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)
• Unwanted / Unplanned pregnancies
• STI & AIDS
• Pregnancy Complications
POST REPRODUCTIVE (45 YEARS & ABOVE)
• Gynecological Malignancies
• Cardiovascular diseases
• Diabetes Mellitus
• Gender Violence
• Enviornmental and occupational hazards
• Sex selective
• Cannot benefit
• Turnpike sex
• Smoking and
• Increase in
quality of life
• Social pressure
• Increase in
• 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
HEALTH CHALLENGES IN WOMEN
• YOUNG ADULTS UNMARRIED
• YOUNG MARRIED ADULTS
• OBSTETRICAL CHALLENGES
• FAMILY PLANNING
Women’s health a major development task for us
An unfinished agenda in our country
Challenges include reducing
Sexually transmitted infection ( HIV, AIDS,HPV)
Female feticide & Violence against women.
Gender Based Health
What Remains to be
Improved in Women’s
• India accounts for 20% of maternal deaths.
• Every minute one women dies of pregnancy
• MMR is 330/ 100,000 live births.(Improving)
still we are far from M D GOALS
• Greater than Bangladesh & Pakistan
• 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.
• 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
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
• 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.
• Improving diet supplimentation of pregnant and lactating
• Health care providers and skilled midwife.
• Strengthening referral system for effective management of
• Tertiary level centers fully equipped.
• Uncontrolled fertility / Sexually transmitted
Unequal power between men and women in
sexual relationship exposes women to
involuntary exposure to sex, sexually
transmitted infections and unwanted
• Empowering women with
• Family planning and
• Sex education of young
• 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
“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
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 China-
•21 of 31 (%67.7)
higher ratio than
sex ration at
•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
• Support services
• Raise awareness
• Mobilize support
Quality of care where health services are
available and affordable
• 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.
• Ante- natal services
• Basic Ante-natal care
• Prompt detection/Management and referal of
• TT Injection
• Iron and folic acid supplementation
• Treatment of other associated infection
• 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
• Preterm labor
• Preterm Rupture of membranes
• Fetal Death
• Skilled birth attendant
• Timely detection and referral of
• Tertiary level Obstretics care
• Family planning services
• Monitoring for post-partum sepsis
Preventing unwanted pregnancy
• Emergency contraception
• Medical termination of
• Management of unsafe abortion
• Post- abortal contraception
planet earth is getting heavier
THE “BOMB” HAS EXPLODED IN
POPULATION CONTROL EXPRESS
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
“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
• Perimenopausal women and oral
contraceptives…can help smooth the ride of
the ovarian roller coaster during
• Teenagers and young adult women…what’s
old and what’s new in the world of oral
What are the benefits of OCs? Besides the
• Reduce the risk of ovarian cancer
• Treating dysmenorrhea
• Treating endometriosis
• Treating PCOS
• Treating acne
• Reducing estrogen deficiency symptoms in perimenopausal
• Continuous and extended cycle OCs may improve mood,
reduce headaches and increase quality of life…
• Long term effects of continuous regimens? Not
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
• 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
• Symptomatic management
• Screening and treatment
• Screening for cervical
• STI treatment education.
• Social marketing of
• Voluntary testing of HIV
• Women controllerd barrier
methods for preventing STI
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
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
When will boys get the HPV
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
• HPV, HSV, HIV, GC, Syphilis
Violence and Women
Today one of every 3
women are subjected
to different forms of
(Heise, Ellsberg, Gottemoeller, 1999).
• "...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."
Discrimination against women
A systematic weapon : Rape
• In South Africa every 83
second one woman is
rapedA report by the U.N.
• 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
WHO, Sexuel violence in conflict setting and the risk of HIV, 2004.
Integrated Regional Information
In the World
• Completed rape at least
once during the life of
women completed rape
• 12-25 percent of all adult
women have been
specified that they were
victims of sexual
haresment or attempted
Koss et al.,1997; Killpatrick et al.,1992; Randall and Haskell, 1995
Eradication of social problems
• Law, public education and services to
– Domestic violence
– Sexual assault
– Forced prostitution
– Early childhood marriages
• Strict regulation of use and abuse of medical
Let’s move into perimenopause…
• Transitional state from reproductive years to
postmenopausal years—length is variable--3 to 10
• 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
• 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
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
Don’t forget your calcium and vitamin D
• The Coppertone girl
To summarise…… Women
• 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.
Empowered people choose the number and timing of their births, using
methods and providers of their choice.
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
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