Reproductive Health – The Indian landscape and its challenges.

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“A woman is a full circle. Within her is the power to create, nurture and transform”

Reproductive health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity, in all matters relating to the reproductive system and to its functions and processes. Reproductive health, therefore, implies that people are able to have a satisfying and safe sex life and that they have the capability to reproduce and the freedom to decide if, when and how often to do so.

Sound reproductive health is integral to the vision that every child is wanted; every birth is safe, every pregnancy is precious, every young person is free from HIV and every girl and woman is treated with dignity.  Implicit in this vision is the idea that men and women will be able to exercise their rights to information on and access to safe, affordable and acceptable methods of fertility regulation as well as quality health care services.  The latter will enable women to experience safe pregnancy and childbirth, across the world.

Indian snapshot

There are several reproductive health concerns in India which need to address in order to improve the reproductive health status of people. In the following paragraphs, an attempt has been made to highlight some of the major concerns.

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“She is clothed in strength and dignity and she laughs without fear of the future”

 

High unwanted fertility

  • As per the National Family Health Survey III – 2005-2006 (NFHS-III), nearly 21% of pregnancies are either unwanted or mistimed.
  • Total fertility refers to the mean number of children born per woman in the age group of 15-49 years.  Total wanted fertility represents the level of fertility that will result theoretically if all unwanted births are prevented.  Total wanted fertility rate in urban areas is 1.6 and in rural areas 2.6, while the total fertility rate is 2.06 in urban areas and 2.98 in rural areas.
  • Unmet need for family planning is an important indicator for assessing potential demand for family planning in India There is a high unmet need for family planning, with 6.2 % for spacing and 6.6% for limiting methods among currently married women.  Unmet need is also high amongst the illiterate and in the lowest wealth quintile.
  • Male participation in sharing responsibility for contraception is low. As per NFHS –III, male sterilization was accepted by only 1% of currently married couples.

 

High maternal mortality

India’s maternal mortality ratio is unacceptably high at 230 per 100,000 live births (2008) as per UN estimates.  Nearly 63,000 Indian women, accounting for almost 18 percent of estimated global maternal deaths, die every year due to causes related to pregnancy and childbirth.  The lifetime risk of maternal mortality is 1 in 70; i.e. one in every 70 pregnant women is at risk of death, even as she gives birth.  Available data also indicate that a significant proportion of women suffer from obstetric morbidities.

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A mother’s dream is to see her children grow up to be healthy, happy and successful.

Sexually Transmitted Infections/Reproductive Tract Infections

Several studies highlight the widespread prevalence of sexually transmitted and reproductive tract infections.  In a nation-wide community-based study, prevalence was nearly 6% in the 15-50 years age group. The problem is further compounded by the prevailing culture of silence, as women are generally reluctant to seek medical treatment for these symptoms.

Government policies/programs:

In 1951, India became the world’s first nation to launch a family planning programme.  Decades later, when the International Conference on Population and Development (Cairo, 1994) prompted a paradigm shift in population programs, with the advocacy of client-centered and quality-oriented reproductive health approaches, India formulated appropriate policy and programmatic responses:

  • The National Population Policy was formulated in the year 2000. It affirms the government’s commitment to promoting voluntary and informed choice and continuation of the target-free approach in family planning service delivery.
  • The National Rural Health Mission (NRHM) was launched in 2005. It  aims to revamp  the public healthcare delivery system and  seeks to provide accessible, affordable and quality health care  to the rural population
  • A national level Reproductive and Child Health Programme II (RCH II) was introduced in 2005 and focus on addressing reproductive health needs of the population through evidence-based technical intervention through a wide range of service delivery network. There is an implicit emphasis on addressing the equity dimension in coverage while maintaining a focus on quality.
  • Conditional Cash Transfer schemes like Janani Suraksha Yojana (for promoting institutional deliveries) were introduced to help address economic barriers to access to services.

Adhbhut Matrutva, an initiative by FOGSI (Federation of Obstetrics and Gynecological Societies of India).

I would appeal to our Prime Minister to link “Adbhut Matrutva” to “Skill India”, health for all program.

Goals that Adhbhut Matrutva takes into consideration are as follows:

  • Linking primary hospitals, to secondary to tertiary care hospitals.
  • Having Mobikes and ambulances equipped with all EMOC tools and disposables.
  • Training paramedical staff for monitoring of pregnancy and labor, enabling them to recognize the danger signals and early referral to a tertiary care.
  • Strengthening our rural infrastructure and manpower.
  • Integrating various agencies and NGOs to work in cohesion and synergies.

Better access to services is the key:

Reproductive health programmes must place emphasis on improving access to quality reproductive health services by gender-sensitive providers.  Maternal death and disability can be reduced dramatically if every woman has access to health services throughout her life, especially during pregnancy and childbirth.

The highest priority needs to be given to ensuring that women have access to skilled birth attendants at the time of giving birth and that women who develop life-threatening complications during pregnancy, childbirth or postpartum can immediately access treatment at adequately-equipped facilities.

The focus needs to be on eliminating delays in decision- making to seek services, ensuring timely transportation to proper facilities and enabling prompt treatment on arrival at facilities.

The importance of Family Planning: The number of unwanted and closely spaced births can be drastically reduced by providing access to quality contraceptive services.  It is vital that services are available to women and men from lower income quintiles, especially in rural areas, which are currently under serviced.

Moreover, a set of emerging issues, such as infertility, reproductive cancers, morbidities such as prolapse and gender-based violence, need to be studied and addressed.

In addition, programs need to focus on preventing and treating reproductive tract and sexually transmitted infections and meeting unmet reproductive health needs of underserved groups, such as adolescents and people living with HIV/AIDS with special reference to information, counseling, and services.

Well, that’s it for this article, folks! This article is just an introduction to the multitude of factors and issues associated with reproductive health in India and we will make an attempt to open up discussions on all those fronts from here on forth. Regardless of the various stigma prevalent regarding reproductive health especially in India, we need to create a safe space for the community to engage in discussions and deliberate further actions. This alongside with institutional support and coordination can help tackle most of the challenges with respect to reproductive health in India. And in that spirit, let’s get down and clean.

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We won’t be distracted by comparison if we are captivated with purpose.

 

 

 

 

 

 

 

 

 

 

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