Women's health

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1. GLOBAL SCENARIO  Women’s health matters not only to women themselves. It is also crucial to the health of the children they will bear.  This underlines an…
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  • 1. GLOBAL SCENARIO  Women’s health matters not only to women themselves. It is also crucial to the health of the children they will bear.  This underlines an important point: paying due attention to the health of girls and women today is an investment not just for the present but also for future generations.  This implies addressing the underlying social and economic determinants of women’s health – including education, which directly benefits women and is important for the survival, growth and development of their children.
  • 2. CONTINUATION,,,  Global causes of the overall burden of disease in females are lower respiratory infections, depression and diarrhoeal diseases.  Neuropsychiatric conditions and sensory disorders – related, for example, to vision and hearing – are also important causes.  Infectious diseases continue to cause over half the DALYs in the African Region but have a much smaller impact in other regions
  • 3. CONTINUATION,,  In all regions and age groups, girls and women in higher income countries have lower levels of mortality and burden of disease than those who live in lower income countries.  Across all ages, the highest mortality and disability rates are found in Africa.
  • 4. CONTINUATION,,,  In childhood, most deaths and disabilities result from communicable diseases such as HIV, diarrhoeal and respiratory diseases, malaria, and maternal and perinatal conditions.  At older ages, patterns of death and disability change to noncommunicable chronic diseases such as heart disease, stroke and cancers. The single exception is in Africa, where communicable diseases remain the chief causes of female deaths up to the age of 60 years.
  • 5. CONTINUATION,,  There are significant regional variations in the composition of the overall burden of death and disability.  In Africa and South-East Asia, communicable diseases are important causes of death and disability at all ages.  However, in women aged 60 years and over, in all regions, most deaths are due to noncommunicable diseases.
  • 6. CONTINUATION,,,  Globally, the single leading risk factor for death and disability in women of reproductive age in low- and middle-income countries is unsafe sex, which can lead to sexually transmitted infections, including HIV.  Women who do not know how to protect themselves from such infections, or who are unable to do so, face increased risks of death or illness.  So do those who cannot protect themselves from unwanted pregnancy or control their fertility because of lack of access to contraception.  There is emerging evidence that violence against women is an important risk factor for their health, although the full dimensions of the problem remain insufficiently measured.
  • 7. WOMEN'S HEALTH IN NEPAL  Nepalese women and girls at large still suffer from poor health compared with their male counterparts, due to lack of adequate health services, general poverty and in some cases, the sociocultural preference for male children.  Women suffer from lack of medical facilities in case of pregnancy complications, malnutrition, anemia, and many other diseases related to their reproductive functions.  The high incidence of malnutrition and a lack of health awareness lead to much sickness in children and to high infant and child mortality rates.
  • 8. ISSUES IN WOMEN’S HEALTH  Female foeticide  Still high infant and child mortality rates and neglect of girls’ health  High maternal mortality rate  Lack of access to adequate health services, especially for reproductive health care and for contraceptive devices
  • 9. ISSUES IN EDUCATION  Low absolute levels of female education (literacy rate, educational attainment, and enrollment rates)  Significant gender gaps in education  Major reasons for not sending daughters to school include lack of household resources; lack of sense of importance since girls will marry; girls’ workload at home; high school fees; lack of female teachers or adequate facilities.
  • 10. ISSUES IN PATRIARCHY AND MARRIAGE  Little control over marriage choice  Early marriage, more so in rural, Terai uneducated women  Vulnerability of widows and divorcees
  • 11. ISSUES IN FERTILITY AND FAMILY PLANNING  Little control over fertility  Still high fertility rate among rural and uneducated women  Low contraceptive use
  • 12. ISSUES IN GENDER-BASED VIOLENCE  Lack of bargaining power of women, dowry, polygyny, and alcoholism as underlying causes of domestic violence  Trafficking of women widespread across all ethnic groups/castes  Poverty and lack of access to economic resources for women outside marriage as causes of women entering into commercial sex work  Inadequate legal framework and general law enforcement on gender-based violence.
