1. Gender inequities in Kerala Dr. Jayasree.A.K

2. Gender inequities in Kerala Beyond women’s education The constraints on women’s economic, social and political participation in all levels Lack of power and control over resources Leads to inequity in health

3. Inequities observed Between genders within gender Among Age groups Socio-economic groups Socio-cultural groups Tribal Sexuality Geographical areas Tribal coastal

4. Maternal Mortality Ratio Still high 66 per lakh (India-178) as against 16 in developed countries This is an indicator of regional disparities in access to health care in Kerala e.g tribal Social exclusion, lack of infrastructure, poor access, systemic neglect, delay in availability of quality care Morbidity higher in women

5. Gendered aging Composition- elderly 60% above 60 are women Kerala- total (12.6% ) M- 11.8%; F 13.3% Life expectancy - 4 yrs gap (M 74; F 78) Widowed : M -1.5%; F - 12.4% 27% bed ridden after 80 yrs - predominantly women

6. Gendered aging Health problems- chronic diseases and disability Live alone, abuse Needs of the institutionalized Lack of social interaction Lack of support system

7. Kerala Study 2012-13 Half of elderly were unhappy or worried, the reasons being absence of an own source of income, being dependent on children, lack of emotional support and ill-treatment by children. Loneliness, isolation, neglect, demise of spouse and subsequent sense of insecurity of widowhood were reported as distressing psychological problems of elderly women

8. Adolescents & Children No female foeticide reported Not much disparity in nutritional status Low birth weight indicates poor reproductive health of adolescents & women High prevalence of Thyroid disorders of women can affect children Violence towards girl children Obesity and PCOD (polycystic ovarian disorder)

9. Reproductive age group Cost of reproduction Medicalisation of pregnancy Caesarian- 30%(NFHS3) 40%(pub) 41(pri) FW (2015) (WHO- 15%) Induction Women becoming more passive No guidelines followed

10. Reproductive health needs Unequal distribution in contraceptive use a(99% -female) Abortion services 2488 (public)8106(pri) (Ratio 1:3) Unreported? 90% private India (NFHS3) Infertility treatment cost

11. Gender based violence/Beyond Reproduction Empowerment indicators Decision making Domestic violence(20%- 65%) Specific health needs Sexual harassment – stress Violence to women outside family – sex workers

12. Mental Health Women Depression Suicide attempts Somatisation disorders Men Alcoholism Suicides Drug abuse

13. Tribals High infant mortality (More than 2 times) High neo-natal mortality Low birth weight Premature delivery Underweight Mothers Anaemia > 50% (others only 7% in the same area)

14. Sexual diversities Barriers to access Stigma Discrimination Social exclusion Lack of skill and attitude on provider side (4% faced physical assault, 11% faced insult and >1% faced sexual assault from health care institutions)

15. Sexual diversities Stress – specific health needs 33% attempted suicide 25% of them desire body change Hormonal intervention needs Surgical intervention needs

16. Women, work and health “No occupation” is the major occupational health hazard High education (90%) Low employment (36%) phenomenon (Overwork, monotonous) Work place-no facilities to look after babies, lack of toilets, no personal protective measures for cleaning workers

17. Who cares women? Women are main care givers (Family, hospital & community) Who cares women in family? Only anecdotal evidences Research needed

18. Priorities for research Maternal mortality – across regions (tribal Morbidity- disparities Obesity- adolescent and adult Mental health, Geriatric health Expenditure on pregnancy and delivery Thyroid disorders- other hormonal, Cancers Unwanted pregnancies Infertility Participatory/Action research should be encouraged

19. Measuring gender inequities Challenges Minimum health equity surveillance system Integrating gender into it Disaggregated data needed Power of qualitative data Integrating gender into curriculum Addressing gender bias in research