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Gender and Population

Empowerment and Population Stabilisation
The word empowerment is often narrowly defined in terms of women's education and employment, both of which have a positive but limited impact on a women's life. Empowerment means a lot more.

It is the ability of a woman to participate in crucial decision making regarding when she gets married, when and how many children she has and the health services that she uses for herself and her family. All these factors impact on the success of the health and population programmes.

Focus on men in Population programmes
Men need to be involved in health and population programmes for the following reasons:

  • Men play an important role in decision making at home and are often better positioned than women to take a decision regarding family size, contraception or caring practices

  • Non-Scalpel vasectomy is convenient and easy option for male sterilization.

  • Condom is a non-intrusive and safe method providing dual protection against diseases as well as pregnancy. Women in traditional settings find it difficult to negotiate the use of condom with their spouses.

  • Effective treatment of reproductive tract infections and sexually transmitted infections requires participation of both partners.

  • Sharing of child care responsibilities enable women to take up other work opportunities.

Maternal Mortality and the population programme
Maternal mortality is not just about the mother dying from maternal causes. It is an indicator of the value placed on the life and well-being of a woman by society. High maternal mortality indicates that a large number of women go through repeated pregnancies in life threatening conditions of poor nutrition and ill-health. This can be either to meet the demand for a male child or simply because they have no contraceptive options that give them the freedom of not conceiving.

Children born to such women often have low birth weight and are likely to die in the very first year of their birth. This, in turn, puts more pressure on the woman to have more children to compensate for the lost children, often placing her life at risk.

So reducing maternal mortality calls for the same interventions that impact the entire spectrum of mother and child health services. Maternal mortality serves as an indicator not just of pregnancy outcomes, but also of a woman's overall health, empowerment, socio-economic status and the availability of quality health services, which have a big role to play in her ability to exercise contraceptive choices.

It is estimated that atleast 20% of maternal deaths could be avoided every year if all women who seek no more children were able to stop conceiving. Contraceptive use reduces maternal mortality by preventing unwanted and high-risk pregnancies and reducing the need for safe abortions.

Maternal deaths
A normal delivery at home may not be life threatening in itself, but the lack of trained help along with the other attendant factors like poor antenatal care, lack of hygiene and crude methods used by untrained attendants at the time of the delivery can make even a normal pregnancy and delivery into a life threatening experience.

More than 60% of maternal deaths take place immediately following delivery, with more than half occurring within a day of delivery. Most of these deaths can be avoided if post-natal complications are identified in time and addressed by a health worker. While all women delivering at home are entitled to a home visit by a health worker within two days of delivery only 2.3% receive such a check-up.

Around 72% of women die due to five direct causes : excessive bleeding or haemorrhage, infection or sepsis, unsafe abortion, difficult or obstructed labour and pregnancy related high blood pressure. Another 20% of deaths are due to conditions that in association with pregnancy can cause the death of the mother, like malaria, anaemia and increasingly, AIDS.

Unsafe abortions
Abortion is legal in India, and is governed by the Medical Termination of Pregnancy (MTP) Act, which was passed way back in 1975. Under the Act, an MTP is permissible within 20 weeks from the date of conception. The law specifies that an abortion shall not be performed at any place other than a Government hospital or a clinic approved for MTP. In India, about one million abortions are performed annually under the MTP Act.

However, as many as six million illegal abortions are estimated to be performed by a variety of medical and non-medical practitioners, most of whom are unqualified/ untrained and "practice" at uncertified places.

Women seek illegal abortions due to lack of access to certified facilities, ignorance about the danger of unsafe abortions, the desire for secrecy due to the stigma attached to pregnancies out of wedlock, lack of privacy or confidentiality or the insistence by some service providers that contraception be a pre-condition for an abortion.

Illegal abortions are a major cause for maternal mortality in India. Women seeking sex selective abortions, which are illegal, may also end up at unsafe abortion clinics.

What needs to be done to reduce maternal mortality?
The first step to reducing maternal mortality is to ensure quality antenatal, natal and post-natal services that identify high risk pregnancies and provide timely support. Safe delivery practices must be ensured through promotion of institutional deliveries and training of birth attendants as well as by making safe delivery kits easily available to women who still deliver at home.

It is also important to strengthen the management of obstetric complications and increase availability of emergency obstetric services. Sensitising family and community members to the danger of obstetric complications, providing community based transport facilities, and ensuring quality emergency obstetric care at the health centres would greatly reduce deaths due to delayed medical attention at the time of delivery.

Adolescent sexual and reproductive health programmes help the youth adopt responsible sexual behaviour, resulting in less number of teenage pregnancies or unwed pregnancies, which often culminate in unsafe abortions in India due to the stigma attached to pregnancies out of wedlock. Providing easy access to safe abortion services would help women terminate unwanted pregnancies without risking their lives. Efficient contraceptive service delivery also goes a long way in avoiding unwanted pregnancies and illegal abortions.

Improvements in the overall health and nutritional status of the girl child and woman are equally important in improving the survival chances of women during pregnancy. The dominant cultural mores and practices often undermine the health and nutritional requirements of a woman. As a result, women are not encouraged to actively seek services often with disastrous consequences. Hence, there is a need to work at the individual, family and community level to bring a change in mindset so that society comes to regard a woman, more so a pregnant woman, as a person deserving the highest priority.

How is antenatal care important for mother and child survival?
Antenatal care covers at least five basic services - pregnancy monitoring, tetanus toxoid vaccine, iron and folic acid tablets (IFA) and nutrition/ safe delivery counselling. These can help women go through the pregnancy safely and ensure that the new born is in good health.

However, many women are not able to access these basic services, resulting in avoidable complications like anaemia, night blindness, babies with low birth weight or delivery related haemorrhage.

The impact of antenatal care on the health and survival of the mother and the child cannot be overemphasized. States which reach out good antenatal care show a marked decline in infant mortality.

Home deliveries in India.
The weakest sections of Indian society are unable to access institutional facilities for deliveries. More than 80% of women delivering at home are illiterate and have a low standard of living. Around 75% of the women delivering at home live in rural areas.

Various factors influence the decision of these women to deliver at home. The major reason relates to service delivery. Most health centres are far from the village. Reaching the facility is difficult in the absence of good roads and transport. Besides, health centres are often lacking in basic amenities like water, working toilets and canteens. Sometimes the attitude of the health workers is reported to be unhelpful. Since most medical staff do not stay at the distant health facilities, they are often not available when the woman requires their services.

On the other hand, delivering at home is more convenient for women from poor rural households, who have other children and household chores to attend. This entails minimum disruption on the home front, tipping the balance of convenience in favour of home deliveries.

The National Rural Health Mission and the Janani Suraksha Programme seeks to overcome these impediments to safe motherhood by actively promoting transportation to a fixed facility and payment for institutional delivery, including cesarean operations.

 
 
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