Revealing the Real Risks: Obstetrical Interventions and Maternal Mortality

By Aeman Nishath

Recently, a woman in Iowa was referred to a university hospital during childbirth because of possible complications. At the university hospital it was decided that a cesarean section should be done. After the cesarean section was completed and the woman was resting in her hospital room, she went into shock and died. An autopsy showed that, during the cesarean section, the surgeon had accidentally nicked the woman's aorta, the biggest artery in the body, which led to internal hemorrhage, shock, and death.

A cesarean section can save the life of the mother or her baby, or both. A cesarean section can kill a mother or her baby, or both. Every procedure or technology used during pregnancy and birth carries risks for the mother and baby. Whether or not to use any procedure or technology will be a judgment based on balancing the chances that it will make things better against the chances that it will make things worse.

We live in the age of technology. Since long before human beings landed on the moon, we have believed that technology can solve all of our problems. It should come as no surprise that doctors and hospitals are using more and more technology and invasive interventions on pregnant and birthing women. Has all this technology solved the problems surrounding birth? Let's look at the record. Is the increasing use of technology saving the lives of more pregnant and birthing women? In fact, the risk of a woman in this country dying from maternal mortality (i.e., causes related to pregnancy) has not decreased in more than 25 years. Each year, nearly 1,000 women die during pregnancy, during birth, or in the first week after giving birth. Nearly half of these deaths could have been prevented with better access to higher-quality maternity care. Hundreds of thousands of other women experience medical complications from pregnancy.2

The data also suggest an increase in recent years in the number of women dying during pregnancy and birth in the US.3 We have known for some time that maternal mortality in the US is underreported--in one state in one year, a third of the maternal deaths had not been reported.4 But the latest evidence suggests that "The actual pregnancy-related death rate could be more than twice as high as that reported for 1990."5

WHY ARE MORE AMERICAN WOMEN DYING?
It is difficult to pinpoint why more American women are dying before, during, and after giving birth--the data give only the leading or immediate cause of death, not the underlying causes. But if we look at the six leading causes of pregnancy-related deaths in the US, three--hemorrhage, anesthesia, infection--are often the result of invasive obstetric interventions.6 For example: Although the immediate cause of death is frequently given as "hemorrhage," in many cases the hemorrhage is associated with cesarean section (as in the case cited in the first paragraph). There is good research, both in the US and the United Kingdom, showing that the maternal mortality rate for cesarean section is four times higher than for vaginal birth.7-9 The rate of maternal mortality is still twice as high as for vaginal birth even when the cesarean section is routine, or "elective"; i.e., it is not an emergency procedure. With nearly twice as many cesarean sections as are necessary being done today in the US, the procedure could be a significant part of the reason for the country's rising rate of maternal mortality.10

Another possible cause of rising pregnancy-related deaths in the US is the markedly increasing use of epidural blocks for normal labor pain. Administering an epidural block doubles the risk that the woman will die; "anesthesia complications" are documented as one of the leading causes of maternal mortality in the US.11

There is good reason to believe that other obstetric technologies also contribute to the rising number of women who die during childbirth in this country. Data from the Centers for Disease Control (CDC) show that in the past ten years the number of women given powerful and dangerous drugs to induce labor has gone from 10 percent of all births to 20 percent.12 In the same ten years, the drug Cytotec, not approved by the FDA for labor induction because of insufficient scientific evaluation of risk--a warning often ignored by doctors--has become the single most popular labor-inducing drug. New scientific data show that inducing labor with Cytotec causes a marked increase in uterine rupture, an obstetric catastrophe in which a quarter of all babies die, many women die as well, and, of the women who survive, almost none can ever have another baby.

Why has the rate of Cytotec-induced labor doubled when the ability of women's bodies to begin labor has not decreased? Further CDC data show that the answer is doctor convenience. In those same ten years, the number of births taking place Monday through Friday greatly increased.13 Like taking prenatal X-rays in the 1930s, prescribing the drug di-ethyl-stillbesterol (DES) to pregnant women in the 1950s, and thalidomide in the 1960s, inducing labor with Cytotec in the 1990s is another obstetric intervention that has gone into widespread use without adequate scientific evaluation, with tragic consequences for thousands of women and babies.

The scientific evidence strongly suggests that the increasing use of obstetric interventions and technologies--cesarean section, epidural anesthesia, and drugs to induce labor--is not saving more women's lives, but ending them. Medical care was responsible for some of the earlier decreasing mortality of pregnant and birthing women, not because of high-tech interventions but because of basic medical advances, such as the discovery of antibiotics and the ability to give safe blood transfusions. There has never been any scientific evidence that such high-tech interventions as the routine use of electronic fetal monitoring during labor decrease the mortality rate of women.14 There is also no scientific evidence to prove that the fall in maternal mortality was because birth was moved into the hospital.15 The evidence does show that, as long as a system is in place that can transport women in labor within 30 minutes to a facility where antibiotics, blood transfusions, and necessary cesarean sections are available, there should be very little maternal mortality. For example, in the Netherlands, a third of all births are planned homebirths attended by midwives that refer women to doctors when necessary. The rate of maternal mortality in the Netherlands is far lower than in the US.

THE IMPORTANCE OF QUALITY CARE
The US spends twice as much as any other country on maternity care, and yet 15 other countries have lower rates of maternal mortality. There are at least two reasons for this, both having to do with access to quality care. More than 40 million Americans have no health insurance; many of these are women needing maternity care. If a woman applies for Medicare support for her maternity care, she must have means testing, which necessitates that she jump through many bureaucratic hoops before she can receive care. This can be a disaster. Furthermore, women receiving publicly funded care go to overcrowded hospitals staffed by interns and residents who are overworked and insufficiently trained.16 In addition, when poor women qualify for their maternity care to be funded by Medicare, they may be referred to a private practitioner, and receive this care in the doctor's private offices and private hospitals. There they often receive less attention than the women whose care is being funded by private insurance instead of public funds, in part because of the cultural and socioeconomic gaps between the poor women and their doctors. The delays and crowding, and lack of understanding and skill of some doctors, can all lead to pregnancy-related deaths.

The second reason the US has a higher rate of maternal mortality than 15 other countries is the way birthing women are cared for here. American doctors insist that women need to be in the hospital when giving birth, yet these same doctors who need to provide maternity care for them are not in the hospital when the women actually give birth, but in their offices doing prenatal checkups on healthy women, or in another hospital doing gynecological surgery, or at home eating dinner.17 So when the birthing woman who is in the hospital (or transported to the hospital) needs urgent attention for developing complications, the obstetrician is often not there, must be called, and may come too late. Research shows that, in more than 70 percent of cases, the main factor in the death of babies at birth is the doctor's absence.18

The US and Canada are the only countries in the world in which obstetricians provide primary birth care for the majority of normal births. The American obstetrician tries to be all things to women: a primary provider of maternity care for healthy pregnant and birthing women; a provider of preventive care for women; a specialist in women's diseases; and a highly skilled surgeon. No other doctor anywhere in healthcare tries to maintain competence at all of these levels and in so many areas because it is unreasonable to expect this from one human being. It's unlikely that an obstetrician can perform a six-hour gynecological surgical procedure on a woman with extensive cancer, then rush to his or her office and do the best job of quietly, patiently counseling a pregnant woman about her sex life. If you are considering a hospital birth with an obstetrician as your primary birth attendant, ask the doctor how much time he or she will spend with you during your labor. One of the reasons a midwife, rather than an obstetrician, is generally a better choice to attend your hospital birth is that, assuming a normal pregnancy, midwives have been shown statistically to be safer birth attendants than doctors.19 This is, in part, because the midwife is there in the hospital with you throughout your labor, while the obstetrician is not.

