An Analytical Study of Factors Related To Reproductive Health

 

Yogita Hiwarkar1* and Amit Hiwarkar2

1Dept. of Community Medicine, Dr. Ulhas Patil Medical College and Hospital, Jalgaon Kh. (M.S.), India

2Dept. of Anaesthesiology, Dr. Ulhas Patil Medical College and Hospital, Jalgaon Kh. (M.S.), India

 

 

ABSTRACT:

The mean age at menarche was 13.32yrs in urban slum and 13.52yrs in rural area. The mean age at marriage was 17.7 yrs in urban slum and 16.8 yrs in rural. The mean gravidity was 2.4 and mean parity was 2.19 in urban area while in rural area mean gravidity was 2.52 and mean parity was 2.18, among the study participants. 65.45 % of the study participants got married before the legal age of marriage, i.e., 18 Years, in urban slum. In rural area, 89.39% of women got married before 18 years.

 

KEYWORDS: Menarch, Marriage, Pregnancy

 

INTRODUCTION:

Reproductive health is a crucial part of general health and a central feature of human development. It is a reflection of health during childhood and crucial during adolescence and adulthood, sets the stage for health beyond the reproductive years for both women and men, and affects the health of the next generation. 
 
Reproductive health is a universal concern, but is of special importance for women particularly during the reproductive years. Men have particular roles and responsibilities in terms of women's reproductive health because of their decision-making powers in reproductive health matters.Young people of both sexes are also particularly vulnerable to reproductive health problems because of a lack of information and access to services(1).
 
Global estimates showed that, between 5-15% of the burden of diseases is associated with failure to address reproductive health needs. The World Bank estimates around 20% loss in total years of healthy life among women of reproductive age group due to gynecological diseases(2).

 

Data on global prevalence of STIs are limited because STI surveillance has been largely neglected and funding for surveillance remains inadequate. The best available estimates indicate that each year some 340 million new cases of syphilis, gonorrhea, chlamydia and trichomoniasis occur in men and women aged 15–49(3).

 

STIs are among the top five disease categories for which adults in developing countries seek health care, and about one-third of STIs globally occur among people younger than 25 years of age (4). RTIs often cause discomfort and lost economic productivity (5). Sexually transmitted diseases (STDs) are a major public health problem worldwide, more so in developing countries where they collectively rank among the five most important causes of healthy productive life lost(6). The World Bank estimates that for adults between 15 to 44 years of age in the developing world, STDs not including HIV infection are the second common cause of healthy life lost in women, after maternal morbidity and mortality(7). Studies in women in developing countries have found RTIs rates ranging from 52% to 92%, and fewer than half the women recognized the conditions as abnormal (8).

In India, Women as a separate group accounts for 407.8 million as per 2001 census. Out of which 183.67 million females are in reproductive age group i.e.15 to 44 years. Most of the knowledge regarding gynecological morbidity in India is based on hospital statistics; information available at community level in India is rare.

 

A few community based studies have focused on an entire range of gynecological morbidity and have shown the prevalence ranging from 26% to 74 %( 7).

 

In Maharashtra, National Family Survey data showed prevalence of any abnormal vaginal discharge high (62.2%) in slums of Mumbai compared to 33.8% in non slum area(8). Owing to a lack of a fully functional STI surveillance system in India, prevalence estimates for STI are varied (9). According to NFHS 3 (2005-06), 11 percent of women who ever had sex had an STI or STI symptom in the 12 months preceding the survey. Women were over four times more likely to say they had an abnormal bad smelling genital discharge than to report a genital sore or ulcer in the past 12 months. These results are based on self reports. By taking in to consideration the above facts and as per recommendations of the World Health Organization(WHO) study group in 1957, that 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, Garg Narendra K.(10) and Garg Narendra K.and Sharma A.B.(11) , the authors have under taken this study with the objective to explore the rural and urban profile of RTI/STIs patients and the differences if any.

 

MATERIALS AND METHOD:

The present study was a community-based study, which was conducted in an Urban slum which is a catchments area of Urban Health and Training Centre and in the field practice area of Rural health training center of a Medical College in Metropolitan city (Mumbai-12) from. September 2007 to November 2009.Reproductive age group (15-45yrs) married women living in the sampled area were taken as sample.

