Dr. Darshna Thakker | Health Messenger! Gynecologist & Obstetrician

1. Dr. Darshna Thakker | Health Messenger! Gynecologist & Obstetrician • Ob. Gyn. Consultant in private practice since 1998 @ Sarjan, • Resource person to NGO / Govt. Prog. Related to Adolescent Health Education, Reproductive Health Care • Areas of Interest : Developing IEC (Information, Education & Communication) material for health care providers & various organizations, delivering Health Messages thro’ print, visual media, TV, video production • Active member of FOGSI – Adolescent Health Committee • National Coordinator –“Protecting Young Girls” Project

2. opening THE window of COMmunication

3. Women Health Issues,Challenges & Solutions Dr. Darshna Thakker Consultant Obstetrician & Gynecologist SARJAN Maternity & Nursing Home, Vasna, Ahmedabad-7 Member : Adolescent Committee FOGSI, (Federation of Ob. Gyn. Societies of INDIA) Expert on Panel: Gender Resource Center Director: Sarjan Communication

4. Why are we HERE? Agenda for ACTION • Reaching un- reached… • Serving underserved • TO FOCUS on the Most Vulnerable. . . • pregnant, newborn, adolescent • Poor , living far from health services A call to action – We all have a role to play

5. Key Facts ~ Global Scenario • Every day, approximately 800 women die from preventable causes related to pregnancy and childbirth. • 99% of all maternal deaths occur in developing countries. • Maternal mortality is higher in women living in rural areas and among poorer communities. • Young adolescents face a higher risk of complications and death as a result of pregnancy than older women. • Skilled care before, during and after childbirth can save the lives of women and newborn babies. • Between 1990 and 2010, maternal mortality worldwide dropped by almost 50%

6. Presentation over view MDG & HER Health Women Health Issues – MANY! Age specific, Problem specific Challenges & Solutions – Our Role Message to Take Home Summarizing High Impact Intervention 6

7. MDG – 189 countries in 2000 signed! • Eradicate Extreme Poverty and Hunger • Achieve Universal Primary Education • Promote Gender Equality and Empower Women • Reduce Child Mortality • Improve Maternal Health • Combat HIV/AIDS, Malaria and TB • Ensure Environmental Sustainability • Develop Global Partnership for Development 53 Indicators, 35 relevant to India

8. GOAL 5: IMPROVE MATERNAL HEALTH • TARGET 6: Reduce by three quarters, between 1990 and 2015, the Maternal Mortality Rate. • Indicator 16: Maternal Mortality Ratio (MMR) • Indicator 17: Proportion of births attended by skilled health personnel The decline in MMR from 1990 to 2009 is 51%. From an estimated MMR level of 437 per 100,000 live births in 1990/1991, India is required to reduce the MMR to 109 per 100,000 live births by 2015

9. Women Health Issues • Physiological – Physical • Teenage >> Obesity, PCOS • Child bearing >> Pregnancy & delivery, Cancer • Menopause >> Cancer • Emotional & Psychological • Teenage >> Tantrums & stress - career • Child bearing >> ? multitasking • Menopause >> midlife crisis

11. Women Health Issues Life cycle approach! • Female fetecide – BIG NO • Adolescent Health – Needs special attention • Pregnancy & Delivery Care – Improving, under utilization of services? • Mid Life Crisis - Menopause • Geriatric problems

12. The fact! Defining HEALTH! • We are still busy managing physiological issues. . . • We must not underestimate the impact of life style, emotional challenges, social & peer pressure on women’ health • WHO HAS TO PLAY ROLE???

13. Sex ratio Ignorance about women health Affordable care Under utilization of available care Poor linkages Lack of integration Commitment & accountability Monitoring & Evaluation Mind set management! BCC IEC Motivation & mobilization Integration Strengthening public-private partnership Will & Wish – Passion Rectify strategy for implementation Challenges & Solutions

14. Women & Cancer • Breast, Cervix, Ovaries, Uterus • Screening Programs – PAP, Mammogram • Poor ratio of regular screening • Late manifestation • Solutions: IEC, Motivation, Reaching Out

15. Teen Girl’s Health Issues • ARSH * STIs & RTIs • PCOS, Obesity, HBP, DM • Teenage Pregnancy & Abortions • Vaccine preventable diseases • Solutions: Health Education, FLE, AFHS, involving community & society at large scale

16. GOAL 5: IMPROVE MATERNAL HEALTH • TARGET 6: Reduce by three quarters, between 1990 and 2015, the Maternal Mortality Rate. • Indicator 16: Maternal Mortality Ratio (MMR) • Indicator 17: Proportion of births attended by skilled health personnel The decline in MMR from 1990 to 2009 is 51%. From an estimated MMR level of 437 per 100,000 live births in 1990/1991, India is required to reduce the MMR to 109 per 100,000 live births by 2015

17. Where do WE STAND? • Kerala, Tamil Nadu and Maharashtra have realized the all India MDG target in 2007-2009 whereas Kerala was the sole State with this distinction in 2004-2006. • The States of Kerala, West Bengal and Bihar and Jharkhand are likely to achieve their State level MMR targets by 2015, with the current trend continuing. The remaining States are likely to miss the targets by 18 to 52 points • Despite this progress, India is expected to fall short of the 2015 target by 26 points MMR Source: Sample Registration System, Office of Registrar General of India

