Reproductive make “crucial choices about their own bodies and

Reproductive health should be looked at through
a lifecycle approach as it affects both men and women from infancy to old age.
According to UNFPA, reproductive health at any age profoundly affects health later
in life. According to the United
Nations Population Fund (UNFPA), unmet needs for sexual and reproductive health
deprive women of the right to make “crucial choices about their own bodies
and futures”, affecting family welfare. Women bear and usually nurture
children, so their reproductive health is inseparable from gender equality. According
to UN estimate, every woman who dies related to pregnancy, out of them
approximately 30 women suffers injury, infection and disabilities. The most
common complications arising due to pregnancy are anemia, infertility, pelvic
pain, incontinence and obstetric fistula. Maternal morbidity in India is very high;
the national data on incidence of maternal morbidity is unfortunately not very
comprehensive hence global estimates are to be inferred.

For
a complex traditional society like India, there exist a multitude of reasons
behind the sad state of maternal health. For the subordinate position that
women are deemed in the Indian society they in majority cases do not get the
required medical attention. On top of generic health disadvantages, with the
advent of reproductive age of a woman the complexities of reproductive system
and child bearing take major role on the mental and physical health. The
general state of woman is vulnerable in the Indian society along with that age,
income group, education, infrastructure available and caste play roles
affecting the health facilities that women can get. India is still one of the
countries ridden with child marriages, more so for girls. Nearly half of
married women (ages 15 to19) have had at least one child (Indian Institute of
Population Sciences and ORC Macro, 2000). A common
consequence of early marriage and childbearing is that girls enter marriage and
become mothers without adequate information about reproductive and sexual
health issues, contraception, sexually transmitted infections (STIs), pregnancy
and childbirth. Maternal and child mortality is high amongst teenage mothers.
This is persistent much more in rural conditions than urban.

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Battle
with poverty is a day and night deal for India, with one third of the world’s
1.2 billion extreme poor living in India alone in 2010.(PTI, 2016) The economically
disadvantaged find it a challenge to provide basic care to the pregnant woman
and also proper medical attention during complications. Malnutrition and Anemia
are two of the big drivers for maternal health problems; both are closely tied
with poverty.  Both poverty and early age
marriages lead to pregnancy for an uneducated or barely educated female. This
makes them less confident about their mind and body and unable to properly seek
or articulate the kind of attention required by them.

With
all the efforts from government, the health facilities at the rural locations
in many a cases still fail the care seeker. Basic conditions of sanitation,
infection prevention and medicines are in a state of misery in remote
locations. On top of this the complex caste system of India can make the
available health facility inaccessible for a lower caste person. (More
prevalent in Northern and western India)

Sexual
education is a topic in India which is in a state where it is dealt with very
little to not at all. Sexual health
is considered to be a state of physical, emotional, mental, and social
well-being in relation to sexuality and not merely the absence of disease or
infirmity as defined by the WHO. Psychological and socio-cultural influences in
the delivery of this education can increase the likelihood of effectiveness.
Primarily, during adolescence (10–19 years) its provision is a crucial
preventative tool, as it is the opportune time when young people experience
developmental changes in their physiology and behavior as they enter adulthood

( Ismile, 2015). This bears direct relation to
reproductive health of women.

There
is notable evidence to suggest that pregnant women living with HIV/AIDS in
India are at enormous risk of being provided with substandard maternal health
care or even to be denied care entirely. Although the actual scope of this
problem is yet to be determined, compelling cases have surfaced revealing the vilification,
discrimination and outright abuse that pregnant women are forced to endure when
they attempt to seek reproductive health care, even at such a critical time as
childbirth. It is estimated that between 2 and 3.6 million people in India are
living with HIV or AIDS, with women making up a significant and increasing
portion of this total. Denial of institutional health care can be especially
devastating for pregnant women with HIV/AIDS since they are predisposed to a
higher risk of complications and other infectious diseases, such as
tuberculosis and malaria. (Center for Reproductive Rights,
2008)

The
subject of women’s rights more so in the developing nations (as the lack of it
is perceived to be more) is of prime concern and constantly discussed topic.
Central and pivotal to women’s right is the right to reproduction. Until and
unless a woman has full control of her body and mind she is unable to exercise
any other right. There is a lack of understanding in the society about what
actually are the reproductive rights of women. Only when a woman has their due
say over termination or not, when and how many children, mode of birth, means
and method of fertility management they can execute their reproductive rights
consciously. To understand and justify all of it, education and access to
information is critical for women.

