m edicin agrawal and unisa, j community med health educ 2013, … · 2018. 6. 13. · received...

Agrawal and Unisa, J Community Med Health Educ 2013, 3:3 DOI: 10.4172/2161-0711.1000207

Research Article Open Access

Volume 3 • Issue 3 • 1000207J Community Med Health EducISSN: 2161-0711 JCMHE, an open access journal

Pregnancies, Abortion and Women’s Health in Rural Haryana, IndiaSutapa Agrawal1* and Sayeed Unisa2

1South Asia Network for Chronic Disease, Public Health Foundation of India, New Delhi, India2Department of Mathematical Demography and Statistics, International Institute for Population Sciences, Mumbai, India

AbstractIn this study women’s perceived health status and self-reported health problems has been examined according to the number

of pregnancies, gestational stage of abortion, and number of abortions among the rural women of Haryana, India by analyzing data from an in-depth interview of 329 ever-married women conducted in five villages of Haryana state of India during the year 2003. From our study, it emerged that women who had undergone an abortion were 1.7 times (OR: 1.68; 95% CI: 0.95-2.98; p=0.076) more likely to perceive their health status as worse with reference to women who had not experienced any abortion. Self-reported health problems such as pain in lower abdomen and body weakness were found to be significantly (p

Citation: Agrawal S, Unisa S (2013) Pregnancies, Abortion and Women’s Health in Rural Haryana, India. J Community Med Health Educ 3: 207. doi:10.4172/2161-0711.1000207

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of all women we found that overall, 91% of the pregnancies resulted in live births, 7% resulted in spontaneous abortion or miscarriage whereas less than 1% pregnancies were aborted intentionally (data not shown). All analysis were done using SPSS statistical software version 19.

Ethical approval: The study received ethical approval from the International Institute for Population Science’s Ethical Review Board. Selected eligible women were interviewed with their prior consent and the respondents had the option of withdrawing at any stage. The analysis presented in this study is based on secondary analysis of existing survey data with all identifying information removed.

ResultsCharacteristics of the study population

The study population primarily consisted of middle-aged women (mean age 33.8 years ± 7.6 SD) (Table 1). The mean age at marriage is 14 years, but rises to 16 for the consummation of the marriage. Respondents are mostly Hindus. The caste composition shows that a higher percentage of women are from high or medium-ranking caste (49%), with scheduled castes and other backward castes amounting each for about 25% of the total. More than 70% respondents are illiterate and only 7% reported high school education. More than half of the respondents were currently working and mostly in the agriculture sector. With regard to women’s exposure to mass media, a very small proportion of the respondents have such exposure. About one-third of the respondents listen to the radio at least once a week followed by only 17% of the respondents who watch television at least once a week. The standard of living of the respondents shows that 21% belongs to low, 44% to medium and 36% to higher standard of living households. More than one third was cohabiting with their in laws.

Perceived health status and self-reported health problems

Table 2 shows the perceived health status of women and self-reported health problems during the last one year preceding the survey. Perceived health status has been seen in terms of perceived health status and specific morbidity conditions among women. A question was asked to the women, “How would you describe your general health in comparison to other women of your age? Would you say it is same as other women, better than other women, somewhat worse than other women or is it much worse than other women?” This perceived health status of the women was asked for the last one year (a year before the date of interview). It was found that a significantly higher proportion of women (47%) reported their health as somewhat worse than other women of their age and 6% reported of a much worse condition since the last one year. However, two out of five women perceived their health status better than other women and another 6% women perceived their health status be the same. Overall, more than half the women were found to have some type of health problems during the last one year (not shown in the table).

Considering the self-reported health problems, almost one in ten women reported to have suffered from cough, cold and fever. Pain in the lower abdomen (indicative of lower reproductive tract infections) and weakness and tiredness (indicative of anemia) – each problem was reported by 8% of women. 7% women had body pain, which includes lower back pain and leg pain and 5% women had specific joint pain. Also, 5% women experienced some problems related to chest and respiration. Further, one in ten women reported having other health problems, which includes allergy, headache, hypertension, heart problems, hearing problems, hysterectomy, hysteria, menstrual irregularities, swelling of body and tuberculosis (Table 2).

