Linkages between Culture, Education and Women's Health in Urban Slums

Meenakshi Thapan

This paper examines some of the important linkages between culture and tradition, education and women's health through an analysis of secondary data from mainly two sources. Although education plays a crucial role in providing the possibilities for personal growth and independence, the importance of cultural norms. values and customs in determining the life choices and physical and mental well-being of women cannot be denied. An empowering education has to address itself to the needs and competencies of women in their daily lives. The significant value of education also lies in its ability to alter women's consciousness and lives from within so that they question these traditions and practices and bring about a change in their everyday lives by asserting themselves through a positive understanding and appreciation of their identities as women.

THIS paper makes an attempt to examine some of the important linkages between culture, women's education and their health in urban slums in India, The paper relies mainly on secondary data to arrive at certain preliminary conclusions which point towards the need for a reassessment of the presumed positive impact of education on women's health and that of their children in conditions where women have poor access to drinking water, live in congested areas surrounded by garbage and open drains, arc unable to seek professional medical assistance, and arc overwhelmed by the social and economic conditions in which they live.

It has been suggested by planners and policy-makers that education is the answer to India's population and health problems as well as in terms of the overal 1 development of the country. In the 1950s and 1960s the major policy objective in the education sector was to expand enrolment. Other policy measures (such as building more schools or training more teachers) were in addition to this primary aim of getting increasing numbers of children into school as fast as possible. It was argued that planned economic growth was only possible if there were sufficient people with the required technical, managerial and industrial skills. Mass education thus became an excellent way of inculcating people with the attitudes and values appropriate lor modernisation. In recent years, women have been singled out for particular attention as they arc seen as the instruments through whom the nation can become more literate.

Jean Dreze and Amartya Sen tell us that education is valuable to the 'freedom of a person1 in certain distinct ways in that it has a certain intrinsic value, it is instrumental to certain personal roles, social roles, and schooling process roles, and it has an empowerment and distributive role in providing greater literacy to disadvantaged groups (1995:1-2). As recently as March 1997, Jejeebhoy has argued that the quality of life, especially women's health, is severely

constrained by low levels of education and control over economic and other material resources among women in India (1997:483). She has therefore suggested the importance of promoting universal primary education for girls and "non-formal education, skill and employment generation for women" (ibid).

Undoubtedly, education is necessary for it is only when our minds are opened up to the alternative realities around us that we can begin to question our condition and attempt to bring about a transformation in our lives that concerns not only the nation's health but also our own well-being as women and individuals. This paper however argues that education alone cannot provide the answer to the many social and cultural problems that beset India's people.

The role of culture in determining the well being of women, for example, cannot be underestimated. This point often remains at the margins of our understanding of the position of women in Indian society. As Martha Nussbaum has recently emphasised:

"Custom decrees who gets access to the education that would open job opportunities and make political rights meaningful. Custom decrees who can go where in what clothing and with whom. Custom decrees who gets to make what sorts of protests against ill-treatment both inside and outside the family, and whose voice of protest is likely to be heard... Customs, in short, are important causes of women's misery and death" (1996:3).

There is undoubtedly an important link between culture and justice and this needs to be carefully examined. It is not sufficient to posit that education is the answer to women's problems. Rather, it is a question of the extent to which this education gives them the space and power to raise their voices against tradition and question their position in society. It therefore, has to be a different kind of education, one that seeks to empower and liberate,

I begin by considering the position or condition of women, broadly speaking, in

Indian society. This gives us an idea of the social conditions in which women exist and an understanding of their position in society. 1 then examine a study of an urban slum in Delhi which shows us how cultural factors prevail in women's lives and influence the choices they make which inevitably affect their well-being. The next study I examine has been conducted in the city of Mumbai and which tells us why slum women refuse to participate in a gynaecological health problem, once again, pointing to their social and economic conditions which prevent them from looking after their own physical and mental well-being. I conclude by arguing for the need for an 'empowering' education that is related to women's lives and needs as well as takes account of the social conditions in which they live.

I Position of Women

Alaka Basu has, very pertinently, pointed out that with increasing interest in "gender as distinct from class issues, the term (status of women) has become extremely value-laden rather than purely descriptive" (1992:52). So rather than getting involved with what constitutes the relatively high or low status of women in India, I will seek to focus on those aspects of women's lives in India which help us to establish the linkages between education and health.

