As we observe yet another Women’s International Day on March 8, and reflect on our past achievements and failures to realize our goals, one of the key issues we need to focus on is women’s health. That Sri Lanka has forged ahead of most other countries in the South Asian region in this area with our low maternal mortality rates and women living longer due to improved health inputs is a well known fact . But a few unmet areas need to be urgently addressed. We still have small communities of women in remote areas whose lives remain virtually unchanged, for whom the benefits of modern technology have passed by due to various cultural, religious and other reasons. These women are constantly bogged down by ill health, are vulnerable to diseases and suffer from malnutrition and under nutrition. Ignorance has been cited as a cause. This calls for more awareness raising on women’s health in general.
The past few decades have also witnessed a sharp rise in Non Communicable Diseases ( NCD) such as cardiac problems, hypertension, diabetes and cancer. Then there is the fast developing issue of antibiotics overuse, where popping pills for even a simple cold or mild fever has become the norm for most women caught up in their busy housework and careers . This could result in Antibiotic Resistance.
Community Physician of the Health Ministry Dr Ramya Premaratne shared some insights into the present status of health among Lankan women and interventions by the Health Ministry to improve the well being of the Lankan woman’s health.
Excerpts…
Q. In a few days’ time we will be observing Women’s International Day ( March 8), when the world will focus attention to promote the quality of women’s health everywhere. In Sri Lanka our low maternal mortality rate, access to free health services, affordable drugs, and long life span have given women an edge over their male counterparts. Yet, despite these achievements there has been a slight increase in maternal deaths according to recent statistics. Do you agree?
A. Direct maternal death rate had increased in comparison to the previous year. Post-viral haemorrhage, heart disease, and gastrointestinal mucosal bleeding have been identified as the main causes. Of the 112 maternal deaths, 68 percent were results of various delays. Other reasons were, not seeking medical advice at the appropriate time and not making regular visits to hospitals.
Q. What is the current rate of maternal deaths in the country? Are these hospital records only?
A. Not only hospital records, these figures are from the Registrar General’s Department (RGD) which is responsible for recording all births and deaths. According to the report, 112 maternal deaths have been reported in 2016 and the maternal mortality ratio (MMR) - the number of maternal deaths per 100,000 live births in a given period-was 33.8.
Q. How do they compare with MMR of say one decade ago?
A. In 2010, the MMR was 31.6 per 100 000 live births.
Q. Where has the highest incidence of such deaths occurred? What are the regions?
A. Colombo and Gampaha District, in the Western Province.
Q. Why?
A. Default clinic attendants . • Unmet need – Several issues in providing Family Planning to needy women.
Q, Has there been a change in the pattern of diseases and illnesses among women in recent years? What are the most common diseases women suffer today as compared with the past?
A.Yes. Mostly the emergence of Non Communicable Diseases such as cardiac problems, hypertension and diabetes.
Q. Pregnancy and obesity – what are the adverse health impacts? New studies have shown a link between obesity and diabetes . Your comments.
A. Being obese during pregnancy increases the risk of various pregnancy complications, including:
• The risk of miscarriage, stillbirth and recurrent miscarriage
• Gestational diabetes
• A pregnancy complication characterized by high blood pressure and signs of damage to another organ system, often the kidneys (preeclampsia)
• Cardiac dysfunction
• Sleep apnea
• A difficult vaginal delivery
• The need for a C-section and the risk of C-section complications, such as wound infections.
• Obesity during pregnancy can cause various health problems for a baby, including:
• Being significantly larger than average (fetal macrosomia) and having more body fat than normal, which increases the risk of metabolic syndrome and childhood obesity
• Having birth defects — and obesity makes it harder to detect these conditions with ultrasound.
Q. Women also have certain problems related to their monthly periods and menstruation. Endometriosis is said to be on the rise. Yet there does not seem to be much research done on this and the tendency is to sideline the issue although it is so common among women of child bearing age. Your comments
A. Endometriosis is an often painful disorder in which tissue that normally lines the inside of your uterus — the endometrium — grows outside your uterus. Endometriosis most commonly involves your ovaries, fallopian tubes and the tissue lining your pelvis. Rarely, endometrial tissue may spread beyond the pelvic organs. Endometriosis is an enigmatic disease which affects up to 6-10% of women of reproductive age. It is present in 25-50% of women with infertility and pelvic pain. Recently an increase in its incidence has been noted in many countries. It is a major burden to its sufferers and to healthcare systems. On January 15, 2018 the South Asian Minimal Access Gynaecology Endometriosis Centre (SAMAGE) was established within the Colombo South Teaching Hospital (Kalubowila Teaching Hospital) under the professorial unit in Obstetrics and Gynaecology, University Sri Jayewardenepura. This Centre will be a referral centre for all complex gynaecological problems with special interest in endometriosis.
Q. More women are also said to be mentally stressed than before for various reasons. This stress could spill over to their families including their children. Do you agree?
A. Yes. A spillover effect occurs within a person and is therefore an intra-individual transmission of stress. A rather similar effect of ‘spilling over emotion’ can be observed between persons. This could have a bad impact on the children.
Q. As a Community Physician at the Health Ministry what are the recent interventions that have been introduced to resolve these problems? ( mention the Life style centres , yoga classes etc)
A. The modern world is facing a pandemic of lifestyle disorders that require changes to be made consciously by individuals themselves, and as yoga is the best lifestyle ever designed, it has potential in the prevention, management, and rehabilitation of prevalent lifestyle disorders. Yogic lifestyle helps humans strengthen themselves and develop positive health, enabling them to withstand stress better.
Q. As we approach another Women’s Int’l Day, the question of gender inequality resulting in violent acts against women including rape and incest are of concern. How can we ensure that all women are able to fulfil their potential to their fullest in safe environments both within and outside their homes, not just on March 8 but every day of their lives?
A. Gender equality is achieved when women and men enjoy the same rights and opportunities across all sectors of society, including economic participation and decision-making, and when the different behaviours, aspirations and needs of women and men are equally valued and favoured.
Violence, rape and incests against women can only be stopped by inculcating spiritual values in the minds of men. This is a challenging task which has to be started during early childhood. We need the help and participation of the clergy of all religions to overcome this challenge.
Q. Safe Motherhood is an Initiative upheld by Sri Lanka in partnership with many countries of the United Nations. Yet, the number of back street abortions that have maimed and killed so many young mothers is increasing to a frightening degree, with some 750 -2,000 illegal abortions said to occur daily in the island. Recent reports reveal that an increasing number of brothels by foreigners and locals have also sprung up in tourist areas. What do you think should be done to put an end to this ?
A. Abortion is generally illegal in Sri Lanka under the Penal Code of 1883. However, despite the legal background a large number of abortions are carried out on a daily basis. The root cause is uncontrollable lust. This shows the degeneration of moral values of the society, which can be attributed to two things:
1. Easy access to abortion which shows the absence of laws to prevent this.
2. Secondly it’s again a spiritual issue. It seems, religions have failed to inculcate the basic tenets in the minds of the followers.
Q. Your message to all Lankan women
A. Visit a gynaecologist if they come across symptoms in their reproductive system. Always try to look at life objectively and make lifestyle change like yoga, when necessary.
I advise pregnant mothers to attend clinics regularly and follow the advice. I also urge young women to seek advice from parents or well informed elders when making decisions on Reproductive matters.