18. Institutional deliveries in India Source MDG _ REPORT_ INDIA 2011 With the existing rate of increase in deliveries by skilled personnel, the likelyachievement for 2015 is only to 62%, which is far short of the targeted universal coverage

19. Causes of Maternal death

20. Trends of Institutional Deliveries

21. Underutilization of ANC/PNC • Poverty • Distance • Lack of information • Inadequate services • Cultural practices • Fact#10MH: The main obstacle to progress towards better health for mothers is the lack of skilled care. This is aggravated by a global shortage of qualified health workers Challenge

22. Happy side of the story! • under the National Rural Health Mission (NRHM) 2005, ASHA (Accredited Social Health Activist) providing support for increasing utilization • Promoting safe delivery at home by ensuring the use of SBAs (Skilled Birth Attendants) has been another important initiative

25. Alarming Facts • Among the age group of 15-49 years, 63% of the maternal deaths were females in the age group of 20-29 years as per the 2007-09

26. Gujarat State

27. INITIATIVES . . . • Chiranjeevi Yojana - aimed at encouraging institutional deliveries and establishing a model of public-private partnership to reduce maternal mortality. Launched in December 2005, it began as a one-year pilot project in five backward districts of Gujarat. 2007> to implement the scheme throughout Gujarat; the Central Government is also recommending the scheme to other states to improve institutional deliveries • focuses on providing free delivery care to women below poverty-line (BPL) through a private obstetrician • As of February 2008, 852 of 2,000 available private specialists have joined the scheme and conducted 1,65,278 deliveries. Of these, 10,278 (6.21%) were caesarean sections, and 11,118 (6.7%) were complicated deliveries J Health Popul Nutr. 2009 April; 27(2): 235–248. PMCID: PMC2761782 Maternal Health in Gujarat, India: A Case Study Dileep V. Mavalankar, Kranti S. Vora, K.V. Ramani, Parvathy Raman, Bharati Sharma, andMudita Upadhyaya

28. Looking back…Training of MBBS doctors on emergency obstetric care • In 2005, the Obstetrics and Gynecology Association of India (FOGSI) started an initiative, along with the Government of Gujarat, to train general doctors (Medical Officers with MBBS degree) in comprehensive EmOC. The design of the course and technical backstopping was done by JHPIEGO and the AMDD project. Master trainers from teaching hospitals were trained at the Christian Medical College, Vellore. • Training of MBBS doctors on anaesthesia - anaesthesia society is not involved in this training and is somewhat opposed to it • Training of skilled birth attendants for normal deliveries - Unfortunately, there is no systematic MIS to record if these trained ANMs have been providing more or better maternal care

29. The guidelines They are many! Country Specific & State Specific Relevance & Impact

30. How can we achieve MDG? • Scaling up and prioritizing a package of high-impact interventions • Strengthening health systems • . . . and INTEGRATING efforts

31. Male Involvement matters!

32. Innovation in Health Care! • More than 100countries are now exploring the use of mobile phones to achieve better health • using innovation to increase efficiency and impact

33. Women Health Issues can be dealt with • Addressing socio – cultural context • Following country specific guidelines • Up scaling of High Impact Intervention • Keeping in mind… • Short & Long term benefits • Achieving MDG

34. Changing scenario • Demands re-designing strategy & planning • Early menarche • Age @ Marriage / sexual activity • Increased prevalence of cancer – breast & cervix • Changing life style • Changing environment & exposure

35. Investing in Preventive Health • Wiser way to reach MDG • Can minimize disease burden • Save time, money & energy! • HOLISTIC approach to health management

36. Changing Trend in Health Care • HR issues at Govt Hospitals • Cost Issues at Private hospitals • Neglected Women Health Dept at Corporate Hospitals • Availability + Affordability + Accessibility is a major challenge! • ? EBM practice, Quality Check & Documentation – Needs improvement

37. Need of the time.. • Being accountable for commitments • Political leadership • Community engagements • Beyond numbers > Focusing on quality… Janani Suraksha Yojana (JSY) ISD 7.39 lakhs in 2005-06 to about 1 crore in 2009-10.

38. . . . Solutions • Educate, engage and mobilize communities • Scale up implementation of the most appropriate interventions • Share best practice, test new approaches, use the best tools possible and audit clinical practice • Track progress and hold all stakeholders (including themselves) accountable for their commitments • Develop and test innovative approaches to delivering essential services

39. Innovative solutions?! • Target specific intervention • Target Population • Target Age / Literacy • Mobile apps! • Social networking – Facebook & others • BISAG & Doordarshan prog with newer ideas

40. Innovation in thought process & action • Sex Education – Boon or Boomerang ?! • Abortion – Legal & SAFE?! • Reaching out via different channels like coffee shops / spa / saloon / SHG / • CORPORATES joining health management • Multidisciplinary approach & synergistic action plans

41. Sharing Data & Sensitizing • Being Sensitive & Sensitized – two different aspects! • Data on fingertips – e.g. Tamilnadu Strengthening Public-Private Partnership

42. Clinical experience & observation • Catching them young really works! • Mass communication MUST have correct messages • Integrated efforts – better accepted • Follow up & helpline – very essential • Well designed IEC material helps many. . .

45. Educational material ! free!!!

46. Building confidence, sharing evidences Counseling program TRUE value based information regarding available options Acknowledgement

47. Thank YOU . . . Presentation designed & developed By Dr Darshna Thakker Consultant Gynecologist & Obstetrician IEC Consultant info@sarjanhealthcare.com www.sarjanhealthcare.com +91 98240 69989