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CHALLENGES IN WOMEN'S HEALTH

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CURRENT CHALLENGES IN WOMEN'S HEALTH,W

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

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    CHALLENGES IN WOMEN'S HEALTH CHALLENGES IN WOMEN'S HEALTH Presentation Transcript

    • CURRENT HEALTH CARE CHALLENGES IN ADULT WOMEN'S HEALTH Narendra Malhotra Jaideep Malhotra Neharika Malhotra Bora www.rainbowhospitals.org mnmhagra3@gmail.com
    • Women’s Health Issues—From Womb to Tomb
    • LIFE CYCLE OF WOMEN & HEALTH ISSUES INFANCY AND CHILDHOOD(0-9 YEARS) • • • • Sex selection Genital mutilation Discriminating nutrition Discriminating Health care
    • ADOLESCENCE ( 10-15 YEARS) • • • • Early child bearing and abortion STD & HIV Infection Undernutrition and Anemia Increase substance abuse
    • REPRODUCTIVE AGE(20-44 YEARS)Unplanned pregnancies • Unwanted / • • • • Abortions STI & AIDS Pregnancy Complications Anemia
    • POST REPRODUCTIVE (45 YEARS & ABOVE) • • • • • Gynecological Malignancies Cardiovascular diseases Osteoporosis Osteoarthritis Diabetes Mellitus LIFE TIME • Gender Violence • Enviornmental and occupational hazards • Depression
    • • • • Violence • Neglect Social pressure • Cannot benefit Increase in from the morbidity services ADOLESENT/ADULT OLDERS CHILDHOOD • Unwanted • Increase in • Sex selective pregnancies, STDs morbidity abortion • Sexual /problems on • Female harassment/abuse quality of life mutilation • Turnpike sex • Nutrition • Smoking and problems substance abuse
    • 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.
    • 7 Dimensions of Wellness Social environmental Occupational Spiritual Intellectual Emotional Physical
    • HEALTH CHALLENGES IN WOMEN • • • • • • • • • • INTRAUTERINE INFANCY CHILDHOOD ADOLESCENT YOUNG ADULTS UNMARRIED YOUNG MARRIED ADULTS OBSTETRICAL CHALLENGES FAMILY PLANNING PERIMENOPAUSAL MENOPAUSAL
    • 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.
    • Gender Based Health What Remains to be Improved in Women’s Health?
    • 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
    • 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.
    • 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
    • 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.
    • 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.
    • • 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.
    • PREVENTION • Empowering women with education and employment. • Family planning and sexual counselling. • Sex education of young adolescents. • Promotion of mutual consent and condom uses.
    • • Female feticide, Domestic violence, rape and sexual abuse occur in all regions, class and age. Affects 30% women worldwide.
    • “Have a son and your name continues!”
    • “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.
    • 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 .
    • Sex distribution for 0-6 years of age in India 1000 1000 1000 980 960 940 920 Girl 945 900 927 880 Boy Boy Girl 1991 2001 Oomman N, Ganatra BR., Sex selection: the systematic elimination of girls. Reprod Health Matters. 2002 May;10(19):184-8.
    • Sex ratio at birth in China1995 In CHINA: 120 •21 of 31 (%67.7) provinces have higher ratio than 108.0 (expected sex ration at birth) 115 •40 million single men by 2020 90 110 105 117,4 116,7 100 95 Guangxi Zhejiang 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.
    • PREVENTION • • • • • • Law Counselling Support services Medicare Raise awareness Mobilize support
    • 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.
    • 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
    • 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.
    • The Challenge of Obstetrics THE GREAT OBSTETRICAL SYNDROME
    • Obstetrical Disease • Preterm labor • Preterm Rupture of membranes • Pre-eclampsia • SGA/IUGR • Fetal Death
    • Disease Treatment Preterm labor Tocolysis Preterm PROM Pre-eclampsia IUGR Expectant management Antihypertensive agents Delivery
    • 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
    • Preventing unwanted pregnancy • Emergency contraception • Medical termination of pregnancy • Management of unsafe abortion complications • Post- abortal contraception planet earth is getting heavier
    • POPULATION EXPLOSION THE “BOMB” HAS EXPLODED IN DEVELOPING COUNTRIES POPULATION CONTROL EXPRESS HAS DERAILED
    • 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
    • “It take many nail to build crib…only one screw to fill it…” What is the best way to prevent pregnancy? “Contraceptives should be used at every conceivable occasion.”
    • 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?
    • 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?
    • 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.
    • 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.
    • Prevention of RTI & STI • Promotion of barrier contraception and distribution • Symptomatic management of RTI • Screening and treatment of sex-workers • Screening for cervical cancer
    • INTERVENTIONS • STI treatment education. • Social marketing of condoms. • Voluntary testing of HIV and counselling. • Women controllerd barrier methods for preventing STI / pregnancy.
    • 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
    • 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…
    • 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?
    • 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?
    • Violence and Women World scale: Today one of every 3 women are subjected to different forms of violence. (Heise, Ellsberg, Gottemoeller, 1999).
    • Discrimination against women • "...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)
    • 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 BosniaHerzegovina between 20 000 and 50 000 women were raped Integrated Regional Information Networks (IRIN) WHO, Sexuel violence in conflict setting and the risk of HIV, 2004.
    • 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
    • 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
    • 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
    • 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)
    • 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.
    • 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!
    • Don’t forget your calcium and vitamin D • The Coppertone girl
    • 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
    • Vision Empowered people choose the number and timing of their births, using methods and providers of their choice. Women empowerment,education,employment,environment
    • some of our social initiatives
    • FOGSI CSR FOR VSR FOR WOMEN
    • 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
    • Questions
    • BE SURE TO BE HERE AT 8 AM IN MORNING TOMORROW FOR YOUR STRESS TEST AND YOUR DOSE OF AROMATHERAPY
    • THANK YOU