Women are clearly at a disadvantage in India with regard to education. Literacy figures g ive us a clear picture of the educational status of Indian girls and women. The 1991 Census data indicate that only 39 per cent of females above age seven are literate, as opposed to 64 per cent of males. Of the 324 million illiterates enumerated in India in 1991,197 million (61 per cent) were girls and women [World Bank 1996:52], Across the states, literacy ranges from only 21 percent in Rajasthan, 23 percentin Bihar, 26 per ccnt in Uttar Pradesh, 51 per cent in Maharashtra, to 87 per cent in Kerala [ibid: 129].

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Underlying the fact of low female literacy in India are the low rates of femafe enrolment and retention. In the nine northern states of India where about 63 per cent of the population lives, only 28 per cent of girls finish the first five years of school. In India as a whole, about 46 per cent of boys and 28 per cent of girls in the appropriate age group progress to upper primary school [World Bank 1996:531.

There are several other factors that contribute to the problem of education for girls and women in India. The most significant linkage is that of socio-economic status. In urban areas, the girls most unlikely to attend school are those from slum families whose adult members work in different low paid and low status occupations or in the un-organised or informal sectors. This suggests that we need to examine the household as a crucial category which affects both the education of girls and the health of women.

In this context, Kapadiaet al (1994) suggest that there is a "complexity to gender related socio-economic status factors" such as edu-cation, employment, income and fertility. We therefore need to examine the "interplay of the entire fabric ofthese factors" operating within the household as well as the wider encompas-sing social, economic and political system in which the household is located (p 198).

The househo ld is undoubtedly the "immediate health environment of its members who 'share (whether equitably or not) a common water source, sanitation facilities, breathing space, a hearth, and other facilities. This has important implications for the acquisition, transmission, prevention and treatment of disease" [Chauerjee 1989:166], The household is also the main socialising unit for its members through, for example, formal or non-formal education which may or may not be equally available for all its members. Girls arc less likely than boys to attend school for longer periods of time and it is therefore presumed that there is a paucity of health related information or knowledge in the household. This limits the practical use of this knowledge through health care practices in the home or in interaction with outside health care agencies.

The differentiation within the household, for example, in terms of the inequality in education made available for girls and boys, the food and nutrition intake, performance of roles and tasks, control over income and its expenditure, has implications for health. This differentiation also draws our attention to the health problems and needs of women in such households. Data on the nutritional status of food intake indicates that in south Asia female children and women are worse off than men [Seshadri 1994:233]. These differences persist in the state of Punjab in India which is relatively more economically developed than other states and where the

literacy figure for women is 50 per cent as compared to 64 per cent for men [World Bank 1996:129]. Even in households where the food is sufficient, if not plentiful, it is often the case that men and male children are fed first followed by the mother-in-law and other older women. A young mother tends to eat whatever is left after everyone has eaten. This suggests that cultural practices and social attitudes place the requirements of women secondary to those of men. The physically strenuous nature of the work that women do and their long hours of work are other factors contributing to the malnutrition of Indian women.

Pregnancy and lactation place special demands on the nutritional status of women and it is clear that women are particularly a; risk in their childbearing years when productive responsibilities are also the hardest. Women tend to work until late in their pregnancies and resume work before they have fully recovered. The lack of rest or additional food results in a "cycle of 'maternal depletion' that can have devastating consequences for a woman's health and undermine her ability to carry out her responsibilities, both reproductive" [World Bank 1996:57].

There is considerable evidence to suggest that male children receive more and better health care at an earlier age than female children do. Das Gupta (1987) found that in the Ludhiana district in Punjab, low caste female children under three years of age received less medical care, of poor quality, than other children and this did not change over two decades. For the state of Uttar Pradesh, reports indicate that more male than female children were fully vaccinated (23 and 17 percent respectively). Moreover, 73 per cent of male children, and 62 percent of female children, were provided with medical help in the case of an acute respira-tory infection. For India as a whole, in 1992-93, more boys than girls were vac-cinated and treated for acute respiratory infections and fever [as given in World Bank 1996:51].

