Journal 2018 (Publication 2)
International Peer-Reviewed Journal
RESEARCH HORIZONS, S.R. NO. 2, VOL. 8 NOVEMBER 2018
NEED FOR CHANGE IN REPRODUCTIVE
HEALTH CARE SYSTEM IN INDIA
Dr. Twinkle Sanghavi*
ABSTRACT
Every society for their existence is dependent on the next generation, to whom they will pass their
culture, heritage and most importantly their identity. Though the baggage of reproduction is on
the shoulder of the women, unfortunately while making policies or making use of new reproductive
technology, women are kept a side, they are not given much importance. The impact of reproductive
technology has not only affected women health but has also affected the child’s health too. Today
also the registered infant and maternal mortality rate is not less. This paper basically addresses
the women well being and there by the well-being of the society and also tries to find the loopholes
in the existing family planning policies.
Keywords : Women, Reproductive Health, Child, New Reproductive Technology.
Introduction
Motherhood in all section of society is given immense importance; generally, on one hand the elite
class has access to the all kind of facilities and a service of good reproductive health care, but on the
other hand there is majority of the population, who are dependent on the government for their health
issues. The reproductive health issue has many sub issues that one needs to address i.e.
malnourishments, infant mortality, maternal mortality, care during pregnancy, care after pregnancy
etc.
The comprehensive approach to reproductive health demands increased awareness on methods of
family planning, maternal health, neonatal morbidity and a growing burden of reproductive ill health
resulting from reproductive tract infections, including sexually transmitted infections, HIV/AIDS, infertility
and the adverse effect on gender-based violence. In order to provide a common scientific platform
for all these specialties and to promote reproductive health research, The Indian Society for the
Study of Reproduction and Fertility (ISSRF) was established in 1988. Over the years, the mandate of
the Society has broadened and now includes various multidisciplinary components of reproductive
health.
Reproductive Health was given an international consensus definition at the International Conference
on Population and Development (ICPD) in 1994. At its core is promotion of reproductive health,
voluntary and safe sexual and reproductive choices for individuals and couples, including decisions
on family size and timing of marriage. Sexuality and reproduction are vital aspects of personal
identity and are fundamental to human well-being fulfilling relationship within diverse cultural contexts.
Sound reproductive health is integral to the vision that every child is wanted, every birth is safe,
every young person is free from HIV, and every girl and woman is treated with dignity. Implicit in this
vision is the idea that men and women will be able to exercise their rights to information on and
access to safe, affordable and acceptable methods of fertility regulation as well as quality health
care services. The latter will enable women to experience safe pregnancy and childbirth, across the
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RESEARCH HORIZONS, S.R. NO. 2, VOL. 8 NOVEMBER 2018
world. Poor women, especially in developing countries, suffer disproportionately from unintended
pregnancies, maternal death and disability, sexually transmitted infections including HIV, gender-
based violence and other problems related to their reproductive system and sexual behavior.
Review of Literature
The available review of literature shows that, the urban population in India is one of the largest in the
world. Its unprecedented growth has resulted in a large section of the population living in abject
poverty in overcrowded slums. In the view of National Family Health Survey 2005 which provides a
national overview of women’s reproductive health within the slum population in India (among other
parameters), it was found that among slum women, not all deliveries are not done by skilled persons,
and several children are delivered at home. Cost, literacy, economic conditions, and the age of the
woman all play a role in determining whether the child is born at home or in a hospital. Many slum
women depend on municipal and government hospitals for healthcare, and they may not consider
reproductive health a priority. Even basic neonatal care can be inaccessible (Hazarika, 2010). Health
facilities at the community level are poorly equipped to deal with gynecological and obstetric
morbidities, since they have neither the diagnostic facilities nor the drugs to treat them. Moreover,
service providers are not trained to detect such morbidities nor to provide sensitive counseling (Satia,
et.Al., 2013). The prevailing order of gender discrimination also plays a very crucial role in the
reproductive health of women, as most home-bound women do not receive adequate nutrition, are
uneducated, and are not taught to take care of their health (Namasivayam, et.al., 2012). Verma and
Gupta have examined the push and pull factors that are responsible for the growth of medical tourism
industry in India (2008). They argue that the private sector has played an important role in popularizing
medical tourism. As Dr. Amit Sen Gupta (2008) writes, “Where is logic of govt. spending energy and
efforts to attract foreign patients for private sector when an overwhelming majority of patients in India
have inadequate access to health care.” Sinha (2008) has expressed concern about the long-term
repercussions of medical tourism in India, as it is well known that the healthcare system in India is
insufficient and requires government intervention to meet increasing needs. On the other hand, high-
end healthcare tourism is accessible only to those who can afford it; it is out of reach for most Indian
citizens. This can lead to severe negative outcomes for the poor of the country. The medical fraternity
has a moral responsibility towards society. In addition to catering to the needs of foreign patients,
they should also work out treatment expenses such that even a common man can afford it. There is a
grave need to develop a clean approach and to regulate the private sector; revenue must be generated
by taxing medical tourism heavily, and this revenue should be used to improve health in the country.
