Health and family welfare has been at the centre of energy welfare programmes. It has been the area of prime concern for the government. Improvement in health and nutritional status of the population has been one of the major thrust areas for the social development programmes of the country. Within sixty years of independence, India has erected a vast health infrastructure including the government and voluntary and private sectors.
Improvement in health care facilities combining latest technological advancement and having accessibility of those facilities have resulted in substantial improvement in overall health situation in the country.
The development in the health sector is clearly manifested in the Infant Mortality Ratio (IMR) which has declined significantly from 134 in 1950 to 63 in 2002. The Infant Mortality Rate is, in fact, a sensitive indicator of health status as well as overall socio-economic development. The decline in IMR is reflected in corresponding increase in life expectancy at birth which rose from 32.45 and 31.66 in 1951 to 61.3 and 63 in 1997-2001 for males and females respectively. Crude death rate, which was 25 per 1000 population in 1951, declined to 8.1 per 1000 in the year 2002.
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This improvement in health sector is attributable to a number of factors which include prevention and control of infectious diseases, application of latest advanced technology in health care sector and health care awareness among the masses.
Despite all these, we are not in a situation to be too happy. Much more needs to be done. The prevalence of infectious disease continues to be an area of major concern. Every year with the onset of monsoon we are faced with new problems of gastroenteritis, dengue fever, Japanese Encephalitis, malaria, etc. though the government takes steps to check the spread of these diseases, the situation, however, becomes difficult and them claim thousands of lives every year. Malaria is a great health problem.
It is an acute parasitic illness caused by mosquitoes. If treatment is not given in time, it may prove fatal. At the time of independence, there were 75 million cases and 0.8 million deaths annually. In 1951, the Government launched the National Malaria Control Programme in 1953 with the objective to bring down malaria transmission to a level at which it would cease to be a major public health problem. In 1958, the programme was converted into the National Malaria Eradication Programme with focus on eradication of malaria from the country.
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Later in 1997, Enhanced Malaria Control Project with the assistance from the World Bank was launched in eight highly malaria prone states predominantly inhabited by the tribes was launched to control the malaria. The effects bore fruits and malaria cases in the country declined to 1.82 million in 2004, as against over 2.66 million cases reported in the year 1997, a decline of about 31.5 per cent.
Dengue is another major health threat transmitted by mosquitoes. It is most serious in children. Generally its outbreak is reported with the start of the monsoon. Dengue is one of the severe forms of diseases which may lead to death. Japanese Encephalitis is an acute viral disease with cases of high fatality and long-term health complications. The prevalence of disease has been wide in states like Bihar, Uttar Pradesh, Andhra Pradesh, Karnataka, West Bengal, Assam, Tamil Nadu, Goa and Haryana where it has acquired serious magnitude.
Kala-afar, a parasitic disease, transmitted by sand flies, has been a major health problem in some states like Bihar, Jharkhand, West Bengal, and Uttar Pradesh where it is endemic. The disease is prevalent among socio-economically poorer sections of society largely living in rural areas. The Central Government launched Kala-afar Control Programme in 1991, as a result of which the cases of Kala-afar declined sharply.
TB is a grave health threat in India. It accounts for nearly one-third of the global TB burden. The disease is one of the India’s most important public health problems. In India, everyday more than 20,000 people become infected with the disease; more than 5,000 develop the disease and over 1,000 die of it. Every year there are 18 lakhs new cases in the country, TB in India kills 14 times more people, than all tropical diseases combined, 21 times more than malaria, and 400 times more than leprosy. Of the total new cases of TB, approximately 8 lakhs are new smear positive and therefore highly infectious. Every smear positive case can infect 10-15 individuals in a year. TB also kills more women than all causes of maternal mortality combined. HIV and multi-drug-resistant TB threaten to make this situation even worse.
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India has always been at the forefront of the fight against TB. It launched the National Tuberculosis Control Programme in 1962 to check its spread. But it failed to achieve the desired goal. Later, Revised National TB Control Programme under the guidance of WHO was launched in the country in 1997, following Directly Observed Treatment Short-Course (DOTS), a five-point strategy. It largely aimed at curbing 85 per cent new sputum positive cases. It is being implemented in a phased manner, with a target of covering the whole country under the programme by 2010 so as to achieve the global targets of TB control.
AIDS (Acquired Immune Deficiency Syndrome) caused by Human Immune Deficiency Virus (HIV), is a serious health problem not only in India, but in the entire world. It mainly affects human immune system. It is transmitted through blood and blood products, physical contacts, infected blood transfusions, contaminated needles, child birth to infected parents, etc. However, it does not spread by kissing, coughing, food, water or mosquito bites, etc. In India, there are about 5.3 million infected people having large population in Maharashtra, Manipur and Tamil Nadu. But due to mass awareness programmes, the cases of AIDS infection have declined in recent times which are a good sign.
Filarial is a serious debilitating disease which is transmitted through mosquitoes. The disease has been reported in 20 States and UTs. The National Filarial Control Programme is operational since 1952, providing protection to 51.71 million urban population. The National Health Policy has envisaged the goal of Lymphatic Filariasis Elimination by the year 2015. As per the reports received from 192 districts, the reported coverage under the Programme is 72.36 per cent. The Department of Health is concerned with the problem of communicable and non-communicable diseases.
