Is there something unique about its
impact on women ? Or inversely, do women bear an
additional burden - in terms of their health, nutrition,
or anything else - in a poverty situation ? This
paper attempts to show that they do - and also why
strategies for women's health and nutrition need to
be emphasised within strategies for general
development.
In the field of nutrition, most strategies have
been aimed at increasing food intake indirectly or
directly (Natarajan, 1974; and NlPCD, 1976.'
Batliwala, 1978). Women are targets of the latter
programmes only during pregnancy and lactation.
On the other hand, there has been little or no study
of the possible effects of reducing energy expend
iture - or to put it simply, reducing the overwhelming
drudgery of the poor, and especially of poor women.
This is not proposed as an alternative to raising food
intake, but as an additional (and possibly critical)
facet of improving women's nutrition and health.
Such energy saving, as we shall see, is not only a
nutritional asset, but may also release a significant
amount of women's time.
The greater work load on women has been
observed for centuries and rather embarassedly
reduced to a sheephish joke by men. But until
recently, there was no detailed study of the relative
work outputs of women and the nature of such
work. In 1981, however, the Application of Science
and Technology to Rural Areas (ASTRA) (a cell of
the Indian Institute of Science, Bangalore) published
72
the report of their three-year field study of rural
energy consumption patterns (ASTRA, 1981). The
study was conducted in rural Karnataka with a
sample of six villages comprising 560 households
and a population of 3,452.
Ono of the most significant results of ASTRA's
study, was the role of human energy - and specifi
cally women's energy - in the rural energy matrix.
Table 1 summarises the findings :
Table 1 . Pattern of Village Energy Supply &
Consumption
Source-wise contribution
Source
Per cent
Human
(Men)
(Women)
(Children)
Animal
Firewood
Kerosene
Electricity
Other
7.7
(3.1)
(3.8)
(0 8)
2.7
81.6
2.1
0.6
5.3
Sector-wise consumption
Activity
Agriculture
Domestic
Lighting
Transport
Industry
Per cent
4.3
88.3
2.2
0.5
4.7
: Fie
St
■ 'RRUral En0r9y C—P-n
Field Study , Bangalore, Indian Institute Patterns - A
of Science,
p. o(J.
If we exclude firewood, we find that human
beings were the most significant energy contributors even more than animals. Moreover, if we disaggre
gate human energy, men, women and children con
tribute 31 /0, 53/ and 16/0 of human energy, resp- ■
ectively. The ASTRA study also showed that' most
human energy was spent not so much on econo
mically productive activities but on survival tasks
such as gathering firewood, fetching water, and
cooking.
What is the role of women in these
and what is the magnitude of the burden activities,
°n them
Table 2 :
Time and calorie expenditure on domestic and agricultural activities and their calorie cost
(for man, woman and child)
I
II
Calorie cost
(cals/minute)
M
W
C
Activity
(A)
(B)
(D)
Hours/day
W
C
0.33
0.41
M
Calorie/day
W
C
Domestic
0.24
(1) Gathering firewood
(a) Walking to source
(b) Return trip with load
(2) Fetching water
(a) Walking to source
(b) Return trip with load
(3) Cooking
(4) Carrying food/walking to farm
(5) Livestock grazing
0 02
1.00
1.63
2.28
1.14
0.47
0.18
Sub-Total
—
(1) Ploughing
(2) Irrigation
(3) Transplanting
(4) Weeding
(5) Harvesting
(6) Winnowing
(7) Threshing
(8) Manuring
(9) Nursery
(10) Harrowing
(11) Transporting (by bullock cart)
0.18
0.30
0.08
0.03
0.18
5.2
6.4
0.02
0.78
4.4*
5 5*
115
122
74
7
232
40
24
4.6*
5.7*
0.13
5.2
6.4
4.4*
5.5*
4.6*
5.7*
1.03
2.5*
5.2
2.8
2.1*
4.4*
2.4*
2.2*
4.6*
2.5*
3
312
274
287
301
68
155
—
—
—
—
—
711
1010
293
—
—
0.33
0.33
0.19
—
—
—
—
5.5 4.7*
—
3.3 2.8‘
5.1* 4 3*
—
5.1* 4.3*
5.3* 4.5* (Manual) ■
0.09
0.14 )
0.13 ) 0.04
0.07 )
0.03
0.05
—
—
Agricultural
Sub-Total
(C)
M
Ill
—
4.5*
4.6’
3.4*
3.0*
5 5*
1.7*
—
—
—
5.3*
5.4
4.0*
3.5’
6.5*
2.0*
—
59
59
25
25
57
—
45 )
31 )
15)
12
6
—
—
—
—
—
334
280
—
7.94
8.42
1.5* 1.7’
(average;
878
715
655
650
_
_
_
__
85
85
51
24
—
_
__
35
—.
—
—
»
Other Activites
(Sweeping, cleaning, child care,
personal care, play, sitting etc)
9.79
Rest & Sleep
(approx)
10.00 10.00 14.00
—■
—
—
550
500
—
—
—
—
2473
2505 1598
P'U.r,,
/ Fie]d Sludy |nd;an
Total
—
—
1.5*
Col. I : Source: of
Compiled
data given in ASTRA, 1981 '• Rural FnP,nu rnnt..
Science.from
Bangalore.
,•
Col. II : *AU estimated or approximated figures.
(i)
Ramanathan1and
G. Nag,Nutrition
: Energy (Second
Cost of HumSn
Laboilft
|n New DcIN
(ii)N.R.LRajaiakshmi,
974 P.
: Applied
Edition),
OxfordNationa|
and IBH,
Socialist Health Review
z
P %
° Hcahh' Ahmednbad.
73
compared to that on men? To determine this, we
have to examine the hours per day spent on domes
tic and agricultural activities and translate these
into calorie costs. Table 2 (col I) present the break
up of hours per day spent on agricultural and
domestic activities by men and women.
The most significant aspect of Table 2 ( col. I)
is that while women average about 6 hours a day on
survival-related and agricultural tasks, men average
only 4 hours a day on the same. Also, the ASTRA
study did not monitor other domestic work such as
cleaning, sweeping, washing of clothes and utensils
and child care, all of which are calorie-intensive and
all of which are performed almost exclusively , by
women. On the other hand, most of the other (i. e.,
non-enumerated) tasks carried out by men are
sedentary in nature • such as visiting the tea shop,
trips to par.chayat offices, talking with friends,
and so on.
We have now to translate the activities of men
and women into calorie costs and compare them
with calorie intake. However, this is not as simple
as it seems for once again the neglect of women
in social research or the ideological biases
within existing information systems becomes
a handicap.
Ramanathan and Nag have reviewed virtually
all calorie cost studies in the country for various
activities in their paper Energy Cost of Human Labour.
They found energy cost estimates for only 10
agricultural activities, compared to 70 industrial
and military activities. Furthermore, there were no
female equivalents for these agricultural tasks, as
though women have not been
participating in
agriculture for several millenia I
The unkindest cut of all is when we find, that
the few women's energy costs (10, to be precise)
which have been measured are clubbed under the
category of 'sedentary people' and include such
pleasant tasks as sewing, knitting, typewriting,
piano-playing and singing. Where have 9O.'b of India's
women gone - the ones who work from morning to
night at back-breaking domestic and economic
tasks and also carry the burden of pregnancy and
child care?
Under the circumstances one is forced to
approximate the energy expenditure of women in
the concerned tasks by using the fomula :
74
, ,
.
energy cost ’minute/adult male
Y
X
Rn«;al Metabolic Rate female
Ba________ ______ _________
Basal Metabolic Rate
male
(the BMR for moderate workers is used throughout the forme
This gives us the estimates of energy cost per
minute per activity for men and women presen e
in Table 2 (col II). Please note that all starred figur s
are estimates based on the above formula.
We are now' ready to calculate the activity-wise
energy output per day for man and woman, shown
in Table 2 (col III).
A note of explanation in needed here : Agricul
tural activities are obviously seasonal but here they
have been averaged over the whole year to obtain
a daily figure, which is more appropriate for determi
ning daily energy output and comparing it with
calorie intake. Thus, during some months of the
year, agricultural activities will account for much
higher energy expenditure than shown in Table z.
(col. Ill)
We see that the calorie (energy) expenditure of
women is higher than that of men. The difference
appears more marginal than I suspect it really is.
First of all, the 'other' activities of men, could not
be clearly enumerated.
The shortage of off-season employment oppor
tunities makes it doubtful that they spend a lot of
energy in non-agricultural activities. Thereto! e one
can postulate that during off-seasons the total
calorie expenditure of men may be significantly
lower than that of women.
Secondly, we see that most of the energy
expenditure of women is on daily, life-supporting
tasks which must be performed regardless of season
and which are generally not shared by men - viz,
cooking, fetching water, gathering firewood, wash
ing, cleaning, and child care.
Thirdly, many of the above activities create a
demand for human energy because of the scarcity
of other energy resources. If cooking fuel and water
were readily available close to the user and the
efficiency .of stoves improved, a saving of nearly
500 calories per day per woman could be effected
Is there a need to bring about such an energy saving
at all ? If food intake more or less matches calorie
output, there would appear to be no ca use for concern
ASTRA's nutrition survey (unpublished) in the village
Ungra (based on monitoring of food purchase and
use overatwo-month period) found that the average
individual intake per day was around 2300 calories
But this, like all other nutrition surveys in the
country, assumes an equal distribution of food
within the family-a highly questionable assumption.
The staple diet in this area is 'ragi' which is
cooked to a dough and separated into balls for
eating. When local women were questioned as to
how they distribute the balls, their answers provided
the following ratio : 2 balls for a man, 1.5 for a
woman and 1 for a child. Obviously this would be a
questionable basis for disaggregating the overall
calorie consumption of the family - but it gives us a
rough idea of intra-familial inequalities in food
distribution. It also shows that food intake is deter
mined not only by work output, but also by social
and cultural factors which have to be studied,
described and tackled.
Let us for a moment, return to the above ratio
and assume it is valid. Applying it to the overall
cereal consumption per day per family (4.24 kg) the
relative food intake per man, woman and child
would then be 3270 calories, 2410 calories and
1640 calories per day respectively. This means an
intake deficit of nearly 100 calories per day per
woman, whereas a man has an intake surplus
of nearly 800 calories.
A deficit of 1C0 calories a day doesn't look
serious until we link it to other facts : (i) The
vast majority of the population have worm infest
ations, and these parasites can 'steal' as much as
one-fourth of the total food intake, (ii) This intake
level for women is a 'maintenance' level which
makes no allowances for the additional 500-600
calories required during pregnancy and lactation and Kamala Jaya Rao (1980) has shown that onethird adult Indian women are in that condition at
any point in time, without the benefit of additional
nutrition during these 'vulnerable periods.