So
the inequalities in maternal health care system are multifold and become quite
evident from discussion above. They become evident in, inequality of access of
publicly funded health care system for the economically disadvantaged, inequality
of state of the facilities depending upon rural and urban areas, inequality of
literacy rate of women resulting in inadequacy of consciousness, inequality of
general facilities for women for the growth of mind and body, inequality of
access of health facility driven by caste system, inequality due to special
circumstance such as HIV.

With
this entire pretext, reproductive health has become a priority for the
development of a country like India. Country’s large adolescent population and
its high rates of child marriage and early childbearing is the largest chunk of
the dynamics to deal with. India’s national family welfare program has two
stated objectives to address the needs of families, mainly women and children,
and to reduce population growth rates. Reproductive health is dependent on one
hand upon socio-cultural and biological factors on the one hand and the quality
of the health care system available to women. Health care system needs to be
equipped with best medical service that can be provided bearing all constraints
as well its efficiency to disseminate information to society in a culturally
conscious manner.

 

In
September 2000, Millennium Declaration on the occasion of Millennium Summit by
United Nations, the Millennium Development Goals (MDGs) was adopted. Which were
mainly aimed at progress towards reducing poverty and improving the quality of
life at the horizon 2015. There are eight broad goals, with 15 targets. Amongst
these goals one of important goal is to improve maternal heath. Subsequently,
UN declaration of Sustainable Development Goals 2015 also includes Reproductive
Health of Women as an important ingredient of social development.

The
key steps taken to accelerate the pace of reduction for Maternal Mortality
Ratio (MMR) under the National Health Mission (NHM) for achieving MDG goals
are:-Promotion of institutional deliveries through Janani Suraksha Yojana; Capacity
building of health care providers in basic and comprehensive obstetric care; Operationalization
of sub-centres, Primary Health Centres, Community Health Centres and District
Hospitals for providing 24×7 basic and comprehensive obstetric care services; Name
Based Web enabled Tracking of Pregnant Women to ensure antenatal, intranatal
and postnatal care; Mother and Child Protection Card in collaboration with the
Ministry of Women and Child Development to monitor service delivery for mothers
and children; Antenatal, Intranatal and Postnatal care including Iron and Folic
Acid supplementation to pregnant & lactating women for prevention and
treatment of anaemia; Engagement of more than 8.9 lakhs Accredited Social
Health Activists (ASHAs) to generate demand and facilitate accessing of health
care services by the community; Village Health and Nutrition Days in rural
areas as an outreach activity, for provision of maternal and child health
services; Health and nutrition education to promote dietary diversification,
inclusion of iron and folate rich food as well as food items that promote iron
absorption; Janani Shishu Suraksha Karyakaram (JSSK) has been launched on
1st June, 2011, which entitles all pregnant women delivering in public
health institutions to absolutely free and no expense delivery including
Caesarean section.  The initiative stipulates free drugs, diagnostics,
blood and diet, besides free transport from home to institution, between
facilities in case of a referral and drop back home.  Similar entitlements
have been put in place for all sick infants accessing public health
institutions for treatment; To sharpen the focus on the low performing
districts, 184 High Priority Districts (HPDs) have been prioritized for
Reproductive Maternal Newborn Child Health+ Adolescent (RMNCH+A) interventions
for achieving improved maternal and child health outcomes.  (Press Information Bureau Government
of India, 2014).

Even
with all these measures the progress is not as great as to make us proud of it.
In India, the MMR declined from 301 per 100 000 live births in 2001–2003, to
178 in 2010–2012. Keeping in view the overall pace of decline in the MMR, it
seems unlikely that India will achieve MDG-5 by reducing the MMR level to 109
by 2015. India is among the 51 nations with slow progress in maternal and child
care.

The
existing literature on Indian context show the importance of community level
education, female exposure to mass media, health expenditure, standard of
living of the household and education level of the female in maternal care.
These parameters are significant in determining the reproductive health status.
Not only the health expenditure but also the health care services bear a
significant impact on the reproductive health of mother and child.