Maternal and Child

By Dr. Sultan Singh

Sociology of Health encompasses many areas of concern, diverse approaches and varied perspectives. The field of Sociology of Health cuts across many traditional areas of sociological enquiry and sociologists who work in this field have differing interests and motivations. Many are interested in particular health problems for their own sake whereas others inter the medical context. This book helps the NGOs, students, researchers and authors who are interested in the field of health studies like health and society, health care utilization, health programmes and health care services, health providers and health facilities.

For the students who comes to Sociology of Health and Women Studies for research and common understanding of basic issues, this book helps in conceptualizing variety of health areas. The book offers the most incisive and compelling analysis of health and health care, women health including health of pregnant and lactating mothers, and infant health, food and diet habits, women addiction, exercise and yoga etc. The book analyses the mother and child health in social
context. This book also covers several areas of research like Rural Studies, Women Studies, Weaker Section, Marginalized Community etc. This book will interest historians, sociologists, public and private health practitioners and policy makers.

• Language: English
• Publisher: Blue Rose Publishers
• Release date: Nov 22, 2022

Book preview

CHAPTER- 1

INTRODUCTION

India, the largest democracy of the world, with great diversity and a population of 121 million, is an age-old civilization, but as a just over 60 years old young independent nation came a long way in developing health care infrastructure and services (Akram, 2014: 101). The colonial era was marked by more individual voluntary efforts that lacked organized planning pertaining to maternal and child health. India, on attaining independence, embarked upon the socialist pattern of planned development and health services, as the foundation of all thing’s found key attention for the socio-economic development process.

The empowerment of half the population is not only a goal, but also an indispensable element for the achievement of equality, sustainable development, peace and democracy. If women empowerment was only the result of constitutional provisions, statutory rules and formulation and implementation of women centric schemes, then perhaps this question standing on the global stage for decades would have ended.

The speed of women empowerment and attainment of gender equality depends on the structure and cultural values of each particular society. It is a good thing that Indian women are getting empowered now because they are slowly coming out of the patriarchal ideology that has penetrated deep into the social system.

The acknowledgment of the existence of women in the country is a happy indicator in this episode. National Family and Health Survey (NFHS)-Five, figures show that there are now 1020 females per thousand males. The sex ratio figures indicate that India's progress towards establishing gender equality is satisfactory. Empowerment is not just a word but a concept, whose main components are health, education, self-reliance and development of leadership ability (Dainik Jagran, March 8, 2022, pp- 06).

Healthy-educated women are not only aware of their rights, but also contribute in building a healthy generation. Achieving a healthy life is not possible only by the availability of medical facilities. This is possible by creating a clean environment. The door of empowerment of women opens on cleanliness. When this truth was acknowledged from the ramparts of Red Fort on August 15, 2014, the voices of strong footsteps towards women empowerment were heard. Freedom from open defecation is directly related to women's health and self-esteem. Open defecation is less than everyone is aware of the spread of diseases, but few people are aware of the fact that it can be dangerous for pregnant women as well as for the fetus. A study conducted on 670 pregnant women from two districts of Odisha, Sundargarh and Khurda coastal region, found that Women are now getting empowered as they are slowly moving out of the realm of patriarchal thinking. Women under Welfare Schemes About two thirds of women who defecate in the open faced difficulties during childbirth as compared to women using file toilets (Dainik Jagran, March 8, 2022, pp- 06).

The happy results of this have been revealed in the report of NFHS-5. The neonatal mortality rate has come down from 29.5 per thousand to 24.9 in the last five years. It is also necessary to discuss that side of women empowerment, on which silence has not only made millions of women ill in the country, but also created a big obstacle in building their strong future (Dainik Jagran, March 8, 2022, pp- 06).

