Health As a Fundamental Human Right
Health is a fundamental human right, yet for millions of Indian women, accessing quality healthcare and exercising autonomy over their own bodies remain distant aspirations. Women’s health in India is shaped by intersecting factors—poverty, gender discrimination, inadequate healthcare infrastructure, social norms that deprioritize women’s well-being, and systemic barriers that deny women control over reproductive choices. While India has made progress in certain health indicators, significant disparities persist, and women continue to face preventable illness, pregnancy-related deaths, and limited agency in health decisions. Understanding these challenges and pathways to health equity is essential for ensuring that every woman can live a healthy, dignified life.
The State of Women’s Health in India
Indian women face a complex health landscape marked by both progress and persistent challenges. Life expectancy for women has increased substantially, from around 36 years at independence to approximately 70 years today. This improvement reflects better nutrition, reduced infectious diseases, improved sanitation, and expanded healthcare access.
However, aggregated statistics mask significant disparities. Women from marginalized communities—Scheduled Castes, Scheduled Tribes, and religious minorities—have worse health outcomes than upper-caste women. Rural women face greater health challenges than urban women. Poor women experience health burdens that wealthy women avoid. Education strongly correlates with health—educated women have better health knowledge, access care more effectively, and make informed decisions.
Disease Burden Affecting Women
The disease burden affecting women includes both conditions specific to female biology—menstruation, pregnancy, childbirth—and conditions affecting all people but manifesting differently in women or receiving inadequate attention due to gender bias in medical research and practice. Reproductive health issues, malnutrition, anemia, mental health conditions, and non-communicable diseases all significantly impact women’s well-being.
Lifecycle Gender Discrimination in Healthcare
Gender discrimination in healthcare manifests throughout women’s lives. Female fetuses face sex-selective abortion. Girl children receive less nutrition and healthcare than boys. Adolescent girls’ health needs are neglected. Adult women’s health is deprioritized compared to husbands’ and children’s. Elderly women face abandonment and healthcare neglect. This lifecycle discrimination produces cumulative health disadvantages.
Maternal Health: Progress and Persistent Challenges
Maternal mortality—deaths of women during pregnancy, childbirth, or postpartum period—is a critical indicator of women’s health status and healthcare system quality. India has made substantial progress, with the Maternal Mortality Ratio declining from around 556 deaths per 100,000 live births in 1990 to approximately 97 in recent estimates. This represents hundreds of thousands of lives saved.
However, India still accounts for a significant proportion of global maternal deaths. Nearly 45,000 women die annually from pregnancy-related causes—deaths that are largely preventable with adequate care. The MMR also varies dramatically across states. Kerala maintains rates comparable to developed nations (around 30), while states like Assam and Uttar Pradesh have MMRs three to four times higher.
Causes of Maternal Mortality
The primary causes of maternal death are hemorrhage (excessive bleeding), sepsis (infection), hypertensive disorders like eclampsia, obstructed labor, and unsafe abortion. These complications often develop suddenly, requiring emergency obstetric care.
- Hemorrhage: Excessive bleeding before, during, or after childbirth.
- Sepsis: Severe infections related to pregnancy or delivery.
- Hypertensive Disorders: Conditions such as pre-eclampsia and eclampsia.
- Obstructed Labor: Prolonged labor due to physical or medical complications.
- Unsafe Abortion: Procedures performed without adequate medical standards.
The “three delays” model explains most maternal deaths:
- Delay in deciding to seek care
- Delay in reaching healthcare facilities
- Delay in receiving adequate care once there
Underlying these immediate causes are structural factors. Malnutrition and anemia make women more vulnerable to complications. Multiple, closely-spaced pregnancies exhaust women’s bodies. Lack of prenatal care means complications aren’t detected early. Inadequate emergency transport prevents timely access to hospitals. Shortages of skilled birth attendants, blood supplies, and surgical capacity mean that even women who reach facilities may not receive life-saving interventions.
Institutional Delivery and Skilled Birth Attendance
Government programs have dramatically increased institutional deliveries. The Janani Suraksha Yojana (JSY), launched in 2005, provides cash incentives for facility births. As a result, institutional delivery rates have risen from around 40% to over 85% nationally. This shift from home births attended by traditional birth attendants to facility births attended by skilled providers has contributed to mortality reduction.
