Data has shown that only 12% of women in India take decisions regarding their own healthcare. In a country which has a large number of anaemic women, women who die during childbirth and women who fall prey to cervical cancer, how can we ensure better health for half of the population? Experts Dr Ruchi Malhotra, Senior Gynaecologist and IVF Expert at Fertile Solutions IVF Centre, Dr Sheetal Aggarwal, Senior Gynaecologist at Apollo Cradle Royale, Dr Richa Jaiswal, Dietician at AIIMS, and Dr Ekta Bajaj, Senior Gynaecologist at the Ujala Cygnus Hospital, weigh in on important questions about women’s health in an interview with The Sunday Guardian.
Dr Ekta Bajaj
Dr Ruchi Malhotra
Dr Richa Jaiswal
Dr Sheetal Aggarwal
Data has shown that only 12% of women in India take decisions regarding their own healthcare. In a country which has a large number of anaemic women, women who
Q: Why is nutrition so important for women’s health?
Dr Aggarwal: The woman is the backbone of society and if she is weak, society is weak. A woman menstruates every month and loses around 30-40 ml of blood per cycle, so she has to replace that. During the reproductive phase, she gives birth to children, who are just like parasites and draw nutrition from the body, irrespective of whether the mother has adequate iron or calcium reserves. This makes it important for the mother to replace all the nutrition she has lost during this time. Today, women are multitasking. They are going out to work as well as looking after their homes and this drains them physically and mentally. Thus, a woman’s nutrition should be a priority area in a national or a state budget.
Q: What is the reason for an increase in infertility, especially among younger women?
Dr Malhotra: This is a very important question. It is because most women are delaying getting married, as many of us are career-oriented, and age is directly related to fertility. Higher the age, lower the fertility. Lifestyles have also changed as there is too much stress. Having more junk food and alcohol, smoking and a sedentary lifestyle also lower fertility.
Q: Can you name the health tests which are a must for every woman?
Dr Bajaj: These are precautionary times so every healthcare approach should be more prophylactic than treatment. Women should go for proper health check-ups for cervical cancer and screening tests like the Pap smear (now called LBC and HPV test). According to the WHO, every woman should take this HPV test after the age of 24 every five years and the LBC Pap smear every three years. As far as breast cancer is concerned, after the age of 35, mammography is very important. If there is a history of breast cancer in the family, one can even go for it before the age of 35. We see young girls of 25-30 years of age in our OPD with lesions like fibroadenosis and fibroadenoma, for which we suggest an ultrasound or MRI. Routine blood tests to check complete blood count, thyroid function test, lipid profile, LFT and TFT should also be part of a woman’s healthcare, keeping in mind the increasing cases of anaemia in India.
Q: What kind of care is required during puberty?
Dr Aggarwal: Puberty is the time when a female starts menstruating. It is generally an anovulatory cycle, which is the period of the first two or three years when the ovaries are not producing eggs. So, a girl may not first bleed for two or three months and then bleed for one month or so. Concerned mothers often come to us saying, our child has not been having periods for three months or the bleeding is too heavy. This is why we need to counsel the mother and the child; we can’t simply put her on hormones. Secondly, diet is very important as we have to ensure that the girl doesn’t become weak. She has to take an iron-rich diet if she continues to bleed. We may give her some haemostatic agents so that bleeding reduces or stops, but never put her on hormones at such a young age to regularise them. Moreover, such young girls should not be put under any kind of stress.
Q: What are some healthy lifestyle choices that all women must make?
Dr Jaiswal: To summarise, meal timings are very important, as most women are driven by emotions and tend to give more time to family members rather than herself. Women shouldn’t skip meals, especially breakfast. Something ready-to-eat and nutritionally fulfilling should be in their bags so they can eat that anytime. Secondly, fibre is very important. Every age has a different demand and folic acid, iron and calcium are important at different stages. There is also a change in the hormones of a woman every ten years which requires support and a stress-free life. Along with nutrition, physical activities and a holistic approach to health should be taken. A good amount of fluid intake (non-carbonated) and fibre intake should be encouraged. Diet should be wholesome.
