Healthy Living

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Women's health refers to the branch of medicine that focuses on the treatment and diagnosis of diseases and conditions that affect a woman's physical and emotional well-being.

Health is an important factor that contributes to human wellbeing and economic growth.

Currently, women in India has to face numerous health issues, which ultimately affect the aggregate economy's output. Addressing the gender, class or ethnic disparities that exist in healthcare and improving the health outcomes can contribute to economic gain through the creation of quality human capital and increased levels of savings and investment.

Family Planning

Family planning enables people to make informed choices about their sexual and reproductive health. Promotion of family planning – and ensuring access to preferred contraceptive methods for women, girls and couples – is essential to securing the well-being and autonomy of women, while supporting the health and development of communities.

  • Benefits of contraception
  • Preventing maternal morbidity and mortality
  • Reducing unsafe abortion from unintended pregnancies
  • Reducing newborn and infant mortality
  • Helping to prevent HIV/AIDS
  • Empowering people and enhancing education
  • Reducing adolescent pregnancies
  • Contributes to Economic Growth

Methods of birth control-

 Abstinence

In the context of pregnancy prevention, abstinence is defined as not having vaginal sex. People may abstain from vaginal sex, even after they have previously been sexually active.

It is the only sure way to prevent pregnancy and protect against sexually transmitted infections (STIs), including HIV.

Barrier method:

Female condom

This condom is worn by the woman inside her vagina. It keeps sperm from getting into her body. It is made of thin, flexible, manmade rubber and is packaged with a lubricant. It can be inserted up to 8 hours before having sex. One should use a new condom each time they have intercourse. One should not use both female and a male condom at the same time.

Male condom

Male condoms are a thin sheath placed over an erect penis to keep sperm from entering a woman's body. Condoms can be made of latex, polyurethane, or "natural/lambskin". The natural kind do not protect against STIs. Condoms work best when used with a vaginal spermicide, which kills the sperm. And one need to use a new condom with each sex act.

Condoms are either  lubricated or nonlubricated.

Lubricated, which can make sexual intercourse more comfortable.

Non-lubricated, which can also be used for oral sex. It is best to add lubrication to non-lubricated condoms if you use them for vaginal or anal sex.  Person can buy them at the drug store. Oil-based lubricants like massage oils, baby oil, lotions, or petroleum jelly will weaken the condom, causing it to tear or break.

Department of Family Welfare has been procuring condoms with effect from 1994-95. Under the free distribution scheme, condoms under brand name 'Nirodh' are made available to acceptors free of charge through primary health centers and subcenters in rural areas and through hospitals, dispensaries, MCH centers. 

Misconceptions about male condom can be seen at Hum do under Nirodh

Oral contraceptives

Oral contraceptives - combined pill ("The pill")

Combined Oral Contraceptives (COCs) contains two hormones (estrogen and progestin) to prevent pregnancy from taking place by stopping ovulation (release of an egg from the ovary). It makes the mucous of the cervix thick making it hard for sperm to get into the uterus. It prevents pregnancy by changing the lining of the uterus making it unlikely for the fertilized egg to be implanted. A pack of oral contraceptive pill contains 28 pills (21 hormonal and 7 non-hormonal (iron). A pill is to be taken every day, the reminder for which is also marked on the COC pack. Under National Family Planning Programme it is available as Mala-N at all public health facilities.

The birth control pill also helps in multiple other ways:

  • Regular use of Mala-N makes periods regular, lighter and less painful.
  • It may also help with premenstrual and menopausal symptoms.

Chhaya-

Chhaya or Centchroman is a non-hormonal pill that needs to be taken twice a week for first 3 months and once a week thereafter. It is a safe and effective method and can be given to breastfeeding mothers. During the first three months of taking Chhaya, women may notice lighter or irregular periods. This should be no cause of worry; as menstrual cycle gets normal once the body gets used to the pill.