All of the nutrition programmes in the country
are aimed at pregnant and lactating women - though
how much of this extra nutrition actually reaches
these women is a moot point (Natarajan,'! 974). But
what of the nutrition deprivation suffered by girls
from infancy to pregnancy? And what of the women
who have fulfilled their reproductive roles, but
must continue to work for their family's survival
without enough food to meet their needs?
Health hazards of cooking stoves and fuels
Beyond the nutrition factor there are other ways
in which the village energy system affects women's
health. Domestic fuel scarcity is only one part of the
crisis women face. Havingobtained some form of
Socialist Health Review
fuel, poor women are forced to cook on stoves which
are both primitive and inefficient. The traditional chula,
used in the vast majority of Indian homes, ranges
from a crude pit or U-shaped pile of bricks to the
more sophisticated fired clay or metal stove. The
cooking efficiency of these stoves is dismally poor :
between 3 and 10*;o (Geller, 1980). Since the fuel
efficiency of a stove determines not only fuel
consumption (and hence fuel-gathering time) but also
the length of time spent in cooking, the traditional
chula condemns women to spend at least 3 hours a
day on cooking, and that too for most of their lives I
As if this were not a severe enough penalty,
some recent studies have highlighted the extreme
health hazards to women and girls where conven
tional bio-mass fuels like firewood, cowdung and
crop wastes are used ascooking fuels (SNDT, 1983).
Dr. Kirk Smith, energy programme chief of the
Resource Systems Institute of East-West Central
Honolulu, conducted a study in rural Gujarat in
association with the National Institute of Occu
pational Health (Ahmedabad) and the Jyoti Solar
Energy Institute (Baroda). The study was conducted
in 4 villages of the Kaira District. Smith's team found
that traditional bio-mass fuels emit more Toxic
Suspended Particulates, (TSP) benzo-a-pyrene,
carbon monoxide and polycyclie organic pollutants
than fossil fuels. Thanks to the crudity of stoves and
the poor ventilation of the rural home, these fuel
emissions produce a deadly disease trap for women
and girls - for the study found that the women
begin regular cooking at around 13 years of age
(Indian Express, 1983).
Clinical studies by the Kirk Smith team found
that women spending around 3 hours a day on cook
ing were exposed to 700 microgrammes of particulate
ma.tter per cubic metre, compared to the safety level
of 75 microgrammes. The benzo-a-pyrene inhaled
alone was equivalent to smoking 20 packets of
cigarettes a day. (SNDT, 1983)
In another study conducted by the Jawaharlal
Institute of Postgraduate Medical Education and
Research
(JIPMER),
20 albino
ratsK were
exposed to cow dung smoke and soon developed
chronic bronchitis, bronchiolitis and emphysema.
The JIPMER Study suggested this as a possible
cause of the high incidence of bronchinal disease
among women and older girls in India (Indian
Express 1983). In light of these facts, it is not
surprising that respiratory disease is one of the
major causes of death among women in India (SNDT,
1983).
75
One of the solutions developed to combat
this problem is the 'smokeless' chula. The 'Nada'
chula and 'Dholadhar' chula, among others, are
some of the most sucessful designs. Designers and
disseminators have reported not only fuel savings
of 50% with these chulas, (IGDP, 1982) but the
remarkable changes they have wrought in the lives
of women and children; the fuel saving has released
precious time which has been used in a variety of
ways, including, as one woman put it, to "just lie
down and rest" (Sarin, 1983).
c
h
I
I
t
(
Unfortunately, women's ill-health and under
nutrition is not of equal concern to all. There is a
growing school of thought which uses theories of
biological adaptation (the 'homeostasis' theory) and
clever statistical gymnastics to prove that there is
in fact no such calorie gap (Sukhatme, 19S I).
The doyen of this school is Prof. P.V. Sukhatme,
a biostatistician with considerable clout who, a
decade ago smashed the theory of the 'protein gap'
in the diets of poor people. He demonstrated that
the protein gap only occurs when there is a calorie
gap - but when overall intake of calories is sufficient,
the amount of protein is also adequate (Sukhatme,
1972).
He was undoubtedly responsible for
elbowing out the vested interests who would
have liked to manufacture and market supplementary
protein to people who had barely enough to eat.
Today his work has taken quite a different
direction - a direction which has frightful implications
for women. To grossly oversimplify his theory, he
states that just as there is inter-individual variation
in food intake, there is also an intra individual
variation. So at times we eat more, and then we eat
less. Thus, ascribing some arbitrary norm such as
'recommended daily allowance' is meaningless,
since both inter- and intra-individual food intakes
will fall into a normal bell curve, with the majority of
people in the centre and a few at either extreme, even
though everyone is healthy (Sukhatme, 1981). From
here, he goes on to state, that the only two indi
cators of malnutrition (either in the form of overnutri
tion or undernutrition) are : whether body weight
remains basically constant (i. e., it is 'maintained'),
and whether the normal level of activity (for which
read 'work') is maintained. He believes that any
one who meets the above criteria cannot be termed
malnourished.
Sukhatme also does not want us to be carried
away by Western norms of how tall or heavy we
should be. A thin, small person is neither stunted
nor underwight - she/he has merely 'adapted' to
76
efficiently use the little food to be had while conti
nuing to labour away for survival.
Therefore, this 'calorie-gap' suffered by women
and by many of the poor is of little consequences
because they 'adapt' themselves and carry on. A
comfortable theory indeed ! Women, in fact, are the
stumbling block in Sukhatme's theory. Can women
'adapt' to calorie deficits of 500 or 600 calories
during pregnancy and lactation ?
Even if they can, Sukhatme ignores the possib
ility that such adaptation over a lifetime may have
disastrous consequences on health. Is this why more
women die, and die earlier than men ? (HFA, 1981)
Is this why maternal mortality is so high - 4001
100,000 ?ls this why the average birth-weight of
poor babies is as low as 2.5 kg (NIN, 1971), leading
to so much child wastage ? In other words this may
be the starting point of the vicious circle of maternal
undernutrition, low birth-weight babies, high infant
mortality and high fertility. In this context, health care
services can play an important role in alleviating the
health problems of women to some extent - but do
they?
First of all, women's health has been confused
with maternal health —once again on the assumption
that women and, maternity are one and the same
thing. The only women-oriented pregrammes in the
national health sector have been Maternal and Child
Health Schemes and to some extent Family Planning.
The health system has yet to waken to the fact that
there arc a large number of women in need of health
care who are neither pregnant nor lactating.
Secondly, the outreach of health services is very
poor with respect to women. Examination of in-andout-patient records of medical institutions reveals
that for every three men who avail of these facilities
only one woman does so. This is by no means
because women are healthier, but because in the
Indian family, the importance given to a woman's
ailments is considrably less than that given to a
man's illness.
Thirdly, the very nature and structure of the
health service;s.ystem mitigates against its reaching
women. Our health system is institution-based.
Women have neither the time, mobility, childcare
facilities nor the leisure to travel long distances at
great expense to seek out the services available in
hospitals and health centres, often at the loss of a
day's wage. A domiciliary system which reaches the
doorstep would automatically benefit more women
than today's set-up.
Finally in our culture, it is women who can best
reach out to and care for other women. Yet in the
present health services, male functionaries heavily
outweigh the females. Although the number
of women doctors has been steadily rising, few of
these are working in the rural areas. It is the lone
cadre of Auxiliary-Nurse-Midwives, poorly paid,
poorly supervised and equipped, sexually harassed
and overloaded with work, who are the sole guard
ians of women's health. Even the celebrated Comm
unity Health Worker Scheme, defeated our hopes
when over 80 of those selected and trained turned
out to be men.
Conclusions
The scarcity of other energy resources in a
rural area creates a demand for human energy particularly in survival-related tasks. When human
energy is expended, women contribute the greatest
share. But in comparison to this energy output,
women get a lower share of food intake, and face a
nutritional deficit. Added to the work burden, women
also suffer further energy deprivation due to lepeated pregnancies and breast feeding, high morbidity
and intestinal infestations. Health care can alleviate
this burden to some extent, but women apparently
have less access to health care facilities due to the
nature and structure of these services. These factors
naturally affect al! the poor, but women are more
seriously affected because of their low status,
and their social and economic roles.
I cannot presume to offer solutions—the com
plexity of the problem is mind-boggling. But I can
and do raise a series of questions which must be
answered if we are to even begin tackling the
problem. The questions are :
(1)
What is the actual pattern of women's work
in different regions?
(2) / What is the energy cost of the activities
performed by men, women and children in different
socio-economic groups - both urban and rural?
(3) What are the effects of human energy sav
ing on nutrition status - with and without increasing
food intake?
(4) Are the calorie intake norms or recomm
ended daily allowances for women at various
activity levels realistic?
(5) What is the actual food intake of women
(at all ages and biological stages) and men ?
(6) How do women utilise the time released by
the provision of alternative energy resources for
(7) What is the actual extent and pattern of
morbidity amongst women ?
(8) What is the outreach of health services to
all women, and what is the level of utilisation of
the former by the latter ?
In conclusion, and although I have said I can
offer no solutions, the interrelationship between
energy scarcity, women's work, nutrition and health
suggests a three-pronged strategy :
Women's deprivation is occurring at three levels:
the socio-cultural level, the environmental level
and the service-programme level. The erosion of rigid
patriarchal system has to occur, and all women's
movements are aiming at this. Improving the
availability of energy resources with priority for the
activities performed by women (collecting fuel and
water, cooking, and so on) is another facet of the
strategy, and one where alternative technology can
play an important part. Finally, there is an urgent
need to restructure and expand the scope of existing
programmes to reach out to women and draw them
into the health care network.
How best all this can be achieved is a matter
for further debate and discussion. But it is clear that
the major thrust has to be on the political front, by
mobilising women to analyse their situation and
articulate their demands.
References
ASTRA. Rural Energy Consumption Patterns—A field study
Indian Institute of Science, Bangalore, 1981
Batliwala, S. Hunger and Health—Analysis of the Nutrition
Problem in India. The Foundation for Research in Community
Health, Bombay, 1978
Geller, Howard. Rural Indian Cookstoves—Fuel efficiency and
energy losses. ASTRA, Indian Institute of Science, Bangalore
1980
ICMRICSSR Study Group. Health for AH: An Alternative
Strategy p. 132 Indian Institute of Education; Pune, 1981
As above, p. 231
Indian Express. Stoves pose health hazard for women. March
18, 1983
Indian Express. Dung smoke may cause Bronchitis. Bombay
March 20, 1983
Indo-Gcrman Dholadhar Project (IGDP). Dhonladhar chulha
ki kahani (pamphlet) I GDP, Palampur, Himachal Pradesh
1982
Jaya Rao, K. Who is malnourished ; Mother or the Woman
Medico Friend Circle Bulletin. 1-5, February 1980
National Institute of Public Co-operation and Child Develop
ment (NIPCCD) UNICEF Study of the Young child — India case
study. NIPCCD, New Delhi, 1976
Natarajan, K.V. Administration and organisational implications
of nutrition programmes of India Paper presented at seminar
on Social and Economic Aspects of Nutrition, New Delh
1974
(Contd. on page 92)
survival tasks ?