Research Methodology
This article includes primary as well as secondary data. Under secondary data various books, journals
and reports are being referred, whereas under primary data information gathered was during the
interview of the expected mothers, the purposive sample of 10 women was taken under studies.
The main objective under research is to understand the gap between the accesses to the proper
reproductive health care for the women, specially living on or below poverty line and the policies that
are designed keeping them in mind but doesn’t reach to them.
Government policies/ Programmes
In 1951, India became the world’s first nation to launch a family planning programme. Decades later,
when the International Conference on Population and Development prompted a paradigm shift in
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population programmes, with the advocacy of client-centered and quality-oriented reproductive health
approaches, India formulated appropriate policy and programmatic responses
·
·
·
The National Population Policy was formulated in the year 2000. It affirms the government’s
commitment to promote voluntary and informed choice, and continuation of the target-free
approach in family planning service delivery.
The National Rural Health Mission (NRHM) was launched in 2005. It aims to revamp the public
healthcare delivery system and seeks to provide accessible, affordable and quality healthcare
to rural population.
A national level Reproductive and Child Health Programme II (RCH II) was introduced in 2005
and focuses on addressing reproductive health needs of the population through evidence-based
technical intervention through wide range of service delivery network. There is implicit emphasis
on addressing the equity dimension in coverage, while maintaining focus on quality.
·
Conditional Cash Transfer schemes like Janani Suraksha Yojana (for promoting institutional
deliveries) were introduced to help address economic barriers for access to services.
Issues in reproductive Health
Reproductive health is a good starting point for addressing gender issues. Before going in the depth
of the problem let us understand what is reproductive health? A reproductive health orientation
means that people have the ability to reproduce as well as to regulate their fertility; that women are
able to undergo pregnancy and childbirth safely; that obstetric and gynecological disorders are
addressed; that the outcome of pregnancy is successful in terms of maternal and child health and
well-being; and that couples are able to enjoy sexual relations free from the fear of disease.
Reproductive health is affected by a variety of socio-cultural and biological factors on the one hand
and the quality of the delivery system and its responsiveness to women’s needs on the other. A
woman-based approach to reproductive health is one which responds to the needs of adult women
and adolescent girls in a culturally sensitive manner.
The reproductive system in function, dysfunction and disease, plays a central role in women’s health.
Health need of women can broadly divide into four categories as follows
1
)
)
Regarding sexual and reproductive function women has special needs
2
Women’s body has more chances of dysfunction and disease due to complex reproductive
system
3
)
)
Women are also subjected to other diseases related to menstrual syemtem.
4
Women are also subject to social disease which affects their Physical, Social, or Mental health.
Studies indicate that compared to men; women suffer more due to disease as they are the one who
will birth to the next generation. Much work has been done in this regard but they have their obstacles
to achieve them.
