India is witnessing huge changes with respect to rights of women in general and communities in particular. People from different part of the country have started acknowledging women’s contribution. From managing household chores to chairing the top post of World Health Organization, women have outshined in all area of excellence and have ascertained their individual identities. The Indian Council of Medical Research (ICMR) has a dedicated division for conducting research on women-centric issues.
ICMR’s health initiatives for women
Surrogacy Bill: To regularize the process and practice of surrogacy in the country, a Surrogacy Regulation Bill was approved by the LokSabha on 26th February 2020. The Parliamentary Panel had recommended that not only close relatives but any woman who is “willing” should be allowed to act as a surrogate. The bill will protect and safeguard the reproductive rights of women. It makes provisions for safe and ethical practice of Assisted Reproductive Technology (ART) services in the country.
Apart from regulating the surrogacy services in the country, the Act will also prohibit commercial sale and purchase of human embryos and gametes. The Indian married couple, Indian-origin married couple and Indian single woman (widow or divorcee) will be allowed to go for ethical surrogacy on fulfilment of certain conditions. It will also control the unethical practices in surrogacy, prevent commercialization of surrogacy and will prohibit potential exploitation of surrogate mothers and children born through surrogacy.
Assisted Reproductive Technology (ART) Bill: To accredit, supervise and regulate the functioning of ART clinics in the country and to check malpractices therein, ICMR developed national guidelines for ART clinics in India which were accepted by the Ministry of Health & Family Welfare (MOHFW), Govt. of India in 2005.
Rights of children born through ART clinics: According to Government of India, the ART services need to be regulated mainly to protect women and children from exploitation. The oocyte donor (egg donor), who is exclusively women, needs to be supported by an insurance cover and be protected from multiple embryo implantations. The bill also intends to make it mandatory to conduct tests to help identify genetic defects within embroys, called pre-genetic implantation testing, for the benefit of the children.
India has become one of the major centres of global fertility industry, with reproductive medical tourism becoming a significant activity. India is leading in ART centres growth and the number of ART cycles performed every year is on the rise. The ART including in-vitro fertilization (IVF) has given hope to multiple childless couples. The ART Bill 2020 has bought into plethora of legal, ethical and social issues related to surrogacy and rights of children and mothers.
Research studies undertaken to address the public health concern around stillbirths: Stillbirths contribute to a substantial burden of perinatal mortality in India. Strategy to map the burden, identify the causes and risk factors and preventive measures for stillbirth both from the medical and sociological perspective and improving quality of maternal care have been initiated. A total of 64 concept proposals were evaluated of which 14 were developed into full proposals and are awaiting sanction of budget.
Research activity undertaken to address maternal mortality: In overcrowded Obstetrics and Gynaecology OPDs of hospitals in India, nurses/obstetricians spent most of the time in clinical care. They have little time to counsel pregnant women, especially primigravida and living in the nuclear family set up, regarding their minor and day-to-day needs. An intervention study comparing two strategies on the status of maternity preparedness among primigravida women was conducted. The study indicated the usefulness of telephonic contacts made by nurses. Information package including booklet and video has been developed for women. The study also found that it is quite feasible to introduce the concept of a separate maternity care room in OBG departments of medical colleges.
Research activities undertaken to address women-centric cancers: The ICMR cancer registry data reports the high burden of cervical and breast cancer in India. Cervical cancer is a vaccine preventable cancer, and there is a need to evolve mechanism to make it more affordable for women. Health system response for making universal screening of cervical cancer possible and down-staging of cervical cancer needs to be expanded. Similarly, examination of woman for breast cancer should be included at every contact with a health provider so as to detect the disease early.
Magnivisualizer for cervical cancer screening: Development of handheld Magnivisualizer for cervical cancer screening has been one of the recent achievements of ICMR. This field-friendly instrument provides an opportunity for less-skilled peripheral health staff to diagnose cervical cancer in women. Cervical cancer is a leading malignancy among women in developing countries like India.
Screening based on visual techniques has been tested in different research settings and found to be useful. However, in the field settings of primary health centres, the only available light source is generally a tungsten bulb emitting yellow light attached to a torch or examination light. A portable, user-friendly, low-cost device called as Magnivisualizer showed better sensitivity to detect significant precancerous lesions of the cervix. Looking at potential utilisation and usefulness of the low cost device (approx. US$160/piece), the Government of India launched this instrument for widespread use.
Research activities to tackle adolescent pregnancies: ICMR has taken several steps for capacity building of peer leaders for prohibiting early marriage and pregnancy among rural unmarried adolescents.
Research activities focused on infertility issues: Prevalence of polycystic ovary syndrome (PCOS) in young girls is increasing at a high rate. Studies have observed biochemical and genetic differences in lean and obese women with PCOS. Data from infertility clinics suggest that PCOS is one of the main causes of female infertility (64%). ICMR has initiated a multi-centric study to address the problems of PCOS in Indian women.
ICMR’s Educational Initiatives for Women
In our country, multiple ground-level initiatives have been taken to provide high quality free education to women and to improve their safety, sanitation, hygiene and health conditions. However, a large number of well-qualified and capable women get left out from our educational ecosystem at all levels due to various circumstances which are usually typical to the gender. The challenges faced by them are several; but most often the "break in career" arises because of motherhood and family responsibilities. To address such issues, ICMR encourage women to start afresh after a break in their careers with the following provisions:
(a) Training programmes: ICMR provides short/long-term training in Indian institutes and grants fellowship to women who had a break in their career but have proven aptitude towards health research in front line and emerging areas. The fellowships are awarded on year-to-year basis, not exceeding three years, based on the satisfactory progress/research output.
Two categories of the fellowships are given below:
(i) Category A - Fellowships are granted to women who hold MD/MS/MDS/ or Ph.D. in bio-medical sciences. The fellowship carries a stipend and contingency grant of up to Rs. 10 lakhs per year.
(ii) Category B - Fellowships are granted to women who have MBBS/BDS/ M.V.Sc. or M.Sc. in bio-medical sciences and have at least two-years working experience in bio-medical contingency grant up to Rs. 10 lakhs per year.
Both fellowships are granted in multiple areas including toxicology, quality control (QC) and quality assurance (QA), genomics, proteomics, biotechnology, geriatrics and genetics stem cell research. Other important areas being drug research, clinical trials, operational research, good clinical practices (GCP); other areas as recommended by the Committee are relevant to National Health Policy, National Health Goals Mental Health and Clinical Psychology
Many women scientists have benefitted from such schemes, and ICMR looks forward to nurture budding young woman scientists of the country. Women scientists are still exceptions rather than the rule. Much work remains to be done to break the stereotypes and close the gender gap, particularly at the top position of our research ecosystem.
ICMR, New Delhi