 

Study design

The study comprises of both quantitative and qualitative components.

Quantitative: Cross-sectional study (Household Survey)

Qualitative: Focus Group Discussion (FGD)

 

Sampling procedure and Sample Size:

 

Urban: Considering the average prevalence of gyneaecological morbidity as 50%, the sample size was calculated at allowable error of 7.5% as follows:

Sample size        =   4 p q

           L2    

                          =  4x 50 x 50    

       7.5 x 7.5          

    = 177

However, to overcome factors such as no cooperation, no availability and refusal of internal examination, 25 % more women were interviewed giving the total sample size of 220.

 

By using simple random sampling, one zone was selected consisting of total population of 11000. As per the national data of NFHS 3 the average household size for an urban area is 4.8. In the pilot study that was conducted the average household size for the slum under study was found to be 5, therefore the number of households in the area III were calculated as,

                                                                                                                                                         

No. of households in Area III

                   =Total population of area III

                            Average family size

                   =   11000

                             5

                   =   2200

 

Every 10th house was selected for the study purpose by systematic random sampling. The first household was selected randomly by using the currency note technique, after which every 10th household was included in the study. Whenever a household was found to be locked or when there were no eligible study subjects in a household the next household on the right was selected for the study purpose. Randomly, only one woman in reproductive age group was selected from each household.

 

Rural: Out of total 15 padas of the village, 3 padas were selected by simple random technique. The total population and total number of households in each pada were as follows:

 

PADA

No. of household

Total population

Pada1

65

362

Pada 2

35

175

Pada 3

56

304

Total

156

841

 

Percentage of reproductive age group women in community is 19%. Applying this percentage to total population, the number of reproductive age group women came out to be 159. But few women were not fitting in eligibility criteria's or they did not give consent. So, the total sample size arrived was 132.

 

Eligibility criteria

a) Inclusion criteria –

1. Ever married women in reproductive age group.

2. Women who have given consent

3. Women residing in the study area since more than six months.

 

b) Exclusion criteria –

1. Pregnant women (because of the invasive research methods involved)

2. Women who had given birth in the previous six weeks because the greater susceptibility to vaginal candidiasis at these times.

3. Unmarried women and girls were not included for cultural and social reasons

 

The data was collected from each sampled women in a pretested questionnaire which include age at menarche, age at marriage, total number of pregnancy and total no of children till the time of data collection.

 

OBSERVATIONS AND DISCUSSION:

On analysis of the collected data, it was revealed that the mean age at menarche was 13.32yrs in urban slum and 13.52yrs in rural area. The mean age at marriage was 17.7 yrs in urban slum and 16.8 yrs in rural area (Table-I). (Table-II) reveals that 50 % women in rural and 30.00% in urban got married even by the age of 16 years while 39.39 and 35.45 % women in rural and urban area respectively got married by the age of 18 years which is legal age of marriage for the women. Only 03.78 % and 12.27 % women in rural and urban area respectively married after attaining 18 years of age. This shows that the tradition of early marriage of women in India.  Early marriage continues to be a problem for girls as that calls for early pregnancy, hence risking the life of the mother and the child. In Maharashtra, alone 21 percent of girls marry before maturity (13), so the situation  is worse in the present study. Early pregnancy, lack of gap between children and deliveries without proper care lead to complications.

 

The mean gravidity was 2.4 and mean parity was 2.19 in urban area while in rural area mean gravidity was 2.52 and mean parity was 2.18, among the study participants (Table-I). While according to NFHS-3 (14), total fertility rate is 2.98 in rural and 2.07 in urban area. So it is higher than national average in urban area may be because majority of population in the study area was Muslim and they do not accept permanent sterilization methods due to religious reasons. In rural area, the fertility rate was lower than the national average for rural area, may be because higher rates of acceptance of permanent sterilization methods in this area and higher incidence of infertility.

 

The majority of the women (77 percent) were having 1-2 children (57.27% in urban and 48.48% in rural). About 37 percent of the women in urban and 41% in rural were found to have three or more children.

