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In the pink of health: Mother and Child

All over India Accredited Social Health Activists (ASHAs) workers visit the houses of pregnant mothers once a few months to ensure that both mother and foetus are healthy. The visits don’t just end there. The workers continue to visit at least till the baby reaches one year. With the assistance of staff from the health department, ASHAs and Anganwadi workers, the government has been ensuring both mothers and children are in the pink of health. India has been making consistent progress in maternal and newborn health.

Statista’s report titled ‘India: Infant mortality rate from 2012 to 2022’ says that India has recorded about 25 deaths per 1,000 live births in 2022. The mortality rate has come down significantly in comparison with the infant mortality rate in 2012, which was 42 deaths per 1,000 live births. However, India has recorded the highest number of preterm births globally, and the number stands at 3.02 million in 2020. It contributes to more than 20% of preterm births occurring globally, according to a study published in The Lancet journal.

Similarly, India’s Maternal Mortality Rate (MMR) has stood at 103 in 2020, as per the United Nations Maternal Mortality Estimation Inter-Agency Group (UN MMEIG) 2020 report titled, ‘Trends in maternal mortality 2000 to 2020’. The report confirms that the MMR has come down by 6.36% during the period 2000-2020. India’s declination rate is higher than the global decline, which is 2.07%.

It is always important to understand the underlying factors impacting the health of mother and child in the journey towards finding a solution.

Factors impacting the health of mother and child

  1. Socio-economic factors: Considered as the fundamental determinants of health, socio-economic factors have a direct impact on the health outcomes of both mothers and children. These factors influence their access to quality healthcare, nutrition, and other resources, hygiene, and overall well-being. Economic constraints can limit a family’s ability to purchase nutritious food and limit their access to prenatal and postnatal care, vaccinations and treatments. It in turn might lead to a range of health problems. Poor sanitation will significantly increase the risk of diseases and infections.
  2. Environmental factors: These factors play a vital role in the well-being of both mother and child. Gone are the days when whole foods were blindly believed to be healthy. Contamination of food with pesticides, pathogens and heavy metals can adversely affect the health of people, especially pregnant women and children who are very sensitive to foodborne illness. These illnesses can in turn lead not just to nutritional deficiencies but also to other health complications. Similarly, limitations to access to clean and safe drinking water can lead to gastrointestinal infections. They are considered dangerous for children and pregnant women.

State efforts

The efforts taken by the government are in line with the UN’s sustainable development goals. The goals are to reduce maternal mortality, end epidemics, reduce neonatal and child mortality, end malnutrition, provide access to sexual and reproductive health services and provide universal access to safe water. Some of the schemes that are taken to tackle the issues are

  1. Pradhan Mantri Surakshit Matritva Abhiyan (PMSMA): The scheme aims at providing free, assured, comprehensive and quality antenatal care on the 9th day of every month to all pregnant women in their second and third trimesters.
  2. Surakshit Matritva Aashwasan (SUMAN): This scheme aims at providing free, assured, dignified, and quality healthcare for every woman and newborn visiting the public health facility. The scheme ensures there is zero tolerance for denial of healthcare service to them.
  3. Janani Shishu Suraksha Karyakaram (JSSK): Under the scheme, every pregnant woman is entitled to avail of free delivery, including caesarean sections, in public hospitals, along with free transportation, diagnostics, medicines and other consumables. Similar entitlements would be provided to sick infants accessing public hospitals.
  4. Mission Saksham Anganwadi and Poshan 2.0: The scheme ensures that pregnant women and lactating mothers get supplementary nutrition. It is to strengthen their nutritional content, thereby nurturing health, wellness and immunity to diseases and malnutrition.

This apart, required maternal and child care will be provided through outreach programmes by Anganwadi staff as a part of their monthly village health, sanitation, and nutrition day. Outreach camps will be organised in remote and tribal locations to increase awareness for maternal and child health services and to track high-risk pregnancies. Staff of health and wellness centres organise camps at localities of marginalised communities on a regular basis. 

