Men’s Participation in Reproductive Health A Study of few Villages in Andhra Pradesh
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Men’s Participation in Reproductive Health
A Study of few Villages in Andhra Pradesh - extracted text
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Men’s Participation in Reproductive Health
A Study of few Villages in Andhra Pradesh
(Sponsored by Achuta Menon Centre,
Sree Chitra Institute ofMedical Sciences)
G. Rama Padma
Principal Investigator
CENTRE FOR ECONOMIC AND SOCIAL STUDIES
Begumpct, Hyderabad, India- 500 016
www.ccss.ac.in
SOCHARA
Community Health
Library and Information Centre (CLIC)
Gemmunity Health Gall
85/2, 1st Main, Maruthi Nagar,
Madiwala, Bengaluru - 560 068
.Tel: 080 -25531518
email: clic@sochara.org / chc@sochara.org
www.sochara.org
Acknowledgement
o
I consider it as primary duty to express my deep sense of gratitude to those who
without whose cooperation, this project would not have seen the light of the day. First
of all I am indebted to Achuta Menon Centre, Sree Chitra Institute of Medical
Sciences without whose assistance this study would not have been feasible. My
thanks are to them.
I would like to express my sincere thanks to Prof. Mahendra Dev, Director CESS for
his cooperation and encouragement.
The extensive discussions held with Dr. Kameswari, Obstetrician and Gynaecologist,
helped in understanding the concepts and classification of various aspects
reproductive health and morbidiites. The discussions with medical officers of the
RCWHC namely, Dr. P.V.Ramani, and Dr. Rdhika Rani helped in understanding the
field level situations. The help rendered by all the health staff, Mr. Chari, Mr. Illaiah,
and Ms.Prabhavathi is remarkable.
My thanks to the research supervisor and the entire field staff who worked with a
commitment. Lastly this project would not have been feasible without the co
operation of the respondents. I am indebted to them.
G.Rama Padma
Principal Investigator
List of Project Personnel
PRINCIPAL INVESTIGATOR
G.Rama Padma
RESEARCH ASSISTANT
K.Panchakshari
PROGRAMMING ASSISTANT
K.Anitha Kumari
P. Pa van Kumar
FIELD INVESTIGATORS
P.Kavitha
G.Krishnasree
Shailaja
P.N.V. Subba Rao
B.Pradeep Reddy
A.V.Rao
M.Suresh
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S.No.
CONTENTS
Page No.
1. Introduction
Defining reproductive health
- Men’s participation in Reproductive health
- Couple Communication and Reproductive Health
- Men’s Role in Family Planning
Men’s influence on Women’s Health
- Men’s Role in Maternal Health
Men’s Involvement in RTIs and STDs
- Women’s Utilization of Health Services
- Men as Responsible Partners in Reproductive Health
- Objectives of the Study
1
1
2
2
5
7
7
11
15
19
19
Influence of Gender on Reproductive Health of Women
Understanding Gender
- Reproductive Health - Gender dimension
- Gender Violence and Reproductive Health
- Gender roles can Harm Reproductive Health
20
20
21
29
31
2.
3. Study Design and Methodology
Sampling Design
- Tools of Data Collection
Preparatory Work Prior to Main Survey
Selection and Training of Field Staff
- Operation of Fieldwork
- Quality Checks of the Data
Coverage of Women
Ethical Concerns
33
33
35
36
37
37
38
39
39
4. Profile of the Study Area and Couples
- An Understanding of the Villages under Study
- Socio-Economic Characteristics of the couples
- Demographic Characteristics of the couples
40
40
41
41
5. Media Exposure and Access to Reproductive Health Services
Exposure to Various Components of Reproductive Health
Types of Exposure
Access to Reproductive Health Services
45
45
48
48
6. Contraceptive Health
Psychological Perspectives of Couples on Family Planning
Husband and Wife Communication
- Current use of Contraception
Contraceptive Morbidity and Utilization of Health Sei vices
- Future Reproductive Planning
56
56
60
61
62
63
7. Fertility Behaviour and Obstetric Health
Particulars related to Marriage
Fertility Behaviour
Obstetric Health
Antepartum Period
Intrapartum Period
Postpartum Period
An understanding of Abortion and Health Care
75
75
76
77
77
80
82
84
8. Sexual Practices and Reproductive Health of Women
Sexual Practices of Men before and after Marriage
Marital Sexual Behaviour and Attitude of Couples
Beliefs of Couples about Sexually Transmitted Diseases
Reproductive Health of Women
Medical and Health Expenditure
105
105
106
107
107
109
9. Family Violence and Reproductive Health
Cognitive levels of Women and Men About Family Violence
Reporting of Family Violence by Women and Men
Family Violence by Background Characteristics of Couples
Violence and Reproductive Health
118
118
120
121
121
10. Summary and Gender Inference
Exposure and access to reproductive health services
Perspectives on family planning, its use, contraceptive morbidity
and utilization of services
Fertility behaviour and obstetric health
Sexual practices and reported sexual morbidity
Family violence and reproductive health of women
128
128
Annexure
Bibliography
Questionnaires used for the study
Coverage of Selected Areas
Location Maps
List of Project Personnel
130
132
133
135
S.No.
TABLE CONTENTS
Page No.
Number of couples by duration of marriage in each of the
villages and the final Sampled couples selected for the study
35
Table-4.1
Socio-Economic Characteristics of the Couple
43
Table-4.2
Demographic Characteristics of the Couples
44
Table-5.1
Couple Exposed to Various Components of Reproductive
Health Through Media
51
Women Exposed to Various Components of Reproductive
Health Through Media by Background Characteristics
52
Men Exposed to Various Components of Reproductive
Health Through Media
53
Cognitive Knowledge of Couples on Access to Various
Components of Reproductive Health
54
Knowledge of Couples on Physical Access to Various
Aspects of Reproductive Health
55
Table-6.1
Percent of Couples by Locus of Control Over Pregnancy
65
Table-6.2
Percent of Couples by Self-efficiency related to Usage of
Contraception
66
Table-6.3
Percent of couples by Value of Pregnancy Avoidance
67
Table-6.4
Details of Husband and wife Communication with respect to
Fertility and Contraception
68
Background Characteristics of the Couples who had
Communicated with Each other on Aspects Related to
Reproduction
69
Table-6.6
Current Use of Contraceptives by Couples in the Villages
70
Table-6.7
Background Characteristics of the Couples who have used a
Permanent Method of Contraception
71
Table-6.8
Particulars of Usage of Contraceptive Methods by Couples
72
Table-6.9
Logistic Regression Analysis of Contraceptive Morbidity
73
Table-6.10
Women suffering from Contraceptive Morbidity and Health Care
Seeking Behaviour by Background Characteristics
74
Table-3.1
Table-5.2
Table-5.3
Table-5.4
Table-5.5
Table-6.5
Table-7.1
Difference of Information Reported by Couples on Fertility
and Obstetric Information
86
Table-7.2
Background Characteristics of Women who experienced
Pregnancy During the Reference Period
87
Table-7.3
Some Particulars of Antenatal Care Taken by Women
88
Table-7.4
Components of Antenatal Care Received by Women
89
Table-7.5
Women Suffered from Various Morbidities during Antepartum
Period and Knowledge of Husbands About it
90
Table-7.6
Women suffered from various Morbidities during Antepartum
Period and the Deciding Person on the need for Antenatal Care
91
Table-7.7
Women suffered from various morbidities during Antepartum
Period And Treatment Particulars
92
Table-7.8
Difference of Opinion between Women and Men related to Care
to be extended by Husbands towards Wives during Pregnancy
93
Table-7.9
Opinion of Wives who have been recently Pregnant and their
husbands Related to Care to be extended by Husbands during
Pregnancy versus Actual Care received
94
Table-7.10
Planned Place of Delivery versus Actual Place of Delivery
94
Table-7.11
Place of Delivery by Background Characteristics of Women
95
Table-7.12
Determinants of Use of Institutional Health Care for Delivery.
Logit Analysis
96
Table-7.13
Women suffered from various morbidities during Delivery and
Knowledge of Husband About it
97
Table-7.14
Women suffered from various Intrapartum morbidities by
Place of Delivery
98
Table-7.15
Women suffered from various Intrapartum morbidities by
Person Decided on Place of Delivery
98
Table-7.16
Difference of Opinion between Women and Men related to the
Care to be extended by Husband towards Wives during Delivery
99
Table-7.17
Expectation of Care during Delivery from Husbands by recently
Pregnant Wives Versus Actual Care received by them
99
Table-7.18
Details of Women who were Pregnant during Reference period
and their Particulars about Postpartum Care
100
o
Determinants of Use of Institutional facilities for Postpartum
Care: Logit Analysis
101
Women suffered from various morbidities After Delivery and
Knowledge of Husbands About it
102
Difference of Reporting between Women and Men related to the
Care to be extended by Husbands towards Wives After Delivery
103
Expectation of Wives who have been recently Pregnant Versus
Actual Care received from Husbands after Delivery
103
Table-7.23
Opinion of Women and Men about certain Aspects of Abortion
104
Table-8.1
Sexual Behaviour and Health Seeking Behaviour of Men before
and after Marriage
111
Socio-economic Characteristics of Men having Extra-marital
Sexual Relationship
112
Table-8.3
Knowledge about Sexually Transmitted Diseases among Couples
113
Table-8.4
Details of Women suffering from Reproductive Tract Infections
114
Table-8.5
Socio-economic Characteristics of Women suffering from
Reproductive Tract Infections
115
Determinants of Health seeking Behaviour of women for
Reproductive Tract Infections
116
Table-8.7
According of Men Expenditure on Wife’s Obstetric Health
117
Table-8.8
Particulars of Health/Medical Expenditure of the Households
in the Study Village
117
Cognitive levels of Men and Women on Physical control of Wife
towards Elders/Parents-in-law
123
Cognitive levels of Men and Women on Physical control of Wife
towards Husband
124
Table-9.3
Differences in Reporting Information related to Family Violence
125
Table-9.4
Background Characteristics of Couples with Family Violence
126
Table-9.5
Differences in Reporting Information related to Violence and
Reproductive Health
127
Impact of Domestic Violence on Various Aspects of
Reproductive Health
127
Table-7.19
Table-7.20
Table-7.21
Table-7.22
Table-8.2
Table-8.6
Table-9.1
Table-9.2
Table-9.6
Introduction
Defining Reproductive Health
The World Health Organization (WHO) defines reproductive health as a state of
complete physical, mental and social well-being, and not merely the absence of
disease or infirmity (WHO, 1992-93). Reproductive health addresses the reproductive
processes, functions and system at all stages of life. Reproductive health, therefore,
implies that people are able to have a responsible, satisfying and safe sexual life and
that they have the capability to reproduce and the freedom to decide if, when and how
often to do so. Implicit in this last condition are the right of men and women to be
informed of and to have access to safe, effective, affordable and acceptable methods
of fertility regulation of their choice and the right of access to appropriate health care
services.
Thus the definition of reproductive health is far broader unlike the definition of
reproductive morbidity and lends itself less readily to measurement. This is more than
mere semantics; addressing issues of reproductive or women's health is, in several
ways, beyond the capability of health professionals. Reproductive morbidity, on the
other hand, is more easily definable, more measurable, and more amenable to
intervention.
Although reproductive (and women's) morbidity includes some
consequences of women’s social status, it does not include low social status per se.
Reproductive (and women's) health, on the other hand, does include the power to
make personal decisions relating to health, including sexual behavior and
reproduction. For both women and men, reproductive health reflects the impact of
health in infancy and childhood as well as in adult life, and beyond reproductive age
as well as within it. Reproductive health sets the ground for human sexuality,
regardless of whether it leads to reproduction.
The ICPD program of Action not only endorsed this view of reproductive health but
also helped operationalize what reproductive health care services should include, as
follows: "Reproductive health care in the context of primary health care should,
interalia, include: family-planning counseling, information, education, communication
and services; education and services for prenatal care, safe delivery and post-natal
care, especially breast-feeding and infant and women's health care; prevention and
appropriate treatment of infertility; abortion as specified in paragraph 8.25, including
prevention of abortion and the management of the consequences of abortion;
treatment of reproductive tract infections; sexually transmitted diseases and other
reproductive health conditions; and information, education and counseling, as
appropriate, on human sexuality, reproductive health and responsible parenthood”
(WHO, 1994).
Men’s Participation in Reproductive Health
The 1994 International Conference on Population and Development, held in Cairo
reminded the world audience that good reproductive health is the right of all people,
men and women alike, and that together they share responsibility for reproductive
matters. By emphasizing gender the prescribed roles men and women play in society
the conference drew attention to the fact that, if men are left out of the reproductive
health equation, they are unlikely to be able to exercise responsibility. The consensus
reached in Cairo is that neither women nor men are likely to enjoy good productive
health until couples are able to discuss sexual matters and make reproductive
decisions together.
Couple Communication and Reproductive Health
When reproductive health decisions are taken jointly by both partners, these decisions
are more likely to be implemented. Men become more supportive by helping their
partners to receive reproductive health services when needed and by providing the
resources needed to obtain these services.
Thus couple, or spousal, communication can be a crucial step toward increasing
men’s participation in reproductive health (Becker, S. 1998; Biddlecom, A.E, et. al.
1997; Lasee, A and Becker, S. 1997; Mahmood, N and Ringheim, K. 1997; OmondiOdhiambo. 1997). Since men, as well as women, play key roles in reproductive
health, communication is necessary for making responsible, healthy decisions.
2
Communication enables husbands and wives to know each other’s attitudes toward
family planning and contraceptive use. It allows them to voice their concerns about
reproductive health issues, such as worries about undesired pregnancies or STD s.
Communication also can encourage shared decision-making and more equitable
gender roles.
Many couples rarely discuss fertility and family planning. Several studies suggest that
spousal communication about family planning usually begins only after the birth of
one or two children (Blanc, A., et. al. 1996; De Silva, W. I. 1994; Fort, A. 1989).
A study conducted in Uttar Pradesh shows that wives basically agreed with the
decisions taken by their husbands. Silent occurrences by women or lack ol protest by
them were interpreted as having arrived at a joint decision. Women almost never
question the decision of their husbands, nor do they enter into any discussion with
them (Khan M E and Patel B. C, 1996).
Some women become pregnant only because they believe their husbands want more
children. But this may not always be true. Surveys in several developing countries
show that only slightly more men than women want to have another child. Increased
communication between
partners
improves understanding
of each partner s
reproductive preferences and decreases some of the consequences of poor
communication, such as unintended pregnancy and a large family size.
A few studies (Becker 1996; Blanc 1996) have found that communication and open
disagreement on sexual and reproductive matters between spouses were uncommon,
and that men rarely discussed family planning and related issues with their wives. To
a great extent, this prevents couples from acting on a commonly held preference. In
the second All India survey by the Operations Research Group of Baroda (ORG), it
was observed that two-thirds of the couples did not communicate with each other
either on the number of children they should have or on the issue of family planning.
Seventy percent of the couples in rural areas and 50 percent in urban aieas did not
discuss these issues. At the national level, in half the cases the husband took the
3
decision and in only one-third of the cases was the decision taken jointly (Khan and
Prasad 1982:336).
Many obstacles prevent men and women from talking about sexual and reproductive
issues. While research is slight, it suggests that a complex web of social and cultural
factors impede such discussions (Meekers, D. and Oladosu, M. 1996). In many
societies sex is taboo subject for men and women to discuss. Also, men and women
are often afraid of rejection by a sex partner, especially at the beginning of a
relationship. Consequently, they may not bring up uncomfortable issues, such as
sexual history or use of contraception (Pliskin, K.L. 1997).
As with decision-making in general, women’s inferior status and lack of power limit
couple communication (Diaz, M. 1997; Salway, S. 1994; Worth, D. 1989). For many
women traditional female gender roles mean they have little say in sexual matters and
lack the status to influence their partner’s behavior (Dixon-Muller, R. 1993; Fort, A.
1989; Van Der Straten, A., King, R., Grinstead, O., Serufilira, A., and Allen, S. 1995;
Worth, D. 1989). Even when men and women discuss reproductive health issues, it is
usually not on equal terms (De Schulter, M. 1998).
Traditional cultures often discourage married women from starting discussions about
contraception. For their part, men may feel there is nothing to discuss or no need to
take account of their wives’ feelings and opinions. In countries such as India, Kenya,
and Nigeria, traditional male dominance is a major obstacle to spousal communication
about family planning (Evaluation Project. 1997; Isiugo-Abanihe, U. C. 1994;
Omondi-Odhiambo. 1997). Also, a husband might consider his wife promiscuous or
unfaithful if she tries to discuss contraception with him. (Fort, A. 1989). In some
cultures it is easier for unmarried women and prostitutes to negotiate sexual activity
with men, including condom use, than for married women to do so with their
husbands (Ulin, P.R., Cayemittes, M., and Metellus, E. 1995).
Increasingly, health care providers and researchers are realizing that the most
appropriate client for reproductive health information and sendees may be the couple
rather than the individual (Becker, S. 1996; Becker, S. and Robinson, J. C. 1998;
4
Keller, S. 1996). For example, men who discuss family planning with their wives are
more likely to use contraception and support their wives’ use of contraception.
Men’s Role in Family Planning
Data on men’s attitudes toward family planning suggests that in many regions men
view family planning favorably and can have a strong influence on the use of
contraception. For example research in Kenya suggests that contraception is two to
three times more likely to be used when husbands rather than wives want to cease
child bearing (http://www: rho.org/htm/menrh_keyissues.htm).
A study of male involvement among five generations of a South Indian family found
that men readily accepted condom use and vasectomy, even though they may not have
liked some of the specific characteristics of the method. Karra, et al., (1997) examines
male involvement in family planning practice and decision-making in one Indian
family over five generations. Data were collected from 152 living family members;
information about an additional 26 members who were deceased or unavailable for
interview were gathered using interviews with their children and siblings. The
majority of the contraception used in this family consisted of male methods
(condoms, vasectomy and natural family' planning). Particularly among older
generations who had limited access to methods for women. The participation of men
in this family was not necessarily dependent upon changes in gender relations, such as
increased spousal communication. Many men in the family reported being motivated
to use male methods by external factors such as desire for the improved economical
status of a smaller family.
Men’s traditional responsibility for providing their families’ economic support is
clearly a motivating factor for fertility regulation among male respondents of all age
groups. Economic pressures forced men from land ownership to private and public
sector employment, a trend initiated by the oldest generation and continued in the
following two generations. Economic pressure, combined with the transition to new
employment sectors, contributed significantly to men’s desire for smaller families.
Moreover, the move to public and private sector employment demanded that the men
obtain higher education. Higher education was readily embraced by the men in this
5
family, because education (whether of the formal western or informal religious type)
is traditionally valued among Brahmins as a means to increase income and accrue
status.
As a result, the men pursued education as a means of competing in the
marketplace.
Their sons also required a good education to compete for jobs. As economic demands
increased with each generation, fathers adopted the strategy of having smaller families
in order to ensure college educations for their sons. As male education assumed
greater importance for defining security and status, the desire to educate daughters in
order to enable them to attract educated and financially successful sons-in-law
followed.
Once they became involved in the urban marketplace, men learned of
contraception and had the option of attaining desired family size.
Effective use of a contraceptive method, and even satisfaction with the method
chosen, is often influenced by men. A man’s support often contributes to better use of
female methods and, for many couples. One of the frequent reasons given by women
for not beginning or continuing to use contraception is their partner’s opposition.
Men who are educated about reproductive health issues are more likely to support
their partner’s decisions and to encourage public policies that result in women
receiving the reproductive health care they need. A project in rural Mali addressed
this goal by using men to promote family planning in local communities.
Many
women reported that male community workers had changed their husbands’ altitudes
towards family planning and had generated more open communication between
spouses about family planning (Kak LP, Signer MB, 1993).
Family planning programmes traditionally have focused on women as the primaiy
beneficiaries of services provision.
Men have been considered “silent partners’
(Forrest, quoted in Edwards, 1994), whereas research on contraceptive acceptance has
concentrated on the methods’ effects on women and factors affecting method choice
(Cosminsky, 1982; Sargent, 1982). Further more, few studies examine the broader
social, economic, and cultural forces affecting individual fertility-regulation decisions
or the decision-making dynamics within couples (Browner, 1986; Handwerker, 1992;
Stark, 1993; Tucker, 1986). Indeed, a consideration of the potential for involving
6
men in family planning and contraceptive decision-making is a recent concern that
has developed largely as a result of efforts to prevent the transmission of HIV/AIDS
(Edwards, 1994). Moreover, a recent review of studies of couples’ behaviour indicate
that reproductive health interventions targeted at couples demonstrate greater impact
than those aimed at a single sex (Becker, 1996).
Unfortunately, perspectives on male involvements are often rooted in negative
assumptions. Programme planners view men as gatekeepers, potential obstructionist
who, if involved in decision-making, will defeat women’s efforts to regulate fertility.
Yet, the limited evidence to date suggests that the most successful family planning
programmes target men as well as women (Ezeh son, 1993, FPAI, 1985) and promote
communication about contraception between spouses (Jolly, 1976).
Men’s influence on Women’s Health
The ways in which men influence women’s health are numerous. Men can have a
positive effect on women’s health by:
.
Using or supporting the use of contraception such that sexual partners are able
to control number and timing of pregnancies.
9
Encouraging women’s to have adequate nutrition during pregnancy and
providing the needed physical, financial, and emotional support to do so.
.
Supporting women during pregnancy, delivery and the postpartum period.
.
Supporting the physical and emotional needs of post-abortion women.
.
Preventing all forms of violence against women.
,
Working to end harmful traditional practices, such as female genital cutting.
Men who are involved in the health of their families also may enjoy better health and
closer relationships with family members (www:rho.org/htm/menrh_keyissues.htm).
Men’s Role in Maternal Health
Helping Pregnant women stay Healthy
Men can help protect the lives and health of women as they become mothers and can
attend to the health of their children. WHO estimates that 585,000 women die each
year from complications of pregnancy, childbirth, and unsafe abortion, about one
death every minute (World Health Organization (WHO), 1996; World Health
7
Organization (WHO), 1998).
Nearly all of these deaths could be prevented.
Pregnancy related complications cause one-quarter to one-half of deaths among
women of reproductive age in developing countries. In some countries pregnancy
related complications are the leading cause of death for reproductive age women
(Fotney J.A, et. al. 1988; Royston E, and Armstrong S, 1989; World Health
Organization (WHO), 1991).
Many thousands of women in developing countries
suffer serious illnesses and disabilities, including chronic pelvic pain, pelvic
inflammatory disease, incontinence, and infertility, caused by pregnancy or its
complications (Fortney J.A, and Smith J.B, 1996).
Safe motherhood consists of ensuring good health for women and their babies during
pregnancy, delivery, and in the postpartum period. Men play many key roles during
women’s pregnancy and delivery and after the baby is bom. Their decisions and
actions often make the difference between illness and health, life and death (American
Association for World Health, 1998; Sherpa H, and Rai D, 1997; Thaddeus S, and
Maine D, 1994).
Involving men in reproductive health has been found to have a positive impact on
women and children’s health in a number of ways, including improving MCH care. A
study on the impact of providing antenatal education to prospective fathers in India
found a significantly higher frequency of antenatal clinic visits and significantly lower
perinatal mortality among the women whose husband received antenatal education
(Bhalerao et al., 1984). Furthermore, men participating in antenatal education tend to
know more about family planning methods and are more concerned about their
partner’s nutritional needs during pregnancy (Raju and Leonard, ed. 2000).
Good nutrition and plenty of rest also are important during pregnancy. Men can help
women have safe pregnancies and healthy babies by ensuring that they receive
nutritious food, especially food strong in iron and fortified with vitamin A (American
Association for World Health, 1998; Sharma R, and Desai S, 1992; Sherpa H and Rai
D, 1997; UNICEF, 1998; West K, 1998).
