This article is written by Sneha Singh, student at Dr. Ram Manohar Lohia National Law University. The article discusses the inequalities a woman has to face when it comes to maternal healthcare, the reasons and what are her rights.
The socio-economic inequalities are visible everywhere but when it comes to healthcare the problem seems to be more toxic. Maternal healthcare is a very important aspect of a woman’s life. Many women die while childbirth due to lack of proper facilities being available.
On television many times we see that they show the condition of hospitals where women are not admitted in the hospitals if they don’t have the required money. They are in pain but the hospital refuses to admit them. Same happened with a lady in my friend’s neighbourhood who was denied access to the hospital as the hospital already had many patients and the woman was also not having that much money as was required to be paid for the fees. It was an emergency situation but they refused to admit her. She was transferred to another hospital but died on the way.
Seeing incidents like these only puts a question on how exactly are the healthcare facilities functioning in our country? How is there inequality in treating patients when a person from a poor background with the scarcity of resources is also in the same pain as the person who has more money or resources at his disposal?
Maternal healthcare as a fundamental right
Right to health is not expressly mentioned anywhere in the Constitution but the Supreme Court in its various judgments has declared the right to health as an integral part of the right to life. Article 21 talks about the right to life with human dignity which implies not merely animal existence and for fulfilling this condition being in good health is important.
The Supreme Court in the case of State of Punjab v. Ram Lubhaya Bagga, held that it is the obligation of the State Government to provide proper health facilities to everyone. The right to health means providing basic health care facilities and a minimum standard of treatment to whosoever is admitted. The same goes for maternal health care facilities too. The court has reiterated this in certain judgments.
In the case of Laxmi Mandal v Deen Dayal Hari Nagar Hospital, the court asked the hospital to pay a compensation of Rs. 2.4 lakhs to the family of the deceased who died while childbirth as her death was preventable. They violated her right to life and health.
The court in the case of Jaitun v Maternity Home, MCD, Jangpura & Ors directed the Municipal Corporation of Delhi and Government of National Capital Territory of Delhi to pay Rs 50,000 compensation to Fatima as she was compelled to give birth to her child under the tree as she was denied basic health facility by the hospital. Her fundamental right to life and health were violated.
How socio–economic inequalities hinder access to human rights
Human rights are guaranteed to each one of us. But when we talk about rights it’s always not the same for all of us. There are many factors which determine whether a person is able to access his human rights or not. And these factors are not made by any laws but the society has set some of the boundaries for people.
Poverty is one of those factors. The case that has been already discussed above, Jaitun v Maternity Home, MCD, Jangpura & Ors where a woman was forced to give birth under a tree is a big example. Right to maternal healthcare is definitely a human right but that was denied to her just because she was poor. Only for the sake of money both her and her child’s life was put in a risky situation.
The other factor is the class to which a person belongs to or what is the status of the person in the society which determines whether he is going to have access to human rights or not. Like the right to health of a lady was denied just because of her poverty in the same way other human rights too are affected based on the socio-economic status of a person. How educated a person is and what occupation he has is also a determining factor when it comes to enjoyment of human rights.
The causes of persistent healthcare inequalities
There are various reasons for healthcare inequalities in India like region, class, religion, caste, gender, sexuality, socio-economic development etc.
Locations also serve as a hindrance to providing medical services. The medical services in urban areas are better than in rural areas. It is also noticed that the healthcare facilities in the southern states are better than in the northern states. And even in the states, the facilities vary on the basis of region. Like for instance, the Malabar region of Kerala lags behind the rest of Kerala when it comes to medical facilities.
The economic status of a person determines whether he gets the proper medical facilities or not. The above-mentioned criteria of geographical location apply mostly to the people who don’t have enough money. It’s been more than 70 years since independence but the medical facilities are still a luxury which only the rich can afford and the people who are rich get access to the required health facilities in whatever hospitals they go to.
Caste and identity
In India, people are recognized by their caste. Even if the scenario is not the same as in the past, still people are discriminated against, based on their caste. The SC’s, ST’s are given differential treatment and here also the money factor plays a role, if they don’t have enough money they have to suffer from poor health facilities and the ones who have money are able to get the required facilities from whichever caste they belong to.
The medical facilities are not available to everyone easily because the investment for its development is not up to the mark. The public health system has failed to protect the poor and marginalised section of the society because the investment is not enough, which has further led to inequality when it comes to health facilities.
According to a report published in a journal, the women belong to various socio-economic backgrounds, and they are neglected on the basis of their gender when it comes to basic healthcare. The life expectancy of females is not high in India, which suggests that there are problems with the health of women. The females have high mortality rates, especially during childhood and their productive years. This all reveals that women don’t get proper medical facilities in comparison to men which shows inequality in medical health care facilities.
