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Gender and Health

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

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  1. Gender and Health Dr. Jayasree.A.K

  2. 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

  3. 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

  4. MMR (SRS-2007-2009) < 100 81 per lakh 212 per lakh

  5. IMR < 30 (SRS-2011) 12 per 1000 44 per 100

  6. SEX RATIO (census 2011) 1084 940

  7. Institutional deliveries (NFHS III) 100 41

  8. Life expectancy (census 2011) 75 (M) 78(F) 64 (M) 68(F)

  9. Gender inequality in other spheres • Literacy • Employment opportunities • Land ownership. • Nutrition and food security.

  10. 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

  11. Ageing Women’s Problems • Heart Disease and Stroke • Osteoporosis, Diabetes, Hypertension, Incontinence, • Arthritis, Malignancies • Reduce Mobility • Older women poorer than older men • Widowhood

  12. 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

  13. Changing morbidity profile • Non communicable diseases • Cancer Breast –Inc- 15/lakh (1st in Kerala) • screening for breast and cervical cancer • Obesity

  14. 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

  15. ContraceptionKSSP survey • Tubectomy- 68% • Vasectomy-5% • Condom- 6%

  16. Infertility • Exploitation in Infertility Clinics KSSP • Infertility treatment 10%

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

  18. 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

  19. 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

  20. Conditioning of Gender Roles and access to Health . • Time spent for waiting and attending antenatal consultations – extensive, deterring many from attending

  21. Unethical clinical trials • Long acting injectable contraceptives • Hormonal contraceptives • Norplant, NET-EN • Anti fertility vaccines • QuinacrineChemical Sterilisation • HPV vaccine

  22. Mental health • Somatisation disorder • Fibromyositis • Suicide KSSP Survey • Depression- 45% • Increases with Low SES • Smoking 38% • Alcoholism 17%; 24% in low income groups

  23. 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

  24. 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%

  25. Misconceptions about sexuality

  26. 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

  27. 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

  28. 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

  29. 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

  30. 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

  31. 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

  32. 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)

  33. Empower women to make reproductive choice First work, Then marriage Gender Strategies envisaged in RH programme

  34. Empowering • Community inputs- Panchayats

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