alexa Pregnancies, Abortion and Womenand#8217;s Health in Rural Haryana, India | OMICS International
ISSN: 2161-0711
Journal of Community Medicine & Health Education

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Pregnancies, Abortion and Women’s Health in Rural Haryana, India

Sutapa Agrawal1* and Sayeed Unisa2

1South Asia Network for Chronic Disease, Public Health Foundation of India, New Delhi, India

2Department of Mathematical Demography and Statistics, International Institute for Population Sciences, Mumbai, India

*Corresponding Author:
Sutapa Agrawal, PhD
South Asia Network for Chronic Disease (SANCD)
Public Health Foundation of India (PHFI)
First Floor, C-1/52 Safdarjung Development Area
New Delhi - 110016, India
E-mail: [email protected], [email protected]

Received date January 08, 2013; Accepted date: April 15, 2013; Published date: April 17, 2013

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

Copyright: © 2013 Agrawal S, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

 

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Abstract

In 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<0.0001) higher among women who had experienced abortion. As the gestational stage of abortion increases (late abortion), the health problem among  women is also found to be more as compared to women who had an early abortion i.e., abortion in the first trimester. Further, repeated pregnancies greatly worsen the health of women and also deteriorate the already prevailing morbidity conditions. 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.

Keywords

Pregnancies; Abortion; Health problems; Women; Rural haryana; India

Introduction

India has made considerable progress in social and economic development in recent decades, as improvement in indicators such as life expectancy, infant mortality, and literacy demonstrate. However, improvement in women’s health, particularly in north India, has lagged behind gains than in other areas. India is one of the few countries in the world where males significantly outnumber females, and its maternal mortality rates in rural areas are among the world highest. Females experience more episodes of illness than males and are less likely to receive medical treatment before the illness is well advanced. Because the nutritional status of women and girls is compromised by unequal access to food and by heavy work demands, females are particularly susceptible to illness.

One of the goals of population and reproductive health policy is to ensure safe motherhood and reduce reproductive health system related morbidity and mortality. Eliminating unsafe abortion will make an important contribution to achieve this goal [1]. At least half a million women die annually in developing countries due to complications arising from pregnancy, birth and unsafe abortion [2]. Abortion is possibly the most divisive women’s health issues that policy makers and planners face particularly in developing countries where safe abortion facilities are not available to most of the women.

Abortion may arouse more mixed feelings and generate more fundamental disagreement than almost any other social or public health issue. Abortion is identified as one of the three most neglected women’s health issues in India [3]. The health risk of abortion multiplies manifold if a woman has to resort to it repeatedly. Given the fact that women in India have little control over their own fertility and also have poor health, the chances are very high that they may not only experience abortion, which includes both spontaneous and induced abortion, once but perhaps more than once [4].

There is undoubtedly considerable morbidity associated with induced abortion, although its magnitude has not been quantified. In many instances, induced abortion and more specifically sex selective abortions take place after 12 weeks of gestation, which is not safe for the health of the women. In most developing countries, the consequences for women’s health, the social and cultural context within which the induced abortions are performed, and even the levels and the characteristics of women resorting to abortion are unknown. Without such information, it is easy for policymakers to avoid politically sensitive decisions about this important aspect of women’s health and rights [5].

In the given perspective, the present study examined the perceived health status and general health problems among women according to the number of pregnancies, number of abortions and gestational stage of abortion in rural Haryana, India.

Materials and Methods

Present paper utilises data collected for the Doctoral dissertation by the lead author, the title of the thesis being, “Inter-linkages between women’s childhood experience, autonomy, sex preference and elimination of the girl child: a study of women in rural Haryana”. Full details have been published elsewhere [6-8]. Briefly, from a cluster of villages with high child sex ratio (number of male children per 100 female children below the age of 7), five villages were selected randomly from Jind district of Haryana. A community-based ethnographic survey was conducted among 329 ever-married women aged 20-52 years, chosen purposively who exhibited any of the following characteristics: a) women whose first two births were female; b) women whose first child was a girl and had experienced either an abortion or female child death. It was assumed that a woman who had a first female child or two first female children was likely to undergo an ultrasound test for subsequent pregnancies, followed by a sex-selective abortion if the fetus was female.

Data are analyzed using descriptive statistics as well as bi-variate methods. Also the chi-square techniques have been applied to explore significant differentials between the variables. The analysis presented in this study is based on all reported abortion cases, be spontaneous (miscarriage) or induced. Based on the information of pregnancy history 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.

Results

Characteristics 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.