Socio-economic and demographic characteristics Percent NumberAge20-29 32.5 10730-39 42.3 13940-52 25.2 83Mean Age 33.8 yearsMarital statusCurrently married 96.7 318Widow 3.3 11Age at marriage when married once 14.4 yearsMean age at consummation of marriage 16.3 yearsSpousal age difference 4.4 yearsCo-residence with husbandLiving with husband 98.1 312Husband living elsewhere 1.9 6Education1

Illiterate 72.9 240Less than high school 20.4 67High school complete and above 6.7 22Husband’s educationIlliterate 33.4 110Less than high school 34.3 113High school complete and above 32.2 106ReligionHindu 97.6 320Muslim 2.4 9Caste/tribe status2

Scheduled caste 25.6 84Other backward class 25.0 82Others 49.4 162Working statusWorking in family farm/ business 29.8 98Employed with someone else 22.2 73Self employed 4.9 16Not working 43.3 142Husband’s occupation3

Agriculture 44.7 147Labour 27.7 91Service 17.6 58Business 5.5 18Co residence with in-lawsYes 35.5 117No 64.4 212Exposure to mass media4

Reads news paper/magazine at least once a week 7.0 23Watches TV at least once a week 16.8 55Listens to the radio at least once a week 31.7 104Visits cinema/theatre at least once a month 0.6 2Standard of living indexLow 20.7 68Medium 43.6 143High 35.7 117Total 100.0 329

1”Less than high school” means 89 completed years of education, “high school complete and above” means 10 or more completed years of education.2 Scheduled castes and scheduled tribes are castes and tribes that the Government of India identifies as socially and economically backward and in need of special protection from social injustice and exploitation. Other backward class category is a diverse collection of intermediate castes that were considered low in the traditional caste hierarchy but are clearly above SC; ‘Others’ is a default residual group that enjoys higher status in the caste hierarchy3 Excludes 4 Not working women

Table 1: Percentage distribution of respondents aged 20-52 years according to socio-economic and demographic characteristics.


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Perceived health status and self-reported health problems of women by number of pregnancies

The effect of number of pregnancies on perceived health status and self-reported health problems of women (Table 3). In case of less number of pregnancies [2-4], except their perceived health status, no differential has been found in the self-reported health problems of women like body pain, pain in lower abdomen or weakness and tiredness. However, a somewhat worse health status was perceived by half of the women who had experienced five or more pregnancies than by women who had experienced 2-4 pregnancies.

Perceived health status and self-reported health problems of women according to gestational stage and number of abortions

It is evident from the table 4 that somewhat worse and much worse perceived health status significantly increases among women who had an abortion after three or more months of gestational period of pregnancy compared to women who had an abortion before three months of pregnancy i.e., in the first trimester. About 56% and 19% women who had experienced abortion after three months of gestational period, perceived their health status as somewhat worse and much worse respectively compared to 40% and 7% women who had an abortion before three months of pregnancy. However, no significant differential has been found in the case of self-reported health problems like body pain, pain in lower abdomen, weakness and tiredness according to gestational stage of abortion.

Looking into perceived health status of women according to the number of abortions, somewhat worst health status was perceived more by women who had experienced only one abortion but health status as much worse was perceived by a considerably larger proportion of women who had experienced two or more abortions compared to women not experiencing any abortion. Considering self-reported health problems, pain in the lower abdomen was reported significantly by a higher percentage of women who had experienced one abortion compared to women not experiencing any abortion. Also a higher percentage of women who reported body weakness and tiredness had experienced two or more abortions compared to women not experiencing any abortion.

