Academic journal article Health Sociology Review

Health Inequity and Women's Self-Help Groups in India: The Role of Caste and Class

Academic journal article Health Sociology Review

Health Inequity and Women's Self-Help Groups in India: The Role of Caste and Class

Article excerpt

Introduction

The United Nations' Millenium Declaration was adopted by 189 nations in 2000. With it came a commitment to fulfilling, by 2015, ten key objectives - the Millenium Development Goals - designed to enhance the economic and social well-being of the vast army of impoverished people throughout the world (United Nations 2006). One of the strategies identified for advancing these goals was the establishment of Self-Help Groups (SHGs), particularly in rural regions with high levels of poverty (IFAD 2006). Self-Help Groups (SHGs) are small voluntary associations of people from the same socio-economic background established for the purpose of solving common problems through self-help and mutual help. These groups are known by different names in different places. Some of the terms used in India for these groups are Sangha, Samooh, Mandai, Dangham, and Samiti and so on, depending upon the region. In India, SHGs are usually oriented to the needs and interests of women, with most of their activities concentrated on financial savings and credit activities (apart from specifically designated activities focusing on women's empowerment, health and educational attainment).

Self-help groups and women's health

There is a common perception in development literature that the increased participation of women in savings and credit activities, or economic attainment, will empower women (Zeller et al 1997:25-8) by helping them to access and utilise better health services and facilities, and by elevating the health, nutritional, and educational status of their families, in particular that of children (Goetz and Gupta 1996:46). One of the major consequences anticipated to result from this empowerment is the enhancement of women's welfare, particularly in relation to their health. The underlying approach to women's participation in micro-finance programmes, then, has been highly instrumental, not only in terms of their own socio-economic well-being but in relation to that of their families as well. Numerous studies have shown, however, that while women may be empowered in one area, this does not necessarily translate into empowerment in others (Malhotra and Mather 1997; Kishor 1995, 2000; Hashemi et al 1996; Beegle et al 1998). This is attributable to a number of factors but fundamental to the constraints on interventions such as SHGs are structural inequalities.

SHGs, caste and class in health inequity

Inequality between men and women is one of the most critical disparities in India. This is not only reflected in educational opportunities but also in relation to the basic human right for survival, and the conditions associated with it, such as adequate nutrition and health. This disparity is clearly reflected in the unbalanced sex-ratio that prevails in India (927 women per thousand men) (Census of India 2001) and which has deteriorated over time. Not surprisingly, in the absence of adequate nutrition and basic health care, women are more vulnerable to disease and experience a higher rate of mortality. Malnutrition and anaemia are also more common among women, leading to problems during pregnancy and childbirth and contributing more than any other factor to high maternal mortality. The lower literacy rate among women (53.7 per cent) (Census of India 2001) compounds the situation, posing a major barrier to women's improved health outcomes.

Attempts to improve women's health in India thus face formidable structural barriers, one of which is gender inequality. No less significant are class and caste. The caste system is a pattern of Hindu social classes. It is a variegated structure comprised of individual and discrete groups or castes. The caste system is the traditional, hereditary system of social stratification of India in which social classes are defined by a number of hierarchical, endogamous groups. Though predominantly a Hindu institution, the caste system is also widely practised in India by Muslims, Sikhs and Christians. …

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