The key problem that comes as an obstacle is of the prevailing philosophy on basis of which the
service is provided, women are always considered as means and target in the fertility control. Though
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women benefited but they were not at the centre of the process. The needs of women have been
traditionally addressed within the concept of Maternal and Child Health (MCH) the need of women is
submerged in the need of mother. Though the MCH programme is going to focus on how healthy the
child as successful outcome, this spotlight resulted in less stress given to health risk that women
carrying during pregnancy, childbirth and other functions. As a result, the tragedy of maternal mortality
in developing countries has now reached dimensions that can be no longer ignored.
Reproductive health is an integrated package. Women cannot be healthy if they have one element
and miss another. Various elements of reproductive health are strongly inter-related. Enhancement
in one element can result in improvement in other elements. Similarly lack of improvement in one
element can hinder progress in other elements. For instance, infant and child survival growth and
development cannot be improved without good maternity care. Proper planning of births, including
adequate child spacing is a basic ingredient of any child survival package.
There are some points that one need to keep in mind and they are
A) Reproductive morbidity and maternal health
Unsafe motherhood is still a reality in much of India and particularly in its rural areas. The number of
women who have access to antenatal care is very less and that is why, high risk cases go undetected,
anemia is acute during pregnancy, deliveries are conducted largely by untrained attendants in
unhygienic conditions and knowledge of health and nutrition needs during pregnancy and the post-
natal period are poorly understood. The official programmes for maternal and child health reaches a
few pregnant and lactating women. Maternal health activities are unbalanced, focusing on immunization
and provision of iron and folic acid, rather than on sustained care of women or on the detection and
referral of high-risk cases. Urgently needed is greater insight into underlying risk factors, into why
women’s reproductive health needs remain unmet. Equally important is the need to structure the
reproductive health services to respond to the gynecological and obstetric conditions women
experience, and which take into consideration the social, cultural and economic constraints that
women face in expressing these conditions and in accessing services for them. Health facilities at the
community level are poorly equipped to deal with gynecological and obstetric morbidities, since they
have neither the diagnostic facilities nor the drugs to treat them. Moreover, service providers are not
trained to detect such morbidities; or to provide sensitive counseling. The prevention and treatment
of common women’s health is not complicated and can be treated at the first level of care. What are
needed at the primary health centre level are facilities for routine diagnosis of gynecological conditions,
improved obstetric care, sensitive counseling and sound referral services.
(
B) Understanding the socio-cultural context of abortion
Improving access to safe abortion should also form part of an overall reproductive health strategy.
Despite the fact that abortion is beyond the reach of most poor women, roughly five million abortions
continue to be performed annually; of these, only about half a million abortions are performed under
the health services network while another estimated 4.5 million occur illegal. And the growing tendency
to misuse complicated prenatal diagnostic techniques to abort female fetuses suggests the disturbing
possibility of increased abortions and repeat abortions. As a result, complications resulting from
unsafe abortion exact a heavy toll, and constitute a major source of reproductive mortality and morbidity:
over 10 percent of all maternal deaths are due to abortions. Safe abortion services are available only
in urban areas since registered practitioners are rarely available in rural areas: in 1984, for example,
only about 1000 physicians of a total of roughly 15000 doctors trained to perform abortions worked in
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rural areas. There is limited publicity about the law and there is a widely held perception that abortion
is illegal. The quality of abortion services and cares at approved centers can be impersonal and
intimidating.
(
C) Infertility
Very minute evidence is available on infertility. There are many factors responsible for infertility amongst
women amongst them some of them are women’s poor health and nutrition status which can lead to
repeated miscarriages and fetal wastage, unhygienic obstetric and abortion procedures and even
such debilitating diseases as tuberculosis. Our society has given immense importance to fertility.
Infertility can have serious effect on women as she fails to achieve her desired family and exposing
her to various kinds of emotional harassment or marital disharmony. Women have to bear the burden
of social, medical harassment even if it’s male’s infertility that stops her from reaching to fertility. We
lack health services which are comprehensive enough to provide access to reliable information,
sympathetic counseling and services to infertile couples. What is required is a sound referral system
for infertile couples, along with primary health care which can provide basic information and
counseling.
