How India's family planning programme places well-being and unlocking the potential of women at its centre

The story of India in the 21st century has been one of extraordinary growth and innovation.

We have revolutionised the data and information industry , and we produce medicine cheaper

than anywhere in the world. We eliminated polio under incredibly challenging circumstances.

But India has not even come close to reaching her full potential, because we have only

leveraged half of our resources into that effort. We've yet to unlock much of the potential of

the other half: India's women.

Only when India's women are on an equal footing with India's men will we be the nation we

want to become. The government has already taken significant steps to provide health and

development to women.

In India, though maternal and infant mortality have dropped precipitously in recent years, 200

women still die every day in child birth. Part of the problem is that not all pregnant women

have easy access to the best ante-natal care.The Pradhan Mantri Surakshit Matritva Abhiyan,

which was launched late last year, guarante es every woman in her second or third trimester

free ante-natal care by private doctors at designated hospitals all over the country on the 9th

of every month.

More than 50 lakh women have been given quality ante-natal checkups under this

scheme.More than 56 lakh pregnant women have been immunised under Mission

Indradhanush and the MAA campaign, through awareness and counselling, continues to

promote better health and nutrition to mothers and children at community level. Family

planning is one of the most critical and long standing health programmes in India. Here too

India has made impressive progress, with the fertility rate dropping from 2.7 to 2.1 over the

last decade. But even today 31 million married women are not using any contraception at all;

about two thirds of the rest are using sterilisation, which is effective but doesn't help women

delay their first pregnancy or space their later children at healthy intervals.

As a result, too many women are either having more children than they want, having children

sooner than they want, or not leaving enough time between children for their bodies to

recover fully from pregnancy . Realising this massive gap, the government has introduced

three new contraceptive methods into the health system, including injectables and a once-aweek

pill, so that more and more women will be able to plan their families.

Among those women who do get pregnant, almost half are between the ages of 15 and 25, so

we're also starting an intense awareness campaign aimed at this age group to make sure that

they know the contraceptive options and feel empowered to exercise them. A complementary

campaign will target men, since contraception isn't always a choice a woman can make on

her own. The better men understand family planning, the more supportive they're likely to be

when it comes to planning their families together with their wives.

The need for better contraception and ante-natal care is not spread evenly around the country

. A quarter of India's mothers who live in the poorest areas are twice as likely to see their

babies die than the rest. That is why we launched Mission Parivar Vikas on World Population

Day on Tuesday , doubling down our efforts in 145 districts in 7 states districts

Responsible for half of the country's infant deaths for intensive improvement in family planning and ante-natal care services.

As part of this Mission we want to ensure that supplies are available at all facilities at all

times for which we are developing a robust Family Planning Logistics Management

Information System. This is a web and mobile based decision-making tool to monitor and

manage the flow of contraceptive supplies to reduce inventory fluctuations and improve

the programme's effectiveness at all public health facilities.

We estimate that in 2017 nearly 137 million women in India are using modern method of

contraception. As a result of this usage, 39 million unintended pregnancies will be prevented;

nearly 12 million unsafe abortions, 16 million total births and 43,000 maternal deaths will be

averted. We firmly believe that family planning is critical for our nation's economic

development, and is a big first step towards growth, equality and sustainable development

that opens the door to opportunity and prosperity for women and families.

Source: The Times of India

Seven million girls go missing in India every decade, say reports

SELECTIVE MORTALITY
In many small families, the missing children are girls. In a
family that already has a daughter, the chances of the second child being a girl drops by 38%.
Smaller percentage of girls is significant as SNCUs are referral units, with most babies being
treated either being referred... from other hospitals in the vicinity DR SATISH MARAVI,
Paediatrician India newborn action plan 2014 has a goal of attaining single digit
neonatal mortality and stillbirth rates by 2030 with efforts like starting birth defect
surveillance in medical colleges HEALTH AND WELFARE MINISTRY OFFICIAL
Families are steadily getting smaller in India but in many homes the missing children are
girls.

SANCHITA SHARMA/HT
Sabita Baria, 22, with her newborn at the special newborn care unit at the Government JP
Hospital in Bhopal, Madhya Pradesh. Her child, a boy, has recovered from birth asphyxia
from prolonged labour.

