Contents
Introduction
Endometriosis affects nearly 40–45 million Indian women, yet WHO notes a 7–10 year diagnostic delay; ICMR’s EndoCare India marks a public-health shift from tertiary care to primary-level recognition.
Endometriosis as a Silent Public Health Challenge
- Burden and Neglect: Endometriosis is a chronic inflammatory gynaecological disorder with multisystem impact. WHO (2023) recognises it as a major contributor to infertility, chronic pelvic pain and mental health morbidity. NFHS-5 data indirectly reflect menstrual morbidity, yet policy attention remains minimal.
- Socio-Cultural Normalisation of Pain: Menstrual pain is socially trivialised as ‘normal’ womanhood. Studies by the George Institute for Global Health highlight stigma, delayed care-seeking and psychological distress, especially in rural and adolescent populations.
ICMR’s EndoCare India: A Paradigm Shift
- From Surgical to Multidisciplinary Care: EndoCare moves beyond laparoscopy-centric, tertiary care models. It integrates gynaecologists, pain specialists, physiotherapists, psychologists and fertility experts—aligning with WHO’s life-course and biopsychosocial approach to chronic diseases.
- Public Sector Scalability: Designed for India’s public health architecture, EndoCare is adaptable under NHM. Pilots at ICMR-NIRRCH sites demonstrate feasibility of decentralised care, unlike fragmented private-sector driven treatment.
- Gender-Responsive Health Governance: EndoCare operationalises gender equity in healthcare delivery. By recognising endometriosis as a legitimate NCD, it challenges systemic gender bias in clinical diagnosis, often termed ‘medical gaslighting’ in feminist health literature.
Institutionalising Standardised Screening: The Missing Link
- Why Screening at Primary Care Matters: Early symptom recognition, not imaging, is the diagnostic bottleneck. Global evidence (NICE-UK, ACOG-USA) shows symptom-based screening can reduce diagnostic delays by half.
- Role of Frontline Healthcare Workers (ASHAs/ANMs): Frontline workers act as gatekeepers of primary healthcare. Training them to identify red flags—severe dysmenorrhoea, school absenteeism, cyclical bowel pain, family history—can trigger early referral to CHCs and district hospitals.
- Standardised Guidelines as Systemic Reform: A uniform screening checklist institutionalises accountability. Similar to NPCDCS for diabetes and hypertension, endometriosis screening can be embedded into RMNCH+A under NHM, ensuring continuity of care.
Transforming Primary Healthcare Outcomes
- Reducing Health Inequities: Standardised screening bridges the urban-rural diagnostic divide. Rural women, often dependent on OTC analgesics, gain structured referral pathways, reducing catastrophic health expenditure.
- Mental Health and Productivity Gains: Early diagnosis mitigates anxiety, depression and economic loss. OECD studies show untreated gynaecological morbidity significantly lowers female labour force participation, aligning endometriosis care with economic empowerment goals.
- Digital Health and Continuum of Care: Telemedicine platforms like e-Sanjeevani can link PHCs to EndoCare hubs. This supports follow-up, counselling and adherence, especially in remote regions.
Implementation Challenges and Way Forward
- Capacity and Workload Constraints: ASHAs are already overburdened. Incentivised training, simplified digital tools and task-sharing are essential to avoid mission creep.
- Policy Recognition and Research Gaps: Endometriosis must be explicitly recognised as a public health priority. Increased funding for cost-effective diagnostics, behavioural research and school-based menstrual education is critical.
Conclusion
Echoing President A.P.J. Abdul Kalam’s vision of ‘inclusive health as national strength’, EndoCare can convert women’s silent suffering into visible policy action through early diagnosis, dignity and gender-just healthcare.
