Access to health care 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 while the girls are treated as a burden to the family. 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.

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. So, 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 mother’s 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 is 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 especially in the urban areas is a rapidly growing problem. Three percent 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.

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

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 occurs more commonly in women than men. It has far reaching effects if not recognized 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.

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 numbers of Indian women still have limited or no access to health care.

Eating a healthy diet is extremely important.

According to the WHO a healthy diet for adults should contain:

Fruit, vegetables, legumes (e.g. lentils and beans), nuts and whole grains (e.g. unprocessed maize, millet, oats, wheat and brown rice).

At least 400 g (i.e. five portions) of fruit and vegetables per day, excluding potatoes, sweet potatoes, cassava and other starchy roots.

Unsaturated fats (eg. found in fish, avocado, nuts, sunflower, canola and olive oil) are preferable to saturated fats (eg. found in meat, butter, palm and coconut oil, cream cheese, ghee and lard).

Industrial trans fats (found in processed food, fast food, snack food, fried food, frozen pizza, cookies, margarines and spreads) are not healthy and should be avoided.

Less than 5 g of salt (equivalent to about one teaspoon) per day should be used and salt should be iodized.
Regular exercise (in addition of a healthy diet) and maintaining a healthy weight (check your BMI) will help cut down your risk of diabetes, hypertension, heart disease, stroke, obesity, osteoporosis and risk of fractures and possibly reduce the risk of certain cancers eg. breast cancer, colon cancer.

Exercise also helps improve body balance and coordination, reduces the risk of depression and improves mental skills which decline with age.

Moderate intensity physical activity could include brisk walking, swimming, cycling, hiking, dancing, aerobic, gardening, household work etc. At least 150 minutes of moderate-intensity physical activity should be performed throughout the week.

Quitting smoking, chewing of tobacco, pan or gutka, cutting down on alcohol will go a long way in reducing the risk or cancer and lung disease.

A regular health check testing for diabetes, anemia, 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.

Finally, as the old saying goes – “Prevention is better than cure”

Following a healthy lifestyle with adequate emphasis on diet and exercise will go a long way in reducing the risk of disease and ill health.

Regular medical checkups and seeking medical help early is extremely important in preventing or treating a disease.

– By Dr Prathima Reddy MBBS, MRCOG (London), FRCOG (London), FACOG (USA) Director, Senior Obstetrician and Gynecologist, Fortis La Femme Hospital, Richmond Road, Bangalore.