For more than 50 years now the US has had a system of maternity care that often boils down to this: A woman goes into labor, goes to the hospital, and is admitted by the labor and delivery (L&D) nurse, who examines her. The L&D nurse then calls the obstetrician, who gives orders over the telephone to the nurse. The obstetrician may or may not come by the hospital during the labor to check the woman. It is the job of the L&D nurse to monitor the labor and call the obstetrician when the birth is imminent so that the doctor does not have to hang around the hospital waiting for the birth.

During my 15 years as Director of Women's and Children's Health for the World Health Organization, I frequently visited the industrialized countries of Europe. I observed that in the 15 countries that lose fewer pregnant and birthing women than the US does--including those countries with the world's lowest rates of maternal mortality--obstetricians remain in the hospitals, ready to jump in and treat serious complications. In those countries, it is the midwives who are out in the community, giving prenatal and postnatal checkups, and who are also in the hospitals as the only health professionals at the births of 80 to 90 percent of women who give birth without serious complications.

It cannot be overemphasized that American women's lack of access to quality, immediate obstetrical attention in the hospital is a major reason so many of them die unnecessarily during pregnancy and childbirth. Put differently, every one of the 15 countries that have lower rates of maternal mortality has universal healthcare coverage for all pregnant and birthing women (with no bureaucratic hoops to jump through), and all obstetricians are hospital-based, ready to care for these women should they develop complications. Furthermore, maternal mortality is not higher in those countries where there are large numbers of planned homebirths with midwives, because there is a system in place for transporting birthing mothers to the hospital, and for managing complications with mutual respect and collaboration between out-of-hospital midwives and hospital staff.

Data from many states in the US show maternal mortality to be four times higher for African-American women than for Caucasian women, and nearly twice as high for Hispanic women.20 The markedly greater risk that African-American and Hispanic women will die during pregnancy and childbirth is because this group includes a higher proportion of uninsured women, poor women, and women who go to hospitals with insufficient and/or poorly trained staff. In short, African-American and Hispanic women have less access to quality maternity care.

WHERE'S THE DATA?
Occasionally, a group of obstetricians tries to get a handle on maternal deaths in their locale. In a study of ten hospitals in the greater Chicago area, reported in 2000, the maternal mortality rate there was twice as high as reported by the CDC.21 Furthermore, on investigation of each case, these Chicago obstetricians found that 37 percent of the deaths were preventable. In the preventable cases, mistakes by doctors and nurses were determined to be the cause of death more than 80 percent of the time. Unfortunately, as is nearly always the case, the study made no attempt to determine how many of the deaths were related to obstetric interventions such as induction of labor, epidural block, and cesarean section. Lamenting that state maternal mortality committees, which carefully review all maternal deaths, are now largely defunct in the US, the study urged that these committees be revived to investigate causes and develop programs of intervention and education.

There is an urgent need for careful auditing of every single maternal death in the US, with a thorough analysis of causes--including underlying causes--and presentation of the results to the public. The Federal Aviation Authority could not set policies for safe flying if they were unaware of half of the planes falling from the skies, and couldn't retrieve the "black boxes" of most of those planes they knew had fallen. But this is analogous to the CDC trying to set policy for safe motherhood when they have limited data on maternal mortality. Federal policy prohibits the CDC from making surveys of what is happening in all states with maternal deaths.22 At the state level, there are enormous pressures from state and local medical societies to prevent adequate investigation of all maternal deaths.23 It's not easy to get information about the nearly 1,000 women who die each year in the US around the time of birth. To begin with, it's difficult to track maternal deaths, as death certificates in only 16 states include a question concerning whether the deceased had been pregnant within a year of her death. Although some states have regulations requiring that such deaths be reported, in no state can anyone, including scientists who want to study why these women die, gain access to information about individual cases of maternal death. If there is an investigation of a maternal death by a hospital, it is a longstanding policy that this happen behind closed doors, which protects the doctor and hospital involved. There is no public accountability. Public knowledge of pregnancy-related deaths does not fit well into any HMO or healthcare facility's marketing efforts. Employees of most hospitals know that their job security often depends on their willingness to keep silent, and the tribal loyalty of doctors is a powerful deterrent to accessing information. The CDC is doing everything it can to push states to improve their maternal death audits. It has had some successes, but today only a few states conduct thorough audits of all maternal deaths, and only one state, Massachusetts, has a law, passed after intense lobbying by consumer groups, mandating that newspapers report maternal deaths.

We know that at least half of these maternal deaths are not reported anywhere, that nearly all of these women die in the hospital, not at home, and that, with adequate medical attention, close to half of these women need not have died. The possibility of liability due to inadequate medical attention has doctors terrified of litigation, and reluctant to release information concerning maternal mortality. American women need to know that their chance of dying around the time of birth is increasing. They have a right to know why.

Special Report: The Myth Of The 'Muslim Population' Bomb

If the Hindutva brigade is to be believed, India will become a Muslim majority country by 2035. INNLIVE sifts through available data to set the record straight.

Will Muslims outnumber Hindus by 2035 and become the majority in India? Several search results on Google warn how the Muslim population in the country will expand to 92.5 crore, while Hindus will shrink to 90.2 crore by 2035. By 2040, Hindu festivals will no longer be celebrated. 

Hyderabad Elections 2009 - Women Psyche

By Samiya Anwar

From the public lavatory to lanes, at every passage and wall we find the big pictures of bade bade neta, their posters with symbols of palm, flower, etc. Off course the rallies of Praja Rajyam not to forget is a part of every ones breakfast table with a hot cuppa of tea early morning. Well known today’s aam janta everyone is talking about the forthcoming elections, it is been more than sixty years of independence India is a free country. First it was poor and underdeveloped. Now it is counted as a developing country. We have traveled a long way. And it won’t be anonymous to say government builds the road we are traveling. The government will always affect our lives.

An election means a call upon to elect a new government. It is no joke. Election is a serious stuff, not fluffy and downy. The rich have been harvesting the benefits of progress, while the gigantic mass is in the dumps into poverty and hunger. It is every one’s primary right to exercise vote if he/she has attained the age of 18 or above. But how many of them actually do it. There is less percentage of people who is enjoying this right in reality.

For some women when it comes to elections it is very different to get the head around, like my mother always voted the person my dad opted. Why the question is always troubled me. When I turned 18, I felt an adult. I thought I am grown and can vote to any person of my choice. My parents and I had a different person to choose. They want me to vote for the candidate they wish. It was not only with me but also to most of my friends. There parents want them to vote accordingly. With the passage of time, things changed when I realized the power of vote

With the present elections in the state there are many women who dare not talk about elections at all. What we are seeing is deeply worrying. But they are confused and disoriented because the aspirations of the people remain unfulfilled after elections. The bag-full of promises seems to be nothing today in their eyes. Should Naidu be given a second chance is the question of many. As we see that the current government failed to maintain the quality of all that Chandrababu Naidu has done for the city and has done nothing for the urban population strongly feels some women in Hyderabad.

