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 ) < per lakh 212 per lakh

IMR < 30 (SRS-2011) 12 per per 100

SEX RATIO (census 2011)

Institutional deliveries (NFHS III) 10041

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 (1 st 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

Contraception KSSP 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 situation KSSP 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 Suicide KSSP 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 … % of women have been victims of intimate-partner violence 10-50% of women have been victims of intimate-partner violence Kerala moreKerala more Women are at greatest risk of violence from men they already know 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 Increased risk of physical/reproductive and mental health problems Homicide, suicide, Homicide, suicide, Bhoomika 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