Socialist Health Review
11
HEALTH OF WOMEN IN THE 'HEALTH' INDUSTRY
C'
h
ti
sujata gotoskar, rohini banaji and vijay kanhere
The authors of this article provide anew dimension to all those working for rational drug policyf
against misuse of drugs, and so on. Individuals and groups working in health have so far formulated their
programmes with a concern for the consumers of drugs. But an important section, the producers of these drugs
is left out. The authors' study of health problems of women workers in the drug industry shows that they are the
first and worst sufferers. They stress the need for health groups to orient themselves towards producers of
drugs, as workers need their expertise, and to find a strong and reliable ally in their fight against.the contro
llers of drug industry. Health groups, trade unions and women's groups have many meeting points.
ii
i
c
i
Jn the last two decades, some amount of thought,
research and action has gone into the health
hazards posed by the drug industry vis-a-vis the
consumers of the products. Voluntary health groups
and agencies are exposing the dangerous effects of
drugs taken in quantities of 5 milligrams a day over
years or also just once. However, hardly has any
concern been directed against the effects of these
drugs on the producers, the people working in the
companies producing these drugs. The workers in
their work process are exposed to the same drug,
inhale the same drug, the drug enters their systems
thorugh touch, through the mouth and through their
respiration. They work for 9 hours a day, day after
day, year after year, producing hormones, vaso
dilators, antibiotics etc.
If one has to look at the drug industry from
the point of view of the health effects on the produ
cers, one cannot be confined to a narrow concep
tion of health as a lack of disease initiated by a
drug. The conception of health effects has to be
broadened considerably.
Drug Production and Worker's Health
The last ten years have seen a phenomenal in
crease in the production of Bombay pharmaceutical
companies and in that of newer industrial centres.
Many more liquid orals, tablets, vials, ampoules
have been thrown in to the market. This is leading, not
to increase in employment, but to the extraction of
more work from less or the same number of work
ers. The impact of this process is increasingly being
felt by the women on the packing lines. Behind the
heavy advertising campaigns stand overworked
packers lifting heavy ampoule-rings or heavy crates
of bottles. This fantastic increase in production,
from 22,000 ampoules per shift to 60,000 ampoules
in 7 years or 8,000 to 50,000 per shift in 11 years,
with very little increase in the number of women
doing the work, is brought about in two ways. These
two related methods produce two types of health
hazards.
78
The simplest, age-old but out-dated method is
to keep the process intact and increase the speed of
the machine and hence of the entire process Such
speed-ups on manually operated packing lines lead
to fatigue, weakness, back-aches, aching arms, feet
and shoulders.
Work on the packing line involves the fitting of
bottles, sealing, labelling, optical checking, packing
in boxes, inserting leaflets and case-packing. All
these jobs may be manually done or some jobs are
semi-automatic or automatic. The manual filling of
bottles is extremely strenuous involving holding
the bottles with hands, regulating the volume of
the liquid by turning a tap or switch on and off,
by pressing a foot pedal to start and stop the flow
while holding the bottle under the nozzle. The
strain is felt most on the arm and feet muscles.
In the manual spooling of adhesives, the opera
tor mounts the rolls of plaster on the machine and
pulls by hand till the plaster reaches the spool. "We
have to stand on one foot and to pedal with the
other to spool, and at the same time guide the plas
ter, and finally cut it when the required length has
been reached. If the roll is tight, continuous pulling
by hand is very strenuous. Continual cutting results
in corns. Carrying rolls causes chest pains4'.
Ail these operations, when manually done cause
extreme fatigue. "We have to lift the heavy rings of
the capsule machine several times in the shift. It is
very exhausting and dangerous as we have to stand
on a stool to fit the heavy rings." By itself the single
operation may not be very heavy, but repeated over
hundreds of times in the 8 hours of shift, everyday,
it becomes strenuous and causes tiredness.
Another major health hazard is the deteriorating
eyesight of the women working on optical • chec
king. Every vial, bottle has to be checked for the
presence of foreign particles. Manual optical chec
king involves the packing up of one or more bottles
or vials (depending on their size and weight), shaking
and viewing them against astrong light, sometimes
against black and white backgrounds in succession.
These have to be checked by the naked eye. Some
women optical checkers told us, ''Before we came
to work here, most of us didn't have to wear spec
tacles. Now almost all of us have glasses. Sometimes
we have to get our glasses renewed every 6 months."
In semi-automatic optical checking, "the bottles
pass on a belt in front of the checker with a strong
light shining through them. The speed of the belt is
high and we cannot shift our eyes at all". ''On
our line, production increased from 8,000 to 50,000
per shift in 11 years due to the introduction of
automatic filling and labelling machines. The optical
checkers have increased from 2 to only 4".
Complaints of eye strain in optical checking
were most widespread in companies where the
women would have to check liquids for one day or
more before moving on to another job. Rotation in
jobs is an accepted practice in many of the larger
pharmaceutical companies. Different types of rota
tion schemes exist. All the women who work in
sections where jobs are rotated said they liked
rotation, for two main reasons: (i) "There are hard
jobs and easy jobs and the same people shouldn't
always have to do the hard jobs", (ii) "It is boring
to do the same job all the time".
Where the workers have complaints of fatigue
or tedium and want rotation they could, through
their unions, try to devise schemes with (a) rapid
rotation, perhaps within lines to prevent strain and
fatigue in certain operations, and (b) rotations on a
longer cycle, such as three months perhaps between
lines, to allow workers to become competent at a
variety of operations.
The operations which were earlier either manual
or semi-automatic and which have now been auto
mated, almost always involve a reduction in the
physical effort required to do the work. However,
with automation, managements have tried to com
bine, two or three operations and a single operator
has ' now to cope with 2 or more machines.
Though the quantum of physical effort has been
reduced, the strain of minding these machines
increases manifold and results in mental strain and
tedium.
Where physical strenous functions have been
automated the women often told us that the work
had become less tiring. Increases in the level of
automation have brought about this result by elimi
nating certain highly repetitive tasks such as
Socialist Health Review
holding bottles or vials under a nozzle, pressing a
lever foot-pedal etc.
Any method which replaces the hazardous
physically strenous and fatiguing work, by work
that is lighter, safer and less unpleasant, and does
it in far less time, is potentially a means of emancipa
tion from long working hours, industrial fatigue,
coercive work routines, health hazards and rigid
sex stereotyping. Whether automation ever has this
meaning, will depend on (i) the way in which it is
introduced, which depends on (ii) how much control
unions exercise over its introduction and use.
Experience of workers demonstrates that if the
changes are made completely under management
control,the chances arethat workloadswill increase,
employment will decline, health hazards will increase
and workers lose any sense of stability in their jobs.
It is only when those who actually work on the
machines in the factories have some control
over this process through their representatives
and unions can the potentiailities of automa
tion be realised.
When production is increased in such propor
tions, not only is there an increase in workloads and
fatigue for the women workers, but it also results
in making the women workers less resistant to the
effects of the drug they are producing. At the same
time, the possibility of the hazards is multiplied due
to the sheer increase in the amount of chemicals
the workers come into contact, as in the case of
optical checking, the eye-strain increases as the
number of bottles and the speed with which they
are to be checked increases. The increase in work
loads or speedups is hazardous in itself and it also
increases the intensity of the hazardous effects of
the chemicals.
Health Costs of 'life saving' Drugs
Here we will go into the case-study of one such
product-lsosorbide dinitrate. This is used as a coronary
vasodilator for the treatment of angina pectoris
patients. It is considered to be a life-saving drug
and is sold under different brand names.
An approximately 1,500-word leaflet, besides
the references of 22 'scientific' books of one of the
companies producing the above drug has only this
to say about the side-effects of the drug :
'Side-effects other than occasional typical
vascular headaches are not common in effective
dose.... Histological (microscopic) examination of
the tissues from animals did not reveal any evidence
79
c
h
ti
ii
i
c
i
of toxic injury as a result of administration of the
drug'. In fact,-says the leaflet, 'the increased exer
cise tolerance produced by the drug usually results
in a gradual lowering of psychic influences, and
often gives the patient a new feeling of well-being.'
efforts given sorbide nitrate, two-thirds su^er.^
from side-effects which included headac es, ma u
(feeling of illness), vertigo (dizziness), dyspepsia
(indigestion), nausea, epistaxis (blee mg
r
nose)" (Martindelle.)
The leaflet refers only to two possible side
effects, 'headache during the early phases of the
rapy' which 'disappear within one week of conti
nuous, uninterrupted therapy'. Secondly, 'mild
gastrointestinal disturbances might occur rarely with
larger doses. These could be prevented by taking
the drug with food'. Lastly, the drug 'should be
given with caution to patients having glaucoma
(severe eye problem).
"In 14 patients, sorbide nitrate when given 5
milligrams sublingually, headaches occurre in
/0
of the patients (Martindelle) "Reports or ankle
oedema associated with Isosorbide t erapy
(Martindelle).
The women packers who work on these drugs,
sorting and filling the tablets into bottles, however,
have a different story to tell, "See how our faces
are swollen up. This line always gives up problems.
Our heads ache, — throbs all day and night. We feel
giddy". 'We don't feel like eating at all, no appe
tite, nausea and constant headaches.". .. . "Our
monthly period is also affected. Very heavy flow and
sometimes two periods in a month."
One of the women operators told us the case
of one woman, who had had two healthy children and
no family history of abnormal children, had a child
who was completely deformed and died a couple
of days after birth. This woman had worked on the
Isosorbide dinitrate line all through her pregnancy.
After this incident, however, the women decided
that no pregnant woman should work on the line.
The department where this drug is packed is a
small 121X81 room, where 8 workers work together at
sorting and filling of the bottles. The sorting woman
shakes the tablets in a scoop and the powder flies
into the air everytime she does it, at least about 20
times in a minute. The room is air-conditioned with
no natural ventilation and with a weak air-condi
tioner and exhaust. The masks given to the women
are very thin, white pieces of cloth and quite
ineffective. The women have to stop working every
few hours in order to go to the dispensary to get
aspirins or simply to breathe air free of the Isosor
bide powder. The women cannot explain about this
too often, as the management might insist on
reducing their trips to the dispensary and push them
for more production. So everything remains un
official -the doses of aspirins, the swollen faces, the
fits of dizziness and nausea.
