LEVELS AND PATTERNS OF REPRODUCTIVE MORBIDITY AND TREATMENT SEEKING BEHAVIOUR AMONG CURRENTLY MARRIED WOMEN IN TAMIL NADU

Transcription

1 CHAPTER V LEVELS AND PATTERNS OF REPRODUCTIVE MORBIDITY AND TREATMENT SEEKING BEHAVIOUR AMONG CURRENTLY MARRIED WOMEN IN TAMIL NADU

2 CHAPTER V LEVELS AND PATTEIU~S OF REPRODUCTIVE MORBIDITY AND TREATMENT SEEKING BEHAVIOUR AMONG CURRENTLY MARRIED WOMEN IN TAMIL NADU 5.1 INTRODUCTION In the previous chapter, we briefly discussed the prevalence of various types of reproductive morbidities and treatment seeking behaviour in India, states, and districts of Tamil Nadu. This was based on the data from the District Level Household Survey-Reproductive and Child Health (DLHS-RCH), second round, carried out during The survey is a rich source of information on reproductive health, as it enquired into and recorded details on symptoms of reproductive morbidity as well as on the treatment such as the place of service and the person providing service. In these aspects, the DLHS-RCH is more comprehensive than many large scale surveys ~nd allows a deeper understanding of the reproductive health situation. Therefore, aspects of reproductive morbidity and treatment seeking of women in Tamil Nadu as ascertained in this survey and available in the DLHS-RCH-2 data set are discussed in this chapter. The point that the data are based on self-reporting is to be,:c kllow!edged. ~ 5.2 LEVELS OF REPRODUCTIVE MORBIDITY AND TREATMENT SEEKING BEHAVIOUR Prevalence of Obstetric Morbidity and Treatment Seeking Behaviour The DLHS-RCH survev - cohected information on obstetric morbidity. related to the last pregnancy during the three-year period preceding the survey. Out of the 25,522 currently married women of age years interviewed in the survey in Tamil Nadu, 8,588 had experienced live births or still births or induced abortion or spontaneous abortion during the three years preceding the survey and out of these, 7,370 had live births, 569 had spontaneous abortion, 537 had induced abortion, and 112 experienced still births. 112

3 Prevalence of Obstetric Morbidity Table 5.1 presents prevalence of various maternal complications among currently married women. Among those women who had experienced live births or still births during three years preceding the survey, little more than one-fourth (26.3 percent) had reported experiencing anyone complication during pregnancy. Swelling of hands and feet was the most common problem during pregnancy (16.0 percent). Besides, paleness, convulsions, visual disturbances, abnormal position of foetus, excessive bleeding, and weak or no movement of foetus were also reported. In Tamil Nadu, 32.1 percent women had reported experience of some complication during delivery. Prolonged labour (for more than 12 hours) and obstructed labour were the more commonly reported problems at the time of delivery. Premature labour, excessive bleeding, and breech presentation were also faced by women quite often during delivery. Table 5.1 reveals that 16.6 percent women in Tamil Nadu had reportedly experienced some complication during post-delivery period, lower abdominal pain (7.2 percent) was the most common among all problems. Women experienced a number of complications or symptoms during their reproductive periods. In order to see the severity of maternal conditions, special tabulation is made and Table 5.2 shows the distribution of the number of maternal complications (during pregnancy, during delivery, and after delivery) among women reporting some maternal complications during three years preceding the survey. About four percent women reported four or more complications during pregnancy. Further, less than one percent reported four or more complications during delivery or child birth and four percent reported four or more complications during post-delivery period. 113