Anemia, while not a direct cause of
maternal deaths, is a factor in almost all such deaths. An anemic woman is five times
more likely to die of pregnancy related causes than a woman who is not anemic
(Viterif. E, 1994). Vitamin A is important to the health of both the mother and the
8
foetus (Sharma R, and Desai S, 1992; UNICEF, 1998). Women need to have enough
vitamin A both to support the healthy development of their baby and to protect their
own health, particularly their eyesight and immune system. Night blindness among
pregnant women is a symptom of vitamin A deficiency.
Antenatal vitamin A
supplements, often provided in pill form, can greatly reduce maternal and child deaths
(UNICEF, 1998). A study of pregnant women in southern Nepal found that low-dose
vitamin A or supplements of beta-carotene, the nutritional precursor of vitamin A,
reduced maternal deaths by an average of 44 percent (West K, 1998).
In order to solve the practical problem of getting pregnant women to antenatal care
clinics, the Deepak Charitable Trust started the Pali Sampark (literally ‘contact the
husband’) programme, which contributed to an increase in women’s attendance.
Also, in the project area where husbands were contacted, women had a more in-depth
understanding of antenatal services compared to women whose husbands had not
been included in the programme.
Although the exact role of husbands is not
conclusive, qualitative research shows that the husbands in the project area held a
more positive view of their potential roles to assist their wives during pregnancy. In
an attempt to increase hospital referrals for high-risk pregnant women, the Society for
Education Welfare and Action (SEWA-Rural) sent postcards to the male members of
the families of such women. They found that hospital referrals did increase and that
there was a tangible increase in the level of awareness among family members.
About 65 peicent responded to suggestions for appropriate care as outlined in the
postcards (SEWA-Rural Research Team, 1998).
Bhalerao, V. R. et al evaluated the role of involving prospective fathers in the care of
pregnant women attending a clinic in Bombay, India. Beginning in October 1982,
pregnant women attending the clinic were requested to ask their husbands to meet
with the resident medical officer of the center. The out come of the maternal health
care programme for the 270 women whose husbands are invited and came (Group 1)
was compared with the outcome of the same programme for 405 women whose
husbands could not be invited (Group 2). I he husbands who attended the center were
educated individually and in groups about their role in nutrition and health of their
wives during pregnancy and their responsibility is subsequent child rearing. The
physiology of pregnancy, complications of pregnancy, and the possible ways and
9
means of preventing the complications were explained in detail. The husbands also
were told to encourage their wives to attend the antenatal clinic of the center as often
as possible. The difference between two groups was a significantly lower perinatal
mortality in Group 1. Further more, more women in Group 1 accepted postpartum
sterilization than women in Group 2. This effort confirms that the involvement of
prospective fathers is possible and pays good dividends even in an uneducated and
now socioeconomic community.
Arranging for skilled care during delivery
In developing countries the majority of women deliver their babies without skilled
assistance, helped only by untrained traditional birth attendants or family members. A
trained attendant present during childbirth can mean the difference between life and
death.
Men can help by arranging for a trained attendant to be available for the
delivery and by paying for the services. They also can arrange ahead of time for
transportation and can buy supplies, if necessary.
Helping after the baby is born
Most maternal deaths occur within three days after delivery, due to infection or
hemorrhage. To prevent deaths, men can learn about potential postpartum
complications and be ready to seek help if they occur. Men also can make sure that
women get good nutrition. While they are breastfeeding, women continue to need
extra vitamin A to ensure that they pass enough of the vitamin on to their infants.
During the postpartum period men can help with heavy housework, such as gathering
wood and water and taking care of other children. They can encourage breastfeeding,
which helps the uterus contract. Finally, they can begin using contraception, either a
temporary method to space the next birth or possibly a vasectomy if no more children
are desired (AAWH, 1998; Sherpa H, and Rai D, 1997).
Men can join in post pregnancy family planning and care at several levels. At most
basic level, they can support their wives’ choices and use of contraceptives. During
the post pregnancy period, all male methods condoms, vasectomy, periodic abstinence
and withdrawal are appropriate for breast-feeding women since there methods do not
affect breast milk.
10
Men fs Involvement in Abortion Care
Post abortion counseling of men can help prevent repeat abortion by stressing the
need for consistent use of reliable contraception to prevent unwanted pregnancy.
Postpartum contact with male partners offers an opportunity to educate men about the
value of spacing children an important factor since a man often has substantial
influence in a couple’s decision to use family planning. One study found that three
quarters of Turkish women who sought abortions were using withdrawal at the time
of conception. In addition many couples do not realize the potential health risk of
repeat abortions, which can impair fertility.
In Egypt, a recent population council study found that women who entered hospitals
for treatment of incomplete abortions worried about being pressured by their
husbands and families during their recovery (Huntington D, 1995). They especially
feared castigation for not being able to carry a pregnancy to term. The women did not
expect support from their spouses, but simply hoped they would not become a source
of worry.
Men’s Involvement in RTIs and STDs
In third world countries, most health care system attends only when they are the target
of family planning programmes. Little attention has been given to the reproductive
health of non-pregnant women. One reason for the relative neglect of gynecological
care is a failure to appreciate the extent of unmet needs in rural areas (Bang, Bang et
al, 1989).
In the overwhelming majority of cases, it is clear that the initiatives to include men
were motivated by a concern about women’s reproductive health which showed little
improvement without men’s support and active involvement. Men s inclusion was
part of an evolutionary process, a consequence of ground realities within the context
of women’s health. For example, a number of NGOs found that sexually transmitted
infections (STIs) could not be treated by simply providing physical access to women-
.friendly health care services. For women, a more crucial question was that of social
access, which invariably included what men in their families had to say. As high as
50 percent of the women in a tribal area of Gujarat who had STI symptoms and had
11
agreed to get themselves examined and treated, backed out because thecmale members
did not allow them to attend the camp (Khan et al, 1998).
In the course of their intervention, Community Aid Sponsorship Programme in
in
alliance with Foster Parents Plan International (CASP-PLAN) realized that many
women with STIs attending their gynaecology clinic were not showing satisfactory
improvement.
A closer probe made it clear that these women required ‘partner
compliance’, which was lacking. The women in their project areas often insisted that
their husbands should also be contacted and sensitized to the fact that their behaviour
has a bearing on the reproductive health of their women partners. A common refrain
was: “Aap hame to samjha dete ho, per hamare adtni ko kaun samjayega ” (you make
us understand everything, but who is going to make our men understand?) (Pal, 1998).
Data collected by the Rural Women’s Social Education Centre (RUWSEC) on
reproductive health problems showed that a significant proportion of reproductive
tract infections (RTIs) among women were a direct result of men’s promiscuity
(Subramanian, 1998).
The effect of men’s attitudes and behaviours with respect to women’s health is
perhaps most evident in STD prevention and treatment. For prevention programmes
to be effective, they need to educate and treat both partners. Increase condom use and
changing high risk sexual behaviours are primary STD prevention strategies. Where
condoms have been heavily promoted by social marketing campaigns, condom use
has gone up markedly.
Increasing condom use is a step toward changing men’s
behaviour in a way that directly affects their own health, as well as the health of their
partners and wives. But surveys show that condom use is much higher out side of
marriage than with spouses and wives with little power to negotiate condom use can
be infected by husbands.
Abstinence, condom use, monogamy and other safer sex practices are some of the
methods of preventing STDs often these safer sex practices assume a context of
rationality and a concern for disease and pregnancy prevention, so that successful
sexual negotiations result in safer sex practices. Sexual negotiation between sexual
partners assumes that there must be a process of bargaining to reach an agreement for
12
the adoption of sexual behaviors, which are for whatever reason, unacceptable to one
of the partners.
The Indian literature on sexual behavior and sexual negotiation, particularly with in
marriage, is sparse. Mumbai has highest number of diagnosed HIV/AIDS cases in
India (Survivelance for HIV infections/ AIDS cases in India, 1998) and heterosexual
intercourse is though to be the primary mode of transmission. Studies on adult sexual
behavior indicate that premarital and extramarital sex occurs across all social strata
and with a range of partners (Nag M., 1995). Sexual violence and coercion have been
found to be wide spread in marriage in rural India (Khan M. E, 1998), but information
about the nature and extent of that coercion is absent.
A study in 1995 (George A, 1995) showed that the following all served to constrain
women’s ability to control their sexual and reproductive lives: women’s economic
dependence on men, poverty, partilocal kinship patterns and married women’s
restricted contact with their natal families legitimacy of male authority and female
submission, limited opportunities for women to influence sexual and contraceptive
decision-making, limited knowledge of bodily process, limited discussion between
married couples about sexual and reproductive concerns, and the threat and use of
violence by husbands.
Research on sexuality, especially in the field of HIV/AIDS has highlighted the
inadequacy of strategies that target only women. Because of unequal gender power
relations, women are especially vulnerable but are unable to negotiate changes in
sexual behavior to practice safe sex with out the co-operation of their sexual partners.
Research on sexual negotiation strategies has dramatically under scored the need for
involving men in programmes that aim at brining about changes in sexual behaviour
for the prevention of infection. Changes in sexual behaviour are also needed for
promoting contraception and addressing other reproductive health problems. There
fore men’s involvement as responsible sexual partners is essential to improving the
-reproductive and sexual health of women (Pachauri S, 1997).
In review of anthropological and socio-cultural studies on sexual behavior,
networking and transmission of HIV, Dyson (1992) hypothesizes that the initiation of
13
sexual intercourse at an earlier age, higher capital frequency, and a greater number of
partners are related to a decline in customary restraints on sexual behavior. Dyson
suggests that change in the notions of what constitutes acceptable partners of a sexual
behavior has resulted from a wider worldview, itself a result of migration, education,
urbanization, mass media and increased economic autonomy for women.
Programmes to encourage men’s participation in reproductive health face a major
challenge in the area of safer sex negotiations. Women often lack sufficient power to
negotiate safer sex with their partners, whether they be married or involved with
commercial sex. A young woman’s emotional involvement with her partner may
prevent her from discussing sex or using condoms (Panos, 1998; 5). Married women
are particularly at risk in some areas, such as Kigali in Rwanda, where a study
indicated 20 percent of HIV positive women had only had one sexual partner, with 45
percent contracting the virus from their husband. (Forman, 1998; 31). For those men
married or single, who do wish to use condoms, having greater power in the
relationship does not always translate into action; hence, interventions are needed to
help men over come their behavioral barriers to negotiating condom use (Warner,
1999).
Sexual Communication between Couples
There seems little doubt that in many sector of Indian society (as in other cultures) a
number of men assert their dominant roles in family life through insistence on their
right to sexual intercourse, “on demand” regardless of the attitudes and
responsiveness of their wives. In some of the studies, the impression is given that the
overwhelming majority of women are therefore unhappy and unwilling participants in
sexual intercourse and that they have very little power of negotiation in the relation to
the use of condoms, as well as timing and situations when their husbands desire
sexual satisfaction from them. On the other hand, the focus of attention on the
negative side of sexual communications and wide prevalence of sexual violence and
coercion with in family may be presenting a distorted picture. Further most of the
findings are based on single-contact interviews that perhaps tends to project a
negative T don’t like- sex’ attitudes and coercion by women. These responses may
represent normative responses rather than actual behavior.
14
Some studies have even indicated that it would be a shameful act if women initiate or
express their desire for sex (Khan et al, 1997 and Khan and Patel, 1996). As in the
few other studies of sexual communication in the literature most of the initiating
signals or messages that existed are non-verbal or indirect. Unlike the general belief
that sexual interaction, in our conservative Indian society, is always initiated by the
husbands; and women remained a passive partner during sexual intercourse a study
shows women also indicate and communicate their desire for sex to their husbands.
However we did find some women who directly speak to their husbands suggesting
sexual desire.
Corresponding in depth studies on inter spouse communication and sexual interaction
is virtually absent in India. Thus besides understanding the sexual behaviors of
general population, it is important that we have ciear data about husband-wife
interactions, including sexual interactions, if we are to develop effective programmes
for prevention of sexually transmitted infections and HIV/AIDS.
Women’s Utilization of Health Services
Women’s access to health care is a complex one, because it is both the outcome of
women’s status in society, including societies response to their health needs, and a
determinant of women’s health and productivity and, so ultimately, of their status.
Four sets of factors influence women’s access to health care, broadly termed need,
permission, ability and availability (Chatterjee, 1983). Interaction of these factors
shows how they result in women’s use of health services. Permission and ability
interact with need to result in demand for health services. Where this demand overlaps
with availability i.e. supply, use of health services occurs. Severely constrained
permission and ability restrict demand by women for health services. Effective
demand or use of health services is further reduced by the inadequate fit between
needs and services available.
Khan et al., (1982) reported that in the U.P villages they studied, only in 9 percent of
female illness was treatment sought from the near by PHC or Government health
facility. The vast majority of women simply used traditional remedies.
15
Few women venture to health centers, clinics and hospitals that are the repositories of
such information. Available data on the extent of utilization of health services
definitely indicate differences between males and females. Despite higher morbidity
among females, more treatment is sought for males, higher percentage of ailing men
than women get treatment, and higher proportion of services are provided to men
(Coyaji, 1980).
Despite higher morbidity and malnutrition among females, they receive less health
care than males. Cause-specific mortality data reveal that female mortality from the
common, major diseases is consistently higher than that of males. Although these
diseases are easier to recognize and are diagnosed more frequently among females,
they are also fatal more often among females because of failure to treat them.
Miller (1981) lists several studies of hospital admissions in different parts of the
country, which demonstrated higher ratios of male to female admissions in hospitals
in the North compared with the South, although boys were favored in all areas. This is
explained by the cultural “belief’ that scarce resources of time and money should not
be spent on girls or women who must tolerate pain and suffering which are their lots.
Hospital and clinic attendance records invariably show a preponderance of males
receiving treatment. The proportion of medical treatment provided to women is lower
weather one considers outpatient attendance or indoor admissions. For example, in
Safdarjung hospital, Delhi only 35 percent of admissions were female (Ghosh, 1985).
Similarly, Khan et al., (1983) reported that a larger number of males were treated at
the primary health centers in Uttar Pradesh, Gujarat and Rajasthan.
Low treatment rates exist despite the availability of free government health facilities
in both rural and urban areas. Khan et al., (1982) found that in the Uttar Pradesh
villages, treatment was sought from the near by primary health center (PHC) or
government health facility, in only 9 percent of female illness. The vast majority of
women simply used traditional remedies. A household health survey in Madhya
Pradesh found that while treatment had been sought for about half of all reported
‘current serious illness’, only 15 percent of patients had approached government
facilities, the remainder seeking private allopathic or traditional care (Jesudason and
16
Chatterjee, 1979). Only one-third of the women respondents knew the location of
nearest sub center and about 40 percent the location of the nearest PHC. Knowledge
of the working timings of these facilities was even pourer. Only a quarter of the
women had actually ever visited the local sub center and less than 20 percent the PHC
itself. Nor do women attend sub centers or PHC’s for antenatal care or for delivery
(Jesudason and Chatterjee, 1979; Jeffery et al., 1984; Khan et al., 1982; 1983).
The latter group of researchers have reported that between 3 and 11 percent of
pregnant women interviewed in Bihar, U.P and Rajasthan received MCH services
such as antenatal check-ups, tetanus toxoid, iron fortification, birth attendance, or
post-partum family planning counseling (Khan and Prasad, 1983b). In Kerala almost
40 percent of women received the first three of these services, but fewer obtained the
last two. The best coverage rates were found in Gujarat where 35-43 percent of
women received the various services.
Official statistics maintain that three-fourths of deliveries in rural areas are conducted
within homes with the help of female relatives, friends, or traditional dais, but micro
level studies generally reports proportions closer to 90-95 percent (Jeffery et al.,
1984). Dyson and Moore (1983) have pointed to geographical differences in birth
attendance by trained personnel, it is lowest in the North and Northwest, and highest
in South. This pattern co-incidence with the status of women in the different regions
and is inversely related to mortality.
A recent study by Ramalinga Swami (1987) in the Southern state of Andhra Pradesh
found that only 2 percent of women in tribal villages and 24 percent in non-tribal
villages were delivered by an Auxiliary Nurse Midwife (ANM) or at a hospital, and
16 percent and 62 percent respectively, received tetanus toxoid in the prenatal period.
In contrast, over 95 percent of all women had been approached for family planning,
and every one knew about the malaria worker. Ramalinga Swami concludes that
while great differences exist in the reach of government services in rural areas, where
there is a desire to reach women (e.g. for family planning),* the services succeed in
doing so.
17
Factors influencing the women's utilization of health services
A few studies in India support the view that female literacy goes hand in hand with
reduced mortality and perhaps better use of health facilities. Krishna P (1975) found
literacy an important variable to explain differences in mortality rates in all states. He
examined over all death rates in terms of literacy, doctor, hospital and bed- population
ratios, percapita expenditures on medical and health services. While literacy was the
most important factor, the health service ratio’s also had some explanatory power.
The influence of female education on health service utilization is also important in
urban settings where health sendees are relatively accessible, as in Kerala. Khandekar
(1974) found that with in middle and low-income groups in Bombay, education had
an impact on the utilization of MCH services.
In most rural areas, one in three women lives more than five kilometers from the
nearest health facility, and 80 percent of rural women live more than five kilometers
form the nearest hospital. The scarcity of vehicles, especially in remote areas and poor
road conditions can make it extremely difficult for women to reach near by facilities,
walking is the primary mode of transportation, even for women in labour. In rural
Tantamia 84 percent of women who have gave birth at home intended to deliver at a
health facility, but did not due to distance and the lack of transportation.
In Zaria, Nigeria a study found that the shift from free to fee based services for
obstetric care reduced admissions overall but significantly increased emergency cases.
The number of maternal deaths rose correspondingly. The poorer women are, the
more likely fees are to affect their use of health services.
Many women describe providers in the formal health care system as unkind, rude,
brusque, unsympathetic and uncaring. Where health workers are perceived to be
hostile and unfriendly, many women rely instead on traditional healers or Traditional
Birth Attendants (TBA’s) for antenatal, delivery and postpartum care. This can lead to
fatal delays in seeking adequate care for pregnancy-related complications. In
Tanzamia, a study found that 21 percent of women delivered at home because at
home because of the rudeness of the health staff- even thought they thought delivering
18
in a health facility was safer.
In Ghana, a study of women who died of pregnancy related complications found that
64 percent of the women had sought help from an herbalist, soothsayer or other
traditional provider before going to a health facility. Families citied cost and the belief
that the woman’s condition would improve or that the woman was not ill enough to
justify the cost involved, as the main reasons for not taking a woman to a hospital (H.
Odoi- Agyarka, N Dollimore, O.Owusu-Aygyei. 1993).
In many parts of the world, women’s decision-making power is extremely limited,
particularly in matters of reproduction and sexuality. Decisions about maternal care
are often made by mother-in law, husband or other family members.
Men as Responsible Partners in Reproductive Health
Since gender inequalities favour men in patriarchal societies and sexual and
reproductive health decisions are made by them, there is a growing realisation that
unless men are reached, programme efforts will have limited impact. While focusing
on women and addressing their reproductive health needs, special efforts should be
made to encourage men to take responsibility for reproductive health as responsible
sexual partners, husbands and father. Given the situation, the present study intends to
proceed with the following objectives.
Objectives of the Study:
The main objectives of the study are to
•
Understand the influence of gender on reproductive health of women
•
Investigate the role of men in promoting reproductive health of women
.
The extent to which women utilize health services for improving one’s own
reproductive health.
19
o
Influence of Gender on Reproductive Health of Women
Understanding Gender
Gender refers to the array of socially constructed roles and relationships, personality
traits, attitudes, behaviours, values relative power and influence that society ascribes
to the two sexes on a differential basis. Gender is relational and refers not simply to
women or men but to the relationship between them (Health Canada, 2000b). All
societies are divided along the “fault lines” of sex and gender (Papanek, 1984) such
that men and women are viewed differently with respect to their roles, responsibilities
and opportunities, with consequences for access to resources and benefits.
o
Gender roles and gender norms are culturally specific and thus vary tremendously
around the world. Almost everywhere, however, men and women differ substantially
from each other in power, status, and freedom. In virtually all societies men have
more power than women have (Berer, M. 1996; Evaluation Project, 1997; Helzner, J.
F. 1996; Moser, C. O. N. 1993; Riley, N. E. 1997).
The term “power” is often used when describing gender differences. “Power” is a
broad concept that describes the ability or freedom of individuals to make decisions
and behave as they choose (CEDPA, 1998; CEDPA, 1996; Hollerbach, P. 1980;
Pfannenschmidt, S. et.al, 1997; Riley, N. E.1997). It also can describe a person’s
access to resources and ability to control them. When the term “power” is associated
with gender, it usually refers to inequities between men and women.
Two types of power help to describe the inequities in male and female gender roles -
“power to” and “power over”. “Power to,” describes the ability of individuals to
control their own lives and to use resources for their own benefit. For instance, a man
is more likely than a woman to have the power to go where he wants, find a good job,
and earn money. “Power over” means that individuals can assert their wishes, even in
the face of opposition, and force others to act in ways that they may not want to
(Hollerbach, 1980; Riley, 1997).
In many cultures, for example, men make
reproductive decisions, such as how many children their wives will have, that can
20
have consequences for women’s health and well being (Evaluation Project, 1997;
Ezeh, 1993; and Mbizvo, 1996).
The facts of gender inequality-the restrictions placed on women's choices,
opportunities and participation-have direct and often malign consequences for
women's health and education, and for their social and economic participation. Yet
until recent years, these restrictions have been considered either unimportant or non
existent, either accepted or ignored. The reality of women's lives has been invisible to
men. This invisibility persists at all levels, from the family to the nation. Though they
share the same space, women and men live in different worlds.
Reproductive Health - Gender dimension
For both women and men, reproductive health reflects the impact of health in infancy
and childhood as well as in adult life, and beyond reproductive age as well as within
it. Reproductive health sets the ground for human sexuality, regardless of whether it
leads to reproduction.
Gender differentials in regard to poor reproductive health stem, in part, from
biological factors. Other gender differentials stem from social, economic and cultural
factors. Women's lack of autonomy in sexual relationship can lead to early and
excessive childbearing as well as exposure to STDs and violence. Women who lack
decision-making power and control of money within the family are often cut off from
essential health services, such as emergency obstetric care. Cultural practices, such as
female genital mutilation, may lead to life-long disability. Although the burden of ill-
health associated with reproduction affects women to a much larger extent than it
does men, and few of the reproductive health problems that men face are life
threatening, these problems do affect men's quality of life and may have serious
repercussions on women's health.
Women particularly those who are poor, face a number of reproductive health
problems, such as reproductive tract infections, complications of pregnancy, fetal
wastage, sexual violence, and poor maternal nutrition. The fact that many women still
face reproduction related morbidity and mortality - both preventable - due both to
social and economic factors and to gender-related antecedents, reveals a lack of
21
access to adequate health services. The young woman who dies in first childbirth at
age 15 likely incurred obstructed labour or haemorrhage associated with malnutrition
or chronic anemia. Chances are, she received less food and health care than her
husband. Few child survival or maternal and child health programs even recognize
such gender differentials as a problem, let alone seek to combat them. The older,
higher parity woman who dies in childbirth not only accumulated the disadvantages
from adolescence, but also may have been weakened or depleted by previous
pregnancies. Lack of information about her physiology, sexuality, and reproductive
health makes her vulnerable to both physical and emotional abuse. Equity and a
strong sense of dignity are precluded (Greer 1987).
Gender inequality and discrimination thus harm girls and women's health directly and
indirectly, throughout the life cycle; and neglect of their health needs prevents many
women from taking a full part in society.
Gender and Contraception Acceptability
The gender differentials in knowledge and use may arise for a number of reasons.
