Dr. Duru Shah, is the Director of Gynaecworld, the Center for Women's Health and Fertility, Chair of the Metropolis Foundation and the founder and president of the PCOS Society. She is a prominent figure in women's health and fertility and is recognised for her pivotal role in bringing adolescent and reproductive & sexual health into the school curriculum in 2007; getting infertility coverage under health insurance in 2019, and introducing Intravenous Iron therapy for pregnant women in the public health system which helped in reducing death and morbidity due to anaemia during labour in rural India. She has also worked actively on raising awareness regarding the high prevalence of diabetes, osteoporosis and hypertension in women between 45 – 60 years in rural India.
Dr. Shah's efforts extend to global platforms like the C-20 Health Vertical, where she highlights the ill effects of Polycystic Ovarian Syndrome (PCOS) and obesity prevalent in India, aiming to address these concerns at an early stage to prevent complications.
In this article, Dr. Shah recommends addressing the broad issue of women’s health by developing targeted healthcare strategies for each life stage, namely- childhood, puberty, adolescence, reproductive age, menopause, and post-menopause. With a significant increase in life expectancy from 25-30 years a century ago to 71.4 years in 2023, new approaches are required and also emerging. By addressing these unique challenges, women's healthcare can be strengthened across their various life stages.
Article begins:
Women go through different phases in life: childhood, puberty, adolescence, reproductive age and menopause. 100 years ago life expectancy of women was 25- 30 years and today in 2023 it has touched 71.4 years. During these various stages of a woman’s life, especially post menopause which women had never experienced before, many new challenges have emerged bringing forth many new strategies to strengthen healthcare in India.
Childhood:
i. Universal Vaccination to be given and making sure that they receive the Rubella vaccine is also administered. This is because if a woman gets infected with Rubella during her early pregnancy, it could lead to severe malformations in the baby born.
Rubella infection does not demonstrate too many symptoms. A pregnant woman may just get a rash for a 2- 3 days and then it’s gone. This may be totally overlooked by her, thinking it’s only an allergic reaction but it could harm the bay permanently if the infection gets transmitted to the baby. Hence as a child if this vaccine is given, it could reduce the percentage of babies born with blindness and mental handicap. As physician if we find that the woman has had Rubella in early pregnancy we would recommend termination of pregnancy, 80% of such babies would get affected.
ii. Preventing obesity through physical exercise and healthy eating, because obesity in children can lead to obesity in adulthood, especially PCOS girls with increased morbidities in adulthood and disability in older age.
iii. It is well known that if a child adds weight from the age of 6 years onwards, it can lead to obesity in adulthood. Hence it is very important that parents encourage exercise in any form such as playing sports like tennis, badminton, swimming or just playing outdoors with other children. The suggestion is to insist that schools have an hour of physical fitness every single day in schools itself. This is where the Departments of Education and Health of the Government of India need to step in and include mandatory physical activity in the school curriculum.
Puberty:
Managing health during puberty depends heavily on awareness, knowledge and behaviors. Therefore creating awareness on girls’ menstrual health and hygiene is crucial. The focus should also be on preventing anaemia due to heavy blood loss during periods. Since puberty is also a growth period, good nutrition and exercise to prevent physical and mental stunting is of paramount importance. This information may appear generic but a large section of our population, especially in rural parts, are not aware of these simple facts and the girls suffer a lot due to lack of adequate knowledge on health and hygiene, proper nutrition and exercise.
Adolescence:
i. Create awareness on their reproductive and sexual health which is so important in today’s world, when adolescents are curious, their hormones are surging and there is ample information available on the internet, which may or may not be the correct information.
ii. Offer them safe contraception and correct information on sexually transmitted infectious and unsafe abortions, so that they can prevent severe morbidity like cancer and infertility in the future.
iii. Vaccinate them with the HPV vaccine to prevent cervical cancer before they become sexually active and in India it should definitely be between 13-14 years of age because a large percentage of our adolescents are sexually active from the age of 16 years onwards.
Reproductive Age:
i. Many young women are into careers today and delay marriage or child bearing till later in the fourth decade of their lives. This deprives them of easy child bearing when they wish to,have children leading to mental and physical stress. Freezing their eggs or embryos, at a younger age and getting health insurance to cover infertility would help them to remain stress free and focus on their careers when they need to, and enjoy childbirth when they are ready for it.
ii. There is a lot of information available on pregnancy care in Urban India, but pre-conception care which is so very important is not being followed even by the educated couple! Before getting pregnant one has to be sure if there are any medical, hormonal or genetic issues which need to be addressed so as to prevent harm to the baby growing in an unhealthy environment of the womb in an affected mother. A visit to the Gynaecologist 3 months before planning a pregnancy is mandatory.
Menopause:
The female hormone “estrogen” wanes as women approach 45 years of age and disappears at menopause leading to a lot of mental emotional and physical distress. Awareness on therapies like Hormone Replacement, Calcium and Vitamin D intake, physical activity and healthy nutrition will offer them a very active 20-25 years ahead preventing morbidity due to osteoporosis, cancers, diabetes, cardiovascular disease etc. if detected at an early stage.
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