Economics and Public Health

Economics and Public Health

Economics and Public Health

A Conversation with Indira Chakravarty

I.M.O.W. Global Council Member Indira Chakravarty, Ph.D. and Doctor of Science, spoke with I.M.O.W. about the perceived economic value of women in India, and how basic rights such as health care, clean water, and basic education can make all the difference for empowering Indian women to contribute fully to the economy and society. Chakravarty is the director general of Health Services and director of the All India Institute of Hygiene and Public Health in Calcutta. She is considered a world leader on global health and environmental issues; her work on public health issues such as consumer safety, nutrition, and water contamination have had a widespread impact in India, as well as countries all over the world.

INTERNATIONAL MUSEUM OF WOMEN: It's a longstanding fact that Indian families have a gender preference for boy children over girls. Have you seen this changing at all?

INDIRA CHAKRAVARTY: Things are changing, but definitely not at the rate we want. Besides the more educated and elite families that prefer a girl child now, I think a family always wants a boy child.

I.M.O.W.: Can you explain why this is? 

 There are many reasons why. The first thing is that a boy child can support the family by working. In the field he can provide an extra hand for labor. Women actually do a lot of work, at home and even in the farmlands, but that's not recognized as much. When all the grains come in, they treat the grains, but because that's not really recognized, there's a feeling that with men you get extra hands to go to work and increase the work capacity for the family.

Another reason is that India still has the dowry system. In most communities, marriage of a girl means expenditure, while marriage of a boy means a kind of income. So, overall Indian families feel that a boy means extra financial resources, extra earnings, and less expenditure. That's why it is still a common concept that boys are preferred to girls, and are still more pampered.

I.M.O.W.: How does this preferential treatment of boys manifest?

If there's money in the house, and an option to send a child to school, would the girl child or the boy child get to go? Well, the boy would go to school, though the girl may be brighter. And if both get to go, then the girl would drop out first if there's a financial crunch. Many families feel it's more important that the boy should be educated because he will remain living with the family and the girl is going to get married and go away. 

Another example is the distribution of food, especially where limitations are concerned. In any household in India, the family eats first, and the lady eats whatever is left after everybody is done. It is in the culture, so it is difficult to change it. If you tell a lady that she doesn't need to wait for leftovers, because she is the one who delivers children, who has a reproductive cycle and loses nutrients every month, who works so much at home and in the field, spending energy by caring for children and by walking miles to collect water and fodder, psychologically, she's still thinking, "Let everybody else be done, I'll have enough after that." When one is satisfied in a negative condition, it is very difficult to make a change, because the women are not aware that they want change. It's there that you need to come in and tell them, "It's quite right for you to have enough nutrition, you should ask for it." I think their rights, in some way, have to be inculcated to change their behavior.

I.M.O.W.: How do you think women's economic potential is viewed in India? Is there a perception that a woman is less economically valuable than a man might be? 

When you talk of economic issues, the first thing we think of is work capacity-how much work can be put in by an individual. In many developing countries and especially in India, we find that from infancy until death, between 60 to 80 percent of all girls and women suffer from anemia, which is an iron deficiency disease. Frequently, we don't see any apparent clinical sign, but it reduces work capacity, because the blood is not able to carry the amount of oxygen it should carry. Oxygen gives you the strength and the stamina to work, and it enables your organs to function normally. In India, we did a hands-on study in seven states, taking blood and measuring the hemoglobin levels, because these indicate anemia. We found that girls and women of all age groups never know what normal life is; they are born with anemia and they die with anemia. So in a situation like that, the work capacity of women never reaches the level it should, just because of a nutritional deficiency that could be easily corrected. 

 In addition to under-nutrition and anemia, are there other barriers that women in India face to full economic participation? What strategies have you seen work successfully in starting to address some of those barriers?

 One issue is literacy. We have seen statistical data that shows that where there are problems in health, environment, or lifestyle, the moment literacy comes in, immediately all other indicators improve. However, it is not general literacy that changes things, but specifically literacy of women. Go anywhere in the world and you will find that this has really helped women, and it needs to be strengthened.

The second issue, along with literacy, is a sharing of the responsibilities between men and women. Their responsibilities are divided; women do this and men do that. If we look into it in India, though, a woman does so much of a man's job, but a man would never do a woman's job.

So women are fighting two things: one is literacy, and the second thing is sharing more responsibility with men. These would result in overall improvement in earning capacities and economic status, and along with that, it would improve issues like health, environment, nutrition, and overall lifestyle.

I.M.O.W.: When you see women in India become economically empowered, do you see improved health outcomes? Is there a correlation? 

It's very funny. In most of the cases, definitely, an improved economic situation leads to better nutrition. But if there is economic improvement without literacy, we have found that some of the health problems don't necessarily decrease. For example, anemia: anemia is connected to so many other things-sanitation, personal hygiene-and a woman has to also learn about that. Just giving some iron tablets would not help. In general, the nutrition of a woman does improve with her economic status, but most importantly, she needs literacy.

I.M.O.W.: Are there cases where you see women in India participating in the economy but unable to reap the rewards? 

 Yes, it's in my work; it's all over the world. I work in the street food sector a lot, just to give you an example, and the women prepare and cook all the food that the man is going to sell. She cooks it, and he goes and sells it and earns the money, using a part of the profit to get the next day's raw food.

So what happens? The woman has no access to the finances. She gets to eat, she lives in a house, but she does the labor and she's not paid for it. That's taken to be a natural thing. She cooks, she gives, they go, and the man here has free rupees in his hand. So, if a man earns 100 rupees a day, and uses 50 rupees to buy the raw food, he has the 50 rupees profit to spend on food and stuff for the house. Tomorrow, if he sells it for 200 rupees, the extra rupees that he gets are not going to benefit the woman. When he earns more, then the benefits are going to go to him, and she will remain where she is.

I.M.O.W.: So what might shift that reality? What do you think it's going to take to see change for women?

 It's literacy; the literacy system is the most important thing. Women will have an extra source of earning money for themselves. When a woman's earnings are linked to a man because she is illiterate and must depend on him to handle the money, then she is dependent on him. He is the one that gets the money and spends the money. It is only with literacy that she can go and sell the food and can calculate the money and keep it. So it is literacy that eventually boils down to giving the woman power in life. It gives women the strength and the confidence, the "Yes, I can!" It is with literacy that she can do it.

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