Women in Asia largely ignorant, fatalistic, about fertility

HONG KONG (Reuters) Wed, Sep 5, 2012 – Women in Asia are largely ignorant about fertility problems and tend to blame their failure to conceive on “God’s will” and bad luck, a survey has found.

The survey, which covered 1,000 women in 10 countries who had been trying to conceive for at least six months, found that 62 percent of them did not suspect they may have a fertility problem.

Photo By AHMAD MASOOD/Reuters

They were even less likely to point the finger at their husbands, with 80 percent of them not suspecting that their partners may have a problem with fertility. Infertility is defined by the World Health Organisation as the inability to conceive after a year of regular, unprotected sex. But only 43 percent of the women surveyed knew that. Only 30 percent of the women, all aged 25-40, recognised that obesity could reduce fertility and only 36 percent knew that chances of getting pregnant declined with age. Forty-three percent did not know a man may be infertile even if he could achieve an erection and 73 percent were unaware that men who had mumps after puberty could be infertile later on.

Instead of getting treatment, 46 percent of respondents blamed their inability to conceive on “God’s will” and 45 percent put it down to bad luck.

Lead researcher P C Wong at the National University Hospital Women’s Centre in Singapore said, “Such a lack of understanding could result in couples waiting too long – only to realise when they finally decided to seek help that it may be too late.”

“That’s a lost opportunity because even if they come for treatment, our success of treatment is higher with younger women,” said Wong, who heads the reproductive endocrinology and infertility division at the hospital.

Chances of success with in-vitro fertilisation – the best known fertility treatment – is 40-50 percent when a woman is under 30 years old but that drops to 10 percent once the woman is over 40. By 44-45, the chance of success is one percent.

“The reason is because eggs in the ovaries decline in quality and quantity … as we go along and age, the chances of conceiving is much lower,” Wong said by telephone.

The survey, commissioned by Merck KGaA unit Merck Serono, covered China, India, Japan, South Korea, Thailand, Vietnam, Singapore, Hong Kong, Taiwan and Malaysia.

Wong said his team hoped to work on a similar survey targeting men in Asia.

(Reporting by Tan Ee Lyn; Editing by Robert Birsel).

 

Braving crowds, waiting for hours for free medicine

For Ramaiyah Venkat, a retired Indian schoolteacher, the two-hour bus journey every three months to get free insulin is worth it even if he has to queue for hours at the dispensary and sometimes gets less than he needs.

Thousands of people like Venkat flock to the huge Rajiv Gandhi General Hospital in Chennai every day. Tamil Nadu is one of two Indian states offering free medicine for all. The state provides a glimpse of the hurdles India faces as it embarks on a programme to extend free drug coverage nationwide.

The Rajiv Gandhi hospital is the most convenient for Venkat. He says he is willing to brave the crowds of patients and their families, many sitting on the hospital floor and some eating food, to see a doctor and then queue to collect his medicine.

“If I have to buy insulin at a chemist’s shop, I will have to spend hundreds of rupees. Instead, I prefer to spend a few on my visits,” said Venkat after receiving the regular supply of medicine that is essential to treat his diabetes.

This time, he said, he got the full three-month dose, but often he has to do with six weeks because of short supplies. A key challenge to expanding the programme is that India’s public health system is already underfunded and struggles to meet the needs of 1.2 billion people, 40 percent of whom live below the poverty line of $1.25 a day.

A paramedic distributes free medicine provided by the government to patients inside a ward at Rajiv Gandhi Government General Hospital (RGGGH) in Chennai July 12, 2012. REUTERS/Babu

The Tamil Nadu programme is popular with poor and working class patients and was opened to all last year after an income eligibility cap was removed, but those seeking treatment often endure lengthy waits and occasional shortages.

To keep costs down, the price the state government pays to pharmaceutical makers is low — between one-sixth and one-tenth of retail in a country with already rock-bottom prices thanks to a big generic drugs industry.

That means bigger drug firms tend to supply just a few of the higher-priced medicines, while bulk items like paracetamol are supplied by small firms, a state official said.

As a result, stocks can sometimes run out.

India’s planned nationwide programme has many of the same features, including centralised procurement, an emphasis on cheap generics, a specific list of permitted drugs and distribution limited to government hospitals and clinics.

“The intention seems to be very good but I have my reservations on the implementation part,” said Ajay Kumar Sharma, who heads the pharmaceutical and healthcare practice for South Asia and the Middle East at Frost & Sullivan.

“If you plan to use the same machinery to execute this agenda, I think it will falter,” Sharma said.

CROWDED HOSPITALS

The Tamil Nadu government says 50 or 60 percent of people in the state use the programme, which cost just over 2 billion rupees last year.

By comparison, retail drug sales in the state, home to 62 million people, were 54 billion rupees, according to the Tamil Nadu Chemists and Druggists Association. Arul Kumar, general secretary of the industry body, figures only up to 30 percent of the population takes advantage of the free programme.

At the Rajiv Gandhi hospital, up to 3,000 in-patients are treated at a time and an additional 12,000 outpatients visit every day, many collecting free medicine.

Crowds fill the corridors and stairwells and spill into the backyard, where the drug distribution counters are located.

Medical treatment can be a luxury in a country where annual public spending on healthcare totals just $4.50. Public health facilities are often overcrowded and understaffed, and many Indians must travel hours to reach one.

India has 9 hospital beds and 6.5 physicians per 10,000 people, according to the World Health Organisation. By comparison, China has 42 beds and 14.2 doctors, while Britain has 33 beds and 27.4 physicians for every 10,000 people.

Those who can afford it tend to choose private health care.

“I prefer my family doctor, whom I trust and who knows my medical history,” said Divya Raman, a 27-year-old IT professional from Chennai who said she had not heard of the free drug programme.

Across India, just 20 percent of people receiving outpatient treatment do so at a government facility. That rises to 40 percent for in-patient care, according to Sakthivel Selvaraj, a health economist in New Delhi who advises the government.

In Rajasthan, the other state which offers free medicine, outpatient visits to public hospitals jumped 60 percent and inpatient admissions are up 20 percent since the programme was launched last year.

‘EASIER SAID THAN DONE’

India’s new programme, to begin by the end of 2012 and roll out nationwide within two years, hopes 52 percent of the population is using free drugs by April 2017. It has budgeted nearly 300 billion rupees to fund it.

The central government, whose subsidies on food, fuel and fertilisers bloat its fiscal deficit, intends to fund 75 percent of the programme, with states paying the rest.

States must also build sourcing networks, set up warehouses with cold storage and mechanisms to test drugs made by the roughly 12,000 drugmakers in India, a mammoth task.

Tamil Nadu, one of India’s largest states, provides 270 different “essential” drugs from a WHO list and a further 174 speciality drugs. To ensure quality, it has tie-ups with 15 private labs to test procured medicines.

While the nationwide rollout promises big volumes for drugmakers, the focus on generics — only 5 percent of the nationwide budget can be used for branded drugs, which is bad news for Big Pharma — means margins are likely to be thin.

(Editing by Tony Munroe and Raju Gopalakrishnan)

Source:http://in.reuters.com/article/2012/07/23/india-free-drugs-chennai-public-health-idINDEE86M00I20120723?feedType=nl&feedName=intopnews