The problem related to women’s health is diverse because of the fact that they are not just a single entity but people capable of giving birth to other humans. It is diverse also because though the women in urban areas might be getting good facilities at all stages of life, those who are in the rural areas are the sufferers whether it is a little girl or an elderly woman. Depending upon how rural the area is, the condition worsens. In urban areas too some problems have been sorted out but new issues have erupted with modernity. Medicircle spoke to eminent doctors,  Dr. Rishma Pai and Dr. Monika Agrawal on issues concerning women’s health in the context of safe motherhood and reproductive health. They highlighted some highly important issues. You can view Dr. Rishma Pai’s full interview here and Dr. Monika Agrawal’s full interview here

Excerpts of what they said in the exclusive conversations with Medicircle:

Dr. Rishma Pai, Visiting Consultant Obstetrician, Gynecologist, and Infertility Specialist at the Lilavati, Jaslok, Hinduja Healthcare Services and Every Woman Cliniqs, Mumbai, listed down the following pillars of safe motherhood and reproductive planning:

• “If couples use contraception, lakhs of lives can be saved. Due to the lack of family planning measures, there is an increased number of abortions and many lives are at risk during the abortion. So, adopting family planning measures is important. 
• Girls and women who want to experience healthy and safe motherhood later in life should take simple early measures. Young girls from the teenage stage itself should be particular about their hemoglobin, ideal weight, iron, and calcium levels in the body. 
• Couples should meet doctors at the planning stage itself instead of the time when the woman has already got pregnant. Meeting a doctor before the wedding or just after it is very important for good reproductive planning. If they come to doctors at this stage, doctors can do simple health checkups like thyroid, hemoglobin, blood sugar, ovary, thalassemia tests, etc. to ensure that there are no complications later on and if there are any complications, then preventive measures are taken well in advance before the pregnancy.
• In Covid times, teleconsultations are also very popular, so young couples can do that as part of their reproductive planning. 
• Also, it's important to be under the guidance of doctors in the post-natal phase. Generally, people tend to disappear and meet doctors during the time of the second pregnancy. This should be avoided, rather regular checkups at that stage are also important for a woman’s reproductive well-being.
• There is a tendency of increased sexually transmitted diseases (STIs) in modern women due to more than one sex partner. So, visiting doctors to keep STIs under check is also very important,” suggests Dr. Rishma.

Dr. Monika Agrawal, Gynaecologist, Laparoscopic Surgeon (Obs & Gyn), and Infertility Specialist associated with Her Care Clinic, Mumbai said, “In rural areas, it is a common trend that a pregnant lady should see the doctor only in the 7th month. This is a wrong thinking. If someone visits a doctor from the very first day, then important supplements can be given to prevent several defects. It has also been observed that because of the advice of the elders, couples are reluctant for sonography. However, contrary to the belief that sonography is harmful, this technique is a boon to detect complications that can get life-threatening later. Sonography is important at intervals and a regular visit to an obstetrician is required every month if we want to ensure safe motherhood.

Also, in rural areas, there is not enough access to the healthcare system. A clean delivery place is required for safe delivery and to avoid post-delivery complications which are lacking in many places.” said Dr. Monika.

Measures to further lower down the maternal mortality rate

Dr. Monika emphasized, “Maternal mortality rate compared to the 1990s has come down. We need to further control the reasons for maternal mortality by putting a stop to (1) bleeding during delivery or abortion (2) sepsis or infection during abortion or delivery (3) dangerous blood pressure levels as out of 10 pregnant women, 1 suffers from hypertension which can get life-threatening (4) obstructed labor leading to uterine rupture.”

Dr. Monika listed down the following three significant Cs to ensure safe motherhood:

1. "Crisis Control – Pregnant women should know about the crises that occur during pregnancy and should have insight about when to contact the doctor. They should be made aware of the red flags.

2. Care – This comprises adolescent care, pregnancy care, postnatal care. There could be helplines or special clinics for adolescents to have easy access so that they can take the advice of experts without any fear or inhibition. Institutional delivery is everyone’s right. Initiatives by FOGSI like drills for Anganwadi workers to train them to identify high-risk cases are important. Nutrition or supplements information especially to women of lower socioeconomic strata is required, antenatal classes can be helpful to make them understand what to consume and what to avoid during pregnancy. 

3. Cure – Right treatment from grassroots to tertiary level is the need. Government has already made initiatives in this regard wherein every 9th day, practitioners of private clinics and hospitals are required to visit and provide services at grassroots levels.” 

Initiatives as suggested by the two eminent doctors are required at individual, family and community levels to lessen the burden of women's poor health on our society. International Day of Action for Women’s Health is being celebrated each year on May 28, for nearly 30 years now. It's high time, we need to take more serious actions!