As election race shifts further women find it a brutal joke .it is like multiple choice questions for many to answer the best of the option given. It is a number game to many. Whosoever comes into power there is less development than what is being promised to them. It is no mindful decision, some vote blindly and some don’t, especially rural women. They need active encouragement to be dragged to the polls

It is no same mind frame of all women. A recent study shows that women are on par with men while excising voting rights. According to 2009 electoral polls women voters are in majority in six states namely Andhra Pradesh, Meghalaya, kerala, Manipur, mizoram, puducherry. Andhra has 2.86 crore women voters as opposed to 2.80 crore men. It has been witnessing a steady increase in the number of women voters

Today’s women are independent and free like India, our country. They are not dependent on men in decision and voice their opinion openly. The urban women run their life on their own. The traditional India has transformed to more advanced and globalize country going the west way. Women play a decisive role in the polls. They exercise it in much greater numbers and greater percentages than men. The vote of women - individually and collectively - can make or break elections, candidates, and outcomes.

Women walk the talk while men just talk and walk away. Women are the ultimate decision makers. They are doing great in every field. It is women who know a lot about what their families and their communities need. They have equal power to men in taking political decisions. As election fever has gripped the city. Who better tell the government what does community needs than women? How do you expect things around you to change when you don't cast your valuable vote thinks Manisha, my friend and a call center employee?

There are more women issues than men to be addressed. Isn’t it? First, it is the safety of women in society she dwells in. many women in the Old City do not trust police. They go through domestic and physical violence and don’t complain. We need a system where women can approach cops fearlessly. The issues like water shortage, frequent power cuts, road accidents and physical abuse of women at workplace should be given first thought.

The self-realization and self-confidence are absolutely essential. Education and work will bring real freedom to the rural woman and Child labor and kids begging at traffic signals are serious issues. The price increase of several commodities and economic slowdown has affected many families. The young college graduates have no job openings and the rest working is fired at any moment. There is no security and safety. What does the future hold for the children is worrisome by women.

The college students especially women are trying to spread awareness about the election campaigns held in Hydrabad and important of “one vote” to save the life of many. Every vote is a precious. We are the tax-payers and only our vote decides the party coming into power. Women’s vote is for the betterment of family and community. So we should think twice before casting vote. Our vote is valuable and so should be our decision.

Nevertheless the world needs more cool brains than hot heads. We need to have a collective effort to select the right candidate. The woman in Hyderabad expects very responsive governance from the future government. Women HOPE for a change.

India Advances, But Women Still Trapped In Dark

The birth of a girl, so goes a popular Hindu saying, is akin to the arrival of Lakshmi - the four-armed goddess of wealth, often depicted holding lotus flowers and an overflowing pot of gold.

That should assure pride of place for women in Indian society, especially now the country is growing both in global influence and affluence.

In reality, India's women are discriminated against, abused and even killed on a scale unparalleled in the top 19 economies of the world, according to a new poll by the Thomson Reuters Foundation.

The survey, polling 370 gender specialists, found Canada to be the best place to be a woman amongst G20 nations, excluding the European Union economic grouping. Saudi Arabia was the second worst, after India.

"It's a miracle a woman survives in India. Even before she is born, she is at risk of being aborted due to our obsession for sons," said Shemeer Padinzjharedil, who runs a website which maps and documents crimes against women.

"As a child, she faces abuse, rape and early marriage and even when she marries, she is killed for dowry. If she survives all of this, as a widow she is discriminated against and given no rights over inheritance or property."

Many of the crimes against women are in India's heavily populated northern plains, where, in parts, there is a deep-rooted mindset that women are inferior and must be restricted to being homemakers and childbearers.

In addition, age-old customs such as payment of hefty dowries at the time of marriage and beliefs linking a female's sexual behaviour to family honour have made girls seem a burden.

The poll results - based on parameters such as quality of health services, threat of physical and sexual violence, level of political voice, and access to property and land rights - jars with the modern-day image of India.

India had a female prime minister, or head of government, as long ago as 1966. Well-dressed women in Western attire driving scooters or cars to work is now an everyday sight in cities.    Women doctors, lawyers, police officers and bureaucrats are common.

But scratch under the surface and the threats in India are manifold - from female foeticide, child marriage, dowry and honour killings to discrimination in health and education and crimes such as rape, domestic violence and human trafficking.

Indeed, a girl's fight for survival begins in the womb due to an overwhelming desire for sons and fear of dowry, which has resulted in 12 million girls being aborted over the last three decades, according to a recent study.

This has led to a decline in the number of women in proportion to men in many areas, resulting in a rise in rapes, human trafficking and, in certain cases,  practices such as "wife-sharing" amongst brothers.

In fact, the curse of dowry continues even after marriage.

One bride was murdered every hour over dowry demands in 2010, says the National Crime Records Bureau. Some are "stove burnings" where in-laws pour kerosene, the commonly-used cooking fuel of poorer homes, over women and set them alight, making it appear accidental.

"The courts are flooded with cases of gender-related crimes," said retired Supreme Court judge Markandey Katju. He said honour and dowry murders should be punished with death.

"These are not normal crimes. These are social crimes because they disrupt the entire social fabric of the community. When you commit crimes against women, it has a lasting impact."

Experts say child marriage remains among the biggest hurdles to women's development in India and has a domino effect. Almost 45 percent of Indian girls are married before they turn 18, says the International Center for Research on Women.

A child bride will drop out of school and is more likely to have complications during child birth. One in five Indian women, many child mothers, die during pregnancy or child birth, the United Nations says.

Their babies, if they survive, are more likely to be underweight and suffer stunting due to poor nourishment. Many will be lucky to survive beyond the age of five.  

In the narrow, crowded alleyways of Sapara slum on the outskirts of Delhi, 15-year-old newly married Aarti has never been to school and says she was married off because her father has tuberculosis and couldn't work or afford to look after her.

"I said no, but my mother said my father was sick, so I had no choice," Aarti said, wearing the traditional bright red bangles of new Hindu brides.

"I spent my time doing domestic chores. I like to play with dolls ... but my grandmother has taken them away now. She says I don't need them any more."

Indian authorities have also struggled to combat rising crimes against women, including domestic violence, molestation, trafficking and rape.

Reports of women being snatched from the streets and gang-raped in moving cars are frequent in Delhi and its neighbourhood. Newspaper reports are full of stories of trafficking and sexual exploitation.

In many cases, violence against women has a level of social acceptability. A government survey found 51 percent of Indian men and 54 percent of women justified wife beating.

India has robust gender laws, but they are hardly enforced, partly because a feudal mindset is as prevalent among bureaucrats, magistrates and the police as it is elsewhere. Politicians are also unwilling to crack down on customary biases against women for fear of losing conservative votes.

"The inheritance law was reformed in 2005, bringing women's legal equality in agricultural land. In reality, however, less than 10 percent women own some kind of land," said Govind Kelkar from land rights group, Landesa India.

"This is more stark as 84 percent of rural women are engaged in agricultural production. There is policy silence on the implementation of laws for women's rights."

Some gains are being made, primarily by instituting gender-sensitive laws and social schemes as well as boosting the number of girls in primary schools, the workforce and village politics, experts say.

More than two decades of economic liberalisation has also helped empower women, and as India has opened up, Western ideas of equality have permeated towns and cities.

The country’s top political positions are held by women, including the head of the main ruling party, Sonia Gandhi, and the country's former president, Pratibha Patil.

"There are two Indias: one where we can see more equality and prosperity for women, but another where the vast majority of women are living with no choice, voice or rights," said Sushma Kapoor, South Asia deputy director for U.N. Women.

