CURRENT CHALLENGES IN WOMEN'S HEALTH,W OMENS DISEASES,HOW TO MAKE WOMEN HEALTHY,WOMEN EDUCATION AND EMPOWERMENT,EMPLOYMENT,ENVIORMENT,STRATERGIES FOR IMPROVING WOMEN'S HEALTH

1. CURRENT HEALTH CARE
CHALLENGES IN
ADULT WOMEN'S HEALTH
Narendra Malhotra
Jaideep Malhotra
Neharika Malhotra Bora
www.rainbowhospitals.org
mnmhagra3@gmail.com

2. Women’s Health Issues—From Womb to Tomb

3. LIFE CYCLE OF WOMEN & HEALTH ISSUES
INFANCY AND CHILDHOOD(0-9 YEARS)
• Sex selection
• Genital mutilation
• Discriminating nutrition
• Discriminating Health care

4. ADOLESCENCE ( 10-15 YEARS)
• Early child bearing and abortion
• STD & HIV Infection
• Undernutrition and Anemia
• Increase substance abuse

5. REPRODUCTIVE AGE(20-44 YEARS)
• Unwanted / Unplanned pregnancies
• Abortions
• STI & AIDS
• Pregnancy Complications
• Anemia

6. POST REPRODUCTIVE (45 YEARS & ABOVE)
• Gynecological Malignancies
• Cardiovascular diseases
• Osteoporosis
• Osteoarthritis
• Diabetes Mellitus
LIFE TIME
• Gender Violence
• Enviornmental and occupational hazards
• Depression

7. CHILDHOOD
• Sex selective
abortion
• Female
mutilation
• Nutrition
problems
• Neglect
• Cannot benefit
from the
services
ADOLESENT/ADULT
• Unwanted
pregnancies, STDs
• Sexual
harassment/abuse
• Turnpike sex
• Smoking and
substance abuse
OLDERS
• Increase in
morbidity
/problems on
quality of life
• Violence
• Social pressure
• Increase in
morbidity

8. Healthy is…
• Living well despite your inescapable
illnesses and diseases.
Total Wellness is…
• The balance and integration of the
physical, intellectual, emotional, spiritual,
occupational, environmental, and social
aspects of the human condition.

9. 7 Dimensions of Wellness
Occupational
Spiritual
Emotional
Physical
Intellectual
environmental
Social

10. HEALTH CHALLENGES IN WOMEN
• INTRAUTERINE
• INFANCY
• CHILDHOOD
• ADOLESCENT
• YOUNG ADULTS UNMARRIED
• YOUNG MARRIED ADULTS
• OBSTETRICAL CHALLENGES
• FAMILY PLANNING
• PERIMENOPAUSAL
• MENOPAUSAL

11. Women’s health a major development task for us
An unfinished agenda in our country
Challenges include reducing
 Maternal mortality
 Unwanted fertility
 Infertility
 Sexually transmitted infection ( HIV, AIDS,HPV)
 Cancers
 Female feticide & Violence against women.

12. Gender Based Health
What Remains to be
Improved in Women’s
Health?

13. HARD FACTS
MATERNAL MORTALITY
• India accounts for 20% of maternal deaths.
• Every minute one women dies of pregnancy
and childbirth.
• MMR is 330/ 100,000 live births.(Improving)
still we are far from M D GOALS
• Greater than Bangladesh & Pakistan

14. HARD FACTS
POPULATION
• Indian population is 1.2 billion.
• India occupies 2.4% of world land.
• 17.5% of world population.
• One out of 6 people in world live in India.
• 35% population below the poverty line.

