Half of pregnancies in India unintended: Lancet

Agencies
December 15, 2017

New York Dec 15: An estimated 15.6 million abortions took place in India in 2015, with the majority of women taking pills at home without adequate counselling, according to a study which found that about half of the pregnancies in the country were unintended.

Published in The Lancet Global Health, the first national study of the incidence of abortion and unintended pregnancy in India found that 15.6 million abortions were performed in the country in 2015.

This translates to an abortion rate of 47 per 1,000 women aged 1549, which is similar to the abortion rate in neighbouring South Asian countries.

"Women in India face considerable challenges trying to obtain abortion care, including the limited availability of abortion services in public health facilities," said Dr Susheela Singh, vice president for international research at New Yorkbased Guttmacher Institute.

"Our findings suggest that a shortage of trained staff and inadequate supplies and equipment are the primary reasons many public facilities don't provide abortion care," said Singh, co-principal investigator of the study.

Researchers found that the vast majority of abortions (81%) were achieved using medication abortion (which, in India, is commonly referred to as medical methods of abortion, or MMA) that was obtained either from a health facility or another source.

Fourteen per cent of abortions were performed surgically in health facilities, and the remaining 5% of abortions were performed outside of health facilities using other, typically unsafe, methods.

The study also estimated the incidence of unintended pregnancy in India and found that out of the total 48.1 million pregnancies in 2015, about half were unintended meaning they were wanted later or not at all.

Unintended Pregnancy Rate

The estimated unintended pregnancy rate was 70 per 1,000 women aged 1549 in 2015, which is similar to the rates in neighbouring Bangladesh (67) and Nepal (68), and much lower than the rate in Pakistan (93).

"Although abortion has been legal under a broad range of criteria in India since 1971, we have never had a reliable estimate of the number occurring until now," said Dr Chander Shekhar, professor at the International Institute for Population Sciences (IIPS) in Mumbai.

"This new evidence provides policymakers with information that is essential for designing and implementing effective reproductive healthcare programmes," said Shekhar.

The researchers used two direct methods for measuring incidence. One was compiling national sales and distribution data on MMA (mifepristone and mifepristone-misoprostol combipacks), which represents the vast majority of all abortions in India.

The second was implementing a large-scale survey of public and private health facilities in six states - Assam, Bihar, Gujarat, Madhya Pradesh, Tamil Nadu and Uttar Pradesh - where close to half of Indian women of reproductive age live.

Currently, slightly fewer than one in four abortions are provided in health facilities, researchers said.

The public sector - which is the main source of health care for rural and poor women - accounts for only one-quarter of facility-based abortion provision, in part because many public facilities do not offer abortion services.

Close to three in four abortions are achieved using MMA drugs from chemists and informal vendors, rather than from health facilities, researchers said.

They said MMA is safe and effective when used in accordance with World Health Organisation guidelines. The researchers propose a number of steps to improve the availability and quality of abortion services in health facilities, including training and certifying more doctors to provide abortion care.

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Agencies
January 5,2020

Washington D.C., Jan 5: After a woman filed a lawsuit against a diet soda company, the California court has declared that the beverage does not promise to help buyers in losing weight.

The woman had gulped down the drink for over a decade but did not lose inches as a result.

The three-judge panel declared during the hearing: "The prevalent understanding of the term in (the marketplace) is that the 'diet' version of a soft drink has fewer calories than its 'regular' counterpart."

However, the members of the US 9th circuit court have felt that the consumers tend to make out something of their own that is unreasonable and eventually hamper the reputation of brands through a deceptive allegation, reports Fox News.

The response was due to a misleading case filed against Diet Dr Pepper by Shana Becerra from Santa Rosa, California. Shana claimed that she has been addictively purchasing the low-calorie beverage for the past 13 years hoping for losing some fat but failed to lose even a single inch.

The woman also stated that the attractive and fit models misled her into believing that drink will help her in perfecting her body like them.

However, the court's decision was that advertisements are for representational purposes only. "Cannot be reasonably understood to convey any specific meaning at all," as written by Judge Jay Bybee.

Shana had last week made such allegation against Diet coke as well where the court came to a similar verdict. She claimed that she had found various studies where it is evident that the artificial sweetener aspartame used in diet beverages actually boosts weight gain.

But the artificial sweetener is approved in by the concerned administrative department and thus is used in most American drinks.

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Agencies
April 21,2020

The Lockdown is not a cure but a critical strategy to prevent the geographical spread of COVID-19.

While pandemics at this level involves actual life threatening situations for individual's or significant others in one's immediate circle, it envisages a marked disruption in routine life. Even after the pandemic has been contained and will come to pass; it's aftermath will leave a trailblazer which demands planning and implementation of a post pandemic reconstruction of society with potentially traumatic experiences varying in intensity, multiplicity and duration.

Degree of Trauma

It would do well for each one of us to realise that the pandemic is "potentially traumatic", since not everyone will experience COVID -19 as a traumatic event in their lives. Yet, there will be those who may develop post pandemic stress reactions, depression and related dysfunction and pathological reactions while still other exhibit healthy reactions to the same set of circumstances.