Workers have no access to correct information
The standard scientific books about drugs state
the following : "Of 42 patients with agina of
80
"In some individuals, the blood accumulates in
abdomen and lower limbs, venuous return of the
blood to the heart is grossly reduced and the cardiac
output and blood pressure fall precipitiously. The
reduced supply of blood to the brain may cause
fainting preceeded by nausea, shivering, cold
sweats. The most likely side-effects of Nitrite therapy
are methaemoglobinaemia (which results in breath
lessness after exertion), serious -hypotension (low
blood pressure)
and
headaches".
(Lewiss
Pharmacology.)
"Nitrites can affect ureteral and uterine smooth
muscles . . " (Goodman Gilman).
This scientific information obviously tallies more
with the experience of the women workers than with
the leaflet put out by the management. But the
day-to-day experience of the women has had up
to this day not much of an effect with the manage
ment as there, is very little easily available material
which the women may use to back up their own
genuine problems. To begin with, there is hardly
any material or research done on the actual effects
of the drug on the producers themselves. The little
research that we could obtain with difficulty con
cerned only the consumers of the drug. And even
this was not easily available. The leaflet that is given
with the drug is obviously misleading and far from
the truth. The labour institutes, chemical directories
and chemical abstracts do not list these effects at
all. It was only after a great deal of scanning through
medical books that the above scant information
could be compiled. How are workers who work for
9 hours at the factory and the women workers who
have an additional shift at home, supposed to know
what it is that they are working at every day ?
There is obviously a monopoly of information
and a systematic campaign of misinformation by
the management. The management has its own
experts, expertise and can handle knowledge and
information and use it for its own purpose. If the
workers have to have some control over their own
si nation, they have to have their own channels of
expertise, information and initiate campaigns on that
basis.
The hitherto most stable organisations of the
workers have been trade unions. The trade unions,
however, especially in a country like India, have not
been stable and confident enough to take up issues
like health of workers seriously and consistently.
it is a fairly new dimension and more effort needs
to go into such a systematic insistence on issues
like health.
On the other hand voluntary health groups are
a comparatively new phenomenon in this country.
These health groups have concerned themselves mainly
with the consumsers of drugs and not the producers This
may be so because as individuals interested in
health issues, their day-to-day contact is with the
consumers. In fact, unless there is such a conscious
perspective, health issues of producers may not be
addressed at all.
When, however, it comes to the question of
the health issues of women workers, there is an
additional dimension to the entire perspective. A
special focus on the special effects on women
workers at the level of research as well as that of
campaign can be effected through the insistence of
women's groups at the workplace.
These three types of organisations and groups
have various meeting points and can come together
over very concrete demands and campaigns, which
in fact have been suggested by the workers them
selves.
The immediate demands in this particular case
may be :
1) Immediate research into how the drug enters the
system of the workers and its effects. Dissemination
of this research; (2) Easy availability of the currently
available research; (3) Regular monitoring of the
health of the workers; (4) Well-ventilated, larger
work-rooms; (5) Proper exhausts; (6) Comfortable
ano effective masks; (7) Gloves; (8) Rotation in
work schedules and new recruitment, so that no
woman receives effective, harmful doses.
which the women breath in. Alternately this pro
cess is automated, the women will have to fill the
hopper which should be covered with a lid to pre
vent the powder from getting into the air. By auto
mation of this process, less powder will fly and
secondly less women will be requited to do the
work, which in turn will result in a lengthier rota
tion cycle. If lor e.g 54 women work on the prod
uct, in rotation, each batch consists of say, six
women. There are nine batches with each batch
working for three days a month on Isosorbide.
If the process is automated, only three women
would be required per shift to work on the product.
There could then be 18 batches, working for only
one-and-a-half day a month on Isosorbide. The
health problems of those working would be consid
erably reduced as they would be working for less
days as well as the atmosphere in which they work
would be less contaminated. The workers would,
however, have to see to it that the production nor
ma are not increased, which is a common demand
of the management incases of automation. For these
demands to be worked out, it is necessary that wo
men workers having similar problems have an oppor
tunity to come together to share their experiences
at work and evolve a common strategy. As of today,
the women workers do not have a platform through
which they can begin to do this. The formation of
plant level women's committees and inter-factory
women's committees could act as such a platform
where women workers could share experiences and
take up collective campaigns on common demands.
Campaigns could be initiated to plan and
attempt the implementation of alternative produc
tion processes centred around the interests of the
pioducers and consumers. And until this alternative
is implemented, the above immediate steps have to
be realised so that the ill-effects of working on a
life-saving drug may be minimised for those who
are producing it.
This article is based on research done for the Union Research
Group, Bombay, (Bulletin issue 3), and for the Society for
Participatory Research in Asia, Delhi.
References
Much of the work process in the packing of
Isosorbide e.g the sorting and filling of the tablets
is manual. While sorting the tablets and while filling
them in bottles by the scoop, the tablets have to be
shaken. This give rise to the powder flying in the air,
Socialist Health Review
Crossland, James. Lcwiss Pharmacology ■ 5th edition.
Goodman Er Gilman. The Pharmacological basis
peutics 6th Edition.
of thera
Martindclle. Extra Pharmacopoeia, 27th and 28th Editions,
81
THE STUDY OF WOMEN, FOOD AND HEALTH IN AFRICA
meredeth turshen
A study of women's health and nutrition must be rooted in a consideration of land tenure, food production,
food distribution, processing, preparation of meals, preservation, storage and consumption viewed as a system.
This article, a chapter in a recently published book (see Perspective) seeks to show how economic and
political decisions (in this case, in Tanzania), affect women's health status and nutrition. Some of the
fundamental causes of malnutrition and disease are, it is felt, beyond the control of African women, and some
causes are rooted in the structure of the global economy as it operates at the level ot the village economy. The
author studies the situation of women's health using theory which is interdisciplinary and historical and offers
a new, more comprehensive analytical framework.
* | he common approach is to look
at women
as housewives, usually within the confines of a
single discipline. Medical anthropologists, for
example, typically study the rituals surrounding
marriage, birth and death; they catalogue taboos
that influence health, such as prohibitions of certain
foods during pregnancy and prescriptions of inter
course after childbirth. We are critical of this approach
because it results in a static view of society, one
that lacks reference to the historical past or political
present, one that isolates the local economy and
stereotypes women.
In our view the problems of the health and
nutrition of women and their families cannot be
understood or solved if they are analyzed at the
level of the household economy alone. A multidis
ciplinary approach is needed, which combines the
interests and insights of economics, sociology and
political science. Looked at through these lenses,
women emerge as farmers and marketers, wives and
mothers, members of cooperatives and political
activists. Women's contribution to the village
economy is linked to national and even international
economics, in this analysis. These linkages are made
necessary by the fact that some of the fundamental
causes of malnutrition and.disease are beyond the
control of African women; some causes are rooted in
the structure of the global economy.
The research methodology and analytical frame
work of the multidisciplinary approach are described
in part one. We begin by laying out schematically the
relationships between food production and nutrition,
between women and health. An explanation of the
theoretical underpinnings of the argument follows.
In part two the approach is applied to the current
situation in Tanzania, where food shortages threaten
to lower the nutritional status of families.
How to Study Women's Health
The study of women's health starts with their
nutrition which, together with land tenure, food
82
production, food distribution, processing, preparation
of meals, preservation, storage and consumption,
must be considered as a system. (Note : The United
Nations Research.Institute for Social Development
is carrying out a research program called "Food
Systems and Society" that uses this approach).
This is because, in the rural areas of Africa, agri
cultural productivity — in its broadest sense, from
plant seeds to the meal served —- determines nutri
tional status. Unfortunately, it is rarely the case that
food production and nutrition are conceived as a
system; all too often agricultural planners ignore the
problems of food consumption and nutrition, espe
cially in countries where cash crops are grown for
export (World Bank, 1981).
If the relationship between food production and
nutrition is a conceptual one, that between woman
and food production is an observed fact in Africa.
In many countries the food system centers on women
who perform most of the manual labor at all stages
of the production process. (Note : The argument for
considering food and nutrition as a system together
with women's role in agriculture is made in a report
prepared for the United Nations Protein Advisory
Group [Eide et al., 1977]. As long ago as 1928
Baumann observed that the field work of subsis
tence farming in Africa is done exclusively or predo
minantly by women. Yet planners continue to ignore
women in their role as farmers and they treat the
food women grow for domestic consumption differ
ently from export crops. Even when the commodity
is the same—for example, rice and maize are both
food crops consumed domestically and cash crops
raised for export—and even when women work on
both garden plots and cash plantations, their contri
bution is disregarded. Despite much rhetoric since
International Women's Year about involving women
in development, male planners persist in designing
improvements in cash crop production for male far
mers. Barbara Rogers (1979), in her study of develop
ment planning, castigates the policy makers of
bilateral and multilateral aid agencies for their discrimination against women.
A concommitant problem with agricultural
inputs is that of the very land being farmed. Patterns
of communal land tenure, dating back to the precolomal era. have changed in this century; under
systems of private property now obtaining in many
countries, women lose traditional land rights. Where
there is land scarcity, as in the coffee farming areas
of Mt. Kilimanjaro, male competition for land suitable
for cash crops pushes women off their maize
shambas and vegetable plots.
The relationship between nutrition and health
is one of synergy : nutrition is the basis of good
health and the determinant of the outcome of most
diseases. Malnutrition both increases susceptibility
to infectious disease and influences the course and
outcome of illness. (Note : Resistance to infection
is determined by a number of host factors, but a
significant variable is the adequacy of immune
response; available evidence suggests that cellular
immune response and antibody synthesis are two
mechanisms by which malnutrition can depress host
resistance [W.H.O., 1972]).
The interaction of
nutrition and infection varies with the type of disease.
At one end of the spectrum are diseases not depen
dent on nutritional status, like tetanus of the
newborn, smallpox, and most of the vector-borne
infections, although nutrition does affect case fatality
rates. At the other end are most of the communi
cable diseases of childhood, diarrheal diseases, and
respiratory infections—the incidence and outcome
of these are very much conditioned by nutritional
status. It is this latter group of diseases that is
most common in Africa and claims the most infant
lives. Diarrheas and respiratory infections are not
preventable by medical means, however, and it is
in this context that the special role of women in
health arises.
Women are the providers of informal health
care : as wives and mothers they are often called
upon to nurse the young and the old, the sick and
the disabled. Even as the network of rural health
services expands in some parts of Africa, women
still undertake the work of primary prevention by
preparing meals, drawing water, bathing children,
washing clothes, clearing the compound of refuse,
and gathering fuel to light fires on cold nights in the
mountainous areas of the continent.
