Impact of Socio Demographic Factors on Reproductive Health of Married Women in Reproductive Age Group

Yogita Amit Hiwarkar¹*, Rathi H.B.²

¹Assistant Professor, Community Medicine, Dr. Ulhas Patil Medical College, Jalgaon Kh.(MS)

²Associate Professor, Community Medicine, Dr. Ulhas Patil Medical College, Jalgaon Kh.(MS)

ABSTRACT:

Objective: To assess the impact of socio demographic factors on reproductive health of married women of reproductive age group.

Material and method: two hundred and twenty women of urban and one hundred and thirty two women of rural setting were taken as sample. Prior to study, consent of every participant was obtained. Data were collected in a preformed proforma.

Variables : Age, literacy status, occupation, religion/caste, type of family, per capita income, presence of indebtedness, type of housing and accesses to safe drinking water and toilet etc.

Observations : In urban area, RTI/STI were found to be more in age group of 15-24 yrs (59.2%), in illiterate women (69.8%), in working women(84%) and in women with joint families(66.1%) while in rural area RTI/STIs are found to be more in age group of 15-24 yrs (79.5%), in illiterate women (87%), in working women (71.9%) and in women with joint families (74.5%). No significant association was found between access to safe drinking water and toilet and RTI/STI in both urban and rural women.

KEYWORDS: Reproductive health, indebtedness, Family, literacy.

INTRODUCTION:

The importance of good health and education to a woman's well-being - and that of her family and society - cannot be overstated. Without reproductive health and freedom, women cannot fully exercise their fundamental human rights, such as those relating to education and employment. Yet around the world, the right to health, and especially reproductive and sexual health, is far from a reality for many women. According to the World Bank, one-third of the illness among women ages 15-44 in developing countries is related to pregnancy, childbirth, abortion, reproductive tract infections, and human immunodeficiency virus and acquired immune deficiency syndrome (HIV/AIDS). Keeping in mind the above facts and as per recommendations of the WHO study group in 1957, in order to obtain a comprehensive picture of a health problem / disease, only vital statistics is not sufficient, more and more such studies have to be undertaken(1,2) the authors have under taken this study with the objective to assess the impact of socio demographic factors on reproductive health of married women of reproductive age group.

MATERIALS AND METHOD:

Present study was conducted in an urban slum and in the field practice area of rural health training centre of Seth G.S.Medical College, Mumbai-12 between September 2007 and November 2009.In the urban slum, the sample size was 220 while in rural area, it was 132. All sampled women were married and in reproductive age group. Prior consent from each sampled was obtained. Statistical analysis was done in terms of simple proportion, Chi-square test etc.

Baseline socio demographic information about women i.e. . age, religion, education, occupation was collected. Information was also collected about type of housing, access to safe drinking water and a toilet, household income, employment status, and indebtedness

SOME OPERATIONAL DEFINATIONS:

HOUSING

Pucca house: The house in which the floor, wall and roof are impermeable to water

Semi-pucca house: The house in which the floor, roof or wall are permeable to water.

Kuchha house: The house in which floor, wall and roof are permeable to water

Access to safe drinking water and toilet: household with safe water in home or within 15 minutes’ walking distances from a water standpoint or protected well, adequate sanitary facility in the home or immediate vicinity.

OBSERVATIONS AND DISCUSSION:

On analysis of the collected data it was noted that in urban area, RTI/STI were found to be more in age group of 15-24 yrs (59.2%), in illiterate women (69.8%), in working women(84%) and in women with joint families(66.1%). The association between education (X² = 10.19, DF=1,P=0.001) , occupation (X² = 62.2, DF=1, P<0.01), type of family (X² = 8.21, DF=1, P=0.004) and presence of RTI/STIs is found to be statistically significant. Religion was not found to be associated with RTI/STIs (Table-I).