Smile Foundation’s role in the health of mother and child

Due to the large population and unevenly distributed medical resources, delivering quality healthcare to everyone, especially those in remote locations, continues to remain a challenge in the country. Smile Foundation bridges that gap through their intervention programmes. For the programmes aimed at providing primary healthcare services at the doorsteps of vulnerable households in rural and urban slums. As a part of the programme, we provide both preventive and curative services by addressing the gaps in availability, accessibility and affordability of healthcare.

Also, we work on increasing awareness of government schemes, supporting the public healthcare system, improving health-seeking behaviour and reducing out-of-pocket expenses. We have upgraded six primary health centers in Bengaluru, Chennai and Hyderabad by providing equipment like ECG machines, OT lights, radiant baby warmers, weighing scales and biomedical waste trolleys, among others. 

Providing specialised consultations through telemedicine services in these cities is also one of our major intervention areas. This year, over 10 lakh people from 16 states have benefitted through our concerted healthcare efforts, of which 75% are women and children. The healthcare initiative has sensitised over 75,000 on topics related to health and hygiene. Over 80,000 people benefited through our telemedicine programme.

Keep spreading smiles everywhere

What is more satisfying than seeing the tears of joy in the eyes of beneficiaries? One such beneficiary is five-year-old Rani, who lives at Sukhrali village in Gurugram. During the pandemic, she suffered from an injury on her right foot and couldn’t walk on her own. She couldn’t go to the hospital due to financial constraints. However, her family came to know about the foundation’s mobile clinic service, ‘Smiles on Wheels,’ and brought her to the clinic. Due to the right and timely medical intervention, Rani’s foot has recovered. She is not just walking without pain but also seen as one of the happiest children in the locality.

To learn more about our healthcare CSR projects and to partner, connect with us at [email protected].

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Health

Strengthening Reproductive Health – a Taboo or a Task?

Recently the global population hit the 8 billion mark, the latest billion having been added during the last 12 years. India had the largest contribution of 177 million people to this most recent billion against 73 million people added by China. The United Nations Population Fund projects India to surpass China as the world’s most populous country in 2023. 

As much as the rapid growth of population in India has been a cause of concern over the last few decades, there is finally some sense of relief with India’s Total Fertility Rate going below the Replacement Fertility Rate indicating population stabilization. However, challenges are still galore with respect to awareness and autonomy of sexual and reproductive health in India.

According to the State of World Population report 2022, almost 50% of the pregnancies in India are unintended, over 60% of which end in abortion. Further, 45% of such abortions are unsafe and closely linked to high Maternal Mortality Rates (MMR) in India. Lack of agency, resources and awareness of sexual and reproductive healthcare is primarily responsible for this situation. 

Estimates show 2.4 million Indian women interested in avoiding pregnancy with an unmet need for modern contraception. All this calls for immediate attention, discussion and action to bridge the gaps in reproductive healthcare in India. We delve into the details here:

What is Reproductive Health?

The WHO defines Reproductive Health as “a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity, in all matters relating to the reproductive system and to its functions and processes.” It further says that reproductive health not only includes the safety and contentment of sex life but also refers to the ability of people to reproduce and the autonomy to decide if, when and how frequently to do so.  

Types of Reproductive Health

Types of reproductive health encompass the health of male and female reproductive system at different stages of life and all biological processes that are linked with reproduction. The main components of reproductive health could be identified as follows:

Adolescent Health

With the onset of puberty in adolescence, both boys and girls experience transition in their physical and psychological development. Menstrual cycle is a complex process that starts in girls at this time along with change in bodily features. 

Boys also experience change in their reproductive organs, physical appearance and voice. Adapting to these changes in their body and mind can be challenging if they do not find right guidance and support.

Sexual Health

This requires a dignified approach to sexuality and sexual relationships and scope of having pleasurable and safe sexual experiences free from coercion, violence and discrimination.