Around seven million girls go missing in India every decade, with the fall in sex ratio
corresponding with rising affluence, increasing availability of sex-determination technology
and declining family size.

The natural sex ratio at birth favours boys, with about 1,020 boys born to 1,000 girls. This
bias in favour of boys is nature’s way of balancing the slightly raised risk of death in baby
boys, which even outs the overall sex ratio by the age of six.

Yet not only are fewer girls born because of sex-selective abortions but more girls are also
dying in the first five years of birth because of neglect.

Around 1.2 million children die before their fifth birthday in India, which puts the country’s
under-5 mortality rate (under-5 deaths/1,000 live births) at 45.

While gender-wise data for 2015-16 is not yet available, the newborn death rate (death within
28 days of birth) in India was 41 for boys and 37 for girls per 1,000 live births in 2005-06,
with states like Uttar Pradesh, Bihar, Madhya Pradesh, Rajasthan, Odisha, Jharkhand,
Chhattisgarh, Uttrakhand and Assam registering a fall sharp in the under-5 gender ratio over
the past decade because many families invest more effort, time and money to save a sick boy
child than a girl.

India also has the world’s highest newborn deaths, more than 700,000 babies dying within the
first 28 days of life every year. Here again, more boys are likely to be saved than girls.

DON’T GIRLS GET SICK?
To save babies in the first most critical 28 days of life — 70% infants deaths occur in the
neonatal period — 662 special neonatal care units (SNCUs) with more than 11,000 beds have
been set up at the district level to prevent deaths from low birthweight (below 2.5 kg),
prematurity, birth asphyxia, sepsis, jaundice and other birth complications. In 2016, 842,000
newborns were treated at these SNCUs across India. Only 41% of them were girls.
“The smaller percentage of girls is significant because SNCUs are referral units, with most
sick babies being treated either being referred from within the hospital or from other hospitals
in the vicinity,” says Dr Satish Maravi, paediatrician in-charge of the SNCU at government
JP district hospital in Bhopal, Madhya Pradesh.

“If the numbers are low for girls, it’s because parents are not bringing their girl child despite
being referred,” he said.

His unit in the city centre has 23 beds, with 30-32 babies being admitted on any given day.
Around 57.5% of these babies are boys, with the percentage of boys being higher in the 34%
cases referred from private hospitals and clinics.

Sabita Baria, 22, is there with her second child, a boy, who suffered birth asphyxia from
prolonged labour. Rainbow Children Hospital, a private clinic in Bhopal, charged her
₹60,000 before referring her son to the JP hospital, where treatment is free. Baria desperately
wants the baby to live.

“We have a five-year-old girl and have been trying for a boy. I won’t ask God for anything
more if my boy lives,” she says, hugging her son in quiet desperation.
Her yet-to-be-named son is ready to be discharged, says staff nurse Meenakshi Pillai, who is
more concerned about the 1.175-kg preterm baby Rinky in the next radiant warmer, who
weighs less than half a healthy birthweight of 2.5kg.

“She’s gained 40gm in a week, which is a sign she’s recovering. She’s started feeding on her
own too, she’s a fighter,” says Pillai.

FIGHTING BIAS
In many homes, girls have to fight to survive. India’s pre-natal diagnostic techniques act bans
both pre-conception and pre-natal tests such as amniocentesis and sonography since 1994 and
2003, respectively. But illegal abortions have kept the sex-ratio at birth skewed in favour of
boys: 919 girls to 1,000 boys were born in the five years preceding 2015-16.

With many states cracking down on doctors conducting illegal sex-determination, the sex
ratio registered a marginal increase to 914 in 2005-06, with Kerala being the most kind to its
girls (1,047 girls born to 1,000 boys), followed by Meghalaya (1,009) and Chhattisgarh (977).
Some states like Maharashtra, Tamil Nadu and Haryana have registered a significant
improvement in the sex ratio, but many others have shown a sharp decline.

Over the past decade, sex ratio at birth plummeted in Sikkim from 984 to 809, Manipur from
1,014 to 962, Mizoram from 1,025 to 946, Manipur from 1,014 to 962, and Jharkhand from
1,091 to 919.

In a family that already has a daughter, the chances of the second child being a girl drops by
38%. The sex ratio for the third child was 1,000 in families with two sons, but dropped to 600
if one of the older siblings was a girl and to 455 if the firstand second born were girls, found
a 2013 study at Indira Gandhi Government Medical College, Nagpur.