 

 

 

TABLE-I: Descriptive statistics related to Age at menarche, Age at marriage, Total number of pregnancies and Total number of children of study participants

PLACE

 

Minimum

Maximum

Mean

Std. Deviation

Urban (n=220)

Age at menarche

11

17

13.32

1.17

 

Age at marriage

12

25

17.78

2.40

 

Total no. of pregnancies

0

8

2.40

1.38

 

Total no. of children

0

8

2.19

1.27

Rural (n=132)

Age at menarche

11

16

13.52

1.29

 

Age at marriage

13

23

16.80

1.76

 

no of pregnancies

0

8

2.52

1.55

 

Total no. of children

0

7

2.18

1.27

 

TABLE-II:  Age at marriage of the study participants

Age at marriage

Urban

Rural

Frequency

Percent

Frequency

Percent

16 or less

66

30

66

50

17-18

78

35.45

52

39.39

19-20

49

22.27

9

6.81

21or more

27

12.27

5

3.78

Total

220

100

132

100

 

 

CONCLUSION AND RECOMMENDATIONS:

This shows that the tradition of early marriage of women in both urban and rural still more or less equally practiced.  Early marriage continues to be a problem for girls as that calls for early pregnancy, hence risking the life of the mother and the child. Therefore efforts must be made by making the community aware about benefits of women marriage at or beyond proper legal age.

·        Services for women with gynecological morbidity need to be coordinated to create a continuum of care i.e. a system of care that meets the multiple and changing needs of reproductive women and that extends from the home and the community to the clinic or hospital and back again.

·        Health services should be improved and made more accessible so that women feel comfortable in seeking treatment and are not deterred by concerns over privacy and confidentiality. Services should be delivered at times according to convenience of women as many women stated that they could not go to health center because of time constraint.

·        Health care personnel need to be trained to detect and treat gynecological diseases that commonly occur in women of reproductive age with special emphasis on STI/RTIs.

·        The staff of such services should be trained to manage sensitively gynecological morbidity and they should try to change responsible cultural practices and to identify psychological distress and anxiety related to reproductive morbidity.

·        Health service staff should offer non-judgmental, empathic care which encourages women to talk about their reproductive health concerns.

 

REFERENCES:

1.       Guidelines on Reproductive Health: United Nations Population Information Network (POPIN) UN Population Division, Department of Economic and Social Affairs, with support from the UN Population Fund (UNFPA)

2.       World Bank. World development report: investing in health. New York: Oxford University Press, 1993.

3.       World Health Organization (WHO), Global Prevalence and Incidence of Selected Curable Sexually Transmitted Infections: Overview and Estimates, Geneva: WHO, 2001

4.       Ibid.; and WHO, Young People and Sexually Transmitted Diseases, Fact Sheet, Geneva: WHO, 1997, No. 186.

5.       Piot P and Rowley J, Economic impact of reproductive tract infections and    resources for their control, in: Germain A et al., eds., Reproductive Tract Infections: Global Impact and Priorities for Women's Reproductive Health, New York: Plenum Press, 1992, pp. 227–249;

6.       Over M, Piot P. HIV infection and sexually transmitted disease. In, Jameson DT, Mosley WH, Measham AR et al eds. Disease Control Priorities in Developing Countries, 445-529, New York, Oxford University Press, 1993.

7.       Progress in Reproductive health Research: Research approaches to the study of reproductive tract infections and other gynecological disorders, WHO, by Shireen Jejeebhoy, Michael Koenig and Christopher Elias, Cambridge University.

8.       Koenig M, Jejeebhoy S, Singh S. et al. Investigating women's gynecological morbidity in India: not just another KAP survey. Rep. Health Matters 1998;6:1–13.

9.       Improving Reproductive Health in Developing Countries. A summary of findings from the National Research Council of the U.S. National Academy of Sciences, 9, National Academy Press, October 1997.

10.     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.

11.     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)

12.     Hawkes S, Santhya KG. Diverse realities: sexually transmitted infections and HIV in India. Sex Transm Infect 2002;78 (Suppl 1) :131–9.

13.     UNICEF report highlights grim condition of women, children in state Express News Service posted: Jan 16, 2009 at 0204 hrs IST

14.     National family health survey 2005-06, Ministry of Health and Family Welfare, Government of India.

 

Received on 12.02.2013

Modified on 18.02.2013

Accepted on 28.02.2013

© A&V Publication all right reserved

Research J. Pharmacology and Pharmacodynamics. 5(1): January –February 2013,43-46