The steps taken by the government towards breaking the taboos related to menstruation will prove to be a milestone in the future. It is noteworthy that the United Nations has recognized menstrual hygiene as a global issue. Globally, around 1.2 billion women do not have access to basic sanitation. In 2020, 342,000 women worldwide died due to cervical cancer, the main reason for which is the un-cleanliness of menstruation, but now the picture is changing. The report of NFHS 5 states that five years ago the percentage of menstrual hygiene among women in the country was 48.2 which have now increased to 72.3 percent. This will have a direct impact on women's health as well as it will affect the literacy scenario among women, as data from the 4th National Family Health Survey shows that about 23 percent of girls reported menstruation as the main reason for dropping out of school. Another important component of empowerment is economic consolidation, as it develops the ability to make decisions (Dainik Jagran, March 8, 2022, pp- 06). The broader concept of economic soundness includes self-employment, establishment of cottage industries and rights to land and property. Women's right to land and property promotes gender equality, which ultimately leads to development.

Despite the exemption in registration fee in case of property in the name of women, the slow increase in the ownership of property of women is the result of patriarchal thinking. To deal with this thinking, women were given the ownership rights of 75,000 houses allotted under the Pradhan Mantri Awas Yojana in 75 districts of Uttar Pradesh last year. Studies show that women who have property in their name are not only participants in domestic decisions, but are also less prone to domestic violence than women who do not have property in their name. Women's direct rights over financial powers increase their self-confidence. In the last few years, the number of women's own bank accounts in India has increased by 25.6 percent. Savings rate is 33 percent of GDP in sustaining India's growth rate, of which 70 percent of household savings contribute. There is no doubt that India's economy is women centric. Overall, women are taking the place of consumers, producers, workers and entrepreneurs in the economy (Dainik Jagran, March 8, 2022, pp- 06).

India’s population increased from 103 crore in 2001 to 121 crore in 2011, an increase of 17.6 per cent (18 crore). Out of 121 crore, 51.6 per cent (62.4 crore) were males and 48.4 per cent (58.6 crore) were females. In 2011, India’s literacy rate was constituted 74 percent of total population aged 7 years and above. The literacy rate of females was 65 per cent in 2011 from 53 percent in 2001. The increase literacy rate in females was in the order of 11 per cent during 2001-2011 (Census, 2011). Improvement in medical technology, quality of life and education during first decade of the 21st century, showed in the overall gender ratio improving from 933 in 2001 to 940 in 2011. This was in line with general improvement in the overall sex ratio since 1991. Unfortunately, according to Census 2011, sex ratio for children up to six years dropped from 927 (Census, 2001) to 914 in 2011 (Mishra and Pandey,2012: XVI).

Health care is the primary need of every society and it is directly related to the health of people. The development of people depends on their good health and this is a new challenge on which further development depends, as healthy and socially aware people are the most important assets of the country (Patakh, 2008: 157). Health is the natural state of man; health is their birth right. This is the result of living according to natural laws relating to environment, body, and the mind. These rules relate to the fresh air, exercise or yoga and rest, sunlight, diet and nutrition, and relaxation, sleep, cleanliness, the attitude of mind and lifestyle. The standard of health of people depends upon the levels of living, literacy, nutrition, sanitation, environment and organization of health services which in turn depends on money, materials and institutions. Health is a logical prerequisite for socio-economic development as it affects both productivity and production. It is an important input for development of man and thereby to nation’s social and economic development (Akram, 2014: 174). The health of the woman is equally important and particularly the reproductive health. Good reproductive health implies not only access to adequate, appropriate and good quality of reproductive health information and services, but also some knowledge of human sexuality and the avoidance of high risk sexual behaviors. Reproductive health care, therefore, includes not only the treatment and prevention of diseases but also the information and means to optimize reproductive health and family planning (Nagla, 2013: 59).

The human resource is also a major factor in the development. The foundations of physical, mental and social development oh human is laid in childhood; whatever a person learns in the early years of life, it is very important in the adjustment in the later life. The child who has been socialized properly, he/she will be better than other people. But our children are deprived of basic facilities like health, education and good nutrition due to poverty, ignorance and other things. The first six years of life are most critical time period of the life and have a great and lasting influence on the quality of the life of a human being (Gangadharn, 2011: 180).