In rural area (Table-II) shows that RTI/STIs are found to be more in age group of 15-24 yrs (79.5%), in illiterate women (87%), in working women (71.9%) and in women with joint families (74.5%). The association between age (X² = 7.7, DF=2, P=0.02), education (X² = 28.85, DF=1, P<0.001), occupation (X² = 4.78, DF=1, P=0.029), caste (X² = 8.13, DF=1, P=0.04), type of family (X² = 5.24, DF=1, P=0.022) and presence of RTI/STIs was found to be statistically significant. In urban area, Statistically significant association was found between Per Capita Income (PCI) (X² = 6.53, DF=1, P=0.011) , presence of indebt ness (X² = 6.97, DF=1, P=0.008), type of housing (X² = 4.8, DF=1,P=0.027) and presence of RTI/STI , with RTI/STI being more in women with Per Capita Income <600 ( very poor class of B.G. Prasad classification) (71.90%), in women belonging to households which are under some kind of debt (64.2%) and in women living in kuccha households (67.6%). No significant association was found between access to safe drinking water and toilet and RTI/STI (Table-III). In rural area, although not statistically significant, RTI/STIs were found to be more in women with Per Capita Income <600 (very poor class of B.G. Prasad classification) (68.6%), in women belonging to households which are under some kind of debt (68.2%) and in women living in kuccha households (69.6%) .No significant association was found between access to safe drinking water and toilet and RTI/STI (Table-IV).

In urban area, although not statistically significant, RTI/STIs were found to be more in age group of 15-24 yrs (59.2%), followed by the age group of 35-45 yrs. In rural area, RTI/STIs are found to be more in age group of 15-24 yrs (79.5%), followed by the age group of 35-45 yrs (53.3%) and minimum in age group of 25-34 yrs. The association was statistically significant with chi square value of 7.7 at DF=2 and P=0.02. Thus reproductive morbidity was common in younger age group as this is a period of maximum sexual and reproductive activity.

In the study done by Savita Sharma et al (3), maximum prevalence was found in the age Group of 25-34 years old. While Monica Rathore et al (4) found an increasing trend in RTIs with increase in age. The prevalence of RTIs was highest (44.7%) in age group 40 to 45 years and lowest (1.7%) in 15 to 19 years age group.

In urban as well as rural area, statistically significant association was found between education and presence of RTI with chi square value of 10.19 at DF=1 and P=0.001 in urban and chi square value of 28.85 at DF=1 and P<0.001 in rural. In urban area, 69.8% of illiterate women while 43.8% of literate women had reproductive morbidity and in rural area, 87% of illiterate women while only 36% of literate women had RTI/STI. The relationship of education and health is a well-established fact. Attainment of education clears various misconceptions about many illnesses including RTIs and encourages preventive practices. It may also be because of education increases the awareness and receptivity to new technologies, which further places the women into new environment of more conscious about their personal hygiene.

Parashar A et al (5) in their study done in Shimala found that the prevalence of RTIs decreased with the attainment of higher educational status. The prevalence was highest among illiterate women.

Monica Rathore et al (4) in their study found that 48% of the study population was illiterate, out of which 29.5% was suffering from RTIs, while only 7.3% of women with secondary and higher secondary education were suffering from RTIs (p<0.001).

Ruchi Sogarwal and L. K. Dwivedi (6) in their study of perceived reproductive morbidity, done in Madhya Pradesh, found that women that are more educated reported higher reproductive health problems in the tribal population, whereas the higher educated non-tribal women were reporting less.

Occupation was also statistically associated with presence of RTI/STI both in urban and rural area with chi square value of 62.2 at DF=1 and P<0.01 in urban and chi square value of 4.78 at DF=1and P=0.029 in rural area. In urban area, 84% of working women had RTI and in rural area, 72% of working women had RTI/STI. Most of them were unskilled workers working on wages or working as a house cleaner in urban area and working on wages in farms in rural area.

Jasmin Helen Prasad et al (7) in their study mentioned that, occupation was a significant factor in STI risk. Women who were agricultural laborers had elevated odds of STIs compared with those who worked solely in the home. The focus group and key informant data suggested that sexual activity is common among workers in agricultural fields. Also, Working women are likely to report more any gynecological problems than non-working women.

In urban area, 43.7% of women living in nuclear family while 66% of women belonging to joint or three generation family had RTI/STI and in rural area, 52% of women living in nuclear family while 74% of women belonging to joint or three generation family had RTI/STI. The association was statistically significant with chi square value of 8.21 at DF=1 and P<0.01 in urban and chi square value of 5.24 at DF=1and P=0.022 in rural area.

