Bengaluru: Access to healthcare in India, especially for women, depends on various factors. Socioeconomic status, education, caste, religion, geography, urban/rural areas of residence and cultural factors. Traditionally, women’s health has received attention only during pregnancy and childbirth. After this, the health of the woman is largely ignored. 

Even today in several parts of India the birth of a boy is celebrated, and a girl mourned. Sons are looked upon as providers as the parents age and sources of dowry. The health of a woman is not given much priority both by the men of the household and by the woman herself. Because of this, women suffer more, receive less treatment and ultimately have poorer medical outcomes.

The middle age is defined as “the period of life between the ages of 45 to 60 years, when one is no longer young, but not yet old."  It is expected that in the next decade 15% of India’s population would be over the age of 40.  This is almost 20 million people who would have specific healthcare needs in this age group.  So, what are the special challenges in the delivery of health care for mothers in their middle age.

According to the World Health Organization, women live longer than men due to biological differences. In India, this is approximately three years more than the men. Non communicable diseases such as cardiovascular disease, stroke, kidney disease, respiratory disease and trauma are the leading causes of death in women worldwide.

What are the medical health issues that are more common in middle aged women?

Diabetes and Hypertension

The incidence of these two diseases which were previously thought to be more common in males are rapidly increasing in women as well. More in the urban areas compared to the rural areas. Both these diseases if discovered late or left untreated can have far reaching consequences. It is known that the incidence of heart attack in women with diabetes is 44% more than men and the incidence of stroke is 27% more than men. Kidney disease is also higher in adults with the above diseases.

Obesity

Obesity especially in the urban areas is a rapidly growing problem. 3% of Indians are obese and 25% are overweight. The factors that have contributed to this are better incomes, lack of exercise, increased consumption of high calorific foods and 'junk food.' Obesity increases the risk of heart disease, diabetes, stroke and osteoporosis and worsens arthritis.

Menopause

The age of menopause in Indian women is between 46 – 48 years. Women going through menopause can suffer from hot flushes, weight gain, depression and osteoporosis. The incidence of some female cancers also increases after menopause.

Cancer

The incidence of female cancers especially breast, cervix and ovary is higher after the age of 40. Breast cancer is now the most common cancer in Indian women surpassing cervical cancer which until recently was the most common one.

Depression

Depression occurs more commonly in women than men. It has far reaching effects if not recognised and treated early. Changes in the hormone levels especially before a period, after delivery and during the menopause can increase the risk of depression.  This is apart from the genetic and environmental factors that can contribute to depression. 

Pregnancy

Not many Indian women become pregnant after the age of 40. However, in recent times due to the wider availability of IVF (test tube baby), women opting to pursue their careers and thus putting off pregnancy till later, more women are pregnant in their late 30s or early 40s.  These pregnancies can be complicated by chromosomal abnormalities in the foetus (Down Syndrome), a higher incidence of diabetes and hypertension in pregnancy and a higher incidence of caesarean sections.

What can women do to remain healthy?

Most women tend to neglect themselves at the cost of their families and children. Although this attitude is changing due to better information, education and better incomes, large number of Indian women still have limited or no access to healthcare.

A regular health check testing for diabetes, anaemia, cholesterol and hypertension at least once a year is recommended.

Screening for breast and cervical cancer regularly as recommended by your doctor is a must. Breast cancer can be detected early with regular mammograms and cervical cancer can be prevented by having regular pap smears.

Women with a family history of breast, ovarian or colon cancer should discuss this with their doctor.

Eating a healthy diet, exercising regularly, not smoking, cutting down on alcohol and maintaining a healthy weight will go a long way in preventing disease.

Finally seeking medical help early is extremely important in preventing or treating a disease.

(Author - Dr Prathima Reddy, MBBS, MRCOG (London), FRCOG (London), FACOG (USA) is the director, senior obstetrician and gynaecologist at Fortis La Femme Hospital, Richmond Road, Bengaluru)