Did you know that kidney disease in India in both men and women are caused more by Diabetes and Hypertension? However, certain conditions affecting kidneys impact women more – for instance, the urinary tract infections that lead to infection and scarring of the kidneys and the development of autoimmune diseases - Rheumatoid Arthritis and Systemic Lupus Erythematous.
Chronic Kidney Disease (CKD –irreversible damage to the kidneys) affects about 10% of the world’s population. Because there is no accurate data, it is not known how widely CKD in India is spread. Studies show that patients diagnosed with End Stage Kidney Disease (ESKD) who are on dialysis or transplantation is over 100,000 per year. This number under-estimates the burden of kidney disease in India given the disparities in wealth between the urban and rural populations and the gross inequality. Women also face unique socio-economic challenges that need to be understood to help improve their access to kidney care and good health.
CKD is said to impact a woman’s fertility apart from the medications, which are also said to affect woman’s fertility. Appropriate medication will also have to be chosen for women of child-bearing age. Pregnancy certainly carries a lot of risk for women with CKD and her unborn child.
Chronic kidney disease can negatively impact a woman’s fertility, and in some cases, the medication used to treat certain kidney diseases can have the same effect. For women of child-bearing age, careful medication has to be chosen as pregnancy carries risks for the woman with CKD and her unborn child.
The risks have many effects including severe high blood pressure, protein losses in the urine, and worsening of CKD in the mother as well as prematurity and low birth weight in the baby. The new-born child may develop future kidney problems because of all these conditions.
Advanced knowledge has helped in better understanding of pregnancy and kidney disease and there have been improvements in the outcomes of pregnancies among patients with ESKD. To achieve this improvement consistently, access to pre-conception primary care to detect baseline kidney problems and access to good prenatal and antenatal care is important.
Kidney replacement therapy will be needed once a patient reaches advanced stages of CKD. The therapy can be either dialysis or kidney transplantation and the latter offers the best outcome. According to many studies, women have more complications with dialysis than men. It is assessed that low blood counts and poor nutritional levels are higher among women.
It is possible that women may fare as well as their male counter-parts post-kidney transplantation. The number of male patients, though, who receive either dialysis or kidney transplantation is greater than women. Medical surveys from other countries have shown that all over the world, including India, there is inequality in the registration of women on deceased organ donation waiting lists and longer waiting times for women on dialysis. Across the world, and in India, women are more often the kidney donors and mothers and wives are more likely the donors than fathers or husbands.
Timely access to kidney care is the recurring theme and there is lot of inequality between genders as far this is concerned. Why the inequality? There are social, educational, economic and psychological factors at play.
India is a country where gender roles are clearly defined. Women don’t’ have easy access to education and are economically dependent on men. And in most families in India, the male member still happens to be the bread-winner. The compulsion among women to keep male members with CKD in work and employment may explain why women happen to be kidney donors in most cases.
Because of this economic condition, a woman may become a donor under obligation or compulsion from the men-folk in the family. Before the transplant happens, a psychological counselling takes place for both the woman donor and the recipient, keeping in view the strong familial, cultural, social factors in families in India.
Working women with a chronic medical condition like ESKD face the challenge of having to spend lot of time on regular dialysis and planning for transplantation and to recover thereafter.
Then there is the stigma of unmarried women in Indian society. In case they are afflicted with a kidney disease, the family not only feels that the woman is a financial burden, but also that the health condition may impact her fertility and pregnancy. This, traditional Indian families feel will affect the woman’s prospects of marriage and future family life.
Important medical concerns have to be taken into consideration. There are particular kidney conditions that afflict women and impact their health, pregnancy in particular and the unborn child too. Several complex socio-economic conditions have to be taken into account to ensure good outcomes of serious health problems.
Better medical knowledge, greater information and awareness and intensified effort from the medical fraternity will help in ensuring good health access to medical care for women. This will ensure better health of the entire family and better well-being of Indian society.