Contrary to these findings Monica Rathore et al(4) found that women from nuclear families had more RTIs. Religion was not found to be associated with RTI/STIs in urban area. In rural area the association between Caste (Tribal/ Nontribal) and presence of RTI/STIs was found to be statistically significant with chi square value of 8.13 at DF=1 and P=0.04. The morbidity was more among tribal (67%) than nontribal women (25%).

In urban area, statistically significant association was found between PCI (X² = 6.53, DF=1, P=0.011) presence of RTI/STI. 72% of women belonging to very poor class according to modified B.G. Prasad class had RTI while 47 % of women above very poor category had RTI/STI. Study participants were also asked about presence of indebt ness in the household. The presence of indebt ness was for various reasons like, routine household expenditure, health, education, buying house or auto rikshaw, etc. The loan was taken mostly from relatives, friends, neighbors or unauthorized moneylenders. Presence of indebt ness is one of the indicators to suggest the economic condition of the family. 64% of participants who said that their families are in some sort of debt were having RTI/STI while 43% of women who do not have any debt were having the morbidity. The association was statistically significant with chi square value of 6.97 at DF=1 and P=0.008. In rural area, although not statistically significant the morbidity was found to be more in women belonging to very poor class according to modified B.G. Prasad class (68.6%) and in women belonging to households, which are under some kind of debt (68.2%).

While Ruchi Sogarwal and L. K. Dwivedi (6) in their study found that Tribal women of high economic status reported a higher prevalence of morbidity (50 percent). On the contrary, non-tribal women had not reported much variation in reproductive health problems by economic condition.

TABLE-I

Association between Age, Education, Occupation, Religion, Type of family and Presence of RTI/STIs in Urban area

Sociodemographic Determinants	RTI/STI present		RTI/STI not present		Total
	n = 93	Row %	n = 88	Row %	n = 181	Row %
AGE X^2 = 1.7 DF=2 P=0.408
15-24	29	59.2	20	40.8	49	100.00%
25-34	49	47.6	54	52.4	103	100.00%
35-45	15	51.7	14	48.3	29	100.00%
literacy status X^2 = 10.19 DF=1 P=0.001 (Statistically significant)
Illiterate	37	69.80%	16	30.20%	53	100.00%
Literate*	56	43.80%	72	56.20%	128	100.00%
OCCUPATION X^2 = 62.2 DF=1 P<0.01 (Statistically significant)
Housewife	25	25.0	75	75.0	100	100.00%
Working	68	84.0	13	16.0	81	100.00%
RELIGION X^2 = 1.6 DF=2 P=0.448
Hindu	21	56.8	16	43.2	37	100.00%
Muslim	66	48.9	69	51.1	135	100.00%
Other**	6	66.7	3	33.3	9	100.00%
TYPE OF FAMILY X^2 = 8.21 DF=1 P=0.004 (Statistically significant)
Nuclear	52	43.70%	67	56.30%	119	100.00%
Non nuclear***	41	66.10%	21	33.90%	62	100.00%

*For analysis purpose all literate women are clubbed together

**Other includes Christian and Buddhist

*** Joint and 3 generation families are clubbed together as non nuclear families for analysis purpose

TABLE-II

Association between Age, Education, Occupation, Religion, Type of family and Presence of RTI/STIs in rural area

Sociodemographic Determinants	RTI/STI present		RTI/STI not present		Total
	n = 65	Row %	n = 39	Row %	n = 104	Row %
AGE X^2 = 7.7 DF=2 P=0.02 (Statistically significant)
15-24	31	79.5	8	20.5	39	100.00%
25-34	18	51.4	17	48.6	35	100.00%
35-45	16	53.3	14	46.7	30	100.00%
literacy status X^2 = 28.85 DF=1 P<0.001 (Statistically significant)
Illiterate	47	87.00%	7	13.00%	54	100.00%
Literate*	18	36.00%	32	64.00%	50	100.00%
OCCUPATION X^2 = 4.78 DF=1 P=0.029 (Statistically significant)
Housewife	24	51.10%	23	48.90%	47	100.00%
Working	41	71.90%	16	28.10%	57	100.00%
CASTE X^2 = 8.13 DF=1 P=0.04 (Statistically significant)
Non Tribal	3	25	9	75	12	100.00%
Tribal	62	67.4	30	32.6	92	100.00%
TYPE OF FAMILY X^2 = 5.24 DF=1 P=0.022 (Statistically significant)
Nuclear	30	52.60%	27	47.40%	57	100.00%
Non nuclear**	35	74.50%	12	25.50%	47	100.00%