Determinants of perceived health status among women

In order to examine the determinants of perceived health status among women, logistic regression analyses have been carried out. Table 5 presents the logistic regression results showing the adjusted effects (odds ratio with 95% confidence interval) of abortion, number of pregnancies and other socio-economic and demographic characteristics on perceived health status among women in rural Haryana.

Regarding perceived health status of women, experiences of abortion and co-residence with in-laws have emerged as statistically significant predictors. Women who had undergone an abortion were 1.7 times (OR: 1.68; 95%CI: 0.95-2.98; p=0.076) more likely to perceive their health status as worse with reference to women who had not experienced any abortion. Also, women who were not residing with their in-laws perceived their health status significantly much worse (OR: 2.06; 95% CI: 1.22-3.48) than women who were residing with their in-laws. Moreover, relatively older women (aged between 40-52 years), illiterate women and women belonging to households with a medium standard of living perceived their health status as much worse, but the results are not statistically significant.

DiscussionIn this study the consequences of abortion on the women’s perceived

health status and self-reported health problems have been examined. Women’s self-reported health problems were examined according to the number of pregnancies, gestational stage of abortion, and number of abortions. We found, as the gestational stage of abortion increases, the health problem among women was also found to be more. Further, repeated pregnancies greatly worsen the health of women and also deteriorate the already prevailing morbidity conditions.

Female morbidity rates can be linked to overall fertility levels in India. In India, childbirth closely follows marriage, which tends to occur at a very young age. About 30% of the Indian females are married between ages 15 and 19 years. Indian women also tend to have closely spaced pregnancies. Some 37% of births occur within two years of the previous birth, endangering both the health of the mother and the survival of the infant and older siblings. In this study we found, more the number of pregnancies, poorer the health status was perceived by women. Among the general health problems, pain in the lower abdomen and body weakness and tiredness has been found to be significantly higher among women who had experienced abortion. As the gestational stage of abortion increases, the health problems among women were

1Indicates perceived health status since last one year in comparison to other women of her age.2Includes Allergy (1.8%), Headache (2.7%), Heart problem (0.6%), Hearing problem (0.6%), Hypertension (2.3%), Hysterectomy (0.6 %), Hysteria (0.6%), Menstrual irregularities (0.9%), Swelling of body (0.6%) and Tuberculosis (0.6%).

Table 2: Percent distribution of women according to their perceived current health status and self-reported specific morbidity conditions.

Health status and general health problem Percent NumberPerceived health status1

Same 6.4 21Better 40.8 133Somewhat worse 46.7 151Much worse 6.1 21Types of specific morbidity conditionsCough cold and fever 8.6 28Body pain 7.4 24Joint pain 4.9 16Pain in lower abdomen 8.3 27Weakness and tiredness 7.7 25Problems related to chest and respiration 4.9 16Other health problems2 11.4 37Total - 326

Health status and general health problems

Number of pregnancies Total Percent

Number of women2- 4 5+

Health status1

Same 5.8 7.0 6.4 21Better 43.9 38.0 40.8 133Somewhat worse 43.9 48.5 46.3 151Much worse 6.5 6.4 6.4 21Total 100.0 100.0 100.0 326Types of general health problemsBody pain 7.0 7.6 7.4 24Pain in lower abdomen 8.3 8.2 8.3 27Weakness and tiredness 7.6 7.6 7.7 25Number of women 155 171

Indicates perceived health status since last one year in comparison to other women of her age.

Table 3: Health status and self-reported general health problems among women by number of pregnancies.


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also found to be more. Logistic regression results also substantiate that experience of abortion significantly aggravates all types of health problems among women even after controlling for the socio-economic and demographic factors. Further, when the number of abortion was taken instead of experience of abortion, the effect of repeated abortion (two or more) was found to be significantly higher for all types of health problems (not shown in the table). However, surprisingly, the number of pregnancies has not come out as a significant factor for the different health problems among women while it is believed that more number of pregnancies worsens women’s health condition.