Emergency contraceptive pills

Ezy Pill or Emergency contraceptive pills, also known as ‘ECPs’ or ‘morning after pills’, are birth control measures for women that may be used in the event of unprotected sexual intercourse to prevent pregnancy. These pills are available with healthcare providers and at public healthcare facilities. It can be taken within 72 hours of the unanticipated and/or unprotected sex. It does not cause an abortion if pregnancy has already taken place.

Misconceptions about oral contrceptives can be seen at Hum do under Mala-N and Ezy Pill.

Injectable Contraceptive MPA
(Under Antara Programme)

Injectable contraceptive is an effective method of contraception that can be injected subcutaneously or in the muscles (usually buttock or upper arm). It prevents pregnancy from taking place by releasing progestogen in the body. Each dose of injectable contraceptive prevents pregnancy for three months. Currently intramuscular variety of Injectable contraceptive is available at government facilities, free of cost.
It is a safe method for maintaining spacing between pregnancies. It can also be used by breastfeeding women (after 6 weeks of delivery) as it does not affect the quantity, quality and composition of breast milk. It reduces blood loss during periods, decreases menstrual cramps and also reduces pre-menstrual tension.

Misconceptions about Injectable Contraceptive can be seen at Hum Do under Injectable Contraceptive.

IUCD/PPIUCD

Intra Uterine Copper Device (IUCD) is a small device made of plastic and copper that is inserted into the uterus (womb). It has two threads at the end, which hang through the entrance of uterus (cervix) into the upper part of vagina. IUCD prevents sperm and egg from meeting and prevents the implantation of fertilized egg in uterine activity. It is effective immediately and provides long-term protection. An IUCD does not cause an abortion.

There are two types of IUCDs:

  • IUCD 375 which is an inverted U-shaped device which provides protection for 5 years
  • IUCD 380-A which is a T-shaped device which provides protection for 10 years

IUCD is an effective method to prevent unwanted pregnancies and there are three methods of IUCD insertions:

Post Partum IUCD (PPIUCD) is the most convenient method and it can be inserted immediately i.e. within 48 hours after giving birth.

Interval IUCD which can be inserted in the uterus at any time of menstrual cycle (after ruling out pregnancy) or it can be also be inserted after 6 weeks of giving birth.

Post Abortion IUCD (PAIUCD) which can be inserted after an abortion.

IUCD Misconceptions can be seen at Hum do under IUCD/PPIUCD.

Sterilization

Sterilization is a permanent procedure to prevent pregnancy. For providing quality care in family planning, a revised ‘Standards on Female and Male sterilization' has been prepared by MOHFW. By following these guidelines, a person can be selected for sterilization.   

Case selection for sterlisation

  • Clients should be married (including ever-married).
  • Female clients should be below the age of 49 years and above the age of 22 years.
  • The couple should have at least one child whose age is above one year unless the sterilization is medically indicated.
  • Clients or their spouses/partners must not have undergone sterilization in the past (not applicable in cases of failure of previous sterilization).
  • Clients must be in a sound state of mind so as to understand the full implications of sterilization.
  • Mentally ill clients must be certified by a psychiatrist, and a statement should be given by the legal guardian/spouse regarding the soundness of the client’s state of mind

The consent of the spouse is not required for sterilization.

Detailed information can be seen atwww.nrhmtn.gov.in/modules/Guidelines%

Female Sterilization

Female sterilization is a permanent procedure to prevent pregnancy. It works by blocking the fallopian tubes (tubes connecting ovaries to uterus). Sterilization is a viable option for women who decide not to have any more children. Sterilization does not give protection from Sexually Transmissible Infections (STIs). The best way to lessen the risk of STIs is to use barrier methods such as condoms.

There are two methods of female sterilization:

  • Interval Sterilisation which can be done any time after ruling out pregnancy and at any time after 6 weeks of giving birth.
  • Post partum sterilization which can be done within 7 days after giving birth.
  • Sterilization with medical termination of pregnancy (MTP) can be performed concurrently.

Misconceptions about female sterlisation can be seen at Hum do under Female Sterilization.

