Sara Rizvi Jafree is assistant professor of sociology at Forman Christian College University, Lahore, and her treatise, The Sociology of South Asian Women’s Health, addresses the knowledge gap in health policy for the women of South Asia and will help mobilise developments in the same.

Jafree is co-author of all chapters; this has maintained critical coherence and a continuity of the thought process, ensuring that the central theme is upheld across the book. Her co-authors — from Bangladesh, India, Pakistan and the United Kingdom — are not just academic scholars, but also practising clinicians and specialists in the field of health policy. They thus bring with them the rich experience of discussing the social and cultural determinants of health behaviour and health outcomes in women of South Asia.

The book does not just rest on theory and discussion, but, from the second chapter onwards, each essay brings empirical evidence from on-ground problems and the limitations of health culture and policy. During the discourse, qualitative and quantitative data obtained from primary and secondary sources has been used to elaborate issues related, inter alia, to mental health, maternal and child health, chronic disease burden, physical disability, climate change, displacement, social ostracisation and policy failure. Each chapter culminates in key recommendations for improving women’s health outcomes.

The first chapter, co-authored with Deepti Sastry (head of monitoring and evaluation at Aktis Strategy, UK), sets the premise for the rest of the book. It is an asset for students and researchers as it brings together theories for addressing women’s health challenges and barriers. Western theories are employed to effectively explain South Asian behaviour. While, to a large extent, the theories discussed are relevant to the South Asian context, they indicate the need for South Asian scholars to consider developing indigenous theories related to women’s health.

The second chapter brings, from Pakistan, Bangladesh and India, case studies of women whose journeys from ill-health to recovery have been challenging because of a lack of support from family and society. Jafree and her co-author Fareen Rahman (a UK-based consultant radiation oncologist) highlight that, had the women received community support and family acceptance, the pain and anguish related to their health issues could have been managed better.

A book of essays by a sociologist and various other scholars, clinicians and specialists addresses the knowledge gap in health policy for the women of South Asia

Two cases worth mentioning are of a blind masseur and a crippled food caterer, who demonstrated strong agency, financial independence and the immense capability of women. The authors argue that the support provided in education, employment, subsidisation and gender solidarity can fight the stigma and discrimination against women suffering from disability, infertility and chronic health problems.

In chapter three, Jafree’s co-authors Rubeena Zakar (professor of public health at the University of Punjab [UoP]) and Shaheda Anwar (associate professor at Sheikh Mujib Medical University, Dhaka) use demographic data from Pakistan, Bangladesh and India to describe challenges in decision-making, which influence maternal health and mortality.

Similarly, in chapter eight, Ainul Momina (faculty member at the UoP) and Jafree use demographic health surveys to assess the role of health insurance in maternal health. Given that the maternal health indicators are such that the unfinished agenda of the United Nations’s ‘Millennium Development Goals by 2015’ has been carried over as ‘Sustainable Development Goals by 2030’, these two chapters are significant.

It is emphasised that mothers’ health and autonomy has great bearing on not just women, but also on the quality of life of children, household dependents and the family overall. In this regard, to quote the authors, “if there is a magic bullet, it would have to be cultural reform for women’s acceptability in making health decisions autonomously. There is thus need for micro community-level interventions of different natures and degrees to benefit the heterogeneous populations controlled by culture and traditions.”

The book recognises the plight of neglected populations such as the impoverished, refugees, internally displaced people and climate-affected women, and discusses their health challenges. Chapter four, co-authored with UK-based quantitative analyst Fionnuala Gormley, details the impact of the feminisation of poverty and investigates if microfinance loans and other poverty interventions have been effective in improving access to health. The chapter also discusses the under-reporting of sustained poverty, which has contributed to low health-seeking behaviour, and thus added to the “iceberg of disease in women of South Asia.”

Primary data collected from women physicians in South Asian communities verifies the co-existence and relationship between chronic health disease and mental health.

In chapter five, Jafree and medical practitioner Baijayanta Mukhopadhyay deliberate upon the impact of the — less discussed and researched — feminisation of displacement, and bring to attention two important yet often overlooked realities: one, the significant physical health consequences facing the displaced and refugee women, and their crippling mental health consequences; and two, the plight of over 10 million displaced women described as being “cyclical ... [because of] post-traumatic stress and recurring problems of adaptation and resettlement.”

Chapter six, co-authored with psychologists Masha Asad Khan and Tahira Jibeen, delves into women’s access to mental healthcare, and is a poignant reminder not just of the related stigma, but also the inadequacy of care services. It brings to light “the gap that initially existed in South Asia for women’s mental healthcare, which has widened [because of] the growing mental health challenges, regional and economic pressures and increasing population rates.” Primary data collected from women physicians in South Asian communities verifies the co-existence and relationship between chronic health disease and mental health — an issue that needs redressing while designing health policy for women.

The last two chapters discuss political and regulatory frameworks in the context of the culture of South Asian countries. Chapter seven, featuring Ainul Momina, Farooq Hasnat (professor of political science at UoP) and Zamarrud Awan (assistant professor of political science at Forman Christian College University), emphasises how poor political acumen of the masses has prevented them from realising that “health is political because planning and distribution of public health services is dependent on political intervention and also because some social groups have more access compared to the others.”

Chapter eight concludes that “culture and traditions influence regulatory practices of state and, in fact, it is culture that underlies in sustaining regressive and inefficient regulatory policies in a nation.”

This book highlights the need for health sector reform in South Asia. In this regard, while the focus is mainly on women’s health, it also opens up a host of vistas for research involving other segments of society, such as men, children, the elderly and the transgender community.

Overall, the book succeeds in driving home the fact that culture and environment are foremost for health policy process for health and social protection of South Asian women.

The reviewer holds a doctorate from the University of Leeds, UK, and is a health policy and systems specialist who till recently worked with the World Health Organisation

The Sociology of South Asian Women’s Health
Edited by Sara Rizvi Jafree
Springer Nature, UK
ISBN: 978-3030502041
229pp.

Published in Dawn, Books & Authors, December 27th, 2020