Perspectives from ISB

We have come a long way since the 90s, and it is time to celebrate women and their achievements. Health is one of them. Years after years, countries have been taking various actions despite the fact that women still face many health problems, and we must re-commit to addressing them. Currently, in India, women face numerous health issues, indirectly affecting the country’s economic output. Therefore, addressing the gender, class, and autochthonous disparities in healthcare improves health outcomes and contributes to monetary gain with an increase in investment and quality human capital.

A woman’s health is like ebbs and flows from Menarche to Menopause with a piece of minimal knowledge of care for herself. Unfortunately, awareness and actions about malnutrition, maternal health and mental health disorders, the sexual and reproductive health and rights, malnutrition, cancer, non-communicable and infectious diseases, and domestic and social violence, from being young to getting old, are still not enough.

At the current pace of 5G, there is a valley of death between the knowledge and the needy. Blame it on the changing lifestyles or lesser body resistance, women’s growing health issues have caught everyone’s eyes. For women, sexual health starts early, often before puberty, and lasts until their final days of life. Sexual and Reproductive Health and Rights (SRHR) acknowledge freedom of choice, dignity, physical safety, free from coercion, discrimination, and violence. Adolescent girls face several sexual and reproductive health challenges due to various myths. Traditional associations often compound cultural norms and religious taboos on menstruation with shame and embarrassment surrounding sexual reproduction. It’s time to change for the good.

Reproductive rights are the least discussed aspect of women’s health. Providing easy access to safe abortion services is still a challenge today, where it accounts for 14% of all maternal mortality rates globally. Awareness regarding contraception and catering to the unmet needs of family planning also needs attention to improve the quality of health. They have the right to good maternal healthcare and correct education to make informed choices and should be given the power to decide what is best for their body, health, and lives.

The Government of India has increased domestic investment in family planning. At the 2012 Summit, India committed to spending $2 billion by 2020 for family planning programmes and, in July 2017, India renewed its commitment to invest $3 billion by 2020. FP2030 is the successor to FP2020 and expands the ambit of the work.

Some of the health issues affect both men and women differently and need to be managed differently. The basis for personalised medicine is that males and females have different biology and immune responses. For example, a University of Alberta-led study shows that when it comes to susceptibility to infections and other health conditions, gender matters. Women have more immature red blood cells in their blood circulation because females are generally more predisposed than males to anaemia post menstruation. The finding suggests women’s immune system might be less active after menstruation, and their odds of getting an infection increase. Therefore, we need to consider these differences when doing research studies, clinical trials, or devising treatment protocols.

The other significant issues affecting women are obesity and polycystic ovarian disease (PCOD). They are associated with lifestyle and dietary habits and may lead to diabetes, heart attack, depression, and cancer.

The most common cancers affecting women are cervical cancer and breast cancer. Numbers show that roughly half a million women die from cervical cancer and half a million from breast cancer each year. Yet, screening, prevention, and treatment are almost non-existent, and where adolescent vaccination needs to take hold.

As per the India National Family Health Survey III (2005-2006) reports, 31% of all women reported having been victims of physical violence over the past 12 months. Another type of violence increasing towards women is obstetric violence and the invisible epidemic of mistreatment of women before and during the childbirth process by the healthcare providers, besides a plethora of other things. In India, obstetric violence is quite a commonly noticed practice, especially in most government hospitals and particularly for women from low socio-economic strata. Non-consented care, non-confidential care, non-dignified care, and detention in facilities are some of its forms. This abuse during the childbirth process is the primary reason many women below the poverty line prefer house births, using local midwives, which puts their lives in danger.

The pattern also raises its ugly head in private hospitals, but differently where institution desired management is done despite available alternatives. For example, the national prevalence of C-sections was 17.2% in 2016, but state prevalence varied surprisingly to 60% in Telangana in 2021.

Globally, about 810 women die daily of preventable causes related to pregnancy and childbirth, and 20% of these are from India. Seven of the top 10 causes of death in women in India are NCDs, heart attacks, stroke, and respiratory diseases. In addition, India carries the highest burden of anaemia despite having various programmes and policies for the past 50 years, since the National Nutritional Anaemia Prophylaxis Programme in 1970.

Depression is the most common mental health problem for women and suicide is also a leading cause of death. Some women may experience symptoms at times of hormonal changes such as perinatal depression, premenstrual dysphoric disorder and peri-menopause related depression. The hesitancy to seek treatment for mental health disorders disproportionally affects women in large part because they are more susceptible than men to many common mental health conditions. Helping sensitise women on mental health issues and giving them the confidence to seek assistance is vital.

Improving healthcare services and education can be the most critical intervention to make women aware of their rights and prevent them from becoming easy prey to severe emotional and mental disturbances. Providing employment opportunities for women will also positively impact women’s health concerns.

Despite taking necessary action to improve health indicators and provide healthcare for all, the government must also focus on the implementation at the primary health care level. Achieving sustainable health through investment and a priority-driven approach to strengthening and expanding healthcare services and creating awareness of women’s rights will effectuate achieving Universal Health Coverage with a particular focus in India right from a girl child’s birth.

Many preventable services related to women’s health concerns could be:

  • Family planning programmes
  • Cervical cancer screening: Pap test (smear) for women aged 25-65
  • Breast cancer screening: Genetic test counselling (BRCA) for women at higher risk and Mammography screenings once in 2 years for the elderly women
  • Bone density screening for all women over 65 years of age or women aged 64 and younger that have gone through menopause
  • Domestic and interpersonal violence screening and counselling for all women
  • Counselling by lifestyle coaches to prevent POCD, obesity, diabetes, hypertension, weight management, and more
  • Bringing support groups into action

Many services have come up to support women during the perinatal period such as breastfeeding support and counselling, birth control and spacing advice, dietary advice, psychological support for depression, etc. Countries should implement novel and innovative supportive policies concerning women’s health. For example, Spain might set a benchmark for other countries by introducing a three-day paid menstrual leave for women, a resting period meant for women with severe menstrual cramps and other associated symptoms. With the increasing number of working women, the Government of India should be considering such a policy. After all, women’s health determines the economic health of the modern world.

The article is written by AMPH Co 2022 students Dr. Fateen Fatima Mazher, Dr. Raghavendra Kumar Gudla, and Shilpa Veerapaneni and is edited by Vandana Yadav, MIHM.

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