From our study, it also emerged that women who had experienced abortion has perceived their health status as relatively worse than their counterparts. Also, women who had a late abortion i.e., abortion at a higher gestational stage perceived their health status as much worse compared to women who had an early abortion i.e., abortion in the first trimester. This finding confirms the ill effect of late abortion on the perceived and self-reported health of women.

In most developing countries, the consequences for women’s health, the social and cultural context within which induced abortions are performed and even the levels and characteristics of women resorting to abortions are unknown [5]. In this context, India is no exception. According to WHO estimates, globally 13% of all pregnancy related deaths (1 in 8) take place due to unsafe abortions, and nearly 90% of unsafe abortions take place in developing countries [9]. Irrespective of the conditions under which the abortion is performed, both morbidity and mortality are closely related to gestational age. The WHO is particularly concerned with the public health aspects of abortion. The International Conference on Population and Development (ICPD) held in Cairo (1994), urged Governments to take appropriate steps to help women avoid abortion which in no case should be promoted as a method of family planning and whenever possible to provide for the humane treatment and counseling of the women who have had recourse to abortion [10].

From the part of the government, abortion should be included in the special health policy agenda in India and appropriate intervention is an urgent requisite to combat health problems of women which is an important consequence of abortion. Also mass media exposure should be made more effective in rural Haryana by incorporating the health consequences related to frequent abortion and abortion at a higher gestational age on the part of women in addition to its legalization. Furthermore, since women who have more than one abortion are at a significantly increased risk of suffering physical squeale, these heightened risks should be thoroughly discussed with women who were seeking abortions.

Limitations of the studyThe data come from a survey, not from hospitals and thus the

results should be interpreted with a caution. The data reflects both the perceived health status and also the self-reported health conditions during 12 months preceding the survey. However, the clinical confirmations of the self-reported health problems were not possible. Therefore it might not reveal the real ailment. But in resource poor and highly populated country such as India, self-reports are one of the most feasible and practicable option for detection of a morbidity.

Acknowledgement

Support for the fieldwork by the Parkes Foundation Small Grant Fund, Department of Biological Anthropology, Cambridge University, U.K. is gratefully acknowledged.

Health status and general health problems

Percentage of women withGestational stage of abortion Number of abortions0-3 months 3+ months 0 1 2+

Health status1

Same 11.5* 7.4* 5.6 11.1 6.9Better 41.4* 18.5* 43.3 31.1 34.5Somewhat worse 40.2* 55.6* 45.6 51.1 44.8Much worse 6.9* 18.5* 5.6 6.7 13.8Types of general health problemsBody pain 11.5 11.1 6.7 13.3 3.4Pain in lower abdomen 13.8 14.8 6.0*** 22.2*** 6.9***Weakness 6.9 7.4 7.5*** 0.0*** 20.7***Total2 87 27 252 45 29

Indicates perceived health status since last one year in comparison to other woman of her age.2For gestational stage of abortion total indicates total number of abortions and for number of abortions total indicates total number of women who had undergone abortion.Significance level by Chi-Sq test: ***at 1% level; * at 10% level

Table 4: Perceived health status and self-reported general health problems among women who had undergone abortion according to gestational stage and number of abortion.

Note: Dependent variables: Model-I - Perceived health status (0=same/better and 1=worst/much worst) RReference category

Table 5: Logistic regression results showing the adjusted effects (odds ratio with 95% CI) of abortion, number of pregnancies and other socio-economic and demographic characteristics on perceived health status among women.