In the basic draft of the National Health Policy implemented by the Government of India in 2017, there was a proposal to make public health as a basic right like education and food, but it was abolished due to some opposition from the states. In the light of World Health Organization standards, we lag behind African countries on many parameters. India ranks 143 in the health index of 188 countries. The National Health Profile 2017 states that there is one allopathic doctor per 11082 persons, while the standard prescribes one doctor per 1,000. 82 percent of rural areas in India have no specialist services, facing a shortage of 50 per cent specialist doctors. The National Health Profile, which highlights the urgent need for about 5 lakh doctors, is sufficient to prove that the goal of 'Health for All' is not possible with the current circumstances and resources. It has been three years since the current health policy was implemented, but we are able to spend only about 1.5 per cent of the GDP. The disappointing fact is that the target of spending two per cent of GDP in 2010 has not been met even by 2020. On the other hand, China is in a better position with 3.2, Bhutan 2.5, Maldives 9.4, Sri Lanka 1.6 and Nepal with 1.1 per cent. A study by Ernst & Young states that because of the lack of public health services in India, 40 million people fall below poverty line every year. The WHO said in a report that 67.78 per cent of people in India get their treatment out of their own pocket, which is higher than the global average of 18.2. Obviously, all government efforts to end poverty are proving to be regressive due to the country's shabby health services (Dainik Jagran, May 20, 2020: 4).

The state of female health is not satisfactory because the education level of men is women due to being a male dominated country. Due to hence, the education level of men is much higher than that of women. The education rate of women is low. Poverty is the main reason for this. Many kinds of restrictions in society, for women, are not able to pass and make themselves and the new generation of their family aware about health. Because of family and social responsibilities and duties, she is unable to take care of her health. Due to which they have to face many diseases. Health levels of uneducated women are even lower than those of the educated, so education is an important link in women’s health.

Compared to cities, there are many health problems in rural areas. Generally, the habitat of the villages is at a lower level than its surrounded land. In this situation, people are used for bathing water in the pond, washing clothes, washing utensils and sometimes drinking something. In India, it has been estimated that about 5 million people suffer from diseases like diarrhea, fever and dysentery (Arora, 2010). In these diseases, they can be protected by a system of pure water. Generally, the frequency of these diseases is not in those places where there is a system of pure water. Rural health has its own problems; on the other hand, there are some different types of urban health problems. Rural women and children face physical ailments.

Health of women is the creator of the universe. Women are axis of development of family and society. Woman gives birth to children and carries forward the family and lineage. Her health is very important because she plays a lot of characters and roles so at every stage her life needs a special care as it is very important for her. As a mother, she has to take full care of baby and take care of the needs of other members of the household, so it is very important to be healthy. Her health then needs a special type of care when she enters adolescence. She enters puberty by crossing the age of adolescence. During this time, women should take such food which fulfills the needs of her body; otherwise, her physical and mental development is greatly affected. Due to lack of vitamins and proteins, they have to face many serious health problems. Women’s health awareness is also necessary because nature has given her the right to produce children. She needs more care during the menstrual process.

During this time, it is necessary to provide that health information. The most important problem is ignorance of health science. If there is proper knowledge and awareness of health science, then many diseases can be prevented. The mother should provide special knowledge about health science so that she can take care of the baby and take care of herself more thoroughly, so that the society and the nation get healthy children. After entering adolescence, she enters into a new life by getting married at a young age where she gets many responsibilities and now she has to pay special attention to the health of her husband and her family member but in order to perform her duties sheone should be health conscious. Here it is necessary to make him aware by health science. She should take special care of herself during pregnancy, her responsibilities increase after becoming a mother. During this time, she completely forgets her health, so men are also expected to take care of their wives. Therefore, now a day a provision has been made to give men leave (paternity leave) because the support of both husband and wife is desirable for children. The main reason for this is the prevalence of single families. As Jawaharlal Nehru says, the status of a nation can be gauged from the status of women there. The condition of women in India is like a powerful society. Women have to bear the brunt of hunger and poverty more than men. Apart from all these, a woman has her primary responsibilities as well as hunger, thirst, education and also has to nurture the family.