*For analysis purpose all literate women are clubbed together

** Joint and 3 generation families are clubbed together as non nuclear families for analysis purpose

TABLE-III

Association between Per Capita Income, Presence of Indebtedness and Presence of RTI/STI in Urban area

Sociodemographic Determinants	RTI/STI present		RTI/STI not present		Total
	n = 93	Row %	n = 88	Row %	n = 181	Row %
PER CAPITA INCOME (PCI) * X^2 = 6.53 DF=1 P=0.011 (Statistically significant)
< Rs 600	23	71.90%	9	28.10%	32	100.00%
> Rs 600	70	47.00%	79	53.00%	149	100.00%
PRESENCE OF INDEBTEDNESS X^2 = 6.97 DF=1 P=0.008 (Statistically significant)
Yes	43	64.2	24	35.8	67	100.00%
No	50	43.9	64	56.1	114	100.00%
TYPE OF HOUSING X^2 = 4.8 DF=1 P=0.027 (Statistically significant)
Kaccha house	25	67.6	12	32.4	37	100.0%
Pucca house	68	47.2	76	52.8	144	100.0%
ACCESS TO SAFE DRINKING WATER AND TOILET X^2 = 0.11 DF=1 P=0.737
Yes	58	50.4	57	49.6	115	100.00%
No	35	53.0	31	47.0	66	100.00%

*PCI <600 is very poor class according to B.G. Prasad classification and for analysis purpose all other classes are clubbed together in > 600 category

TABLE-IV

Association between Per Capita Income, Presence of Indebtedness and Presence of RTI/STIs Rural area

Sociodemographic Determinants	RTI/STI present		RTI/STI not present		Total
	n = 65	Row %	n = 39	Row %	n = 104	Row %
PER CAPITA INCOME (PCI)* X^2 = 0.83 DF=1 P=0.362
< Rs 600	24	68.60%	11	31.40%	35	100.00%
> Rs 600	41	59.40%	28	40.60%	69	100.00%
PRESENCE OF INDEBTEDNESS X^2 = 0.38 DF=1 P=0.535
Yes	15	68.2	7	31.8	22	100.00%
No	50	61.0	32	39.0	82	100.00%
TYPE OF HOUSING X^2 = 1.75 DF=1 P=0.185
Kaccha house	32	69.6	14	30.4	46	100.00%
Pucca house	33	56.9	25	43.1	58	100.00%
ACCESS TO SAFE DRINKING WATER X^2 = 0.73 DF=1 P=0.39
Yes	5	50	5	50	10	100.00%
No	60	63.8	34	36.2	94	100.00%

*PCI <600 is very poor class according to B.G. Prasad classification and for analysis purpose all other classes are clubbed together in > 600 category

A. Parashar et al (5) found that 9 (69.2%) of those who were in class IV of Prasad classification were suffering from RTIs. 38 (54.3%) of those in class III, 120 (43.3%) of those in class II, 51 (21.2%) of those in class I were suffering from one or other type of syndrome. The prevalence of RTIs was significantly related to per capita monthly income (c2 = 45.36, p <0.001).

Housing condition is also one of the indicators of the socioeconomic condition of the family. Women were also asked about the access to safe drinking water or toilet facilities, i.e., household with safe water in home or within 15 minutes’ walking distances from a water standpoint or protected well, adequate sanitary facility in the home or immediate vicinity. Access to safe drinking water or toilet facilities is essential in order to maintain a good hygiene.