Gender experts say the challenges are immense, given India's vast population of 1.2 billion, its diversity, and geographical spread. But they add they are not insurmountable.

Tiny pockets show positive change by giving women opportunities such as access to higher education, vocational training and finance - tools that should transform the perception of women as burdens to assets.

A new Oprah Winfrey-style television talk show called "Satyamev Jayate" (Truth alone prevails), hosted by popular Bollywood actor Aamir Khan, has in recent weeks focused on issues such as foeticide, and dowry and honour killings.

The shows have won wide acclaim and stirred debate in the media, but experts say the efforts to increase awareness in Indian society as a whole need to be sustained.

"Laws alone can only play 20 percent of the role in empowering women in this country," said judge Katju.

"Eighty percent of the role will be played by education, by changing the mindset, the mentality of men who are still to a large extent feudal-minded which means they regard women as inferior."

Fighting Rapes With Politics In India

Providing political voice to women will have a big impact on their ability to access justice. In the aftermath of the brutal Delhi gangrape, there have been numerous demands for effective policy measures that can prevent crimes against women. The government is placing its bets on a stringent law that calls for greater punishment to culprits of rape and violence against women, including the option of death penalty. Others are demanding fast-track courts, increased policing on the streets and CCTVs. In its wisdom, the Mumbai Police passed orders to crack down on unmarried couples in isolated spots, a measure that was quickly revoked after it met with widespread criticism.

Amid the din, there is little discussion of policy measures that have been proven to be effective through rigorous research. One such remarkably effective solution is something so familiar that few could have guessed it: political representation for women.

In a recently published paper in a leading economics journal, Harvard professor Lakshmi Iyer and her co-authors study crime data from 17 major states in India and over 22 years (1985-2007) to find the effect of political reservations for women at the local level on crimes against women. They find the reservations, as mandated by the 73rd constitutional amendment, enabled significantly more women to get crimes against them recorded, and resulted in more effective police action — both in terms of the number of arrests and the quality of women’s interactions with the police.

The study’s first finding initially shocked the researchers. “We were hoping to find that this (reservations for women) would reduce crimes against women,” says Iyer. “But we found exactly the opposite.” They found that after the implementation of reservations, documented crimes against women (per 1,000 population) shot up by 46 percent, including a 23 percent increase in rapes and 13 percent increase in kidnapping.

Analysing their data for crimes not associated with women (like property crimes) or crimes that are less likely to be under-reported (like murders and suicides), and piecing together information from a few other studies, the researchers conclude that the spike in the figures reflect more accurate reporting rather than an increase in actual crimes committed against women after reservations were implemented. This is both due to greater police responsiveness to crimes against women and a greater willingness of women to report crimes in the presence of local female leaders.

The study also finds a remarkable impact on the effectiveness of police action. After the implementation of reservations for women, the number of arrests for crimes against women rose by 30 percent without any drop in the quality of police action as reflected by a constant rate of chargesheeting. Moreover, women living in villages with a female pradhan displayed greater satisfaction in their interactions with the police.

What make these results even more interesting is that local elected representatives have no formal authority over the police, which operates under the mandate of the state government. These results, therefore, point to a significant leverage that local leaders have over the police through informal channels of influence, and suggest an even stronger possibility of such influence if the state representatives (MLAs) were also women.

The findings add to the significant body of evidence emerging in the past 15 years, which shows that political reservations at the local level has benefited women in multiple ways. It has significantly improved their participation at various stages of the political process (not just elections), and has weakened stereotypes about gender roles in the public and domestic spheres, among others. Taken together, they make a compelling case for the passage of the Women’s Reservation Bill that will extend political reservations for women to state and national legislatures.

The MPs who passed the 73rd constitutional amendment Act two decades ago may have relied on the hope and promise of women’s empowerment through political reservations. The ones in Parliament now can do better: they have hard evidence that political representation significantly improves the voice of women in the criminal justice system. Will they choose to act?

'Media, Men & Mood Makes Women Miserable'

Media has made women’s bodies the focus; their ‘naked’ bodies are in every Ad and newspaper. Not just women but men can be seen naked. How women are being portrayed affects how we view them in our society.  Therefore the body has become the subject of desire and violence, Jeelani Bano, a noted urdu writer and president of Asmita, stressed the point to explore the women status in present scenario.

Addressing a gethering at Asmita Resource Centre for Women organised a programme on International Women’s Day celebnrations at Sundarayya Vignana Kendram in Hyderabad. She said that girls and women are being violated in trains, buses and streets. Even if the perpetrators are caught they are not punished as per the law. Who will be responsible for the woman on the street and how can we stop this violence.  

Satyavati is a writer and founder member of the first feminist magazine in Andhra Pradesh, Bhumika. She has won a national award for gender sensitivity in media by UNFPA in 2008. She started her talk with a few questions -- Where are we? How far have we come? What have we accomplished? We need to celebrate this day but we must ask who is this development reaching? Are women at the receiving end? Due to globalization in the state since 1990’s a lot has changed in terms of technology but the NCRB records show a high incidence of violence against women. Every few minutes, hours, there are cases of acid attack, displacement, rape in the country.  We have emphasized the need for laws to protect women like Section 498A which has been misused according to many. She spoke about the PCPNDT Act and its poor implementation, which has resulted in low sex ratio in Andhra. She also stressed on the role of the police and the denial to lodge FIR’s in cases of violence. 

Jhansi Geddam, Convener at Dalit Sthree Sakthi which is a community-based organisation fighting for the rights of dalit women addressed the gathering. She has run many campaigns and actively fought the discrimination and violence faced by dalit women and girls. She strives towards the freedom, equality, and rights of dalit women.  She asked, “How long will be keep talking about violence? How many mindsets and government sets will we change?  There are 1000 cases of Nirbhaya in the state of Andhra Pradesh which are equally relevant but we do not hear their stories. Triveni, a 13 year old girl was gang raped in Borbanda and in Tenali a girl died due to acid attack. We do not know these stories. There is an exclusion of Muslim, minorities, Dalit and Aadivasis. She also narrated the lack of discussion on cases of violence against Muslim, Dalit and Aadivasi women. The media, police and political parties play dual roles and have failed to do their duty.  Crores of rupees are allocated for women under the women and child and social welfare ministry which does not reach the women."

Keshav Rado Jadhav is a human rights activist. He also teaches at the English department of Osmania University. He is also actively involved in the Telangana movement. Referring to Sita he said that the notion of purity is only discussed when it comes to women. “In leadership it has always been men. In Muslim History, Razia was the Queen of Delhi and was dethroned soon. All religions are equally oppressive and deny women equal rights,” he added.  Referring to the Telangana struggle he mentioned that three dalit women who struggled for separate state were arrested and following this 25,000 women came out to fight and were sent to jail. According to him women are as intelligent as men but are restricted and denied basic freedoms. 

Dr. Prashanti and Jajula Gauri also spoke about their varied experiences. She is the project director of Andhra Pradesh Mahila Samatha Society (APMSS). APMSS works towards the empowerment of women through education. It is under the Mahila Samakhya programme of Government of India.  She asked, “When the system doesn’t respond what do we do and whom do we turn too? There are laws and they are working, amendments are being made in laws but what are the immediate solutions.  Mahila Samkhaya experience has shown that response of panchayat has been positive. Non literate woman working as para legal workers has been able to take the laws to the people. In Warangal Nelakutur mandal women trained as para legal workers have formed nyaaya committees to address cases of child marriages, sex selection. These women wear purple sarees and travel across the mandal to address cases of VAW.  The women see them and seek support. We need to support each other, form pressure groups to fight against violence.”