4 Table 5.1: Prevalence of Various Types of Obstetric Morbidity among Currently Types of Maternal Complication Complications during pregnancy Swelling of hands and feet Paleness Visual disturbances Excessive bleeding Convulsions Weak or no movement of foetus Abnormal position of foetus Other Married Women (15-44), Tamil Nadu _._.ma~'y".~~.~.~~mplica!!q.~.~.!!~:t~kl!!"egnan~)'m... mm.....c... _ Number of Women who Reported Complication 1, Percent of Women who Reported Complication !,2.~~L... _~_..J._ _ Complications during delivery Premature labour Excessive bleeding Prolonged labour (more than 12 hours) Obstructed labour Breech presentation Other... ~.~)'.. ~~.~.~~~pli~a!!q.~.~.!!!~.~ll~!~iverl ,..._.. _._... _-_... - Complications Complaints during post~delivery period Higher fever Lower abdominal pain Foul smelling vaginal discharge Excessive bleeding Convulsion Severe headache Other _... ~.~)'.. ~~.~.. ~~~P!~~l!.~!Q.~.~Q.~p!~~.!I_t!lft!!.. ~!!~.~~!:)'..._ Any One Obstetric Morbidity 3, Number of Women 7,482 7,482 SOUTce: Computed from DLHS-RCH data file. \E= During the first six weeks after delivery. Note: '- Based on self-reponed complications_ 2. Those women who experienced live or still births during three years preceding the survey. 3. The percentages are computed after applying survey sample weights and the number of women given is unweighted. 4. Percent of each complication will not add up to total percent because some women reported more than one complicat ion _...!,.~.'!~.._.._......_.! ~.~..._._..._ 114

5 Table 5.2: Percentage Distribution of Currently Married Women (15-44) who Reported Some Obstetric Morbidity by Number of Complications, Tamil Nadu Percent of 'Vomen who Reported any Number of Complications Pregnancy Delivery Post-delivery Complication Complication One complication Two complications Three complications Four or more complications _A!l~.~~U:~~~ ~~_~pli~a!ion~ J_OQ:Q J_Q~ )_9Q~ A verage number of complications C Number of Women who Reported Any Complication Source: Computed from DLHS RCH, data file. >K' = During the first six weeks after delivery. {:,= Among those who reported any complication. Note: 1,990 2,439 1,245 I. Based on self-reported complications. 2. Those women who experienced live or still births during three years preceding the survey. 3. TIle percentages are computed after applying survey sample weights and the number of women given is unweighted Treatment Seeking for Pregnancy and Post-Delivery Complications Among those women who had experienced some complication during pregnancy, 64.4 percent of women had sought treatment (Table 5.3). Moreover, about two-fifths (40.1 percent) sought treatment from the private health facility than the public health facility (26.5 percent). Private hospital/clinic (36.2 percent) was preferred to the government/municipal hospitals (15.9 percent) for treatment. Among women who had reported any pregnancy complication, more than half (56.4 percent) sought treatment from doctors and only 7.5 percent sought assistance from ANM/Nurse/LHV. 115

6 Table 5.3: Source of Treatment for Pregnancy Complications among Currently Source of Treatment Public Health Facility Government/municipal hospital Government dispensary UHCIUHP/UFWC CHC/rural hospital Primary health centre Health sub-centre Government ISM hospital/clinic Private Health Facility Private hospital/clinic NGO/trust hospital/clinic Private ISM hospital/clinic...- Other..--. Married Women (15-44), Tamil Nadu Number of Women II Percent Among who Reported Complication Sought Treatment Person Providing Treatment Doctor 1, ANMINurse/LHV Other J~Qt repo~~.~l..._ Sought treatment from anyone source Did not seek anv treatment na - Not reported na Th~ I,m 10ao 10QO Number of\vomen 1,990 1,990 1,262 Source: Computed from DLHS RCH data file. UHC; Utban Health Centre; UIIP= Urban Health Post; UFWC= Urban Family Welfare Centre; CHC; Community Health Centre: ISM= Indian System of Medicine; NCO= Non Governmental Organisation; ANl\1= Auxiliary Nurse Midwife; LHV;Lady Health Visit; na= Not Applicable. Not.: I. The percentages are computed after applying. survey sample 'we ighls and the number of women given is unweighted. 2. Total number and percentages may add 10 more than because multiple responses were recorded _.-lq_... Q:~... _._... 2.:.... Women who had experienced any post-delivery complication in Tamil Nadu, 61.9 percent sought treatment for post-delivery complication (Table 5.4). More sought treatment from the private health facility (36.4 percent) than the public health facility (25.9 percent). Among all the medical institutes, government/municipality hospitals (18.8 percent) and private hospital/clinic (32.1 percent) had more patients for post-delivery complications. Among those who had treatment, half went to private hospital/clinics (Sl.8 percent), and nearly onethird sought treatment in government/municipal hospital (30.3 percent) during post-delivery 116