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D) Sexually transmitted diseases and AIDS
Reproductive health in India is very poorly understood. Primarily, in the Indian context socio- cultural
norms, beliefs practices play a major role in making women more venerable to reproductive health
problems. In many cases if women raise any question related to HIV or STD they are considered as
characterless and hence these women take STD as their destiny, and do not seek any medical help
for the same. Though the child marriage are no longer practice in the breath the way it used to be
which has helped in decreasing many problem of women, the problem with early marriage and
childbearing is that young girls are often not adequately prepared with information regarding
reproductive and sexual health issues, including sexual intercourse, contraception, sexually transmitted
infections and diseases. The reproductive health concept is not limited to mothers nor is it limited to
women in the childbearing age. Urgently needed is a primary health care system which caters to the
growing problem of STDs; counseling and recommendation at the marginal level along with improved
diagnostic facilities at the primary health centre level. At the same time, not enough has been done to
educate the larger population - and especially isolated, invisible and powerless women - about STDs
and HIV/AIDS, their prevention, symptoms, modes of transmission and treatment. On the one hand,
strategies need to be devised, which are sensitive to women’s lack of control over sexuality and
which can provide information at the doorsteps of secluded women. On the other hand, strategies
need to be devised to inform, sensitize and communicate with men, and particularly young men. Men
are an important audience for such communication, both in their own interests and because of the
role they play in conveying information—and disease—to women. Young and adolescent males are a
highly vulnerable group, generally ignorant of STDs and their prevention and information strategies
need to include these groups.
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E) Malnutrition
While nutrition and iron supplementation programmes for pregnant and lactating women do exist,
the little available evidence suggests that they neither reach their intended populations, nor have
been successful in reducing the prevalence of anemia among those they do reach. Traditionally our
elders in the house give suggestion on what to it during pregnancy for betterment of child’s health,
but very few will talk about the things to eat before one conceives, afterbirth also lactation is given
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more attention than the mother. In some cases, as women are even compelled to eat particular food
for all nine months for the preference of ‘boy child’. There is a lack of approach which can educate
people for right food and women’s right time to get pregnant and that is why many mothers cannot
feed their children due to lack of nourishment.
(
F) The situation of adolescents, particularly adolescent girls
The National Population Policy- 2000 has recommended adolescents as an underserved vulnerable
group that need to be served especially by providing productive health information and services.
Most of the adolescent reproductive health programs focus on the 15-19-year-old age group. There
is an increasing need to focus on 10-14-year group. What is therefore urgently required for both
adolescent girls and adolescent boy programmes which help deal with their own well-being, their
health, their bodies.
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G) Contraceptives
Lots of research has taken place for controlling the population, new techniques and contraceptives
are invented but unfortunately it has made women more of gunie pig of trying all methods for marketing
them in the market. There are very few contraceptives which has proved useful majority has one or
the other problem. The availability of I pill which was good for those women who took with little
precaution, but has proved disaster for young girls who used it without any proper information.
Above mentioned issues and many other issues need to be included in reproductive health care
services.
Conclusion
It has been very well-established fact that gender- sensitive approaches is necessary to understand
and respond to different needs and constrains of individuals based on their gender and sexuality,
like counseling in which women are convinced to use other contraceptive preferably man oriented.
The strategic need can be met by increasing the focus on gender- sensitive services, reproductive
health programme. By modifying the gender relations and power in a community gender equity can
be brought.
Thus, the reproductive health care programmes must be designed with gender perspective which
takes into account the varied gender roles, social and economic relationship and needs, access to
resources and other constraints and opportunities imposed by society or cultural, age, religion, on
both men and women. The following point to be kept in mind when we talk about gender sensitive
approach.
1)
2)
3)
Providing HIV/AIDS prevention education for both partners.
The strategies to be develop which is gender sensitive and culturally appropriate.
Involve men as much as possible in every stage of reproductive matter to make them more
sensitive.
4
)
)
Women need to be given more employment opportunities.
5
The new research on technology should focus on the both the sexes.
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*
Assistant Professor, Department of sociology, Maniben Nanavati Women’s College
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