 Jajula Gauri is a noted dalit Telugu writer who has published a number of short stories. She referred to the Justice Verma Committee Recommendations and flagged three sections of the Indian Penal code section 100, 376A and section 375. She spoke of the insensitivity of the police while recording cases of sexual violence. Violence is perpetrated against children as young as 2 years old. She also referred to the recent sexual harassment act and violence against women in the workplace, which is on the rise.  She also discussed the delay in recording cases of violence, due to jurisdictional issues where the police demand proof to file FIR’s in cases of violence against women. The case of Nirbhaya was dealt with in a short duration, unlike other cases which take much longer. 

Tirupatamma is the secretary of Chaitanya Vikalangula Hakkula Vedika (CVHV). CVHV works towards enabling human rights and strengthening the rights of persons with disabilities. She said that her counseling centre has taken up 40 cases of violence against women and children but the police did not respond. They referred these cases to Human Rights Commission and the State Commission for Women, but there was inadequate response from them. They have also filed a case of Sexual harassment by a District judge on a girl. The case was referred to the State Human rights Commission and State Commission for Women.  She narrated her experience with the police in Mahbubnagar who focus on the character of the victim rather than the violence by the perpetrators.  

Santoshi Rani Karamcheti is the assistant state coordinator of Centre for Advocacy and Research (CFAR). The organisation works in the area of advocating with media on the response to HIV- through prevention, care and support services. CFAR also seeks to address the structural barriers that impact marginalized communities, and the violence, stigma and discrimination faced by them.  She shared the findings of the survey conducted by CFAR.  The cases ranged from child marriages to aggravated forms of violence; both subtle and extreme cases were shared.  In Guntur a woman’s both hands were cut off by her husband and the children were watching the crime.  She also spoke about a case where the abusive husband is in jail but the woman can still hear his threats and feels unsafe. 

Transgenders are another vulnerable group who survive on alms and are generally seen on the train. Violence by the police has been on the rise. 40 Transgender persons were unlawfully arrested by the police while travelling from Warangal to Kagaznagar. A case was registered against them and then they were forcefully examined in the hospital. They were told that the examination was to ascertain whether they were male or female. They were stripped in public and when Medical doctors and police both are insensitive and abet these acts of violence, whom do we turn to for support. 

Over 150 participants from 40 NGOs of the districts and around 30 representatives from local NGOs actively took part in the discussions and interacted with the speakers. They discussed a wide range of topics including the recent gang rape case in Delhi, the harassment of the girl on the streets of Guwahati, the increasing numbers of violence against women from Dalit, Adivasi and Minority communities and the recommendations by the Justice Verma Committee following the Delhi gang rape.

A short film called Moggalu screened, produced by Asmita, based on a girl who has to fight against child marriage. The film discusses the ills of child marriage and the laws pertinent to it. The film focused on the role of teachers in enabling young girls to fight child marriages. Later, a performance by the cultural group from Chaitanya Vikalangula Hakkula Vedika thrilled by audiences, the group act tackled the realities of child marriage.

Jobs For Women: Why India Does Worse Than Somalia

As Women’s Day rolls in and various debates around the Indian woman unfold–such as her role, education, freedom, responsibilities and job prospects–one thing is clear: the percentage of women in India’s workforce is declining.

Women’s workforce participation in India is the lowest among the BRICS nations. A range of countries, such as Bahrain, Malaysia and even Somalia (37%) do much better.

A law with flaws

By M H Ahssan

If the government fails to take on board some of the constructive suggestions made on the draft Women's Reservation Bill, it might not serve the purpose for which it has been conceived.

Here we go again. Even those who feel most passionately on this subject must now feel weary at hearing the same set of arguments repeated for and against the long-pending Women's Reservation Bill. While across party lines women politicians are convinced that the Bill must go through - the notable exceptions being Jaya Prada of the Samajwadi Party and Uma Bharati of the Bharatiya Janashakti Party - the same set of male politicians who opposed it in the past continue to do so.

Sharad Yadav of the Janata Dal (United), who will long be remembered for his remark that the Bill would bring into Parliament more women with short hair, has once again staked his claim to notoriety by threatening to drink poison rather than allow the Bill to pass. Although he has retracted this comment, his penchant for the dramatic remains unaltered over the years. Of the other Yadavs, Mulayam sets out the same arguments as Sharad, about a separate quota for Backward Castes, while Lalu, after initially maintaining a diplomatic silence, has now aligned himself with Mulayam and Sharad. And interestingly, while the BJP is whole-heartedly supporting the Bill, its allies, JD (U) and Shiv Sena are opposing it.

Real possibility
The major difference this time from the episodes in the past when the Bill was introduced and then pushed to committee in the face of opposition is that the government has enough support to get two-thirds of the votes in Parliament. Thus, regardless of the threats and noises made by those who oppose it, the Bill could be passed.

It will not happen overnight or even within the 100 days promised by the government because it is still in committee and that committee has to be reconstituted. Given the way these processes work, even setting up a new Committee on Law and Justice will take some time. So the earliest we could see the Bill emerge again would be in the winter session of Parliament. A great deal can happen before that eventuality.

In its anxiety to push through the Bill, the government could brush aside genuine reservations about the current draft of the law and place it before the House unchanged. If there is a constructive debate, something that is not at all guaranteed, then once again the Bill could go into committee to incorporate recommendations. If there is no debate but disruption, as in the past, the government might withdraw it and send it to committee. Or if there is some debate but little opposition, the Bill could go through in its current form.

The last outcome would be the most unsatisfactory. For, if the government fails to take on board some of the constructive suggestions that have been made on the draft, the Bill that is placed in Parliament and somehow pushed through might not serve the purpose for which it has been conceived. The main reason for advocating a quota for women in Parliament is because women do not have a level playing field in the world of politics. Even though political parties have promised to field more women candidates, in fact their numbers have not increased. More women were elected to the 15th Lok Sabha because women's success rate is much higher than that of men. Given this, if political parties had ensured that at least a third of their candidates were women, it is possible that their number in Parliament would have seen a dramatic increase. That this has not happened illustrates the problem women face, particularly those without family connections, to find a place in the political arena.

A quota will automatically bring up the numbers. But will it make a difference? Who are the women who will get elected? The Yadavs believe that this will only empower the "elite class" of women. That can only be proven if tested.

Doesn't work
What has been tested and has not worked satisfactorily is the system of rotation of seats. Through the 73rd and 74th amendment, the 33 per cent reservation for women in panchayats and nagar palikas is implemented by reserving one third of the constituencies for women. But as this changes after each election, women cannot stand from the same constituency. A study by the Panchayati Raj Ministry had recommended that this system be scrapped as they found that only 15 per cent of the women got re-elected for a second term.

This happens because when male politicians find that their constituency has been reserved for women, they make their wives or women relatives contest. And once the constituency reverts to being general, they reclaim it and send the women back to the kitchen. Thus, the women literally tend the constituency for their men until it can be returned to them. This makes a mockery of the spirit in which the idea of quotas was conceived. Only a few women have managed to break through and win from "general" seats after first having won through the women's quota.

