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On a mission possible

Dr. Duru Shah, president of Federation of Obstetrics and Gynaecology Societies of India, on issues related to maternal health

WOMAN `S POINT Dr. Duru Shah, president of Federation of Obstetrics and Gynaecology Societies of India, (FOGSI)

" Let us treat the woman as a body with a soul and not only as technicians attending to her reproductive system." Saying so, Dr. Duru Shah, president, Federation of Obstetrics and Gynaecological Societies of India, (FOGSI) raised the issues relating to women's health from a clinical to a sublime plane. She was addressing the august gathering of doctors who assembled, in the city, for the 49th All India Congress of Obstetrics and Gynaecology.

Excerpts from an interview with Dr. Duru Shah

As president of FOGSI what are the main issues before you?

I have decided to concentrate on the youth: on adolescents, both boys and girls, between the age group15 to 20. We will focus on issues, which relate to their health, since they are the productive force of tomorrow. They are India's tomorrow. In this context we are trying to sensitise more than 20,000 gynaecologists who are our members. We will sensitise them plus the young people themselves. It is an outreach programme. We have developed a programme where the whole educational content is for the doctors. It is called Youth Express. We will have our speakers who will go to the doctors. The two main things focussed are preventing HIV and promoting contraception. Today, 50 per cent of all new HIV infections are in the youth. So we are talking to the youth and not the older people as we are looking at preventing all this in the future. 2006 is the year of the youth for FOGSI

Do you think maternal care has improved in the last decade or so?

Almost 35 per cent of deliveries in the country are conducted by `dais' or maids. Not even by mid wives. So it leads to a lot of complications. In the villages there is inadequate transport system from home to the district hospital. Most women die during transportation. So FOGSI has gone into partnership with the Government Of India where Rs. 25 crore has been allotted to train 2,000 of their doctors from primary health centres. We will be doing so in the next five years.

Then would you say that deliveries at home are unsafe?

Our maids are not well trained. Either the baby dies or the mother dies. I would say that home deliveries in rural areas are not safe. Statistics wise in western countries hardly 5 to 10 women to every 100,000 deliveries die during childbirth whereas in India 460 women die to every 100,000 childbirths. In cities the scene is different.

Is C-Section being abused by doctors, going by the increase in the number of Caesarean deliveries?

No, I don't agree with this. C- Section is performed only because there is a problem with the baby or the mother. As technology is advancing we can tell earlier that the baby or the mother is in trouble. After knowing this why wait? Today, science gives us prior information that before the heartbeat begins to occur we know if there is some damage occurring to the brain, so we deliver the baby early. Today C-Section is very safe. There may be a few people who are doing it unnecessarily but then in every field you have all kinds. Look at the politicians. But as doctors we are more human than commercial.

What about pre-natal sex determination?

There are two areas of concern. As doctors we can definitely do something. Female foeticide is occurring all over the country but gynaecologists are not the only ones to blame. Patients get ultrasound done and determine the sex and go for termination to another place and give some different reason. It is a crime to do sex selection and the statistics are going up. There are 927 females to 1,000 males in the country and in some States it is even 700 to 1,000. I am appealing to all my doctors to look at it as a social concern. But the concern is that if we don't do this they may go to a quack. But I know of many young couples thrilled at having a female child.

Your second concern?

It is the issue of sexual abuse. Lots of young women are sexually abused. There is not sufficient medical evidence to nab the culprit. We have made a film to teach them how to collect sufficient medical evidence so that the culprit is booked. These are two issues where doctors can help and justice is done to women.

Is breastfeeding being practised more now?

We encourage our mothers to breast feed for a year. The aim of FOGSI is natal, maternal health.

What about the belief that fluids are not good for a mother after childbirth?

All these are myths. On the contrary, scientifically we need mothers to be hydrated after delivery. Pregnancy is a condition when the blood thickens.

There are still grey areas in IVF treatments

We have been able to achieve a lot. As of today there are no rules and regulations for Assisted Reproduction, but it is in the process. Sometime this can lead to unethical practices.

The role of nutrition in maternal care

Anaemia and osteoporosis in women are the two leading concerns caused due to poor nutrition.

Your speech was titled, `Mission Possible', so is the present picture of maternal health in the country a rosy one?

Kerala can teach the rest of India the way forward to improve maternal health. But there is a very long way to go especially in rural areas. We gynaecologists need to do a lot so that one day we are as good as the developed world and proud of our statistics. And it is not a mission impossible.

Fact file

The importance of focusing on the youth arrives from the facts that those under 25 years account for 50 per cent of HIV infections in India (Joint United National Project on HIV/AIDS). According to UN figures, 30 per cent of girls in the 15-19 years age group have their first child before the age of 19 years. Pregnancy before 18 years carries many health risks. Teenagers are more likely to die in pregnancy or childbirth before 20-24 years. 14 per cent of abortions occur in adolescents. Raising the mother's age from 18-23 years will reduce population momentum by 40 per cent, says the UN.

PRIYADARSSHINI SHARMA

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