Male Sterilisation

Male sterilization is a permanent method of contraception for men. It works by blocking the Vas (tubes connecting testicles to urethra). After vasectomy procedure, there is no sperm in semen. While testicles still produce sperm, it is not transported outside the testicles and is instead absorbed by the body. There are two methods of male sterilization:

  • Conventional Vasectomy which requires an incision.
  • Non-Scalpel Vasectomy (NSV) which does not require an incision and is a simple, safe, sound, short, stitch less and scalpel less procedure. It takes only 5-15 mins to perform and the beneficiary can walk out within 10 minutes after the operation. It does not interfere with manual labour of any kind nor does it affect a person’s sex drive.

Misconceptions about NSV can been seen at Hum do under Male Sterilization.

What are the common issues faced by women?

Some of the sociocultural factors that affects women and girls to attend best possible level of health include:

  • social norms that hamper education and paid employment opportunities;
  • an exclusive focus on women’s reproductive roles not overall health;
  • more susceptible to physical, sexual and emotional violence; and
  • unequal power relationships between men and women and effects of poverty.

There are varied issues related to women’s health from pregnancy and menopause to gynecological conditions. Health care during pregnancy and related problems are mentioned in pregnancy section.

Gynecological health and disorders- Abnormal Uterine Bleeding,

Breast Cancer / Carcinoma,  Cervical Cancer,  Fibroids, Infertility, Mastitis, , Post Menopausal Bleeding,  Polycystic Ovary Syndrome (PCOS),  Premenstrual Syndrome Sexually Transmitted Infections

Issues related to women’s overall health and wellness  include violence against women, women with disabilities and their unique challenges, Osteoporosis, Chronic obstructive pulmonary disease (COPD), non communicable diseases.

Malnutrition

Nutrition plays a major role in an individual's overall health. Psychological and physical health status is often dramatically impacted by the presence of malnutrition. 

Maternal malnutrition has been associated with an increased risk of maternal mortality and also child mortality. Addressing the issues of malnutrition would have a beneficial outcomes for women and children.

In India, a third of women of reproductive age are undernourished. Maternal malnutrition has been associated with an increased risk of maternal mortality and low birth weight babies.

National Iron Plus Initiative for Anemia Control implemented by Ministry of Health and Family Welfare, Government of India provides iron supplementation to children adolescents and pregnant and lactating women and women in child wearing age. (www.nhp.gov.in/national-iron-plus-initiative-for-anemia-control_pg)

Information about healthy diet can be seen at www.nhp.gov.in/healthlyliving/healthy-diet

Maternal health

Maternal health refers to the health of women during pregnancy childbirth and postpartum period. The major direct causes of maternal mortality and morbidity are:

India contributed to nearly 20 percent of all maternal deaths worldwide between 1992 and 2006. The primary reasons for the high levels of maternal mortality are directly related to disparities of economic conditions and cultural constraints limiting access to care.

However, maternal mortality is not identical across all of India or even a particular state urban areas often have lower overall maternal mortality due to the availability of adequate medical resources. For those states where there is higher literacy and growth rates tend to have greater maternal health and also lower infant mortality.

Maternal mortality ratio (MMR) in India has decreased by 77%, from 556 per 100 000 live births in 1990 to 130 per 100 000 live births in 2016.

Skilled care before, during and after childbirth can save the lives of women and newborn babies. Promotion of institutional deliveries, Pradhan Mantri Surakshit Matritva Abhiyan, various other programmes through RMNCHA strategy and commitment to provide universal health coverage, strengthening of health care delivery system are helpful in reducing maternal and infant mortality in the country.

Mental health

Some mental disorders are more common in women than men such as depression and anxiety. Certain disorders are related to hormonal changes such as Premenstrual Syndrome, perinatal depression, perimenopause related depression

Suicide

Suicide is a major problem in India and further the rate of suicide has been found to be higher in women as compared to men. India accounted for 36·6% of the global suicide deaths among women and 24·3% among men in 2016 with 18% of the world’s population living in India

The most common reasons for women's suicide is directly related to:

  1. Depression
  2. Anxiety
  3. Gender discrimination
  4. Domestic violence

The suicide rate is particularly high among female sex workers in India, who face numerous forms of discrimination for their gender and line of work.