  • 13. ISSUES ON THE ECONOMIC PARTICIPATION OF WOMEN  Women’s limited access to productive assets — land and property, credit, and modern avenues of knowledge and information — reinforced by unequal inheritance laws and by social norms that confine women’s resource base only to marriage  Lack of information on women’s employment and wages, and underreporting or "invisibility" of women’s economic activities  Concentration of women in low-productive, subsistence agriculture  Concentration of women in low-wage, low-skill, menial jobs in the agriculture and nonagricultural sectors, due to lack of education, training, information, and bargaining power  High and increasing work burden without concomitant increase in access to resources  Poor working environment — e.g. concentration at lower level jobs, poor working conditions, lack of child care facilities at workplaces, and trade unions’ lack of awareness of women's problems — and the gaps between law and practice  Child labor (girls more than boys)
  • 14. FACTORS AFFECTING WOMEN’S HEALTH  Behavioral and socio-cultural conditions or ways of living.  Environment  Economic status  Education  Occupation  Political system  Health services
  • 15. BEHAVIORAL AND SOCIO-CULTURAL CONDITIONS OR WAYS OF LIVING  Behavioral and socio-cultural conditions or ways of living is one of the major factors influencing health in Nepal.  Ways of living or life styles reflect a whole range of social value, attitude, and behavior.  It is composed of cultural and behavioral pattern and life long personal habits (e.g. smoking, alcoholism) that have developed through the process of socialization.  Lifestyles are learnt through social interaction with parents, peer groups, friends and siblings and through schools and mass media.  It is known that developed countries have coronary artery disease, lung cancer, drug addiction etc. which are mainly due to change in life style as sedentary life, lack of exercise, excess use of fat etc.  On the other hand, developing countries where old traditions are still followed are suffering from illness and death which occur due to poor sanitation, poor personal hygiene, bad custom and cultural patterns.
  • 16. CONTINUATION,,  All lifestyles have their own good and harmful points e.g. adequate sleep, enough nutrition, regular exercise are good habit as per health point of view.  To fulfill (achieve) the optimum health of an individual, we should handle healthy lifestyle.  Health is both a consequence of an individual’s lifestyle and a factor in determining it.
  • 17. ENVIRONMENT  Environment is one of the major factors influencing health in Nepal. Environment can be defined as any factor in which human being comes in contact either directly or indirectly. According to ecological concept, health is a positive interaction between man and his environment.  Environment can be classified as external and internal environment. External environment means all that which is external to human hosts and where they are exposed after conception. Internal environment includes each and every component, part, tissue, organ and system and their harmonious functioning within the system.
  • 18. ECONOMIC STATUS  Economic status is one of the major factors influencing health in Nepal.  Now, in developing countries, the rate of morbidity is decreasing and their life expectancy is increasing due to the slow increasing pattern of socio-economic status.  The economic status determines the purchasing power, standard of living, quality of life, family size and the pattern of illness.  It is also an important factor in seeking health care.  But people with higher economic status are also suffering from many diseases such as hypertension, diabetes, heart disease etc.  If a person has low income, his nutrition will also be poor. He will get poor education, which leads to poor hygiene practice. It causes a problem of diminished body resistance, diminished body resistance causes illness and illness decreases the work capacity, which ultimately reduces the productivity.
  • 19. EDUCATION  Education of the individual is one of the major factors influencing health in Nepal. Studies show that higher the education, lower the morbidity and increase life expectancy of an individual. It shows that education has direct relation with health status of an individual.
  • 20. OCCUPATION  Occupation of the individual is one of the major factors influencing health in Nepal. The employed in productive works promotes health. The unemployed usually shows a higher incidence of ill health and death. Loss of work may mean loss of income and status. It can cause psychological and social damage.
  • 21. POLITICAL SYSTEM  Political system is one of the major factors influencing health in Nepal. Health and its service is directly related to political system and policy of the country. Decision concerning resource allocation, manpower, choice of technology, availability and accessibility of service is always determined by political system.
  • 22. HEALTH SERVICE  Health service is one of the major factors influencing health in Nepal.  Health service means all those personal and community services including medical care which are directed towards the promotion and protection of health of the community.  The population and health of the community are influenced not only by its physical and social environment but also by the health services provided to people.  The medical care and health services help to protect different kinds of illnesses.  To be effective, the health services must reach the social periphery, they should be equitably distributed, accessible at a cost the country and the community can afford and socially acceptable.