This traditional form of informal health care was
subject to contradictory pulls in the colonial period.
On the one hand, the need for it grew as new types
Socialist Health Review
of work gave rise to new health problems and as
the public and private sectors of the colonial system
failed to provide adequate welfare or social services
(Turshen, 1977). The need was especially great in
those subsistence areas to which male migrant
laborers returned when old, ill or unemployed. On
the other hand, women's informal nursing skills were
undermined as health care was socialized (in the
sense of being performed as a service outside the
home) in government and missionary clinics and as
traditional medical knowledge was devalued and
replaced by western- medicine. Demand for home
care was rising at the same time as traditional
medical knowledge, especially of herbal remedies/
was declining
These, then, are the relationships between
women, food and health. Our next task is to make
explicit ihe theoretical underpinnings of the analysis.
To build a complex argument such as this, it is
necessary to draw upon theory that facilitates the
process of relating information from several separate
academic disciplines—in this instance, agricultural
economics, medicine, public health, and women's
studies; in other words, there is a need for theory
that encompasses interdisciplinary studies. A second
need is for historical method, because there is no
adequate explanation of the current development
dilemma in Africa without reference to African his
tory. Colonial accounts of the last century are not
useful substitutes for the combination of oral history
and anthropological field work that gives Africans
the central role in their own stories.
Third, one needs theory to make sense of con
tradictions, which seem to abound in descriptions of
Africa. One narrow example from African women's
history will serve as an illustration. A number of
authors (Boserup, 1970; Robers, 1979) have made
convincing, if damning, critiques of the education
given African girls by Christian missionaries. The
emphasis on home economics (interpreted as cooking
and sewing), not only belittled the African woman's
understanding of her familial environment, but also
taught her to want European manufactured goods
that were often inappropriate and beyond her moans.
Yet if one reads the biographies of today's African
women leaders, it is interesting to note how many
of them are graduates of such classes, or are the
daughters of women trained in this way.
Finally, one needs theory to explain the social
oppression of women, their subordinate political
position, and their economic exportation. To make
83
sense of the realities of women's lives in a sophisti
cated .way requires theory that differentiates the
nature of constraints on a woman like Jihan Sadat
from the actual existence of a poor village woman
living in rural Egypt.
levels of analysis, we will be moving from the
national up to the international economy and then
turning to the village and household economy.
This process may be thought of as linking macro
analysis to microanalysis.
To sum up, the theory employed is interdiscipli
nary, uses historical method, relies on dialectics to
analyze contradictions, and combines feminist
theory of women's subordination with Marxist theory
of class conflict. Hypotheses based on this body of
theory are best tested in participatory research.
(Note : Sources of information on participatory
research methodology are the International Council
for Adult Education in Toronto and the United
Nations Research Institute for Social development in
Geneva). In participatory research, the subjects
become the research workers by defining their own
problems, gathering empirical data, experimenting
with solutions, and using the results to refine the
analysis of their problems. This technique is parti
cularly important for women who are too often cast
as passive recipients of development programs or,
at best, as respondents in surveys. Participatory
research empowers women in a way that traditional
metnods, including participant-observation can
never do. It also has the advantage of speeding up
the process of returning research results to the
people most directly concerned.
The nature of the present economic crisis in
Tanzania is described in the following news report.
"Tanzania's economic problems... have forced the
.suspension of development projects in the 1982-83
fiscal year. President Julius Nyerere said the coun
try's small amount of foreign exchange earnings
would instead be used to pay forspare parts and other
essentials Observers said that shortages had red
uced Tanzania's small manufacturing sector to 30
percent of capacity, and that there were widespread
shortages of such essentials as flour, sugar and
cooking oil Inflation is running between 40 and 60
percent annually. Although Nyerere had refused
IMF demands to devalue the Tanzanian shilling,
the currency was in fact devalued by 10 percent in
March, 1982. The IMF had sought a 50 percent
devaluation" {Africa Report, 1982b).
With these research tools it is possible to
analyze the international situation in African coun
tries and find out how women, food and health are
linked to the economic, social and political system.
Internal analysis is insufficient, however, since, the
national system is subject to international control.
One form of international control is neocolonialism,
which is continuing economic domination of a former
colony by the metropolitan power. Many would say
that Gabon is still controlled by France in this way.
A more subtle form of contiol is exerted by inter
national institutions like the World Bank and the
International Monetary Fund which dictate the
terms on which African nations can borrow money
for development projects. Marxist theories of
imperialism are useful in understanding international
relations, including the role of financial institutions
(Brewer, 1980).
Women's Health in Tanzania
There is so little information available on
women in general and women's health in particular
that it is easier to begin this discussion with a
description of the present economic crisis in Tanza
nia and deduce its impact on women. In terms of
84
Why does the IMF seek a 50 percent devalua
tion of the Tanzanian shilling, and why does Nyerere
refuse? Tanzania is unable to balance its interna
tional income (composed of export earnings and
current borrowing) with its international expenses
(imports and debt servicing ) There are three ways
to deal with balance of payment deficits: (1) impose
import restrictions or capital controls, (2) deflate
the economy by reducing economic activity, or (3)
devalue the currency (Block, 1977). The IMF
recommends devaluation because it leaves tha
market open and unimpaired, and the capitalist
firms that the IMF serves want to continue selling
their manufactured goods to Tanzania unimpeded
by import restrictions. The firms are not affected if
it costs Tanzania twice as much to buy their products.
Nyerere opposes devaluation because it raises
the cost of imports and reduces real wage levels.
With dwindling reserves of foreign currency and
unable to negotiate a loan from the IMF (with which
Tanzania has been bickering for years over terms
and conditions) he is forced to cut imports. The
effect of the cut is to create a shortage of spare
parts, which in turn reduces manufacturing to 30
percent of capacity. With machines turned off', men
and women seeking employment in Tanzania's small
industrial sector must be turned away, those who
hold onto their jobs receive wages worth 10 percent
less. A new system of financial incentives allows
industry to knock an additional 10 to 20 percent off
the pay of idle that is, less productive—workers
(Dimsdale, 1982).
What will be the impact on women workers?
omen are concentrated in low paying jobs, in
Tanzania as elsewhere;-their incomes are already
inadequate (Shields, 1980) . Urban women thrown
out of work will spend more time cultivating their
small shambos (the kitchen gardens found near all
residences) and may turn to casual prostitution to
supplement their incomes, according to a survery of
women workers in Dar es Salaam (Bryceson, 1980).
Meanwhile, inflation is running between 40 and
60 percent a year. In North America and Europe,
inflation rates of 10 percent are a cause for alarm
and government intervention; the impact of rates
that average 50 percent in Third World countries less
able to absorb inflation is devastating. Since it falls
to women in Africa to purchase the food and clothing
they and their children need —- and in the cities they
must also buy fuel and water — inflation will lower
their standard of living, including nutritional stan
dards.
One cannot assume, however, that all essentials
are there to be purchased at any price, since the
article in Africa Report states that there are widespreadshortagesof flour, sugar and cooking oil. These
commodities are essential to urban women. Inevi
tably a black market has appeared and there are
reports of hoarding and corruption. According to.
New African magazine, "Sugar at the controlled
price cost Tshs 8.50 a kilo but during a serious short
age, prices can shoot up to Tshs 30 a kilo" {New
African 1982a).
cash crop areas receiving most of the colony's reso
urces. The coffee areas are on the northeastern and
northwestern borders where the climate is favorable.
Population density is quite high in these regions).
This program will deepen the crisis for women in
rural and urban areas, according to our analysis. To
understand why we draw this conclusion, it is nece
ssary to read reports on increased coffee production
{African Business
1982) together with earlier
notices of expected widespread food shortages and
possible famine (Africa Report, 1981a). In 1981
Tanzanian officials predicted that food stocks would
run out within a year. In January 1982, the Minis
ter for Agriculture announced that Tanzania would
need 300,000 tons of food aid. (Three months later
Western nations offered 260,000 tons of emergency
food aid) {Africa Report 1982a).
Food aid however, is not a long-term answer.
Even the official agencies now admit its failure.
New African (1982b) reported the findings of a
confidential report by the European Court of Audi
tors, which severely criticizes the European Econo
mic Community’s food aid to Third World countries
during the last decade. A few years ago such scand
als were reported, not by official agencies, but by
groups like the Institute for Food and Development
Policy (Lappe ?nd Collins, 1977) and individuals
like Susan George (1976). Of course the donor
countries are not yet ready to abandon food aid
altogether; it remains a convenient way to dispose of
agricultural surpluses "while profiting from the resul
tant political and economic influence '• (New
African 1982b).
In the countryside there is a return to the subsis
tence economy; surpluses are being bartered rather
than sold (Dimsdale, 1982). (Note : Subsistence to
day should not be imagined as a return to the roman
tic villages describedjin anthroplogical accounts of
the colonial era. Too much change has occurred — in
land tenure and cropping patterns, for example — for
that past to be recaptured, if indeed it ever existed).
If this means that women are now grinding their own
grain, pressing oil seeds, and processing sugar cane,
then their work load is increasing. One wonders
which of their many other duties will be neglected
and what will be the impact of increased energy
expenditures on their own health.
The connection between famine and increased
acerage under cash crops turns on insufficient food
production. While the IMF is pushing for more land
to be given over to a non-nutritive export crop, the
World Bank reports that in Sub-Saharan Africa as
a whole, food production per person declinedin the
1970s. "Imports of food grains (wheat, rice and
maize) soared - by 9 percent since the early
1906 — reinforcing food dependency" (World Bank,
1980; 3). To realize what increased coffee produc
tion means to rural women in Bukoba or Kiliman
jaro where most coffee plantations are located,
we must turn to the internal analysis of women,
food and health at the microlevel of the household
and village economy.
To secure a large loan from the IMF, Tanzania
has adopted a program designed to increase the
coffee crop by 5 to 6 percent a year. (Note: Tanzania
was unevenly developed in the colonial period, with
Studies that describe the relationship between
women, nutrition and food production in north
eastern Tanzania were reviewed by the authors of a
report prepared for the United Nations Protein
Socialist Health Review
85
Advisory Group (Eide et al., 1977). These authors
conclude that• although cash crop areas like Mt.
Kilimanjaro are supposedly the prosperous regions
of the country, infant mortality is exceptionally
high there. (Note: This finding is not reflected in
official statistics for Kilimanjaro Region; the dis
crepancy may be accounted for by the level of
aggregation of government data). Infant deaths are
more numerous on the mountain than on the poor
maize-growing plains to the south. The authors
relate this finding to what they term 'culture-specific
factors' that help to determine women's position in
the family (Eide, 1977 : III. 85).