However, institutional delivery alone doesn’t guarantee quality care. Many facilities lack adequate staffing, equipment, medications, or blood supplies. Private facilities, while better equipped, are financially inaccessible for poor women. The quality of care at government facilities varies enormously, with some providing excellent care while others offer only minimal services.
Disrespectful and abusive treatment during childbirth—verbal abuse, physical abuse, lack of privacy, non-consented procedures—affects many women. This “obstetric violence” traumatizes women and may deter future facility use. Ensuring respectful maternity care is crucial for improving maternal health outcomes.
Prenatal and Postnatal Care
Adequate prenatal care enables early detection and management of complications, yet many women receive insufficient care. While most women receive some prenatal checkups, the recommended number and quality often fall short. Testing for anemia, blood pressure, infections, and fetal development may not occur. Nutritional counseling and supplements may not be provided.
Postnatal care is particularly neglected. Women and newborns are most vulnerable in the immediate postpartum period, yet postnatal checkups are less common than prenatal visits. Many women return to household work within days of delivery without adequate rest or monitoring for complications like postpartum hemorrhage or infection.
Reproductive Health And Rights
Reproductive health encompasses the ability to have a satisfying sex life, capacity to reproduce, and freedom to decide if, when, and how often to reproduce. Reproductive rights include autonomy in sexual and reproductive decisions, access to information and services, and freedom from coercion and discrimination. For Indian women, these rights are frequently compromised.
Family Planning And Contraception
India was among the first countries to adopt an official family planning program in 1952, yet implementation has often prioritized population control over women’s autonomy. Contraceptive access has expanded, with approximately 54% of married women using some contraceptive method. However, female sterilization dominates, accounting for two-thirds of contraceptive use.
The overwhelming reliance on permanent female sterilization reflects both limited method choices and coercive family planning practices. Women face pressure—from husbands, families, health workers, and sometimes government campaigns—to undergo sterilization after one or two children. Sterilization camps conducting surgeries in substandard conditions have resulted in deaths and complications.
Reversible contraceptive methods—pills, IUDs, injectables—are underutilized, partly due to limited availability, inadequate counseling, and misconceptions about side effects. Male contraceptive methods are rarely used, reflecting gender norms placing birth control responsibility on women. Condom use for dual protection against pregnancy and STIs remains low.
Inequality In Contraceptive Access
Access to contraception varies by geography, class, and social group. Urban, educated women have better access and more method choices than rural, poor, or less educated women. Unmarried women and adolescents face particular barriers, with providers often refusing services based on marital status.
Abortion Access
Abortion has been legal in India since 1971 under the Medical Termination of Pregnancy Act, which was amended in 2021 to expand access. Legal abortion is available up to 20 weeks of pregnancy, and up to 24 weeks in special categories like rape survivors, minors, or fetal abnormalities. Abortion is framed as a healthcare service rather than requiring justification.
However, legal rights don’t translate to accessible services. Safe abortion facilities are concentrated in urban areas, leaving rural women with limited options. Many government facilities lack trained providers or necessary equipment. Private providers may charge unaffordable fees. The result is that many women—estimated in millions annually—resort to unsafe abortions performed by untrained providers or through unsafe methods.
Unsafe abortion is a leading cause of maternal mortality and morbidity. Complications include hemorrhage, infection, and uterine perforation, sometimes resulting in death or permanent disability like infertility. The women who die from unsafe abortions are disproportionately young, poor, rural, and marginalized.
Social stigma surrounding abortion prevents many women from seeking services openly. Unmarried women, adolescents, and those seeking sex-selective abortion (which is illegal but still occurs) face particular stigma. Confidentiality concerns deter some women from accessing facilities where privacy may not be protected.
Menstrual Health
Menstruation affects women for approximately 40 years of their lives, yet menstrual health remains neglected. Many women lack access to sanitary products, using cloth, rags, or other materials that may be unhygienic. Sanitary pads are expensive for poor women, and disposal facilities are inadequate even where products are available.
Menstrual taboos restrict women’s activities during periods. In some communities, menstruating women are considered impure and excluded from kitchens, temples, and social activities. These restrictions reinforce shame about natural bodily functions and limit women’s participation in daily life.
