India is an ethnically and linguistically diverse country. It is also variable in terms of socio-economic and development indicators. Moreover the federal structure stipulated in the Indian constitution makes health care predominantly a state-level responsibility. As a result, depending on the economic prosperity, dominant political ideology, and even some cultural factors, access to healthcare varies across individual states. Given the breadth of diversity of Indian demographics, picking merely one group for analysis is a challenging endeavor. This is so because demographic groups in India intersect across language, caste, gender and class lines. When we apply these parameters to the Indian population we get thousands of small groups with marked differences between them in terms of privilege and quality of life. As a result no one group can be said to directly relate and represent India and its healthcare system. In order to overcome this challenge, the biggest minority group in the country is chosen, namely, women.
It is often pointed out by social scientists that women in India comprise the largest minority community. This ‘minority’ status has two key aspects – one figurative (that they are not empowered) and the other literal (they are only 49% of the total population). One of the anomalies regarding Indian demographics is the skewered sex-ratio. Country-wide statistics show that for every 49 females there are 51 males. This is a significant disparity in a population of more than 1.2 billion. One of the main reasons for this situation is a culturally promoted preference for boys over girls. As a consequence thousands of female fetuses are aborted annually, some even at advanced stages of pregnancy. This also puts the life of the mother at risk. It is not surprising then that India (especially the rural regions) score poorly in terms of maternity health parameters. Equally, rural India fares rather poorly on child nutrition and infant mortality counts. For healthcare providers the challenge is clear cut. The success of any healthcare initiative is pivoted on its effectiveness in improving quality of healthcare for women, and by extension children. (Ridge, 2010, p.1)
On top of the diversities in politics, economy and socio-culture, the geography and climate of the Indian subcontinent is also very diverse. This means that there cannot be a nation level one-size-fits-all approach to offering health care to women. Indeed, each of the Indian states (or provinces) has a different track record in providing healthcare for women. Among the 30 odd Indian States, Kerala, Himachal Pradesh and Tamil Nadu rank high in terms of access to public health care for this demographic group. There are some uniting undercurrents between the successful states. For example, states like Kerala and Tamil Nadu have had strong presence of socialist political parties. These parties have always exerted pressure toward implementing social welfare schemes, some of which were women centric. The fact that Tamil Nadu had elected a woman as its Chief Minister (J. Jayalalitha) is another important factor. In contrast, in most of the other states, public health care is either of poor quality or nearly nonexistent. (Kumar, 2007, p.160)