IMPROVING WOMEN’S HEALTH POLICY & INTERVENTIONS DR CHITRA RAGHUNANDAN DIR. PROFESSOR OBS & GYNE DEPT, L.H.M.C & S.S.K.H, NEW DELHI DR SHILPA DHINGRA ASST. PROFESSOR

Women’s health a major development task for us An unfinished agenda Challenges include reducing Maternal mortality Unwanted fertility Sexually transmitted infection ( HIV, AIDS) Female feticide & Violence against women.

LIFE CYCLE OF WOMEN & HEALTH ISSUES INFANCY AND CHILDHOOD(0-9 YEARS) Sex selection Genital mutilation Discriminating nutrition Discriminating Health care

ADOLESCENCE ( 10-15 YEARS) Early child bearing and abortion STD & HIV Infection Undernutrition and Anemia Increase substance abuse

REPRODUCTIVE AGE(20-44 YEARS) Unwanted / Unplanned pregnancies Abortions STI & AIDS Pregnancy Complications Anemia

POST REPRODUCTIVE (45 YEARS & ABOVE) Gynecological Malignancies Cardiovascular diseases Osteoporosis Osteoarthritis Diabetes Mellitus LIFE TIME Gender Violence Enviornmental and occupational hazards Depression

HARD FACTS MATERNAL MORTALITY India accounts for 20% of maternal deaths. Every minute one women dies of pregnancy and childbirth. MMR is 330/ 100,000 live births. Greater than Bangladesh & Pakistan

HARD FACTS POPULATION PARABLES Indian population is 1.2 billion. India occupies 2.4% of world land. 17.5% of world population. One out of 6 people in world live in India. 35% population below the poverty line.

HARD FACTS The total number of HIV Rose from 8 million in 1990 to 34 million in 2010 Prevalence of HIV in children- 3.4 million People newly infected in 2010- 2.7 million India has population of 1 Billion out of which half in sexually active group Total number of people with HIV in India is 23.9 lakhs in 2009 with children accounting for 3.5% Parent to child transmission: 5.4% of all routes

HARD FACTS FEMALE FETICIDE / GENDER ISSUE Sex Ratio 940/ 1000. Deficit of 3 crore women. 60 million girls missing. 2000 girls aborted everyday in India. A girl child is killed and disowned every hour. 35% of girls sexually abused between 12 to 16 years.

KEY ISSUES, POLICY & INTERVENTIONS Complication of pregnancy and childbirth are major cause of death and disability among women of reproductive age leading to high maternal mortality in India. PREVENTION Improving diet supplimentation of pregnant and lactating women. Health care providers and skilled midwife. Strengthening referral system for effective management of complications. Tertiary level centers fully equipped.

Uncontrolled fertility / Sexually transmitted infection Unequal power between men and women in sexual relationship exposes women to involuntary exposure to sex, sexually transmitted infections and unwanted pregnancy.

PREVENTION Empowering women with education and employment. Family planning and sexual counselling. Sex education of young adolescents. Promotion of mutual consent and condom uses.

Female feticide, Domestic violence, rape and sexual abuse occur in all regions, class and age. Affects 30% women worldwide.

PREVENTION Law Counselling Support services Medicare Raise awareness Mobilize support

STAKE HOLDERS Family Society Health Professionals Strong & Sustained government agencies Well endowed resourses.

INTERVENTIONS Strengthen the performance of overall health system specially district level. Effective programs to promote increased utilization of maternal health services / EOC. Women access to basic and comprehensive emergency obstetric care. Availability of skilled birth attendant. Information on maternal morbidity Maternal death audits.

Quality of care where health services are available and affordable NEEDS Skilled staff / Professionals. Effective client provider interaction. Adequate supply of drugs. Communication programmes. Information to poor women and family On health problems and importance of seeking care.

Focused Interventions Ante- natal services Basic Ante-natal care Prompt detection/Management and referal of ante-natal complications TT Injection Iron and folic acid supplementation Treatment of other associated infection

Safe Delivery Post-Partum Care Skilled birth attendant Timely detection and referral of intra-natal complications Tertiary level Obstretics care Post-Partum Care Family planning services Monitoring for post-partum sepsis

Preventing unwanted pregnancy Emergency contraception Medical termination of pregnancy Management of unsafe abortion complications Post- abortal contraception

Prevention of RTI & STI Promotion of barrier contraception and distribution Symptomatic management of RTI Screening and treatment of sex-workers Screening for cervical cancer

Positive Health promotions Public education program for adequate nutrition Decision on family size Safer sex Male participation Education and employment School Health Program On reproductive health, dangers of substance abuse

Eradication of social problems Law, public education and services to eradicate Domestic violence Sexual assault Forced prostitution Early childhood marriages Strict regulation of use and abuse of medical technology

INTERVENTIONS STI treatment education. Social marketing of condoms. Voluntary testing of HIV and counselling. Women controllerd barrier methods for preventing STI / pregnancy.

To summarise…… Women Health requires Favourable health policies. Strengthening and expanding health services. Positive attitude and approach. Long term basis … improvement in nutrition, education and employment opportunities for women for positive impact on health.

Thank you