Adult women are similarly disadvantaged with respect to health care. Household surveys report more incidence of illness for females than for males. This is particularly striking as women tend not to reveal or emphasise their own illnesses in interviews. Community-based studies also suggest that as women receive less medical treatment than men, there is a tendency for relatively higher morbidity rates among them. Fewer women than men are hospitalised or visit health clinics as evident from hospital and health centre records (ibid). Moreover, women tend to rely on self-care, home remedies, and traditional medical care as compared to men who receive more modern medical treatment.

It is an undisputed fact that across regions socio-economic differentials are the clearest indicators of the status of health of women. Indifferent health becomes the basis of a cycle from which poor women are never entirely able to escape. A woman's health determines her productivity and her income determines how much she and her family can eat. A woman's health is therefore essential for her well-being and that of her children and household.

In poor households, pressure on young girls to earn begins at an early age. In rural areas, girls may work with their parents in agricultural occupations or in home-based industries such as carpet weaving or bidi (cigarette) rolling [World Bank 1996:58]. In urban areas, poor girls in slums may assist their mothers by working as domestic help in middle class homes, hawking sundry food items, selling newspapers, incense sticks and other trivia at traffic intersections, and also help out in taking care of younger siblings at home. Young girls arc therefore not only denied access to education but also tend to be more malnourished than their male siblings because of unequal distribution of food in the household. It has however been observed that girls from the lowest socio-economic strata receive more equitable treatment than girls from more well-off upper caste families (ibid). This concern is possibly a reflection of their potential as income earners even at a young age, It remains the case that gender inequality in the household places a greater burden of poverty on women than on men.

E D U C A T I O N A N D W O M E N ' S H E A L T H

The importance of the link between a woman's educational level and her health (and that of her children) cannot be overemphasised. Studies in India have consistently shown a strong relationship between mother 's educat ion and hog children's survival. These studies indicate that women would have greater autonomy, decision-making authority, and knowledge about their health and that of their children if they are educated. Caldwell, Reddy and Caldwell (1989) have, for example, argued that these changes are not the direct result of health education acquired at school but more the sense of empowerment schooling can convey. LcVine (1980) has proposed that schooling is a form of "assertiveness training" which enables women to form their own opinions and act on them, believe in the efficacy of their actions and not be influenced, intimidated or bullied by others. There is no doubt that educated women tend to be more assertive, move out from within traditional c o n f i n e s and use external resources much more e f fect ive ly than uneducated women. However, on examining data on associations between the educational

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levels of women and rates of fertility and child survival, for example, we find that the effect of primary education is in fact negligible while that of secondary level is more significant.

It is commonly believed, particularly by social demographers for whom this is an important research interest currently, that women's schooling will contribute to greater 'autonomy* for women and thereby result in reduced fertility levels [for example, Jeffery and Basu 1996]. This is however a rather simplistic understanding of the situation especially in the Indian context. The question of what constitutes autonomy for women in the context of their everyday lives is a problematic issue and needs to be carefully considered from the point of view of women1 s experience rather than theoretical definitions.

In the context of schooling and fertility in southern Asia, Alaka Basu (1996) has argued that the relationshipbctween women's autonomy and fertility is rather complex. Looking at the inverse cffccts of schooling, Basu points out that schooling can in fact reduce women's freedomi n decision-making through theprocess of'sanskritisation' where women tend to adopt dominant role models provided by caste and class affiliations such as female seclusion, imposition of restrictions on widow remarriage, and so on. In relation to fertility, Basu agrees that women's ability to acquire an understanding about fertility control does not necessarily result in actual fertility decline. It is the united effort of husband and wi fe together that can contribute to intentional fertility decline and while female schooling may well be responsible for this joint effort, its value as the only determinant of women's autonomy is rather limited [Basu 1996].

In the rel at i vely progress! ve state of Kerala, S Irudayarajan et al, in a reccnt paper, find direct links between schooling and fertility but argue that fertility is strongly affected by husband's and wife's schooling (1996). Schooling is expected to result in better use of contraccption and bring about fertility reduction. Although the authors conclude that male and female schooling have the same impact with regard to the effect of contraceptive use on fertility, they a I so argue that the husband's schooling levels have the least influence on desired family size. Female schooling, it would appear, is one of the key determinants of autonomy in reproductive decisions. On the other hand, the authors present a rather dismal picture of women's autonomy in Kerala where although they hold property or an independent source of income, it is rarely retained under their control. So that the question of women's autonomy remains rather problematic in the Indian context where a woman may exercise her choice in one sphere but be restricted in other domains. Secondly, women in both

rural and urban contexts often use covert and strategic forms of decision-making which may not reflect autonomous conduct but which gives them some influence in decision-making within the household.

