CSES in Media

‘Gender difference beneficial to women’

This report on CSES study was published in The Hindu on 05/04/2010

Study moots specific intervention in certain districts

Study conducted by Kochi-based CSES raises Concern over high rate of caesarean sections

A study by the Kochi-based Centre for Socio-Economic and Environmental Studies (CSES) on ‘Health of women in Kerala’ has pointed out that gender difference was advantageous to women in the State.

The gender difference was negligible in Kerala in the prevalence of stunting, underweight and anaemia among children below the age of 5. Even the small differences that existed in Kerala favoured females. Wasting, stunting, underweight and anaemia were less prevalent among girls in Kerala compared to their counterparts in the rest of the country, the study by N. Ajith Kumar and D. Radha Devi of the CSES said.

The study said over two-thirds of girls in Kerala got married at the age of 20 years or above while the proportion was only 36 per cent for all-India. In Kerala, there was no marriage below 15 years, but 9 per cent of the total reported marriages were in the 15-17 year age group, which is below the legal minimum age. Nearly three-fourths of the marriages before the girl attained 18 years of age were from the three districts of Malappuram, Kannur and Kasaragod. This calls for specific interventions in these districts. It also implied that there were differences between the districts in achievements in the health sector and therefore a uniform strategy for the entire State may not be appropriate. This was particularly important because the State-level indicators camouflaged the low performance of certain districts which, in turn, would result in ignoring health issues in certain parts of the State which needed more attention.

Special needs

Women have special health needs during the reproductive age. The health issues during this period related to pregnancy, delivery, post- delivery, menstruation, menopause, etc., as well as family planning. Almost all pregnant women in Kerala had made the recommended three antenatal care visits while only half had done so at the national level. However, even in Kerala only about one-third had received all recommended types of antenatal care. Regarding the quality of ante-natal care, most of the women in Kerala had taken all the desired measures except having at least two TT injections. About one-in-ten women die not take the recommended two TT injections. On these aspects also, Kerala’s position was better than the national scenario. Another noteworthy difference between Kerala and India was that while almost all deliveries in Kerala took place in health institutions, institutional deliveries formed only 39 per cent at the all-India level. The percentage of deliveries with post-natal check-up was only 41 per cent in India compared to 87 per cent in Kerala, though there was scope for improvement even in Kerala.

Caesarean rate

The study pointed out that almost one-third of the deliveries in Kerala were caesarean sections. The caesarean rate in Kerala was more than three times the national rate and was much higher than the maximum justifiable rate of 15 per cent recommended by the World Health Organisation. It is well known that the medical risks involved in a caesarean are much higher than that in normal delivery. Several reasons have been attributed to the high caesarean rate in Kerala. They included high rate of institutional delivery and higher dependence on private hospitals. It could be the profit motive operating in private sector institutions that resulted in the performance of a higher volume of elective caesarean sections. The one-child norm was cited as another reason for higher proportion of caesarians. It was pointed out that in such a situation, the child and the mother were very precious and the doctor did not have much elbow space. It is reported that in some cases, caesarean section was performed on demand by the family so that the delivery occurred at an auspicious time. Though it was mandatory for the hospitals to report to the local bodies on the details of delivery, including whether a caesarean was performed, such data was not analysed at the hospital level or doctor level.

Further research on the high caesarean rate in Kerala, its reasons and consequences needs to be undertaken. It was also interesting to note that the number of ante-natal care (ANC) visits is much higher in Kerala compared to the all-India scenario.