Mother and Child: As a Single Unit

All mothers are different, all infants are different, and each mother-infant relationship is unique. The interaction between a mother and her infant is not a mechanical one, and an infant is not merely a device which, when applied to a motherly breast automatically sucks (Gupta and Sharma, 2014). A woman who is delighted and proud of being pregnant finds it hard to feel a personal love for the child she has never seen or felt. But when the baby starts to move, it helps to believe that after all, the baby is a real person. As pregnancy progresses, women’s thoughts turn more realistically to her child, what it will mean to care for the child. There are some of the bases by which mother and child are treated as single unit.

• The health of a child is closely related to the mother’s health.

• The fetus is part of the mother during the prenatal period.

• After delivery, the child is dependent on the mother.

• Certain diseases of mother affect the child health.

• Certain drug intake adversely affects the fetus.

• The first teacher of the child is mother.

There are strong evidences for a close and inseparable link between the health of mother and child (Bhutta et al, 2010). The leading reasons of mother and neonatal mortality and morbidity are associated and are important time points for both mother and child health overlap, with timing of birth or delivery being very sensitive time period for women and children. The interventions that women get before pregnancy, during the period of the pregnancy and during delivery or births have useful effects on their newborns health. Such as, ANC and the skilled birth attendance address not only the leading causes of mother’s death, but also the major reasons of infant mortality such as diseases or infection, the problems come to light from premature birth, and intra-partum related infant deaths (Lassi et al, 2013).

Alongside the continuity of care, a number of the low-cost involvements, covering counseling and family planning services, antibiotics, vaccinations, and micro-nutritional supplements, can have important effects on mothers and their children while promoting better food and hygiene practices (Weeks et al, 2006). Improving women’s nutritional status has translational benefits for their children. Good health and the nutritional status of mothers are very important contributors to the survival of the infant, when a woman is malnourished or receives inadequate healthcare, her child is at higher risk of illness and premature death. Mother’s diseases, infections and poor health frequently contribute to newborn mortality and morbidity. The relationship between mother’s health and the survival of the infant has also been showed to be statistically significant in many research studies. The newborns whose mothers had died during delivery were more likely to die in their first year compared to those whose mothers were still alive (Lassi et al, 2013).

Importance of a Child after Marriage:

Now we are discussing about importance of a child after marriage in Indian context. Motherhood is a role and an institution in Indian society that defines the identity of a woman and gives her status of adult. From early childhood, a girl is socialized to be the future mother and the family reproducer. So, when a woman is not a mother by situations or choice, she is considered incomplete with deviant identity (Bhambhani and Inbanathan, 2018).

Childlessness and infertility are regarded as culturally notable problems in India which have socio-religious implications. In the context of Hindu religion, such as the Vedas and Upanishads, epic poems like Ramayana and Mahabharata and social commentaries like Kautilaya’s Arthasastra have been convinced to have children, as according to these sources childlessness is a curse. Hindus believe that the child, specially a male child, is required to assured their rebirth. They think that only son can execute death rituals. For many people, not having children, it means them not finding peace in their life. So, they try to find different ways of having children that may fulfill the culturally accepted conception of their own (apne) and children (aulad), as illustrated in Urdu and Hindi languages. Taking of different plans for emergence of the family basically depends on the cultural norms to establish valid kin-relationship, and thus on the capability to be fertile (Mishra and Dubey, 2014).

When defined as a medical condition inherent in biological body of the individual. Impotance isn’t a serious disorder for life. Although, infertility is a situation, that threats the social relationships, social status and honor of the family. The capability to bear children is considered the very significant and unique role of a woman and also her responsibility to society (Izubara, 2000).