15. HARD FACTS
• The total number of HIV Rose from 8 million in 1990
to 34 million in 2010
• Prevalence of HIV in children- 3.4 million
• People newly infected in 2010- 2.7 million
• India has population of 1 Billion out of which half in
sexually active group
• Total number of people with HIV in India is 23.9
lakhs in 2009 with children accounting for 3.5%
• Parent to child transmission: 5.4% of all routes

16. HARD FACTS
FEMALE FETICIDE / GENDER ISSUE
• Sex Ratio 940/ 1000.
• Deficit of 3 crore women.
• 60 million girls missing.
• 2000 girls aborted everyday in India.
• A girl child is killed and disowned
every hour.
• 35% of girls sexually abused between
12 to 16 years.

17. KEY ISSUES, POLICY & INTERVENTIONS
Complication of pregnancy and childbirth are major cause of
death and disability among women of reproductive age
leading to high maternal mortality in India.
PREVENTION
• Improving diet supplimentation of pregnant and lactating
women.
• Health care providers and skilled midwife.
• Strengthening referral system for effective management of
complications.
• Tertiary level centers fully equipped.

18. • Uncontrolled fertility / Sexually transmitted
infection
Unequal power between men and women in
sexual relationship exposes women to
involuntary exposure to sex, sexually
transmitted infections and unwanted
pregnancy.

19. PREVENTION
• Empowering women with
education and
employment.
• Family planning and
sexual counselling.
• Sex education of young
adolescents.
• Promotion of mutual
consent and condom uses.

20. • Female feticide, Domestic
violence, rape and sexual
abuse occur in all regions,
class and age.
Affects 30% women
worldwide.

21. “Have a son and
your name continues!”

22. “Last year only one girl child was
born in our village. All other
families had sons”
Kristof, Nicholas D. 1993.
"Peasants of China discover new way to weed out girls."
The New York Times, 21 July, 1.

23. Today, the vast majority in Asia, I
in different populations,
60 million girls at least, otherwise
expected to be alive,
are missing due to gender selective
abortion, infanticide or neglect .

24. Girl
Boy
880
900
920
940
960
980
1000
1991
2001
945
927
1000 1000
Sex distribution for 0-6 years of age in India
Girl
Boy
Oomman N, Ganatra BR., Sex selection: the systematic
elimination of girls. Reprod Health Matters. 2002 May;10(19):184-8.

25. 117,4
116,7
90
95
100
105
110
115
120
Guangxi Zhejiang
Sex ratio at birth in China-
1995
In CHINA:
•21 of 31 (%67.7)
provinces have
higher ratio than
108.0 (expected
sex ration at
birth)
•40 million single
men by 2020
Gu B, Roy K. Sex ratio at birth in China, with reference to
other areas in East Asia: what we know. Asia Pac Popul J. 1995
Sep;10(3):17-42.

26. PREVENTION
• Law
• Counselling
• Support services
• Medicare
• Raise awareness
• Mobilize support

27. Quality of care where health services are
available and affordable
NEEDS
• Skilled staff / Professionals.
• Effective client provider interaction.
• Adequate supply of drugs.
• Communication programmes.
• Information to poor women and family
• On health problems and importance of seeking care.

28. Focused Interventions
• Ante- natal services
• Basic Ante-natal care
• Prompt detection/Management and referal of
ante-natal complications
• TT Injection
• Iron and folic acid supplementation
• Treatment of other associated infection

29. INTERVENTIONS
• Strengthen the performance of overall health system
specially district level.
• Effective programs to promote increased utilization
of maternal health services / EOC.
• Women access to basic and comprehensive
emergency obstetric care.
• Availability of skilled birth attendant.
• Information on maternal morbidity
• Maternal death audits.