7 period. Very few sought treatment from ANMlNurseILHV. More than eighty percent of those who had treatment for post-delivery complications did seek it from medical doctors. A negligible percentage of women sought treatment from other than health professional for post-delivery complication. Table 5.4: Source of Treatment for Post-Delivery Related Complications among Currently Married Women (15-44), Tamil Nadu Number Percent Among who Source of Treatment of Reported Sought Women Complication Treatment Public Health Facility S Government/municipal hospital Government dispensary UHC/UHP/UFWC CHClrural hospital Primary health centre Health sub-centre Government ISM hospital/clinic Private Health Facility S.7 Private hospital/clinic NGO/trust hospital/clinic Private ISM hospital/clinic Other Person Providing Treatment Doctor ANMlNurse/LHV Other _ Sought treatment from anyone source Did not seek anv treatment na - Not reported J 0.0 na Total 1, Number of Women 1,245 1, Source: Computed from DLHS RCH data liie. UIIC= Urban Health Centre; UHP= Urban Health Post; UFWC~ Urban Family Welfare Centre; CHC= Community Health Centre: ISI\1= Indian System of Medicine; NGO= Non-Govemmenlal Organis.lion: ANI\1~ Auxiliary Nurse Midwife; LHV= Lady Health Visit; na= Not Applicable. Note: I. The percentages are computed after. applying survey sample weighls and 1he number of women given is unwcighled. 2. Total number and percentages may add 10 mofe than because multiple responses were recorded. 117

8 Prevalence of Post-Abortion Complications The DLHS-RCH survey also collected information on post-abortion related complications and treatment seeking behaviour. This morbidity is based on self-reported complication. Of the. 25,522 currently married women interviewed, 1,106 had an induced abortion or spontaneous abortion during the three years preceding the survey. Table 5.5 shows that 11.9 percent women had experienced some health problems within six weeks after induced abortion; lower abdominal pain (6.3 percent), and excessive bleeding (4.2 percent) were the most commonly reported problems. Reported complications were high for women with spontaneous abortion (20.4 percent); excessive bleeding, and pain in lower abdomen were the frequently reported problems. Overall, among women who had induced or spontaneous abortion 16 percent reported some health problem. 118

9 Table 5.5: Prevalence of Post-Abortion Complications among Currently Married Women (15-44), Tamil Nadu Type of Health Problems Any health problems after abortion Excessive bleeding High fever POlil smelling discharge Pain in lower abdomen Convulsion Severe headache Other Number of Women Number of Women I Types of Abortion Induced Abortion Spontaneous Abortion Induced or Spontaneous Abortions, Percent Among those who Number Percent Among who Number Percent Among who.. -. ;, Had Reported any of Had Reported any of Had Reported any Abortion C~mplication Women - Abortion ComElication ~ Women Abortion ComElication na na na Source: C'ompuicil from DLHS RCH data tile. n:\'--= N(lI AppiiclIblc. Note: I. Based on self~rcported complications within six weeks OrnbOi1ion. 2. Those women who had an induced abortion or a sponwneolls abortion during tllrce years preceding the survey. 3. The percentages are computed afier applying survey sample weights,mel the number of'women given is unweighted. 4. Totall1tlll1ber and percentages may add to more thall because multiple responses were recorded l.(j ,106 1,