“India newborn action plan 2014 has a goal of attaining single-digit neonatal mortality and
stillbirth rates by 2030, with efforts including setting up of SNCUs at the district level,
starting birthdefect surveillance in medical colleges, and getting ASHAs (community health
workers) to visit one crore newborns at home within 42 days of birth each year,” says a health
and family welfare ministry official, who did not wish to be named.

How many children are saved depends on the last-mile reach. Unless community health
workers ensure all sick babies, irrespective of gender, get the best possible treatment, India
will continue to lose girls as families shrink.

Source: Hindustan Times

Hold the painkillers

They may overtax kidneys and reduce muscles’ ability to recover, say studiesTaking ibuprofen and related over-the-counter painkillers could have unintended and
worrisome consequences for people who vigorously exercise. These popular medicines,
known as non-steroidal anti-inflammatory drugs, or NSAIDs, work by suppressing
inflammation. But according to two new studies, in the process they potentially may also
overtax the kidneys during prolonged exercise and reduce muscles’ ability to recover
afterward.

Anyone who spends time around people who exercise knows that painkiller use is common
among them. Some athletes joke about taking “vitamin I,” or ibuprofen, to blunt the pain of
strenuous training and competitions. Others rely on naproxen or other NSAIDs to make hard
exercise more tolerable.

NSAID use is especially widespread among athletes in strenuous endurance sports like
marathon and ultramarathon running.

But in recent years, there have been hints that NSAIDs might not have the effects in athletes
that they anticipate.Some studies have found that those who take the painkillers experience
just as much muscle soreness as those who do not. A few case studies also have suggested
that NSAIDs might contribute to kidney problems in endurance athletes, and it was this
possibility that caught the attention of Dr. Grant S. Lipman, a clinical associate professor of
medicine at Stanford University and the medical director for several ultramarathons.

How they work
NSAIDs work, in part, by blunting the body’s production of a particular group of
biochemicals, called prostaglandins, that otherwise flood the site of injuries in the body.
There, they jump-start processes contributing to pain and inflammation. Prostaglandins also
prompt blood vessels to dilate, or widen, increasing blood flow to the affected area.
Taking NSAIDs results in fewer prostaglandins and consequently less inflammation and less
dilation of blood vessels. Whether these effects are advisable in people exercising for hours
has been uncertain, however.

Study results
So for one of the new studies, published on July 5 in the Emergency Medical Journal, Dr.
Lipman asked 89 participants in several multi-day ultramarathons around the world to
swallow either an ibuprofen pill or a placebo every four hours during a 50-mile stage of their
race.
Afterwards, he and his colleagues drew blood from the racers and checked their levels of
creatinine, a byproduct of the kidneys’ blood filtering process. High levels of creatinine in an
otherwise healthy person are considered to be a sign of acute kidney injury.
The researchers found that many of the ultra runners, about 44%, had creatinine levels high
enough to indicate acute kidney injury after running 50 miles.

But the incidence was particularly high among the runners who had taken ibuprofen. They
were about 18% more likely to have developed an acute kidney injury than the racers
swallowing a placebo. Furthermore, their injuries, based on creatinine levels, tended to be
more severe.

The study did not follow the racers in subsequent days or weeks, but Dr. Lipman believes that
they all recovered normal kidney function soon after the event ended. The experiment also
was not designed to determine why ibuprofen might have increased the risk for kidney
problems in the racers. But Dr. Lipman and his colleagues suspect that, by inhibiting
prostaglandins, the drug prevented blood vessels from widening as they otherwise might
have. Slightly strangling blood flow to the kidneys, he says, might make it harder for those
organs to filter the blood.

The second study, published in May in the Proceedings of the National Academy of Sciences,
raised similar concerns. It found that by reducing the production of prostaglandins, NSAIDs
change how a body responds to exertion, this time deep within the muscles. For that study,
researchers in the department of microbiology at Stanford University looked first at muscle
cells and tissue from mice that had experienced slight muscular injuries, comparable to those
we might develop during strenuous exercise. The tissue soon filled with a particular type of
prostaglandin that turned out to have an important role: It stimulated stem cells within the
muscles to start multiplying, creating new muscle cells that then repaired the tissue damage.
Afterwards, tests showed that the healed muscle tissue was stronger than it had been before.
This microscopic process mimics what should happen when we exercise strenuously,
straining and then rebuilding our muscles.