Factors such as intrafamilial food distribution
appear to be crucial when economic conditions are
unfavorable, as they are now (Ahican Business,
1 982). Coffee growers receive an average price of
Tshs 15 per kilo as compared with the 1981 world
market price received by the Coffee Authority of
Tanzania, which was Tshs 28 per kilo, and growers
may have to wait as long as six months to receive
payment. As a result, an estimated 30 percent of
the crop is reportedly smuggled into Kenya, where
the price received is six times the Tanzanian price
(Dimsdale, 1982). The loss of foreign exchange to
the Coffee Authority only aggravates Tanzania's
crisis. In these circumstances, the tradition of
differentiating between men and women's food
and the custom of serving husbands large portions
of meat result in nutrition problems for less privile
ged family members.
Prevailing inequalities in landholdings here
are accentuated by coffee production. The wives
of better-off farmers with more land and cattle are
under less strain than women in low income groups.
Wealth allows some women to ride to distant farm
plots while poorer women walk. Wealthier women
carr hire workers to help harvest crops and to trans
port them, while poorer women may spend long
periods away from home walking to their fields,
working in them, and carrying heavy harvest loads
uphill on the return journey. A little wealth also
makes it easier to keep cattle and goats since cash
buys lorry loads of grass, which has to be brought
up from the plain to feed animals kept in stalls or
tethered because there is no grazing land available
on the mountain, nor is there space to grow fodder.
Cash crops are a source of income to men and
in households where income is pooled — a practice
by no means to be taken for granted in Africa
(Shields, 1976)—women may profit and use the
money to lighten their workload. But studies show
86
that such women are a minority. For the majority of
poor women' coffee crops pn nearby land wi orce
them to walk farther to grow maize on distant fields;
they will have a heavier work load as food produ
cers, less time for household tasks and a bigger
struggle to provide the family with nutritious food"
(Eide et al., 1977 : 11.87).
.. .
*>
For solutions we must turn once more to the
international level, not because Tanzania bears no
responsibility for its internal affairs nor because
there are no further improvements to be made in
domestic policy, but because the ultimate determi
nants of solutions are external. Few' countries have
tried as hard as Tanzania to improve the living
standards of their masses, but government plans
have often been sabotaged by unfavorable inter
national terms of trade. Yet the IMF and the world
Bank do not suggest changes at the international
level; indeed the degree to which they shift respon
sibility for economic crises to national governments
is striking. The adjustments recommended by the
IMF as conditions of loans are always national
policy changes, which have significant social con
sequences. The lending policy of the IMF encour
ages 'loan dependency' in the same way it fosters
food dependency and leads to what Cheryl Payer
(1975) has called the 'debt trap.'
The World Bank's solutions, presented in the
report on 'Accelerated Development in Sub-Saharan
Africa," emphasizes production of cash crops for
export (World Bank. 1980). The Bank claims that
there is an extra-ordinary degree of similarity throu
ghout the region inthe nature of the policy problems
that have arisen and in the national responses to
them. (One wonders what role the IMF has played
in its imposition of uniform conditions). Among
shortcomings of existing policy cited by the Bank
are a bias against exports and a bias against
agriculture. In reading the Bank report, one expe
riences the sensation of deja vu; in the nineteenth
century, imperialists rationalized their colonial policy
with the doctrine of natural advantage. Once again
the Bank seems to be advocating that African
nations specialize in producing primary commodities
for the nothern industrialized nations.
The countries of the Third World oppose that
rationale and have submitted a program for change
called "The New International Economic Order"
(United Nations, 1974). It is not possible here to
describe the program in detail; it may suffice to say
that implementation of the program of action on
trade and development of raw mateials and primary
(Contd. on page 92)
f^2iinprax;s
THE BHUTAN' PHENOMENON
Why Are Women Hunted Down As Witches ?
kashtakari sanghatana
The Kashtakari Sanghatna is a left democratic mass organisation of maiginal farmers and agricultural
workers of Thane District in Maharashtra. Even while launching numerous struggles around the problems of the
adivasis, it seeks continually to build-up political consciousness in its membership.
Women have been the backbone of the organisation and have consistently remained in the forefront of the
movement. However the conscious struggle for women's liberation has only recently become part of the
organisation's efforts. Recently, in a women's meeting, a militant Sanghathana member, forced into the
background by political repression, raised an issue of vita! importance to the adivasi women. She expressed her
fears of being suspected as a witch. Once a courageous fighter, now apprehensive of being hunted as a
'bhutali', (witch) her predicament threw into clear relief the contradiction of adivasi womankind - power and
powerlessness - reducing them to being victims of cruel inhumanity.
Till today, various problems have forced the Sanghatna to take adhoc treasures vis- a-vis the torture of
women 'bhutalis'. The efforts of the activists have been reduced to a battle of wits to minimise the
brutality, peoples science movement groups made efforts to expose the superstition. But the ‘bhutali'
remains mystified and entrenched in the adivasi mind and almost defies a rational solution.
The persecution of 'bhutali' reflects the deteriorating health status of the adivasi. The challenge to evolve
a creative response to the situation confronts the organisation. This reponse while being innovative and
revolutionary needs to be integral to the ethos and existence of the adivasis, their symbiotic relationship to the
forest and their faltering steps into modern society. The search for the 'old yet new' is just beginning.
very single year, with almost unfailing regularity
adivasi women of Thane District, become unwi
lling victims of a bizarre ritual which ends/ in many
cases, with the whole village (men, women and chil
dren) crying in a frenzy "death to the witch". In a
rapid sequence of events which allow no single
member of the village community to remain unaffec
ted or uninvolved, a group of women (or in some
cases a single woman) is suspected of witchcraft
and, with no warning whatsoever, forced to stand
trial. Put in the dock by the village males (with the
village women looking on), and sometimes even in
absentia, the women are tried and summarily han
ded a foregone conclusion : the sentence of guilty.
The guilty woman (women) is responsible for the
many evils that may have befallen the village. She
has to take on herself the blame for all the mishaps
that may have happened. She is liable for punish
ment. The trial is swift and final. The accused stands
in the dock, already adjudged guilty. She has
neither the right of counsel (any one defending her
is in turn an accomplice and immediately suspect)
or defence, she is neither tried nor are her pleas
recorded. She stands a mute spectator to her 'trial'
and a witness to her own execution.
The whole village is prosecutor, judge and jury
and finally the executioner. The guilty victim is then
Socialist Health Review
subjected to the brutal sentence. In most cases she
(they) is stoned. Sometimes death comes as a
merciful release. Every single member (for fear of
being identified as an accomplice and meeting the
same fate) takes part in the execution of the sen
tence. In most cases the event remains locked in the
silence of the village. In very few cases does it reach
the outer world.
What is witch-hunting ?
Why and how does it occur ?
Disease and death form an integral part of the
lives of the impoverished adivasis. In many instances.
poverty renders them helpless. Sometimes several
deaths plague a single family, at other times an
epidemic ravages the village. On some occasions
mishaps befall a village, on other occasions disease
affects livestock and cattle. The adivasi wonders
at these inexplicable mysteries. He searches for the
root cause of these maladies. And he finds 'a
witch-. He is then impelled to rid the village of
this pernicious cause and hunts down the witch
with uncontrolled emotion.
Incidents of witch-hunting take place the year
round. But they errupt with increased intensity during
the monsoon. The reasons for this- spurt in witchhunting are not hard to find.
87
1) Increased Starvation, Widespread Malnutri
tion, Lowered Resistance: The begining of the mon
soons finds many adivasr families with depleted
food'reserves. In many cases food stocks are the
balance that remains after sowing. While food has
already become scarce during the summer months,
the adivasi can migrate in search of work and
survival. With the onset of the monsoons, work in
the brick kilns, salt pans, sand dredgers, stone
quarries and earth transport, comes to a halt. The
adivasis return to their villages, many of them empty
handed. In the villages the availability of work is
almost nil, besides many have to choose between
working or cultivating their own land.
The ageold recourse of the adivasi in the face of
starvation was to search for food in the jungle, wild
roots, fruit, leaves and tubers With these he was
able to survive and had evolved elaborate methods
of de-toxifying the poisonous roots and tubers, and
make them edible. He celebrated this symbiotic
reliance on the jungle with the feast of 'kohli' (eating
of tender shoots from the jungle). Without eating
kohli, the adivasi cannot begin transplantation,
(indicative of his understanding that the bounty of
the forest took priority to the fruit of his own labour).
Today, rampant deforestation and extensive monoulture of commercial teak varieties has drastically
reduced the availability of food from the jungle and
increased starvation.
Thegroups most affected by the growing starva
tion are the older people and the children, who face
increased malnutrition and lowered resistance to
infection.
2) Inaccesibility of Health Care, Disrupted Com
munication, Shortage of Money: The rains reduce
movement to a minimum. Most of the villages remain
cut off. ST services are withdrawn as roads become
slushy. The bullock carts, inexpensive means of tra
nsport are dismantled for the rains, cart tracks
through the fields np longer exist. Taking a sick
person to the hospital or PHC is possible only with
makeshift stretchers. Added to this is "no money0
not only to travel, but also to pay for, medical
services because even the PHC doctorswill not treat
a person, however serious, free. The lack of money
becomes a compelling reason for not taking the
sick person to the hospital or PHC for treatment.
3) Heavy Demands of Cultivation, Illness as
incapacitation : The adivasi methods of cultivation
are backward and labour intensive. Every able
bodied person is required for work. The youngest
children do baby-sitting, the slightly older take care
of the cattle, while 1he others assist in cultivation.
Under such circumstances, a person is considered to
be sick only when he is bed-ridden and incapacited.
88
Till such a time (till the person falls seriously HI),
everyone works and is not considered sick as long
as the person can work. The breakdown of health is
considered important only when it becomes an impediment to work.
Most adivasis consider going to the hospital as
a last resort, when all other efforts have faded. They
prefer the village bhagat because he works free,
while the hospital or PHC costs money. Most patients
are taken to the hospital when they are very serious.
Taking a person to hospital/PHC is a disruption of
the work-schedule as many are needed to take the
person in a stretcher or remain in the hospital to
cook for the patient. Hence the gravity of the illness
is important to motivate people to take the patient
to a medical facility.
4) Increased Waterborne Infection : The rains
wash down the dirt from the hill slopes. Water
rushes down the denuded hill sides. The thick for
ests and undergrowth assisted in the percolation
and filtration of water. Now the streams are a
muddy flow, carrying with them infection. The jungle
serves as a toilet for the villagers and all of it reaches
the streams. In addition, the adivasis relish the fish
in the streams, which for many families is probably
their major source of edible protein. The tiny
fingerlings are eaten without removing the entrails.
While the use of powdered tamarind leaves help to
destroy any micro-organisms in the entrails,
possibilities of infection still remain.