They may reflect actual differences in knowledge and use, or gender-related
differences in the accuracy of reports (either deliberate or unintentional) or a mixture
of the two
‘Acceptability’ of a contraceptive method refers to how well, given existing choices,
the method meets user preferences. Acceptability is therefore relative, conditional and
utility-driven. Couples who are keenly dissatisfied with other methods have a felt
need for alternatives. They are more likely than others to be satisfied with a method
that fulfils that need. In all likelihood, men and women have somewhat different
criteria for whether a method is acceptable, yet clinical and acceptability research on
contraceptive methods has largely excluded partners, whether male or female.
Failure to recognize that the male partner may have the final say on method use has
been detrimental to expanding contraceptive choices for women. Ignoring the
perspective of the female partner may be equally damaging to the prospects of
methods for men. Women have been responsible for contraceptive for too long not to
take a critical interest in the development of such methods.
22
Social and cultural factors, including gender norms, condition women’s reproductive
intentions- that is, the number of children they want and how they want their births
spaced. If women could have only the number they wanted, the total fertility rate in
many countries would fall by nearly one child per women. The fewer children women
want, the more time they spend in need of contraception, and the more services are
required.
Women do not always get the support they need to fulfil their reproductive intentions.
In some settings, fearing reprisal from disapproving husbands or others, many resort
to clandestine use of contraception (Snow, R., et al. 1997). Women interviewed in a
five-year women’s studies project, carried out in eight countries by Family Health
International, said that to attain their family planning objectives, they needed
supportive partners, adequate information, unobtrusive methods and respectful
services (Barnett, Barbara, and Jane Stein. 1998).
Most modem contraceptive rely on women to initiate and control their use: oral
contraceptives,
intra-uterine devices
(IUDs),
diaphragms,
cervical
caps
and
injectables have no counterpart methods for men. Among the 58 percent of married
couples practicing contraception worldwide, less than one third rely on a method
iequiring male participation (condom and vasectomy) or cooperation (rhythm and
withdrawal). In less developed regions, nearly two thirds of contraceptive users rely
on female sterilization or IUDs (United Nations. 2000).
Gender Differences in Reporting of contraceptive usage
Research on gender differences in reporting the use of specific methods has shown
that women consistently under-report the use of male methods (Ezeh AC, 1995). One
explanation may be that women are too shy or embarrassed to report use of condoms
or withdrawal. Alternatively, women may think that they should not report use of
condoms or withdrawal, because they are not the ones actually physically using the
method. Although the DHS questionnaire is designed to avoid this misunderstanding,
it may still happen in certain cases. On the other hand, it
could be that men are using withdrawal without the knowledge of their wives. Any of
these factors could explain the higher reported use of male methods by men.
7.3
Differences in reporting by sex may also be due to the perceptions of whether
particular behaviour constitutes contraception or not. Men report higher periodic
abstinence than women. One explanation for this is that men may interpret periodic
abstinence after a birth, for example, as a means of avoiding another pregnancy while
women primarily consider it to be for other reasons, e g. to ensure the health of the
newborn. Equally, men and women may differentially report condom use that is
intended primarily to prevent HIV/STD infection and not pregnancy. An analysis of
the Tanzanian DHS found that reported condom prevalence increased by 300 percent
among women when a probe was added that asked about condom use with any partner
in the last month but did not specifically mention preventing pregnancy. The
comparable increase among men was 18 percent (Ruttenberg N, Blanc A and Kapiga
S, 1994).
Men also reported higher than expected current use of female methods. It is unlikely
that the same arguments would hold for women under-reporting female methods,
although more research is needed. It may be that men are over- reporting use of both
male and female methods, which would compound the reporting error. As female
methods are generally less immediately visible during the sexual act (e g. injection,
IUD and pill) it is possible that men may be unaware that their partner has ceased to
use a method, leading them to over-report current use.
If the differences by sex reflect real differences in use as opposed to reporting error,
and given that our sample is limited to the currently married population, the
explanation must lie in one or other of the partners using contraception outside the
marital union. Men are often assumed to use condoms for extra-marital relations.
Large differences in ever-use of condoms might suggest past use by males with sexual
partners prior to marriage as well as with past and current extra-marital partners. Men
are generally older than the women they many, e g. in Pakistan men are on average
6.7 years older than their spouses. Thus, men may have a number of years prior to
marriage in which sexual activity could occur.
Supporting evidence for this comes from the DHS conducted in Zimbabwe in 1994,
which contained a module on HIV/AIDS and sexually transmitted diseases. Although
not part of the male questionnaire, the module included questions to currently married
24
men and women about their use of condoms both within and outside the marriage. Of
those men having sex in the last four weeks with their spouse, 12 percent had used a
condom, whereas of those men who had had sex with a non-spouse, 60 percent had
used a condom.
Gender and Adolescent Pregnancy
One important development in adolescence is coming to terms with one's sexual
identity. Recognizing one's sexuality has been viewed as a male sphere in the country.
The media presents sex as hedonism with the exhortation that it is "dirty" and
"immoral." The age of menarche has dropped due to improved nutrition. This
indicates a lengthening of the reproductive span and earlier exposure to pregnancy.
During this difficult period in life's transition, little attention has been given to the
problem of malnutrition. Puberty means increased nutritional requirements, which are,
recognized more for male adolescents, the potential work force. In ihe 1992 National
Nutrition Survey, females aged 13 and above had higher rates of anemia and iodine
deficiency than males. A mother with iodine deficiency runs higher risks of delivering
a child with congenital anomalies, including mental retardation. Biologically and
psychologically, the female adolescent is still unprepared for pregnancy. These
handicaps remain for young mothers who survive subsequent pregnancies. A
relatively high prevalence of fetal loss among adolescents has been observed. Among
those less than 20 years of age, 12.2 percent of the women reported some fetal loss
(NSO 1993).
Adolescent contraceptive use remains low. The Philippine National Demographic
Survey in 1993 revealed that the contraceptive prevalence rate for women 15-19 years
of age was 1.3 percent (NSO 1993). Of women aged 15-19, 7 percent had begun
childbearing, 5 percent were already mothers, and 1 percent was pregnant for the first
time at the time of the survey. At exact age 18, 10.3 percent had begun childbearing;
at age 19, nearly a fifth of the group (19 percent) started building their family. Rural
teenagers were twice as likely to experience teenage pregnancy as their urban
counterparts.
In Western Mindanao, cultural factors impinging on women’s roles and status partially
explain the high proportion of teenagers bearing children (13 percent). Teenagers in
25
urban areas with recreational and educational facilities have alternatives other than
childbearing. Teenagers in the city may also have more exposure to information and
methods regarding family planning and safe sex. The Philippine data showed that
education tends to depress fertility in the earliest childbearing years. The percentage
of childbearing was 15 percent among women with no education, compared to 2
percent among women who had higher education. Despite the overall low teenage
pregnancy rate, the magnitude is immense in light of the fact that in the 1990 census,
about 5.5 percent of the country’s population was 15 to 19 years of age (NSO 1993).
The phenomenon of teenage pregnancy is a fast emerging concern in many societies.
The disadvantaged status of the teenage mother affects the health and welfare of her
children. Her underprivileged position tends to be repeated in the lives of her
daughters. With modernization and urbanization, traditional systems, such as
extended family networks that once regulated sexuality have eroded. Young people
become exposed to diametrically opposed messages regarding sex roles from peers
and the family.
Gender and Safe motherhood
Women’s gender roles do give them some power. Usually, however, it is much more
limited in scope than men’s (Gage, 1995). Like a man’s power, a woman’s power is
influenced by such factors as her culture, age, income, and education. Some studies
have found that women’s power increases as their stains in the community improves.
In Nigeria, for example, Yoruba women who have many children, especially sons,
have more say than their husbands about whether or not they will have more children.
Among Yoruba women with few children, however, their husbands’ fertility desires
usually prevail (Bankole, 1995). However in order to attain the ‘power’ many women
tend to take risk. It is not uncommon for women in Africa, when about to give birth,
to bid their older children farewell.
Ninety-nine percent of the approximately 500,000 maternal deaths each year are in
developing countries, where complications of pregnancy and childbirth take the life of
about 1 out of every 48 women. In some settings; as many as 40 percent of women
suffer from serious illness following a birth (Fortney and Smith. 1996).
26
Avoiding unwanted pregnancy through family planning and proper antenatal care
reduces maternal mortality. Only 70 percent of births in the developing world are
preceded by even a single antenatal visit. Each year, 38 million women receive no
antenatal care. Only about half of all pregnant women receive tetanus injections.
The vast majority of the studies that had any information on women's utilisation of
pregnancy and delivery care reveals an overwhelming evidence women distrusted or
disliked hospital delivery and preferred natural childbirth, and believed that antenatal
care was not necessary. A study from rural Rajasthan (Hitesh 1996) reports that a very
large proportion of pregnant women referred to tertiary centres did not avail of the
referral because of lack of money, transportation facilities or time, and those who did
go were better-off and/or had their own means of transport. The interplay of gender
and social status is borne out by this study, which shows further that when relatives
were able to provide social support in terms of taking over the woman's domestic
responsibilities, there was an even higher likelihood of a pregnant woman availing of
referral even among the better off. Very similar findings are reflected in another
study, also from Rajasthan (Unnithan-Kumar 1999), which found that work and lack
of social support impeded access to health services.
A study of women from a fishing community in southern Tamil Nadu (Ram 1994)
examining why women did not use delivery services found that some of the reasons
reported by the women included prolonged stay in hospital disrupting their gender
based domestic responsibilities, caste gap between provider and user, harsh treatment
by delivery staff and unnecessary medical interventions. Studies examining the
association of various socio-economic factors with utilisation of services indirectly
through statistical analysis (as opposed to direct questioning) find that women using
antenatal care were economically better-off than those not (Khandekar et al. 1993),
had more years of education themselves as well as were married to men with more
years of education (Khan et al. 1997), were non-working women and did not belong
to the Scheduled Castes (Khandekar et al. 1993). Interestingly, though, these
associations are interpreted as implying the ignorance of women. The studies then
argue for convincing and educating the illiterate women on the need for antenatal care
and for trained attendance at birth, without probing further ways in which socio
economic status may act as a barrier to utilisation of services. The conclusions drawn
27
from the findings leap far beyond available hard evidence and in some sense, appear
to reflect gender, social and medical biases in interpretation - that antenatal and
delivery care is inherently 'good' for women irrespective of their quality, that anyone
who does not see this 'truth' has to be ignorant and uninformed and needs to be
educated and made aware.
In terms of choice of provider for reproductive health care, a preference for traditional
dais (traditional birth attendants or TBAs) for delivery care is indicated by many
studies. The low cost of services appears to be an important consideration. In the only
study that actually documents cost of care, from Vellore in Tamil Nadu
(Sahachowdhury 1998), the average expense incurred by a household for a delivery
by the dai was reported to be Rs.25, an amount that would be inadequate even for
getting a woman in labour to a health facility. This may be interpreted in two ways -
as reflecting the inability of households to pay more, or the unwillingness to invest on
childbirth, a reflection on the value placed on a life-and-death situation for women by
their households and society at large. Cost was a consideration in choice of provider
for induced abortion for one-third of the respondents, according to one study (Ganatra
et al. 1998b). The same study also reported that women's heavy work load at home
made them prefer abortion providers who did not insist on repeated visits or an
overnight stay.
Gender and Reproductive Tract Infections
Little is known about the dynamics of couples' sexual and reproductive decision
making or about how gender roles affect these decisions. Such decisions can include
whether to practice family planning, choosing when and how to have sexual relations,
engaging in extramarital sexual relations, and using condoms to prevent STDs.
Male gender roles harm men's health as well women's. A mix of cultural norms, social
expectations, and men's sex drive encourages men's risky sexual behavior (Berker, G.
1996; Center for Development And Population Activities, 1996; Danforth, N. 1998;
Speidel, J. 1998). Some societies, as in Haiti and Thailand, accept that married men
will have extramarital sex, either with girlfriends or prostitutes (Tangchonlatip, K.,
and Ford, N. 1993; Ulin, P. R., and Cayemittes, M., and Metellus, E. 1995). Similarly,
in many Latin American and Caribbean cultures, the concept of machismo encourages
28
men to be promiscuous to prove their masculinity (Barker, G. 1996). Such male
gender roles can contribute to their contracting STDs and passing them on to their
wives or girlfriends.
The occurrence of RTIs has a strong gender dimension. Sexual contact, usually
intercourse, is necessary for transmission. Thus, lessons learned on now to modify
unsafe sexual practices can be applied to reduce the risks. Second, Rd Is discriminate
biologically against women. Anatomic differences make RTIs more easily
transmissible, yet more difficult to diagnose in women. STDs are more frequently
asymptomatic in women than men, and clinical symptoms are more subtle in women.
Even worse, the long-term complications in women are far more common and serious.
The intrinsic gender breakdown also exists with unplanned pregnancy, as women
obviously bear the entire burden of health risks associated with it. Third, a powei
imbalance between the sexes favours men. Women frequently have little power over
when, with whom, and under what conditions sexual relations occur. This situation
influences whether any preventive measures are used against RTIs. The womans
status depends on her role as a wife and mother. If RTIs impair her reproductive
capability, she is stigmatized. Fourth, the groups most likely to be affected by RTiS
and unplanned pregnancy are younger women with lower incomes. The poor
represent those at greatest risk for sexually transmitted infections. If men are willing
to use condoms properly, protection against transmission is ensured by preventing
direct contact with semen, genital discharge, genital lesions, and infectious secretions
(Cates and Stone 1992).
Gender Violence and Reproductive Health
Gender violence, until recently a marginal subject among themes related to health, has
such a significant impact in women's health that it is responsible for one in every five
potential years of healthy life lost (Heise L, 1994).
Contrary io common sense that imagines pregnancy as a sanctified state of peace and
beatitude. Violence does not necessarily decrease during this period, tending in many
cases to increase in intensity or frequency (Stewart DE, Cecutti A, 1993). The
prevalence of violence during pregnancy tends to be higher than that found for
29
physical and sexual violence in the previous year among populations of non-pregnant
women. This leads some authors to postulate that pregnancy could be considered as
an increased risk factor for violence (Stark E, Flitcraft A, 1995).
Sexual violence leads to unwanted pregnancies not only in the context of rape by
strangers but also in forced sexual intercourse within intimate relationships, and
seems to have important consequences (Gielen C A et.al. 1994).
Studies suggest that the younger the women, the more vulnerable they are to violence
during pregnancy, which affects 24 percent of all pregnant adolescent women (Parker
B et. al. 1993). Unplanned pregnancies are also associated to violence. In a study
conducted by Stewart and Cecutti (1993), 88 percent of the women who refened
sexual abuse during the current pregnancy declared that it was not planned, whereas
just 30 percent of the women who did not refer abuse had unplanned pregnancies.
Younger women were also more vulnerable to unwanted pregnancies.
Domestic violence during pregnancy can have an adverse effect due to direct physical
trauma, that in most cases seems to be directed particular lady to the abdomen
(Stewart DE, Cecutti A, 1993) In a study with 203 pregnant women assisted for
physical traumas, 31.5 percent of them were victims of intentional violence (Poole
and Martin, 1996). The consequences of these traumas are several direct obstetric
outcomes, which affect both mother and child's health.
In a study with 218 women that suffered domestic violence assisted at an emergency
room, 5 percent of the women declared the abortion was due to violence, and. 16
percent declared they had attempted suicide previously (Berrios and Grady, 1991).
These aggressions have also been held responsible for abruptio placentae, rupture of
the uterus, liver or spleen, pelvic fractures, premature births, premature rupture of the
membranes, fetal infection and fractures (Council on Scientific Affairs, 1992,
http://www.nhvbc: com/nhwomen/fact3.htm).
Indirect repercussions on the health of the newly bom are equally important. Low
weight births have been associated with violence, an effect that, in turn, is associated
30
with other risk factors, such as smoking, drug abuse, and inadequate prenatal care, as
well as other health problems (Campbell JC, 1995).
Gender roles can Harm Reproductive Health
The traditional gender roles can jeopardize the reproductive health of both women and
men. Inequities in power often make women vulnerable to men's risky sexual
behavior and irresponsible decisions. Because of their gender roles, many women
around the world have trouble talking about sex or mentioning reproductive health
concerns (Blanc, A. et.al. 1996; Glimore, S.et.al. 1995; Ulin, P.R., et.al.1995; Van
Der Straten, et.al. 1995).
Women may submit to men because they are afraid of retaliation, such as being
beaten or divorced, and because their gender roles place them in subordinate positions
in society (Barnett, J. et.al. 1996; Dixon-Mueller, R. 1993). For women worldwide,
the impact of gender inequality is apparent in many of their reproductive health
problems (Alan Guttmacher Institute, 1998; Barnett and Stein, 1998; Hardon, A.
1995; Mbizvo and Bassett, 1996; Mccauley, A.P et.al. 1994; Salter et.al. 1997; United
Nations, 1995).
Thus Gender has a powerful influence on reproductive decision
making and behavior (Blanc, A. et.al. 1996; USAID 1997).
Gender is just one of many factors that influence couples and affects their
reproductive decisions. Education level, family pressures, social expectations,
socioeconomic status, exposure to mass media, personal experience, expectations for
the future, and religion also shape such decisions (Beckman, L. 1983; Hollerbach, P.
1980). Consequently, no two couples' "decision-making environments" are identical
(Hull, T. 1983). Some researchers have suggested that personal reproductive decisions
result from many smaller, incremental decisions (Binyange, M, et.al. 1993; Mumford,
S. 1983; Wilkinson, D, et.al. 1994). Other researchers suggest that in fertility
decisions, social and cultural norms and expectations often prevail over individual
preferences (Hull, T. 1983).
At the same time Men's control over reproductive decision-making may be
weakening, particularly among younger generations and in certain cultures. In many
31
societies, as social, economic, and educational opportunities for women increase,
traditional gender roles are starting to change. As a result, power is being redistributed
between men and women. Evidence from several countries demonstrates that;
increasingly reproductive decisions are being made jointly by couples, not by men
alone (Grady, W. R et. al. 1996; Ogawa, N. et.al. 1993).
32
Study Design and Methodology
Historically Andhra Pradesh has been a diverse state in terms of socio-economic and
demographic levels. Of the three main regions of Andhra Pradesh, Telangana is the
most backward. Demographically coastal Andhra is close to the levels of Kerala,
Telangana can be compared to the backward states of India. Rangareddy is one of the
districts of Telangana region. Geographically Hyderabad, the capital of the state, is in
the midst of Rangareddy district. The city of Hyderabad is recognized as one of the
fastest growing cities in India not only in terms of population density but also in terms
better infra-structural facilities such as health, accessibility, and communication
facilities. Though Hyderabad is located in the center of the district, it seems the
development has not percolated into the district. According to the latest census, the
Rangareddy district is one of the backward districts in terms of developmental
indicators. Due to the existing socio-economic situation of the district, a study in the
rural areas of Rangareddy district is felt interesting.
Sampling Design
Sampling for the present study is done at two levels; sampling of the area and
sampling of the couples. As mentioned above, the district of Rangareddy is choosen
for the current study. With in the district there are a total of 29 primary health centres
(PHC) in the rural areas. Of them 20 are known as round the clock women health
centres (RCWHC) and 9 are ordinary primary health centres. RCWHC is an upgraded
PHC and it is created with an intention to provide comprehensive reproductive health
care, especially to make maternal health services available 24 hours of the day. The
Government has made it mandatory to appoint at least one lady gynecologist at these
centres, either on regular or contract basis. Structurally these centres are upgraded in
terms of equipment, medicines and manpower. The current study is intended to focus
on utilization of reproductive health services by women. Among various factors that
determine the utilization of health services by women is the availability of health
facilities. Therefore it is decided to select a few villages, which are covered under a
RCWHC that have better health facilities. According to the state Government
officials, the RCWHC located at Shamirpet has adequate health facilities and has been
33
identified as one of the best performing centers over years. Thus for the present study
villages covered under Shamirpet RCWHC is selected as the study area.
Profile of the Health center
Shameerpet is acclaimed as one of the best Primary health centres in Andhra Pradesh.
It is situated at a distance of 20 kms from Hyderabad. Shamirpet is one of the old
PHCs of the state. In 1983-84 it was selected for up gradation and there after was one
of the ‘upgraded primary health centers’ of the state. As part of the up gradation
process a new building was built in 1984. In 1999 under the RCH programme the
health center was converted as ‘Round the clock women health center’. The center is
well equipped with the necessary infrastructure both in terms of equipment and
manpower. It has 30 beds for inpatients. All the equipment has been in condition and
has been in use. The center has been receiving necessary medicines regularly. The
center was chosen for various special programmes, both by the Government and the
voluntary units. Frequently students of Gandhi medical college visit the center for
training. The Shamirpet RCWHC covers a population of 96,109 as on April 2003. It
has nine sub-centres and 30 villages under it. Of the total population 47 percent are
main workers, 3 percent are marginal workers, and 51 percent are non-workers.
Selection of the villages
Shamirpet RCWHC has nine sub-centres and provides health services to a population
of 30 villages. Random sampling technique is used to select the villages. First,
selection of sub-centres was done. Out of the nine sub-centres, one-third of them, i.e.
three centres are selected at random. The selected sub-centers are Shamirpet,
Devaryamjal, and Aliabad. From each of the sub-centres, one village is selected at
random. Thus the selected villages for the study are Shamirpet, Pothaipally, and
Turkapally. According to the village administrative boundaries, there is one hamlet
each attached to Pothaipally, and Turkapally. Yelgalguda is a hamlet of Pothaipally,
and Turkapally Thanda is the hamlet of Turkapally.
Selection of the Couples
The main objective of the study is to see the influence of gender on reproductive
health. Also literature suggests that traditional gender roles are starting to change.
Thus, in order to examine the dynamics of the changed gender roles, a purposive
34
sampling technique is adopted for the study. The unit of the study is couples, i.e.
wives in reproductive age group (13-49 years). Studies have shown that gender roles
tend to diminish with lesser differences in spousal socio-economic and demographic
characteristics. In Indian setting, ‘duration of marriage of the couples’ is assumed as
an important variable in deciding power differences between the couples. Thus as a
first step, house listing of all the couples by duration of marriage is carried out in the
sampled villages. Subsequently all the couples are categorized on the basis of
‘duration of marriage’ at 5 year intervals. Broadly thus the couples are classified as (i)
those married less than or equal to 5years ago; (ii) those married between 6 to 10
years ago; (iii) those married between 11 to 15 years ago; (iv) those married between
16 to 20 years ago; and (iv) those married between 21 to 25 years ago; and (iv) those
married more than 25 years ago. In each of these categories randomly ten percent of
couples are selected for the study, so that 10 percent of total couples in reproductive
age group in all the study villages comprises the sample. Thus the selected number of
couples for the study is 223. Table-3.1 gives the particulars of the selected couples by
duration of marriage in each of the selected the village.
Table-3.1 Number of couples by duration of marriage in each of the villages and
the final sampled couples selected for the study.
Village
Number of couples by duration of marriage
Total
(Yrs)
couple
5
Shamirpet
TTI5
TT5
T77
T55
s
21-25
15
139
91
1110
’PT
W
Yelgalguda
TZ
TZ
~6
Pothaipally
T5
72
3V
3T
TL
TIT
Turkapally
T62
T35
T75
85
77
678
Turkapally Tanda
T(T
H)
5
7
7
T
Total couples
527
W
3T7
2W
277
257
2777
Number of
Selected Couples
53
5T
35
25
29
25
223
Tools of Data collection
A review of methodologies on male’s participation has been largely based on
qualitative methods of data collection. A few other researchers have used both
35
structured tools as well as in-depth case studies. The present study attempted to
collect information using both structured schedules as well as by using qualitative
techniques such as focus group discussions and in-depth interviews.
e
Focus Group Discussions (FGDs) is carried at two different stages of work.
The first round of FGDs is conducted with men and women to understand the
‘power’ relations with in the community in those villages. The information
collected by these discussions not only helped in understanding the gender
relations in the study areas but also helped in preparation of individual
interview schedules. The FGDs also helped in building a rapport with the
community. The second round of FGDs is conducted to a group of husbands
and wives, separately, on their perceptions of reproductive illness and the need
for a medical care.