Domestic Violence

Domestic violence is a major issue in India. Domestic violence defined as acts of physical, psychological, and sexual violence against women is found across the world and is currently viewed as a hidden epidemic by the World Health Organization. 1 in 3, or 35%, of women have experienced physical and/or sexual violence by an intimate partner or non-partner sexual violence.

As per reports of India National Family Health Survey III (2005-2006), 31 percent of all women reported having been the victims of physical violence in the last 12 months. However, the actual number of victims may be much higher. The study found that the poorest women faired worst among middle and high-income women.

As per reports of India National Family Health Survey IV (2015-2016), thirty percent of women have experienced physical violence since age 15, and 6 percent have ever experienced sexual violence in their lifetime. Four percent of ever-pregnant women have experienced physical violence during any pregnancy.

Violence adversely affects women’s physical, sexual and reproductive, and mental health. WHO together with other agencies developed the strategies that are summarized in R.E.S.P.E.C.T, with each letter representing one strategy.

R – Relationship skills strengthened.

E – Empowerment of women.

S – Services ensured.

P – Poverty reduced.

E – Environments made safe.

C – Child and adolescent abuse prevented.

T – Transformed attitudes, beliefs and norms.  

For women related legislation in India- Click here  https://wcd.nic.in/act/2314

How Indian women are being treated in the work environment?

Working and employment conditions are different for different sexes. Majority of women working are exposed to risks of infection, violence, musculoskeletal injuries and burn out. Women generally suffer discrimination and harassment more often then men, especially non-traditional occupations.

http://www.who.int/gender/other_health/Gender,HealthandWorklast.pdf

Gender empowerment for India: http://wcd.nic.in/publication/gdigemSummary%20Report/GDIGEMSummary.pdf

Medical tests for Women in 20's and 30's

  • Weighing weight: One should weigh regularly, as too much of it may puts you at high risk for developing a number of diseases later in life.
  • Blood Pressure. It's simple, it's cheap and it's quick.
  • Cholesterol Profile. One should also have a cholesterol test. Everyone age 20 and over should know their cholesterol numbers, and get them checked at least once every five years.
  • For Women Only: Breast Exam, Pelvic Exam and Pap. A clinical breast exam and 10 minutes of mild discomfort from the pelvic exam pays big dividends in protecting from cancer and diseases that can cause infertility. If you've had abnormal Paps in the past, be sure to get a new Pap smear as often as your doctor recommends. For those with no history of an abnormal Pap, a Pap smear can be done every three years, rather than annually.
  • Protecting Your Eyes. You may not have considered this, but at some point before you're 40, visit an eye care provider for an exam.
  • Checking Your Immunizations. Update any immunizations that you might need.

Medical tests for Women in 40's

  • Blood sugar: Decades of eating the wrong food (like coffee, hot dogs, fries can get the picture) plus weight gain (often due to hormonal changes) may have overworked the pancreas. At at age 45, be sure to get a fasting blood sugar test, and then again at least once every three years.
  • Breast exam and mammogram: One might be regularly checking breasts at home but still doctor should do an exam annually, but most experts recommend having a mammogram test done after age 40.
  • Blood pressure: Blood pressure may rise with the increasing age that's common. Fortunately, one can lower his/her blood pressure through diet, exercise, and medication.
  • Weighing one's weight: Taking care of weight is another factor as overweight can put one at high risk for developing a number of diseases, including diabetes and heart disease.
  • Pelvic exam and pap: A women should get this test done especially if she is sexually active. 
  • Looking for moles: Unusual moles or skin changes can leads to cancer but these are curable. if diagnosed at an early stage.
  • Protecting ones eyes: Having trouble reading or working at the computer? It's not unusual. After 40 make sure to get eyes examined regularly every two years until age 60  to check for common problems like presbyopia, glaucoma and many more.
  • Checking for regular immunizations: Ask your doctor if you need a tetanus booster shot, flu shot, or pneumonia vaccine.

IEC Material on Women's Health

External Links/References