To recap, this maze of insecurity and uncerta
inty, the tribal places unquestioning reliance on the
bhagat as his refuge, hoping through him to find a
way out of a seemingly hopeless situation.
The bhagat is the tribal priest and medicine man
rolled into one. He is a villager like the others, who
has initiated himself into 'bhagatship'. He supports
himself by his work on his lands, being a bhagat
brings in no income, on the contrary it is often a drain
on his own time and resources. He performs the
few rituals that exist in the adivasi religion. His
major function, which continues throughout the
year, is as healer and medicine man.
The warli religion is based on spirit worship.
Some elements of hinduism have crept in, but remain
on the fringes of their worship and ritual. The
koknas have absorbed much more of hindu beliefs,
deities and tradition. The religion of the people cen
tres around the appeasement of the spirits whose
anger the people fear. Religion does not provide any
morality or enforce an ethical code.
The adivasi medicine is from the jungle. Over
years of experience, the bhagats have discovered a
variety of rootsj herbs and medicinal plants that they
dispense to the sick. The knowledge of thes’e
medicinal plants is handed down by word of mouth.
However, once the bhagat has handed down the
knowledge of the various remedies, he is supposed
to stop dispensing these medicines as with the
knowledge he has also handed down the power
and efficacy of the medicine. The system of diagn
osis centres round 'knots'. The body, according to
their system, consists of different knots of muscle,
nerve and blood vessel. Good health is a manifest
ation that equilibrium prevails, with each knot
being in place and maintaining the desired tension.
Illness occurs when the equilibrium is affected and
the knots are either dislocated or lose their required
tension. The treatment for illness is either in the form
of branding or consumptiom of medicine, inhalation
or even tying some herbs on the body.
The bhagat, then, is the immediate and in a
•sense ideal solution, for a variety of reasons : he is
accessible; he is known; he is understandable; he is
inexpensive; he is reliable; and, he is acceptable.
Hence he forms an integral part of the adivasis heal
ing system.
The treatment that the bhagat gives is a comb
ination of spirit worship and offering to appease
the angry spirit, and the use of herbal medicine
combined at times with branding. The proportion
of spirit worship and dispensing of herbal medicine
varies widely with different bhagats. The efficacy of
the bhagat however is progressively diminishing.
The reasons for the decreases in his effectiveness
are largely .beyond his control.
a) Deforestation and Monoculture : Large
tracts of mixed forests are being felled and replaced
by monoculture of teak. A teak plantation supports
no other forms of flora or fauna. With deforestation
most of the traditionally used herbs are difficult to
find. Many bhagats decrease the use of herbs
because finding the herbs is a time consuming
process. The numbers of herbal medicine-men is
also on the decrease.
b) Lack on Continuity : As handing over
knowledge of herbs means that the bhagat loses his
power and efficacy, many bhagats die with their
extensive knowledge acquired over the years. The
tradition is not handed down.
c) Modern Diseases and Epidemics : with
migration to the slums and shanty towns on the
fringes of the cities, many adivasis return with in
fections which are totally new. The adivasi pharmacopia can no longer cope with the new diseases.
d) Lowered Health levels : The destruction
of the forests, the elimination of mixed forests (with
Socialist Health Review
a variety of fruit and nut trees), the disappearance
of game and the general growth of the population
coupled with increased exploitation has had a
severe effect on the diet of the adivasis, their intake
of protein, vitamins and trace minerals resulting in a
general lowering of the health of local adivasi
population.
Caught in a vice of growing demands on his
knowledge and powers of healing on the one hand,
and a growing inability to deal,with new conditions
both in terms of diagnosis and therapy, a significant
change is taking place in the system: a) there is a
distinct shift in the bhagats modus operandi, moving
more and more into spirit worship and appeasement
rather than dispensing herbal medicine, b) The
tribal medical system is becoming progressively in
effective and with it grows the bhagats' failure.
To the mind, the new situation is inexplicable.
They do not understand the changing circumstances
that contribute to its deterioration. The bhagat *.
cannot fail because he is in continual communica
tion with the spirits. He can do no wrong. The blame
has to be fixed elsewhere. And so, the witch
becomes the cause of all the calamities and mishaps
that befall a family or the village.
What are the events that culminate in this
brutality?
The first event that triggers-off a witch hunt is
either a prolonged illness, an inexplicable death, a
series of deaths in a family, an epidemic that affects
the inhabitants of a village or the livestock, wide
spread crop disease or failure, a number of mishaps
or calamities that occur, or a combination of them.
It begins with a murmur, ('there is a witch')
either emanating from the bhagat's mouth or from
one of the affected individuals or groups. The
murmur grows into a crescendo as the word spreads.
The male members of the village start to take notice,
the women of the village begin to fear.
A collection is made by the villagers to cover
the. costs of discovering the witch. A group of
villagers is assigned the task and they go from
bhagat to bhagat in search of an elusive prey.
The bhagat tries out a variety of rituals, (dann
heme - read the message in grains of rice; diva
heme - identify the witch in the light of a lamp), vati
chalavne (using a cup which "moves' and identifies
the witch), he may conduct the sacrifice of a chicken
or goat and try and read the indications spelt out in
the entrails. The group of villagers may go to more
than one bhagat to make certain ot the identity of the
witch. The bhagat who identifies the witch is not
usually from the same village or locality. But through
careful, intelligent questioning he is able to locate
89
either quarrelsome women, destitute women, women
with poor family support, women who are generally
socially weak, midwives and so on. The bhagat
then proceeds to identify the witch and generally
gives a vague description of the women on the
basis of the descriptions unwittingly given by the
women themselves. Once an identity is given, the
group of men may go to another bhagat for a
confirmation. Here too a subtle process of questions
and-answers is carried out and the identity of the
witch given in similar though vague terms.
Once the process of identification is over, the
next step of the village is to find the woman to fit
the identity. Depending on the vagueness of the
description given, the villagers (male) call for an
identification parade. The parade can also consist
of making all the women stand on a tava (frying
pan) made red hot, on the assumption that the
witches' feet will not burn. Sometimes this is by
passed and the witch is pointed out by one of the
villagers and supported by the others. A third
possibility is all the women who come close to the
description are beaten-up till they confess to their
nefarious activities and their crimes.
Once a witch or witches are identified, the
whole village goes through the bizarre ritual of
exorcising her of the evil spirit, or her association
with the goddess Himai. Acting on the assumption
that she feels no pain, the woman.'women are
beaten with clubs, stones or whatever else the
villagers can lay their hands on. No one, whosoever
they be (man, woman or child), whatsoever their
relationship with the culprit be, wheresoever their
sympathies may lie, whatever their beliefs may be,
can abstain from this brutal activity, because an
accusing finger will point in her/his direction. She/
he will be accused of being accomplices of the
witch.
The witch/witches are beaten till she/they fall
senseless. Sometimes they survive. Survivors in
most cases leave the village because the sword of
an encore hangs continually on their heads. If a witch
dies, she is summarily buried (not burnt) and the
village maintains a stonewalled silence. If news of
her death leaks out to the police, the villagers settle
on who will take the onus of the 'murder' and
assure him with money and legal assistance and the
assurance that no one will testify against him at
the trial.
After the ritualistic sacrifice is over, the
catharsis complete, the village settles down with a
sense of release that the cause of their anxiety has
been eliminated. The women still shudder at the
frightening events that has shattered their lives
90
and a gnawing fear that they could be next in line.
What does the Bhutali phenomenon represent?
At the outset, we must make it clear that the
efforts to understand the phenomenon are in no
way complete and need further elaboration. We
are putting down our reflections as they have
occured to us, hoping to organise them further as
we learn more about the living and .thinking and
feeling of the adivasi women and men.
a) The torture and death of the bhutali,
provides a bizarre ritual which serves (provides) as
catharsis | a ritualistic release of tension/aggression
reseptment of the tribal accumulated in his experi
ence of the many painful events that continually
plague his existence, the feelings of helplessness
which accompanies his efforts to resolve them, the
fears and insecurities that harass him all the while,
and his forced acceptance of the unwanted unacc
eptable events of disease, death, mishaps and
calamities. Through this catharsis, he finds release
without having to confront the truth of the situation
and thereby is reconciled once again to the situation.
b; The torture and death of the bhutali,
thereby provides a rationalisation (explanation) of
the failure of the bhagat to heal, and the relative
inefficacy of the medical system. This rationalisation
helps to diffuse any attempts to reassess the system
of healing. The process is enhanced by the subtle
shift from dispensing herbal medicine to sorcery and
witchcraft that has taken place in the modus
operandi of the bhagats.
c) The torture and death of the bhutali
legitimises the man's innate suspicion of the vilesguile-deviousness' of women.
(The efforts of women to develop their own
means of self-defence and countering the brute
force of man have always been interpreted as
scheming and guile). Hence in warli society every
woman is a potential witch. No woman can ever
claim to be free from this cruel possibility.
d) The torture and death of the bhutali provide a
mechanism that compensates man's inability to
resolve the problems of his existence (the here and
now), by projecting (transferring) the root cause of
all that is evil (painful) in his present outside of
himself (beyond). This compensation helps him to
reconcile himself to his here and now, without being
forced by the nature of the events into seeking a
rational explanation for them.
e) The torture and death of the* bhutali serves
as the 'ultimate' mechnism of control of women by
men. It manifests the use of brute force (mens' forte)
to crush the spirit of women and keep them in perp
etual bondage. The accustion of being a bhutali is
continually resorted to by man to maintain the sub
jugation of women. (such references can be obser
ve ..ven in interactions between husband and wife).
l ie torture and death of the bhutali which takes
place in the presence of women remains a con
stant reminder that the duty of women is to con
form and obey even when the order/command is a
painful death.
f) The torture and death of Bhutali hence
becomes the final (definitive) seal on the domina
tion of women by men. The threat of the acrimonitious investigation and trial culminating in a violent
brutal punishment hangs continually as a sword on
the head of every woman, threatening to snap at the
slightest provocation
g) The torture and death of the bhutali therefore
is geared towards a conclusive suppression of any
act of defiance on the part of women. The bhutali
can be seen as the personification of defiance to
the male order (organisation) of his world. She
defies their efforts to reorganise their lives accor
ding to their plan and hence deserves the brutal treat
ment meted out to her.
h) The torture and death of the bhutali remains
a constant warning to every woman that 'any act of
insubordination to male domination will meet with
a violent end'. This warning needs to be reinforced
fromlime to time and hence periodic witch-hunting
expeditions serve both a therapeutic as well as a
preventive function in terms of the malaise of maledominated society namely, the presence and think
ing of women.
i) The torture and death of bhutali is related to
the mystique that grows round 'blood - foetus pregnancy' in the primitive mind. The mystique
develops in the sense of awe and moves into the
realm of fear. The male in his attempt to control the
fear, seeks to control/crush/ suppress the root cause
of the fear, the women. The domiant male also
revolts against the realisation of the .superior posi
tion of women which comes through their power to
create and sustain life. His role in the creation of
life remains minimal. Hisrefusalto admit his subord
inate place finds its expression in- his act of
domination.
j) The torture and death of bhutali is the
logical culmination of the Pure-Impure Contradic
tion. This ritualistic impurity is extened into the
interpretation of the female principle as dark, unruly,
anarchic, devious, dangerous; while the man rem
ains pure, rational, righteous. In the 'impurity' preju
dice lie the roots of torture of womankind and their
death to rid society of the 'evil principle'. The bhutali
is a devotee of Himai, the goddess (the only female
Socialist Health Review
principle in the warli pantheon) of evil. The Principles
of Good and Evil are embodied in man and woman.
k) The torture and death of the Bhutali (in many
cases the suin/midwife) represents the ancient rivalry
between the Bhagat and the Suim The Midwife in
her role of assisting in the birth of new life has
knowledge of the mysteries of life which will always
remain inaccessible to the bhagat. Her knowledge
brings power and draws her inexorably into the
power struggle with the Bhagat who triumphs in
condemning her to death.
