From a young age, as Sainath's photographs so clearly document, even five-year old girls and even women when they are pregnant, are expected to take care of the siblings, to do all of the household work, to provide healthcare to family members and also to undertake productive even if unremunerated outside the home, typically in very dangerous conditions-and certainly the photographs that Sainath has provided demonstrate this in ways that no words could fully convey. So is it not a wonder that over the years, when I spent a great deal of time in rural areas of South Asia and also in urban slums asking women and young girls (in the evening when all the work was done), "what are your main health concerns?" or "what makes you not feel good?" that the most common answers were "backache" and "white discharge" (white discharge being a symptom of reproductive tract infection). Neither of these problems has anywhere been recognized-by governments, by the World Health Organization, by donors and others-as a matter of any concern in public health.
Now looking at the centrality of girls' and women's sexuality to their lives-sexuality in the circumstances that I have described, and certainly in the conditions of wide-spread violence that Smita described, and under the conditions of work that Sainath's photographs document-there is no way that a woman in rural India (or elsewhere) can be healthy unless she is able to control her own body and her sexuality. Furthermore, for women and girls, unlike for men, the exercise of other fundamental human rights is not possible if a woman cannot control her own body. But across the subcontinent, in all the hundreds of cultures and traditions that exist there, a woman's sexuality is entirely controlled by the men in her life. Before she marries, while she is in her parental home, her sexuality is controlled by her male relatives-her father, brothers, uncles and cousins-and what has come to light over the last couple of decades, that was not nearly as well-known thirty years ago when I started to work in the subcontinent, is the amount of violence, sexual violence, that occurs against girls in their families by male relatives. You have heard from Smita about the violence that occurs outside the household against girls and women.
After marriage a woman's sexuality is her husband's proprietary right both under law and in social practice. She is blamed by her husband, and by the entire family, if she and her husband fail to produce a child. It is highly likely in the circumstances of the subcontinent, that in at least half of the cases infertility is probably on the side of the man, not necessarily on the side of the woman. But it is inevitably the woman who is blamed and the consequence will be violence, divorce, expulsion from the household, torture-even though it may not be her fault. But an even worse example of this is that if she, the woman, does not produce a son, or more than one son preferably, she is also blamed for that. And most women that I have worked with India still do not know that it is the male sperm that determines the sex of the child. That one piece of information for women across the subcontinent could make an enormous difference in their lives. I cannot tell you the numbers of women that I have met and talked with over the years who blame themselves alone for failing to bear a son for their husband and in-laws.