.
Individual interviews of couples are conducted separately for couples, both
husbands and wives, with the help of interview schedule. This structured tool
helped in bring out information on knowledge, access, and gender roles with
respect to reproductive behaviour, health, morbidity and utilization of health
services by women. The support wives expected and leceived from husbands
is also collected.
9
From the collected data, a few couples, either one or both of them, suffering
from reproductive health are selected for in-depth interviews.
While designing the tools, care is taken to incorporate appropriate validity checks for
editing the information at field level. Discussions with a programmer helped to
modify the schedules suitable for entry checks. Similarly discussions with a
statistician are made to check whether all the information can be pooled for
appropriate analysis.
Preparatory Work Prior to Main Survey
A lot of preparatory work is done prior to the actual data collection. First, discussions
are held with gynecologists to enable the researcher to familiarize with various
components of reproductive morbidity and health. After the initial FGDs, the
information collected helped in preparation of interview schedules. These schedules
are initially developed in English. Then translated into Telugu and were again back
36
translated to check ambiguity in expression. Subsequently the questionnaires are pre
tested before finalizing and printing. Meanwhile permission was sought from the
Directorate of Health and Family Welfare and district collector to seek cooperation at
District level. The permission from them facilitated in obtaining permission from the
District Medical and Health officer of Rangareddy district to collect relevant
information from the selected RCWHC. Subsequently interactions with village heads,
and popular persons of the village are made. This exercise helped in explaining the
purpose of study and facilitated to conduct focus group discussions prior to the main
survey.
Selection and Training of Field Staff
Persons preferably with a graduation or post graduation in social work/ sociology/
home science are recruited as field investigators. For interviewing wife and husband,
both female and male investigators are recruited. The principal investigator imparted
required training to the recruited the field staff. The focus of training covered on
several aspects, which included an understanding of the scope of the study, research
design, explanation of the questionnaires, and development of rapport and
interviewing skills.
During the training special lectures are held on gender
perspectives in health, basic knowledge on female reproductive organ and its
function, components of reproductive health and morbidity. Mock interviews, role
play and discussions are organised to improve the skills of the investigators. At the
end of the training the best performing candidates are selected for the survey.
Operation of Fieldwork
Participatory Approach
Before starting the data collection activity as a preliminary exercise, village social
maps are prepared with the help of some of local people and multipurpose health
workers. First the maps were drawn on a mud floor. Sketches were drawn with
identification of houses, and other land marks such as water tanks, school building,
temples, any other religious places, health facilities, place of local quacks etc. These
sketches are drawn with the help of coloured powders, different type of leaves,
pebbles, wood pieces etc. There after a similar map was drawn on paper and asked the
local persons to correct for any changes. This participatory technique enabled the field
37
c
staff in developing a lot of interaction with the local people, which subsequently
helped in building a lapport. These social maps subsequently helped in door-to-door
field survey.
Survey Method of Data Collection
The social maps helped the investigators to have clarity of universe, thus could move
from one household to another without missing any household during the house
listing exercise. From each of the household, particulars of the couples by duration of
marriage are collected. This list formed as a universe to select the sample. Once the
sample is identified, with the help of interview schedule, the couple, both wife and
husband, are interviewed separately.
Qualitative Method of Data Collection
A few of the investigators are trained in the techniques of qualitative methods of data
collection. The principal investigator with the support of these investigators
conducted focus group discussions. The first round of FGDs are organised to
understand the existing ‘power’ relations between men and women with in the
community and the existing gender preferences. This type of information helped in
designing the schedules. The second round of FGDs are organised for wives and
husbands separately to understand their knowledge, attitude and obstacles in seeking
health services. Gender dimensions and constraints in hindering utilization of health
services are focused. Also from the couples’s point of view, suggestive measures to
improve couples reproductive health are noted down. In addition to the FGDs a few
in-depth interviews of selected couples are done. Selection of the couples is based on
the information collected through interview schedules. Couples, either wife or
husband or both, suffering from any reproductive morbidity are selected at random for
in-depth interviews.
Quality Checks of the Data
During the survey the field editors simultaneously edited the questionnaires. Care is
taken regarding validation, mistakes and missing information.
All the filled in
questionnaires are once again edited at the office and open-ended questions are coded
before the entry. The entered data is subsequently scrutinized and validation is done
before the analysis.
38
Coverage of Women
Of the 223 total women identified for the survey, all were interviewed. None of the
women refused to give information. A few women though initially refused, repeated
assurance of the confidentiality of the information and interest showed by the
investigators in clarifying all their doubts, resulted in complete coverage.
Ethical Concerns
Before proceeding with the survey the interviewers took informed consent from all
respondents.
Since a majority of them were either illiterates or had low literacy
levels, their written consent was difficult to obtain. Therefore, their oral consent was
considered adequate.
The field team assured them about confidentiality of their
responses and ensured that the information will be used only for research purpose.
Also care is taken to see that no member was present other than respondent at the time
of interview. Despite special efforts, if privacy is at stake, the interviewers are
instructed to shift to the general topics from sensitive topics. After ensuring the
privacy, a continuation of sensitive information is collected. Especially when young
women are interviewed, if there is a chance for mother-in-law or other elder members
of the family came and sat along with the respondent, then the interviewer tried to
explain these members in detail about the purpose of the study and tried to see that the
persons left the respondent alone. Since the study is based on personal information of
the individuals, it was anticipated that there could be a refusal to answer along the mid
way even after initially accepting for the interview they may be non-cooperative. One
such experience faced by a lady investigator is as follows. A respondent at mid way of
the interview was unwilling to give further information as she realized that the
investigator is unmarried. The respondent questioned the validity to collect
information by an unmarried investigator on reproductive behaviour. Then again, the
respondent was made to realize that formal education attained by the investigator is
adequate for her to discuss on the reproductive issues even though the investigator do
o
not have a personal experience. Barring this incident there was no violent refusals. It
took more than an hour for interview and in few cases repeated sittings on
respondents’ request was obliged. No amount was paid to the respondents, as the form
of data collection did not disturb their daily economic activity. The constituted ethical
committee for the project has approved the study.
39
Profile of the Study Area and Couples
The present chapter briefly describes about the study area and the couples. As
mentioned in the previous chapter, for the present study three villages namely
Shamirpet, Potaipally, and Turkapally are selected. Yeligalguda and Turkapally
Thanda are the hamlets of Pathaipally and Turkapally respectively.
An Understanding of the Villages under study
Transportation to Villages
All the villages are well connected by roads and have both public as well as private
transportation facilities. Transportation is available at a frequency of 10 to 15 minutes
from each of the villages. All the villages are located at a distance of 20-35 Kms.
from Hyderabad, the capital city of Andhra Pradesh.
Availability of Health Facilities
Pothaipally, Yeligalguda, and Turkapally Thanda have no health care providers in the
village. Shamirpet has primary health centre, a few private clinics in the village.
Turkapally has a sub-centre and one private clinic in the village. A few unqualified
rural medical practitioners (RMPs) residing in Shamirpet and Turkapally are the other
health care providers to whom villagers go.
Basic Household Amenities
All the villages are connected with piped drinking water supply. However most of
them have to get water from a public tap. Eighty percent of the households get water
from a distance of 100 meters from their house, 14 percent has to go to a distance of
nearly 200 meters, and 6 percent of the households have to go beyond 200 meters.
More than half of the households (51.4 percent) do not have toilet facilities. Forty-six
households have own toilet facility and the remaining use shared facility. Village wise
analysis shows that all the houses in Turkapally Thanda and 83 percent of households
in Yeligalguda have no toilet facility. Almost all the households use electricity as a
source for lighting during nights.
40
Socio-Economic Characteristics of the Couples
Education
There are differences between the educational level of wives and husbands in the
study villages. More than half of the wives (57 percent) are illiterates where as the
corresponding percentage of the husbands is 28.7 (Table-4.1). Fifteen percent of the
wives are educated up to primary and 28 percent have studied above primary level.
Among husbands 26 percent of them are studied up to primary and 45 percent are
educated above primary level.
Religion and Caste/Tribe
A majority of the couples in the study are followers of Hindu religion (91 percent), 6
percent of them are Muslims and a marginal percent of the couples are followers of
Christianity (2.7 percent). Caste composition of the couples indicates that two-thirds
of them are from backward castes (62.8 percent). Nearly one fifth of them are from
Scheduled castes and 3.6 percent are from Scheduled tribes. Twelve percent of the
total couples belong to forward castes.
Type of Family
Nearly three fourths of the total families are nuclear (72.6 percent), i.e., it consists of a
husband and a wife with unmarried children, and the remaining are either extended or
joint families (27.4 percent).
Work Status
More than half of the wives are working out side home either as daily wagers (30
percent), skilled workers (7.6 percent) or engaged in business (21 percent). Excepting
one person in Turkapally village, all husbands under study are engaged in income
generating activities. A majority of them are working for daily wages (39.5 percent).
Followed by men engaged in skilled work (17 percent), clerical jobs (16.6 percent),
cultivation (14.8 percent) and business (11.2 percent).
Demographic Characteristics of the Couples
Age distribution
Sixty percent of women are aged below 25 years of age; its conesponding percentage
for men is 31 percent. Seventeen percent of the women, and 22 percent of men are in
41
the age group of 26 to 30 years. Nine percent of the women and 20 percent of the men
are above 40 years of age.
Marriage particulars
Median age at marriage as well as cohabitation for women in all the villages is 16
years. Distribution of couples by duration of marriage reveals that 23 percent of the
couples are married less than two years ago; 21 percent are married 3 to 5 years ago.
Sixteen percent of the couples are married 21 years ago.
Parity
One fifth of the couples are still childless at the time of survey and another one-fifth
of the couples have a single child. Twenty two percent of the couples have four or
more children.
42
Table-4.1 Socio-Economic Characteristics of the Couples
Socio-economic
Characteristics
Wife’s education
Illiterate
Up to primary
Above primary
Husband’s
education
Illiterate
Up to primary
Above primary
Religion
Hindu
Muslim
Christian
Caste/Tribe
Scheduled caste
Scheduled tribe
Other backward caste
Others
Type of family
Nuclear
Non nucleai
Wife’s work status
Not working
Daily wage
Skilled worker
Business
Husband’s work
status
Cultivation
Daily wage
Skilled worker
Business
Clerical
Not working
Total
(Number)
Percentage of Couples
Shamirpet
Pothaipally
Turkapally
Total
53.6
17.0
29.5
55.3
7.9
36.8
63.0
15.1
21.9
57.0
14.8
28.3
26.8
24.1
49.1
18.4
31.6
50.0
37.0
27.4
35.6
28.7
26.5
44.8
90.2
5.4
4.5
97.4
0.0
2.6
89.0
11.0
0.0
91.0
6.3
2.7
16.1
3.6
70.5
9.8
47.4
0.0
44.7
7.9
15.1
5.5
60.3
19.2
21.1
3.6
62.8
12.6
74.1
25.9
73.7
26.3
69.9
30.1
72.6
27.4
48.2
27.7
7.1
17.0
34.2
36.8
7.9
34.2
21.1
8.2
27.4
41.3
30.0
7.6
21.1
14.3
41.1
13.4
8.9
22.3
0.0
10.5
44.7
21.1
10.5
13.2
0.0
17.8
34.2
21.9
15.1
9.6
1.4
14.8
39.5
17.5
11.2
5(E2
(H2)
T7^
(38)
3277
(73)
(100.0)
223
30.1
16.6
0.4
43
Table-4.2 Demographic Characteristics of the Couples
Demographic
Characteristics
Current age of wife
<=15
16-20
21-25
26-30
31-35
36-40
40+
Current age of
husband
<=25
26-30
31-35
36-40
40+
Duration of
marriage
<=2
3-5
6-10
11-15
16-20
21 +
Parity
0
1
2
3
4+
Total
(Number)
Percentage of Couples
Shamirpet
Pothaipally
Turkapally
Total
0.0
34.8
5.3
34.2
27.7
17.0
8.0
21.1
15.8
2.6
5.5
26.0
24.7
17.8
6.3
6.3
10.5
10.5
8.2
5.5
12.3
2.7
31.8
25.6
17.0
7.2
6.7
9.0
28.6
34.2
34.2
24.1
21.4
7.1
18.8
23.7
15.8
5.3
19.2
16.4
9.6
21.1
20.5
22.3
23.2
23.7
23.7
13.2
24.7
16.4
23.3
17.8
13.7
9.6
17.8
16.1
20.5
19.2
15.1
20.2
20.2
17.5
21.9
19.7
22.4
TDO70
(223)
16.1
16.1
8.0
14.3
20.5
20.5
17.9
19.6
21.4
(112)
13.2
5.3
21.1
18.4
21.1
21.1
15.8
23.7
TTTT
(38)
23.3
32.7
(73)
31.4
22.4
18.8
7.6
19.7
21.1
14.8
8.1
16.6
44
Media Exposure and Access to Reproductive Health
Services
Utilization of reproductive health services is dependent in part on couples’ exposure
and awareness of available reproductive health services. Awareness levels of both the
couples is felt essential to understand whether it has any impact on care seeking
behaviour of women. This chapter discusses on survey findings on couples’ exposure
to messages related to some components of reproductive health such as family
planning, pregnancy care, delivery care, care after child birth, AIDS, and other
reproductive health problems. The couples are asked separately on whether they
recalled hearing or seeing any of the message in a month prior to the survey, and if so,
the type and source of message. In addition to exposure to availability of health
services, their information on access to these services is also collected.
Exposure to Various Components of Reproductive Health
There have been differences between couples’ exposure to various aspects of
reproductive health (Table-5.1). Comparatively more men (75.3 percent) have
recalled hearing or seeing at least one message over past one month than the women
(59.6 percent). Individually though more than half of the women and men are exposed
to messages on aspects of reproductive health, only 35.4 percent of both the couples
are exposed to at least one of the aspects of reproductive health. In the sampled
villages 87 percent of the families either a husband or wife are exposed to messages
related to reproductive health. Messages related to obstetric and gynecological aspects
more women are exposed to media than men. Whereas men are more exposed to
messages on family planning and AIDS.
Family Planning
Women who are exposed to message on family planning, 33 percent were exposed to
the message about how to stop having further children, 27 percent were exposed on
how to space between children, 23 percent exposed about postponement of first birth,
and the remaining about how many children a couple should have. Where as among
men 81 percent are exposed on how many number of children, and the remaining are
exposed on how to stop having children.
45
Women in the age group of 26 to35 years (20 percent), educated above primary level
(25.4 percent), relatively more from nuclear families (16 percent), with increase in
duration of marriage and parity, and those relatively with high earnings are more
exposed to family planning messages (Table 5.2). Similarly men educated above high
school (68.4 percent) from nuclear families (26.5 percent) married less than five years
ago (60 percent), and those working in non-agricultural activities are exposed to
family planning messages (Table 5.3).
Pregnancy Care
Health care to be taken by a mother during pregnancy was the main message on
which 63 percent of the women were exposed; where as 46 percent of men mentioned
to have exposed on health of the foetus. Exposure to pregnancy care is observed more
among women who are less than 25 years of age, younger the duration of marriage,
those educated above primary level, and women of lesser parities. Unlike women,
men exposed to pregnancy care are less. There has been a clear association with their
socio-economic status and exposure to pregnancy care. More men between 20-30
years of age, married less than two years ago, with increase in educational level,
working in tertiary sector, and those who have two or fewer children are more
exposed to media on pregnancy care.
Delivery Care
On information related to delivery care, only one-fourth of the exposed women heard
or seen a message about place of delivery; its corresponding percentage among men is
41 percent.
Women above 36 years of age are more exposed on delivery care. Apart from age,
exposure to delivery care is also associated with women if they have studied above
primary level, forward castes, women residing in nuclear families, with parity level of
2 or 3 and those from better earning families. Men aged between 21 to 30 years,
educated above high school level, working in office jobs, with lesser duration of
marriage and those from nuclear families are more exposed to messages related to
delivery care.
46
After child birth
Messages related to care after childbirth drew maximum attention of women.
However 65 percent of these women were actually exposed to the messages on child’s
vaccination. Only 15 percent of women were exposed on postpartum care. Similarly
more men exposed to messages related to vaccination of children.
Among those who are exposed, more women in the age group of 21-30 years, those
educated above primary level (47 percent), those engaged in daily wages or skilled
work, from backward castes (53 percent) and those married 3-5 years ago are exposed
to media. Among men if they are aged between 21-40 years (75 percent), with
increase in educational level, from nuclear families (17 percent), and those married
less than 5 years ago (26 percent) are exposed to messages related to care after child
birth.
AIDS
Government and non-govemmental organizations have been taking a lot of interest in
bringing awareness about AIDS. Despite all efforts only 25.6 percent of women, 71.7
percent of men are exposed to message on AIDS. A majority of the couples (90
percent) are exposed on messages related to prevention of AIDS and very few of them
(less than 5 percent) were exposed to messages on spread of AIDS. Among women
who are in the age group of 16 to 25 years (54 percent), educated (58 percent), and
non-working women (54 percent) are exposed to messages on AIDS. Three-fourths of
men aged between 21-40 years, those educated up to high school or above (94.7
percent), those working in nonagricultural activities, from backward castes and with
lesser duration of maniage are exposed to messages on AIDS.
Other Reproductive Health Problems
Messages related to reproductive health problems, i.e. other than family planning,
obstetric care and AIDS, very few women and men are exposed. Better-educated
persons from high castes are more exposed to such messages than the remaining.
47
Types of Exposure
Type of media exposure differs from women and men in the study areas. Women are
more exposed through interpersonal communication while more men are exposed
through mass media. Fewer women are exposed by multiple sources than men. Again
media of exposure among women differed with type of message. On issues related to
pregnancy and childbirth or other reproductive health problems more than 80 percent
of the exposed women have heard about it through interpersonal communication.
Whereas messages on family planning and AIDS, mass media has been the main
source for a majority of women, 66 percent and 94 percent respectively. In other
words on issues, which are socially accepted for conversation women felt convenient
to discuss and learn about it through interpersonal communication. Despite many
decades of efforts still a conversation related to family planning is not a topic of
acceptance. Io converse on AIDS is further unapproved in a community, especially
among women. Thus women largely rely on mass media as a major source of
information. In case with men though mass media has been the chief source of
information for all types of messages, yet more than half of them who have heard or
seen were also exposed through interpersonal communication and group meetings.
Men, as compared to women, have fewer inhibitions to know about the specified
issues. With in the topics, men took less interest to be acquainted with messages
related to pregnancy and childcare as many think it is an area mainly confined to
women.
Access to Reproductive Health Services
Reproductive health of women is affected by social, psychic and economic costs of
care. Access to services is in turn assessed in two ways, cognitive and physical.
Cognitive access refers to couple’s awareness about the availability of services.
Physical accessibility refers to the physical distance and travel time to reach a facility.
Reproductive health services are broadly categorized as services related to temporary
methods of contraception, medical termination of pregnancy, permanent sterilization,
pregnancy care, delivery care, postpartum care, gynaecological health problems,
sexually transmitted diseases, and AIDS.
48
Cognitive access
Cognitive levels of men and women on components of health care are culturally
controlled. Health care referring to obstetric and gynaecological health comparatively
more women reported better knowledge than men. Services related to family
planning, STDs and AIDS, more men reported better knowledge. Table-5.4 shows the
cognitive knowledge levels on access to various components of reproductive health
care. Every woman is aware of availability of pregnancy and delivery care. Almost
every woman also knows facilities for postpartum care and other gynaecological
health problems. Availability of sterilization facilities is known to 91 percent of
women. On contrary only 19 percent of women are aware of availability of temporary
methods of contraception. Services related to medical termination of pregnancy is
known to 36 percent of women, and about STDs only 28 percent of women are aware
of it. Very few women know about the availability of health care facilities for AIDS.
Cognitive levels of men on access of reproductive health services reveal that, a
majority (96 percent) is aware of sterilization facilities. Knowledge about pregnancy
and delivery care facilities is known to nearly three-fourths of men. Cognitive
knowledge about temporary methods of contraception is known to tv'o-thirds of men.
Even though knowledge about STDs and AIDS is known to more men compared to
women, barely one out of two men is aware of them.
Physical access
Cognitive levels of access to various components of reproductive health are similar to
the physical access for both women and men. That is the couple that cognized about
existence of health facilities for various components of reproductive health, are also
certain about the location of the facilities (Table-5.5). Presence of round the clock
health center (RCWHC) at Shamirpet is referred as the main source of access for
reproductive health services by all the women and men, who have expressed
awareness about physical access. While three fourths of the woman in the study areas
knew that sterilization and obstetric health services are available at RCWHC,
Shamirpet, interestingly less than one-tenth of the women knew it as a source for
temporary contraceptives and AIDS. Only one-fifth of the women knew that services
related to medical termination of pregnancy and STDs are available at RCWHC. The
next most recognized place of health facility is private clinic/hospital by the women.
49
Unlike women, men did not refer RCWHC as the main source of health facility. A
considerable percent of men recognized private clinic/hospitals as a source of health
facility for most of the reproductive health care. For temporary methods men equally
relied on medical shops. Interestingly men mentioned Anganwadi workers as source
of supply for temporary methods while none of the women ever mentioned about
them, despite the probability for more women to interact with them than men.
