Counting older women: Measuring the health and wellbeing of older women in LMICs.

Health systems globally are unprepared for responding to the needs of aging populations-the majority of whom are women. This is exacerbated by data systems that exclude older women. There is an urgent need to address this gap to ensure policies and services promote healthy aging across the life course.

How does eye care seeking behaviour change with increasing age and visual impairment? Intersectional analysis of older adults in the Indian Sundarbans.

BACKGROUND: Visual impairment disproportionately affects people in the low-income countries. A high proportion of visual impairment can be prevented or cured. Yet, care seeking for eye health is restricted for women and older adults. This article uses the intersectionality approach to understand how eye care seeking behaviour changes in men and women with increase in age and visual impairment in a poor and underserved region of India. It brings forth the commonalities and differences between the various groups. METHODS: The article is based on qualitative data. Persons aged 50 years and more are categorized into young-old, middle-old and old-old. Men and women with low vision/ high visual impairment have been selected from each of the three age groups. In-depth interviews have been carried out with 24 study participants. Data saturation has been attained. The JHPIEGO Gender Analysis Framework underpins the study. The narrative data has been coded in NVivo 10 software. RESULTS: Various symptoms are associated with visual impairment. The young-old with low vision do not report much difficulty due to visual impairment. Study participants with high visual impairment, and in the older age groups do. Difficulty in the discharge of regular chores due to visual impairment is rarely reported. Impaired vision is considered to be inevitable with advancing age. Care seeking is delayed for eye health. Typically, outpatient care from nearby health care facilities has been sought by men and women in every group. Inpatient care is limitedly sought, and mostly restricted to men. Eye care seeking behaviour changes among men with increase in age and visual impairment. Women consistently seek less care than men for both outpatient and inpatient eye care. Study participants of both genders become dependent with increasing age and visual impairment. Traditional patriarchal privileges enjoyed by men (such as mobility and economic independence) decrease with age. The vulnerability of women gets compounded with time. CONCLUSIONS: The article presents a granulated understanding of eye care seeking behaviour among older adults in India. Such differentials need to be taken cognizance of in programmes promoting universal access to health care. Existing conceptualizations on access to health care need to be revisited.

Youth-friendly services in two rural districts of West Bengal and Jharkhand, India: definite progress, a long way to go.

It is a continuing challenge to reach rural youth in India with sexual and reproductive health services. Drawing on a large survey among 6,572 young people aged 15-24 and 264 rural health providers accessed by them in rural West Bengal and Jharkhand, we witnessed a long-awaited response to national efforts to promote birth spacing. That 31% of young, married women without children were using contraception to delay a first birth was evidence of cracks in the persistent tradition of demonstrating fertility soon after marriage. The coverage of public sector services for reproductive and sexual health is highly variable and the scope largely restricted to married women, with unmarried young women and men relying mainly on the informal private sector, and seriously underserved. Strong social norms proscribing pre-marital sexual relationships perpetuate barriers in meeting their needs. Access to contraception is affected by negative provider attitudes and reluctance to report having sex underestimates the real scale of unmet need. Yet, 30% of providers reported unmarried young women seeking abortion services. To address the needs of all rural youth, the public sector needs to expand its remit or engage with informal providers, train them to deliver youth-friendly services and give them a recognised role in abortion referral.