On May 8th, 2018, Dr. Purnima Madhivanan lectured about the increasing health disparities throughout India, specifically noting the difficulties in which women living in rural India must endure when considering their reproductive health. Dr. Madhivanan is currently an Associate Professor of Epidemiology at Florida International University. Prior to her research in Miami, she received a Master of Public Health, as well as her Ph. D, at the University of California, Berkeley, finishing her postdoctoral schooling at the University of Michigan. Her research focuses on the health disparities in India, resulting in women being in higher risk for reproductive difficulties.
Throughout my experience in India, I focused on the stigmas in which women in India must face when needing a cervical cancer screening. Facing the cultural stigma of having one’s genitals looked at by anyone other than a spouse, being unable to relinquish the responsibilities of that day—including taking care of the children, cleaning, and cooking, distance, and necessity for permission by a dominating male, women are not likely to pursue the path to cervical cancer screenings, even if a clinic was easily accessible. At the end of Dr. Madhivanan’s lecture, she communicated her distaste for the VIA (Visual Inspection with Acetic Acid) technique that is being utilized in India, in which vinegar is used to test for cervical cancer. Although a significantly less expensive technique, the procedure can be not only damaging to the woman’s body, but inaccurate. It was through her explanation that I was able to fully understand the hardships of the women in India. Even though there are methods to “help” the prevention and treatment of cervical cancer efforts, they still prove to be detrimental.
It was very clear that Dr. Madhivanan’s passion lies in the wellbeing of women, and the understanding that one’s gender and socioeconomic status should not be the deciding factor in their personal health. Health disparities are a global health issue, considering the issue that it is not only the women in India of low-caste who face adversity, but women in the United States who are oppressed for their race and/or ethnicity. Dr. Madhivanan mentioned during her lecture, “only 48% of indigenous tribal populations, and 20% of low-caste Hindu women, attend public hospitals with access to HIV prevention services.” This fact is significant, considering that India is “ranked as the third largest number of people living with HIV in the world,” (UNICEF, India 2015) and women are accountable for 40% of that population. (Mothi, Lala, & Tappuni, 2016) In the United States, although African Americans only account for 14% of the population, they are accounted for “44% of new HIV infections in 2009 and 46% of people living with HIV infection in 2008,” and the next year, the estimated rate of new HIV infections among African American men was “six and a half times as high as that of Caucasian men. In the same year, the estimated rate of new HIV infections among African American women was 15 times that of Caucasian women.” (Lee, Ko, Tan, Patel, Balkrishnan, & Chang, 2014)
She presented many facts that showered the severity of the health disparity, including there being about 5000 HIV testing centers that provide PMTCT services in India, however only 12% of these centers being located in rural areas, and only 9% of women living in rural India had received HIV testing during their pregnancy. (Madhivanan, 2018) Problems such as these are what further the divide between upper caste and lower caste women, and when thinking about the lack of HIV testing and medical treatment as a global health issue, furthers the divide between those of higher and lower socioeconomic status, and by race.
Throughout the duration of the trip, I wondered often times—where is the government’s role? When exactly do they begin to play a part in the prevention and treatment of many of the illnesses in India? There are efforts made by citizens in India, who volunteer their doctoral abilities to clinics without a fee in order to screen as many women at a time as possible. There are global efforts being made as well, with citizens from other countries donating money to clinics and hospitals in India to further the cervical cancer screenings, as well as volunteering their medical abilities. There are students from other countries who are doing research to lessen the gap between women who are unable to receive screenings and those who are, however I do not believe there have been enough efforts by the government. With India being the second highest populated country, and third highest GDP in the world, only behind the United States and China, the help should be there.
They have been using their voices to positively benefit women in India though, just not to the extent in which I would see as thorough. For example, too many women were facing complications at birth that resulted in the death of the baby, the mother, or both. This was happening because of the high numbers of deliveries being done at home. Dr. Madhivanan mentioned that “38% of women are having institutional deliveries; the rest are done at home.” (Madhivanan, 2018) The government attempted to combat this issue by giving monetary compensations post-birth. This not only enticed other women to have birth in a hospital, but the same woman who is likely to have more than one child to have birth in a hospital.
Dr. Madhivanan’s lecture truly outlined the adversities that women must face in order to have a healthy reproductive system. It was also noted on a trip to the community where there were no doctors who were female, and no women in line to be seen at the mobile clinic, that women are not completely seen in the health community. I hope that eventually this will not be a real problem, with more women entering the health profession every single day. Women see the problem of women, and it will take a woman to make the change.
UNICEF, India (2015). Available at: http://www.unicef.in/Story/1123/HIV-AIDS) [accessed on 23 October 2016].
