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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.
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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
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 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 • QuinacrineChemical 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;Only5% take treatment • Adolescents- 40% no illness (1 yr) • 5% permanent illness Adults > 35 yrs • Isolation during menstruation • Lack of proper knowledge - 65%
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, Anganwadiworkers,DaisPoorly paid • Gender preference of specialties • Cure vs Care
Gender based violence …. Nature and Extent • 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 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)
Empower women to make reproductive choice First work, Then marriage Gender Strategies envisaged in RH programme
Empowering • Community inputs- Panchayats