30. The Challenge of
Obstetrics
THE GREAT
OBSTETRICAL
SYNDROME

31. • Preterm labor
• Preterm Rupture of membranes
• Pre-eclampsia
• SGA/IUGR
• Fetal Death
Obstetrical Disease

32. Disease Treatment
Preterm labor Tocolysis
Preterm PROM
Expectant
management
Pre-eclampsia
Antihypertensive
agents
IUGR Delivery

33. Safe Delivery
• Skilled birth attendant
• Timely detection and referral of
intra-natal complications
• Tertiary level Obstretics care
Post-Partum Care
• Family planning services
• Monitoring for post-partum sepsis

34. Preventing unwanted pregnancy
• Emergency contraception
• Medical termination of
pregnancy
• Management of unsafe abortion
complications
• Post- abortal contraception
planet earth is getting heavier

35. POPULATION EXPLOSION
THE “BOMB” HAS EXPLODED IN
DEVELOPING COUNTRIES
POPULATION CONTROL EXPRESS
HAS DERAILED

36. Today a basket of contraceptive choices available to women
and various studies have shown that today even in the
educated and developed world the first year failure rates
are much higher in typical users than perfect users

37. “Contraceptives should be used at
every conceivable occasion.”
“It take many nail to build crib…only one
screw to fill it…”
What is the best way to prevent
pregnancy?

38. Oral contraceptives
• Perimenopausal women and oral
contraceptives…can help smooth the ride of
the ovarian roller coaster during
perimenopause
• Teenagers and young adult women…what’s
old and what’s new in the world of oral
contraceptives?

39. What are the benefits of OCs? Besides the
obvious?
• Reduce the risk of ovarian cancer
• Treating dysmenorrhea
• Treating endometriosis
• Treating PCOS
• Treating acne
• Reducing estrogen deficiency symptoms in perimenopausal
females
• Continuous and extended cycle OCs may improve mood,
reduce headaches and increase quality of life…
• Long term effects of continuous regimens? Not
known…fertility? Thromboembolism?

40. Sexually Transmitted Disease
•Young women know very little
information on STDs and
because of the fear of being
branded as sexual active they
hardly try to learn information.
• Woman equipping less power as
a decision maker has resulted
with late diagnosis and
treatment.

41. Sex trade/tourism..
• 4 million people in sex abuse traffic is
estimated in the world.
• The revenue / year of organized criminal
organizations is 7 billion dollars
• 500,000 women and children for the sex
trade is estimated to infiltrate into
European Union countries in 1995.

42. Prevention of RTI & STI
• Promotion of barrier
contraception and
distribution
• Symptomatic management
of RTI
• Screening and treatment
of sex-workers
• Screening for cervical
cancer

43. INTERVENTIONS
• STI treatment education.
• Social marketing of
condoms.
• Voluntary testing of HIV
and counselling.
• Women controllerd barrier
methods for preventing STI
/ pregnancy.

44. Positive Health promotions
• Public education program for
– adequate nutrition
– Decision on family size
– Safer sex
– Male participation
– Education and employment
• School Health Program
– On reproductive health, dangers of substance
abuse

45. The HPV vaccine in young women
• Gardasil /Cervarix to prevent cervical cancer (HPV
16, 18) and genital warts (HPV-6 and11)
• By the way there are over 100 types of HPV, 30 of
which invade mucus membranes
• Vaccinate girls between 9 and 26
• Is it 100% effective? HPV naïve, yes; already + HPV
with above types? Not effective…

46. Can Gardasil /Cervarix prevent other
cancers caused by HPV?
• Squamous cell carcinoma of the rectum
• Squamous cell carcinoma of the vagina
• Squamous cell carcinoma of the mouth and
throat
When will boys get the HPV
vaccine?

47. Before we leave the topic of STDs…
• Forget teenagers for a moment…
• The fastest rising group for STDs in U.S. is
the over 60 crowd and now also in asian
countries
• HPV, HSV, HIV, GC, Syphilis
• Why?

48. Violence and Women
World scale:
Today one of every 3
women are subjected
to different forms of
violence.
(Heise, Ellsberg, Gottemoeller, 1999).

