women's health in india women's health in india women's health in india can be examined in terms of multiple indicators, which vary by geography, socioeconomic standing and culture. to adequately improve the health of women in india multiple dimensions of wellbeing must be analysed in relation to global health averages and also in comparison to men in india. health is an important factor that contributes to human wellbeing and economic growth. community health worker preparing a vaccine in odisha, india currently, women in india face a multitude of health problems, which ultimately affect the aggregate economy's output. addressing the gender, class or ethnic disparities that exist in healthcare and improving the health outcomes can contribute to economic gain through the creation of quality human capital and increased levels of savings and investment. gender bias in access to healthcare the united nations ranks india as a middle-income country. findings from the world economic forum indicate that india is one of the worst countries in the world in terms of gender inequality. the 2011 united nations development programme's human development report ranked india 132 out of 187 in terms of gender inequality. the value of this multidimensional indicator, gender inequality index (gii) is determined by numerous factors including maternal mortality rate, adolescent fertility rate, educational achievement and labour force participation rate. gender inequality in india is exemplified by women's lower likelihood of being literate, continuing their education and participating in the labour force. gender is one of the main social determinants of health—which include social, economic, and political factors—that play a major role in the health outcomes of women in india and access to healthcare in india. therefore, the high level of gender inequality in india negatively impacts the health of women. studies have indicated that boys are more likely to receive treatment from health care facilities compared to girls, when controlled for ses status. the role that gender plays in health care access can be determined by examining resource allocation within the household and public sphere. gender discrimination begins before birth; females are the most commonly aborted sex in india. if a female fetus is not aborted, the mother's pregnancy can be a stressful experience, due to her family's preference for a son. once born, daughters are prone to being fed less than sons, especially when there are multiple girls already in the household. as women mature into adulthood, many of the barriers preventing them from achieving equitable levels of health stem from the low status of women and girls in indian society, particularly in the rural and poverty-affected areas. the low status of—and subsequent discrimination against—women in india can be attributed to many cultural norms. societal forces of patriarchy, hierarchy and multigenerational families contribute to indian gender roles. men use greater privileges and superior rights to create an unequal society that leaves women with little to no power. this societal structure is exemplified with women's low participation within india's national parliament and the labour force. women are also seen as less valuable to a family due to marriage obligations. although illegal, indian cultural norms often force payment of a dowry to the husband's family. the higher future financial burden of daughters creates a power structure that favours sons in household formation. additionally, women are often perceived as being incapable of taking care of parents in old age, which creates even greater preference for sons over daughters. taken together, women are oftentimes seen less valuable than men. with lower involvement in the public sphere—as exemplified by the labour and political participation rates—and the stigma of being less valuable within a family, women face a unique form of gender discrimination. gender inequalities, in turn, are directly related to poor health outcomes for women. numerous studies have found that the rates of admission to hospitals vary dramatically with gender, with men visiting hospitals more frequently than women. differential access to healthcare occurs because women typically are entitled to a lower share of household resources and thus utilise healthcare resources to a lesser degree than men. amartya sen has attributed access to fewer household resources to their weaker bargaining power within the household. furthermore, it has been found that indian women frequently underreport illnesses. the underreporting of illness may be contributed to these cultural norms and gender expectations within the household. gender also dramatically influences the use of antenatal care and utilisation of immunisations. a study by choi in 2006 found that boys are more likely to receive immunisations than girls in rural areas. this finding has led researchers to believe that the sex of a child leads to different levels of health care being administered in rural areas. there is also a gender component associated with mobility. indian women are more likely to have difficulty traveling in public spaces than men, resulting in greater difficulty to access services. cooperative conflicts approach to gender biases amartya sen's cooperative conflicts approach to gender biases frames women's gender disadvantage through three different responses: breakdown wellbeing, perceived interest and perceived contribution responses. the breakdown well-being response—derived from the nash equilibrium—describes breakdown positions between individuals during cooperative decisions. when the breakdown position of one individual is less than the other person, the solution to any conflict will ultimately result in less favourable conditions for the first individual. in terms of women's health in india, the overall gender disadvantage facing women—represented by cultural and societal factors that favour men over women—negatively impacts their ability to make decisions