A few weeks ago we had published an article on the top health diseases affecting urban women in India. We now would like to focus our attention on the three key health challenges of women in rural India. The top 3 health diseases and conditions affecting women in rural India include cervical cancer, maternal mortality and diseases from excessive tobacco consumption.
Cervical cancer—which can be prevented with timely screening, vaccination and appropriate treatment—is the most common form of cancer among women in rural India. Cervical cancer or cancer of the cervix can also be defined as a type of cancer that happens in the cells of the cervix which is the lower part of the uterus that connects to the vagina. It affects mostly women over the age of 30.
Nationwide, the disease accounts for an estimated 24 percent of India’s cancer cases among women, compared with 20 percent for breast cancer. More than 130,000 new cases—roughly one fourth of the global total—are reported in the country every year. In addition, an estimated 74,000 Indian women die annually from the disease, which results from the abnormal growth of cells in the cervix (the narrow opening of the uterus or womb). Incidence of this cancer begins to rise among Indian women in their early 30s and peaks at ages 40 to 50.
Its main underlying cause is the human papillomavirus (HPV) which is a sexually transmitted and largely symptomless infection for which there is currently no cure. A number of factors indirectly heighten the risk of cervical cancer by increasing the likelihood that a woman will contract an HPV infection. These factors include early age at first intercourse and multiple sex partners. Rural Indian women are most affected since they tend to marry earlier and have more children than urban Indian women. HPV can be prevented with a vaccine.
A reliance on indigenous cures in some rural Indian villages and a traditional reluctance among many villagers to seek medical assistance for gynecological and other matters may also heighten women’s vulnerability to infection and disease.
India launched its National Cancer Control Programme in 1975-76 in response to the increasing incidence of various cancers affecting women and men. In 1990-91, the national government added a District Cancer Control Program (DCCP) in an effort to extend prevention and early detection services to rural communities. With little enthusiasm from the states to continue the programme when government funding ended, the DCCP has been reoriented; its goals now include collecting cancer data.
Maternal death is defined as the death of a woman while pregnant or within 42 days of termination of pregnancy,irrespective of the duration and the site of the pregnancy, from any cause related to or aggravated by the pregnancy or its management, but not from accidental or incidental causes.
One fifth of the 2,87,000 maternal deaths worldwide in 2010 occurred in India. The current Maternal Mortality Ratio (MMR) in India is 212, whereas the country’s target in this respect, as per the MDGs, is 109 by 2015.
Institutional deliveries are often promoted for reducing maternal and neonatal mortality. Yet, many women in low and middle income countries, including India, continue to deliver babies at home without the presence of a skilled attendant. There is a lack of health infrastructure in India to support institutional delivery as well as a lack of awareness amongst women about existing schemes. Of the 284 districts in nine high focus states which account for 62 percent of maternal deaths in the country, institutional delivery is less than 60% in 170 districts In several parts of rural India, the practices around pregnancy and childbirth remain steeped in unawareness and misconceptions. Delivering a child at home is a common practice and lack of hygienic practices poses a threat to both mother and child.
An estimated 47,000 pregnant women or new mothers die each year in India, often from preventable causes including haemorrhage, sepsis and anaemia. In order to achieve the required level of reduction in maternal mortality and infant mortality, a scheme called Janani Suraksha Yojana (JSY) or Safe Motherhood Scheme was launched in 2005. Under JSY, each eligible woman is tracked from the time of her pregnancy and care is provided to her on a continuous basis. Every pregnant woman registered under the scheme receives at least three antenatal checkups including tetanus toxoid injections and IFA (iron, folic acid) tablets during the course of her pregnancy. During these interactions, she is encouraged by the health personnel to deliver in a health institution.
3.DISEASES RESULTING FROM TOBACCO CONSUMPTION
With over 12.1 million women smokers, India is home to second highest number of women smokers globally. Illiteracy, poor health care and malnutrition add to an alarming rate of growth in cancer, cardiovascular and respiratory disorders among women who smoke and chew tobacco. Poor awareness of the harmful impact of tobacco and the social acceptability of chewing tobacco are the primary reasons for this worrying trend, say experts. In particular, poor women in rural areas with little or no education, who consume smokeless tobacco -are rarely counselled about the adverse effects of smokeless tobacco during pregnancy. They are not told about the risks of complicated pregnancies which can include sudden death, preeclampsia and preterm delivery and their babies having low birth weight or being stunted.
Tobacco consumption among Indian women doubled during the period 1995-96 to 2009-10 from 10 to 20 per cent. A typical traditional chulha (stove) emits smoke equal to 400 cigarettes per day. Indoor air pollution from chulhas causes 4,00,000 premature deaths every year in India. To combat this, A National Biomass Cookstove Programme (NBCP) was proposed by the Ministry of New and Renewable Energy during the 12th Plan to support research and development of standards and scale up demonstration of improved biomass cookstoves on a cost sharing basis. The objective was to replace the existing traditional chulhas by improved biomass cook stoves for domestic and community cooking, thus saving fuel and reducing health hazards.
4.MENSTRUAL HEALTH AND SANITATION ISSUES
In rural India, 97% of women lack access to basic hygienic means that allow them to stay clean throughout their menstrual cycle. Women resort to unhygienic alternatives like old cloth rags, husks, sand, or even ashes which results in vaginal infections often leading to chronic Reproductive Tract Infections (RTIs), pelvic inflammatory diseases, child birth issues and sometimes life threatening cervical cancer.
There is a lot of social stigma, cultural norms, lack of awareness and economic barriers that prevent women from acting on information about menstrual health.Cultural barriers include the infamous Chaupaddi, a practice that bars menstruating women from living in their homes, and conducting daily activities such as cooking, bathing and praying. Economic constraints are another important barrier as rural households cannot afford menstrual products such as sanitary napkins,and tampons. Given these tough economic realities, even if women are aware of their menstrual needs, they cannot afford to spend on such supplies. This calls for a need to develop cost effective, sustainable menstrual hygiene supplies.
The Ministry of Health and Family Welfare launched a program to provide highly subsidised sanitary napkins, under the brand “Freedays”, to 15 million adolescent girls across rural India. In an effort to tackle the disposal facet of the problem, the government’s Swachh Bharat Swachh Vidalaya mission encourages the construction of incinerators in schools.