Schools often lack adequate facilities for menstrual hygiene management—private, clean toilets with water and disposal facilities. The absence of these facilities contributes to school absenteeism among adolescent girls, affecting their education. Lack of menstrual education leaves many girls unprepared for their first period, experiencing fear and confusion.
Recent initiatives have improved menstrual health awareness and product access. Campaigns challenging menstrual taboos have generated public discussion. Government schemes distribute sanitary pads in some states. However, comprehensive menstrual health—encompassing products, facilities, education, and dismantling of stigma—remains unfulfilled for many women.
Reproductive Autonomy
Perhaps the most fundamental reproductive rights issue is autonomy—women’s ability to make their own decisions about their bodies and reproduction. For many Indian women, this autonomy is severely limited. Family members, particularly husbands and mothers-in-law, often control decisions about contraception, pregnancy, childbearing, and healthcare.
Women may face pressure to bear children soon after marriage and continue bearing children until producing sons. Decisions about pregnancy spacing, family size, and contraceptive method are often made by others. Women seeking sterilization may require husband’s consent, while those opposing it may be coerced. Abortion decisions may be controlled by families rather than women themselves.
Young married women face particular pressure, expected to prove fertility quickly. Those who don’t conceive face stigma and sometimes abuse, even when infertility stems from male factors. Reproductive coercion—forcing or preventing pregnancy against women’s wishes—is common but rarely acknowledged as a violation of rights.
Nutrition And Anemia
Malnutrition and anemia are pervasive health problems affecting Indian women across their lifespans. Approximately 53% of women of reproductive age are anemic, with higher rates among adolescent girls and pregnant women. Anemia contributes to maternal mortality, low birth weight, and impaired child development.
Causes And Consequences
The causes of women’s malnutrition are multiple. Poverty limits food access for entire families. Within households, food distribution favors males—men and boys eat first and consume more, while women and girls eat last and less. Cultural norms in some communities discourage women from eating certain nutritious foods or adequate quantities.
Repeated pregnancies and breastfeeding deplete women’s nutritional stores. Iron deficiency results from inadequate dietary iron, poor iron absorption, blood loss during menstruation, and parasitic infections. Folic acid deficiency affects pregnant women, risking fetal neural tube defects.
The consequences of malnutrition extend beyond individual health. Malnourished women have more pregnancy complications, deliver low birth weight babies, and produce less breast milk. Children born to malnourished mothers face developmental challenges. The intergenerational transmission of malnutrition perpetuates cycles of poor health.
Interventions And Limitations
Government programs address nutrition through multiple channels. The Integrated Child Development Services (ICDS) provides supplementary nutrition to pregnant and lactating women and young children. Anemia prevention programs distribute iron-folic acid supplements. Midday meal schemes ensure children receive at least one nutritious meal daily.
However, implementation gaps limit effectiveness. Supplements are often not consumed due to side effects, irregular supply, or lack of awareness about importance. Nutrition education is inadequate. The quality and quantity of supplementary food sometimes falls short. Monitoring and accountability are weak.
Addressing women’s nutrition requires confronting household food distribution inequities. Social norms that deprioritize women’s nutritional needs must change. Women need nutrition education, agency to access and consume adequate food, and freedom from the demands of repeated pregnancies without adequate recovery time.
Mental Health
Mental health is often overlooked in discussions of women’s health, yet women face significant mental health burdens. Depression, anxiety, trauma-related disorders, and other mental health conditions substantially affect women’s well-being and functioning.
Prevalence And Causes
Women have higher rates of depression and anxiety disorders than men. Multiple factors contribute to this disparity. Gender-based violence and abuse cause trauma and mental health conditions. The stress of managing household responsibilities, childcare, work, and multiple demands without adequate support affects mental health. Discrimination, powerlessness, and lack of autonomy create psychological distress.
Perinatal mental health—during pregnancy and postpartum—receives particular attention. Postpartum depression affects 10–15% of women but often goes unrecognized and untreated. Women suffering postpartum depression struggle to care for themselves and their babies, yet stigma and lack of services prevent many from seeking help.
