Serving women in India
Last year’s UN Political Declaration on UHC highlighted the need to ‘mainstream a gender perspective when designing, implementing and monitoring health policies, taking into account the specific needs of all women and girls, with a view to achieving equality and the empowerment of women in health systems delivery.’
This month FIGO has spoken with Dr Jaideep Malhotra, Past President of FOGSI and Member of FIGO Committee on Reproductive Medicine, Endocrinology and Infertility.
"It was a dream for me to become a doctor and to serve the women of India.
I feel very blessed because the education system in our country, especially the higher education in the medical colleges, is very affordable and as far as training is concerned we have plenty of opportunity to learn as the patient load in the hospitals is too high for doctors to handle.
I am very happy and satisfied to be able to serve women of our country, not only through the various organisations I have headed but also through our NGO" Smriti", which works towards saving the female child.
I have written several books and made several public education films which are very well accepted, on contraception, incredible motherhood, doctor-patient relationship and infertility.
It has also been a huge pleasure for me to initiate "Club 35 Plus" for women aged 35 and over, educating them on pre- and post-menopause. This club is very popular all over the country and it is now in more than 50 cities.
To be able to be at the helm of affairs and bring changes in the health systems and be awarded Hon. fellowship of the Royal College of UK and Ireland and felicitated by the Prime Minister of Nepal for helping Nepal produce their first three hundred IVF babies has given me sheer joy.
I am a third generation private practitioner in our family, yet life has been full of challenges at every step.
India is a huge country with a complex health scenario: the policies are made by the central government, yet health is a state subject, so implementation depends on the local state government.
Private practice is totally different from the public sector. The whole health system, till recently, was dependent on small to medium sized private hospitals where the medical practitioner is in charge of everything, and that is very challenging not only for the provider, but for the beneficiaries too, as nobody saves for medical needs and very few in our country have medical insurance.
As a medical practitioner, you are not only providing medical services, but you are expected to look after everything, right from infrastructure, paramedics, housekeeping, pharmacy, finances and nuances of bureaucracy and the various legal acts which are implemented differently in different states.
This a 24x7 job, with sometimes minimal quality time for yourself and family. You come across so many difficult situations, where even with your best foot forward you are unable to help women. Women’s health does not only need health systems, it needs major changes in societal behaviour and understanding.
In terms of gender equality, my greatest frustration has been that we don't have faith in our girls and women. We don't encourage and drill confidence in them and that is why, even after good education, empowerment is absolutely lacking. In spite of worshipping female goddess, the women on earth are not treated as equal to men, so much so that the women themselves feel inferior.
To stop the current practices of gender bias and female feticide, and to educate and develop the skills of the girls so that they are really empowered in the true sense, my organisation has a theme, initially ‘Educate and Empower Girls to Save them’ but now renamed as ‘Make the Boys Understand and Educate the Girls to Empower and Save them’. (बेटा समझाओ, बेटी बचाओ).
India is striving very hard to improve the lives of women, and our government has initiated many new schemes for women and girls. We are close to achieving our SDGs and I feel proud of it, but we are still far away from achieving equality and empowerment of women in health systems delivery.
Two main reasons for this; the first is our societal and cultural mindsets, and second is the women themselves.
Today our Government has shown the intent to work towards this goal, but we are still struggling to reach out. We have the schemes and systems in place, and we have definite involvement of women in policy making and a huge workforce of Asha Workers (middle level providers) in the field for implementing of the health policies. But, what is lacking are the number of medical professionals and support staff on the field.
We need to strengthen our monitoring systems and accountability. If we are able to work on them, I am sure the rest will become very achievable changes which we want to see in the health of girls and women of our country.
Vision for the future of women’s health in India
We are not doing badly as far as women’s health is concerned. India is a huge country with a large population yet our literacy levels, our age of marriage, our total fertility rates, our gender ratio, MMR and NMR have all improved in the past few decades.
Our future is bright, and the democracy of India is our biggest asset. All we need is persistent political will and the policies framed to be implemented in a strategic way, where access and awareness go hand in hand with the schemes.
I would like to see in my lifetime that the foundations for every pregnancy are being laid strong, and that a happy healthy environment exists for our girls to be educated, grow physically and mentally strong, and for there to be uniform availability and access to care.
With a government scheme like Ayushman Bharat, I can foresee this happening.
In the words of our first Prime Minister Shri Jawahar Lal Nehru: "To awaken a Nation, its women have to be awakened, because when women move, the family, society and the nation moves."