Alleviation: An International Journal of Nutrition, Gender & Social Development, ISSN 2348-9340 Volume 1, Number 1 (2014), pp. 1 - 8
© Arya PG College, Panipat & Business Press India Publication, Delhi
www.aryapgcollege.com

Integrated Health Promotion Programmes for Women: Need and Ways

Indu Bansal, Mayanka Singh
Prof. & Dean, Faculty of Home Science, Ph.D Research Scholar
Faculty of Home Science
Banasthali Vidyapith, Tonk (Rajasthan), India
Email: mannusingh.singh3@gmail.com

Introduction

Sound health is now recognized as a key issue for all goals of development and sustainability. Indirectly, many reproductive health issues are part of empowerment and extension programmes aimed at improving the health and well being. Multiple factors, including socio-economic status, social values, accessibility and quality of health care as well as the promotion of gender equality and empowerment of women, are known to be important for health and can be taken as determinates of integrated health. This addresses a wide range of conditions, health behaviours, health indicators that affect health directly or indirectly e.g. Wellness (Cognitive, physical, behavioral, nutrition), quality of life of women, quality of life of children, and quality of life of families. Many factors can affect reproductive health e.g. pregnancy and childbirth, including preconception health status, age, access to appropriate health care, preconception and interconnection, education, poverty and also physical and mental health of parents and caregivers. The social determinants like family income and environmental factors that influence maternal health also affect pregnancy outcomes and infant health.

Reproductive Health versus Women Health

In the current climate, women health has been reduced to reproductive, specially a medical-technical problem.

Reproductive health is defined as A state in which people have the ability to reproduce and regulate their fertility; women are able to go through pregnancy and childbirth safely, the outcome of pregnancy is successful in terms of maternal and infant survival and well-being, and couples are able to have sexual relations free from fear of pregnancy and contracting disease.

Reproductive health is often seen as:
• A vision emerging from population-control ideologies rather than a concern for women's health.
• A new term for family planning.
• A term in which the underlying, critical issue of sexual health gets lost or submerged.
• A term which ignores the social, cultural and political contexts of health.
• A medical approach which offers technological fixes rather than structural and social changes.
Locating reproductive health in the broader context of women's health has emerged from recent critiques of the concept of reproductive health, who often feel that provision of medical services alone will not lead to significant improvements in women's health. Key underlying factor is the complex web of gender and sexual relations, participation in crucial decision-making, power structures, choices and lack of choices, access to basic needs - all of which determine women health status. A new term Women's health came into existence which has been defined as personal and social state of balance and well-being in which a woman feels strong, active, creative, wise and worthwhile where her own body’s power of healing is intact, where all her diverse capacities and rhythms are valued, where she may make choices, express herself, and move about freely.
Several women's activists find the concept of women's health more meaningful than the concept of reproductive health. Other groups, researchers and activists feel that an artificial dichotomy is being created.

Integrated Health Promotion

Although reproductive health has often been linked with women’s empowerment and rights in principle, but practically there is little understanding of ways to translate this into action. It is critical to bridge this gap between principle and reality, by exploring how reproductive health programs can, in practice, become more empowering for women. Social factors need to be seen as central to the concept of reproductive health and as the basis on which technical solutions rest, rather than vice-versa. It has also been critical in shifting the focus of health programs from a population control approach to addressing rights and development.

It means enabling women to analyze their own situation, to decide their priorities, develop solutions to their problems and to take collective action to improve various aspects of their lives. This cannot be done through government efforts. Worldwide, advocacy has only recently been recognized as a vital mechanism for effecting change and ensuring accountability.

Emphasizing the cultural, social and economic factors that influence sexual and reproductive health, the Ford Foundation has directed its support to three general areas since 1990: strengthening social science research, enabling women and their partners to be more directly involved in the design and implementation of reproductive health programs and policies, and promoting discussion of religious and ethical values related to reproductive behaviour.

Health Promotion Programmes: Problems of Concern

Encouraged by these developments and keeping in view the need for team work to develop and extend information, support to grass root level workers, monitoring and evaluation of existing programmes through neutral groups researcher commenced efforts to find out problems of concern, persistent disparities in maternal, infant, and child health as planning exercise to outline a program for ‘Health promotion and disease prevention in families’. Community based cross- sectional surveys, among pregnant and lactating women were conducted in rural and urban areas of Tonk district of Rajasthan state of India. A medical, obstetric and reproductive history was obtained. Use of antenatal services and delivery care were examined along with this. Infant Death Audit was also part of the survey. Study was the part of a United Nations International Children’s Emergency Fund (UNICEF) sponsored project on ‘Integrated Management of Neonatal and Childhood Illness’ (IMNCI) programme in Tonk district of Rajasthan during 2008-2011.

Data revealed that despite the high antenatal clinic attendance (More than 90% visited PHC or hospital at least once), some of the health risks related to pregnancy noted were - Hypertension and heart disease, diabetes, depression, genetic conditions. Some of the other factors more prevalent in illiterate and low income group subjects were- Sexually Transmitted Diseases (STDs), tobacco use, inadequate nutrition, unhealthy weight, unhygienic conditions. Multiple factors were related to quality of delivery care, including socio- economic status, education, social values, attitude of elderly members of the family and caretaker. For many families, after delivery and child care comes from someone other than the child’s mother. Folk remedies were more common in joint families and with more adult female members.

Infant Death Audits inferred that many health problems such as jaundice, urinary tract infections, diarrhea, pneumonia and asthma, were reported as some of the causes of infant deaths. Moreover Sudden Infant Death Syndrome (SIDS) was the leading cause of death in children up to one year of age. In addition, other conditions that often go away without treatment include things like eczema, blocked tear ducts, cradle cap, hair loss, acrocyanosis (Blue hands and feet at times), and umbilical hernia (Belly button protrudes out at times, especially when baby cries or strains ).