50
c
Table-5.1 Couples Exposed to Various Components of Reproductive Health
Through Media
Couples Exposed to Media
Components of
Reproductive Health
Women
Men
Both
Either of
the
the couples
couples
Family Planning
T3T
Pregnancy Care
3TK
Delivery Care
TTO
After Child Birth
TTd
377
TO
T5
779
30
TO
77
TO)
7JD3
70
7T77
70
77
Other Reproductive
74
70
O
T37
50
753
3M
TOT
Health Problems
At least one of the
components
51
Table-5.2 Women Exposed to Various Components of Reproductive Health
Through Media by Background Characteristics
Socio-economic
Characteristics
Current age
<=15
16-20
21-25
26-30
31-35
36-40
40+
Education
Illiterate
Up to primary
Above primary
Work status
Not working
Daily wage
Skilled worker
Business
Caste/Tribe
Scheduled caste
Scheduled tribe
Other backward caste
Others
Type of family
Nuclear
Non nuclear
Marriage Duration
<=2
3-5
6-10
11-15
16-20
21 +
Parity
0
1
2
3
4+
Daily earning
0
<=20
21-25
26-30
30+
Total
(Number)
Components of Reproductive Health
Family
Planning
Pregnancy
Care
Delivery
Care
After
Child
Birth
AIDS
Other
Reproductive
Health
Problems
0.0
12.7
15.8
20.5
20.0
6.7
0.0
16.7
40.8
35.1
23.1
6.7
26.7
35.0
0.0
16.9
21.1
15.4
0.0
20.0
25.0
0.0
38.0
45.6
41.0
6.7
40.0
30.0
33.3
1.4
29.8
28.2
33.3
20.0
25.0
0.0
12.7
8.8
5.1
6.7
13.3
10.0
8.7
9.1
25.4
23.6
30.3
49.2
14.2
9.1
27.0
33.1
30.3
47.6
18.9
18.2
42.9
7.9
3.0
15.9
16.3
11.9
5.9
12.8
40.2
32.8
11.8
21.3
18.5
19.4
0.0
17.0
38.0
46.3
47.1
17.0
33.7
23.9
11.8
17.0
10.9
6.0
0.0
14.9
10.6
14.3
14.3
12.5
27.7
32.9
35.7
25.0
19.1
15.0
21.4
25.0
29.8
36.4
53.6
25.0
23.4
24.3
35.7
25.0
4.3
10.7
7.1
25.0
16.0
6.6
31.5
32.8
18.5
13.1
37.7
34.4
24.7
27.9
9.3
9.8
13.5
12.7
18.9
15.2
22.2
2.8
46.1
38.3
27.0
18.2
16.7
27.7
15.4
27.6
18.9
3.0
11.1
23.3
32.7
53.2
37.8
39.4
11.1
30.5
21.1
34.0
24.3
30.3
22.2
19.4
15.3
8.5
8.1
6.0
0.0
11.1
11.1
17.7
15.4
13.6
10.0
48.9
33.3
7.7
25.0
20.0
11.1
24.4
25.6
18.1
8.0
20.0
51.1
48.7
43.2
24.0
26.7
26.7
33.3
22.7
20.0
20.0
6.7
7.7
6.8
6.0
15.8
8.5
17.1
2.6
33.3
1X5
(30)
42.7
17.0
41.5
13.6
40.0
19.5
12.8
17.1
10.5
33.3
34.1
10.6
26.8
13.2
53.3
11.0
6.4
9.8
2.6
26.6
31.8
(71)
17.0
(38)
39.0
36.2
51.2
10.5
53.3
36.8
(82)
25.6
(57)
TT
(21)
52
if <? ( A
2S3
I
ko
Table-5.3 Men Exposed to Various Components of Reproductive Health
Through Media
Components of Reproductive Health
Socio-economic
Characteristics
Age
<=20
21-30
31-40
40+
Education
Illiterate
Up to primary
High school
Above high school
Work status
Cultivation
Daily wage
Skilled worker
Business
Clerical
Not working
Caste/Tribe
Scheduled caste
Scheduled tribe
Other backward caste
Others
Type of family
Nuclear
Non nuclear
Marriage Duration
3-5
6-10
11-15
16-20
21+
Parity
0
1
2
3
4+
Total
(Number)
Family
Planning
Pregnancy
Care
Delivery
Care
After
Child
Birth
AIDS
Other
Reproductive
Health
Problems
0.0
30.5
18.6
11.2
0.0
26.3
13.6
4.5
0.0
14.4
8.5
2.3
0.0
22.9
15.3
0.0
50.0
79.7
72.9
50.0
0.0
5.9
1.7
2.3
3.1
13.6
35.8
68.4
4.7
13.6
27.2
42.1
1.6
3.1
50.0
1.7
19.8
26.3
11.9
66.1
25.9
31.6
87.7
94.7
1.6
0.0
7.4
22.2
15.2
12.5
20.5
63.6
55.7
84.6
88.0
21.2
10.2
33.3
16.0
6.1
12.5
23.1
12.0
40.5
48.6
100.0
100.0
23.4
18.6
50.0
12.5
12.8
19.3
25.0
12.5
26.5
14.8
3.0
3.4
15.4
12.0
27.0
0.0
16.0
21.6
0.0
91.9
100.0
3.0
0.0
2.6
4.0
16.2
0.0
74.5
68.6
85.7
62.5
2.1
4.3
3.6
12.5
6.4
17.0
10.0
15.0
17.9
12.5
17.9
25.0
17.9
19.7
11.7
6.6
13.1
70.4
75.4
3.1
6.6
32.7
27.1
32.4
13.3
22.2
5.3
42.3
12.5
18.9
6.7
16.7
2.6
23.1
4.2
16.2
3.3
5.6
2.6
26.9
27.1
13.5
10.0
5.6
0.0
86.5
75.0
75.7
66.7
72.2
47.4
7.7
6.3
5.4
0.0
0.0
0.0
22.2
35.5
28.2
24.4
8.7
2X3
(52)
35.5
20.0
25.6
6.7
33.3
18.4
(41)
11.1
4.4
37.8
33.3
8.9
0.0
82.2
80.0
82.1
68.9
8.2
13.3
2.2
5.1
0.0
0.0
16.1
~r\?r
To"
(36)
(160)
(9)
17.7
15.3
6.6
2.0
T03
(23)
17.3
53
Table-5.4 Cognitive Knowledge of Couples on Access to Various
Components of Reproductive Health
Percentage of couples
Components of Reproductive
Health
Women
Men
Either
Both
Temporaiy contraceptives
TO
TO
ITT
Medical termination of pregnancy
339
^3
733
Sterilization
PT7T
753
7E7
^73
Pregnancy care
TOO
733
TOO
70'
Delivery care
TOO
777T
TOO
7771
Postpartum care
or
557
TOO
573
Women’s other health problems
50
50
537
30
“STDs
733
503
373
T577
AIDS
T23
333
44.4
4.5
Total
773
223
223
223
54
Table-5.5 Knowledge of Couples on Physical Access to Various Aspects of
Reproductive Health
Aspects of Reproductive Health
Temporary methods of contraception
PHC/ Sub-centre /MPHA's
Pvt. Clinic/Hospital
Medical Shops / Depot Holder
Anganwadi Workers
Medical termination of pregnancy
PHC/MPHA's/ Sub-centre
Pvt. Clinic/Hospital/Voluntary agency
Govt. Medical college hospital
Medical Shops
Sterilization
PHC/ Sub-centre/ MPHA's
Pvt. Clinic/Hospital/Voluntary agency
Govt. Medical college hospital
Pregnancy care
PHC/ Sub-centre/ MPHA's
Pvt. Clinic/Hospital/Voluntary agency
Govt. Medical college hospital
Anganwadi Workers
Delivery care
PHC/ Sub-centre/ MPHA's
Pvt. Hospital/Voluntary agency
Govt. Medical college hospital
TBA’s (Dai)________________
Postpartum care
PHC/ Sub-centre/ MPHA's
Pvt. Clinic/ Hospital/ Voluntary agency
Govt. Medical college hospital
TBA's (Dai)_____________________
Gynaecological health problems
PHC/ Sub-centre/ MPHA's
Pvt. Hospital/Voluntary agencies
Govt Medical college hospital
STDs
PHC/ Sub-centre/ MPHA's
Pvt. Clinic/ Hospital/Voluntary agency
Govt./ Medical college hospital
AIDS
PHC
Pvt. Clinic/Hospital
Govt. Medical college hospital
Total
Percentage of couples
Women
Men
“6^6“
18.8
10.3
2.7
5.8
22.4
14.3
23.3
4.5
35.9
55.6
20.2
14.8
30.0
24.2
1.3
0.9
91.0
95.5
71.3
17.9
1.8
68.2
25.6
1.8
100.0
73.5
73.1
25.6
1.3
47.5
24.2
1.3
0.4
100.0
77.1
72.6
24.7
1.3
1.3
51.1
23.3
1.8
0.9
99.1
58.7
73.5
23.8
1.3
0.4
34.5
22.4
1.8
96.9
51.6
66.4
30.0
0.4
25.6
24.7
1.3
28.3
50.2
22.9
4.9
0.4
25.6
23.3
1.3
12.6
36.3
10.8
1.3
0.4
22.0
13.9
0.4
223
223
55
Contraceptive Health
Contraceptive behaviour of couples has a direct bearing on reproductive health of
woman. Contraceptive behaviour in turn depends on various factors such as cognitive
levels of the couples about pregnancy and planning of family. Thus present section
first discusses about couples perspectives to wards family planning. Apart from
individual planning, combined planning of the couples is likely to have a direct
bearing on reproductive health of the couple. Thus the role of husband towards
contraceptive health can be viewed in terms of nusbano and wife communication on
related matters. Thus the present study also focuses on this aspect. Thereafter, extent
of contraceptive usage between the couples, related morbidity and care seeking
behaviour is covered in this chapter.
Psychological Perspectives of Couples on Family Planning
Individual cognitive levels on family planning are essential to understand couples
reproductive behaviour. It also helps to recognize the extent of gender differences
towards reproductive control. In the present study psychological perspectives of
couples are analysed mainly from three broad points of view. Firstly the couples
perspectives are examined on locus control over pregnancy; secondly the couples’
self-efficiency related to usage of contraception; lastly about the couples’ perception
related to pregnancy avoidance is discussed.
Locus of Control over Pregnancy
Table-6.1 gives details of the couples by locus of control over pregnancy. The couples
are asked whether they agree or not to various traits of control over pregnancy, lhe
responses are analysed in a scale of four i.e. strongly agree, agree, disagree, and
strongly disagree. The findings indicate that nearly nine out of ten women and three
out of four men have agreed that 'if one of the couple does not desire, they cannot
have sex ’. Though the statement actually refers to both the couples, but both men and
women seem to have associated it to a husband. That is, they opine that if husband
does not desire, wife cannot have sex.
56
A majority of women (95 percent) and men (90 percent) have agreed that, most often
it is not possible to prevent a pregnancy. If a woman is meant to be pregnant, she will
be pregnant'. In other words most of the couple perceive that woman’s body is
destined to become pregnant thus prevention of pregnancy is not in one’s control.
Nearly all the couples agree that a woman is synonymous to pregnancy. While
acknowledging the association between woman and pregnancy, yet all these women
also agree that a couple can limit the number of children they want. Whereas still one
fourth of the men disagreed and three fourths of them agreed that a coupe can limit
the number of children. Even though most of the women thought that a couple can
limit the number of children they want, at the same time nine out of ten women think
that ''luck plays a big part in determining whether a woman can keep from getting
pregnant'. Interestingly comparatively few men thought the role of luck than women.
Despite women’s reliance on luck, again women accept the role of individual
behaviour. Nine out of ten women agreed that, lif a couple is careful, an unwanted
pregnancy will rarely happen'. Eight of ten men agreed with it.
The opinion of women and men on locus of control over pregnancy though infers that
women have been expressing contradictorily, it in turn indicate that a majority of
women believe in having a control over pregnancy, provided they have a control on
their bodies. The reactions of men on control over pregnancy is not so varied as that
of women probably because men assume that woman’s, may be wife’s, body is in
their control.
Self-efficiency Related to Usage of Contraception
Cognitive levels on self-efficiency on usage of contraception not only elicit individual
capabilities but also reflect the gender differentials in a community. Self-efficiency is
addressed to only those couples that were not using any method of contraception
(Table-6.2). The responses of couples are categorized in a similar manner, as that of
previous section on locus of control over pregnancy. Perceptions related to ‘capability
to obtain a method of family planning' indicate that more than eighty percent of
women do not cognize that they have a capacity where as 95 percent of men feel that
they have the capability. One of the reasons for not in favour of a temporary method
of contraception is reflected in couples’ opinion that, nearly 90 percent of both the
couples admitted that they find great difficulty in always remembering to use
57
contraception in order to avoid pregnancy. Though opinion on couples is similar with
respect to memory, it differed in terms of coital behaviour. When asked on 'ifI could
not get contraception, I could still keep myself not contributing to pregnancy by
refraining from sexual activity', there has been vast differences in opinion between
women and men. Nearly 80 percent of women felt that they could not refrain from
sexual activity. In other words women do not have control on their bodies. Where as,
opinion of men differed. Nearly half of the men felt that they could refrain from
sexual activity. Similarly there is a difference in perceptions of women and men about
the capability to use a contraceptive method every time when they wanted to use.
Nearly 80 percent of women disagreed with the statement, i.e. they felt they do not
have the capability where as 77 percent of men expressed that they have the capability
to use contraception as and when they desired.
It is again convivial to know that more than half of the women (57 percent) disagreed
to the statement on 'negotiating with spouse about the use of a method of family
planning would be impossible for me\ In other words, 57 percent of the women felt
that they could negotiate with their husbands. Slightly more men (63 percent) felt that
they could negotiate with their wives.
One way to maintain better reproductive health is to practice single-sexual partners
and the capacity to impress upon the spouses to follow it. It also reflects the level of
confidence one has upon other. Eighty two percent of women agreed to the statement
that, V am capable of persuading my spouse from extramarital sexual contacts'.
Relatively few men (71 percent) felt that they can persuade their wives. More
encouraging aspect in the context of reproductive health is that, nearly 95 percent of
both the couples agreed that they are capable of seeking treatment if they have any
reproductive health problems.
Information on self-efficiency brings out certain extreme perceptions of women. On
one-hand women seems to have no capabilities to obtain a method and have denied
the capability to use a method whenever they wanted, which indicates poor cognitive
access to contraception as well as their inability to ascertain themselves. Their
inability is again reiterated by not able to refrain from sex, if contraception is not
available. In contrast women seems to have confidence in negotiating their husbands
58
about usage of a family planning method. Probably here women have indicated about
terminal methods and not the temporary methods. In a society where by and large
across all communities a small family size has been accepted, probably negotiating
husbands in favour of terminal methods, especially tubectomy is not felt difficult by
women. However to negotiate husband in favour of usage of temporary contraceptive
methods is difficult because of the unequal power relations in the family.
Woman’s self-efficiency in negotiating their husbands against extramarital sexual
relations has to be understood with a caution. Is it really likely the women have the
capability or is that women assume that they can restrain their husbands from
extramarital sexual relations?
Value of Pregnancy Avoidance
Table 6.3 gives couples’ perceptions on value of pregnancy avoidance. The couples
are asked to reply how they value to each of the statements related to avoidance of
pregnancy, i.e. whether they feel it important or not and how severely they feel about
each of the statements. The responses are categorized as unimportant, mildly
important, moderately important and very important. The opinion about pregnancy
avoidance is asked to only those women who have not adopted permanent method of
contraception.
Couples who are uncertain about future need of children are asked to react to the
statement: 'how important it is to you to have no more children'. Almost every
woman mentioned that it is very important for her not to have any more children in
future. Where as opinion of men differed. Fifty percent of men agreed with women,
33 percent moderately agreed to the statement, but 11 percent felt it is unimportant i.e.
these 11 percent of men opine that to have children is necessary. Even though all
women said that to have no more children is very important to them, yet not all could
agree to the statement that, 'because I do not want to have more children, I make sure
that I am protected from getting pregnant'. Where as, men’s opinion is by and large
in coherence with previous opinion. This in turn reflects on the capabilities of the
women to have a say or control over future pregnancies. Despite woman’s
unwillingness, they are not certain to take a decision in accordance to their will.
59
The couples intending to have more children were asked to mention their opinion on
two aspects. First, couples were asked about, lhow important it is to delay the birth of
your next child'' and secondly on ‘because I want to delay having more children, I
make sure that I am protectedfrom getting pregnant Eighty seven percent of women
felt it is very important for them to delay the birth of next child, yet all could not
protect themselves from getting pregnant. It indicates that all women are not capable
of either obtaining a method of contraception, or persuade their husbands in favour of
postponing pregnancy by protecting one self.
Husband and wife Communication
An understanding between husband and wife is necessary to avoid untimely as well as
unnecessary pregnancies so that it may avoid deterioration of woman’s health in
general and reproductive health in particular. Table-6.4 gives details related to
husband and wife communication among the study couples. The table draws attention
on two aspects. Primarily, nearly six out of ten couples (57.8 percent) have ever
discussed about issues related to fertility. Secondly, there are differences in reporting
between women and men, especially on certain topics.
A further analysis of the couples who ever had a discussion indicate that, educated
couples from forward castes, nuclear families, and those married 3 to 10 years ago
with two children communicated on issues related to fertility among themselves
(Table-6.5). In other words with increase in education levels, couples from better
social status felt comfortable to communicate with each other. Extent of discussion on
various topics related to reproduction varied. Table-6.4 shows that more couples
reported to have had a discussion on ‘total number of children required’ (47.5
percent); ‘whether to use a method or not’ (46.2 percent); ‘type of method’ (47.1
percent); and ‘who should use between the couples’ (45.3 percent). Also the findings
indicate that only a few couples discussed on whether to use a contraceptive method
prior to first pregnancy (22.9 percent), and hardly any one discussed on postponement
of a pregnancy or spacing between children. All this in turn reveals that the couples
who ever initiated a discussion was more about usage of terminal methods rather than
on temporary methods, i.e. those who have already attained the desired family size.
60
More w^men reported to have had a discussion between the spouses than the men.
Differences in reporting varied by type of topics (Table-6.4). More women than men
said that they had a discussion related to number of children the couple wanted; to use
a contraceptive method or not; type of method to be used; and who should use. Where
as relatively more men said that they had discussions on spacing and postponement of
children. Differences in reporting are minimal only on two topics, i.e. whether they
have ever discussed prior to first pregnancy or not, and whether to consult a medical
person prior to use a method.
Current Use of Contraception
A little more than half of the couples (53.5 percent) are using contraception at the
time of survey (Table-6.6). A majority of them are adopters of permanent methods of
contraception, 92.4 percent are users of female sterilization and 0.8 percent (one
person) is a user of male sterilization. Even though only a few couples (6.8 percent)
used temporary methods of contraception, there is a difference in reporting between
the couples. More men have reported about usage of condoms and periodic abstinence
than women. The couples who were using temporary methods are married less than
five years ago; living separately i.e. in nuclear families; educated i.e. husbands studied
above high school level and wife educated above primary level; and are having one or
no children.
The median age at sterilization for the women in the villages is 21 years. Iable-6.7
gives details of the couples those have opted for a permanent sterilization. Nearly six
out ten couples are illiterates. Relatively more workingwomen preferred to go for
sterilization then non-working women. A higher percent of wives, whose husbands
engaged in business, have gone for sterilization. Three out of four women are
sterilized by the age of 30 years. Seven out of ten women went for sterilization by 10
years of completed married life and with two living children. Relatively a higher
percent of couples living in nuclear families adopted sterilization than those living in
joint families.
Situations leading to use of contraception
Table-6.8 gives various details pertaining to usage of contraception by the couples.
Motivating persons behind the couples to use a method of contraception differs
61
between couples. Nearly half of the men were self-motivated to use a contraceptive
method to limit the number of children. Comparatively fewer women (30 percent)
were self-motivated than men. In other words women depended more on others rather
than self for usage of contraception. This is more so if they have to use temporary
methods of contraception. Only one-third of the couples together were motivated to
use a method of contraception. Once motivated there is an improvement in making
decisions by self among women (41 percent). Thus, either individually or in
consultation with husband 71 percent of women could decide to use a contraceptive
method. Corresponding percentage for men is 79 percent. The main reason to opt for
a contraceptive method by the couples is to stop further pregnancies. Thus 97 percent
of the total users of contraception are adopters of sterilization. One woman in the
study villages opted to go for a hysterectomy instead of tubectomy due to prolonged
menstruation. Interestingly three men expressed that their wives have opted for
tubectomy to either postpone pregnancy or to have a gap between pregnancies. This in
turn suggests lack of adequate knowledge on methods of contraception.
Contraceptive Morbidity and Utilization of Health Services
Out of total women who have used a method of contraception, 16.7 percent of women
reported to have suffered from illness after its use. All of these women are users of
terminal method, i.e. the women who underwent tubectomy. A further analysis of the
woman suffering from contraceptive morbidity is carried out to understand the non
medical factors determining the morbidity. The findings of the logistic regression
analysis reveals that (Table-6.9), ‘marriage between non-relatives’; ‘husband and wife
communication’; ‘type of family’; ‘caste’; and ‘having a health center in the village’
are proved to be significant determinants of a woman suffering from contraceptive
morbidity. In other words, if a woman is not related to her husband prior to marriage
she is likely to suffer from 0.331 times more than those women who are related prior
to marriage. Again if she is living in a joint family she is likely to suffer 0.111 times
more than the women living in nuclear families. A workingwomen is more likely to
suffer from contraceptive morbidity by 4.0756 times more than non-workingwomen.
Women from scheduled castes or tribes are likely to suffer from contraceptive
morbidity 3.739 times more than the women from other castes. Having a
communication between husband and wife (0.070) showed a positive association with
62
contraceptive morbidity and similarly having a health center in a village (0.095) is
positively associated with contraceptive morbidity.
These findings infer that those women living in joint families especially married to
non-relative is likely to feel hesitant and probably may not be in a position to express
the need to rest for self after a tubectomy. This is more likely in deprived
communities where working outside home does not empower her position in the
family rather becomes a requirement at the cost of health. Similarly the relationship
between husband-wife communication and presence of the morbidity probably
indicates differently that is, having morbidity might have helped the couple to
communicate with each other. In a similar manner having a health center in the
village might have encouraged the women to acknowledge the morbidity.
Among the women who have suffered from contraceptive morbidity, 76.3 percent
sought treatment. A review of the women who have not sought treatment indicates
that (Table 6.10), a majority of them are from non-nuclear families, either relatively
younger aged women or those reaching to menopause, deprived communities (either
belong to scheduled castes/ tribes or backward castes), and have never discussed with
husbands about their problem. Relatively a higher percent of workingwomen did not
seek treatment than non-working women.
In other words it suggests that younger
aged women living in non-nuclear families probably feel hesitant to seek treatment, as
they have to take head of the household’s permission. Women from deprived classes,
those working for wages may be do not wish to forego their wages for a day or not in
a position to spend money to seek treatment vis-a-vis other immediate priorities.
Among those who have sought treatment, a majority of these women preferred private
clinics or hospitals (64.3 percent) than from public health facility like the RCWHC
(35.7 percent).
Future reproductive planning
Nearly half of the women (50.2 percent) are not the adopters of a permanent method
of contraception in the study villages. A majority of these women are intending to
have more children in future. After achieving the desired number of children, 89
percent of the women are interested in using any method of contraception. Of them
63
only half of them are clear about their future choice of method. These women prefer
to go for a tubectomy, as they want to stop further pregnancies. Among the remaining,
even though a few do want to have any more children yet are unsure about usage of
contraception mainly because of uncertainty of their husband’s decision.