Need for commercialization of health services
The need for commercialization of health services is being talked about a lot. It is a part of the discussion because of the deteriorating health facilities at the government hospitals. On the other hand, the private hospitals provide all the necessary requirements to treat a patient, maintain good hygiene and provide a good environment for the better recovery of the patients. But is this a good enough reason for the commercialization of health services. There are certain arguments for and against the need for commercialization.
Arguments in support of commercialization
- The traffic in government hospitals can be reduced because those who have money and can afford will rather go to private hospitals which provide better facilities. In this way, poor people can be treated in government hospitals.
- The treatment facility in private hospitals is better as they have better equipment and medicines.
- It ensures that the doctors are well rewarded for the work they are doing.
- Better hygiene, a good infrastructure, 24-hour availability of nurses and doctors facilitate quick recovery of patients. It also helps in improving the Indian health care facilities which lag behind its western counterparts.
Arguments against commercialization
- The medical facility is a basic requirement of an individual. Either it should be free or subsidized. Commercialisation will only make the situation worse for the people who are below the poverty line.
- The beneficiaries of commercialisation are rich people. The poor cannot afford it and for the middle-class people if they are able to pay for it, they are charged extra by the hospitals who try to make maximum money when they see the person can afford a few more thousands.
- The worth of a person’s life is measured according to the money they have.
- Commercialisation is a way of filing pockets and generating revenue for private companies.
- There is a lot of corruption and partiality in private hospitals.
Comparison with other developing countries
According to data released in the bulletin of the WHO around half a million women who are residing in developing countries continue to die from maternal causes every year. Key health-care interventions, attendance to antenatal care, skilled health workers can help in improving maternal health which is limited in developing countries.
In developing countries too, the difference in the data of maternal health care is determined by various factors like whether the women are rich and affluent or she is poor. The region to which she belongs, whether urban or rural is also a determining factor. The other criteria like women’s age, ethnicity, education, religion, culture, cost, location all are important. The rural women in northern India and those in KwaZulu Natal, South Africa don’t use antenatal care adequately.
Analysis of data on inequalities in utilization of preventive care
The variation in utilization of preventive care services such as antenatal care and immunizations by reasons like socioeconomic status, gender and geography. For immunizations, coverage was 44% in 2005-06. The inequality exists by the wealth and education people have in a household.
Inequality on the basis of caste– The data shows that in 2005-06, the immunization coverage for Scheduled caste and Scheduled tribes was 31.3% and 39.7% respectively in comparison to another caste which was 53.8% and the inequality increasing with time.
Inequality on the basis of the region– The inequality exists on the basis of where a person resides, in rural or in urban areas. In urban areas, the coverage is 58% in comparison to rural areas where it is 39%.
Inequality on the basis of gender– The gender gap has widened with time. In 1992-93, the gender gap was 2.6% which has widened to 3.8% in 2005-06.
The pattern is similar when it comes to antenatal care coverage. 77% of the Indian women received some form of antenatal care in the three years preceding survey in 2005-06, even though only 52% among them had recommended three or more visits. There has been progress in antenatal care coverage over time. But still, the inequalities exist based on wealth, education and the region(urban or rural). There is a difference for both the preventive care services based on the state. The number of antenatal visits and the type of services that are provided during those visits also vary.
Lack of legal awareness among people
Legal awareness also known as public legal education helps to promote consciousness of legal culture which helps in understanding the formation of laws and the rule of law. It empowers the people so that they can understand justice and can demand accountability and effective remedies wherever required.
A person can ask for his right or even understand that his right has been infringed only if he is aware that he possesses a right. And for the infringement of such rights, he can take legal action. The former Chief Justice of India Ranjan Gogoi has said in a valedictory ceremony that for securing social and economic progress it is important that people are aware of their rights and the means of securing those rights. The root cause of deception, exploitation and deprivation of rights and benefits of the masses is the absence of awareness.
There are many reasons which led to lack of legal awareness among people like they are illiterate and even if they are literate they are not in a situation to afford the fees of the lawyers due to their social and economic backwardness. There is provision for free legal aid under Article 39-A of the Constitution for the weaker section of the people.
It is the responsibility of the young minds to spread awareness among the people regarding their rights. The technology can make it easier, the various mobile applications should be used to tell people about their rights and also regarding how they can get legal aid, information about their case etc.
The maternal healthcare facilities are a necessity for a woman during pregnancy but the socio-economic factors deprive many women of having access to them. It is an urgent requirement for the authorities to take action for providing everyone with adequate healthcare despite the individual’s age, region which she belongs to, the wealth she possesses, and by doing so the lives of many women who die every year due to lack of proper maternal healthcare facilities can be saved.
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