Experts call for holistic approach to reproductive healthcare

In a recently held consultation in Delhi on maternal and reproductive health, experts called for key shift in policy for healthcare of women. They said policy planners should look at women's health with a wide angle lens, include sexual health within the ambit of reproductive health, and make access to reproductive health services universal and free. They also stressed on the need for a holistic approach on women's health.

The consultation was organised by the non-profit, Population Foundation of India (PFI), in collaboration with the Woodrow Wilson International Center for Scholars, the United Nations Population Fund and the Maternal Health Task Force of Harvard University. It had civil society representatives, field researchers, public health experts and policy makers.

At the end of the meeting, the group drafted a set of recommendations. The recommendations will influence global agenda and sustainable development goals (SDGs), which will replace the millennium development goals (MDGs) in 2015. The recommendations will become part of suggestions extended by the Harvard University and Woodrow Wilson International Center to agencies in the United States and global bodies working for SDGs. In India, they will be shared and pursued with the Union government.

Srinath Reddy, president of Public Health Foundation of India, while delivering the keynote lecture, said international discourse on maternal health must include maternal morbidity as a key issue in SDGs for action, measurement and evaluation. For each woman who dies in child birth, an estimated 20 more suffer from infection, injury and disability connected to pregnancy and childbirth. Experts said India's policies are too limited to include them and extend treatment.

Another key recommendation that emerged was to bring scattered programmes under one umbrella. "The "S" (sexual health) is handled by agencies like National AIDS Control Organisation while reproductive health has a separate department. It seems as if RH is not related to S. They, along with maternal health, should be brought under one programme," said Gita Sen, professor of public policy at Indian Institute of Management in Bengaluru.

In the same vein, Malalay Ahmadzai, health specialist, UNICEF, said that paediatrics and gynaecology are treated as separate disciplines in India. "The gynae ward is far from the children's ward, making it difficult to give proper care to the new born. They should be closely located. This shows the approach towards reproductive health, too,” she said.

The experts also noted that obstetricians and gynaecologists are not trained to conduct vasectomies. Recommendations noted that basic integration of family planning with maternal health would be needed for this training.

Poonam Muttreja, executive director of PFI, said, "Although the government has endorsed universal health coverage (UHC) in the 12th Five Year Plan document, the slowing down of economic growth and the high fiscal deficit have meant insufficient financial allocations during the coming year. As a result, plans for UHC is not likely to be rolled out this year." A member of UNICEF said that this will affect efforts towards reducing maternal mortality rate (MMR) in India and meeting the millennium development goal.

Despite declines over the past decade, MMR in India remains high, with 212 women dying per 100,000 live births every year. States like Assam, Rajasthan and Uttar Pradesh have MMR of over 300. India’s target for 2015 is MMR of 109.

Expressed in sheer numbers, between 78,000-100,000 women die annually in India as a result of childbirth and pregnancy, the main causes of these deaths are haemorrhage, eclampsia, hypertension, sepsis, obstructed labour, anaemia and unsafe abortions. These numbers underscore the need for skilled attendants at birth, and better nutrition and safe abortion facilities.