For young brides, the threat is particularly acute in the patriarchal kinship system found in most parts of northren India, as women are primarily involved in their matrimonial homes as adults and children by rising or produce children, particularly sons. Women who don’t meet these assumptions face social disadvantages, possibly including dowry and divorce threats regulated regarding wife’s home of birth (Bumiller, 1991; Unisa, 1999 and Patel, 1994). The Bombay High Court (BHC) has termed the tendency to convict a life partner for not conceived. BHC allowed a 62-year-old husband to divorce on this basis. The husband had filed a petition in the High Court challenging the May 2010 order of a family court for divorce from the wife (Dainik Jagran, January 15, 2018: 1). In developing countries like India, children may be major to women gaining adult status and achieving acceptance in community. Females and males with fertility problems may resist labeling themselves as infertile (Hollos, 2003 and Feldman, 2002). The health department team systematically raided the house in Samana Bahu village (Karnal), where a woman was given medicine to be a boy against the rules. 700 rupees, peacock feathers, ivory powder and indigenous medicine were recovered from the woman's house for selling medicines (Dainik Bhaskar, January 11, 2018).

The social construction of infertility in comparison to other diseases conditions is striking Because (a) No matter how physicians may define infertility, couples do not define themselves as infertile or present themselves for treatment. Unless they accept parenting as the desired social role (b) while the biomedical model considers medical conditions as a phenomenon affecting the individual, infertility is often viewed as a condition. (c) The presence of infertility is indicated, not by the presence of pathological symptoms but by the absence of a desired state. This is called non-incidence transition (d) the possible treatment options present in the case of infertility include voluntarily child-free, adoption, self-rearing or changing partners (Koropatnick et al, 1993).

In the context of India, ppost-marriage pregnancy and childbirth are the main goals for couples, especially females. Infertile females have to face many problems in the society. Woman having a child is most important for self and also for family honor. A baby plays an important role in supporting the bond between husband and wife. For many women, their family was incomplete without children. Male children were a crucial part for the family and without a child there was no meaning of their marriage. Having, a child after marriage not only makes relationship between the husband and wife more emotional but also saves both of them from getting bored. Many women felt that the birth of a child gives an honorable place in the society. Women who are childless hear many taunts and unfriendly behaviour from other people. The child is most important for the prestige and equality in the family and also in the society. Childless women avoid the social works and functions because people ignore them (Mishra and Dubey, 2014).

Progeny is needed for the expansion of the family. Only one male child represents the family’s next generation. A woman must have a child, especially a male child because in future only a male child can continue the family name. This statement refers to the son’s preference and the significance of the son or the status attached to a male child’s mother in society. In the eyes of in-laws, the child gives respect and honor to most of the women and establishes them in the family. Many women admitted that producing the healthy children especially male children earned them praise and mother-in-law status. The importance of having a child of your own is emphasized time and again in religious texts. Such religious ideas have been implanted in the psyche of many of these females since childhood. Many women mentioned that it is imperative to perform funeral ceremony or rituals related to death, especially the son. If they have no children of their own, their soul will become unsaturated.

Motherhood is the unique feeling for a female which also symbolizes womanhood. Many women emphasizing that child are necessary for womanhood. Without a child woman’s life is of inferior quality because she is missing out on the world’s most valuable pleasures. Women believed that having a biological child of their own was essential to a sense of womanhood. The feeling of being a mother is very adorable and blissful. The life of a married woman is nothing without being a mother. Only after having a child a woman can understand the feelings of a mother. Producing children is considered an essential duty in the life of a woman after marriage, by which the value of a woman is assessed. Some women told the reason for their infertility to God. They believed that they would be able to enjoy motherhood only if there was God’s grace (Mishra and Dubey, 2014).