II Role of Cultural Factors:

Case Study 1 In her study of slum women in Delhi,

Alaka Basu (1992) highlights cultural factors as being responsible for differences between women from two different communities (from Uttar Pradesh and Tamil Nadu) which resulted in very different educational levels, employment patterns, and lifestyles. These differences had important ramifications for the health of the women and the children of the two communities. Basu defines 'culture' in terms of region of origin and 'cultural norms' as attitudes and practices common to regional groups notwithstanding the socio-economic differences within them. The position of women was affected by their respective cultural backgrounds which was responsible for the differences in behaviour.

Both groups of women lived in the same slum which was part of a large multicultural resettlement colony set up in the mid-1970s to house migrant squatters from all over the city. All the households in the area belong to the lower socio-economic classes. Basu tells us that they were provided with the minimum facilities of public water and toilets and allowed freedom to do as they liked with their 25 square yard plots. Most homes therefore consisted of single rooms in which all household, and sometimes business activities, were conducted. The general level of sanitation and hygiene was very poor, due to expansion of the households and the daily lifestyles of the slum-dwellers. Although public toilets have been provided, they are woefully inadequate, not cleaned properly and often not used by women and adolescent girls due to cultural and security restrictions. The insanitary conditions in the slum were accentuated by the garbage lying around on the streets and by-lancs.

The slum appears to be well provided with health care faci l i t ies , There are f ive dispensaries run by the government which is open to the public. Although these health centres provide free facilities, they are inadequately equipped with medicines, their working hours are limited, and they do not have sufficient full-time doctors. There are several private practitioners whose main disadvantage, apart from the fact that they are expensive, is that they are predominantly male. The educational facilities in the slum are also impressive. The government runs nursery schools and pre-school centres but these remain poorly utilised even by working mothers. There are also some government-

run primary , secondary and senior secondary schools in the area but once again attendance at these is poor.

The socio-cultural variations in the lifestyles of the two groups of women is reflected in their initial motivation to migration where the north Indian women were not as economically motivated to migrate as the Tamil women primarily because they belong "to a culture of low female participation in the labour force" and also do not find the opportunities for employment in the city very attractive [ibid:37]. The socio-cultural variations in economic well-being suggest that the women from Tamil Nadu are overall in a better position than the women from Uttar Pradesh. Basu further points out that as the households from Tamil Nadu are more likely to have migrated in family groups, they have strong family and kinship ties and tend to function as a group in both their living arrangements as well as in the daily activities of their everyday life. Basu concludes that this "expression of greater intra-household unity and equality is also a result of and not just a cause of the greater economic emancipation and autonomy in decision-making that the south Indian women enjoy*' [ibid:38f 391.

Basu's data indicates that women from Tamil Nadu are much more likely to be worki ng than those from Uttar Pradesh which has implications for women's self-confidence and independence. Domestic service is their preferred employment. Women from Uttar Pradesh are engaged in more home-based activities for purposes of earning an income such as sewing, food processing and so on and therefore have minimum interaction with the outside world especially with men. The data on education for women from Tamil Nadu suggests that education "acts as a break on employment" (p 44), that is, that women with some education are reluctant to take up the low status jobs that are available to them in the city.

Basu also provides data on regional differences in the position of women in terms of exposure to and interaction with the outside world. The women from Tamil Nadu are clearly much better off than women from Uttar Pradesh in every sphere. (See Basu 1992 for spcci tic detaiIs.) Taking educatio nal differences into account while determining the position of women, it appears that while education and employment are powerful tools for changing women's position i n a direction conducive to lower fertility and mortality rates, educat ional and occupat iona l differentials indicative of the status of women are distinctly lower for women of Tamil Nadu than for Uttar Pradesh. For example, educated Tamil Nadu women may take less, not more, of a responsibility for household food expenditure than uneducated women. Moreover, it is clear that uncducated Tamil

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women have higher Levels of exposure, interaction and autonomy in decision-making than women from Uttar Pradesh. Basu concludes that the cultural and regional backgrounds of women therefore have a profound influence (in the same way as education or occupation) on the position of women and through this, their fertility and child mortality levels.