  • 23. GENDER AND GENDER BASED VIOLENCE AND ABUSE  Gender refers to the socially constructed characteristics of women and men – such as norms(ways of behaving that are considered normal in a particular society), roles and relationships between groups of women and men.
  • 24. GENDER-BASED VIOLENCE  “Any act of gender-based violence that results in, or is likely to result in, physical, sexual, or psychological harm or suffering to women, including threats of such acts, coercion or arbitrary deprivation of liberty, whether occurring in public or private life”
  • 25. GBS CONTINUATION  Nepali women and girls are vulnerable to both – domestic and – public violence, such as rape, sexual abuse in the workplace, and – human trafficking.  Moreover, harmful traditional practices, such as – dowry-related violence, – Deuki (offering infant girls to temples where they live without education or proper care), – Chhaupadi (keeping menstruating women in a shed away from the home), and – accusations of witchcraft, can also be life threatening.
  • 26. TYPES OF GBV BASED ON PLACE OF OCCURRENCE  Domestic  Custodial  Public violence & trafficking  In conflict situation DOMESTIC VIOLENCE  Nepal passed the 2008 Domestic Violence (Offence and Punishment) Act in May 2009; the act defines domestic violence as “any form of physical, mental, sexual, and economic abuse perpetrated by any person to the other person with whom he has a family relationship.”  Violence between two intimately linked partners of opposite sex.  Physical, verbal, emotional, psychological and/or sexual battering of women/men by her/his partner or spouse. – Examples: threats or intimidating words; hitting, using a weapon, rape, imprisonment, financial control, abusive or demeaning language.
  • 27. CUSTODY  The protective care or guardianship of institutions/people or system (laws, policies etc.)  Most common form of custodial violence :-Imprisonment- By authority people ,By colleagues, Refugee camp & Rehabilitation centre.
  • 28. PUBLIC VIOLENCE & TRAFFICKING  Ranges from teasing to forced prostitution & mass rape.  Public places-vehicle, street, school, working places, hat bazaar etc.  Trafficking of women and children VAW IN CONFLICT SITUATION  Conflict increases all forms of GBV.  Mass displacement leading to more vulnerability of women and children. Examples: Mass rape, military sexual slavery, forced prostitution, forced marriage and pregnancy.  Women forced to offer sex for survival, or in exchange for food, shelter or protection.
  • 29. ESPECIAL FORM OF VAW IN NEPAL  Culture is not only supporting GBV but also aggravating it. Examples:  Deuki (western regions of Nepal young girl is offered to the local temple)  Jhuma (It is the system in which second girl child is offered to the monastery)  Bhatti pasal  Kamalari  Polygamy.
  • 30. NDHS 2016  Experience of violence: Twenty-two percent of women in Nepal age 15-49 have experienced physical violence since age 15, and 7% have ever experienced sexual violence. Six percent of women who have ever been pregnant have experienced violence during pregnancy.  Spousal violence: Twenty-six percent of ever-married women have ever experienced spousal physical, sexual, or emotional violence. The most common type of spousal violence is physical violence (23%), followed by emotional violence (12%). Seven percent of ever-married women have experienced spousal sexual violence.
  • 31. NDHS 2016  Trends in spousal violence: Ever-married women’s experience of spousal physical, sexual, or emotional violence has declined from 32% in the 2011 NDHS to 26% in the 2016 NDHS. This decline is due to declines in emotional violence and sexual violence only.  Injuries due to spousal violence: Thirty-four percent of women who have experienced spousal physical or sexual violence have sustained injuries. Cuts and bruises are the most common types of injuries reported. Discomfort in the form of “aches” is also common.  Help seeking: Sixty-six percent of women who have experienced any type of physical or sexual violence have not sought any help or talked with anyone about resisting or stopping the violence they experience.
  • 32. SDG 5- GENDER EQUALITY  Despite significant improvements, discrimination and violence against women and girls remains.  More than a quarter (26 percent) of women aged 15-49 years have experienced physical or sexual violence.  Domestic violence predominates among the different forms of violence followed by girl trafficking, physical and sexual abuse, social abuses and malpractices such as allegations of witchcraft, chhaupadi (exclusion from the family during menstruation), dowry and early marriage (before the age of 18 years).
