Healthcare Strategies and Planning for Social Inclusion and Development: Volume 2: Social, Economic, and Health Disparities of Rural Women

By Basanta Kumara Behera, Ram Prasad and Shyambhavee Behera

Healthcare Strategies and Planning for Social Inclusion and Development: Volume Two: Social, Economic, and Health Disparities of Rural Women examines rural women, particularly in developing countries, and how social and economic constraints they experience impact their ability to advocate for their own health and impede their access to healthcare. This volume discusses the economic and social barriers rural women confront in exercising their right to health care. It explains how geographical isolation, economic instability, healthcare provider shortages, lack of appropriate funding, resource limitations, and lack of health education are just few factors that make rural health care difficult.

The book also covers the impact of social isolation on the health needs of rural women which include chronic diseases, mental health, and OB/GYN services as well as how the lack of opportunities for formal education restrict rural women from working outside the household. This volume will be a useful resource to graduate students in public and global health, public health professionals, health and social work researchers, and health policymakers interested in women’s health, especially in developing countries.

• Discusses health disparities of rural women in chronic diseases, access to pediatric and ob/gyn services, and mental health treatment
• Examines the health consequences of poverty and food insecurity on health
• Covers health care access and reproductive health outcomes for rural women

• Language: English
• Publisher: Academic Press
• Release date: Mar 30, 2022
• ISBN: 9780323904193

Basanta Kumara Behera

From 1978 to 2009, Professor Behera was a Professor of Biotechnology at three distinguished Indian universities, where he taught several postgraduate courses on bio-energy management and biomass processing technology. In 2009 he joined a MNS company as an adviser for speciality chemicals production and drug design through microbial processing technology. Professor Behera is associated with national and international companies as a technical adviser for the production of biopharmaceuticals under cGMP norms. He is an accomplished writer and has authored books published by CRC Press (USA) and Springer Verlag (Germany). Professor Behera's writing takes many forms including free verse, haiku, Senryu, Sonnet, Tanka and quatrain. He publishes English poems in both national and international magazines.

Book preview

Chapter 1: Rural women’s health disparities

Abstract

The chapter begins with the concept of rural locality which is defined in various forms on the basis of geographical location and demographic structure. It also explains how women play a key role in developing the structure and function of rural communities with special reference to agricultural productivity. In spite of so much effort and scarifies, rural women, still, confront a lot of hurdles to avail the access to better health, education, and sustainable livelihood. In this connection, various social determinants like gender inequality, starvation, nonavailability of basic nutrients, etc. are described in detail, on the basis of social exclusion, disparity, aging issues, domestic violence, and health problem like obstetric and reproduction.

Keywords

Rural women; Sustainable development; Livestock management; Health disparity; Food security; Poverty eradication; COVID-19

1.1: What is rural area?

Generally, rural area or countryside is a geographic area that is located outside towns and cities. Cities, towns, and suburbs are classified as urban areas. Typically, urban areas have high population density and rural areas have low population density (Fig. 1.1).

Fig. 1.1

Fig. 1.1 Showing the rural area of different countries located outside the urban area.

Different countries have varying definitions of rural for statistical and administrative purposes:

In Canada, Urban area is defined as having a population of at least 1000 and a density of 400 or more people per square kilometer. All territory outside an urban area is defined as rural area (Fig. 1.2).

Fig. 1.2

Fig. 1.2 Showing landscape of rural area, Canada.

About 60 million, or one in five Americans, live in rural America. In America, rural areas defined by the official Census Bureau classification are sparsely populated, have low housing density, and are far from urban center (Fig. 1.3). Urban areas make up only 3% of the entire land area of the country but are home to more than 80% of the population. Conversely, 97% of the country’s landmass is rural but only 19.3% of the population lives there [1].

Fig. 1.3

Fig. 1.3 Showing landscape of rural area, America.

Brazil does not have a national parameter to define the rural areas. The rural areas are defined administratively by Brazilian municipalities. Rural areas are any place outside a municipality’s urban development.

In France and Germany, the rural areas are known as the localities situated outside the urban areas (Fig. 1.4). About 15% of French population lives in rural areas, spread over 90% of the country. Germany is divided into 402 administrative districts, 295 rural districts, and 117 urban districts.

Fig. 1.4

Fig. 1.4 Showing landscape of rural area, France.

In Britain, rural is defined by the Department for Environment, Food and Rural Affairs (DEFRA), using population data from the latest census. The rural area falls outside of settlements with more than 10,000 resident populations.

China has the world’s largest population (1.42 billion), followed by India (1.35 billion). The rural population (% of total population) in India was reported as 65.53% in 2019, according to the World Bank collection of development indicators. The National Sample Survey Organization (NSSO) defines rural as follows: an area with population density of up to 400 per square kilometer. The village should have clear surveyed boundaries, but no municipal board. A minimum of 75% of male working population involved in agriculture and allied activities. Researve Bank of India defines rural areas as those areas with a population of less than 40,000. Indian villages have a population of fewer than 500, while 3976 villages have a population of 10,000  +. Most of the villages have their own temple, mosque, or church, depending on the local religious following. Rural houses in India are mostly made of nondurable materials taken from the locality (Fig. 1.5).

