On the chilling night of January 17, 36-year-old Suraiya Bano, a pregnant woman, in labor, was turned away by three hospitals in Jammu and Kashmir, forcing her to give birth by the roadside. The baby died minutes later in the freezing cold. Earlier that evening she had to be carried by her husband on his shoulders along a snow-covered road from their remote Moori settlement to a hospital three kilometers away.

Doctors asked him to take her to the Kupwara district hospital and arranged a vehicle. There, she was referred to Kashmirs main maternity hospital in Srinagar, 62 kilometers away. After six hours of travelling to the maternity hospital, doctors conducted some tests and then told the couple to go home, as the hospital had no space to accommodate Suraiya Bano.

Suraiya’s husband Wazir Ahmad said that in the freezing conditions, they spent the night by a roadside. All of a sudden, Suraiya gave birth to the baby, but moments later the baby died.

Srinagar-based social activist Dilshana Andrabi states that poor Indian women like Bano being denied health care in state-run facilities is a major concern. Andrabi mentioned that recent surveys have highlighted that poor women are on the receiving end of the miserable state-run health services.

A study was released on January 22 by Oxfam, a confederation of 20 independent charitable organizations focusing on the alleviation of global poverty. It suggested that the poor are denied health care, making them vulnerable to greater risks of diseases.

It mentioned that as the governments reduce their expenditure on essential public services such as education and health care, women and girls are the first to be affected.

Oxfams executive director, Winnie Byanyima, says that Indian women and girls from lower castes are the most affected by the growing economic disparity. She said that the life expectancy of a low-caste woman is almost 15 years lesser than that of an upper-case woman as high-quality medical care is only available to those who can pay for it.

Tara Devi comes from a peasant family in Uttar Pradesh. Her pregnant daughter died a year ago because the health care facility in her village was not equipped to conduct a birth by cesarean section. They had to wait for hours to get transport to a hospital. Devi mentioned that her daughter died on the way along with her baby and they could not complain to anyone.

Shamaila Khalil, program coordinator at Oxfam India, said that Dalit women in India die 14.6 years earlier than those of a higher caste. The health system for the poor, especially women from marginalized communities, is a mess.

Khalil added that India ranks the third lowest on health on the World Economic Forums Gender Gap Index. Instead of investing more in reinforcing the health system to ensure that every woman receives the care that she needs, there has been a decline in the health budget for villages, including an acute reduction for reproductive and child health.

She further mentioned that India cannot expect to ensure good health care for every woman by spending only 1,112 rupees (US$15) per head per annum. According to her, more needs to be done to provide psychosocial support and care, more so, in cases related to mental health and gender-based violence.

Archbishop Felix Toppo of Ranchi says that the Indian government has not done enough to address the emerging health care crisis. Archbishop Toppo added that comprehensive health service is needed for the poor, especially women.

Indias is the worlds sixth-largest economy with gross domestic product (GDP) of US$2.848 trillion and the third largest by purchasing power parity. However, studies suggest that poverty is so rampant that about 200 million of the 1.2 billion people have no income for a full meal a day.

As per the latest National Health Profile, India spends a little over one percent of its GDP on health care, which is one of the lowest in the world. According to the annual report of the state-run Central Bureau of Health Intelligence, India spends less than Bhutan (2.5 percent), Sri Lanka (1.6 percent) and Nepal (1.1 percent) on health care.

Studies also suggest that when the poor are neglected, women and girls are the most vulnerable.

Womens disproportionate poverty, low socioeconomic status, gender discrimination and reproductive role jeopardize their health and also limit their access to health services, suggests a research article written by Raju Kowsalya and Shanmugam Manoharan of Annamalai University. The article stated that domestic violence, rape and sexual abuse affect womens productivity, autonomy, quality of life as well as physical and mental well-being.