Menstrual Cycle System: A Step for Motherhood:

The world changed. Traditions, thinking, changed everything but the tradition of discriminating against women during menstruation and treating them as untouchables in many villages of Malla Danupur in Bageshwar district, Uttarakhand has not changed. In the 21st century, where daughters are touching the sky, in these villages, adolescent girls and women are being kept in animal clusters when menstruation occurs. They have to spend at least four nights in the cowshed. The people of Malla Danupar are in every nook and corner of the country and many are also abroad, but the rural society has not been able to come out of the orthodox tradition even today. Due to the high Himalayas, it gets cold for eight months here. In such a situation, women have to spend cold nights during the laying of straw in the cowshed in limited warm clothes during the menstruation. Women are considered untouchable during menstruation in almost all villages of the mountainous region. Women are kept separately in a room in the house for at least four days. The work is allowed after purification on the fifth day. According to the elders of the village, all the houses have temples of deities. Keeping women at home during menstruation makes the deity angry (Amar Ujala, April, 2018: 9).

Menstruation as soon as this name comes to us somewhere, we become silent and shy away from talking about the subject. The first misconception remains in our society, that menstruation is impure. While the truth is that menstruation is a natural somatic process in a woman’s life. Because of these, woman is called Janani (Amar Ujala, February 7, 2018: 6).

At the starting of the puberty, most of the girls grow taller and faster compared to boys of the same age. The difference between the age at which puberty starts and growth rate during the puberty is completely normal. Many girls worry because some friends are growing and maturing fast. On the other hand, a girl who matures early may feel self-conscious because her breasts are much larger than those of girls her age. Some girls mature various years before time or even later compared to the others of the same age. Either a girl matures slowly; she and other girls go through exactly same changes such as they enter in the womanhood. They grow taller and their breasts become bigger and rounder. The enlarger breasts will allow her to feed babies from her body.

A major change that occurs during the growth of a girl’s femininity is onset of the menstruation. It is a blood’s monthly discharge and tissue from the vagina. It is a normal part of the life of a woman. Most of the girls begin menstruating when their age nearabout twelve years, but some of the girls start at an earlier or later age (Sheth, 1999). In India, the mean age of menstruation has been reported to be between the ages of 12-13.6 years in various studies (Vaidya, 1998 and Sheila, 1993). It is interesting to note that the age of menarche is gradually decreasing by about 1 year in every 100 years in most developed societies, but it is not easy to precisely measure the age of menarche on a large sample. The word menstruation derived from menstrual or is monthly; itself emphasizes its regular monthly occurrence. The average time interval between the start of 1 cycle and next should be 29.5 days, which so closely matches lunar month, is surprising (Kothari, 2010).

The World Health Organization defines adolescence as the age group of 10 to 19 years. In India, adolescence is defined as the period between 10 to 18 years. There are estimated 200 million adolescents who comprise 1/5 of the total population (Shanbhag, et. al., 2012). Each woman tends to have her own rhythm of menstrual cycle. The menstrual flow and bleeding may last for 2 to 7 days. The average blood-loss ranges from about 30 to 180 milliliters (Sheth, 1999).The menstrual cycle and other changes associated with puberty are controlled by certain hormones released from the pituitary gland in the brain. The cycle prepares a woman for pregnancy. If pregnancy does not occur, the lining breaks down and the blood or cells are discharged out.

Menstruation is a sign of good health if it occurs regularly without any excessive pain. Fatigue or blood loss it is normal for women to experience moderate to mild discomfort a few days before or during menstruation. However a few women suffer from severe symptoms of distress depression, body swelling or pain in their breasts, anxiety fatigue ,headache, stomach ache, thighs, back and abdomen, pre-menstrual syndrome (PMC), a disorder characterized by some or all of these symptoms, may occur when progesterone level are low. Generally women continue to do their normal work. Generally, the menstrual discharge is absorbed by a clean cloth or sanitary towel, a disposable pad that covers the opening of the vagina. A roll tampon of absorbent material that is worn inside the vagina is also used. A young woman does not miss her periods unless she is pregnant or is under emotional stress, nor has severe weight loss or abnormal hormonal balance. If she happens to miss her periods frequently or it occurs less than every fifty to sixty days, a doctor needs to be consulting (Sheth, 1999).

