On International Day of Action for Women’s Health, two women scientists — Dr Renu Swarup, Secretary, Department of Biotechnology, Ministry of Science and Technology, and Chairperson, BIRAC (L) and Dr Gagandeep Kang, Executive Director, Translational Health Science and Technology Institute (R)– talk to Akanki Sharma about their contributions to women’s well-being
Keep yourself relaxed, stay happy and fit : Dr Renu Swarup
She elaborates on the various initiatives the Department of Biotechnolgy (DBT) has taken for ensuring women’s good health, while also advising them to stay stress-free
Has the Department of Biotechnology come up with any project which would have focussed specifically on the health of women in India?
There is major emphasis on programmes which focus on women’s health. In fact, maternal and child health is a priority with us and we have a large number of programmes, both at the Department of Biotechnology and our public sector BIRAC. The emphasis is at providing affordable healthcare intervention, doing early diagnosis of diseases and finding preventive cure. And, in that, we are looking at a large number of initiatives.
Kindly elaborate on these initiatives.
There are a few major initiatives. In fact, in February this year, we launched our programme — the Atal JaiAnusandhan Biotech Mission under which we have GARBH-ini. In this, we are doing a cohort study on pre-term birth, wherein more than 8,000 pregnant women’s samples will be collected to study the parameters for pre-term birth, its side effects and early diagnosis. For this, we are bringing a genomics technology that can bring in predictive markers, so that pre-term can be predicted early and actions can be taken to either prevent it or see how we can bring in the intervention into it.
We have also set up one of the largest biorepositories which will have the samples collected and linked with genomics data. In addition, we have tied up with IIT Madras for bringing in artificial intelligence to develop predictive markers. A study has been launched in southern India, which is looking at a similar angle — what are the interventions or what is the growth pattern for pregnant women, what are the interventions that are going to their diet and how a child is being tracked till about two years of age after he/she is born.
A similar study is being conducted in Delhi which is on bringing in improved nutritional intervention to see its impact on pregnancy, childbirth, child rate at that time and the child growth till two years of age.
Some of the common diseases in women include breast and cervical cancer, any steps being taken regarding their prevention?
We are working on different diagnostics screening devices, both for breast cancer and cervical cancer and we also have a number of devices which are in advanced stages of development.
One is thermal image device system, which is with AI tool that looks at the heat map and takes a normal image and then we can do a protective marking. For cervical cancer also, we have a large number of screening devices which are being worked out. Apart from it, we are also supporting a major programme on developing an indigenous HPV vaccine for cervical cancer. Currently, we are using the imported vaccine in one or two states where it has got in but we are supporting one of our Indian manufacturers to come up with the HPV vaccine under our Grand Challenges initiative.
Can biotechnology also contribute towards the menstrual hygiene of women?
We have some programmes that are looking at biodegradable sanitary napkins. Looking at greener technologies, one of the startups is even looking at the way of disposal of sanitary napkins. Of late, we have also awarded one of the startups namely Padcare Labs under our Soch grant. The company is developing a minimum viable product for rapid, easy, economical and eco-friendly sanitary pad sterilisation, partial segregation and disposal at waste generation level which overcomes issues of smell, unhygienic environment and unsafe handling.
You have been working for a longer tenure. How do you maintain a balance between your personal and professional life, specially focussing on keeping yourself healthy?
I wish I could do more than what I do. However, with the time I have, I try to see that I factor in at least the minimal amount that’s required for my daily schedule of exercise in the morning before I get into the office. I try to factor in at least 60 minutes of workout schedule either by walking and exercises or yoga. Also, I try to maintain a diet as healthy as possible, whether I am in office or somewhere out. I also try to ensure that I get healthy food from home. That’s the maximum I do but I wish I could go beyond it. And, the most important thing is to get a regular check up, so that in case something is not right, I can take an immediate action on it.
Three things you would like to tell working women for keeping themselves healthy?
Women must find time for themselves: Dr Gagandeep Kang
With major health issues affecting the women of India, she tells how they are always late to come to hospital for checkups. Her advice is that women should keep things in moderation
From the beginning of your career to getting recognised by the Royal Society of London, how has your journey been being a woman scientist?
I think that women scientists in most places tend to be invisible, partly because they are culturally conditioned not to put themselves forward. Fortunately, this trend is changing now but it certainly wasn’t the case when I started. I spent most of my career trying to find places to work where I wasn’t stepping on somebody’s toes. That’s how I ended up working on rotavirus vaccine — something that nobody else was interested in. Later on, I discovered that if you work hard enough, long enough and broad enough on any one subject, you become an expert. Thus, I have been recognised for the work I have done and it’s indeed because of focus and a long-term commitment.
Also, in health it’s not just one person. It’s always a contribution of a lot of people who work on a particular problem and I’ve been lucky that throughout my career, I have worked with some of the most wonderful people.
What are the major health issues women face in India? Working as a scientist all these years, have you worked on anything specific related to women’s health?