Fertility indicators in relation to position of women based on their cultural background are a reflection of female attitudes and knowledge rather than purely household or community characteristics. Here again, the Tamil women scored over the women from Uttar Pradesh due to their greater exposure to, and interaction with, the outside world and more autonomy in decision-making. Basu argues that a minimum level of numeracy is essential for parity-specific birth control to be possible and it also indirectly affects the woman's responses to everyday life, especially in those situations where decision-making is required. While numeracy i s much more common in the younger women in both groups, "even the oldestTamil women were more likely to give a numerical response to questions on ideal family size than were the youngest age groups from Uttar Pradesh" (1992:100). As regards birth control practice, once again, Tamil women were ahead especially in the 15-29 age group.

The data concerning infant and child mortality in relation to the position of women leads Basu to conclude that "women's roles defined by their cultural background influence gender differences in physical well-being through both positive discrimination in favour of boys as well as inadvertent discrimination due to the customs and fears bred by the norms of female scculsion and economic dependence" (1992:176). She also suggests that differences in women's levels of seclusion and in their ability to interact with the outside world leads to differences in levels of knowledge about health conducive behaviour and on abilities to act on the basis of this knowledge. For example, the urban slum environment was particularly effective in the spread of gastro-intestinal infections partly because of the insecurities and fears of north Indian families in sending young girls to the toilet. Regarding nutritional practice, the lack of information and decision-making autonomy resulted in north Indian women delaying the onset of breast-feeding until the third day after birth. In the ease of the women fromTamil Nadu, their excessive interaction with the outside world resulted in shorter durations of breast-feeding and in the infrequent cooking of food. The women from Uttar Pradesh were further disadvantaged in their relatively poor use of antenatal care and of modern health facilities for childbirth. They also did not comply with the rules for effective immunisation. Once

again, Basu concludes that this is due to the "fears and poor access to information that resulted from the women's seclusion and economic dependence" [ibid: 176-77]. The role of women's status indicators was further accentuated by the lower impact of maternal education of child mortality. In fact, among uneducated women, Basu observed that the Tamils experienced better child survival than the other group of women.

It is an undisputed fact that education in general has positive consequences for lowering fertility and child mortality. However, the "economic independence of women is of paramount importance in rais-ing women's status in general resulting in greater gender equality in physical well-being" (Basu 1992:239). This independence, argues Basu, will reduce the need for several children as well as increase the ability to rear them. 1 would like to add that women's eco-nomic independence needs also to be but-tressed by social and cultural practices that value their physical and mental well-being. This is suggestive of a need for an attitu-dinal change towards women and girls in all sections and regions of Indian society, northern or southern, and it is this change that can help education in ensuring their well-being. Some effort also needs to be made to ensure that policy recommendations and imple-mentation address the needs of women, are relevant to their daily lives, and take into account the cultural factors and social attitudes which influence their behaviour.

The next case study illustrates how women did not benefit from the health facilities made available to them primarily because of the lack of such foresight and therefore refused to participate in a gynaecological health programme.

Ill Slum Women in Mumbai:

Case Study 2 Mulgaonkar and others (1994) have in a

study of the perceptions of slum women in Mumbai provided a vivid accountof women's reasons for their refusal to participate in a gynaecological health programme run by Strechitkarni, a women's welfare organi-sation. They argue that women have been seen as instruments through which national health and family planning goals can be achieved (forexample, through child survival and fertility control) and there is in fact very little concern for women's own health needs. They suggest that any attempt to examine the health care related problems of Indian women is incomplete without an under-standing of "their social status, culture, traditions, health-seeking and dietary behaviour (1994:146). A change in this aspect of their lives is most urgently needed, a change which education can only partially

resolve, in order to bring about an improve-ment in health seeking and dietary behaviour and quality of living.

The organisation Streehitkarni has delivered integrated health and development services for improving the health of women and children for about 29 years to a population of approximately 1,00,000 (i c, 15,000) households Living in urban slums in the city of Mumbai. The area has several hundred 'chawls' (one room tenements) and 'zopadis' (huts) spread out over a large area. Mulgaonkar and others tell us that the zopadi colonies are an assortment of dwellings con-structed out of any available item. Each hut is about eight feet by eight feet in area and houses an entire family. Narrow pathways run through the colony with open drains on either side. The colonies are very congested and lack basic amenities: about 250 people share one toilet whereas in the chawl, about 15-20 persons share atoilet The drainage system in most of these colonies is also very poor.