10 Table 5.6: Source of Treatment for Post-Abortion Complications among Currently Married Women (15-44), Tamil Nadu Induced Abortion Spontaneous Abortion Induced 01' Spontaneous Abortions Percent Among "'Eo Perccnt AmonG who Percent Am~ng wl10 Source of Trclltlllcnt Numher of Number of Numbcl' '-'-",.. Reportcd any Sought. Rcpol tcd lllly Sought Reported any Sought \Vomcn C(!'~l licati'!.n Treatment "'omen of Women Co ml!!.ica ~I TI'eatmcnt. Com~lieation Treatment... i-, ". Public Health Facility Government/Illunicipal hospital Government dispensary UHC/UI-IP/UFWC I I CHC/rural hospital Primary health centre Health sub centre l.l IJ Government ISM hospital/clinic Private Health radlity Private hospital/clinic ,4 66) NGO/trust hospital/clinic Private ISM hospital/clinic I Chemist/medical shop II Other Person Providing Treatmcnt Doctor RO ANMINurse/UIV , Other _ _ _-_ _..._..._ _...-_ _..._... SO/lghllreollllel1ljj'olll liny ol1e.i'oi/rce _ Didnol.l'ct'k any IrCallllcn/ l1a I1l1 Nol rcpor/cd I / 0 no na I 0.9 nl/ To/al N limber of Women who Reported Complicatioll/S()~ght Treatment Sourcr: Computed from DLHS.RC;';H"'. 2:;';O;;;O-:;'2--;;07 4 -:;d,-: tt-a 7- li7"k UHC= Urban Health Centre; UHP= Urban Health Post; UFWC= Urban Family Welf."" Centre; CHC= Community Health Centre; ISM= Indian System of Medicine; NGO= Non-Governmental Organisation; ANM= Auxiliary Nurse Midwife; LHV= l.ady Health Visit: ISM= Indian System "rmedicine: na= Not Applicahle. Notl': I. Th~ pcl'ccnl'lgcs arc computed after arplying survey sample weigh Is <11,,1 the lilimher OfWOll1ell given is unweightcd. 2, Tot;.11 number HIlO pcrccnl~lgcs may add to more than 100,0 because Illultiple responses wert! recorded, 120

11 Treatment Seeking for Post-Abortion Complications Of the women who had an induced abortion related complication, 58.2 percent had sought treatment from the private health facility compared to 17.5 percent from the public health facility; the highest percentage of women (49.0 percent) went to seek treatment in private hospital/clinic (Table 5.6). Similarly, in case of complications associated with spontaneous abortion, about two-thirds (65.2 percent) of women had treatment from private health facility compared to 21.7 percent from public health facility; the majority of women (58.9 percent) obtained treatment from private hospital/clinic. Clearly, preference for private medical sectors is very strong. Further, doctor and ANMINurse/LHV were the major medical professionals to provide treatment to the women who had reported any post-abortion related complications; 62.6 percent, 78.0 percent, and 72.5 percent women were treated by the medical doctors for induced, spontaneous, and induced or spontaneous abortions respectively GYNAECOLOGICAL AND OTHER RELATED MORBIDITY AND TREA TMENT SEEKING BEHAVIOUR Gynaecological related morbidity, especially RTIISTI and menstrual related problems, continues to be a major and growing public health problem in many parts of the world including India. The ICPD Programme of Action (PoA) asked that all countries provide diagnosis and treatment of common reproductive tract infection/sexually transmitted infection. Many sexually transmitted infections contribute to the risk of HIV transmission. After the ICPD conference, the PoA provides reproductive and sexual health needs and health care services by existing reproductive health services. In this section prevalence and treatment for three types of gynaecological related morbidity such as symptoms of RTl/STl, abnormal vaginal discharge, and menstrual problems are discussed in the context oftami1 Nadu Prevalence of Reproductive Tract Infection/Sexually Transmitted Infection, and Abnormal Vaginal Discharge Infonnation on common symptoms of reproductive tract infection/sexually transmitted infection was collected in District Level Household Survey-Reproductive and Child 121

12 Health -2, About one-fifth (17".l percent) of women in Tamil Nadu had reported some symptoms ofrtiisti during three months prior to the survey (Table 5.7). The symptoms reported were low backache (9.6 percent), and pain in lower abdomen not related to menses (5.8 percent), followed by itching over vulva, some mass coming out of vagina, pain during intercourse, any involuntary escape of urine while coughing or sneezing. frequent/painful passage of urine, boils/ulcers/warts around the vulva, fever, and swelling/lump in breast, bleeding after intercourse, and swelling in the groin. In addition, among those who reported symptoms, 9.1 percent reported four or more symptoms of RTIISTI and little more than one-fifth (21.0 percent) reported three or more symptoms. On an average a woman reported 1.9 symptoms. Table 5.7: Prevalence of Various Type of Symptom of Reproductive Tract Infection/Sexually Transmitted Infection among Currently Married Women (15-44), Types of Symptom Tamil Nadu Number of 'Vomen who Reported the Percentage who Reported the Symptom Itching over vulva ], Boils/ulcers/warts around the vulva 323].2 Pain in lower abdomen not related to menses 1, Low backache 2, Pain during sexual intercourse 5]2 2.0 Bleeding after sexual intercourse Swelling in the groin ] Frequent/painful passage of urine 455 ].7 Fever Some mass coming out of vagina Any involuntary escape of urine while coughing or sneezing Swelling/lump in breast Symptom. A~L'!.!!~_~):!!!P_!~_~ ~)L:gn1~!L..._....._._..._._.....'!z~:!.~....J1.. J... Any abnonnal vaginal discharge 2, Number of 'V omen 25,522 25,522 Source: Computed from DLHS RCH data liie. Note: I. Based on self-reported symptoms during three months prior to the survey. 2. The percentages are compu1ed ~fier applying survey sample \veights and the number of women given is unweighted. 3. The numbers and percentages for the listed symptoms do not add to total because many reported more than one symptom. The DLHS-RCH survey also collected information on reproductive health problems such, as abnormal vaginal discharge, colour of discharge, texture of discharge, and odour of 122