I) The torture and death of the bhutali is a
manifestation of the Principle of Good (the Bhagatmale) finally eastablishing his supremacy in crushing
the Principle of Evil (the Bhutali- woman). The bhag
at as tradition goes can do no wrong nor can he
harbour any evil towards anyone. All wrong and evil
can be born therefore only in the womb of woman,
and takes physical form in the body of a woman.
m) The torture and death of the bhutali remains
a flagrant contradiction in the organisation of warli
society. On the one hand the two sacraments (rites
of passage/initiation) namely the zoli : (tying of the
cradle) which initiates the new born child as a mem
ber of the tribe and is given a name and the lagin
(marriage-the rite of initiation into the perpetuation
of the tribe) by which the man and woman become
adult members of the tribe are both performed by
adult women. The male has no effective role to play
in either of these two rites. Yet which being the
High Priestess of the community, the woman must
be continually kept in her rightful place. The Bhutali
is the warning that the Mighty can be thrown down
from their lofty thrones and made to mingle in the
dust. This contradiction in warli society remains
unquestioned.
n) In fact, the torture and the death of the Bhu
tali, as has been from time immemorial, becomes
the rationalisation for the failure of man to organise
his universe. The bhutali becomes the scapegoat
that exonarates man of his failure in exercising his
'divinely appointed' responsibility to keep order in
his world.
Where do we go from here ?
It is sometimes disconcerting to discover that
the fear of the bhutali is so deeply rooted in the
adivasi mind that the eradication of this horrendous
annhilation of women suspected as being witches
defies an easy solution. And yet there must be a
way out. Our own struggle to find a way out of
this malaise that strikes a death blow to the awake
ning of women throws up five possibilies. We share
them below.
91
(Contd. from page 86)
commodities would offer Tanzania more options
than that of devaluing its currency or curtailing
its development programs. The amelioration of
terms of trade would offer Tanzanian coffee farmers
better returns on the crop they now produce, obvia
ting the need to expand production at rates of 5
and 6 percent per annum. Improved terms of trade
would also alter the economic circumstances of
women and offer the possibility of better health and
nutrition for themselves and their families. The New
International Economic Order holds the promise of
a future for Tanzania radically different from the
grim one currently predicted.
References
African Business (19S2) (Sept.) : 40.
Africa Report (1982a) (March'April) : 37.
Africa Report (1982b) May June) : 30.
Baumann, Hermann (1928) "The Division of Work According
to Sex in African Hoe Culture," Africa 7.
Block, Fred (1977) The Origins Of International Economic Diso
rder, Berkeley : University of California Press.
Boserup, Ester (1970) Women's Role In Economic Development
N. Y. : Martin's Press.
Brewer, Anthony (1983) Marxist Theories Of Imperialism : A
Critical Survey. London : Routledge Er Kegan Paul.
Bryceson, Deborah (1980) The Proletarianization of Women
in Tanzania, Review Of African Political Economy 17.
Dimsdale., Jhon (1982) Two Roads to Socialism, Africa
Report (Sept/Oct) : 14-17.
Eide, Wenche Barth et al. (1977) Women in Food Production,
Food Handling and Nutrition with Special Emphasis on Africa.
United Nations Protein Advisory Group.
George, Susan
(1976) How The
Other Half Dies.
Harmor.dsworth : Penguin Bocks.
Lappe, Frances Moore and Joseph Collins (1977) Food First.
N. Y. : Ballantine Books.
Nev/African (1982a) (March) : 23.
New African (1982b) (June) : 40.
Payer. Cheryl (1975) The Debt Trap : The IMF And the Third
World. N. Y, : Monthly Review Press.
Rogers, Barbara (1979) The Domestication Of Women. N. Y. :
St. Martin’s Press.
Shields, Nwanganga (1976) The Relevance of Current Models
of Married Women’s Labor Force Participation to Africa.
Seminar on Household Models of Economic Demograhic
Decision-Making Mexico City (Sept.).
Shields, Nwangana (1980) Women in the Urban Labor Markets
of Africa : The Case of . Tanzania, World Bank Staff Working
Paper No. 380. •
Turshen, Meredeth (1977) The Impact of Colonialism onHealth and Health Services in Tanzania, International Journal
Of Heatih Services 7 : 7-35.
United Nations (1974) General Assembly Resolutions 3201
(S-VI) and 3202 (S-VI).
World Health Organization (1972) Human Development And
Public Health. WHO Technical Report Serjes No. 485.
World Bank (1981) Nutritional Consequences of Agricultural
Projects: Conceptual Relationships and Assessment Approaches.
World Bank Staff Working Paper No. 456.
World Bank (1980) Accelerated Development in Sub-Saharan
Africa. Washington, D.C
(Contd. from page 77) National Institute of Nutrition, Nutrition Atlas of India
p. 27-29. NIN, Hyderabad. 1971
Rajalakshmi, R. Applied Nutrition. II Edition, Oxford and IBH
Publishing company. 1974
Ramanathan, N.L and Nag, P. K. Energy cost of human labour.
National Institute of Occupational Health, Ahmedabad.,
Undated
Sarin, Madhu, Personal communications from Sarin, the
designer of the Nada chulha. August 1983
SNDT University. Biomass fuel hazards for Indian women
Bulletin of the Unit on Women’s studies. Bombay. May, 1983.
Sukhatme, P. V. On measurement of Poverty. Economic and
Political Weekly XVI, (32) : 1318-1324 1981
Sukhatme, P. V. Protein strategy and agricultural development,
Presidential address: All India Agricultural Economics Con
ference, BHU,
Varanasi, Indian Society of Agricultural
Economics. 1972
a) Awakening the Women : To understand the
reality of the bhutali phenomenon in all its different
dimensions. (In the minds of many woman there is
a lurking doubt that the bhutali may be real. This
comes to the fore especially in the minds of women
affected by unfortunate events and they support
their husbands in the hunt for the witch). This
awakening is part of the wider struggle of the
women for emancipation and equality. This awaken
ing must also form part of the general awakening of
the male population. (The men too have a tremen
dous fear of the witch and which is the reason for
the vehemence with which they act to annhilate her).
Since the bulk of the population is illiterate, the
process of awakening will have to make extensive
use of drama, song and discussion.
b) Improved Health
is the cornerstone :
Because if one goes through the earlier part of this
paper one notices that the event that triggers the
witch hunt, is in most cases 'unexplained' disease or
death. The deterioration of the adivasi health system
is a major area of concern when one looks at the
bhutali problem. Any effort will have to be directed
to attain three goals :
i) A re-evaluation and change of the adivasis
understanding of health, disease, and health care.
ii) Taking health to the grass-roots in the form of
more radical health care systems and creative
responses to the health problems iii) Developing
a local integrated system of preventive health care
c) The Enlightened Bhagat is the Key : As the
central person in the traditional health care system
of the adivasis, ths bhagat plays a crucial role
(whether positive or negative). Hence any action
for integrated creative health care would necessarily
need to include the 'enlightened bhagat' (Any
attempt to substitute the present with a parallel
system even if it provides a superior and more
efficient system would be counter-productive).
Those 'enlightened bhagats' would have to be
involved in a process that is geared to : i) improv
ing diagnostic skills, ii) identification of herbal
remedies and their medicinal porperties, together
with methods of cultivating and preserving various
herbal plants, iii) Development of supplementary
skills and medicine to complement those areas
where the local systems and remedies are insufficient
iv) Development of preventive health care as a
system in its own right with the bhagats.
d) Education to develop scientific attitude •
A consistent programme to introduce a scientific
temperament coupled with the struggle against super
stition should run through the whole effort which
would integrate the various parts as one integrated
look at life and its different processes.
This short paper tries to put forward what we
are thinking and hoping to put into effect. We need
assistance and co-operation at every step y0Ur
solidarity is as necessary as ourefforts. We hope you
will become part of this process of struggling for the
liberation of the adivasi and the women in particular
92
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Give Us an Answer
All our life is on fire, all our prices rising,
Give us an answer, 0 rulers of the country I
A handful of American wheat, a kilo of milo mixed with chaff
Doesn't our country grow crops
Or do we have only mud-mixed grains ?
Give us an answer
We have forgotten the colour of milk
Coconuts and dried fruits have gone underground
Our children have only jaggery tea for nourishment
Sweet oil for cooking is the price of gold
Coconut oil for our hair is not to be had
Without rock oil for lamps we are familiar with darkness
We burn in the summer, we are drenched in the rains
We bear the rigor of winter without any clothes
Why don't we yet have any shelter ?
We toil night and day and sleep half-starved
While the parasites fill their bellies with butter
Why does the thief get food while the owner is cheated ?
There are pastures for the cattle of the rich
For forest development land is preserved
Why is there no land to support living people ?
Tall buildings rise before our eyes
The roads cannot contain these motorcycles and cars
On whose lobour has such development been built ?
We filled the jails for independence
We hurled bombs into the cars of the white men
Did we do it to fatten the sacred cow ?
When we ask for a rise in wages, for work for the unemployed
Why are we met with jail, beatings and bullets ?
Now you have taken a new disguise
And appear in the colours of socialism
But we no longer want for today, promises of tomorrow 1
Now we will stand on our own feet
We will throw caste and religious differences to the winds
We call for the sisterhood and brotherhood of all toilers 1
We vow today to fight with our lives
We wiil bury capitalism in the grave
And sound the drums of our state !
BhaskarJadhav. 1971
(Original in Marathi)
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