Not every girl or woman necessarily feels sad before her periods. And yet, 75 per cent experience some pre menstrual stress (PMS) such as bloating, abdominal heaviness, fatigue and more breast tenderness from their physical ailments, increased emotional reactivity and blue mood. About three to seven per cent women are troubling. Women in their 20s to 30s suffer from a severe form of pre menstrual stress known as pre menstrual dysphonic disorder- PMDD, sometimes following pregnancy or after discontinuing the contraceptive pill (Sheth, 1999). The DLH&FS- 2007-08 reported that about twenty per cent of the women in India had menstrual problems. In India, among women who have stated problems related to menstruation, 63 per cent reported painful periods and 25 per cent replied irregular periods whereas 14 per cent replied infrequent bleeding. Of these, twenty per cent of women replied menstrual problems, 22.3 per cent were the adolescent females. Adolescent women mentioned problems related to menstruation as painful periods (79.5 per cent), irregular periods (18.7 per cent) and less bleeding (9.6 per cent) and prolonged bleeding (7.2 per cent). Menstruation problems are therefore more prevalent among adolescent girl (Varghese et al, 2019 and DLHS, 2007-08).

Disorders of the woman reproductive system often involve menstrual dysfunction. Excessive or infrequent bleeding and spotting before menstruation are some common menstrual problem. If a woman has not had a period since puberty, the condition is called primary amenorrhea. This may be due to disorders in the pituitary gland and hypothalamus in the brain. Secondary amenorrhea, another missed period, is commonly experienced by women at some point during their lives. Amenorrhea can be caused by a change, loss, or increase in body weight. Amenorrhea can be caused by deficiencies of pituitary and ovarian hormones.

Amenorrhea can also be caused by rigorous athletic training. Painful menstruation is called dysmenorrheal which can be so severe that one form cannot function normally for one or more days each month. Low progesterone levels may be the causes. A low level of this hormone increases the prostaglandin levels which are chemical substances that cause the uterine muscles to contract, resulting in pain. Drugs such as ibuprofen or naproxen which inhibit prostaglandin synthesis can help. Secondary dysmenorrheal is caused by uterine tumors ovarian cysts fluid containing tumors of ovary pelvic infection intrauterine devices etc. correction of the underlying cause would get rid of the painful menses. Abnormal bleeding includes excessive duration or volume, low menstrual flow. Excessive menstrual bleeding due to irregular hormonal regulation, emotional factors fibroids or uterine tumors diseases (Sheth, 1999).

Women Health: Pre-Pregnancy Health Care

The identification of significance of the health of women before the pregnancy and their health behaviors after pregnancy has led to a growing interest in pre-pregnancy healthcare in the last decade (Freda et al., 2006 and Mason et al., 2014). The evidence shows that improving the health of women and their health behaviors has potential to improve the pregnancy outcomes and child health beyond birth (Ben and Kuh, 2002).

However certain instructions may differ, there is a wide concurrence that care before pregnancy includes IFA tablets to prevent neural tube defects, stop smoking and stopping the use of alcohol, achieving and maintaining healthy weight, includes screening for diseases, avoidance of environmental and occupational risks, and pre-existing situations additional care and medication review (Cragan et al., 2006 and Nykjaer et al., 2014). Despite the significance of good healthcare before pregnancy and its crucial to improve the pregnancy and child health outcomes, relatively little is known about behavior of women related to pre pregnancy health care. A most explored area has been the utilization of IFA tablets by women during the period of pre-pregnancy, which has consistently noticed that majority of women don’t take it before the conception of pregnancy (Goldberg et al., 2006 and McNulty et al., 2011). Other health behaviors in the period before pregnancy have been less explored; however available evidence shows that a short proportion of women adhere recommendations related to lifestyle and diet (Khodr et al., 2014 and Maher et al., 2014).