It by implementing the National Health Programmes that the authorities are trying to check the spread of various diseases such as Malaria, Filarial, AIDS, TB, Cancer, etc. It implements Disease Surveillance Programme to prevent the outbreak of infectious diseases. However, there are wide intra-regional and intra-state disparities in health service coverage.
In 1952, India was the first country globally to launch a national programme, with a view to stabilize the population at a level consistent with the requirement of national economy. Half a century after formulating the National Family Welfare Programme, the demographic indicators show that eight states and union territories, accounting for 11 per cent of country’s population, have achieved replacement levels of fertility while twelve states are making steady progress in this regard. However, four states, namely Bihar, Rajasthan, Madhya Pradesh and Uttar Pradesh, constituting nearly 35.6 per cent of the total population need significant improvement. Obviously, it is these states which are adversely affecting the family welfare programmes.
There are a number of factors which combine to contribute in the poor functional status of the Health and Family Welfare Sector which include lack of skilled and dedicated human resources and infrastructure facilities, lack of proper training and skill upgradation of the personnel involved, lack of appropriate referral system and absence of well established linkages between different components of the system so proper training and coordination between various segments of the system may make a difference. Besides, health care facilities should be made available at grass-root levels.
Media and NGOs should work to make people aware of government’s different schemes and programmes. Moreover, common masses need to be educated towards the various health hazards. All these would definitely bring about desired change in the area of health and family welfare of the masses was not very different. When the British came to India, they remained indifferent to this social vice. Even after independence, the destinies of the women remained unchanged, but only grew in dimensions.
Indeed, a few more forms of violence like female foeticide developed because of the progress in the field of science and technology. The problems of dowry and dowry-related crimes increased in severity with growing materialism. A large number of brides are killed every year for dowry.
With the growth and progress in every sphere of life, crime against women rose and assumed an alarming proportion. According to an estimate women from prenatal stage to their death have to confront thirty specific forms of violence, which include foeticide, infanticide, differentiation in the supply of sufficient nutritious food, child marriages, physical assault, forced marriages, prostitution, sexual abuse, bride-burning, wife battering, witch-hunting, neglect of old women, etc. These crimes against women are daily affairs and are regular features in media.
Crime and violence against women are further complicated by other factors such as communal, caste, class and religious factors. Whether there is communal violence, class struggle and religious strife, women are the worst victims. Religious fundamentalists first impose restrictions on women and they are badly penalised for daring to break them.
Atrocities on women have their roots, to some extent, in their weaker social position. It is largely due to this fact that women are perceived as the weaker sex, depending on men economically, socially or otherwise, hence less chances of resisting any torture and violence. If she is uneducated and unskilled, a woman seldom has any choice but to bear all the atrocities, inflicted upon her.
The atrocities on women are to be seen in the context of growing tendency of violence in society. The causes are to be found in human natures temperament, desire and behaviour.
Accumulation of wealth, animal instincts and egocentricity are some other factors which contributed to the spread of violence aeainst women. Only a thorough revamping of thought and scientific temperament can redeem Indian women from their present plight. Most the rules framed for women have been implemented after the sanction of the autocratic patriarchal thumb. Particularly in a society like India, it is imperative that women are given a key role to play in decision-making, especially when it is concerned with them.
However, times have undergone radical changes. The government has taken substantial steps to bring about changes in the social condition of women. They have been provided with a fair deal of protection and responsibility with the Hindu Code Bill (1956), Hindu Succession Act, Anti-Dowry Act (1961), Equal Payment of Remuneration Act (1976), Right to Divorce to provide legal safeguards.
This is however strange to note that despite sufficient legal safeguard, the atrocities on Indian women have multiplied and they are more vulnerable to men’s exploitation. So remedy lies in changing our mindset, attitude, our outlook, and our approach. We must accept the changing scenario and accordingly bring about changes in our mentality.
The rising trend of violence against women lies in lack of social action. Though there are sufficient legal provisions, yet their effectiveness lies in implementation. They are seldom implemented with sincerity and care. Those who are responsible for implementing them have been found violating them. But the signs of optimism are there too. Women crime cells have been formed which exclusively deal with the crimes related to women. In recent times, the passing of the Domestic Violence Act, 2005 is a milestone in this regard.
It is really a welcome step taken to ensure social dignity and respect in woman’s life. If implemented with sincerity, it will definitely bring about great change in the lives of women. What is earnestly needed is that society must be sensitised to change its outlook towards women. Mere acts or laws cannot bring the desired result unless they are accepted wholeheartedly by every section of society. The government and non¬government organisations should come forward and create awareness among the masses with respect to social status of women.
Media can play an effective role in this regard. Besides all this, law-enforcing agencies must be trained and made sensitive to the issue. Above all, women must organise themselves and raise their voice against the system which acts insensitively towards them. When situation demands, they should voice their protest loudly and clearly. They should be made aware of their rights and stand up against the situations which intend to cause them harm. Only then the situation will change and it will certainly bring new confidence in this section of society, who numerically constitute half of the population, but are abused and tortured.