Reluctant patients--the women of India.

Indias higher female than male mortality rates through age 50 indicate that health services do not reach women especially in rural areas. Inaccessibility of health services does not seem to be the reason because even when primary care centers are nearby women do not use them to the extent anticipated. The community health worker scheme was designed to provide health services to reach villages but over 90% of the workers are men and they see more male than female patients. It is commonly believed that Indian woman are reluctant to consult male doctors but health centers with female doctors see no more women patients than do those with male doctors. The problem seems to be that women because of their household responsibilities and out of ignorance tend to neglect their illnesses until they become too sick to move around. Their frequent dependence on others in the family to get them medical attention also has the effect of delaying visits to a health center. The current distinction between curative and preventive care is dysfunctional from the viewpoint of women patients. The health services should have a mechanism to encourage women to seek early help and the ability to handle medical emergencies in the field. Care-givers should become active in identifying ill women and persuading them to get help. Auxiliary nurse midwives who already have many responsibilities will be most active in handling medical emergencies in the field. Only qualified nurse midwives should be recruited and they should receive constant training and retraining. The suggested improvements would require understanding of the problems of Indias woman more than additional financial outlays.