Sex and gender discrimination is an issue of immense proportions in India. Many of the country’s women and girls experience such discrimination even before birth. In many cases, the discrimination continues all the way to the end of their lives. Sex and gender discrimination can impair and limit educational attainment, employment potential and opportunities, financial wellbeing, health and wellbeing, and even take lives.
While efforts are being made to address these issues, the problem is deeply ingrained and systemic. As such, effectively countering these problems may require generations of concerted efforts. For now, swathes of India’s women and girls, as well as members of the LGBTQ+ community and other marginalised groups, are often left to suffer in silence.
India fourth from last in global health and survival rates for women rankings
India failed to improve gender equality parameters in regards to health and employment opportunity, according to the Global Gender Gap Report 2020 released in December last year by the World Economic Forum (WEF).
In the overall metrics, of the 153 countries surveyed, India ranked 112th – falling four places compared to 2019’s report. This suggests that not only is insufficient progress being made, India is actually falling behind in many respects. The overall metric was largely influenced by a small number of factors in which India is in the bottom five of all countries listed — denoting key areas where issues are not being addressed.
In terms of health and survival rates for women, India ranked fourth from last. This is an alarming statistic, with the WEF noting that millions of women in India have yet to be granted the same level of access to healthcare as men.
The WEF metrics take into account survival rates. This, therefore, includes two factors unique to women — abortion and sex selection. Unsafe abortion is a major issue in India. As many as 56 percent of such procedures carried out in the country are considered to be unsafe, with such procedures responsible for the deaths of thirteen women every day in India.
Though illegal, the practice of unsafe abortion continues. Depending on the source, the issue is either being alleviated or is continuing to worsen. Because of its illegal nature, a large burden of the illegal abortion practice is unreported, making true estimates of the practice difficult. This is not to say India’s abortion laws are illiberal – the Union Government even took steps earlier this year to liberalise further the country’s abortion laws by extending the timeframe within which an abortion can be availed from twenty to 24 weeks. This was approved by lawmakers. However, issues of social stigma and accessibility continue to provide obstacles and drive women seeking an abortion to turn to illegal, backdoor providers.
Of the four metrics that the WEF uses to measure inequality — political empowerment, health and survival, economic participation and opportunity and educational attainment – India performed well only on the issue of political empowerment. Health and survival and economic participation show India to be in the bottom five countries, while educational attainment places India at the 112th rank.
Sexual discrimination — from cradle to the grave
While the scope of the practice of sex-selective abortion is all but unknown due to its illegal methodology, the reasons behind it are in most cases fairly well understood.
The practice has roots in culture, as well as deeply rooted, patriarchal views on work and education. For many families — particularly those in rural locations — the need for a male child comes from the viewpoint that the child would soon be working in rural occupations such as farming. For those living in poverty having another working person could mean food on the table.
Some families take this concept further, only providing adequate education, nourishment and medical treatments to the boys of the family. Often they do so in the hope and belief that the male child could go on to take a high paying job and support the family.
The practice of sex-selective abortion has perhaps been best-epitomised in the area of Uttarkashi. Between February and April 2019, not a single female child was born out of 216 births spanning 132 villages. Given the usual birth rate slightly deviates from a fifty percent split between boys and girls, this absence of female children cannot reasonably be put down to coincidence, and a full-scale district investigation was launched.
Many families continue to have children until a boy is born, deeming girls born in the interim as unwanted. Roughly 239,000 girls under the age of five died in India every year between 2000 and 2005 due to gender-based neglect, according to a 2018 study.
According to Professor Amy O. Tsui, PhD of the Johns Hopkins Bloomberg School of Public Health, the issue of sex-selective abortion and the issue of male preference may even be increasing
“Social norms around male roles in society sustain the desire of couples to ensure a male heir among their offspring. Patriarchal customs can protect land ownership with only males having property rights…Paradoxically, as India’s fertility rates reach replacement level (2.1 births per woman on average), the demand for sons appears to be increasing. It also appears to be strongest for first births and among the better educated females and wealthier couples.”
Sex discrimination and gender imbalance
India’s sex ratio at birth has improved, Union Minister for Women and Child Development Smriti Irani reported in comments made last year. However, such a claim seems very much dependent on the figures used.
Irani credited the Centre’s Beti Bachao, Beti Padhao (Save Daughter, Educate Daughter) initiative with the improvement. This scheme was lauded by Union Finance Minister Nirmala Sitharaman during this year’s Union Budget. According to the data presented by Irani, the disparity in India’s sex ratio at birth was alleviated by thirteen points since 2015, from 918 girls for every thousand boys to 931 girls for every thousand boys.
Niti Aayog data released last year contradicts this claim, however. The data indicated a worsening sex ratio at birth in twelve states out of 22 surveyed. As previously reported by Health Issues India, data is limited with just 22 states and union territories reporting on their sex ratios). In addition, government data fails to take into account information from private institutions as it relies on updates from Anganwadi and Asha workers. Therefore, it only registers information from government institutions and home deliveries.