Needs review
Several alternative systems have been mooted but none of them are as simple to implement as the rotation system. Even so, given the experience at the local government level, the issue of whether the Bill should continue with the rotation system for Parliament and State assemblies must be addressed before the final draft of the Bill is placed in the House.

We love symbols in this country. We have a woman President and a woman Speaker of the Lok Sabha. We also have powerful women heading leading national parties. But all of this and the Women's Reservation Bill together do not necessarily add up to women's "empowerment". Symbolism serves a purpose if it is followed up by solid programmes and efforts that can make a difference to the lives of women, that can give them economic and physical security and above all that can guarantee that their voices will be heard regardless of their caste or class.

Lifestyle@Work: What Women Do And Men Ought To Do?

By Peter Dean / Molly Shepard (Guest Writers)

We’d like to request that you list on a piece of paper the attributes that best describe the behavior of the ideal leader to whom you would happily report. Please do this now. When your list is completed, please read the article first before referring again to your list.

At The Leader Edge or Leaders By Design, we have decades of collective experience researching leadership. Recent findings in neuroscience, along with decades of observations running a firm dedicated to coaching executive men and women leaders, have led us to the insights we share below.

Political carrots for India's women

By M H Ahssan

The freshly-minted Congress-led United Progressive Alliance (UPA) government has wasted no time in relaying an unequivocal message to a lucrative Indian constituency - women. Close on the heels of earning political points for appointing Meira Kumar as the country's first Dalit (untouchable) woman speaker of the Lower House (Lok Sabha) last month, the UPA has now committed itself to a cachet of women-empowerment measures.

As showcased by President Pratibha Patil in her parliamentary address on June 4, the UPA has now promised to reserve 50% of its seats for the fairer sex in village councils and city municipalities in its 100-day action plan. The measure is a throwback to erstwhile Congress prime minister Rajiv Gandhi's move in 1992 to earmark 33% of all seats for women in panchayats (elected village councils).

Widely seen as a deft political masterstroke, this radical move will give a substantially larger representation to Indian women in a country with a population of 1.1 billion - an increase from their current entitlement to a third of the seats in urban and rural councils.

When viewed along with the government's commitment to push for the path-breaking Women's Reservation Bill - that seeks to reserve a third of the elected seats in parliament and in state legislatures for women - this move will ensure the largest-ever political space to Indian women compared to any other country in the world at any time.

Among the UPA's other women-centric welfare measures include 100% literacy for women (as against the current figure of 54%) in the next five years through the National Literacy Mission, fixing the women's quota in central government jobs and setting up of the National Mission on Empowerment of Women for the implementation of women welfare programs. All these items are listed as priorities in the government's "100-Day Action Plan" with the women's reservation bill leading the list of 25 promises for action.

However, what has most spiked the adrenaline of Indian feminists is the UPA's resolve to pass the contentious Women's Reservation Bill within the first 100 days of its five-year term. Laden as this promise is with political, economic and social overtones, it will be interesting to watch how the government steers this controversial bill through the corridors of parliament. The bill has been scuttled repeatedly in the past by caste-based parties which are emphatic that its benefits will accrue only for the elite and not the underprivileged.

Unsurprisingly, the UPA's announcement about the bill's passage generated its share of drama with Sharad Yadav, a longstanding critic of the bill and Janata Dal (United) leader, declaring that he "will consume poison and die but won't allow the Women's Reservation Bill without a quota for Dalit/tribal women".

Amar Singh, the Samajwadi Party leader, has also asserted that "instead of the government earmarking seats for women, it should leave it to political parties to choose the seats on which they want to field women candidates". Singh demanded that the bill be recast after discussion with political parties, "otherwise in its present form, it would uproot many established political leaders from their constituencies".

The drama over the bill, which is close to the heart of UPA chairperson Sonia Gandhi, prompted the government to say it would hold consultations with all political parties to get around the resistance from caste-based parties who are insisting on a separate quota for Other Backward Caste (OBC) and Muslim women.

Given the bill's explosive nature, all eyes are now focused on how the Congress-led government will fulfill its promise. More so considering the bill requires a constitutional amendment and a two-thirds majority in both the houses for its passage. In the Lok Sabha, where the UPA government has a majority, it still needs the support of 364 members. No wonder the legislation has hit roadblocks since 1996 when it was drafted during prime minister H D Deve Gowda's tenure.

In other words, while the UPA government has successfully used the opportunity of the parliament's inaugural session to herald path-breaking announcements for women's empowerment, and be seen as a party with an inclusive agenda, it is their successful implementation of the promises that will truly test the party's mettle.

Meira Kumar's appointment as speaker is definitely a savvy move, given the fact that Dalits feature at the bottom of India's deeply-entrenched caste pyramid. She was elected on a Congress ticket from the state of Bihar.

But while Kumar may be part of a record 58-strong contingent of women MPs in the new parliament, the fair sex constitutes just 10% of India's Lower House. The Congress party thus seems to have got a tad carried away while proving its earnestness for women's welfare. For instance, its decision to recast the National Literacy Mission (NLM) as the National Mission for Female Literacy is definitely driven by political considerations considering the Human Resources Development (HRD) Ministry, under whose ambit the scheme falls, is yet to even flesh out its implementation details.

Plus, the funding for the literacy mission has not yet been upgraded since its inception many years ago. Observers point out that it is rather audacious of the UPA government to envision that 100% literacy for Indian women will be achieved in the next five years considering currently only 54% of this demographic is literate as against 75% men, according to a 2001 census.

According to a HRD Ministry source, it will be impossible to achieve this feat through the current NLM template. And by the time the mission's format is reworked and more money pumped in, it will be difficult for its benefits to percolate down to more than 5.5 million women as against the promised 500 million.

But regardless of inherent flaws in UPA's women-oriented schemes, there's no doubt that in one fell swoop the party has endeared itself to women voters. It is a move that will obviously help the party reap rich demographic dividends when it next goes to polls. At least for the time being, UPA's astute thinkers have managed a coup of sorts.

A Message To Women From A Man: You Are Not “Crazy”

You’re so sensitive. You’re so emotional. You’re defensive. You’re overreacting. Calm down. Relax. Stop freaking out! You’re crazy! I was just joking, don’t you have a sense of humor? You’re so dramatic. Just get over it already!

Sound familiar?

If you’re a woman, it probably does.

Do you ever hear any of these comments from your spouse, partner, boss, friends, colleagues, or relatives after you have expressed frustration, sadness, or anger about something they have done or said?

When someone says these things to you, it’s not an example of inconsiderate behavior. When your spouse shows up half an hour late to dinner without calling—that’s inconsiderate behavior. A remark intended to shut you down like, “Calm down, you’re overreacting,” after you just addressed someone else’s bad behavior, is emotional manipulation—pure and simple.


And this is the sort of emotional manipulation that feeds an epidemic in our country, an epidemic that defines women as crazy, irrational, overly sensitive, unhinged. This epidemic helps fuel the idea that women need only the slightest provocation to unleash their (crazy) emotions. It’s patently false and unfair.

I think it’s time to separate inconsiderate behavior from emotional manipulation and we need to use a word not found in our normal vocabulary.

I want to introduce a helpful term to identify these reactions: gaslighting.

Gaslighting is a term, often used by mental health professionals (I am not one), to describe manipulative behavior used to confuse people into thinking their reactions are so far off base that they’re crazy.