  • 33. THE PROPOSED SPECIFIC TARGETS FOR SDG 5 FOR NEPAL INCLUDE THE FOLLOWING (i) Eliminate gender disparities at all levels of education by 2030 particularly in tertiary level education (which currently stands at 0.71) and in the literacy rates of women and men aged 15-24 years (which currently stands at 0.85). (ii) Eliminate wage discrimination for similar work. (iii) Eliminate physical and sexual violence. (iv) Eliminate all harmful practices, such as child, early and forced marriage. (v) Increase the proportion of seats held by women in the national parliament to 40 percent. (vi) Increase women‘s share in public service decision making positions to at least 28 percent.
  • 34. CHILD MARRIAGE AND PREGNANCY  In Nepal, the civil code of 1963(11th amendment)fixed the legal age for marriage is 18 for girls in parental conscent.  Age at first marriage: The median age at first marriage among women and men has increased by 1 year over the past decade. On average, women marry 4 years earlier than men (17.9 years versus 21.7 years).[NDHS 2016]  Thirty-seven percent of girls in Nepal marry before age 18 and 10 percent are married by age 15.  UNICEF data indicates that Nepal has the third highest rate of child marriage in Asia, after Bangladesh and India.
  • 35. CAUSES OF CHILD MARRIAGE  poverty,  lack of access to education,  child labor,  social pressures  gender inequality,  damaging social norms that make girls less valued than boys in Nepali society.
  • 36. CONSEQUENCES OF CHILD MARRIAGE  Married children usually dropped out of school  Married girls had babies early, because they did not have information about and access to contraception, and sometimes because their in-laws and husbands pressured them to give birth as soon, and as frequently, as possible.
  • 37. LAW FOR CHILD MARRIAGE IN NEPAL  Child marriage is illegal in Nepal and has been since 1963.  The current law sets the minimum age of marriage at 20 for both men and women.  Under the law, adults who marry children, family members and other adults who arrange marriages of children, and religious leaders who perform child marriages are all committing crimes and are subject to prosecution.  Arranging a child marriage or marrying a child is punishable by imprisonment and fines, which vary depending on the age and gender of the child involved.
  • 38. CONTINUATION  These range from six months to three years in prison and a fine of 1,000 to 10,000 rupees (US$9- $94) if the case involves a girl under the age of ten.  The lowest penalty under the law is a fine of up to 700 rupees ($6.60) for a person who has finalized arrangements for a child marriage which has not yet taken place.
  • 39. GIRL TRAFFICKING  Girl trafficking is defined as the selling and buying of girls illegally. It is one of the major social crimes in Nepal that is being closely monitored even by the international agencies.  Trafficking of girls from Nepali land to Indian premises for forced prostitution is one of the busiest trafficking routes in all over the world. Approximately somewhere around 5 to 10 thousand girls are the victim of trafficking to India every year.  Report of Maiti Nepal and government showed that about 10 to 15 thousand of girls are exported in the world from Nepal.
  • 40. CAUSES OF GIRL TRAFFICKING  Lack of education  Unemployment  Poverty  Lack of awareness in the peoples’ mind especially in rural area  Nepalese girls are thinking by heart, not with mind.  Open boarder between Nepal and India  Lack of the development of infrastructures and social services in the rural area  Lack of government policies, strategy and laws to punish and discourage trafficker
  • 41. IMPACT OF GIRL TRAFFICKING  These days, a lethal infection, AIDS has been spread quickly because of girls trafficking.  The girls who are sold in prostitution houses return to Nepal being HIV contaminated.  They pass on HIV to different young people in Nepal.  A few girls who are exploited by HIV and other lethal sickness are probably going to submit suicide.  Our nation is constrained to contribute more cash to cure the HIV tainted young people.
  • 42. WOMEN'S RIGHTHUMAN RIGHTS  Right to equality  Right to freedom  Press and publication rights  Right to criminal justice  Right against preventive detention  Right to information  Right to property  Cul
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