Sex discrimination in India claims the lives of almost 240,000 girls aged beneath the age of five every year. Shocking cases such as that of a newborn girl being buried alive in a clay pot made headlines last year, underlying the very real, and very morbid reality, that babies and infants are often neglected and killed simply for being female.
Female genital mutilation
Female genital mutilation is a global menace. As described by the World Health Organization (WHO), the practice is “recognised internationally as a violation of the human rights of girls and women” and “[reflecting] deep-rooted inequality between the sexes.”
The silence in India surrounding female genital mutilation can be attributed – at least in part – to the Government. In 2017, the existence of the practice in the country was denied altogether. The Ministry of Women and Child Development asserted at the time that there was “no official data or study which supports [its] existence.” This was despite then-Minister of Women and Child Development Maneka Gandhi declaring earlier “we will write to respective state governments and Syedna, the Bohra high priest shortly to issue an edict to community members to give up female genital mutilation voluntarily as it is a crime under Indian Penal Code (IPC) and Protection of Children from Sexual Offenses (POCSO) Act, 2012. If the Syedna does not respond then we will bring in a law to ban the practice in India.”
In India’s Bohra Muslim community, one which numbers at more than one million according to the Joshua Project, an incidence of female genital mutilation (practiced as khatna or khafz) is pegged to have taken place in around 75 percent of women in a first-of-its-kind study published in 2018.
Menstrual health — stigmatised through lack of knowledge?
Stigma and discrimination does not end after childbirth for women and girls in India. In fact, this stigma extends even to the most basic of biological functions in females. Menstrual health, despite being a norm of everyday life for almost half the population, is a matter of contention and challenge. Health Issues India spoke exclusively to Dr Supriya Garikipati, associate professor in gender and development at the University of Liverpool, on the matter last year
“Women in India are effectively denied an environment where they can discuss menstrual issues with peers and elders. The singular policy focus on disposable pads also effectively denies women the right to informed choice. These awareness issues are exacerbated when combined with lack of access to the range of menstrual products and lack of access to right WASH and disposal facilities.”
A major issue is simply the lack of knowledge. This, in part, is borne of the unwillingness of most people to discuss the topic due to the societal taboo. Often this leaves girls going through puberty and beginning their menstrual cycles all but unaware of what will occur, or proper hygiene procedure
“Educational materials used in schools [need] to be made more accessible and sessions on menstruation and fertility need to be carried out in a utilitarian way where girls and boys are encouraged to question and discuss issues with peers.”
Labour participation: Where are India’s women?
Labour participation for women stands at a mere 23 percent. Only Saudi Arabia records fewer women in the workplace than India among the G20 nations. Even taking India’s gender imbalance into account, the country has far fewer women in the workplace than would be expected of an economy of this size.
Of the women missing from the workforce, many have obtained at least a secondary level of education. Almost 120 million women who have at least a secondary education do not participate in the workforce. The consequence is that India’s gross domestic product is missing out on more than Rs 30 lakh crore and the chance for a more educated workforce.
Sexual harassment and rape — an ever present threat
The crisis of sexual harassment and discrimination
India has had its own #MeToo movement in recent years, highlighting prominent cases of sexual harassment as well as underlying the issue as a societal problem of severe proportions.
According to statistics released by the National Crime Records Bureau (NCRB), of India’s states and union territories, Uttar Pradesh recorded the most sexual harassment cases that year, with 5,830. Madhya Pradesh followed with 2,985 cases, with Maharashtra placing third, reporting 2,910 cases. Of cities, Delhi recorded the most cases of sexual harassment in India in 2017, with 613, followed by Mumbai, with 391, and Kanpur, with 162. Telangana recorded more cases of sexual harassment in the workplace than any other state. Bihar was the state to record the most cases of sexual harassment on public transport.
While these figures seem severe, they likely only scratch the surface of the problem. While prominent cases — or those that were particularly violent, resulting in deaths — are likely to make media headlines, a vast number of cases go unreported. In many cases, women are often shamed for being the victim in these circumstances. Indeed this concept also extends to men who are the victims of sexual violence, with severe societal stigma placed on those taking their claims public.
Rape: India’s silent crisis
Rape is a major issue in India that too often goes unreported — whether through fear of repercussion or the view that authorities will simply do nothing. In 2013, 93 women were raped every day in India. According to the National Crime Records Bureau (NCRB), 34,651 cases of rape were reported in 2015. According to Feminism India, 2.5 million crimes against women – of which rape accounts for around twelve percent – have been reported in the last decade. The overall number of crimes against women increased by 83 percent between 2007 and 2016.
The Independent reports that “rape is one of the most under-reported crimes in India – with some estimates indicating ninety to 95 percent of rape cases remain unreported.”
Medical matters and gender specific healthcare
Hysterectomies as a first-line solution to infection
At the more extreme end of societal impact of menstrual stigma is a situation currently being uncovered in Maharashtra. It was reported by the BBC that thousands of women in the state have opted to undergo voluntary hysterectomies in order to no longer deal with the issue of their periods. This disturbing practice is creating “villages of womb-less women.” According to Dr Garikipati
“An organisation that we work with, MARI, has observed that in some villages in Andhra and Telangana the incidence of hysterectomies are extremely high – close to 100 percent and some as young as 23 years of age. Once a woman has conceived the desired number of children, apparently the medical practitioner recommends hysterectomy as a way of killing two birds with one stone – alleviate any minor gynaecological complaints and rid women of the stigma of menstruation.”