The term comes from the 1944 MGM film, Gaslight, starring Ingrid Bergman. Bergman’s husband in the film, played by Charles Boyer, wants to get his hands on her jewelry. He realizes he can accomplish this by having her certified as insane and hauled off to a mental institution. To pull of this task, he intentionally sets the gaslights in their home to flicker off and on, and every time Bergman’s character reacts to it, he tells her she’s just seeing things. In this setting, a gaslighter is someone who presents false information to alter the victim’s perception of him or herself.

Today, when the term is referenced, it’s usually because the perpetrator says things like, “You’re so stupid” or “No one will ever want you,” to the victim. This is an intentional, pre-meditated form of gaslighting, much like the actions of Charles Boyer’s character in Gaslight, where he strategically plots to confuse Ingrid Bergman’s character into believing herself unhinged.

The form of gaslighting I’m addressing is not always pre-mediated or intentional, which makes it worse, because it means all of us, especially women, have dealt with it at one time or another.

Those who engage in gaslighting create a reaction—whether it’s anger, frustration, sadness—in the person they are dealing with. Then, when that person reacts, the gaslighter makes them feel uncomfortable and insecure by behaving as if their feelings aren’t rational or normal.

My friend Anna (all names changed to protect privacy) is married to a man who feels it necessary to make random and unprompted comments about her weight. Whenever she gets upset or frustrated with his insensitive comments, he responds in the same, defeating way, “You’re so sensitive. I’m just joking.”

My friend Abbie works for a man who finds a way, almost daily, to unnecessarily to unnecessarily shoot down her performance and her work product. Comments like, “Can’t you do something right?” or “Why did I hire you?” are regular occurrences for her. Her boss has no problem firing people (he does it regularly), so you wouldn’t know that based on these comments, Abbie has worked for him for six years. But every time she stands up for herself and says, “It doesn’t help me when you say these things,” she gets the same reaction: “Relax; you’re overreacting.”

Abbie thinks her boss is just being a jerk in these moments, but the truth is, he is making those comments to manipulate her into thinking her reactions are out of whack. And it’s exactly that kind manipulation that has left her feeling guilty about being sensitive, and as a result, she has not left her job.

But gaslighting can be as simple as someone smiling and saying something like, “You’re so sensitive,” to somebody else. Such a comment may seem innocuous enough, but in that moment, the speaker is making a judgment about how someone else should feel.

While dealing with gaslighting isn’t a universal truth for women, we all certainly know plenty of women who encounter it at work, home, or in personal relationships.

And the act of gaslighting does not simply affect women who are not quite sure of themselves. Even vocal, confident, assertive women are vulnerable to gaslighting.

Why?

Because women bare the brunt of our neurosis. It is much easier for us to place our emotional burdens on the shoulders of our wives, our female friends, our girlfriends, our female employees, our female colleagues, than for us to impose them on the shoulders of men.

It’s a whole lot easier to emotionally manipulate someone who has been conditioned by our society to accept it. We continue to burden women because they don’t refuse our burdens as easily. It’s the ultimate cowardice.

Whether gaslighting is conscious or not, it produces the same result: it renders some women emotionally mute.

These women aren’t able to clearly express to their spouses that what is said or done to them is hurtful. They can’t tell their boss that his behavior is disrespectful and prevents them from doing their best work. They can’t tell their parents that, when they are being critical, they are doing more harm than good.

When these women receive any sort of push back to their reactions, they often brush it off by saying, “Forget it, it’s okay.”

That “forget it” isn’t just about dismissing a thought, it is about self-dismissal. It’s heartbreaking.

No wonder some women are unconsciously passive aggressive when expressing anger, sadness, or frustration. For years, they have been subjected to so much gaslighting that they can no longer express themselves in a way that feels authentic to them.

They say, “I’m sorry,” before giving their opinion. In an email or text message, they place a smiley face next to a serious question or concern, thereby reducing the impact of having to express their true feelings.

You know how it looks: “You’re late :)”

These are the same women who stay in relationships they don’t belong in, who don’t follow their dreams, who withdraw from the kind of life they want to live.

Since I have embarked on this feminist self-exploration in my life and in the lives of the women I know, this concept of women as “crazy” has really emerged as a major issue in society at large and an equally major frustration for the women in my life, in general.

From the way women are portrayed on reality shows, to how we condition boys and girls to see women, we have come to accept the idea that women are unbalanced, irrational individuals, especially in times of anger and frustration.

Just the other day, on a flight from San Francisco to Los Angeles, a flight attendant who had come to recognize me from my many trips asked me what I did for a living. When I told her that I write mainly about women, she immediately laughed and asked, “Oh, about how crazy we are?”

Her gut reaction to my work made me really depressed. While she made her response in jest, her question nonetheless makes visible a pattern of sexist commentary that travels through all facets of society on how men view women, which also greatly impacts how women may view themselves.

As far as I am concerned, the epidemic of gaslighting is part of the struggle against the obstacles of inequality that women constantly face. Acts of gaslighting steal their most powerful tool: their voice. This is something we do to women every day, in many different ways.

I don’t think this idea that women are “crazy,” is based in some sort of massive conspiracy. Rather, I believe it’s connected to the slow and steady drumbeat of women being undermined and dismissed, on a daily basis. And gaslighting is one of many reasons why we are dealing with this public construction of women as “crazy.”

I recognize that I’ve been guilty of gaslighting my women friends in the past (but never my male friends—surprise, surprise). It’s shameful, but I’m glad I realized that I did it on occasion and put a stop to it.

While I take total responsibility for my actions, I do believe that I, along with many men, am a byproduct of our conditioning. It’s about the general insight our conditioning gives us into admitting fault and exposing any emotion.

When we are discouraged in our youth and early adulthood from expressing emotion, it causes many of us to remain steadfast in our refusal to express regret when we see someone in pain from our actions.

When I was writing this piece, I was reminded of one of my favorite Gloria Steinem quotes, “The first problem for all of us, men and women, is not to learn, but to unlearn.”

So for many of us, it’s first about unlearning how to flicker those gaslights and learning how to acknowledge and understand the feelings, opinions, and positions of the women in our lives.

But isn’t the issue of gaslighting ultimately about whether we are conditioned to believe that women’s opinions don’t hold as much weight as ours? That what women have to say, what they feel, isn’t quite as legitimate?

Politics of Discourse: Feminism as a Global Epidemic

By M H Ahssan

Talking to a friend that was criticizing someone for being a feminist and becoming friend with men, I glanced at him with an explicit question in my eyes and unintentionally laughed loud- maybe that loud laugh depicted the anger I had internally, not against him but against politicization of feminism as “anti men” which I call “violence against discourse”.

So I asked him what feminism meant for him and without a second thought he said, those who are pro women and hate men and some of them eventually marry women being women themselves because they hate men.

Now hearing such a definition from a development specialist was a bet to digest but rather than criticizing him for having such an idea about feminism, I want to look at the process in which definitely something gone wrong- my definition of wrong here is that “something happened against what was intended unintentionally or by deliberate efforts.

So its important to see where does feminism come from or how it started? Now rather than giving you a history lesson, simply let’s say that the theory was an invention of struggles for women’s rights, struggles for women labors by social activists to integrate women and their existence into state and public spheres. No matter how feminism started, it meant o decrease the deprivation of women to live and contribute as an active member of any society, so that women also enjoy their fundamental human rights. I am sure that scholars and experts of feminism theory would agree with me that feminism epistemologically never meant to discriminate against anyone’s human rights, even not of “men”.

