The Indian Health Paradox: Lessons from Bangladesh

This article was originally published in Medical Journal of Dr. D.Y. Patil University | July-August 2014 | Vol 7 | Issue 4

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By Carol Vlassoff

The editorial entitled, The Indian health paradox: Lessons from Bangladesh, highlights an apparent contradiction in India’s growth story: That improvement in the nation’s health has not been commensurate with its economic growth. It notes that, while India is faring well in gross domestic product (GDP) per capita, it performs poorly in health indicators such as life expectancy at birth, infant and child mortality, access to sanitation, and child nutrition and immunization. Bangladesh, by contrast, while one of the world’s poorest countries with a per capita GDP of half that of India, is faring much better than India in terms of health indicators.

The author sees this paradox as rooted in gender equality, in which Bangladesh also outperforms India. Females are better represented in the labor force than in India, they have higher literacy and school enrolment and their representation in parliament is also more. As the editorial notes, all these indicators are powerful measures of women’s empowerment.

One of the main findings of my book, Gender Equality and Inequality in Rural India, Blessed with a Son, referred to in the editorial, is the importance of female education, coupled with female labor force participation in the modern sector.[1] My research was conducted in a relatively prosperous community in rural Maharashtra, where economic development had occurred over the three decades of the study, and where female education had increased dramatically. Now, most adolescent girls finish high school before marrying, meaning that they were well prepared to pursue careers in white-collar jobs.

Interestingly, as the editorial explains, women’s participation in the modern labor sector had many benefits, including in several reproductive health indicators and in the reduction of son preference. Unfortunately, most girls did not use their education because they were married off soon after finishing their secondary schooling.

During my recent trip to India to launch my book (which included a guest lecture at Padmashree Dr. D.Y. Patil Medical College, Hospital and Research Center, Pune) I was able to visit novel income generating and empowering projects for women, one of which, “Women on Wings” I will briefly describe here.

“Women on Wings” is a nongovernmental organization that aims to create 1 million jobs for rural Indian women by 2018. It is on track to meet its goal. The organization has fuelled 101,250 new jobs since its beginning in 2007, through partnering with Indian businesses that share its vision, but lack the relevant business know-how.

Women on Wings does not create jobs from scratch, but works with Indian businesses to help them develop, improve and expand their work, while at the same time creating new jobs for women. It works primarily through volunteers, bringing experts from overseas and India to work with managers of Indian social companies to create sustainable employment opportunities. In order to qualify for support, partner businesses have to comply with a set of principles and standards, and must have a minimum staff component of 300 women, a proven business concept which is viable for expansion, and they must become profitable and independent within 3 years.

An interesting Women on Wings initiative, currently being developed in Latur and Tuljapur, Maharashtra, is a sanitary napkin production and sales project that aims to create a sustainable model for the production, marketing and distribution of sanitary napkins. It not only creates jobs for rural women, but also empowers them with greater freedom of mobility during their menstrual cycles. In many parts of rural India, girls have to stay home because they lack readily disposable products and have to rely on cloth rags that need changing frequently. Because of the stigma attached to menstruation, these cloths are often washed and stored in unhygienic conditions, harboring microorganisms that can cause vaginal infections.

While many important initiatives to enhance women’s status are underway in India and Bangladesh, attaining true gender equality remains a challenge in both countries. In Bangladesh, girls enroll in school in large numbers, but many drop out before completion. Women in formal employment are less skilled and more poorly paid than men.[2] Laws to protect women’s rights are rarely enforced and women still face discrimination and violence.[2]

In India, especially in rural areas, girls are expected to marry soon after completing their education, making it difficult for them to use their skills in the modern labor force. In my study, I found that those few women who took jobs after marriage had to juggle domestic responsibilities with the challenges of professional work. However, those who received support from their families, especially help with childcare, were able to cope much more easily than those expected to put in a “double day” both at work and at home.

The promotion of examples such as these, with the support of the popular media, can encourage their acceptance in the Indian psyche.


Carol Vlassoff

Department of Epidemiology and Community Medicine,

Faculty of Medicine, University of Ottawa, Ontario, Canada


Address for correspondence:

Dr. Carol Vlassoff,

201-959 North River Rd., Ottawa, ON, K1K3B3, Canada.




1. Vlassoff C. Gender Equality and Inequality in Rural India:

Blessed with a Son. New York: Palgrave MacMillan; 2013.


2. Chowdhury AM, Bhuiya A, Chowdhury ME, Rasheed S, Hussain

Z, Chen LC. The Bangladesh paradox: Exceptional health

achievement despite economic poverty. Lancet 2013;382:1734-45.