In India, discussing women’s sexual and reproductive health is still a taboo, especially in rural areas. According to the Global Nutrition Report 2017, 51% of Indian women between 15 to 49 years are anemic. According to the Ministry of Health and Family Welfare, India’s Maternal Maternity Ratio (MMR) is 113, which means there were 113 deaths per 100,000 live births between 2016-2018. India still has a long way to reduce its MMR to 70 per 100,000 live births by 2030 to match the Sustainable Development Goal target.

Ⓒ Ramamohan/RDT

In a conversation with Dr. Jyothi, Head of Obstetrics and Gynecology at RDT Bathalapalli hospital, she explains the situation in Anantapur, provides her insight, and highlights the steps that can be taken to improve the situation. Her experience with the RDT hospital network, which has performed over 9,036 institutional deliveries and 2,167 gynae surgeries during 2020-2021, has been for over ten decades. Here is an excerpt.

Dr. Jyothi, head of Gynecology and Obstetrics department at RDT Bathalapalli hospital. Ⓒ Roberto Rodriguez/RDT

What is the ground situation of women’s sexual reproductive health in Anantapur? Do the women have issues? Are they severe?

Women are taught and expected to suffer in silence. If she is able to do that, she is considered a high-value woman in society. Hence, issues related to their health are always neglected, and never spoken about. In rural India, it is worse than in the cities. Here in Anantapur, many women have high-risk pregnancies, which is a result of ignoring nutrition intake and subtle signs of complications. Anemia and urinary tract infections (UTIs) are rampant among women here. However, they often avoid getting it treated and end up increasing their complications. Women are reluctant to go to remote places for a check-up even for severe problems.

In terms of awareness, what is the situation?

Ten years ago, women had no awareness at all in rural areas. As I mentioned, women are not expected to share their problems. So, now when they visit us, we try to make them talk. The government is focusing on awareness campaigns and I must say that accredited social health activists (ASHA) are doing a great job. In my opinion, there is an increase of 50% in terms of awareness as compared to ten years ago. Even in our Bathalapalli hospital, we receive fewer anemia and UTI cases than we received ten years ago. Women are also more open to pap-smear tests and feel less shy about it. However, even though the situation has improved, it is still not enough. All the stigmas and taboos related to women’s health are very well deep-rooted and we need to address those roots. It will certainly take some time but I am hopeful.

Ⓒ RDT staff

How do women take care of their intimate health?

Interestingly, there are two extremely opposite groups of women. The first group, which I will classify as more literate and with media exposure, and the second group is less literate with less or no media exposure. The first group of women sometimes over-indulge in taking care of their intimate health. The focus is more on beautifying than on hygiene, which sometimes can create complications. The second group of women, on the other hand, completely neglect their intimate health and hygiene. But what is common between the two groups of women is that they only consult doctors when the situation goes out of hand.

In your opinion, what steps can be taken to improve the existing condition?

There are two ways that have proven to be effective in Anantapur. First is to bank on sanghams, to strengthen them in a way where women not only pool their savings, and discuss their daily chores but also talk about their health. I believe, giving training at the community level to selected women representatives of sanghams can be very helpful. So, when the sangham meets every month, they discuss their health and identify their problems, and visit doctors on time if need be. The second is to develop effective communication skills among the nurses and rural health organizers. They have knowledge but often lack the skills to communicate with the women in a way that will help them to open up. At the RDT healthcare network, we do have training for nurses and rural health organizers and they are very helpful.

Ⓒ Nagappa/RDT

What is the role of the doctors regarding this issue?

To put it simply, the most important role is to maintain effective communication with the patients. There are also many other psychological and social factors that prevent women from being more open and forthcoming. In many households, women eat less than other members of their family even during and after pregnancy. There are also instances where their husbands’ families taunt them or make them feel guilty if they eat a little extra. As doctors, we should understand their situation, and instead of just prescribing medicines and telling them to focus on nutrition, we should give them the space to talk and share in a way that helps them to take their health issues seriously. Apart from this, we should develop a strong medical network. Here in RDT, we have volunteers, health organizers, and telecommunications that help us to reach out to women, especially for follow-ups.

Ⓒ Cristofol Oliver/RDT

Would you like to share a specific message?

Women are beautiful creatures. Independence is their jewel and health is their crown. We need rural women to realize this as they suffer more. I always say that saving money is important but saving health is more important. The COVID-19 times have only proved it more correct. The day when rural women enjoy the same independence as enjoyed by most urban women should come sooner.

Text: Dyuti Khulbe adapted by VFF USA