13 discharge in the three months preceding the survey among currently married women. N early ten percent of women in Tamil N adu had experienced symptoms of any abnormal vaginal discharge, where 6.6 percent women had wetness or stain under clothes and 1.4 percent has foul odour discharge Treatment Seeking for Abnormal Vaginal Discharge Among women who reported any abnormal vaginal discharge, more than two-fifths (41.9 percent) sought treatment mostly from a medical institution (Table 5.8), this was nearly equally divided between private (23.5 percent) and public (21.4 percent) medical sectors. Majority of women sought treatment from doctor and some from ANMINurse/LHV. 123

14 Table 5.8: Source of Treatment for Abnormal Vaginal Discharge among Currently Source of Treatment Public Health Facility Government/municipal hospital Government dispensary UHC/UHPIUFWC CHClrural hospital Primary health centre Health sub-centre OutreachiMCP clinic in village Government ISM hospital/clinic Private Health Facility NGO/trust hospital/clinic Private hospital/clinic Private ISM hospital/clinic Chemist/medical shop Home remedy Other Person Providing Treatment Doctor AN MIN urse/lhv Trained/untrained dai Relative/friends Chemist/medical shop Other Married Women (15-44), Tamil Nadu Number of Women Percent Among who Reported Sought Discharge Treatment _ _ Sought treatment 1, Did not seek anv treatment 1, na Not reported na Total 2, Number of Women who Reported Discharge/Sought Treatment 2,651 2,651 1,086 Source: Computed framdlhs RCH, data file. UUC= Urban liealth Centre; UHP= Urban Health Post: VFWC= Urban Family Welfare Cenlre; CHC= Community Health Centre; MCP= Maternal and Child Post: NGO= Non-GoycrnmentaIOrganisation; IS1\1= Indian System armedicine; ANM=Auxiliary nurse Midwife; LHV=Lady Health Visit; na=not Applicable. Note: 1. The percentages are computed after applying survey sample weights and the number ofwomcn given is unweighted. 2. Total number and percentages may add to more than because multiple responses were recorded Prevalence of Menstruation Problems The DLHS-RCH survey was the first major survey in which information was collected on menstruation related problems among currently married women (15-44 years). Out of 25,522 women interviewed in the survey, 21,328 women were reported to be currently 124

15 menstruating fo.l1owed by 1,665 currently pregnant, 1,435 repdrted in amenorrhea peridd, and the remaining 1,094 reported had reached menopause. The analysis is based Dn the 21,328 currently married women after excluding pregnant, amenorrhic, and mendpausal WDmen from the sample. Of them, 12.5 percent reported symptdms of some menstruation related problem during the three months preceding the survey (Table 5.9). More than half Df them reported painful periods, followed by delayed periods (24.8 percent), excessive bleeding (15.9 percent), frequent or shdrt periods (11.0 percent), scanty bleeding, prolonged bleeding, inter-menstrual bleeding, no periods, and cdntinuous bleeding. Table 5.9: Prevalence of Various Symptoms of Menstruation Related Problems Types of Symptom among Currently Married Women (15-44), Tamil Nadu Any menstrual problems No periods Painful peridds Frequent Dr shdrt periods Delayed peri Dds Prolonged bleeding Excessive bleeding Continuous bleeding Scanty bleeding Inter-menstrual bleeding Number of Women Sourc,,: Computed from DLHS-RCH, data file Not,,: Number of Women who Reported the Symptom 2, , ,328 I, Based on self, reported health problems during three months prior to the survey_ 2. The percentages are computed after applying survey sample weights and the number of women given is unweighted. 3. Total number and percentages may add to lllore than because multiple responses were recorded. Percent who Reported the Symptom , Treatment Seeking for Menstruation Problem Table 5.10 presents source of treatment (institution) for symptoms of menstruation related problems. In Tamil Nadu, more than two-fifths (42.5 percent) of women who. had reported symptoms of any menstruation related problems sought some treatment. Nearly Dne-third of women did so from private health facility and 14.8 percent of women frdm public health facility. Thus, of those who. had sought treatment, 69.4 percent women went to. private health facilities and 34.8 percent o.fwomen sought treatment from public health 125