Streehitkarni undertook a project with 1,048 randomly selected households in such a colony and monitored women's health problems in these households for three years. The gynaecological programme for women, run by this organisation, which included free check-ups as well as the detection of cancer and lower reproductive tract infections, was poorly received in the community with only 638 (i e, 61 per cent) out of 1,048 women turning up for the check-up during the one year of study. Further, on inquiry, 410 women (39 per cent) refused to participate in the programme. Mulgaonkar and others examine the reasons as to why this happened. The main reasons given were socio-economic in nature and included "poverty, loss of wages, lack of time, unsuitable time schedule, distance to clinic and social hardships faced by women" (1994:149), Mulgaonkar and others add, "Apart from poverty, women's hard manual labour, the necessity for income generating activity to meet the children's essential needs and economic constraints prevent them from seeking health care" [ibid: 150]. Among what the authors identify as "cultural factors" are the women's complacency regarding their health, fatalistic attitude, faith in traditional beliefs, fear of exposure to male doctors, of blood collection, of internal check-ups, and so on. A major factor responsible for their refusal to attend the clinic was the husband's opposition to suchchcck-ups. Women in fact sought health care only when theirgynaecological problems became severe. On the basis of their study interspersed with women's voices which painfully and poignantly reveal their poverty, insecurities, and fears, the authors conclude that "the socio-cultural and economic realities that face women in India complicate their access to health services" [Mulgaonkar et al 1994:163].

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SOME EXAMPLES FROM THE W O M E N ' S

NARRATIVES

(1) "We don't have money to pay for medicines. If any problem occurs we always wait and watch and allow it to get cured naturally. We go to general hospital when it is extremely unbearable. Wc get free medicines and food there." (Dema Gala 35 years, Hindu Gujarati).

(2) "For the past three years, my husband has been without a job because of a strike, I do all kinds of odd jobs to run the house and educate my children. I bring work at home to earn more money and make ends meet. I do not have money. I do not find enough time for work. So when do I come for check-up? And, if I do come, are you going to run my home or give me a job?" (Nirmala Pingle 35 years, Marathi Hindu).

(3) "I am a vegetable vendor. I leave the house at 5 am in the morning and come back in time to cook and serve lunch. I am back to work again at 3 p m in the evening. Now tell me when do I have the time for your clinic?" (Kalimani 40 years, Telugu Hindu).

(4) "I spend all my time doing housework. I have to wash the clothes and utensils, prepare food for everybody at home, take my children to school. Besides, I have to stand in a big queue to get water from the municipal tap. I hardly can manage all this. So I don't get time to come to your clinic." (Jayashri Rane 30 years, Hindu Marathi).

(5) "My mother-in-law takes objection and says that you will take me under the pretext of examining us and insert a loop." (Anita Konvilkar 20 years, Hindu Marathi).

(6) "My husband doesn't allow me to come for check-up. He says that I have had enough number of children and I have the operation for tube ligation. So what is the point of going for check-up? He feels that 1 don't need a check-up at all." (Taramati Dubai 25 years, Hindu Marathi).

(7) "My husband is a drunkard and is in the house 24 hours of the day. He does not like my going out. He beats me if I go. Besides, my housework keeps me busy throughout the day." (Manjula Govilkar 30 years, Hindu Marathi).

(8) "I have all kinds of diseases like joint pains, high blood pressure, kidney and heart disease. I am fed up with taking medicines. I am made of only skin and bones and my funeral pyre is almost ready. I am of no use to my husband. He is not interested in me. He has made his arrangements elsewhere. He isn't bothered about me. So I have decided not to seek a doctor." (Sulochana Khandare 47 years, Hindu Marathi).

