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.
|