Such extreme measures are often related to employment. Many women in the area are employed in sugarcane harvesting. The unsanitary conditions result in many women contracting infections. It is believed that doctors in the area are offering the surgery as a first resort due to it being a lucrative practice. For the women often facing losing work and risking starvation for them and their families, it is a choice they simply are forced to make.
“India faces several major challenges in family planning, the first of which is the prominence of female sterilisation as the most used contraceptive method and one promoted by the government. Although other methods are available (condoms, pills, IUDs [intrauterine devices, or the coil] and recently injectables), female sterilisation accounts for three quarters of contraceptive use.”
HPV vaccination denied?
Cervical cancer is an issue exclusive to women. It can also be all but eliminated should the HPV vaccine be made widely available to India’s women. Given the high rate of death, would the vaccine be more of a priority if it were an issue for both genders? As a leading health concern among women, responsible for thousands of deaths, it amounts to discrimination to exclude it from the Universal Immunisation Programme (UIP).
Around 67,500 Indian women lose their lives to cervical cancer every year – a rate of one death every eight minutes. Cervical cancer accounts for seventeen percent of all deaths due to cancer in the nation. 432.2 million girls and women aged fifteen and above are at risk of developing the disease. It is believed that one in every 53 Indian women will develop the disease in their lifetime.
Infection by the HPV virus is the leading cause of cervical cancer, accounting for more than ninety percent of cases. Despite these figures, the HPV vaccine is yet to be included in the country’s Universal Immunisation Programme (UIP) despite the urging of health experts.
According to a study published in The Lancet, “among girls and women aged thirteen to nineteen, the research showed that prevalence of infection with HPV-16 and HPV-18 – the two strains of the virus responsible for seventy percent of cervical cancer cases – dropped by 83 percent with HPV vaccination.” Ignoring the potential to all but eliminate the condition in the face of overwhelming evidence amounts to negligence against women’s health.
Stigma against the LGBTQ+ community
Discrimation within medical textbooks
Discrimination does not just exist along gender lines, but is also deeply entrenched against members of the LGBTQ+ community.
For example, medical textbooks in India have been found to contain outdated principles citing homosexuality as a pathological disorder. Such information could be enshrining this way of thinking into a new generation of doctors, leading to poor health outcomes in the LGBTQ+ community as a result of discrimination.
Dr Sameera Mahamud Jahagirdar – Assistant Professor at the Department of Critical Care Medicine of the Mahatma Gandhi Medical College & Research Institute – spoke to Health Issues India on the matter, as well as her own personal experiences as a member of the LGBTIQ community within the healthcare field.
“…Such textbooks infuse medical knowledge which is intended to pathologize the LGBTIQ related content in the curriculum. On the contrary, any subject related to sexuality, gender variations are never being taught by these teachers to their students. They are selectively omitted.”
Progress is being made in legislation, though society still holds prejudice
India’s Supreme Court struck down Section 377 in 2018. This colonial-era law outlawed same-sex relations in the country. Its removal was hailed as a key milestone by the LGBTQ+ community in India, signing a move forward for the country at least in terms of legislation. However, many legislative challenges still remain.
“We still cannot marry, we still cannot adopt. We have many, many years before any of this [happens],” said Reyansh Naarang, an activist at LGBT+ rights group Nazariya in New Delhi.
Indeed LGBTQ+ individuals still do not hold many of the same legal rights as heterosexual individuals. The removal of Section 377 has sparked hope of further reform, though change is unlikely to come at a rapid pace, as the government has largely remained silent on the issue.
Trans rights bill causes controversy within the very community it is meant to protect
The Transgender Persons (Protection of Rights) Bill, established at the end of last year, came on the first anniversary of the removal of section 377. While in theory a step in the right direction for trans rights — prohibiting discrimination against transgender persons with regard to things like education, employment and the ability to rent or buy property — the Bill was met with criticism from trans rights groups.
The reason for this was the “right to self-perceived identity”, a clause that granted individuals the right to determine their own gender, but came with strings attached. If a transgender individual wishes to be legally recognised as such, the individual must submit proof to the government that gender-reasignment surgery has taken place.
“Certification itself is discrimination. It’s humiliation of a human being,” said Jaya Bachchan, a member of India’s upper house of parliament. Bachchan was among a number of lawmakers requesting the Bill be reviewed.
A long process to change
While some legislative progress is being made to prevent discrimination in regards to sex, gender, or sexuality, legislation can only go so far in addressing deeply held cultural stigma. For example, sex between homosexual couples is now legal in India, but this does not necessarily mean that it is accepted by the majority within the nation.
In a healthcare context, India ranking fourth from last in the world for gender parity in healthcare is a telling fact. This underlines that there is a long way to go for equality between the sexes to be reached. It is unlikely these issues will be resolved in the near future, however, steps in the right direction — both legally and culturally — must be made, no matter how incrementally, in order to achieve this goal.