64
Table 6.1 Percent of Couples by Locus of Control Over Pregnancy
Aspects related to Locus of Control over Pregnancy
If one of the couple does not desire, they cannot have sex.
o Strongly Agree
o Agree
o Disagree
o Strongly disagree
Most often it is not possible to prevent a pregnancy. If a
woman is meant to be pregnant, she will be pregnant
o Strongly Agree
o Agree
o Disagree
o Strongly disagree
A couple can limit the number of children they have
o Strongly Agree
o Agree
o Disagree
Strongly disagree
o
_________________ __________
Luck plays a big part in determining whether a woman
can keep from getting pregnant.
o Strongly Agree
o Agree
o Disagree
o Strongly disagree
If a couple is careful, an unwanted pregnancy will rarely
happen
o Strongly Agree
o Agree
o Disagree
o Strongly disagree
Total Couples
Women
Men
48.4
39.9
7.6
4.0
35.9
47.1
15.7
1.3
21.5
72.2
5.8
0.4
17.9
73.1
9.0
0.0
73.1
21.1
5.4
0.4
48.9
27.4
23.3
0.0
49.3
30.5
17.5
2.7
24.7
34.1
38.1
3.1
62.3
31.4
5.4
0.9
18.8
58.3
21.1
1.8
|
I2J
65
Tabic 6.2 Percent of Couples by Self-efficiency related to Usage of Contraception
Aspects related Self-efficiency on usage of contraception
Capable of obtaining a method of family planning
o Strongly Agree
o Agree
o Disagree
o Strongly disagree
I have great difficulty in always remembering to use
contraception in order to avoid pregnancy
o Strongly Agree
o Agree
o Disagree
o Strongly disagree
TO could not get contraception, I could still keep myself
not contributing to pregnancy by refraining from sexual
activity
o Strongly Agree
o Agree
o Disagree
disagree ______ ___
_________ o Strongly
_____________
I am capable of using contraccptive method every time
when I need
o Strongly Agree
o Agree
o Disagree
disagree
o Strongly
____________
_____ ___________________
"Negotiating with my spouse about the use of a method of
family planning would be impossible for me
o Strongly Agree
o Agree
o Disagree
disagree
_________ o Strongly
_______________________
I am capable of persuading my husband-{restraiiiiiig my
self) from extra-marital sexual contacts
o Strongly Agree
o Agree
o Disagree
o Strongly disagree
I am capable of seeking treatment if I have any
reproductive health problems
o Strongly Agree
o Agree
o Disagree
o Strongly disagree
I Total Couples
Women
Men
2.9
16.5
35.0
45.6
42.7
52.4
3.9
1.0
40.8
47.6
10.7
1.0
23.3
65.0
11.7
0.0
1.9
19.4
63.1
15.5
3.9
40.8
52.4
2.9
3.9
18.4
39.8
37.9
23.3
53.4
22.3
1.0
2.9
39.8
31.1
26.2
1.9
35.0
48.5
14.6
21.1
61.4
17.0
0.4
9.9
61.4
25.6
3.1
39.0
55.6
4.9
0.4
13.0
83.4
3.6
0.0
HET"
(46.2)
66
Table 6.3 Percent of couples by Value of Pregnancy Avoidance
Aspects related to Value of Pregnancy Avoidance
Extent of self importance to have no more children
o Unimportant
o Mildly Important
o Moderately Important
o Very Important
Because I do not want to have more children, I make sure
that I am protected from getting pregnant
o Unimportant
o Mildly Important
o Moderately Important
Important
o Very
_______
Total couples Answ ered
Extent of importance to delay the birth of your next child
o Unimportant
o Mildly Important
o Moderately Important
o Very Important
^Because”! want to delay having more chiTdreh, I make sure
that I am protected from getting pregnant
o Unimportant
o Mildly Important
o Moderately Important
o Very Important
Total Couples
Women
Men
0.0
0.0
0.0
100.0
11.1
0.0
33.3
55.6
0.0
12.5
0.0
87.5
11.1
0.0
44.4
44.4
K
0.0
12.5
0.0
87.5
66.3
12.9
7.9
12.9
75.5
11.8
6.9
5.9
63.4
15.8
8.9
11.9
101
(45.3)
67
Table-6.4 Details of Husband and wife Communication with respect to Fertility
and Contraception
Various aspects
Total number of children required
Percent of
Percent of
Wives
Husbands
1T7
T73
7TT
Whether discussed prior to first pregnancy
Post pone children
Z7
Space between children
TO
Whether to use a contraceptive method or not
7Z9
Type of method
OT
3K7T
Who should use between the couple
453
TH
Availability of a contraceptive method
3CT
3T4'
Health problems as a consequence of
T73
TO
To consult a medical person prior to use a metlibcf
S.l
33
Couples ever had a communication with each
57.8
553
other
(129)
(124)
contraceptive usage
Total number of couples
223
68
Table 6.5 Background Characteristics of the Couples who had Communicated
with Each other on Aspects Related to Reproduction
Socio-economic Characteristics
Education
Illiterate
Up to primary
Above primary'
High school
Above high school
Work status
Not working
Daily wage
Skilled worker
Business
Clerical
Cultivation
Current age
<=15
16-20
21-25
26-30
31-35
36-40
40+______________
Duration of marriage
3-5
6-10
11-15
16-20
21 +
Parity
0
1
2
3
4+
Religion
Hindu
Muslim
Christian
Caste/Tribe
Scheduled caste
Scheduled tribe
Other backward caste
Others
Type of family
Nuclear
I Non nuclear
** No observations
*** Not Categorized
Percent of
men
Total
Number
39.1
67.8
»**
64
59
♦ ♦♦
55.6
73.7
81
19
♦*
100.0
50.0
48.7
64.0
64.9
60.6
1
88
39
25
37
33
0.0
50.7
57.9
71.8
86.7
60.0
50.0
6
71
57
39
15
15
20
0.0
39.7
76.0
64.3
58.8
50.0
2
68
50
42
17
44
40.4
63.8
64.9
57.6
83.3
55.6
52
47
37
33
18
36
50.0
48.9
67.6
66.7
55.6
50.0
52
47
37
33
18
36
35.6
46.7
82.1
65.9
62.0
45
45
39
44
50
28.9
64.4
71.8
65.9
52.0
45
45
39
44
50
58.1
57.1
50.0
203
14
6
55.2
71.4
33.3
203
14
6
53.2
37.5
58.6
67.9
47
8
140
28
511
25.0
55.7
71.4
47
8
140
28
61.7
47.5
162
61
58.6
47.5
162
61
Total
Percent of
Number
women
Couples communication
52.0
66.7
65.1
**
127
33
63
♦*
63.4
47.1
65.4
59.6
**
82
68
26
47
69
Table 6.6 Current Use of Contraceptives by Couples in the Villages
Type of Contraceptive method
Percentage
According to
wives
Percentage
According to
Husbands
94.0
0.9
92.4
0.8
1.7
0.9
1.7
1.7
0.8
2.5
0.9
1.7
523"
(H7)
313"
Type of Method
Permanent method
Female Sterilization
Male Sterilization
Modem Temporary methods
- IUD
- Oral Pills
Condoms
Traditional methods
Periodic abstinence
’Total Users
Total Couples
(119)
123
70
Table 6.7 Background Characteristics of the Couples who have used a
Permanent Method of Contraception
Socio-economic Characteristics
Total
Percent of
Number
women
Individual characteristics
Percent of
men
Total
Number
70.3
52.5
64
59
38.3
21.1
81
19
0.0
50.0
43.6
60.0
45.9
54.5
1
88
39
25
37
33
0.0
11.8
44.0
69.0
88.2
84.1
2
68
50
42
17
44
Education
Illiterate
Up to primary
Above primary
High school
Above high school
61.4
45.5
28.6
**
Work status
Not working
Daily wage
Skilled worker
Business
Clerical
Cultivation
37.0
56.7
82.4
53.2
**
Current age
<=15
16-20
21-25
26-30
31-35
36-40
40+
Common characteristics
Duration of marriage
6
0.0
71
12.7
57
49.1
39
76.9
15
100.0
15
86.7
20
80.0
Percent of couples
Number of couples
0.0
21.3
69.4
•84.8
94.4
83.8
52
47
36
33
18
37
0.0
4.4
71.8
82.2
89.8
45
45
39
45
49
50.2
50.0
33.3
203
14
6
Caste/Ti ibe
Scheduled caste
Scheduled tribe
Other backward caste
Others
44.7
25.0
53.6
46.4
47
8
140
28
Type of family
Nuclear
Non nuclear
51.9
44.3
162
61
59.7
37.4
124
99
3-5
6-10
11-15
16-20
21+__________________
Paritv
0
1
2
3
4+
Religion
Hindu
Muslim
Christian
Had Communication
Yes
No
** No observations
*** Not Categorized
127
33
63
♦♦
92
67
17
47
71
Table-6.8 Particulars of Usage of Contraceptive Methods by Couples
Usage of Contraceptives
Particulars
Permanent
Method
Women Men
Motivated by
Self
Spouse
Both
Parent-In-laws
Others
Decided by
Self
Spouse
Both
Reason to use a method
Postpone pregnancy
Gap between pregnancies
Stop further pregnancies
Health concerns
Total Users by method
Femporary
Method
Women Men
30.6
28.8
30.6
1.8
8.1
50.5
12.6
30.6
0.9
5.4
0.0
66.7
33.3
0.0
0.0
75.0
0.0
12.5
0.0
12.5
41.4
28.8
29.7
55.9
10.8
33.3
0.0
66.7
33.3
75.0
0.0
12.5
0.0
0.0
99.1
0.9
0.9
1.8
97.3
0.0
50.0
50.0
0.0
0.0
50.0
37.5
0.0
12.5
in
“8
(3.6)
(49.8)
Total contraceptive Users
119
(53.4)
72
Table-6.9 Logistic Regression Analysis of Contraceptive Morbidity
Dependent variables
Contraceptive Morbidity
Women’s Age
Women’s Education
Women’s work status **
Men’s Age
Men’s Education
Men’s work status
Type of family **
Marriage Duration
Parity
Husband-Wife Communication *’
Consanguineous marriage ’
Caste **
Having Property
Availability of Health Centre **
13
.221
-.447
1.559
-.039
.473
-1.511
1.511
.404
-.038
1.303
-1.106
1.319
.042
1.203
.546“
.630
.744
.720
448
818
.948
.856
.594
.719
.664
.861
.709
.720
Exp (By
0'4^
.639
4.756
.962
1.605
.221
4.529
1.497
.963
3.681
.331
3.739
1.043
3.329
* Indicates sigmjicance
significance at .U1
.01 percent tevci.
level.
★^Indicates significance at 0.1 percent level
73
Table 6.10 Women suffering from Contraceptive Morbidity and Health
Care Seeking Behaviour by Background Characteristics
Background Characteristics
Women’s Age
<=30
30-40
40+
Education
Illiterate
Literate
Work status
Working
Not working
Castc/Tribe
Scheduled caste/Scheduled tribe
Backward castes
Type of family
Nuclear
Non nuclear
Husband wife communication
on Contraceptive morbidity
Discussed
Not discussed
Availability of Health Center
Available
Not available
Total
Percent of women suffering from
morbidity
Treatment
Bid not seek
sought
treatment
62.5
85.7
75.0
37.5
14.3
25.0
73.3
75.0
26.7
25.0
69.2
83.3
30.8
16.7
75.0
74.4
25.0
80.0
50.0
20.0
50.0
100.0
70.6
0.0
29.4
71.4
75.0
25.0
28.6
73.6
26.3
26.6
74
Fertility Behaviour and Obstetric Health
The present chapter discusses on couples’ fertility behaviour and its impact on
obstetric health of women. Primarily the chapter first focuses certain aspects related to
marriage, because in the Indian context largely fertility occurs with in the union of
marriage.
Particulars related to Marriage
Median age at marriage for the women in the sampled villages is 15 years and for men
it is 21 years. An increase in age at marriage of women and men is only marginal over
the years. Median age at marriage of the women currently aged between 20-25 years
is 16 years and that of women who are currently aged between 40-49 years is 15
years. As against the practicing age at marriage, 89 percent of the women are aware
that minimum legal age at maniage for girls in India is 18 years. More men (95
percent) are aware about girl’s legal age at marriage. Knowledge about legal age at
marriage of boys is relatively lesser among both women (78 percent) and men (88
percent). Parents wants their daughters to be married at an early age is mainly for the
fear of rising dowry demands with time. Parents are not worried about the reparations
of early age at marriage. Rather every one opines that a girl’s happiness lies in her
being married.
Consanguineous marriage is a practice in the villages under study. More than onethird of the couples (36.3 percent) are related to each other before their marriage.
Many of them have married to their first cousins, and a few women were married to
their maternal uncles. Parents play a major role in deciding the marriage of daughters.
Before deciding the marriage, 10 percent of the women were not consulted by their
parents. The remaining 90 percent of the women though were consulted by their
parents before the marriage, but to seek their opinion was mere a formality. In a real
sense girl’s parents decide the marriage according to their choice and assume that they
are making a best decision for the daughter and most of the daughters too opine the
same.
75
Fertility Behaviour
Out of total 223 couples, 178 women (79.2 percent) had live birth at least once in life.
The median age at first pregnancy for these women is 17 years and median age at last
pregnancy for the sterilized women is 21 years. Median number of children ever bom
per woman is 3.
The median number of children bom to the women, who have
married more than 16 years, is 4. Twenty percent of the women never had a live
birth. Of them 11.7 percent never conceived where as 8.5 percent experienced
pregnancy, but never had a live birth. All these women are below 30 years of age;
68.9 percent of them are aged between 16-20 years, 13 percent are below 16 years of
the age the remaining are between 20-30 years of age.
Reporting on pregnancy particulars is given in Table-7.1. By and large men and
women reported similarly on information related to successful out come of a
pregnancy. That is information about number live births, number of currently
surviving and non-surviving children, knowledge about date of last birth, and timing
of last pregnancy. The differences in reporting between women and men were related
to still birth, abortion, and current pregnancy. An analysis of in-depth interviews of
the couples that reported differently reveals that, there was an occurrence of stillbirth
and women did not want to acknowledge stillbirth while husbands did not mind
giving the details of it. Women insisted the stillbirths as infant deaths. In the
community it is considered that death of an infant could occur due to various
‘external’ reasons, whereas a stillbirth is associated to women. Probably women do
not want to be held self-responsible and subject to criticism, thus may be trying to
evade the truth of stillbirths. For the same reason less men knew about wife’s
abortions. The three women have not informed their husbands or parents-in-law about
the abortions they had. Perhaps for this reason one woman did not disclose about her
pregnancy to husband, as she wants to wait until certain period to confirm the
continuity of pregnancy. The differences in reported by women and men also suggest
the existing gendered attitude towards women. Woman’s relative position in the
family and immediate family is largely related to her reproductive capabilities. Thus
the desire to conceive among women, especially soon after marriage, is very much
apparent in the reply of women on timing of pregnancy. The women who were
pregnant during the reference period were asked to express whether they wanted to be
76
pregnant at that time or not. Every woman replied the desire to be pregnant. Even
though almost all of their husbands agreed, one person admitted that his wife had
become pregnant accidentally. On contrary his wife wanted to be pregnant and bear a
child to improve her relative position in the house. This particular woman wanted the
child, as it was her first pregnancy.
Obstetric Health
The present section discusses about various aspects of obstetric health in terms of
realization for the need for a care, the deciding persons in promotion of care, actual
care taken by the women during three specific periods viz. antepartum, intrapartum,
and postpartum. Also women’s expectation of support from husband versus actual
support received is analysed. Apart from the women who have experienced pregnancy
recently, also opinion of the other women’s expectation of care during specific
periods of obstetiic health is examined.
Characteristics of the Women
Of the total 223 couples identified for the study, ninety-four women (42.2 percent)
had experienced pregnancy during the reference period of two years. Of them 7
women were pregnant more than once during the reference period. Table-7.2 gives
socio-economic details of these women. A majority of the women (54.3 percent) are
aged between 16-20 years and 35 percent are between 20-24 years of age. One fifth of
the women are pregnant for the first time and another one fifth of the women are of
parity two. Thirty eight percent of the women are of parity one and 4.3 percent of
women are of parity four or more. Forty three percent of these women are illiterate
and 38 percent of them are educated above primary level. Most of the women belong
to deprived sections; 58 percent are from backward castes and 30 percent are from
scheduled categories. Three fourths of them are living in nuclear families. Thirty
seven percent of the women are related to their husbands prior to marriage. More than
half of the women (53 percent) are engaged in income generating activities.
Antepartum Period
The safe motherhood initiate proclaims that all pregnant women must receive basic,
professional antenatal care (Harrison, 1990). Ideally antenatal care should monitor a
77
pregnancy for signs of complications, detect and treat pre-existing and concurrent
problems of pregnancy, and provide advice and counseling on preventive care, diet
during pregnancy, delivery care, postnatal care, and related issues. The Reproductive
and Child Health programme recommends that as part of antenatal care, women
receive two doses of tetanus toxoid vaccine, adequate amounts of iron and folic acid
tablets or syrup to prevent and treat anaemia and at least three antenatal check-ups
that include blood pressure check-ups and other procedures to detect pregnancy
complications (Ministry of Health and Family Welfare, 1997,1998b).
Details ofAntenatal Care and Role of Husband
Results indicate a high rate of antenatal care utilization by women (96.8 percent) in
the villages (Table 7.3). All of them had antenatal care from one or more qualified
health personnel for care; 89 percent went to allopathic doctor, 27.5 percent to Multi
purpose health worker in the RCWHC and 2 percent to other health personnel. Either
the elderly female family members or the husbands are the main persons advised the
women to seek treatment. Actual decision to seek treatment is rested with husbands in
more than half of the women (51.6 percent).
The next main person involved in
decision-making is the elderly female member of the family. Less than one-tenth of
the woman could decide by herself on the need to take a treatment. It is interesting to
know that; there has been an apparent difference in the place of antenatal care sought
by women and the deciding person. When husband or elderly female member of the
family decided about the need for antenatal care, the women sought antenatal care
from private allopathic doctor or a Government maternity hospital. When women took
a decision by her a majority went to the RCWHC or sub-centre.
Nine out of ten women, who had an antenatal care, were tested for risk pregnancy
(Table-7.4). Relatively more women who have sought care from a private doctor were
tested against risk pregnancy. Ninety-eight percent of the women were given lb A
tablets, and 96 percent took IT injections. Nine out of ten women had weight and
height measured, blood pressure was tested, their blood and urine was tested. A
majority of the women received advise during antenatal care was related to food (98
percent); followed by advise on danger signs of pregnancy (65 percent).
78
o
Antepartum Morbidities and Treatment seeking Behaviour
Out of total women who have been pregnant during reference period, 47.8 percent
suffered from antepartum morbidities. Table 7.5 gives details of women suffered from
various morbidities during antepartum period. The table also provides information
about awareness levels of husbands about different antepartum morbidities faced by
their wives. The findings reveal that a majority of the husbands (64.4 percent)
reported that they are not aware of the morbidities faced by their wives during recent
pregnancy. Seven percent of the husbands mentioned that their wives never faced any
morbidity, while the wives did suffer from illnesses.
lable 7.6 provides information about women suffered from antepartum morbidities
vis-a-vis the role of husband on decision to seek antenatal care or not. For morbidities
such as fits and bleeding during pregnancy all husbands perceived the necessity to
seek treatment thus advised their wives to go for treatment. For other morbidities like
fever for more than 3 days, severe vomiting, varicose veins more than half of the
husbands decided in favour of seeking a treatment. For the remaining morbidities
other members of the family, mostly the elderly women at home decided the need for
seeking a treatment. Irrespective of the ailment, a majority of the women sought
treatment from a qualified health professional, i.e. an allopathic doctor (Table 7.7).
Support ofMen towards IVives during Pregnancy: Expectation versus Reality
I his section unveils the differences in opinion of women and men regarding the role
of husbands towards wives during pregnancy. Also an attempt is made to look at the
disparities in expectation of wives, who were pregnant during the reference period,
vis-a-vis the actual support extended by the husbands during pregnancy. Table 7.8
reveals that almost every woman, irrespective of their age or parity, expects their
husbands to extend care. Especially expectations are high with respect to emotional
support, health and nutritional care. On physical help like managing older children or
assisting in- household work less than three percent of women opine that there is no
necessity for husbands to extend help. On the other hand, less than half of the men
ever felt that they to extend support to wives during pregnancy. A majority of these
men reported that they have to extend emotional support and the care towards wives’
health by either taking the wife for antenatal checkup or by arranging someone to go
79
with wife for a checkup. Only one out ten men perceived their role in terms of
physical help.
All the women who had been pregnant during the reference period opine that
husbands should extend emotional support, health care and nutritional care (Table
7.9). On extending physical care two percent of women felt no necessity and the
remaining 98 percent felt the need. Opinion of the husbands is far below than the
expectations of wives. Nearly half the men feel that they have to talk affectionately
when wife is pregnant and perceived their responsibility in providing necessary
support to have antenatal care. Even though not many men opined their role as
supporters to wife during pregnancy, more women felt or reported that their
husband’s did extend support related to health, nutrition and physical help. There has
been a shortfall in opinion related to emotional support.
Intrapartum period
Intrapartum is the shortest phase compared to ante and postpartum periods.
This
phase is unpredictable and at any time during labour, complications may develop.
Place of Delivery
Once a woman is pregnant, the family plans about the place of delivery. It is assumed
that if actual place of delivery is different to that of actual place of delivery7, there is a
probability of occurrence of an emergency, which might have forced for the change.
The Table-10 shows that in the present study, a majority of the women had a delivery
as per the plan. Less than two percent of deliveries though initially planned to have at
an institution, private hospital. Around 8 percent of women though initially planned
for a home delivery, however finally they had to go to an institute; 2.8 percent at
RCWHC and 4.3 percent at private hospital; due to prolonged or difficult labour.
An analysis by place of delivery also reveals that nearly 75 percent of women
delivered at an institution. Despite a high level utilization of health sendees during
antepartum period, there is a decline in institutional health care for delivery in the
villages. A separate analysis by place of delivery by background characteristics of
women reveal that relatively more women who are educated, nonworking, from non-
80
deprived castes, lower parities, nuclear families had a delivery at institution than the
other women (Table 7.11). Also the table reveals that when husband is the main
decision maker regarding place of delivery, there are higher chances for women to
have a delivery at institution. An analysis by logistic regression revels similarly
(Table?. 12). Among various socio-economic variables, women works status (0.302),
type of family (0.190), having a vehicle in the house (5.958), and deciding person
about place of delivery (4.725) came out as significant determinants of utilization of
health facilities for delivery. That is if a woman is not working, from nuclear family,
when husband is the deciding person and if household has a vehicle there are more
chances for woman to have an institutional delivery.
Intrapartum Morbidity
Women suffered from morbidities during delivery are given in Table 7.13. Among the
women who give birth to a child during the reference period, 39 peicent have suffered
from intrapartum morbidities. Of these women nearly 60 percent had to undergo
caesarean section, 22 percent experienced labour for more than 18 hours, 15 percent
suffered from excessive bleeding and in another 15 percent of cases child was not
bom five hours after the sac burst. One out of ten women were recorded with high
Blood Pressure and the baby was in breech position. Despite such experiences by the
wives, 74.3 percent of their husbands reported that their wives had no problems
during delivery. Three percent of men admitted that they ignorant about wives
experiences of intrapartum morbidities. It is likely that because of the nature of these
morbidities, excepting one woman all of them had an institutional delivery (Table
7.14). In other all these women were taken to a hospital having experienced problems
at the time of delivery. The deciding person about the place of delivery in turn
reiterates that in majority of the cases it is the elderly women who took a decision in
favour of institution. Husbands’ were involved in decision making on visible
morbidities such as, long period of labour and if caesarean was required.
Support of Men towards Wives during Delivery: Expectation versus Reality
This section reveals the differences in opinion of women and men regarding the role
of husbands towards wives during delivery. In addition an attempt is made to look at
the disparities in expectation of wives, who were pregnant during the reference
period, vis-a-vis the actual support extended by the husbands during delivery.
81
Findings reveal that 99 percent women of all ages expect their husbands to extend
care (Table 7.16). Expectations are equal with respect to physical, health and financial
care. On emotional support there is a marginal decline in expectation. On the other
hand, three fourth of the men visualize their support only in terms of finances. Less
than half of them thought they could support in calling a health personnel and even
less than a quarter of men realized their responsibilities in terms of getting necessary
medicines or arranging transportation. Least considered support by men is on
emotional front.
Opinion of women who had been pregnant during the reference period and their
husbands did not alter much to the opinion of over all women and men in the
community regarding extension of support to wives during delivery (Table 7.17).
Actual support extended by husbands, compared to the opinions expressed by them is
shortfall on all aspects excepting the emotional support. In other words even though
many men opined that their major role lies in extending financial support (75 percent)
during delivery, actually much lesser percent did support financially (57 percent).
This is probably because traditionally in few cultures for cost of first and at times the
second delivery of a woman is borne by her parents rather than the husband. Similarly
differences are noted with respect to emotional support. While many opine that it is
least kind of support they should be extending to wife (11.8 percent), actually 23.5
percent of women felt that they have received the support emotionally from husbands.
This needs to be interpreted with care. Probably though men do not realize, but do
extend emotional support to wives in situations like this or these women are happy
with the extent of emotional support they received from husbands while husbands
themselves did not perceive it as a support.
Postpartum Period
Postpartum period is not officially defined, however it is supposed to be the period
after the delivery of placenta to the following six weeks.
Postpartum Care
Table 7.18 provides details of knowledge and practices related to postpartum care.
Knowledge levels of all the women related to postpartum care is mainly related to
diet. Fifty nine percent of women opine that women should continue to take nutritious
82
diet, 48 percent believe in following certain restrictions in diet. Around 35 percent
women believe that one should have adequate rest during postpartum period and
should not indulge in heavy work. Very few women, 1.4 percent, thought that regular
health checkups are essential.
Among the women who had been pregnant during the reference period, nearly 85 of
the women resumed to household work two weeks after the delivery. An analysis of
types of physical activity carried by these women included, cooking (83 percent),
carrying older children (78 percent), lifting water, (52 percent), washing and rinsing
of clothes (47.8 percent), bringing water from distance and lifting heavy items (4.3
percent each). Only 12 percent of them had a postpartum checkup. Most of them had
postpartum check up from qualified health personnel and went for a checkup 20 days
after the delivery.