The one thing that you learn about any aspect of working in medicine in India is that for everything, women will come later to hospital, and it starts at the beginning of life. If you do a survey on girls and boys being brought to hospitals for a particular condition– even for something common like diarrohea or pneumonia, it will be 60 per cent boys and 40 per cent girls. Also, when you work in fields like surgery or medicine, you find that by the time women come for treatments, their tumours would have grown to an extent where they have become inoperable, their chronic medical condition – say diabetes – will be completely out of control.
The work that I have done with women is largely around nutrition, and anemia is a particular problem that we have looked at. You see women with haemoglobin three and four and wonder how they are walking around. Nevertheless, this is something where early pick up and screening could have resulted in women getting just oral therapy, but then it becomes this slow that you have to give them transfusion since that brings along with it a host of other problems.
We have found it difficult to address the problem of anemia in India because we don’t initiate treatment early and then we don’t follow up on whether the women are responding to the treatment or not. The first thing is simple iron tablets. Many women cannot tolerate iron tablets and stop taking them and we don’t know it because there is no monitoring system. Around nutrition, we don’t know what the adequacy of a diet is for a pregnant woman in India– how much weight should she be gaining, what should she be eating at the various stages of her pregnancy. So, these are the issues that we are working on now but seeing their effects will take another generation.
Besides, one huge problem that you can look at in India is the height of women. Being under 150 centimetres is a risk factor for many things, particularly for childbirth. Small women will have a smaller pelvis which will mean that their babies will not come out normally. The nutrition problem, when girls grow taller and bigger, that’s when you will start seeing the intergenerational effect of the intervention that we do today.
Is Translational Health Science Technology Institute (THSTI) doing anything in the direction of improving women’s health? Any specific projects for preventing diseases like breast cancer and cervical cancer?
We are not working on cancers at the moment but we have a huge study going on in Gurugram. This is a cohort of pregnant women that is being followed up. The idea here is to find out why Indian babies are born too soon. Currently, pre-term birth rate in India is higher than anywhere else in the world. One of my colleagues is working on this problem. She has a cohort and we have found that 14 per cent of babies who have been born in the cohort are pre-term. We are also looking at genetics and environmental factors, along with doing multiple ultrasounds in pregnancies– to try to understand ‘can you predict which baby is going to be born pre-term and which ones will be going all the way to term’. Although, they already have a clue that if you live with very high environmental pollution inside or outside your house, the chances of preterm birth are much higher.
A 2017 Lancet study says that close to half (48 per cent) of all pregnancies in the country are unintended largely because women have no information about safe sex or don’t have access to contraceptives. How do you think this issue can be resolved?
Currently, the norm is for women to have two children. But if you want two of them to grow and develop properly, WHO recommends that you have at least three years of gap between your pregnancies. What happens to us is that once you start having children, you have them at an early age and then you go on to have multiple children at very short intervals because you are not educated and don’t have access to contraception. In states where access to contraception is good, the interval between babies is longer. For instance, women have much fewer children and better-spaced pregnancies in Kerala and Tamil Nadu as comparison to Uttar Pradesh and Madhya Pradesh.
Can state governments play any role in this regard?
In India, we have both oral contraception as well as mechanical devices for contraception. Oral contraception is supposed to be available but it is not frequently provided and this is not something that is discussed frequently because women don’t come to health facilities until they are sick. So, you will come for antenatal care because it is required but then you are already pregnant. Now that’s a stage where you should be offering counselling and family planning services, for when the baby is delivered and frequently systems are so focussed on the delivery of antenatal care that they forget about the post-pregnancy part– whether it is delivering a copper-T or Copper-7 or giving oral contraceptives.
Contraceptives that women can control is empowering to women and that’s the evidence of what’s happening to families in southern India.
What specific contribution can biotechnology make towards keeping women healthy?
Biotechnology can contribute in a number of ways if you take it as discovery and use of biologicals, drugs, vaccines and devices. One of those that doesn’t get taken into account is how you tailor any of those for women. For instance, dosage of most of the drugs used in India is based on a 70 kilogram man but not everyone is of 70 kilograms.
Women in India tend to be more small, they have hormonal cycles which affects the way their body processes drugs, vaccines or any kind of biological and we don’t take those into account. So, when we think about developing new products through biotechnology, it has to be something that is suitable for the entire population, and not just the half of it.
When we design new drugs or develop new biologicals which are intended for treating people, we have to make sure that we are developing them in a way that they are useful for all populations and not just the one.
But how will this be possible? What factors are required to be taken into consideration while the process is going on?
By doing clinical trials that are designed to take these factors into account. Currently, a clinical trial is designed to make sure that the drug or vaccine has the best possible effect on what they call the general population. But frequently the general population is not representative of anything more than where the trial is being done. This is something where even regulatory process can help where the regulators argue that you need subgroups composed of a particular type. For instance, if you say women who are in the reproductive age and women who are not in the reproductive age for diabetes drug, will ensure that you have an efficient number when these products are evaluated for us to have some level of certainty that they will or won’t work or won’t have side effects.
Amidst the daily busy schedule, how do you ensure to keep yourself healthy?
I run in the morning and do yoga whenever I can. In addition, I eat lots of fruits and vegetables.
Three things you would like to tell working women for keeping themselves healthy?