Fig. 1.5

Fig. 1.5 Showing landscape of a rural village in India.

In Japan, rural areas referred to as Inak (the countryside or one’s native village). The rural areas refer to all nonurban areas (Fig. 1.6).

Fig. 1.6

Fig. 1.6 Showing rural landscape in Japan.

For policymaking purposes, urban area is defined based on population density and the percentage of densely inhabited. Areas that do not meet the population density threshold are rural.

In Pakistan, the rural area is defined as an area that does not come within an urban boundary. According to the 2017 census, about 64% of Pakistanis live in rural areas.

1.2: Access to rural women

For sustainable development in rural areas, the women workforce is the key player for achieving the transformational economic, environmental, and social inclusion. But limited access to credit, healthcare, and education are among the many challenges they face which further worsen due to sudden climate changes, economical and food crises.

So, the only solution for such crises is to empower rural women and involve them in administrative and planning, as decision-maker in state policy finalization. It is necessary to frame well-planned policy at state and national levels to prevent violence against women, prosecuting the culprits before legal authority for justice followed by action. In addition, opportunity should be provided for women’s economic independence and should facilitate them with all types of disease preventive measures while involving them in handling health risk measures during pandemic situation like COVID-19.

1.2.1: Rural women as community resource person

Rural women constitute one-fourth of the world’s population [2]. They are closely associated with various agricultural practices as labor force (Fig. 1.7), and perform most of the unpaid care work in rural areas [3].

Fig. 1.7

Fig. 1.7 Low wage paid rural women working as daily wages in house construction, India.

They are the basic workforce for developing community economy which is ultimately responsible for national economy. Mostly, rural women manage the agricultural activities as paid laborers or cultivators doing labor on their own land. The types of agricultural activities taken up by women include: sowing, crop plantation, weeding, irrigation, fertilizer application, and other works related to crop management and development (Fig. 1.8).

Fig. 1.8

Fig. 1.8 Rural women in India involved in crop plantation.

Rural livelihood is entirely based on the support and sacrifice of rural women. Rural women play a key role in structure and functioning of rural community (Fig. 1.9).

Fig. 1.9

Fig. 1.9 Low wage paid rural women working nearby a rural village, India.

Total household work including food and nutrition security, generating income, and overall well-being of family and community are well managed by rural women. But rural women and girls regularly confront the problem of social exclusion, and restriction from fully enjoying their human rights, and health disparity.

1.2.2: Rural women as health workforce

To provide access to quality healthcare in rural areas, it is necessary to form well-educated and trained women health workforce with basic knowledge in primary healthcare. They should be culturally competent with professional license or diploma certificate. Strategies for increasing the efficacy of professional workforce in rural areas include:

•Engaging interprofessional teams to coordinate appropriate care for patients,

•Developing confidence that all professionals are sincerely involved in training and allowed scope for further practice,

•Removing state and federal barriers to professional practice, where appropriate, and

•Allowing to change policy for expressing the existing scope of practice if it is ensured that healthcare workers can provide comparable or better care.

Still, in many developing countries, the rural villages have inadequate health workforce, especially women health providers. In Bangladesh, major deliveries take place at home (62%), and more than 56% of deliveries are assisted by traditional birth attendants (TBAs). In Bangladesh, 36% women do not receive any antenatal care from medically trained persons, and the situation is much worse in rural areas [4].

Almost 94% of maternal deaths occur in low- and middle-income countries (LMICs), including India [5]. India has reported 45,000 maternal deaths in 2015. It is mainly due to lack of female health workforce, socioeconomic and policy-level factors that influence institutional or home delivery without skilled care [6,7]. The only solution for such problem is to train educated rural women, as healthcare provider to meet maternal health, and refer the case to nearby primary health center, in case of any emergency.

Globally, irrespective of the status of a country, rural women have been encountering less access to healthcare than urban women. This problem is more common in the rural areas of developing countries [8], or in least developed countries [9].

Many rural areas have limited number of healthcare providers, especially women health providers. This is mainly due to multiple barriers like geographic location, poor infrastructure for communication, unfavorable weather condition, and inadequate financial resources and specialty healthcare services [10]. In addition, rural localities are restricted access to online information technology compared to urban residents [11], particularly online access to healthcare providers [12].

In addition, women are deprived of access to other productive resources and services. Rural women should access to legislation and policies, decentralize administrative and institutional capacities, and public awareness campaigns need to assert, protect, and enhance rural women’s right to health services. Rural women are deprived of accessing financial transition in bank as provided to male; social exclusion in cultural and other social activities; developing any enterprises; and lack of ownership over asserts that can be used as collateral to leverage loans.

1.2.3: Rural women resource to manage energy and drinking water

For sustainable health management and promotion, it is primarily important for a country to have well-managed water resource system. So, the United Nations Environment Programme (UNEP) is working to develop a coherent approach for measuring water-related issues through several multilateral environmental agreement and research bodies. So, Sustainable Development Goals go beyond drinking water, sanitation, and hygiene to also address the quality and sustainability of water resources, which are critical to the survival of people and the planet. The SDGs 2030 goal is to centralize water resources and improve drinking water quality management, sanitation, and hygiene, including health, education, and poverty