49. • "...any distinction, exclusion or restriction
made on the basis of sex which has the effect
or purpose of impairing or nullifying the
recognition, enjoyment or exercise by women,
irrespective of their marital status, on a basis
of equality of men and women, of human
rights and fundamental freedoms in the
political, economic, social, cultural, civil or
any other field."
(UN, CEDAW-1994)
Discrimination against women

50. A systematic weapon : Rape
• In South Africa every 83
second one woman is
rapedA report by the U.N.
(1996)
• Special Rapporteur on
Rwanda estimated that at
least 250 000 women were
raped during the genocide.
• During the 1992-1995
conflict in Bosnia-
Herzegovina between 20
000 and 50 000 women
were raped
WHO, Sexuel violence in conflict setting and the risk of HIV, 2004.
Integrated Regional Information
Networks (IRIN)

51. In the World
• Completed rape at least
once during the life of
women completed rape
USA 14-20%
Canada: 40%
• 12-25 percent of all adult
women have been
specified that they were
victims of sexual
haresment or attempted
rape.
Koss et al.,1997; Killpatrick et al.,1992; Randall and Haskell, 1995

52. Eradication of social problems
• Law, public education and services to
eradicate
– Domestic violence
– Sexual assault
– Forced prostitution
– Early childhood marriages
• Strict regulation of use and abuse of medical
technology

53. Let’s move into perimenopause…
• Transitional state from reproductive years to
postmenopausal years—length is variable--3 to 10
years
• Ovary is on a roller-coaster ride
• Variable menstrual cycles (greater than 7 days,
different from normal)
• FSH is rising
• Late perimenopause—greater than 2 skipped cycles
and an interval of amenorrhea (greater than 60
days)—vasomotor symptoms begin
• Final menstrual period (hallelujah!)—no periods for a
year
• Welcome to your postmenopausal years

54. Older Ages and Women
• The expected duration of life in our
country, the birth (DIE-2000)
-71.0 years for women
-66.4 years for men
• At least 35 countries in the world in the
birth of the expected life span for women
has reached 80 years. Women live
average 6-8 years more than men. (WHO)

55. Older Ages and Women
• A long way with diseases ..
Health care access problems
In our country, all illiterate population over 65 years
is 24% and 74% are women.
Elderly women than elderly men are poor and lack
social protection.

56. Ladies! Expose yourself! And your kids!!!
• 10-15 minutes every day or every other day!
• Lighter skin? Less time. Darker skin? More time.
• Obviously if you have had skin cancer or are at high
risk for skin cancer, the prudent recommendation is
to take vitamin D orally.
• Other cancers that may be prevented by vitamin D?
Colon cancer, ovarian cancer, prostate cancer
• Tell your husbands to get those prostates out in the
sun!

57. Don’t forget your calcium and vitamin D
• The Coppertone girl

58. To summarise…… Women
Health requires
• Favourable health policies.
• Strengthening and expanding health services.
• Positive attitude and approach.
• Long term basis … improvement in nutrition,
education and employment opportunities for
women for positive impact on health.

59. Vision
Empowered people choose the number and timing of their births, using
methods and providers of their choice.
Women empowerment,education,employment,environment

60. some of our social initiatives

61. FOGSI CSR FOR VSR FOR WOMEN

62. Helpful Websites
 Go Red for Women www.goredforwomen.org
 Centers For Disease Control www.cdc.gov
 The Way To Eat www.thewaytoeat.net
 The National Women’s Health Information Center
www.4women.gov
 The Mayo Clinic www.MayoClinic.com
 National Cancer Institute www.cancer.gov
 National Osteoporosis Foundation www.nof.org
 Womens Health www.womenshealth.gov
 American Heart Association www.americanheart.gov
 American Stroke Association www.strokeassociation.org
 National Stroke Association www.stroke.org
 Susan G. Komen www.Komen.org
 SMRITI www.smritiindia.org
 FOGSI www.fogsi.org

63. Questions

64. BE SURE TO BE HERE AT 8 AM IN
MORNING TOMORROW FOR YOUR
STRESS TEST AND YOUR DOSE OF
AROMATHERAPY

65. THANK YOU