Q: Would you add anything about the importance of a healthy diet?
Dr Jaiswal: It is important to start reading about food levels. Food diversity is also very important and in a country like India, where we have very diverse foods available, we should not avoid seasonal foods. Women should embrace practices like ‘poshan ke liye paudhe’ (plants for nutrition) and grow plants for good foods. The importance of nutrition for women must also be inculcated among men in order to bring wider changes in society.
Q: Many women starve themselves to lose weight. How can it be harmful?
Dr Jaiswal: Starvation isn’t absolutely wrong but it should be time-bound and well-monitored, and the expected deficiencies should be taken into consideration. A team should work with a person for binding the time of fasting and what should be eaten after breaking the fast. Weight reduction should not be undertaken through starvation but a holistic approach with complete nutrition. The aim should be to maintain an ideal body weight and also provide basic nutrition according to their particular age group.
Q: How important is hygiene?
Dr Bajaj: Hygiene is very important as women are prone to infections like UTIs and vaginal infections. Hygiene plays a major role, even before any antibiotics do their work. There are campaigns on menstrual hygiene now and people are becoming more aware about it.
Q: Any tips regarding menstrual hygiene?
Dr Malhotra: During menstruation, one should change her pad every 4-6 hours and use clean toilets. Women also need to learn the importance of using sanitary pads rather than other products in the market.
Q: What other health problems need to be discussed more?
Dr Aggarwal: PCOD is a very common problem in which the ovaries ovulate but the eggs are not released into the fallopian tubes, making the ovaries polycystic. Because this is an anovulatory cycle, hormonal imbalance takes place. Hence, the testosterone level rises in the female, leading to hair growth on the upper lip and chin, acne formation and neck pigmentation. Since it is a lifestyle disorder, women also tend to become obese and have irregular cycles. This can also cause infertility and loss of confidence. Earlier, PCOD could be seen in younger age groups, but now I see it in the reproductive age groups too. To prevent it, lifestyle changes need to be made, the woman has to be put on a diet, and if she is obese, she has to lose weight. Even if she loses 10% of it, most problems would be solved. So, the main concerns are having a proper diet, being physically active and proper medication.
Q: Studies indicate that every eight minutes a woman in India dies due to cervical cancer, more than 48% of women are anaemic, only 21.8% mothers get full antenatal care, and more than 1 lakh women die every year due to pregnancy-related problems. What can be done to improve such a scenario?
Dr Bajaj: You have raised three issues: anaemia, cervical cancer and pregnancy-related problems. First of all, anaemia is very common in India because women lose too much blood every month. Iron and calcium supplements are very important to eradicate this, especially during pregnancy and lactation, as blood is comparatively thinner at these times. There is also no proper spacing between births and after one or two years, they are pregnant again, when their body is not prepared, and thus the situation worsens.
For cervical cancer, tests like LBC and HPV are very good as precautionary measures to reduce the number of cases. We cannot reach each and every woman in the country due to India’s high population but we should definitely try. Screening tests should be done too. Most importantly, the cervical cancer vaccine should be used frequently. There are two types of vaccines available and they are expensive—it costs between Rs 2,000 and Rs 3000—and needed in three doses which cannot be affordable for everyone. But the vaccine is very important and effective as it prevents cervical cancer. So, awareness programs for the vaccine must be promoted and this vaccine should be added to the national immunisation programme because the ideal age for this vaccine is 9-13 years. Secondly, screening should be done.
Regarding pregnancy issues, maternal mortality is very high in spite of all the efforts taken. The main reasons are anaemia and delivery-related complications. In spite of so many hospital services, people still deliver at home, which is really not good and may lead to the death of the mother. So, the government should also promote hospital deliveries.