Today feminism has become like the antibiotic pill that its side affects are stronger than the treatment or curing of an illness, especially in the developing or less developed countries. So during the journey of around 40 years, feminism has carried a negative baggage, heavier than the healing it can provide for women in the so called “third world” countries.

Working on women rights and gender equality, I have learned that most of those who created the “agenda” of making feminism as anti men, labeling feminists as lesbians only, have created a more violent attitude of men towards women, which I don’t criticize at all. Feminism theory or its movements were carried out in a way to isolate women and claim independence and authority for women, which is obvious that if women are in the corners not challenging their stereotypes, then they are independent, aren’t they?

However, the main question would be “is it all what feminism wanted to bring to the women of the world?” I do value the significant international movements that brought “women’s issues” to the fore front of the United Nations and other international instruments policies. In additions, I am sure women right activists that are now labeled as feminists; don’t want to create a world only for women, but to have women having the equal rights as men in their societies. It is very important not to overlook the gender power relations among women and men that shape women’s and men’s identity in a society.

So the dilemma exists among the theory versus application that most of the time theories are developed with a certain parameters that may or may not fit properly with contextual feasibilities of any society. No matter how globalized the world has become today, still each society has its own context and characteristics that needs to be understood and recognized, otherwise anything alien to the context and characteristic would make an opposite impact.

So now it’s also important for theorists and academia to understand that no academic doctrine can be effective in addressing global issues unless they aren’t associated with realities of people’s lives not only what they are, but why they are having certain subjectivities. This is very timely that lessons learnt from around the globe are incorporated in global discourses, researching and documenting the harms that are created by such discourses particularly “Feminism” in various parts of the world, so that countries and communities especially women aren’t the escape goat for the global theories that didn’t change their lives but increased their burden and curses.

Women in medicine—whatever next?

By Reema Fatima Subia

The Changing Face of Medicine: Women Doctors and the Evolution of Health Care in America

One afternoon at the Royal College of Physicians, I expressed mild interest in the fact that in the election for my successor as Academic Vice President, there had been no female candidates. My (senior and male) colleague looked at me in astonishment and said “haven't there been enough women already?” An interesting perspective given that in around 500 years there have been only two female presidents and only three female vice presidents of the Royal College of Physicians of London. What is this all about?

Historically, caring for the sick was seen as women's work. The baton was taken back by the men when it secured professional status with the creation of the first medical royal colleges and societies. Since then, medicine has been dominated by men. But times are changing—just more than 500 years later—and women now make up the majority of medical school entrants, and are likely to become the dominant gender in the medical workforce in the next 10—15 years. Is this a triumph for those seeking gender equality, or is it a problem for the profession?

In the UK, this issue first hit the media spotlight in 2005, following which the Royal College of Physicians of London developed proposals for a research project to find the evidence base for a number of developing issues related to the increase in the number of women in the medical workforce. As the newest appointed female College Officer, I was asked to chair the research steering group. We appointed a researcher, and set off on an interesting journey to produce an unbiased and accurate evidence base. The research, done by Mary Ann Elston, will be published by the Royal College of Physicians next month. Perhaps I should have anticipated the potential controversy around the interpretation of those facts, given that each participant in the project was either a man or a woman, and came to it with their own values and experiences on the subject.

Ann Boulis and Jerry Jacobs' book about women doctors and their relation to the evolution of health care in the USA is timely and discusses these issues from a perspective that is pleasantly sympathetic to women. They have collated and analysed an impressive dossier of qualitative and quantitative data and put forward some suggestions as to why the “gender gap” still exists in the USA and how to address it. Not surprisingly, most of the challenges facing women doctors in the USA echo those being experienced in the UK, but interestingly, the UK seems to be doing better.

One explanation for why there has been this increase in women in medical schools is the depressing thought that it has come from the decline in status of the medical profession overall. Boulis and Jacobs have posed convincing arguments to show us how it is not a simple as that. The status of medicine was apparently declining before the rise in female applicants, and has been influenced by complex societal changes that reflect current general sociological trends in the USA. Moreover, American women are now better educated so provide a better pool of applicants and have access to impressive female role models.

There have also been government initiatives to reduce barriers and discrimination affecting women in the professional workforce. The authors describe a positive feedback loop of declining discrimination, expanding opportunities, women's early success, and continued women's interest in medicine over time. There was concern in the USA that the number of male applicants to medical school was declining, but the research in this book has shown that this is also not really the case. The percentage of male applicants has declined, but actual total numbers are still rising, although at a slower rate than the numbers of female applicants.

This is also the case in the UK. An interesting aside is the effect of the Vietnam War Draft in the USA, which encouraged men into the medical profession to avoid being called up, although this levelled off and then declined in the 1980s.
Another observation that also holds true for the UK is the so-called gender segregation within medicine: that women tend to aggregate in specialties with particular characteristics. These have been described as the more planable and less technical specialties, and those with a higher emphasis on the caring aspects of medicine. For example, there are more women in general practice and palliative care, and fewer in surgery or clinical research.

Why is this? The evidence presented in the book suggests that women and men have a similar approach to patient care, and practise in very similar ways, so segregation is not only caused by women's choice of career, there are other factors. What is interesting is that those in favour of better equality for women refer to these factors as “barriers”, whereas those who think there is no problem with gender equality attribute the career differences to choice. A choice becomes a barrier when it is influenced by external factors that make women decide not to choose that specialty. Examples include: gender stereotypes about appropriate roles for women; lack of flexibility in the structure of the working day; and out of hours work at times when child care is hard to find. All these become barriers that influence the choice about whether to enter that specialty.

Part-time working is a continuing source of controversy in medicine. With the increased number of women coming into the workforce, and their likelihood of working less than full time to complete their families, there will need to be alterations in the current pattern of the working day, and more opportunity for part-time work. It is essential to maintain the workforce, which means keeping women in the workplace. But this means that more people (jobs) will be required to fill the same number of working hours. An alternative approach would be to encourage women to work longer hours, but this would need to be supported by more flexible and accessible child care. Either way, an increase in part-time working will be more expensive.

Here in the UK, a 2006 report called for action in taking steps to increase the number of women in the most senior positions in medicine. A working party chaired by Baroness Deech has been set up and will report later this year. Although women will soon be the majority of medical school entrants, the numbers at the top do not reflect those going in at the lower levels. One of the arguments here is that it is not possible to become a part-time leader, and it is difficult to reach leadership status if you have not invested in the necessary extra activities along the way. The barriers to this—or the “choice” not to do these activities—is influenced by a number of issues. The working week has become longer, and societal expectations still presume that women will continue with the majority of the household chores and the child care. This makes it difficult for women with family responsibilities to participate in the “extras”, which involve going to meetings before or after the working day and participating in international travel.

The gender gap in medicine is narrowing. Gender equality is slowly filtering into the medical workplace, but there is still a way to go. The situation in the UK is better than the USA, with better pay equality, maternity leave provision, and opportunity for part-time working at consultant level, but organisational and cultural barriers continue to inhibit true equality in the medical workplace. Books like this, together with the research completed by the Royal College of Physicians, have presented the data in a usable form. It is now up to the profession to interpret it and act on it.

When I first became interested in women in medicine, I thought that I personally had not come across any discrimination in the workplace, but I now think that it was there, but subtle. It is only when you look carefully that you notice problems with the perceived normality around you.