Table 7.19 shows that among the women who had a delivery
during the reference period, higher aged women (2.120), and those working for wages
(4.712), and if husbands are educated above primary level (2.521) have higher
chances to go for postnatal health check up. This may be because, while a majority of
the women and men do not realize the requirement for postnatal check up, with
increase in husband’s educational level, they are more likely to support women to
have a health checkup. If women is relatively of older ages and working out side
home, probably she has can perceive, express and may go for postpartum checkup.
Postp a rtu in Mo rb idity
Out of total women who had a delivery during the reference peiiod, 49 percent of
them suffered from postpartum morbidities (Table 7.20). A majoiity of the women
experienced pain in lower abdomen, 20 percent of them suffered from depression, 17
percent suffered from fever for more than 3 days and an equal percent of women
experienced painful as well as burning urination, 14 percent of them had excessive
bleeding. Husbands’ knowledge about wives’ postpartum morbidities is similarly poor
as information about intrapartum morbidities. Only less than three percent of
husbands at all knew about wives’ illnesses during postpartum period.
Support ofMen towards Wives After Delivery: Expectation versus Reality
This section reveals the opinion of women and men regarding the role of husbands
towards wives during delivery. Like the opinion of wives during different obstetric
83
periods, almost every woman expects husband’s support during postpartum period.
Every one hopes that husbands should take care of their health by helping her to have
regular checkups, provide physical help and see that wife do not get physically stained
during the period. In addition women also want their husbands to be responsible
fathers by managing older children during this phase and extend adequate emotional
support to wives. On the other hand men seems to be not very sensitive towards
women for a support during postpartum period. Only half the men felt the necessity to
extend physical help and take care of health of wives’ during the period. One third of
the men perceived their role as fathers, and one-quarter of them felt the need to
provide physical help.
Opinion of women who had been pregnant during the reference period and their
husbands did not alter much to the opinion of over all women and men in the
community regarding extension of support to wives after delivery (Table 7.22). The
only difference is that 5.4 percent of overall men expressed no necessity to support
wives after delivery whereas among recent fathers none expressed like wise.
Actual support extended by husbands, compared to the opinions expressed by them is
shortfall in extending health support. Even though many men opined that their role
lies in extending health support (45.7 percent) after delivery, actually much lesser
percent did support (4.3 percent). This is because probably men opined extending
health support refers to child rather than mother. There is an increase in the support
extended by husbands in managing older children, by not allowing wife to strain, and
providing emotional support to wife.
An understanding of Abortion and Health Care
Literally abortion’ means ‘premature delivery’. Abortion may take place due to
unhealthy condition of the pregnant woman or due to unwanted pregnancies. In the
present study perceptions of women and men about abortion and utilization of health
facilities for it is examined. Table 7.22 provides opinion of women and men on
various aspects related to abortion. As a first reaction, a majority of women and men
in the villages under study consider that induced abortion is a non-appreciating
decision. Among the couples, relatively more men (83 percent) are not in favour of
abortion than women (62.8 percent). Though a majority is not in favour of induced
84
abortion, yet on health grounds 95 percent of women and 81 percent of men consider
it as acceptable. Every alternate woman and one out of three men opine that a woman
can abort to avoid further children. Nearly one third of the couples do agree that
abortion can be done to space between children. To postpone first birth a majority of
the couples, especially more women, are not in favour of induced abortion.
To have an abortion a majority of the couples (95 percent women; 81 percent men)
opine it is necessary for wife to take husband’s permission. More women (78.9
percent) opine that permission of parents-in-law is needed than the men (38.1
percent). Requirement of permission of woman’s parents is considered low by both
the couples. Though none of women felt the need to take permission from health
personnel, but 21.5 percent men thought it was necessary. At the same time almost
every woman and mea felt the need to take consult a doctor.
Every woman and 80 percent of men feel discussion between the couples prior to
abortion is necessary. Every alternate woman opined that discussion should be
focused on health consequences of women and on the necessity for abortion. One fifth
of the women thought couple should discuss on place of abortion, future fertility, and
social consequences. Men gave importance in the order of the need, place, financial
and method of abortion.
At the time of abortion, more than 80 percent of couples felt the necessity of husband
to be along with wife. The main reason, according to couples, for wanting to stay with
wife is to give a written agreement at the hospital. Most of them opine that unless
husband signs on the agreement forms a woman cannot have an abortion. The other
reason for wanting husbands to be with wives at time of abortion is to provide
financial support. Apart from husband, the other expected members to be
accompanied with a woman for abortion are mother and mother-in-law. More women
wanted mother-in-law to be with them because they opine that it helps them against
future mistreatment.
85
Table 7.1 Difference of Information Reported by Couples on Fertility and
Obstetric Information
Aspects related to Fertility and Obstetrics
Number ol couples
Reported
Women
Men
Number of live births
rzs-
T7K
Currently surviving children
T7T
TH
Number of non-surviving children
T37
TT7
Knowledge about date of last birth
T7K
T7K
Number of times wife had still births
2
2
Whether had still births
2
4
Whether had abortion
T2
T5
Number of times wife had abortion
T2
T5
Out come of abortion
T2
T5‘
22
29’
22
22
Number of times conceived after Deepavali 20'2T
T2T
W
Outcome of the pregnancy occurred after
TT~
TA
22
22
c
Currently pregnant
’
Month of pregnancy
~
Deepavali 2001
Timing of pregnancy: Wanted to be pregnant at
that time
86
Table 7.2 Background Characteristics of Women who experienced
Pregnancy During the Reference Period
Characteristics
Women’s age
<=15
16-20
21-25
26-30
Parity
0
1
2
3
4+
Women’s education
Illiterate
Up to primary
Above primary
Caste/Tribe
Scheduled cast/ tribe
Other backward caste
Others
Type of family
Nuclear
Non nuclear
Consanguineous
Yes
No
Women’s work status
Not working
Working out side Home
Total Women
Percent of Women
2.1
54.3
35.1
8.5
21.3
38.3
20.2
16.0
4.3
43.6
18.1
38.3
29.8
58.5
11.7
72.3
27.7
37.2
62.8
47.9
52.1
“91“
87
Table 7.3 Some Particulars of Antenatal Care Taken by Women
Particulars of Antenatal Care
Percent of
Women
Location of ANC visits
Round the Clock Women Health Centre
39.6
Govt.hospital
7.7
Pvt.hospital/doctor
76.9
Persons examined during gestation
Allopathic Doctor
89.0
MPHA
26.6
Other health personnel
2.2
Persons advised woman for a check-up
Husband
47.3
Mother/Mother-in-law
48.4
Self
3.3
Person Decided for a check-up
Husband
51.6
Mother/Mother-in-law
39.6
Self
8.8
1
Opinion of Husbands on Antenatal Care
ANC is necessary during Pregnancy
98.9
ANC is not necessary during Pregnancy
1.1
Husband accompanied to ANC
BO
Reasons for not Accompanying wife for ANC
Female assistant desired by Women
58.8
Men have to attend to work
42.2
Total Women who had ANC
(W8)
91
88
Table 7.4 Components of Antenatal Care Received by Women
Quality particulars
Percent of women
Had TT injection
Had IFA tablets
77^
Women tested for risk pregnancy
7T2
Tests Conducted
Weight measured
96.7
Height measured
87.9
Blood pressure checked
91.2
Blood test
91.2
Urine test
92.3
Abdomen measured with tape
56.0
Listened to baby’s heart beat
52.7
Internal exam
68.1
X-ray taken
44.0
Scanned/seen baby on TV screen
52.7
Amniocentesis
11.0
Advised on
Diet
97.8
Danger signs of pregnancy
64.8
Delivery care
31.9
Newborn care
27.5
Family planning
18.7
Total Women
89
Table 7.5 Women Suffered from Various Morbidities during Antepartum Period
and Knowledge of Husbands About it
Percent of
Percent of
Women
Husbands
Suffered
Aware
Swelling of hands & feet
40
4^
Blurred vision
15.6
0.0
Giddiness
26.7
11.1
Fits
4.4
4.4
Urinary problem
15.6
6.7
Varicose veins
4.4
4.4
Fever >3days
15.6
2.2
High blood pressure
11.1
0.0
Severe vomiting whether treatment required
22.2
2.2
Diabetes
0.0
2.2
No movement of fetus
2.2
0.0
Bleeding
2.2
2.2
Other Morbidities
0.0
4.4
None
11.1
6.7
Do not Know
0.0
64.4
Morbidities During Antepartum Period
Total Women
47.8
(45)
90
o
Table 7.6 Women suffered from Various Morbidities during Antepartum period
And the Deciding Person on the need for Antenatal Care
Morbidities During Antepartum Period
Decision Made by (%)
Others
Husband
Swelling of hands & feet
3KT
Blurred vision
28.6
71.4
Giddiness
33.3
66.7
Fits
100.0
0.0
Urinary problem
42.9
57.1
Varicose veins
50.0
50.0
Fever >3days
57.1
42.9
High blood pressure
40.0
60.0
Severe vomiting whether treatment required
50.0
50.0
No movement of fetus
0.0
100.0
Bleeding
100.0
0.0
Total Women suffered from Antepartum
47^
Morbidities
(45)
91
i able 7.7 Women Suffered from Various Morbidities during Antepartum period
And Treatment Particulars
Morbidities During Antepartum Period
Swelling of hands & feet
Person Consulted by women (%)
Health Assistant
Allopathic
Doctor
W
IW.O
Blurred vision
100.0
0.0
Giddiness
100.0
0.0
Fits
100.0
0.0
Urinary problem
100.0
0.0
Varicose veins
50.0
50.0
Fever >3days
85.7
14.3
High blood pressure
100.0
0.0
Severe vomiting whether treatment required
100.0
0.0
No movement of fetus
100.0
0.0
Bleeding
100.0
0.0
Other Morbidities
80.0
20.0
Total Women with Antepartum Morbidities
(45)
92
Table 7.8 Difference of Opinion between Women and Men related to Care to be
extended by Husbands towards Wives during Pregnancy
Opinion of
Opinion of
Husbands (%)
Wives (%)
Talk affectionately
48.0
100.0
Express concern towards health
25.6
100.0
Take you to an antenatal check up
27.4
100.0
Arrange with someone to go to antenatal checkup
30.0
100.0
Arrange/Assist in transportation
7.6
99.5
Monitor on intake of medicines
13.0
98.0
Get fruits/sweets for you
21.5
100.0
Take interest towards your diet
9.4
99.5
Manage older children
13.5
98.0
I Assist in household work
12.6
97.5
Types of Care
Emotional
Health
Nutritional
Physical
Total Couples
223
93
Table 7.9 Opinion of Wives who have been recently Pregnant and their husbands
Related to Care to be extended by Husbands during Pregnancy versus Actual
Care received
Actual care
Opinion of (%)
Types of Care
Wives
Husbands
received by
Wives (%)
Emotional
Talk affectionately
Express concern towards health
100.0
46.8
23.4
100.0
28.7
14.9
100.0
27.7
46.8
100.0
29.8
7.4
98.9
100.0
4.3
6.4
12.8
24.5
100.0
25.5
44.7
100.0
6.4
13.8
97.9
97.9
11.7
17.0
8.5
19.1
Health
Take you to an antenatal check up
Arrange with someone to go to
antenatal checkup
Arrange/Assist in transportation
Monitor on intake of medicines
Nutritional
Get fruits/sweets for you
Take interest towards your diet
Physical
Manage older children
Assist in household work
94
Total Couples
Table 7.10 Planned Place of Delivery versus Actual Place of Delivery
Planned place of delivery
Actual place of delivery (Percent of Women)
RCWHC7
Private hospital
Home
Govt, hospital
PHC/Govt.hospital
20.3
0.0
0.0
Pvt.hospital/Doctor
1.4
46.4
1.4
Home
2.8
4.3
23.1
94
Table 7.11 Place of Delivery by Background Characteristics of Women
Characteristics
Women’s age
<=20
21-30
Women’s education
Illiterate
Up to primary
Above primary
Women’s work status
Not working
Working
Caste/Tribe
Scheduled caste/tribe
Other backward caste
Others
Type of family
Nuclear
Non nuclear
Parity
1
2
3+
“Consanguineous
Yes
No
Decision Made By
Husband
Father-in-law
Elderly female members
Total Women
Percent of Women
Home
Institution
75.8
75.0
24.2
25.0
74.3
61.5
85.7
25.7
38.5
14.3
81.6
67.7
18.4
32.3
70.8
76.3
85.7
29.2
23.7
14.3
71.2
88.2
28.8
11.8
77.4
77.8
63.2
22.6
22.2
36.8
76.9
74.1
23.1
25.6
80.0
100.0
69
20.0
0.0
30.2
95
Table-7.12 Determinants of Use of Institutional Health Care for
Delivery: Logit Analysis
Explanatory variables
Institutional Delivery
Exp (B)
Women’s Age
TTPT
34V
TVTV
Women’s Education
-.017
.454
.983
Women’s work status **
-1.199
.709
.302
Men’s education
-.053
.443
.948
Men’s work status
-.147
.800
.864
Type of family **
-1.662
.965
.190
Parity
-.625
.487
.535
Caste
-.321
.720
.725
Having Vehicle **
1.784
.778
5.956
Deciding Person on place of delivery **
1.553
.930
4.725
Family Violence
.805
.703
2.236
★^Indicates significance at 0.1 percent level
96
Table 7.13 Women suffered from various morbidities during Delivery and
Knowledge of Husbands About it
Percent of
Percent of
Women
Husbands
Suffered
Aware
Labour more than 18 hours
IZ.’l
171
Use of forceps
3.7
1.4
Excessive bleeding (More than 3 sarees stained)
14.8
0.0
Sac burst and even after 5 hours child was not bom
14.8
7.2
Sac burst and the fluid was greenish colored
0.0
1.4
Baby was in breech position/not in normal position
11.1
1.4
High BP
11.1
0.0
Caesarean
59.3
0.0
Other Morbidities
3.7
0.0
0.0
76.8
0.0
4.3
Morbidities During Intrapartum Period
o
None
Do not Know
Tbtal Couples’ Knowledge
___ ——
69
97
Table 7.14 Wome.i suffered from various Intrapartum morbidities by
Place of Delivery
Morbidities During Intrapartum Period
Percent of Women
Suffered by Place of
Delivery
Home
Hospital
TOO
Labour more than 18 hours
Use of forceps
0.0
100.0
Excessive bleeding (More than 3 sarees stained)
25.0
75.0
Sac burst and even after 5 hours child was not bom
0.0
100.0
Baby was in breech position/not in normal position
0.0
100.0
High BP
0.0
100.0
Caesarean
0.0
100.0
Other morbidities
0.0
100.0
Table 7.15 Women suffered from various Intrapartum morbidities by
Person Decided on Place of Delivery
Morbidities During Intrapartum Period
Person decided on Place of
Delivery
Husband/
Elderly
Father-in-law
Women
7S’677
Labour more than 18 hours
Use of forceps
0.0
100.0
Excessive bleeding (More than 3 sarees stained)
0.0
100.0
Sac burst and even after 5 hours child was not born
50.0
50.0
Baby was in breech position/not in normal position
0.0
100.0
High BP
0.0
100.0
Caesarean
43.8
56.3
Other Morbidities
100.0
0.0
98
Table 7.16 Difference of Opinion between Women and Men related to the Care
to be extended by Husbands towards Wives during Delivery
Opinion of
Opinion of Wives
Husbands (%)
(%)
Call for an assistant/health personnel
40.6
99.5
Arrange transportation
22.6
98.0
Get necessary items/medicines
23.6
99.5
Financial help
74.1
99.0
Emotional support
8.0
97.0
Not necessary
T7
Types of Care
Total couples
Tabic 7.17 Expectation of Care during Delivery from Husbands by recently
Pregnant Wives Versus Actual Care received by them
Types of Care
Expectation
Actual Care Received (%)
of Wives
According I According to
(%)
to Wives
Husbands
Call for an assistant/health personnel
97.1
5.9
39.7
Arrange transportation
95.6
17.6
25.0
Get necessary items/medicines
97.1
32.4
19.1
Financial help
97.1
57.5
75.0
Emotional support
94.2
23.5
11.8
2^3
W
2.9
W
Did not help at all
Not Necessary
T3
Total Percent
** Not Applicable
99
Table 7.18 Details of Women who were Pregnant during Reference period and
their Particulars about Postpartum Care
Particulars of Postpartum Care
Percent of Women
Knowledge about Postpartum Care
Nutritional diet
59.4
Restricted diet
47.8
Adequate rest
34.8
Not to indulge in heavy work
36.2
Abstaining sex
5.8
Feeding practices
11.6
Regular health checkup
1.4
Had Postpartum Checkup
T2Tr
Place of Checkup
RCWHC/SC
10.1
Govt. Hospital
4.3
Private Clinic/hospital
21.7
Other Places
2.9
Type of Physical work done
Cooking
83.0
Carrying older children
78.3
Lifting water
52.0
Rinsing clothes
47.8
Bring water from distance
4.3
Lifting heavy items
4.3
Total Women
39.1
(27)
100
Table-7.19 Determinants of Use of Institutional facilities for
Postpartum Care: Logit analysis
Explanatory variables
Postpartum Care
Exp (B)
K
Women’s Age **
775T
37T
Women’s Education
-.483
.452
.617
Women’s work status **
1.550
.650
4.712
Men’s education **
.925
.469
2.521
Men’s work status
.013
.663
1.013
Type of family
-.547
.673
.579
Parity
.479
.444
1.614
Caste
.048
.645
1.049
Having Vehicle
-.828
.692
.437
Deciding Person on place of delivery
-.060
.724
.941
Family Violence
-.218
.612
.804
Postpartum morbidities
.644
.657
1.905
o
★'Indicates significance at 0. / percent level
101
Table 7.20 Women suffered from various morbidities After Delivery and
Knowledge of Husbands About it
Differences in Reporting about
Morbidities After delivery
Postpartum morbidities (%)
Women
Men
Pus formation in tare
TO
W
Fever >3 days
17.2
2.9
Pain in lower abdomen
69.0
1.4
Painful, burning feeling when urinating
17.2
0.0
Changes in mental make-up
10.3
0.0
Fits/convulsions
0.0
1.4
Discharge that smells
6.9
0.0
Breast abscess
6.9
0.0
Excess bleeding
13.8
0.0
Depression
20.0
0.0
Backache
10.3
0.0
Total Couples
42.11
(29)
>*
102
Vo
Table 7.21 Difference of Reporting between Women and Men related to
the Care to be extended by Husbands towards Wives After Delivery
Types of Care
Differences in Reporting about
Intrapartum morbidities (%)
husbands
Wives
Arrange/take you for a health checkup
^53
TOO
Managing older children
36.5
98.6
Not allowing you to strain physically
28.4
100.0
Providing physical help
50.7
100.0
Extending emotional support
0.0
94.2
Any other
0.0
1.2
Not necessary
5.4
0.0
223
Total Couples
Table 7.22 Expectation of Wives who have been recently Pregnant Versus Actual
Care received from Husbands after Delivery
Expectation
Actual Care received (%)
of Wives
According to
According to
(%)
Wives
Husbands
Arrange/take you for a health checkup
TOO
43
437
Managing older children
98.6
34.8
24.3
Not allowing you to strain physically
100.0
44.9
35.7
Providing physical help
100.0
31.9
50.0
Extending emotional support
94.2
31.9
4.3
Any other
1.4
1.4
0.0
Types of Care
Total Couples
K9’
103
Table 7.23 Opinion of Women and Men about certain Aspects of Abortion
Various Aspects On Abortion
Can a Woman go for Abortion
Agree
Disagree
Woman can go for Abortion for Reasons Like
For Health of Woman
To Avoid further Children
To postpone first Birth
To Space between Children
For having Abortion Permission required from
Husband
Parents-in-law
Parents
Others
Health Personnel
Not necessary
Need to discuss between Couple prior to going for
an Abortion
Required
Not required
Couples’ Need to Discuss on
To decided on abortion
Place of abortion
Method of abortion
Health consequences
Future fertility
Social consequences
Ethical consequences
Financial aspects
~TIie need for Husband to be with woman at the
time of Abortion
Need to be
No need
Person required to Accompany Woman for
Abortion
Mother
Mother-in-law
Sister
Relatives
Opinion of
Women (%)
Opinion of
Men (%)
37.2
62.8
17.0
83.0
95.5
53.4
12.1
81.2
32.7
17.0
28.7
30.0
84.8
94.6
78.9
15.2
0.9
0.0
0.0
21.5
0.4
99.6
0.4
79.8
20.2
42.2
26.0
68.1
52.7
8.1
52.0
24.6
10.1
20.6
22.9
10.3
14.3
38.1
8.1
0.0
7.2
3.9
2.4
30.0
15.2
82.1
17.9
72.2
52.5
4.5
0.4
69.5
28.3
0.9
1.8
84.8
104
Sexual Practices and Reproductive Health of Women
Sexual health depends not only the practices, but also on individual attitude and
knowledge. Sexual practices of men before and after marriage have important
reproductive health implications, both for men themselves and for the wives. This
chapter examines sexual practices of men vis-a-vis their sexual health. Besides the
chapter focuses on reproductive health of women, and couples knowledge about it. In
the end an effort is made to over view on household health expenditure.
Sexual practices of Men Before and After Marriage
In all the villages 28.7 percent of the total men had premarital sexual experience
Table 8.1). Median age at first sexual contact of these men is 19 years. Some of them
had premarital sexual contacts as early as at 16 years. After marriage extramarital
sexual contacts have lessened among men (13 percent). Before marriage 11.7 percent
had sexual relationship with multiple partners; after marriage it is declined to 2.8
percent. Prior to marriage, only 1.3 percent of men always used condoms, one out of
four men (23.3 percent) before marriage never used condoms. This percentage is
decreased after marriage is also may be because over men having extramarital
relations decreased. Socio-economic background of men having extra-marital sexual
relations reveal that, comparatively men in the age group of 31-40 years are more
involved in relations than the younger or older men (Table 8.2). If men are married
for than 10 years, showed interest to go to other women than the recently married
men. Men with less educational levels; engaged in skilled work or business; from
backward castes and from tribes; those had non-consanguineous marriage; and from
non-nuclear families maintained extramarital sexual relations.
Sexually transmitted Diseases and Health Care Seeking behaviour
Men who had premarital sexual relations, 17.2 percent suffered from sexually
transmitted diseases (Table 8.1). Many of them experienced difficulty in urination.
Only 6.4 percent of men tried to seek treatment from allopathic doctor and the
remaining tried self-treatment or never tried to seek treatment. After marriage 3 men
out of 29 men, those ever maintained extramarital sexual relations, suffered from
105
STDs. Only one of them felt necessary to seek treatment from a doctor, while the
remaining tried self-treatment.
Marital Sexual Behaviour and Attitude of Couples
Median age at first sexual intercourse for women is 16 years. Two women out of total
223 women had first coital relation at the age of 11 years. Sixty percent of women had
first coital relation by 16 years of age. Ninety four percent of women had coital
relations while they are still in adolescent age. Many of the women were ignorant or
had partial knowledge about coitus. Having been exposed to coitus at an early age, 30
percent of the women felt scared; 7 percent of women never liked it. Forty seven
percent of women felt shy about it and 31 percent women liked it.
There have been differences in reporting between women and men on information
related to sexual practices of the couples. During four weeks prior to the survey, the
couples were asked to mention certain details related to sexual practices. Out of total
223 couples, 222 couples stayed together. According to men 81 percent of them have
coitus once per day, 16.6 percent reported that they have coitus twice per day, and 2.4
percent of the men said that they involve three in it three times a day. According to
women 99.6 percent have sex once per day and a marginal percent of women
admitted that they have coitus two times a day. A majority of the women opine that
their duty is to oblige husbands’ sexual desires. At the same time they consider that
having coitus once in a day is an acceptable practice. Where as, men differ their
opinion with women. Men think that there is no ideal number of times a couple should
involve in coitus per day and also opine that a husband has every right on wife’s
body, thus wife should not deny husbands’ sexual demands.