Socio-economic and demographic characteristics Percent Number
Age    
20-29 32.5 107
30-39 42.3 139
40-52 25.2 83
Mean Age 33.8 years  
Marital status    
Currently married 96.7 318
Widow 3.3 11
Age at marriage when married once 14.4 years  
Mean age at consummation of marriage 16.3 years  
Spousal age difference 4.4 years  
Co-residence with husband    
Living with husband 98.1 312
Husband living elsewhere 1.9 6
Education1    
Illiterate 72.9 240
Less than high school 20.4 67
High school complete and above 6.7 22
Husband’s education    
Illiterate 33.4 110
Less than high school 34.3 113
High school complete and above 32.2 106
Religion    
Hindu 97.6 320
Muslim 2.4 9
Caste/tribe status2    
Scheduled caste 25.6 84
Other backward class 25.0 82
Others 49.4 162
Working status    
Working in family farm/ business 29.8 98
Employed with someone else 22.2 73
Self employed 4.9 16
Not working 43.3 142
Husband’s occupation3    
Agriculture 44.7 147
Labour 27.7 91
Service 17.6 58
Business 5.5 18
Co residence with in-laws    
Yes 35.5 117
No 64.4 212
Exposure to mass media4    
Reads news paper/magazine at least once a week 7.0 23
Watches TV at least once a week 16.8 55
Listens to the radio at least once a week 31.7 104
Visits cinema/theatre at least once a month 0.6 2
Standard of living index    
Low 20.7 68
Medium 43.6 143
High 35.7 117
Total 100.0 329

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

Perceived health status and self-reported health problems

Table 2 shows the perceived health status of women and selfreported 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).

Health status and general health problem Percent Number
Perceived health status1    
Same 6.4 21
Better 40.8 133
Somewhat worse 46.7 151
Much worse 6.1 21
Types of specific morbidity conditions    
Cough cold and fever 8.6 28
Body pain 7.4 24
Joint pain 4.9 16
Pain in lower abdomen 8.3 27
Weakness and tiredness 7.7 25
Problems related to chest and respiration 4.9 16
Other health problems2 11.4 37
Total - 326

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

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.

Health status and general health problems Number of pregnancies Total Percent Number of women
2- 4 5+
Health status1        
Same 5.8 7.0 6.4 21
Better 43.9 38.0 40.8 133
Somewhat worse 43.9 48.5 46.3 151
Much worse 6.5 6.4 6.4 21
Total 100.0 100.0 100.0 326
Types of general health problems        
Body pain 7.0 7.6 7.4 24
Pain in lower abdomen 8.3 8.2 8.3 27
Weakness and tiredness 7.6 7.6 7.7 25
Number of women 155 171    

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

Health status and general health problems Percentage of women with
Gestational stage of abortion Number of abortions
0-3 months 3+ months 0 1 2+
Health status1          
Same 11.5* 7.4* 5.6 11.1 6.9
Better 41.4* 18.5* 43.3 31.1 34.5
Somewhat worse 40.2* 55.6* 45.6 51.1 44.8
Much worse 6.9* 18.5* 5.6 6.7 13.8
Types of general health problems          
Body pain 11.5 11.1 6.7 13.3 3.4
Pain 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

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.

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.

Selected predictors Perceived health status
OR (95%CI) p-value
Number of pregnancies    
2 to 4 R 1.00 (ref)  
5 + 0.80 (0.47-1.34) 0.391
Abortion    
No R 1.00 (ref)  
Yes 1.68 (0.95-2.98) 0.076
Age    
20-29 R 1.00 (ref)  
30-39 1.16 (0.64-2.10) 0.621
40-52 1.38 (0.68-2.80) 0.366
Education    
Illiterate R 1.00 (ref)  
Literate 0.64 (0.36-1.14) 0.127
Currently working    
No R 1.00 (ref)  
Yes 0.98 (0.61-1.57) 0.917
Caste/tribe status    
Scheduled caste R 1.00 (ref)  
Other backward class 1.09 (0.54-2.20) 0.803
Others 0.97 (0.48-1.95) 0.938
Standard of living index    
Low R 1.00 (ref)  
Medium 1.45 (0.73-2.87) 0.285
High 1.21 (0.55-2.67) 0.646
Co residence with in-laws    
Yes R 1.00 (ref)  
No 2.06 (1.22-3.48) 0.007
Constant 0.55  
-2 Log likelihood 430.9  
Number of women 325  

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.

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.

Discussion

In 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 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 study

The 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.

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.

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