But when the researchers used NSAIDs to block the production of prostaglandins within the
muscles, they noted that fewer stem cells became active, fewer new cells were produced, and
the muscle tissue, even after healing, was not as strong and springy as in tissues that had not
been exposed to the drug. They saw the same reaction both in isolated muscle cells in petri
dishes and in living mice treated with NSAIDs.

We are not mice, of course. But the findings imply that in people, too, anti-inflammatory
painkillers might slightly impair muscles’ ability to regenerate and strengthen after hard
workouts, says Helen Blau, the director of the Baxter Laboratory for Stem Cell Biology at
Stanford, who oversaw the experiment. “There’s a reason for the inflammation” in the body
after exercise, she says. “It’s part of the regenerative process and not a bad thing.” In fact, at
the cellular level, she says, “it does look as if no pain means no gain.” She suggests that those
of us who exercise might want to consider options others than NSAIDs to relieve the aches
associated with working out and competing.

Dr. Lipman, who is a clinician as well as a distance runner, agrees. “Maybe consider
acetaminophen,” he says, a painkiller found in Tylenol that does not affect inflammation. Or
skip the drugs altogether. “I often tell people, think ice baths,” he says.

Source:  The Hindu

Health education centre for kids soon

To educate school children from an early age on personal hygiene and how diseases can be prevented, a health education centre has been proposed on the lines of the US centre in Indiana. The project would be a collaborative effort of Chandigarh Rotary Club and UT administration.

A land will be allotted for the centre, though the area for the same is yet to be identified. Two doctors from PGIMER and Government Medical College and Hospital (GMCH) 32 were sent to the US recently to study the feasibility of the centre. A project report is being prepared to be submitted to the UT adviser for the same.

“We had sent Dr Atul Sachdev from GMCH and Dr J S Thakur from the school of public health, PGIMER to study the model in the US before replicating the idea here. The project is funded by the Rotary Club,“ said health secretary UT Anurag Aggarwal.

“It's an early stage of the project, which aims at teaching school children about personal hygiene. Also there will be working models that will enable students to understand human body parts in an interesting way,“ said former president of the Rotary Club R K Saboo, who was also a part of this visit. He said, “At a later stage, we will have teleconference where the students can interact with experts in any part of the world,“ said Saboo.

If the proposal is accepted, such a centre will be unique to the city. Unlike a classroom session, the centre will have interesting model and visual learning aids. “We are drafting the project which will be tailor made for our requirement. After it is introduced for government schools, we will engage private schools as well,“ said Thakur.

Source : The Hindu

This test can predict death risk in breast cancer patients

Method, called MammaPrint, looks for a 70-gene signature

A molecular test can pinpoint which patients are at low risk of death from breast cancer even

20 years after diagnosis and tumour removal, a study has found.

As a result, ‘ultra-low’ risk patients could be treated less aggressively and overtreatment

avoided, leading to fewer toxic effects, researchers said. “This is an important step forward

for personalising care for women with breast cancer,” said Laura J. Esserman, from the

University of California, San Francisco, in the U.S.

“We can now test small node-negative breast cancers, and if they are in the ultra-low risk

category, we can tell women that they are highly unlikely to die of their cancers and do not

need aggressive treatment, including radiation after lumpectomy,” said Ms. Esserman.

First evidence

This is the first evidence that it is possible to run a diagnostic test at the time of diagnosis and

identify ultra-low risk tumours.

“This is an exciting advance because approximately 20-25% of tumours diagnosed today may

be ultra-low risk,” said Ms. Esserman.

In the study published in the journal JAMA Oncology , researchers sought to determine

whether a 70-gene test could accurately and reliably identify tumours with indolent, or slowgrowing,

behaviour to assess the risk of cancer recurrence up to 20 years after diagnosis.

The same test had shown last year that nearly half of early-stage breast cancer patients, who

met traditional criteria for high risk, could safely skip chemotherapy based on the biological

make-up of their tumours.

Researchers disclosed that the test, called Mamma Print, tests for a 70-gene signature that can

predict whether cancer will recur in early-stage breast cancer patients.

Source : The Hindu