Vikram Patel et al (8) in their study mentioned that not having a toilet in the house was significantly associated with presence of vaginal discharge in multivariate logistic regression model.

Bansal A.K. et al (9) also reported more or less similar observations in their study.

In urban area, 67.6% of women who lived in Kaccha house had RTI while 47% of those living in Pucca house had RTI. The association between housing and presence of RTI was found to be statistically significant with chi square value of 4.8 at DF=1 and P=0.027. Although not statistically significant, the morbidity was more in women living in household, which did not have access to toilet and safe drinking water. In rural area, although not statistically significant the RTI/STI were found to be more in women living in Kuccha households (69.6%)and which did not have access to safe drinking water or toilet facilities(63.8%). The findings of the present study are more or less in accordance of the findings of various studies conducted by various authors.

CONCLUSION:

From above observations and discussion, the authors reached to the conclusion that the association between education (X² = 10.19, DF=1,P=0.001) , occupation (X² = 62.2, DF=1, P<0.01), type of family (X² = 8.21, DF=1, P=0.004) and presence of RTI/STIs is found to be statistically significant. Religion was not found to be associated with RTI/STIs. While in rural area, the association between age (X² = 7.7, DF=2, P=0.02), education (X² = 28.85, DF=1, P<0.001), occupation (X² = 4.78, DF=1, P=0.029), caste (X² = 8.13, DF=1, P=0.04), type of family (X² = 5.24, DF=1, P=0.022) and presence of RTI/STIs was found to be statistically significant. In urban area, Statistically significant association was found between PCI (X² = 6.53, DF=1, P=0.011), presence of indebt ness (X² = 6.97, DF=1, P=0.008), type of housing (X² = 4.8, DF=1,P=0.027) and presence of RTI/STI while in rural setting it was insignificant. This shows that in urban setting as expected the variables study in this study have more impact regarding RTI/STI. In comparision to rural setting.

REFERENCES:

1. Garg Narendra K.: Evaluation of the impact of emesis and emesis plus purgation Therapy; Research J Pharmacology and Pharmacodynamics (2) March-April; 2010:201-202.

2. Garg Narendra K and Sharma A.B.: Epidemiological profile of patients attending a tertiary care hospital, Muktsar,Punjab (India); Research J Pharmacology and Pharmacodynamics:3 (6)

3. Savita Sharma, BP Gupta, The prevalence of reproductive tract infections and sexually transmitted diseases among married women in the reproductive age group in a rural area, Indian journal of Community Medicine, Vol.34, issue 1, pg 62-64.

4. Monika Rathore, S.S. Swami, B.L. Gupta et al, Community Based Study of Self Reported Morbidity of Reproductive Tract Among women of Reproductive Age in Rural Area of Rajasthan, IJCM, Vol. 28, No. 3 (2003-07 - 2003-09)

5. Parashar A, Gupta BP, Bhardwaj AK, Sharin R. Prevalence of RTIs among women of reproductive age group in Shimla city. Indian J Commun Med 2006;31:15-7

6. Ruchi Sogarwal1 & L. K. Dwivedi, National AIDS Control Organization (NACO), New Delhi Reproductive Morbidity among Tribal and Non-tribal Women in India: A Special Focus to Domestic Violence

7. Jasmin Helen Prasad, Sulochana Abraham, Kathleen M. Kurz et al, Reproductive Tract Infections Among Young Married Women in Tamil Nadu, India, International Family Planning Perspectives, Volume 31, Number 2, June 2005

8. Vikram Patel, Sulochana Pednekar, Helen Weiss, et al, Why do women complain of vaginal discharge? A population survey of infectious and psychosocial risk factors in a South Asian community, International Journal of Epidemiology 2005 34(4):853-862; doi:10.1093/ije/dyi072.

9. Bansal A.K. and Garg Narendra K.; Information, education, communication in context of reproductive and child health including HIV/AIDS : J. of Ravishankar University; Vol. 14; No. B 9Science) 2001 : pp 28-34

Received on 05.04.2013

Modified on 15.05.2013

Accepted on 20.05.2013

© A&V Publication all right reserved

Research J. Pharmacology and Pharmacodynamics. 5(3): May–June 2013, 197-201