Selected predictorsPerceived health status

OR (95%CI) p-valueNumber of pregnancies2 to 4 R 1.00 (ref)5 + 0.80 (0.47-1.34) 0.391AbortionNo R 1.00 (ref)Yes 1.68 (0.95-2.98) 0.076Age20-29 R 1.00 (ref)30-39 1.16 (0.64-2.10) 0.62140-52 1.38 (0.68-2.80) 0.366EducationIlliterate R 1.00 (ref)Literate 0.64 (0.36-1.14) 0.127Currently workingNo R 1.00 (ref)Yes 0.98 (0.61-1.57) 0.917Caste/tribe statusScheduled caste R 1.00 (ref)Other backward class 1.09 (0.54-2.20) 0.803Others 0.97 (0.48-1.95) 0.938Standard of living indexLow R 1.00 (ref)Medium 1.45 (0.73-2.87) 0.285High 1.21 (0.55-2.67) 0.646Co residence with in-lawsYes R 1.00 (ref)No 2.06 (1.22-3.48) 0.007Constant 0.55-2 Log likelihood 430.9Number of women 325


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Author’s contribution

SA conceived and designed the study, analyzed and interpreted the data, and wrote and drafted the manuscript; SU helped for important intellectual content of the manuscript; all authors approve the final version.

References

1. Gunasekera PC, Wijesinghe PS (2001) Reducing abortions is a public health issue. Ceylon Med J 46: 41-44.

2. International Women’s Health Coalition (2001) Population control and women’s health: Balancing the scales. (Unpublished) 20 p.

3. Ford Foundation Report (1997) Advocacy for reproductive health and women’s empowerment in India.

4. Babu N, Nidhi P, Verma RK (1998) Abortion in India: What Does the National Family Health Survey Tell Us? Journal of Family Welfare 44: 45-53.

5. Barreto T, Campbell OM, Davies JL, Fauveau V, Filippi VG, et al. (1992) Investigating induced abortion in developing countries: methods and problems. Stud Fam Plann 23: 159-170.

6. Agrawal S (2004) Interlinkages between Women’s Childhood Experience, Autonomy, Sex preference and Elimination of the Girl Child: A Study of Women in Rural Haryana. Unpublished Ph.D. Thesis, International Institute for Population Sciences, Mumbai, India.

7. Agrawal S, Unisa S (2007) Discrimination from conception to childhood: a study of girl children in rural Haryana. In I. Attane and C.Z. Guilmoto (Eds.) Watering the Neighbour’s Garden: The Growing Demographic Female Deficit in Asia, CICRED, Paris, 247-266.

8. Agrawal S, Unisa S (2010) Active and passive elimination of girl child: Findings from rural Haryana. In TV Sekher and N Hatti (Eds.) Unwanted Daughters: Gender Discrimination in Modern India. Rawat Publications, Jaipur, India 222-243.

9. World Health Organization (WHO) (2011) Unsafe Abortion: Global and Regional Estimates of the Incidence of Unsafe Abortion and Associated Mortality in 2008, sixth ed., Geneva: WHO, 2011.

10. United Nations (1994) Report of the International Conference on Population and Development, Cairo, 5-13 September 1994 (A/CONF.171/13/Rev.1).

http://www.ncbi.nlm.nih.gov/pubmed/11727573http://www.ncbi.nlm.nih.gov/pubmed/11727573http://www.womenstudies.in/elib/gender_and_health/gh_advocacy_for.pdfhttp://www.womenstudies.in/elib/gender_and_health/gh_advocacy_for.pdfhttp://www.womenstudies.in/elib/abortion/ab_abortion_in_india_what.pdfhttp://www.womenstudies.in/elib/abortion/ab_abortion_in_india_what.pdfhttp://www.ncbi.nlm.nih.gov/pubmed/http://www.ncbi.nlm.nih.gov/pubmed/http://www.ncbi.nlm.nih.gov/pubmed/

TitleCorresponding authorAbstractKeywordsIntroductionMethods and Materials ResultsCharacteristics of the study population Perceived health status and self-reported health problems Perceived health status and self-reported health problems of women by number of pregnancies Perceived health status and self-reported health problems of women according to gestational stage anDeterminants of perceived health status among women

DiscussionLimitations of the study AcknowledgementAuthor’s contribution Table 1Table 2Table 3Table 4Table 5References

m edicin agrawal and unisa, j community med health educ 2013, … · 2018. 6. 13. · received...

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