Gender and Health

Dr. Jayasree.A.K

Women Health Problems- current scenario

• Demographic Shift- Aged women• Changing morbidity profile-e.g.Cancer Breast• Obesity > NCDs• Family Planning not Women Centered• Contraception• Infertility• Abortions

Women Health Problems-

current scenario

• Mental health problems• Menstrual problems• Sexuality rights• Over medicalisation• Caeserian, Hysterectomies, Infertility clinics• New Technologies Targeting women• Gender based violence

MMR (SRS-2007-2009) < 100

81 per lakh

212 per lakh

IMR < 30 (SRS-2011)

12 per 1000

44 per 100

SEX RATIO (census 2011)

1084

940

Institutional deliveries (NFHS III)

100 41

Life expectancy (census 2011)

75 (M) 78(F) 64 (M) 68(F)

Gender inequality in other spheres

• Literacy

• Employment opportunities

• Land ownership.

• Nutrition and food security.

Health of Aged women

• Proportion of elderly -12%- 20% by 2030• Female life expectancy- 78%

• Three persons in work support one old person• 1.5:1 in 2030

Ageing Women’s Problems

• Heart Disease and Stroke • Osteoporosis, Diabetes, Hypertension,

Incontinence, • Arthritis, Malignancies• Reduce Mobility• Older women poorer than older men• Widowhood

KSSP study

• 57% get some pension;7% work• Those who depend others, 61% depend sons• 40% have physical problems• Arthritis, Hypertension, eye problems,

diabetes• 75% seek health care; 72% modern medicine• 85% do not have mental disturbances• 33% loneliness; more among Low income gp

Changing morbidity profile

• Non communicable diseases

• Cancer Breast –Inc- 15/lakh (1st in Kerala)

• screening for breast and cervical cancer

• Obesity

Contraception

• Family Planning not Women friendly• Reproductive rights-cafeteria approach• Contraception without coercion• Right to decide the number and spacing • Prevention and treatment of STDs • Basic gynaecological care

ContraceptionKSSP survey

• Tubectomy- 68%

• Vasectomy-5%

• Condom- 6%

Infertility

• Exploitation in Infertility Clinics

KSSP• Infertility treatment 10%

Abortions

• Safe and legal abortion (septic)• Rights-varied status in countries• Indian situationKSSP• Abortion 14%• Unwanted pregnancy - 26%• Mother’s ill-health 46% ?

Access to health care

• Over medicalisation• Caeserian, Hysterectomies, Infertility clinics• New Technologies Targeting women• Less hospital beds• Household responsibilities• No privacy in clinics• Providers male dominated

Medical Technologies

• Sex detection tests• Ultrasound, Chorionic Villi biopsy, • amniocentesis• Selective Abortion• High Caesarean & hysterctomies• Assisted Reproductive Technologies• IVF: In Vitro Fertilization• BRCA1: BRCA2: Breast Cancer• Preventive Mastectomy

Conditioning of Gender Roles and access to Health .

• Time spent for waiting and attending antenatal consultations – extensive, deterring many from attending

Unethical clinical trials

• Long acting injectable contraceptives• Hormonal contraceptives• Norplant, NET-EN• Anti fertility vaccines• Quinacrine Chemical Sterilisation• HPV vaccine

Mental health

• Somatisation disorder• Fibromyositis• SuicideKSSP Survey• Depression- 45%• Increases with Low SES• Smoking 38%• Alcoholism 17%; 24% in low income groups

Suicide

• India 7 per lakhs• Kerala 28 per lakhs• Men 3 times more than women (completed

suicide)• Women 3 times more than men (attempted

suicide)• In kerala women suicide and attempt more

than other places• Family suicide is more in kerala

Adolescent health(KSSP)Menstrual problems• 23% isolated during

menstruation• 54% no proper knowledge• 69% suffer from pain;Only

5% take treatment

• Adolescents- 40% no illness (1 yr)

• 5% permanent illness

Adults > 35 yrs• Isolation during

menstruation• Lack of proper

knowledge - 65%

Misconceptions about sexuality

Rubella vaccination

• To prevent congenital rubella syndrome

• It can be given along with measles and also during adolescent period

• People’s participation should be considered

Working women: Health problems

• 94 % unorganised sector• 81% Agriculture• Unskilled and underpaid jobs• Long erratic working hours• Absence of gender conscious colleagues• Home tasks• Occupational health

Women as health care providers

• Health care at home: mother, wife, sister• Health providers at hospitals• Hierarchical• Nurses, ANMs, Public Health Nurse, Lady

health visitor, Anganwadi workers,Dais Poorly paid

• Gender preference of specialties• Cure vs Care

Gender based violence….

• 10-50% of women have been victims of intimate-partner violence

•Kerala more

• Women are at greatest risk of violence from men they already know

Nature and Extent

Consequences

• Increased risk of physical/reproductive and mental health problems

• Homicide, suicide,

• Bhoomika

Tribal health- Child mortality

• Still birth• Perinatal mortality• Infant Mortality• Under-5 mortality• not a recent

phenomenon • result of a long process

of change in environment & culture

Sexual health rights

• Health for All Women• Women’s Health Day- May 28• Primary Health Care and Women’s Reproductive

and Sexual Rights: Where are we today? • Health Sector Reforms: Hazardous to Women's

Health • Violence against Women: A Global Health

Emergency• Reproductive Justice not Population Control

Indian Women’s Health Movement

• Access to health care• Reproductive rights • Population control policies • Contraceptive usage-women’s control• Unethical Drug Trials• High Dose Oestrogen Progesterone • Long Acting Hormonal Contraceptives• Safe motherhood, Abortion, sterilisation• Sex selection and selective abortion• PNDT ACT (prenatal diagnostic technique)

Gender Strategies envisaged in RH programme

• Empower women to make reproductive choice

First work, Then marriage

Empowering

• Community inputs- Panchayats