Women in violent relationships have high rates of mental health problems. The trauma of ongoing abuse, fear, and helplessness creates depression, anxiety, and post-traumatic stress. Yet mental health services rarely screen for intimate partner violence or address the context of women’s distress.
Access To Mental Health Services
Mental health services in India are severely inadequate for the entire population, and women face additional barriers. Mental illness stigma is intense, with mental health problems viewed as shameful. Women fear being labeled “mad” or blamed for family problems.
Mental health services are concentrated in urban areas and often unavailable in smaller towns and rural areas where most women live. Even where services exist, they may be unaffordable for poor women. Cultural insensitivity and lack of women mental health providers deter some women from seeking care.
Integration of mental health into primary healthcare—screening for depression during prenatal visits, training general healthcare providers to recognize and treat common mental health conditions—could improve access. Community-based mental health services and peer support groups offer alternatives to facility-based care.
Gender Bias In Healthcare
Healthcare systems in India, like elsewhere, reflect and perpetuate gender bias. This bias affects how women’s health complaints are received, diagnosed, and treated.
Medical Research And Knowledge Gaps
Medical research has historically focused on male subjects, treating male physiology as the norm. Women were often excluded from clinical trials, leaving knowledge gaps about how conditions affect women differently and how treatments work in women’s bodies. Cardiovascular disease, for example, presents differently in women but is often misdiagnosed because symptoms don’t match male-pattern presentation.
Conditions primarily affecting women—endometriosis, polycystic ovary syndrome, adenomyosis—are underresearched and poorly understood. Women suffering these conditions face delayed diagnosis, inadequate treatment options, and dismissal of their symptoms. Pain conditions that disproportionately affect women, like migraines and fibromyalgia, are often not taken seriously.
Provider Attitudes And Treatment
Healthcare providers, carrying societal gender biases, sometimes dismiss women’s health complaints as exaggerated, psychosomatic, or attention-seeking. Women’s pain may be undertreated compared to men’s. Women reporting symptoms may face skepticism where men would be believed and investigated.
Reproductive health needs may be prioritized over women’s other health concerns. Women may be viewed primarily as mothers and reproductive vessels rather than complete persons with diverse health needs. Non-reproductive health issues may receive insufficient attention.
Women’s autonomy in healthcare decisions is often disregarded. Providers may speak to husbands rather than women patients, seek husband’s consent for women’s treatment, or dismiss women’s preferences about care. This paternalism denies women agency over their own bodies and health.
Healthcare Access Barriers
Beyond gender-specific issues, women face general barriers to accessing healthcare that are shaped by gender inequality.
Financial Barriers
Healthcare costs create significant barriers for women who often lack independent income and control over household finances. Even when healthcare services are theoretically free at government facilities, hidden costs—transportation, medications, diagnostic tests, informal payments—strain budgets. For treatments requiring multiple visits or extended care, costs accumulate beyond poor families’ capacity.
Women may be denied healthcare because families deem the expense unjustified for daughters or wives. Healthcare spending decisions favor males, with families more willing to pay for sons’ or husbands’ care than for daughters’ or wives’. Women themselves internalize this devaluation, avoiding seeking care to spare families the expense.
Health insurance coverage, while expanding, often doesn’t cover women adequately. Women in informal employment lack employer-provided insurance. Schemes covering the poor may not include all services women need. High out-of-pocket spending on healthcare pushes families into poverty and discourages women from seeking necessary care.
Geographic Barriers
Healthcare infrastructure is unevenly distributed, concentrated in urban areas and underserving rural regions where most Indians live. Rural women must travel long distances to reach health facilities, requiring transportation that may be unavailable or unaffordable. For pregnant women, sick individuals, or emergencies, these distances can be deadly.
Primary health centers and sub-centers that should provide basic care in villages are often understaffed, poorly equipped, or non-functional. Women needing specialist care must travel to district hospitals or cities, a journey that cost, time, and family restrictions may prevent.
Mobility restrictions limit women’s ability to travel for healthcare. Cultural norms in some communities prevent women from traveling alone or far from home. Women need male relatives’ permission and accompaniment to access healthcare, creating dependency and delay. Emergency situations where decisions and action must be rapid become impossible to navigate under these restrictions.