16 facilities (some went to both public and private centre). Majority of women had treatment at private hospital/clinic (60.7 percent) followed by government/municipal hospital (23.0 percent). About 38.7 of women sought treatment from medical doctors for menstruation problem; very few women obtained treatment from paramedical workers (ANMINurse/LHN). Table 5.10: Source of Treatment for Menstruation Related Problems among Source of Treatment Public Health Facility Government/municipal hospital Government dispensary UHC/UHP/UFWC CHC/rural hospital Primary health centre Health sub-centre Outreach/M CP clinic in village Government ISM hospital/clinic Private Health Facility Private hospital/clinic Private ISM hospitavcjinic Chemist/medical shop NGO/trust hospitavcjinic Home remedy Other Person Providing Treatment Currently Married Women (15-44), Tamil Nadu Number of Women Percent Among Percent Among Those who Those who Sought Reported Health Treatment Problem ] Doctor ' ANMlNurse/LHV Trained/untrained dai Relative/friends Chemist/medical shop Other Soughttreatment J,J Did not seek any treatment J, na Total 2, Number of Women who Reported Problems/Sought Treatment 2,74] 2,741 1,146 Source: Computed from DLHS RCH, data file, VIIC= Urban Health Centre; UHP= Urban Health Post; UF\VC= Urban Family Welfare Centre; CHe= Community Health Centre; MCI"" Maternal and Cbild Post: NGO= Non Governmental Organisation: ISM= Indian System ofl\'ledieine; ANM= Auxiliary Nurse Midwife; LlIV= Lady Health Visit; na= Not Applicable. Note: I. The percentages are computed after applying survey sample \veighls and the number of women given is un\veighted. 2. Total number and percentages may add to more than because multiple responses were recorded.. 126

17 5.2.3 CONTRACEPTIVE MORBIDITY AND TREATMENT SEEKING BEHAVIOUR Prevalence of Contraceptive Morbidity Women currently using modern family planning methods were asked whether they were experiencing any problems using their current method, and if so, what those problems were. An understanding of the experience of health problems among users is important in efforts to improve the delivery of family planning services. Of the 25,522 currently married women interviewed, 2J.,860 were not currently pregnant of whom, 14,382 were using some family planning method at the time of survey and 13,059 of them were using a modem method of contraception. Table 5.11 reveals that 13.0 percent women, who had used any modem contraceptive methods, had reported at least one problem in Tamil Nadu. The reported problems were the highest among IUD users (15.3 percent), followed by the sterilised (12.9 percent) and oral pin users (7.9 percent). Among modem method users, bodyachelbackache (S.5 percent) and weakness/inability to work (5.S percent) were the common health problems. Excessive bleeding (4.9 percent) was the most common problem reported by IUD users in the state. Bodyachelbackacbe (3.9 percent), weakness/inability to work (2.S percent), white discharge (2.1 percent), and irregular periods (1.8 percent) were also reported to a smaner extant. Among users of oral pills, weakness/inability to work (3.4 percent) was the most common health problem, followed by irregular periods (2.7 percent), white discharge (2.0 percent), and spotting (l.s percent). It must be noted here that this infonnation is on the basis of self reporting and some of the reported problems need not necessarily be attributable to the contraception. 127