with regards to seeking out healthcare. the perceived interest response describes the outcome of a bargained decision when one individual attaches less value to his or her well-being. any bargaining solution derived between the aforementioned individual and another individual will always result in a less favourable outcome for the person who attaches less value to their well-being. the health status of women in india relates to the perceived interest response because of the societal and cultural practices that create an environment where the self-worth of women is marginalised compared to men. therefore, outcomes relating to healthcare decisions within households will favour the men, due to greater self-worth. the perceived contribution response describes the more favourable position of an individual when the individual's contribution is perceived as contributing more to a group than other individuals. the more favourable perception gives the individual a better outcome in a bargaining solution. in terms of women's health in india, males' perceived contribution to household productivity is higher than that of women, which ultimately affects the bargaining power that women have with regards to accessing healthcare. problems with india's healthcare system at the turn of the 21st century india's health care system is strained in terms of the number of healthcare professionals including doctors and nurses. the health care system is also highly concentrated in urban areas. this results in many individuals in rural areas seeking care from unqualified providers with varying results. it has also been found that many individuals who claim to be physicians actually lack formal training. nearly 25 percent of physicians classified as allopathic (mainstream medical) providers actually had no medical training; this phenomenon varies geographically. women are negatively affected by the geographic bias within implementation of the current healthcare system in india. of all health workers in the country, nearly two thirds are men. this especially affects rural areas where it has been found that out of all doctors, only 6 percent are women. this translates into approximately 0.5 female allopathic physicians per 10,000 individuals in rural areas. a disparity in access to maternal care between rural and urban populations is one of the ramifications of a highly concentrated urban medical system. according to government of india national family health survey (nfhs ii, 1998–1999) the maternal mortality in rural areas is approximately 132 percent the number of maternal mortality in urban areas. the indian government has taken steps to alleviate some of the current gender inequalities. in 1992, the government of india established the national commission for women. the commission was meant to address many of the inequalities women face, specifically rape, family and guardianship. however, the slow pace of change in the judicial system and the aforementioned cultural norms have prevented the full adoption of policies meant to promote equality between men and women. in 2005 india enacted the national rural health mission (nrhm). some of its primary goals were to reduce infant mortality and also the maternal mortality ratio. additionally, the nhrm aimed to create universal access to public health services and also balance the gender ratio. however, a 2011 research study conducted by nair and panda found that although india was able to improve some measures of maternal health since the enactment of the nhrm in 2005, the country was still far behind most emerging economies. outcomes health problems of tribal women the high incidence of breast lumps among adivasi women of adilabad in telangana has created apprehension of more serious health impacts for this remote population. "leave alone breast cancer or any other type of carcinoma, even routine mammarian infections were unknown among indigenous people belonging to the gond, pardhan, kolam and thotti," points out dr. thodsam chandu, the district immunisation officer, himself a gond. malnutrition and morbidity further information: malnutrition in india poverty and malnutrition are common issues faced by indian women. nutrition plays a major role in and individual's overall health; psychological and physical health status is often dramatically impacted by the presence of malnutrition. india currently has one of the highest rates of malnourished women among developing countries. a study in 2000 found that nearly 70 percent of non-pregnant women and 75 percent of pregnant women were anemic in terms of iron-deficiency. one of the main drivers of malnutrition is gender specific selection of the distribution of food resources. a 2012 study by tarozzi have found the nutritional intake of early adolescents to be approximately equal. however, the rate of malnutrition increases for women as they enter adulthood. furthermore, jose et al. found that malnutrition increased for ever-married women compared to non-married women. maternal malnutrition has been associated with an increased risk of maternal mortality and also child birth defects. addressing the problem of malnutrition would lead to beneficial outcomes for women and children. breast cancer india is facing a growing cancer epidemic, with a large increase in the number of women with breast cancer. by the year 2020 nearly 70 percent of the world's cancer cases will come from developing countries, with a fifth of those cases coming from india. much of the sudden increase in breast cancer cases is attributed to the rise in westernisation of the country. this includes, but is not limited to, westernised diet, greater urban concentrations of women, and later child bearing. additionally, problems with india's health care infrastructure prevent adequate screenings and access for women, ultimately leading to lower health outcomes compared to more developed countries. as of 2012, india has a shortage of trained oncologists and cancer centres, further straining the health care system. maternal health