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China and India together account for over one-third of the world’s population and both countries have considerably fewer women than men.. With long histories of skewed sex ratios and gender discrimination, these two countries have experienced a sharp decline in the birth of girls since the late 20th century. The unfolding and intimate relationship between gendered social structures, son preference, fertility decline, and new sex determination technologies has had serious demographic and social consequences, resulting in millions of “missing” girls, surplus males, bride shortages, and possibly, rising levels of gender violence. Even as women’s socio-economic indicators such as life expectancy, literacy, education, and fertility have improved, families continue to show a preference for sons raising questions between the tenuous relationship between development and gender equality. The advantages of raising sons over daughters, supported by traditional kinship, family, and marriage systems, appear to have got further entrenched in the era of neoliberal economies. Family planning policies of both nations, advocating small families, and the advent of pre-natal sex selection technologies further set the stage for the prevention of birth of daughters. Governments in both countries have since banned sex determination and launched policies and schemes to redress the gender imbalance and improve the value of the girl child. While these policies have not been highly successful, other social forces such as urbanization and rising educational levels are beginning to transform the way girls are perceived. A kernel of hope seems to be emerging at the beginning of the 21st century, as some improvement is visible in the sex ratio at birth in some of the worst affected regions in the two countries.

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Indrani Gupta and Kanksha Barman

The first HIV (human immunodeficiency virus) case in India was detected in 1986 among female sex workers. The rapid spread in HIV infections subsequently due mainly to high-risk behavior among vulnerable population groups required a sensitive, multisectoral, multipronged response that had to influence risk behavior and alleviate the socioeconomic impact of the epidemic. The journey has been a unique one in many ways in the history of public health in India. The challenges emanated from the economic, social, legal, and cultural contexts in which risk-taking behavior took place, and to be effective, the response required a framework that had to be vastly different from the usual public health approaches adopted in the country. The fairly successful national response was made possible due to the presence and subsequent co-option of a vibrant civil society, which shaped discussions and discourses around sex, sexuality, and gender and could reach out to marginalized and stigmatized groups with messages and interventions. During the course of the thirty years of response to the epidemic, shifts in positions of individuals in the three organs of the government—executive, legislative, and judiciary—on key sensitive issues around sexual behavior and preferences could be discerned to some extent, which was unprecedented and helped strengthen the response. New infections have come down significantly over the years and treatment has scaled up massively. However, the momentum in national HIV programs has slowed down globally and in India, with lower finances and a shift to other national priorities. The sociocultural and economic contexts have yet to change for most of the groups vulnerable to HIV, and they will continue to determine risk behavior, requiring interventions to continue at a fairly high level of intensity.

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Cigarette smoking in the People’s Republic of China (PRC) is a highly gendered practice. The vast majority of China’s three hundred million plus smokers are men: in 2016, about 48 percent of men over age 15 were current smokers, but less than 2 percent of women smoked. The stark difference in this pattern of men and women’s smoking behavior is often attributed to lingering cultural taboos against female smoking assumed to have been in place for centuries. In fact, the virtual exclusivity of male smoking in China is of relatively recent vintage, dating only from the mid-1900s. From the 17th to the 19th centuries, smoking was socially acceptable for Chinese women. Granted, there were gendered and class differences in the location of tobacco consumption. Chinese men could smoke in public, but well-mannered women smoked privately out of view. After cigarettes were introduced into China at the end of the 19th century, some women, especially those living in coastal cities, took to smoking them rather than pipe tobacco. In the opening decades of the 20th century, the number of women who smoked cigarettes increased, but this trend was reversed in the 1930s and 1940s. After the establishment of the PRC in 1949, the number of women who smoked diminished even further such that by the 1980s, only a small percentage of women consumed tobacco products of any kind. Many social, economic, and cultural factors contributed to the gendered pattern of smoking that emerged in China over the course of the 20th century. An essential aspect of this history was the transformation in social norms that made cigarette smoking less rather than more respectable for women as time went on. At the beginning of the century, many women were already accustomed to smoking pipe tobacco. Some women, including those who identified as forward-looking “New Women,” preferred cigarettes. However, by mid-century cigarettes came to be widely associated with a stigmatized type of New Woman known as the “Modern Girl.” Portrayed in popular culture and political rhetoric alike as extravagant and sexually promiscuous, the Modern Girl’s pursuit of luxury came to symbolize bourgeois decadence and insufficient national loyalty. These associations came forward into the PRC period and as a result, most women born after 1949 elected not to smoke at all. Major differences in male and female smoking prevalence rates persist because female smoking remains objectionable to many Chinese citizens in the 21st century.