18 Ta ble 5.11: Prevalence of Various Health Problems among Currently Married Women (1544) who are Currently Using Some Modern Methods, Tamil Nadu Type of Method Any Type of Health Problem Female Oral Modern IUD Sterilisation Pills Method Any health problems after using method Weakness/inability to work Bodyachelbackache Cramps Weight gain Dizziness Nausea/vomiting Breast tenderness Irregular periods Excessive bleeding Spotting White discharge Other Number of Users 12, ,059 Source: Compulcd from DlHS RCH, dala file. Note: I. Based on self reporled heahh problems. 2. The percemages are compuied after applying survey sample weighls and Ihe number of women given is unweighled Treatment Seeking for Contraceptive Morbidity Table 5.12 reveals that 68.6 percent of sterilised women and 67.2 percent of IUD users with contraceptive morbidity sought treatment. Private (37.1 percent) and public health sectors (36.3 percent) are nearly equally preferred among sterilisation acceptors, who had reported any complication for it. Treatment in private health sectors (44.5 percent), was preferred to public health institutions (20.9 percent) by women who had experienced complication after using the IUD. In nearly 90 percent of cases, the treatment was by a doctor; very few obtained treatment from paramedical staff. Thus, overwhelming preference for treatment is a physician. 128

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20 5.3 SUMMARY This chapter clearly shows that reproductive morbidity in Tamil Nadu is quite high. Almost half of the currently married women in the state reported obstetric or maternal morbidity. Majority of women suffered with some problems during delivery, the levels of complications during pregnancy and after delivery were lower. This raises the concern about Emergency Obstetric Care (EmOC) in the state. The high percentage of women with delivery complications indicates that proper health care during delivery is lacking. This requires well developed health infrastructure and referral services to save the mother and the newborn. Treatment seeking for complications during pregnancy and post-natal period is also low; apparently these are not taken seriously by women as one-third who had reported complications during those periods did not seek treatment. One-fifth of women who had spontaneous abortion reported some complication. However, the rate of complications is low after induced abortion which may be because these are conducted under some medical supervision. Besides, treatment seeking for complications due to spontaneous abortion is high and this shows awareness of health care services. Nearly twenty percent of women had also reported symptoms of RTIISTI but very few women reported abnormal vaginal discharge and menstrual problems and less than half of them sought treatment for these problems. It may be due to lack of awareness regarding the symptoms or due to negligence. More than ten percent of women had reported complications after using any kind of modem contraception and majority of them sought treatment. This gives a clear picture of efficient follow up care among the respondent. Women who had reported swelling in hand and feet and paleness which are the most common symptoms during pregnancy happen to be fatal if remain untreated. Similarly, the highest percentage of women had reported prolonged labour during delivery followed by obstructed labour, which could result in maternal death and still birth. For pregnancy, as well as post-delivery complications, women preferred to obtain treatment at private health facilities which suggests that the services available in public health facility did not satisfy the need of women during emergency. Majority of women had sought health care for abortion under private health facilities specially in private hospital and clinic probably because induced abortion is a sensitive matter but the quality of abortion services in private facility is 130

21 still dubious. Many women reported lower abdominal pain and low backache. While this may not be fatal, but if not treated can cause further complications. Abnormal vaginal discharge is an important indicator of gynecological morbidity and almost equal percentage of women sought treatment in public and from private health facilities. Sterilised women experienced more of body ache, weakness and white discharge. Similarly, IUD users reported on excessive bleeding and weakness. Irregular period, spotting, and weakness are quite common among oral pill users. These problems need to be addressed and provision of proper follow up care and information on side effects before acceptance of method may reduce the complications. There is marginal difference observed between public and private health sectors on treatment seeking for complication of sterilisations, but private sector was preferred by rod users. For all complications, doctors are the main source or health personnel to provide health care and this denotes that women are aware of health care providers, instead of opting for self-medication or seek treatment from quacks. Overall, there is considerable reproductive morbidity among women. While some problems, especially those associated with delivery are taken seriously, many are ignored. For complications, private health care providers are preferred to public institutions. However, in case of contraceptive morbidity public providers are as frequently approached as the private. The fact that contraceptive services, especially sterilisation, are mainly obtained from the public health system due to the family welfare programme probably leads to a high utilisation of these services for contraceptive morbidity. 131