Infertility:

India has experienced a dramatic fertility decline (from 5.2 children per woman in 1971-72 to 2.2 children in 2015-16) over the last 50–years (Halli et al, 2019). Infertility is a serious health issue worldwide, affecting about 8 per cent to 10 per cent of couples. Of 60 to 80 million couples worldwide who suffer from infertility every year, perhaps 15 to 20 million couples (25 per cent) are in India alone. As per reported by the WHO, one out of every 4 couples in developing countries is affected by primary and secondary infertility (Katole and Saoji, 2019). According to WHO, the national prevalence of primary infertility in India was 3 per cent and secondary infertility was 8 percent. According to NFHS-3, 2 per cent of currently married women age 45 to 49 were infertile (Manna et al, 2014, and Kerala and Sasikala, 2011). To be a mother is every woman’s dream. Childlessness is a serious and painful situation for women and couples. Although, this is generally noticed as a private matter to be resolved; in the field of medical or adoption. This situations have serious demographic, socio-economic and health implications. Living as an involuntarily childless is challenging for a woman as well as for her femininity. Norms can be tough for those who choose to live according to their own preferences, but it is tougher for those who have no preference (Aiswarya and Moli, 2012).

Childlessness or infertility is particular concern because of the extent of problem and social dishonor linked to it. The factors affecting this status of women are their socio-cultural background, labor force etc. Infertility is not the fault of women but still an infertile woman is considered lowly and evil in the eyes of the society (Devi and Raya, 2011). In India, childless women are socially dishonored and face serious personal and social results, including socio-economic deprivation; violence and marital disruption (Mulgaonkar, 2002). A woman’s social status increases when she gives birth to a child. A woman in India, who is childless, has to face mental, physical and psychological harassment, especially in rural areas. Due to urbanization, rise of nuclear family, increase in women’s employment and their education; some women may choose not to have children for a certain period of time (Aiswarya and Moli, 2012). According to the WHO, The operational definition of primary infertility is the lack of conception despite cohabitation and exposure to the risk of pregnancy (in the absence of contraception) for a period of two years or more. The WHO defines infertility as the inability to conceive (organic or functional) a pregnancy after two years of regular sexual intercourse without contraception, or inability to carry a pregnancy to live birth. Childlessness is known as a woman who has no live birth or not live children at the end of her reproductive life span (WHO, 1991). The WHO (2012), reported that 1 in every 4 couples in the developing countries was found affected by infertility (Udgiri and Patil, 2019).

Pregnancy Care:

For the reasons of shame, hesitation and fear, most people lie to the doctor. They do not give the correct information about their diseases to the doctor. In fact, in front of the doctor, people understand that by lying, the doctor will be saved from scolding, bitter medicines or injections. This is revealed by a recent study. According to this study, 50 per cent of the patients do not honestly tell the doctor about their problems. As a result, the disease progresses and the treatment become ineffective (Amar Ujala: Rupayan, March 9, 2018: 12). In doing so, they may forget that by hiding information, they are doing dishonest to their own body. This has a direct impact on diagnosis and prescription. Experts believe that it is better for the patient to tell every problem clearly to his doctor than to lie. Taking external medicine without a doctor's advice can prove to be fatal.

Pregnancy care includes prenatal health care and postpartum health care for expectant mothers. It includes pre pregnancy, pregnancy, and treatment and training to ensure labour and delivery for mother and child. "Prenatal care helps reduce risks during pregnancy and increases the chances of a safe and healthy delivery. Regular antenatal health checkup visits can help your doctor monitor your pregnancy and identify any problems or complications before they become serious. Mothers who do not receive prenatal care are three times as likely to be born at low birth weight. Low birth weight newborns are five times more likely to die than mothers receiving prenatal care. Prenatal health care ideally starts at least three