Family planning and pre pregnancy contraceptive use decisions are mostly of husbands and or other family members. Giving birth to male child is considered important in spite of ill health of mother due to frequent pregnancies, miscarriages, losing child in between, poor nutritional and other resources, and non willingness of woman.

Health Programme Integration: As Key to Empowerment

Several community health groups asserted that in India, where poverty and social injustice result in a widespread neglect of all health needs, it is essential to broaden and deepen the concept, shape understanding and inform programming in the area of development of women health and disease promotion in an integrated way. The following are important aspects, to quality women's health care and as well assured good family health apart from human rights of women such as enough clean water, and food, food security, and nutrition:
• Education and growth opportunities to enhance women's information base, validating their knowledge and experiences.
• Equitable distribution of work at home and outside to empower them to assure equal status in society.
• Assured and adequate income as the right to livelihood.
• Safety and mobility with satisfactory working and living conditions
• Comprehensive health care including effective as well as safe contraception with control over one's body and decision.
•Linking concepts of reproductive rights to human rights of women.
•Freedom from abuse and violence.
•The risk of maternal and infant mortality related complications can be reduced by increasing access to quality preconception (Before pregnancy) and interconnection (Between pregnancies) care.
•Including women's perspectives in developing educational, material and monitoring programs is very important to shift power relations within families, within communities and within health care systems.
•There is also a dire need to include men in all programmes for their own sexual well being as well as those of their partners facilitating adaptation by wish not by push. Increasing men's involvement will change gender conditioning (Lies in social roles and responsibilities that men and women learn as children, from parents and other role models, in the mass media, schools and other social institutions) as well as create initiatives that incorporate mechanisms to increase men's awareness of, knowledge of , sensitivity to women's expressed and unexpressed needs, and responsiveness to these needs (Unexpressed needs would be based on socio-cultural-economic analyses of women's situation in that particular area).

How to Integrate

Health service integration aims to increase access to and quality of health services. One recent definition involves having various services on offer at the same facility or through a functional referral system. In this context, differentiation exists between (i) physical integration of services in the same location, and (ii) linking of services where functional referral ensures that people are directed to the location where the services they require are available with health service providers actively encouraging the use of other services during a visit.

Observations have shown that a high proportion of patients referred from one health service to another never follow through with the referral. Hence, physical integration may in some cases be preferable to minimize this problem. Local public health, economic and socio cultural contexts are extremely important in determining when each of these variations preferable, and must be re-evaluated if circumstances change.

Physical integration, where services are offered in the same location, is often preferred by service users, at least when the providers are trusted and the location is accessible and welcoming. Governments and other providers that choose to physically integrate services must also assure to structure integrated services to cater to the population as a whole in a geographic area as well as services for specific population groups for example maternal and child health, family planning, STI and abortion services. It is especially important in case of urban population and district head quarters.

There are many cases where physical integration is not affordable or practical, and in such circumstances it is important to have functional referral systems that ensure that service users are clearly directed to the location where the services they require are on offer, and supported to ensure follow-up. It is also crucial to recognize that some of the most strategic entry points for these services may be located in primary health care centres and hospital-based clinics - more appropriate in this context, tuberculosis detection and treatment programmes.

The Role of Law and Policy

The legal and policy environment shapes the availability of health services and programmes as well as the degree to which they are responsive to the individual needs and expectations of people. Law and public policy are also key tools to influence social and economic context: reinforcing positive social determinants and reduce health inequity. Human rights provide a legal framework within which national laws, policies and services can be formulated and assessed. International legal and policy agreements clearly direct governments to provide appropriate and quality sexual and reproductive health information and services, to individuals (And couples) including adolescents, without discrimination.

National law is the primary instrument by which a state acts. In the area of health, a State’s policy may, for example, guarantee a right to health, or the special protection of maternity and childhood. National laws may establish a national health system and/ or national health insurance and must ensure that no laws, policies or practices discriminate in access to health information and services on the grounds of race, colour, sex, national or social origin,socio-economic or other status.

Few governments can provide the full range of health services that might be required by their populations. While a small number of wealthy countries have relatively comprehensive national health insurance and health service delivery systems that cater for the entire population, it is not possible in a country like India owing to large population, wide gap in social, economic geographic, climatic and other conditions. Health sector action must be supplemented by the work of other sectors of government, NGOs and other civil society groups.

Conclusions

The range of services and programmes required will vary by context but, in every setting, ensuring the provision of appropriate services and programmes requires systematic consideration of the rights, needs and aspirations of the people involved, the larger social and economic environment, the health systems within which services will be requested and delivered, as well as the national legal and policy framework within which they operate. Consideration of all of these issues will help to determine the most relevant services and how they might best be delivered.

In most places, people access health services from a wide variety of formal and informal providers, and health-related behaviors are influenced from many directions. In such a complex environment, while there are no quick fixes or standard prescriptions, there are many mutually reinforcing opportunities for integration of health services, both public and private, to more effectively related to disease promotion and health-related needs.

So- Be prepared to provide higher quality care with better life outcomes.

References

Bongaarts J (1994) Population Policy Options in the Developing World. Science 263: 771-76.
Schultz TP (1993) Investments in the Schooling and Health of Women and Men: Quantities and Returns. J of Human Resource, 28: 694–734.
UN Department of Social Affairs (2004) World Population Policies. New York: Population Division.
http://www.unfpa.org/gender/empowerment.htm
http://www.unfpa.org/webdav/site/global/shared/icpd/kampala.pdf