Social And Cultural Barriers
Social norms about modesty and honor affect women’s healthcare access. Some women avoid male healthcare providers, yet female providers are scarce. Examinations requiring physical exposure may be refused due to modesty concerns. Gynecological and reproductive health issues carry particular stigma, preventing women from discussing symptoms or seeking care.
Health literacy affects women’s ability to navigate healthcare systems. Less educated women may not understand when to seek care, where to go, or how to communicate with providers. Medical terminology and clinical settings may be intimidating, preventing effective engagement with healthcare.
Discrimination based on caste, religion, or other identities compounds barriers. Dalit and Adivasi women may face disrespect or refusal of care at healthcare facilities. Muslim women may encounter prejudice. Disabilities create additional access challenges. These intersecting discriminations mean the most marginalized women face the greatest healthcare barriers.
Government Programs And Policies
India has implemented numerous programs addressing women’s health, with varying degrees of success.
National Health Mission
The National Health Mission, encompassing the National Rural Health Mission and National Urban Health Mission, is the primary framework for public health service delivery. It aims to provide accessible, affordable, quality healthcare, with specific focus on maternal and child health.
Under NHM, ASHA (Accredited Social Health Activist) workers serve as community health workers, linking villages to health systems. ASHAs facilitate prenatal checkups, institutional deliveries, immunizations, and health education. Their contribution to improving maternal and child health has been significant, though they face inadequate compensation and recognition.
Janani Suraksha Yojana
JSY provides cash incentives for institutional deliveries, covering costs and compensating for lost wages. It has successfully increased facility births, particularly in rural and underserved areas. However, ensuring quality care at facilities that receive increased patient load remains challenging.
Pradhan Mantri Matru Vandana Yojana
This maternity benefit program provides cash transfers to pregnant and lactating women for first live birth. The transfers aim to compensate for wage loss and encourage prenatal care, institutional delivery, and postnatal care. Coverage has expanded but remains incomplete, and transfer amounts may be insufficient to fully offset economic impacts of pregnancy.
Ayushman Bharat
The Ayushman Bharat – Pradhan Mantri Jan Arogya Yojana provides health insurance covering hospitalization costs for poor families. It reduces financial barriers to accessing treatment for serious conditions. However, coverage gaps remain—outpatient care, medications, and many services women need aren’t covered. Implementation challenges affect actual accessibility.
Limitations Of Programs
Despite multiple programs, implementation gaps limit effectiveness. Facilities may lack staff, equipment, or supplies. Services may be of poor quality. Corruption and informal payments persist. Monitoring and accountability are weak, allowing dysfunction to continue without consequences.
Programs often focus on maternal and child health while neglecting other dimensions of women’s health. Reproductive health services beyond pregnancy are limited. Mental health is barely addressed. Non-communicable diseases affecting women receive inadequate attention. Women’s health needs throughout the lifecycle require comprehensive approaches, not just pregnancy-focused programs.
Pathways To Health Equity
Achieving health equity for women requires addressing immediate healthcare needs while tackling underlying determinants of health inequality.
Strengthening Healthcare Systems
Healthcare infrastructure must expand to rural and underserved areas. Every village should have functional primary health centers with trained staff, essential medications, and equipment. District hospitals must have capacity for emergency obstetric care, surgeries, and specialist services.
Healthcare workforce shortages must be addressed—recruiting, training, and deploying adequate numbers of doctors, nurses, midwives, and specialists. Female healthcare providers are particularly needed. Retention in rural and difficult areas requires adequate compensation, housing, and career development opportunities.
Quality of care must improve through training, protocols, supervision, and accountability. Respectful, non-discriminatory care should be standard. Gender-sensitive care that respects women’s autonomy should be mandated. Systems for reporting and addressing poor quality care or provider misconduct must function effectively.
Key Healthcare System Needs
- Expansion of primary healthcare infrastructure in rural areas
- Adequate emergency and specialist services at district hospitals
- Recruitment and retention of trained healthcare professionals
- Standardized, respectful, and gender-sensitive quality of care
Ensuring Financial Protection
Universal health coverage ensuring all women can access needed care without financial hardship is essential. Expansion of health insurance, free services at public facilities, and regulation of private sector costs can reduce financial barriers.
