Health for all women in India

Dr Araveeti Ramayogaiah, Founder, OPSDH, highlights issues in women’s health and recommends measures to tackle these problems

“Good health is more than the absence of disease and the well-being of a woman’s body, mind and spirit”.
– Where Women Have No Doctor

Women usually suffer from health problems due to poor nutrition, reproduction issues, medical problems, work hazards, mental problems, low social status, poverty and violence.

In spite of 67 years post-independence, the paucity of statistics on women’s health is disturbing.

As per to 2011 statistics:

• 61 per cent of women married before age of 16 years
• Life expectancy of women was 64.2 years.
• 1,70,000 deaths of women happened due to AIDS
• 48.46 per cent of population related to female sex
• 940 females were present per 1000 males
• In 0-6 years, there were 914 girls per 1000 boys.

According to National Family Health Survey III:

• 13 per cent of women were overweight
• 55 per cent women were anaemic
• 11 per cent of women were under 145 cm in height
• 36 per cent of women had body mass index (BMI) which was less than normal.
• 59 per cent women only were literate.
• 16 per cent women were pregnant in teenage.
• 57 per cent women were only aware about HIV/ AIDS
• 37 per cent women experienced domestic violence

Pregnancy

Age at marriage, child bearing, child spacing, fertility patterns, literacy percentage, level of education, economic status, customs and beliefs, role of women in society etc influence the nature and outcome of pregnancy.

Health risks are more if pregnancy is before 18 years and after 35 years. Age between 20-30 years is very ideal for pregnancy. The gap of three years between two successive births give good protection from several problems ‘Delay the first, postpone the second and prevent the third” as far as possible.

The risk factors in pregnancy are elderly primi, short stature, mal presentation, bleeding from vulva, eclampsia, anaemia, twins, hydromnios, still birth, intrauterine death, elderly with multiple pregnancies, prolonged pregnancy, previous caesarians, and general diseases.

All pregnant women should visit health functionaries during pregnancy, at the time of birth and after birth. Risks of child bearing can be greatly reduced with good nourishment, regular maternal care, birth assistance by skilled birth attendant, accessing specialised care at the time of need and regular checkups after child birth.

Medical termination of pregnancy (MTP) prevailing in India is right method to terminate harmful pregnancy.

Health functionaries should be humane with adequate skills. They should avoid unnecessary interventions for commercial purpose.

Planning

Family planning can influence the health of women and to:

1. Bear children at desired age
2. Choose number of children
3. Decide on the age gap between her children

The best contraception method is one that allows sexual intercourse and prevents conception. Contraceptive methods should be effective, long acting, safe, coital independent, reversible, available at the time of the need and affordable with minimal side effects.

Birth control is fundamental in our ability to maintain autonomy of our lives. Cafeteria choice should be the approach where an individual can choose birth control methods based on her needs.

Infertility

Infertility is defined as failure to conceive within one or more years of regular unprotected coitus. Both wife and husband should be tested to identify reasons for infertility. The faults should be treated simultaneously.

Maternal Mortality Ratio

Maternal Mortality Ratio (MMR) refers to death of women during pregnancy or within 42 days after delivery/ termination of pregnancy per one lakh live births. In 2010 MMR was 212 in India, 35 in Srilanka and 37 in China. The National Rural Health Mission (NRHM) launched in 2005 targeted to bring down MMR to 100 by 2012, but could not. As per Goal 5 of Millennium Development Goals (MDGs), we have to reduce three fourth of MMR from 1990 to 2015. We may not achieve this goal.

Menopause

Menopause is cessation of ovarian function leading to permanent amenorrhoea (stopping of menstruation). It normally occurs between 45 to 50 years of age. This may be delayed in women with good nutrition and health.

Menopause is responsible for symptoms like hot flushes, sweating, insomnia (lack of sleep), headache, irritability, depression, cancer phobia, lack of concentration and decrease in libido (sexual desire) in women. 60 to 70 per cent of women go through menopause without any problem.

Adequate diet, exercises and social work largely prevent menopausal problems. Few years back, modern medicine started using hormonal therapy for managing menopausal symptoms. This therapy is not advised in women suffering from cancer. Hormonal therapy can cause cancer of uterus and breast, venous thrombo embolic diseases, coronary heart diseases, gall bladder, dementia and Alzheimers disease. Women in menopause should manage symptoms through life style changes than with medicines.

Cancer in women

According to several reports, cancer is less in developing countries. 5.37 lakh women suffered from cancer and 3.26 lakh died due to cancer in 2012. Late first pregnancy, multi-parity, obesity, tobacco use, alcohol consumption, use of hormones for longer duration, avoiding breastfeeding of babies largely contribute for cancer in women. Healthy living, safe sex practices and adequate nutrition prevent cancers to a large extent.

Breast feeding

Exclusive breastfeeding with at least one feed at night prevents pregnancy for six months with very rare failure. Breastfeeding soon after birth contributes for quick involution of uterus and reduction chances of post partum haemorrhage (PPH). It also helps in loss of weight, lowers chances of breast cancer, ovarian cancer and osteoporosis. Breast feeding contributes for delay in menstruation, contribute for emotional fulfillment and psychological advantages.

What ails women health

Birth rate mostly is related to social development. Family planning methods are not real solutions. Child marriages, maternity at younger age, life without any choice is contributing to several health problems among women in India. Caste system and capitalism is obstructing positive changes in society.

Recommendations

• Provisions for all social determinants of health on war footing. Immediate priority should be given to adequate food, shelter and sanitation.
• 1985 Rock Feller sponsored study on “Good Health at Low Cost” should be followed.
• All women should avoid tobacco, alcohol and mood-altering drugs.
• Physical activity should not be neglected by women.
• Sexual relations should be completely voluntary and safe methods should be practiced.
• All mid-wives should be trained and skilled to help women in pregnancy, child birth and during emergency.
• The state should provide emergency transport system, low-cost cancer screening, accessible family planning services and trained health workers.
• All women should be provided medical care with respect everywhere. Opportunity should be given for health workers and groups of women alone to change.
• Good education, waiting period before getting marriage, having children at appropriate time, correct decisions about boyfriends and sex contribute largely towards women health.
• Best models of health in the world are in UK, Cuba, Srilanka and most of the European countries. Our nation should emulate the best models.
• Nationalisation of medical education, paramedical education, nursing and medical care run by commercial organisations should be taken up.

‘Where Women Have No Doctor’, a health guide for women highlights the issues faced in women’s health. It includes early marriage, lack of knowledge about health, lack of money to pay for health services, lack of training among health workers on women’s health and lack of women’s health services.

This Women’s Day, let’s the entire nation join hands to safeguard women’s health.