Although the authors have not provided any data on the educational levels of these women, it is clear that education is not the only answer. The women1 s faith i n traditional beliefs which come in the way of their seeki ng

health care might perhaps change through education but what about their conditions of existence? The unhygienic conditions in which they live and the social and cultural restraints that are placed on them through the attitudes of their husbands, mothers-in-law, and other members of the family, influence their attitude towards seeking health care facilities. Their self-esteem and self-worth is lowered by their position in the household and in the wider society so that perhaps for them their own health is not the most important thing in life. The education which would be useful for them would have to be an education that can change their ways of thinking about themselves conditioned as they are by their experience of poverty and subjugation. Such an education would therefore have to be an empowering education that would help them to seek alternatives for themselves which would include the maintenance and care of their bodies as part of an understanding that emphasises self-concern as much as sacrifice and submission.

CONCLUDING COMMENTS

Radical educational theorists such as Illich (1972) and Freire (1972) have argued that formal schooling is in fact a mode of oppression, an activity which prevents development from taking place.

It is an ideological device used by the dominant classes to justify and maintain the inequalities in society. Invention and creativity are discouraged in students who are treated as receptacles in whom the required knowledge is filled by the teacher. Invention, inquiry and creativity are discouraged and therefore Illich advocates the 'deschooling' of society. Freire, on the other hand, believed that the main goal of education was to raise 'critical consciousness' so that people could "perceive social, political and economic considerations and take action against the oppressive elements of society" (1972:15). Ron Dore (1976) however added that people need to learn knowledge and skills in order to escape from poverty. Merely raising their critical awareness will not provide those skills and knowledge. It is this approach that is most relevant in our attempt to evolve an 'empowering' education for women.

Empowerment has become something of a catchword among feminist writers in recent years. It could be seen as "social mobilisation around women's major concerns" (e g, divorce, property rights, cost of living) or as a "change in women's state of mind"; and as "gains in access to the bases of social power" [Friedmann 1994:116]. All the three things should happen together ideally but sometimes, feminists tend to focus on one more than the others. It would appear then that bringing about a change in women's state of mind, through, for example, education

will not be sufficient in itself for the empowerment of women. There has to be a simultaneous process of social mobilisation around women's concerns as well as a movement for ensuring gains in their access to the bases of social power. Above all, women' s needs ha ve to be directly addressed.

Maxine Molyneux has identified two kinds of gender interests which "may develop by virtue of their [women's and men's] social positioning through gender attributes" (1985:232). These interests have been identified as strategic gender needs and practical gender needs by Molyneux. Strategic gender needs are those needs which women identi fy as a result of their su bordinate position to men i n their society while practical gender needs emerge from women's experience of the concrete conditions in their everyday existence. Practical needs are therefore normally aresponse to an immediate perceived necessity which is identified by women in a particular context. The identification of both kinds of needs and the planning and implementation of possible solutions arc no doubt crucial to any development programme.

Often the two kinds of needs intermesh to the extent that some practical gender needs may be rooted in the fact of women's subordination to men. Women may also be aware of the restricted and limited nature of their lives and not know what to do about it. Naila Kabeer points to "strategies of 'empowerment from within'" which could provide women with perspectives that entail "reflection, analysis and assessment of what has hitherto been taken for granted so as to uncover the socially constructed and socially shared basis of apparently individual problems" [Kabeer 1994:245]. This will possibly result in the emergence of "new forms of consciousness" through women's access to "intangible resources of analytical skills, social networks, organisational strength, solidarity and sense of not being alone" [Kabeer 1-994:246].

In improving health care for women, planners have to keep in mind that women and their children have poor health status and that women are unable to seek professional help due to a variety of factors including seclusion, tradition, passivity, and poverty. Health care facilities have therefore to be made accessible for women in their settings and circumstances (that is, by improving the health environment of the household, the availability of food, knowledge about health and child care) and in a sense, as Meera Chatterjee (1989) puts it, women's competence in these areas has to be developed. It is only when policy is related to the needs of women as well as aims to develop their competencies, not only in academic but in practical terms, that education can play a role in the transformation of their

Economic and Political Weekly October 25, 1991 WS-87

lives by empowering them to meet the challenges of everyday li fe as well as to work towards a more independent future,

[An earlier version of this paper was presented at the First Annual conference of the Comparative Education Society of Asia held in Tokyo, Japan, in December 1996. I thank Hironaka Kazuhiko of Kyushu Kyoritsu University for making it possible for me to participate in this conference. It was T N Krishnan who first encouraged me to work in the area of women's education and health and (his paper is a small salute to his memory ]

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