Out-of-pocket spending on healthcare must decrease through comprehensive insurance coverage, free provision of medications and diagnostics, and elimination of informal payments. Financial protection schemes should cover all services women need—not just hospitalization but outpatient care, mental health, chronic disease management, and preventive services.
Components Of Financial Protection
| Area | Required Measures |
|---|---|
| Health Insurance | Comprehensive coverage for inpatient and outpatient care |
| Public Healthcare | Free services, medicines, and diagnostics |
| Cost Regulation | Control of private sector pricing and informal payments |
Reproductive Justice
Moving beyond narrow family planning to comprehensive reproductive health services means ensuring access to full range of contraceptive methods, safe abortion services, infertility treatment, and sexual health services. These should be available without discrimination based on marital status, age, or any other factor.
Reproductive autonomy requires that women can make decisions about their bodies free from coercion. Informed, voluntary consent should govern all reproductive health interventions—no forced or coerced sterilizations, no pressure for unwanted pregnancies or abortions, and full information about all options.
Comprehensive sexuality education in schools and communities provides young people with knowledge about bodies, reproduction, relationships, and rights. This education should be age-appropriate, scientifically accurate, and inclusive of diverse experiences.
Core Elements Of Reproductive Justice
- Access to comprehensive reproductive health services
- Protection of reproductive autonomy and informed consent
- Non-discriminatory service delivery
- Comprehensive and inclusive sexuality education
Addressing Malnutrition
Ensuring women’s adequate nutrition requires addressing household-level food distribution inequities, providing supplementary nutrition, treating anemia, and improving food security. Behavior change communication challenging norms that deprioritize women’s nutritional needs is essential.
Spacing pregnancies adequately through contraceptive access allows women’s bodies to recover between births. Reducing total fertility reduces the cumulative nutritional drain of repeated pregnancies and lactation. Empowering women to decide family size and spacing has health benefits.
Mental Health Services
Integrating mental health into primary healthcare makes services more accessible. Training all healthcare providers to recognize and respond to common mental health conditions can dramatically increase identification and treatment.
Community-based services, peer support groups, and hotlines provide alternatives to facility-based care. Reducing stigma through public awareness campaigns can encourage help-seeking. Addressing the social determinants of mental health—violence, discrimination, powerlessness—is crucial for prevention.
Mental Health Interventions
- Integration of mental health into primary healthcare
- Training healthcare providers in mental health care
- Community-based and peer support services
- Stigma reduction and preventive social interventions
Challenging Gender Norms
Ultimately, women’s health equity requires challenging gender inequality itself. Education and economic empowerment give women resources and agency to prioritize their own health. Legal protections against discrimination and violence create safer environments. Political representation ensures women’s health needs are addressed in policy.
Men’s engagement in supporting women’s health—sharing household and care work, respecting women’s health decisions, accompanying women to healthcare—can reduce barriers. Family and community education changing attitudes about women’s value and rights creates supportive environments.
Conclusion
Women’s health in India is both a human rights issue and a development imperative. Every woman who dies in childbirth, suffers from preventable illness, or is denied autonomy over her own body represents a failure of healthcare systems and societal commitment to women’s well-being. The persistence of maternal mortality, malnutrition, reproductive coercion, and healthcare discrimination reflects how deeply gender inequality is embedded in Indian society.
Yet progress is possible and has occurred. Maternal mortality has declined substantially. Contraceptive access has expanded. Institutional delivery rates have increased. Legal frameworks recognize reproductive rights. These achievements demonstrate that when resources, policies, and political will align, women’s health improves.
Realizing health equity for all women requires sustained commitment to strengthening healthcare systems, ensuring financial protection, respecting reproductive autonomy, addressing malnutrition, providing mental health services, and challenging gender discrimination. It requires recognizing that women’s health is not just about reproduction and motherhood but about whole persons deserving comprehensive healthcare throughout their lives.
Women’s health is inextricably linked to women’s rights—the right to life, dignity, autonomy, equality, and freedom from discrimination and violence. Protecting and promoting women’s health means honoring these rights. When every Indian woman can access quality healthcare without financial hardship, make autonomous decisions about her body and health, and live free from preventable illness and premature death, India will have fulfilled its constitutional promise of equality and its international human rights obligations. Until then, the struggle for women’s health equity continues.
