Credible Neglect in Incredible India: Regional Pattern of Gender Bias in Child Health in India

IntroductionAdvancement of health care services is of utmost importance for its intrinsic value. The provision of public health is a basic human right and a crucial merit good. With the inception of the Human Development Index (HDI), the Human Poverty Index (HPI), and the Gender-related Development Index (GDI) by the United Nations Development Programme (UNDP), governments are required to redefine development. Universal access to health together with safe drinking water, sanitation, nutrition, basic education, information and employment are essential to balanced development. If India, like China, is to glean the gains of a demographic dividend and become an economic superpower by 2030, it will have to guarantee that her people are healthy, live long, generate wealth and dodge the tag of a ?high risk country'.Since the Bhore Committee Report (1) and the Constitution of India, the Government of India (GoI) has corroborated many times its aim of advancing the average health of its citizens, reducing inequalities in health and, fostering financial access to health care, particularly for the most destitute. In the Directive Principles of State Policy of the Constitution of India, Articles 38-2 and 41 stress the need for equitable access and assistance to the sick and the underserved, right to employment and education, while Article 47 stresses on improving nutrition, the standard of living and, public health. Article 39 and Article 45 directs for gender equality and protection of children rights including education (2: 84-91). A World Bank report on gender and development begins with the statement: ?Large gender disparities in basic human rights, in resources and economic opportunity...are pervasive around the world... these disparities are inextricably linked to poverty' (3).The dual causality between health and wealth is well documented. Health and mortality status of infants and gender bias in health are ?synoptic indicators' of a society's present condition. A study of gender bias with reference to child health is relevant as an area of research in its own right since children are helpless and solely depend on the social setting in which they are born. Health being one of the most basic capabilities, removal of gender bias in child health can go a long way in achieving gender parity in many other dimensions of human development. Gender-specific health policies would make women more independent and empowered and, thus achieve some of the goals laid by Millennium Development Declaration (declared in September 2000 by 189 countries).Background and hypothesesLet us start with a theoretical background of gender bias. Biologically women tend to have a lower mortality rate than men at nearly all age groups, ceteris paribus (4:11). But, owing to the gender bias against women in many parts of the world, women receive less attention and care than men do, and particularly girls often receive far lesser support as compared to boys. As a consequence, mortality rates of females often exceed those of males (4-11). Gender discrimination prevails regardless of the realisation that prejudice in morbidity, nutritional status, or use of health care will probably contribute to greater gender bias in mortality (12-22).Gender bias, even when it is not disastrous, may still generate greater debility among surviving girls and its effect may be perpetuated over generations (4,11,23-25). If the ?Barker thesis' (i.e., fetal origin of adult diseases hypothesis) (26,27) is true, there is a possibility of a causal connection ?that goes from nutritional neglect of women to maternal undernourishment, and from there to fetal growth retardation and underweight babies, thence to greater child undernourishment' and to a higher incidence of permanent disadvantages in health much later in adult life (28,29). ?What begins as a neglect of the interests of women ends up causing adversities in the health and survival of all-even at advanced ages' (28). …