Mothi, S., Lala, M., & Tappuni, A. (2016). HIV/ AIDS in women and children in India. Oral Diseases, 2219-24. doi:10.1111/odi.12450
Madhivanan, P. (2018). Health Disparities. Personal collections of P. Madhivanan, Florida International University, Miami, FL.
Throughout my experience in India, I focused on the stigmas in which women in India must face when needing a cervical cancer screening. Facing the cultural stigma of having one’s genitals looked at by anyone other than a spouse, being unable to relinquish the responsibilities of that day—including taking care of the children, cleaning, and cooking, distance, and necessity for permission by a dominating male, women are not likely to pursue the path to cervical cancer screenings, even if a clinic was easily accessible. At the end of Dr. Madhivanan’s lecture, she communicated her distaste for the VIA (Visual Inspection with Acetic Acid) technique that is being utilized in India, in which vinegar is used to test for cervical cancer. Although a significantly less expensive technique, the procedure can be not only damaging to the woman’s body, but inaccurate. It was through her explanation that I was able to fully understand the hardships of the women in India. Even though there are methods to “help” the prevention and treatment of cervical cancer efforts, they still prove to be detrimental.
It was very clear that Dr. Madhivanan’s passion lies in the wellbeing of women, and the understanding that one’s gender and socioeconomic status should not be the deciding factor in their personal health. Health disparities are a global health issue, considering the issue that it is not only the women in India of low-caste who face adversity, but women in the United States who are oppressed for their race and/or ethnicity. Dr. Madhivanan mentioned during her lecture, “only 48% of indigenous tribal populations, and 20% of low-caste Hindu women, attend public hospitals with access to HIV prevention services.” This fact is significant, considering that India is “ranked as the third largest number of people living with HIV in the world,” (UNICEF, India 2015) and women are accountable for 40% of that population. (Mothi, Lala, & Tappuni, 2016) In the United States, although African Americans only account for 14% of the population, they are accounted for “44% of new HIV infections in 2009 and 46% of people living with HIV infection in 2008,” and the next year, the estimated rate of new HIV infections among African American men was “six and a half times as high as that of Caucasian men. In the same year, the estimated rate of new HIV infections among African American women was 15 times that of Caucasian women.” (Lee, Ko, Tan, Patel, Balkrishnan, & Chang, 2014)
She presented many facts that showered the severity of the health disparity, including there being about 5000 HIV testing centers that provide PMTCT services in India, however only 12% of these centers being located in rural areas, and only 9% of women living in rural India had received HIV testing during their pregnancy. (Madhivanan, 2018) Problems such as these are what further the divide between upper caste and lower caste women, and when thinking about the lack of HIV testing and medical treatment as a global health issue, furthers the divide between those of higher and lower socioeconomic status, and by race.
Throughout the duration of the trip, I wondered often times—where is the government’s role? When exactly do they begin to play a part in the prevention and treatment of many of the illnesses in India? There are efforts made by citizens in India, who volunteer their doctoral abilities to clinics without a fee in order to screen as many women at a time as possible. There are global efforts being made as well, with citizens from other countries donating money to clinics and hospitals in India to further the cervical cancer screenings, as well as volunteering their medical abilities. There are students from other countries who are doing research to lessen the gap between women who are unable to receive screenings and those who are, however I do not believe there have been enough efforts by the government. With India being the second highest populated country, and third highest GDP in the world, only behind the United States and China, the help should be there.
They have been using their voices to positively benefit women in India though, just not to the extent in which I would see as thorough. For example, too many women were facing complications at birth that resulted in the death of the baby, the mother, or both. This was happening because of the high numbers of deliveries being done at home. Dr. Madhivanan mentioned that “38% of women are having institutional deliveries; the rest are done at home.” (Madhivanan, 2018) The government attempted to combat this issue by giving monetary compensations post-birth. This not only enticed other women to have birth in a hospital, but the same woman who is likely to have more than one child to have birth in a hospital.
Dr. Madhivanan’s lecture truly outlined the adversities that women must face in order to have a healthy reproductive system. It was also noted on a trip to the community where there were no doctors who were female, and no women in line to be seen at the mobile clinic, that women are not completely seen in the health community. I hope that eventually this will not be a real problem, with more women entering the health profession every single day. Women see the problem of women, and it will take a woman to make the change.
UNICEF, India (2015). Available at: http://www.unicef.in/Story/1123/HIV-AIDS) [accessed on 23 October 2016].
Mothi, S., Lala, M., & Tappuni, A. (2016). HIV/ AIDS in women and children in India. Oral Diseases, 2219-24. doi:10.1111/odi.12450
Madhivanan, P. (2018). Health Disparities. Personal collections of P. Madhivanan, Florida International University, Miami, FL.