"Psychological reactions to the pandemic can be distilled into four distinct prototypical patterns, namely, Resilience, Recovery, Chronic and Delayed patterns which may vary in intensity, multiplicity, and duration. Resilient individual have an ability to bounce back from adversity and experience modest or little disruption in normal functioning and are able to maintain a relatively stable, healthy levels of psychological functioning even after enduring the pandemic. Recovery pattern is characterised by relatively rapid reduction in symptoms and return to normal functioning whereas chronic pattern is characterised by symptoms and dysfunction of a long duration," says Pune-based military psychologist Lt Col Dr Samir Rawat.

Challenges at the Individual and Community Levels

From a psychological perspective, post pandemic reconstruction would entail catering to the problems, concerns and needs of those adversely impacted by the COVID -19 with stress symptoms typically characterised by individual's experiencing an overwhelming trauma of the pandemic (for example, recurring nightmares/ breaking into a cold sweat, flashback of stressful events, increasing irritability, low frustration tolerance or emotional numbing).

It could also manifest in depressive symptoms which may result in lack of interest or diminished pleasure in activities and things which you earlier liked to do, feelings of worthlessness or even survivor guilt in case of a loss of a loved one due to COVID-19, fleeting thoughts of death and suicidal ideation. Physical symptoms, on the other hand could be a decrease in appetite, weight and sleep problems, inability to focus and lack of concentration.

Undoubtedly, the pandemic will cause a financial loss of varying magnitude to many, especially the marginalised and economically disadvantaged strata of daily wage earners; it will also lead to loss of jobs (already beginning to show), homelessness, occupational difficulties and new challenges in interpersonal relations at work and on the home front, besides physical health problems and psychological barriers with new norms of accepted social behaviour (social distancing, handshakes, an obsession for cleanliness to name a few).

Emotional battles

Many factors may influence whether individuals come out stronger and more resilient or surrender to the pandemic. Emotion Regulation is one such long term critical factor that can play an important role in contributing to varying degrees of adaptation with negative or positive outcomes. While we know that primary emotions are fear, anger, disgust, joy, anticipation, acceptance, sadness and surprise, other basic emotions include wonder, love, desire, joy, hatred, sadness, attachment, disgust, rage and even expectancy .

To be able to regulate these emotions and avoid negativity , especially on social media platforms is likely to increase efforts in emotion regulation which involves initiating, increasing or maintaining an emotional response.

This means by regulating or on the other hand by stopping, decreasing or avoiding an emotional response, that is, by down-regulating, depending on the individual's objectives and goals or his /her ability to regulate emotions in the valued and given direction.

"One of the best ways to regulate emotions is through cognitive restructuring wherein we change the way we think; after all it is not the event but the interpretation of the event which is perceived as stressful and finding meaning promotes resilience and reduces risk and vulnerability to stress," advises Dr Rawat.

Adding, "Clearly, we need to have a psychological plan to prevent, mitigate and minimise negative outcomes by post pandemic reconstruction of society at an individual and community level all over the country; this has to be integrated by all leaders across verticals in diverse domains."

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Agencies
March 15,2020

Should you let your babies "cry it out" or rush to their side? Researchers have found that leaving an infant to 'cry it out' from birth up to 18 months does not adversely affect their behaviour development or attachment.

The study, published in the Journal of Child Psychology and Psychiatry, found that an infant's development and attachment to their parents is not affected by being left to "cry it out" and can actually decrease the amount of crying and duration.

"Only two previous studies nearly 50 or 20 years ago had investigated whether letting babies 'cry it out' affects babies' development. Our study documents contemporary parenting in the UK and the different approaches to crying used," said the study's researcher Ayten Bilgin from the University of Warwick in the UK.

For the study, the researchers followed 178 infants and their mums over 18 months and repeatedly assessed whether parents intervened immediately when a baby cried or let the baby let it cry out a few times or often.

They found that it made little difference to the baby’s development by 18 months.

The use of parent’s leaving their baby to ‘cry it out’ was assessed via maternal report at term, 3, 6 and 18 months and cry duration at term, 3 and 18 months.

Duration and frequency of fussing and crying was assessed at the same ages with the Crying Pattern Questionnaire.

According to the researchers, how sensitive the mother is in interaction with their baby was video-recorded and rated at 3 and 18 months of age.

Attachment was assessed at 18 months using a gold standard experimental procedure, the strange situation test, which assesses how securely an infant is attached to the major caregiver during separation and reunion episodes.

Behavioural development was assessed by direct observation in play with the mother and during assessment by a psychologist and a parent-report questionnaire at 18 months.

Researchers found that whether contemporary parents respond immediately or leave their infant to cry it out a few times to often makes no difference on the short - or longer term relationship with the mother or the infants behaviour.

This study shows that 2/3 of mum's parent intuitively and learn from their infant, meaning they intervene when they were just born immediately, but as they get older the mother waits a bit to see whether the baby can calm themselves, so babies learn self-regulation.

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