Maternal Health

This refers to health of women during pregnancy, childbirth and postnatal period. Maternal health is closely associated with sexual and reproductive health of women and also with the health and well-being of the child.

What are the Problems of Reproductive Health?

Some of the major issues concerning reproductive health and rights in India are:

Lack of Proper Menstrual Management

According to NFHS India (2019-21), 50% of women in India use cloth during menstruation which does not qualify as hygienic protection. Limited sanitary options, period poverty, poor accessibility and affordability of resources result in poor menstrual management. This can lead to reproductive and Urinary Tract infections.  Adding to it, the taboos and restrictions around menstruation make periods a stressful and unpleasant experience for many.

Sexually Transmissible Infections (STIs)

STIs otherwise called reproductive tract infections (RTIs) are an important public health problem in India. Data from ICMR study of 2002-03 puts STI prevalence at 30-35 million episodes per year. Some STIs if left untreated can cause serious and permanent health issues in infected individuals. Adolescent and young adults are disproportionately affected by STIs due to lack of awareness and can have lifelong implications.

Contraception

The NFHS-5 claims that in India, the onus of birth control still largely remains on women. Myths, misconceptions and prevalent social attitudes discourage men from participating in family planning though male sterilization is safer and easier. Male sterilization is as low as 0.3 % and less than one in 10 men use condoms. 

Further evidence suggests, over 30 million married women are unable to use contraception in their reproductive phase and 2 million adolescent women lack access to contemporary contraception.

Pregnancy

Pregnancy is a complex reproductive process and might have complications before, during or post pregnancy that affect the health of mother, child or both. Timely and suitable healthcare in all phases of pregnancy is utterly important for decreasing risk of maternal and child mortality.

Abortion

Though abortion or medical termination of pregnancy has been legal in India since 1971, women in India face many structural and cultural barriers in accessing safe abortion services. 78% of the 15 million abortions in India are done outside medical facilities.

Ways to Improve Reproductive Health Issues

The UNFPA suggests having a life-cycle approach to reproductive health as Reproductive Health is crucial to a person’s wellbeing at all stages of life. The major areas where we should work to improve reproductive health are:

Information

Creating awareness about reproductive process and importance of reproductive health through proper channels could bust myths. Comprehensive sex education should be imparted to adolescents to guide them in taking care of their reproductive health and make right choices.

Empowerment

Being aware is necessary but not sufficient to ensure good reproductive health. One needs to have the access and affordability to necessary information and healthcare resources and also the freedom to make choices regarding one’s sexual and reproductive life.

Availability of Resources

This is highly essential to ensure that individuals can actually make choices in matters relating to their own bodies and reproductive status. For example, availability of medical supplies like contraceptives, medicines and medical equipment and skilled healthcare professionals etc. can meet the relevant requirements timely and efficiently.

Sexual and Reproductive Health Rights (SRHR)

SRHR are included in UN SDGs and mandated to be recognized within the framework of human rights. India has huge gaps in its laws and policies relevant to SRHR. Realization of SRHR can be achieved by ensuring individual’s right to-

  • Define their own sexuality, choose their sexual partners and decide their sexual status
  • Decide if, when and whom to marry
  • Decide if, when and by what means and how many kids to have
  • Have access to information, resources, services and support required to ensure the above

Integrated Services

Services across various sectors like healthcare, healthcare professionals, education, transport, legal aid must be strengthened and integrated to build a strong support system for reproductive health care in the country.

Concluding Thoughts

Apart from the numerous strategies and interventions which the government or private bodies can do to improve the status of reproductive health in India, the first and foremost requirement is to acknowledge sexual and reproductive health as integral to general well-being of an individual and thus significant in building a healthy and prosperous nation. 

Only when we change the social perception of sexual and reproductive health from taboo to a necessary task; we can truly make sincere efforts to improve the scenario.

Smile Foundation and Women Healthcare

Smile Foundation cares for women and their reproductive healthcare through its healthcare initiative, Health Cannot Wait. Learn more here!

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