Sexual Behaviour of Men after Morbidity
Three men out 223 men suffered from STDs at the time of survey. Two of them
discussed about illness with wives. They knew that their ill health may have an effect
on women’s gynaecological ill health, thus they started using condoms during coital
relations with wife. One of them never discussed with wife, but has stopped coital
relations with her. All three of them continued to have extramarital sexual relations.
106
The only precaution they felt necessary was to use condoms, thus all three men used
condoms during relations with other women.
Beliefs of Couples about Sexually Transmitted Disease
A majority of women and men are not aware about STDs. When all the women are
asked to express whether they are disagree or do not know about the statements
related to STDs. The statements were:
A person contacts gonorrhea only once, after that he or she becomes immune
to the diseases
Syphilis can be treated with penicillin and other antibiotics
Venereal disease can be passed from a mother to her baby before or during
birth
Some people who have venereal diseases show no symptoms at all
It is harmful for a man to have sex with another man.
The results show that for most of the beliefs about STDs considerable variations are
noticed between men and women (Table 8.3). On ‘venereal disease can be passed
from a mother to her baby before or during birth’, 85 percent of men and 35 percent
of women agreed. For the remaining aspects a majority expressed ignorance. One out
of four, both women and men, agreed that ‘some people who have venereal diseases
show no symptoms at all’. Relatively more women (13.9 percent) believed than men
(9.4 percent) about the statement that ‘it is harmful for a man to have sex with another
man’. Hardly any woman believed about the statement ‘a person contacts gonorrhea
only once, after that he or she becomes immune to the diseases’ and ‘syphilis can be
treated with penicillin and other antibiotics’ where as 12 percent and 47 percent of
men respectively believed on the statements.
Reproductive Health of Women
Women’s reproductive health situation is analysed before and after the marriage. Out
of the total women, 29.6 percent of them have suffered from menstrual related ill
health. One out of women experienced abdominal pain, 9 percent had irregular
periods. Less than one percent of women suffered from prolonged menstruation and
vaginal discharge. Nearly half of the women felt the need to seek treatment. Forty
percent of them went to an allopathic doctor.
107
One out of four women (24.7 percent) were suffering from reproductive tract
infections at the time of survey (Table 8.4). Some of the mentioned illnesses by the
women are, nearly six out of ten women reported pain at the mouth of vagina; three
out of ten women expressed sever pain deep inside the vagina. Sixteen percent of
women noticed abnormal vaginal discharge.
Women by their background characteristics reveal that (Table 8.5) relatively a higher
percent of women aged between 31-35 years (40 percent); with parity three or more
(59.3 percent); women belonged to Scheduled tribes (37.5 percent) and Backward
castes (26.4 percent) suffered from reproductive tract infections. Marginally a higher
percent of women who had consanguineous marriages (27.6 percent) and husbands
having extramarital sexual relations (27.9 percent) suffered from reproductive tract
infections.
Generally in traditional societies it is believed that disclosing about reproductive tract
infections, unlike maternal morbidities, among women is a matter of shame. However
53 percent of women in the villages did not hesitate to discuss their illness to
husbands. 27 percent of women felt comfortable to share their problems with elderly
women. The remaining women felt comfortable to discuss about illness with peei
group women. For seeking health care however 64 percent of women felt it is
necessary7 to inform husband and take his permission. Among the 55 women who
suffered from one or the other reproductive tract infections, only 27 percent sought
treatment. All these women either sought treatment from qualified health personnel,
either doctors or health assistants; either at round the clock health center or at a
private hospital.
Factors, which determine to seek health care for reproductive tract infections, is
analysed by a logit model. Table 8.6 shows that if wife discusses about her
reproductive tract infection with her husband, she has 33.903 chances more to seek
treatment than those women who do not discuss with wives. Illiterate women (0.142)
and those working or daily wages (2.388) have high probability to seek care in the
villages under study. Women with fewer children have 0.294 chances more to seek
health care than women with more children. Domestic violence at home is a
108
detrimental to women to seek health care. In the houses without family violence,
women have 3.015 chances more to seek health care than the families, which has
violence.
Medical and Health Expenditure
Expenditure toyvards IVives Health
In many communities it is believed that men should take care of household finances.
One way of assessing men’s ability to support their wives, children and other family
members is by spending towards medical and health aspects. Table 8.7 gives details
of health expenditure incurred towards wives’ obstetric and other reproductive health
care. Out of total couples, 81.1 percent of husbands mentioned that their wives sought
medical and health care during their last pregnancy. All of them said that wife had
sought care during antenatal period, 68.4 percent during delivery, and 59.2 percent
during postpartum period. Eighty nine percent of these husbands agreed that there was
a need to spend money in cash or kind. Slightly a lesser percent of husbands did spend
towards wives’ obstetric care than the required because the remaining could not spend
due to lack of adequate finances.
Out of total couples, 7.6 percent of husbands said that their wives required seeking
reproductive health care, and in all cases husbands did spend towards them. Excepting
for one woman, in all other cases husbands had to spend to spend money and tor one
woman she sought treatment from round the clock health centre.
Household Health Expenditure
Seventy percent of the total families had incurred medical expenditure during one
year prior to the survey. One fifths of the husbands reported having spent some
money on them selves, 69 spent money on the health care of wives, 49 percent on
their children, 8.3 percent towards their parents and 1.9 percent for others. An
analysis of expenditure in terms of rupees reveals that median amount of money spent
by the households is Rs.2500, minimum amount spend by a household is Rs. 100 and
maximum amount spent is Rs.45000. Out of total household, 16.6 percent of the
households had to take loan to meet the medical expenditure. Out of total amount
taken on loan 64.9 percent of households had taken for the sake of wives, 35 percent
109
for health care of children, 22 percent for themselves and the rest for the remaining
persons of the family.
110
Table 8.1 Sexual Behaviour and Health Seeking Behaviour of Men
Before and After Marriage
Percent of Men
Particulars of Sexual Activity and Health
Men ever had extramarital sexual contact
Prior to
After
Marriage
Marriage
TO
my
19 years
Median Age at first sexual contact
TT7
2.8
Always
1.3
1.3
Sometimes
4.0
4.0
Never
23.3
7.6
Any discharge from your penis
0.4
0.4
Any sore on your genital or anal area
0.9
0.0
Difficulty urinating
4.5
0.4
Pain with urination
0.9
0.0
Very frequent urination
0.4
0.0
Swelling of your testes or in groin area (penis)
0.0
0.4
Any one problem
4.9
0.4
Number of men
(H)
(3)
Allopathic Doctor
54.5
33.3
Self /friends/Never sought treatment
45.5
66.7
Men having contacts with multiple women
Ever used Condoms during sexual contacts
Experienced any of the morbidities
Sought Treatment for the Morbidities from
Total Men who had contacts
111
Table 8.2 Socio-economic Characteristics of Men having
Extra-marital Sexual Relationship
Socio-economic Characteristics
Current age
21-25
26-30
31-35
36-40
40+
Duration of marriage
<=2
3-5
6-10
11-15
16-20
21 +
Parity
0
1
2
3
4+
Education
Illiterate
Up to primary
High school
Above high school
Work status
Daily wage
Skilled worker
Business
Clerical
Cultivation
Caste/Tribe
Scheduled caste
Scheduled tribe
Other backward caste
Others
Consanguineous Marriage
Yes
No
Type of family
Nuclear
Non nuclear
Total
Extra-marital relationship of
Men in Percent
Having
Not Having
11.8
10.0
16.7
23.5
11.4
88.2
90.0
83.3
76.5
88.6
11.5
10.6
8.1
21.2
16.7
13.9
88.5
89.4
91.9
78.8
83.3
86.1
8.9
15.6
15.4
15.9
10.0
91.1
84.4
84.6
84.1
90.0
10.9
16.9
13.6
5.3
’
89.1
83.1
86.4
94.7
11.4
17.9
16.0
10.8
12.1
88.6
82.1
84.0
89.2
87.9
8.5
12.5
15.7
7.1
91.5
87.5
84.3
92.9
12.3
13.4
87.7
86.6
12.3
14.8
29
(13.0)
87.7
85.2
194
(87.0)
112
Table 8.3 Knowledge about Sexually Transmitted Diseases among Couples
Percent of Women
Percent of Men
Particulars of Knowledge
Agree
Do
Do not
not
Know
Agree
agree
Do
Do
not
not
agree
Know
A person contacts gonorrhea
only one, after that he or has
12.1
17.9
70.0
0.9
0.4
98.7
47.1
10.3
42.6
0.9
2.2
96.9
84.3
2.2
13.5
35.0
0.0
65.0
40.8
7.6
57.6
26.9
1.8
71.3
9.4
11.7
_____
78.9
13.9
0.9
85.2
becomes immune to the disease
Syphilis can be treated with
penicillin and other antibiotics
Venereal diseases can be passed
from a mother to her baby
before or during birth
Some people who have venereal
diseases show no symptoms at
o
all
It is harmful for a man to have
sex with another man
Total Couples
113
113
Table 8.4 Details of women suffering from Reproductive Tract Infections
Details of Reproductive Tract Infections
Percent of
Women suffered
Pain at the mouth of vagina
50
Pain inside the vagina
30
Abnormal vaginal discharge
TKT
Frequent urination or Pam during urination
Pain during / after intercourse
5^
Itching/Irritation in vaginal area
Severe lower abdominal pain
Bad odour in vaginal area
rs
Giddiness along with fever
Blood spots after intercourse
W
Total Women Suffered
24.7
(55)
114
Table 8.5 Socio-economic Characteristics of Women suffering from
Reproductive Tract Infections
Socio-economic Characteristics
Education
Illiterate
Up to primary
Above primary
Work status
Not working
Daily wage
Skilled worker
Business
Current age
<=15
16-20
21-25
26-30
31-35
36-40
40+
Duration of marriage
<=2
3-5
6-10
11-15
16-20
21 +
Parity
0
1
2
3
4+____________________________________
Religion
Hindu
Muslim
Christian
Caste/Tribe
Scheduled caste
Scheduled tribe
Other backward caste
Others
Consanguineous marriage
Yes
No
Type of family
Nuclear
Non nuclear
Husband with Extramarital sexual relations
Having
Not having
Total
Percent of Women Suffered
No
Yes
25.2
21.2
25.4
74.8
78.8
74.6
22.0
30.9
19.2
23.4
78.0
69.1
80.8
76.6
33.3
19.7
22.8
20.5
40.0
33.3
35.0
66.7
80.3
77.2
79.5
60.0
66.7
65.0
21.2
21.3
27.0
21.2
27.8
21.8
78.8
78.7
73.0
78.8
72.2
66.7
22.2
24.4
15.4
27.3
32.0
77.8
75.6
84.6
72.7
68.0
26.1
7.1
16.7
73.9
92.9
83.3
19.1
37.5
26.4
21.4
80.9
62.5
73.6
78.6
29.6
21.8
70.4
78.2
23.5
27.9
76.5
72.1
27.6
24.2
2^7
(55)
72.4
75.8
“753”
(168)
115
Table 8.6 Determinants of Health seeking Behaviour of women for
Reproductive tract infections
Dependent variables
Reproductive Health
Problems
‘Life threatening*
Women’s Age
Women’s Education **
Women’s work status
Men’s Age
Men’s education **
Men’s work status
Type of family
Marriage Duration
Parity
Consanguineous Marriage **
Caste
Religion **
Having Property
Having Vehicle
Availability of Health Centre
Awareness of AIDS **
Awareness of Reproductive Health
Problems
ste:
2CT
.397
.328
.298
-.578
-.452
-.289
-.389
.061
-.739
-1.58
1.051
-.217
-.296
-.201
-.389
.566
.245
.362
.260
.236
.398
.377
.317
.268
.365
.422
.807
.366
.432
.344
.412
.499
Exp (B)
1.299
1.487
1.388
1.348
.561
.636
.749
.678
1.063
.478
.854
.478
.805
.744
.818
.678
1.762
**Indicates significance at 0.1 percent level
116
Table 8.7 According to Men Expenditure on Wife’s Obstetric Health
Expenditure on Wife’s Reproductive Health
Wife sought treatment during
Pregnant
Delivery
Six weeks after birth
Needed to spend either in cash/kind for wife’s
obstetric Health
Needed
Not needed
Unable to seek proper medical treatment due to lack
of adequate finances for wife’s obstetric health
Could not seek care
Could seek care
Do not Know
During last one year needed to spend for wife’s
reproductive health care
Needed
Not needed
Women sought treatment
Percent oT
Men
81.1
68.4
59.2
89.3
10.7
17.1
82.3
0.6
7.6
91.9
TOW
Table 8.8 Particulars of Health/Medical Expenditure
of the Households in the Study Villages
Details of Medical Expenditure
Percent of Families incurred on Medical expenditure
during past one year
Persons on whom Expenditure was incurred
- Self
- Wife
Children
Parents
Others
Total Expenditure incurred per year in Rupees
Median amount spent
Minimum amount spent
Maximum amount spent
Percent of families felt the expenditure incurred is
beyond their family financial status
Total Families
Extent
70.0“
20.5
69.2
49.4
8.3
1.9
2500
100
40,000
16.6
117
Family Violence and Reproductive Health
Gender based violence occurs in all societies and is largely unpolished. Such violence
occurs within the home or in wider community and it affects women and girls
disproportionately. Family violence, which typically occurs when a man beats female
partners, is the most prevalent form of gender-based violence. In the present study
primarily cognitive levels of couples related to violence is examined; next the extent
of violence among the couples is studied.
Cognitive levels of Women and Men About Family Violence
Women’s behaviour is always at vigilance in a gendered based society. Especially in
natal family she is expected to be at her best in manners. If woman deviates from
expectations she is subjected not only to criticism, but also in certain situations it is
approved that her family members can physically control her. Hence a wife’s relative
position not only depends on her behaviour but also upon the cognitive levels of her
immediate family members, especially husbands. In the present section perceptions of
men and women attitude towards expected behaviour as well as physical control of
wife is examined.
To assess the cognitive levels of men and women, each of them are asked to agree or
disagree to certain statements related to wile’s behaviour and physical control. If they
agree strongly, the responses are noted separately to understand the intensity of their
altitude. Every woman agreed that wife should always show respect to elders
particularly her in-laws in the family (Table 9.1). Though 94 percent men agreed
similarly, the difference between women and men existed on levels; 89.2 percent of
women strongly agreed, 38.6 percent of men agreed strongly. Similarly perceptions of
women and men are asked about whether wife should show respect to her husband
(Table 9.2). All women again agreed on this view as well. More men (96.4 percent)
wanted wives to show respect towards husbands than towards elders/in-laws.
Ninety percent of women agreed that wife should always follow instructions given to
her. whether liked or not. by elders particularly her in-laws in the family as well as
towards husband. Seventy two percent of men agreed that wife should follow
118
instructions, yet slightly more than them (77 percent) wanted wife to follow the
instructions of husband.
Unlike earlier opinions, fewer women (50 percent) agreed to the statement that if
necessary one should use force to make wife listen to all instructions of elders
particularly her in-laws in the family or her husband. Men as well agreed in less
percent (31), yet again when referred to listening to instructions of husband a little
higher percent of them (49) did not mind forcing wife.
If wife disobeys instructions of elders particularly her in-laws in the family, 99
percent of women appreciate persuasion would bring a change in wife, 19 percent of
them do not mind verbal insults, 9 percent of women opine that physical beating is
required, and 6.7 percent expressed that physical isolation will make a wife realize
and would obey. Similar disobedience if shewed towards husbands, opinion of
women about persuasion and verbal insults has not differed. However there is a
decline in percent of women supporting physical beating or physical isolation as
measures to used to bring a change in wife. Even though by and large men opine that
persuasion and verbal insults should be the measures to be taken, relatively more
percent of men (12 percent) felt physically wife can be beaten to make her listen to
the instructions of husbands.
Only four out of ten women opine that there is no harm if wife sometimes disagrees
with instructions given to her by elders particularly her in-laws in the family or her
husband. More men (74 percent) agreed than women to the statement. When the
statement referred to husbands, the percentage of men agreeing has come down to
63.Moe than 95 percent of women opine that no verbal insults and/or physical
beating should be used against wife if she does not follow instructions given to her by
elders particularly her in-laws in the family or her husband. While women perceive
like this, still four out of ten disagree with this attitude.
Thus, cognitive levels of women and men indicate evident gendered attitude towards
women. While most of the women seem to follow polite manners of respecting elders,
at the same time they are made to internalize to accept a subordinate position by
accepting certain levels of measurements against wives to bring a ‘desirable change .
119
However given an option most of the women seems to have not in favour of physical
control. On the other hand some men though seem to be liberal under various
situations, yet when it is applicable to the behaviour of wife towards husband, there
has been an expression of physical control. Again given an open choice, still four
tenths of husbands could not really accept a complete lack of physical control of wife.
Reporting of Family Violence by Women and Men
Reporting on family violence is given in Table-9.3. There is a lot of variation between
the information provided by women and men. The couples are asked to mention
whether the women were physically hit, slapped, kicked or tried to hurt by their
husbands. Twenty one percent of women agreed that there has been violence at home,
where as more men (56 percent) reported the same. Similarly there have been
differences in reporting by men and women about the number of times violence
occurred at home. Women tried to report less number of times than men.
An analysis of reporting by types of violence reveals that, more women reported of
various severities than men. More women (68.8 percent) reported of slapping/pushing
than men (23.2 percent). Half of the women also mentioned that their husbands either
punched or kicked where as less than one percent of men agreed about it. A few
women (6.3 percent) have mentioned that their husbands have used a stick or weapon
during violence, where none among men reported the same. A majority of men (89.6
percent) reported the violence was largely confined to shouting and yelling. Similarly
a majority of women (81.3 percent) too agreed that shouting and yelling was part of
violence but not always it was confined to it.
Reactions of wives after the violence show a distinctive difference in reporting
between women and men. Every man mentioned that after the episode, his wife cried
and did nothing. Though 75 percent of women did agree that they cried, only 27
percent have mentioned that they did nothing subsequent to the violence. Almost
seventeen percent of women mentioned that they have shouted and yelled back at
husbands during violence. Another four percent of women stated that they have stated
that as a reciprocal reaction to violence, they have either hit or slapped their husbands.
120
Reporting about wives seeking help after violence was more by men (2.7 percent)
than by women (1.3 percent). Though very few women sought medical help aftei
violence, yet there are differences in reporting among women (0.9 percent) and men
(0.4 percent).
Family Violence by Background Characteristics of Couples
Table 9.4 gives details of the couples’ background characteristics. A higher -percent of
illiterate women (30.7 percent) reported of family violence than the educated women.
Among men a decline in family violence is reported if he is educated above high
school. Non-working women reported less in percent than the workingwomen.
Among men skilled workers reported comparatively less violence than the men in
other occupations. Among both women and men with increase in age, duration of
marriage, and parity extent of violence is high. Religion wise analysis reveals that a
higher percent of Hindu women reported violence, where as among men a higher
percent of Muslims mentioned of occurrence of violence. Both women and men from
deprived castes reported of violence than others. Relatively more women from nuclear
families admitted of occurrence of violence, where as among men those living in joint
families reported of violence.
Violence and Reproductive Health
Gender violence, until recently a marginal subject among themes relate to health, has
such a significant impact on women’s health that it is responsible for one in every five
potential years of healthy life lost (Heise L, 1994). In the present study impact of
violence on some of the reproductive aspects of women is analysed.
Existence of violence has a bearing on the reproductive health of women. Table 9.6
shows controlling all other variables, influence of domestic violence on certain
aspects of reproductive health are analysed by a logit model. Results show that wives
which living in a family, which has violence, has higher chances to suffer from
contraceptive morbidity than the women who never faced family violence.
Occunence of violence during pregnancy is the most tragic faces of gender violence,
resulting in serious consequences for women’s physical and mental health. In the
121
present study, five pregnant women (2.2 percent of total women) mentioned that their
husbands behaved violently during the pregnancy. Six husbands (3.6 percent) agreed
that their wives were pregnant when they violently misbehaved with them. Impact of
violence on antepartum and intrapartum morbidities is found to be insignificant in the
present study. However, impact of domestic violence on decision made by husband on
place of delivery came out as a significant determinant. In other words in families
which has no family violence, there is higher chances for husbands decide in favour
of institutional delivery (0.404 times) for wives than the husbands from a family
which has violence. Impact of violence resulted as a significant determinant of wife
suffering from postpartum morbidities. In the villages, if there is no family violence
women are 0.725 times less likely to suffer from postpartum morbidities than the
women from family violence.
Both men and women were asked to report whether there is any violence existed
related to couples’ sexual behaviour. On matters related to sexual behaviour, fewer
men reported about of presence of violence between the couple as compared to
women. While 21.1 percent of women mentioned that their husbands had sex when
they themselves were not interested, relatively less men (17 percent) did mention the
same. Similarly more women (12.8 percent) than men (7.9 percent) reported that their
husbands had forcible sex when they were not interested in it. Again violence showed
a significant positive association with contraceptive Specifically in families where
women experience violence due to her relative low position; she cannot assert herself
for basic postoperative rest either after sterilization or after childbirth. In such
situations women instead of recovering to normal health, by involving in all kinds of
domestic work further likely to deteriorate their health condition. In such situations
seeking of health care for themselves is meager.
122
Table 9.1 Cognitive levels of—
Men and' Womenion Physical control of Wife
towards Elders/Parents-in-law
Aspects ot Physical control of Wile
Wife should always show respect to elders particularly her inlaws in the family
- Strongly agree
- Agree
Disagree
Do not know
,
Wife should always follow instructions given to her, whether
liked or not, by elders particularly her in-laws in the family
- Strongly agree
Agree
Disagree
- Strongly disagree
Do not know
________
____
1 ' 1 use force to make wife listen to all
If necessary
one shoulcf
instructions of elders particularly her in-laws in the family
- Strongly agree
Agree
- Disagree
- Strongly disagree
- Do not know_____________
If wife disobeys instructions of elders particularly her in-laws
in the family, the following measures should be used.
Verbal insults
Physical isolation
- Physical beating
Persuasion
Other
_______
_________
There is no harm if wife sometimes disagrees with instructions
given to her by elders particularly her in-laws in the family
- Strongly agree
Agree
Disagree
- Strongly disagree
Do not know
___
_____
No verbal insults and/or physical beating should be used against wife even if she does not follow instructions given to
her by elders particularly her in-laws in the family
- Strongly agree
Agree
- Disagree
- Strongly disagree
- Do not know
__________
Total Number Couples
Cognitive levels of
MenWomen
89.2
10.8
0.0
0.0
38.6
55.6
4.9
0.9
20.2
70.4
8.1
1.3
0.0
17.9
54.3
23.8
3.1
0.9
7.6
43.0
39.5
9.9
0.0
6.3
24.7
60.5
7.2
1.3
19.3
6.7
9.0
99.1
0.0
33.2
2.7
8.5
82.5
0.9
6.7
33.2
40.4
19.7
00
5.9
68.2
25.1
0.4
0.4
48.4
47.5
3.1
0.9
0.0
6.7
54.3
35.9
1.8
1.3
223
123
Table 9.2 Cognitive levels of Men and Women on Physical control of Wife
towards Husband
Aspects of Physical control of Wife
Wife should always show respect to her husband.
Strongly agree
Agree
Disagree
Wife should always follow instructions given to her, whether
she likes or not, by her husband
Strongly agree
Agree
Disagree
Strongly disagree
if necessary wife should be forced to listen to all instructions
given to her by her husband
Strongly agree
Agree
Disagree
Strongly disagree
Do not know
If wife disobeys instructions of her, the following measures
should be taken
Verbal insults
Physical isolation
Physical beating
Persuasion
Other
'There is no harm if wife sometimes disobeys instructions
given by her husband
Strongly agree
Agree
Disagree
Strongly disagree
No verbal insults and/or physical beating should be used
Cognitive levels of
Men
Women
78.0
18.4
94.6
5.4
0.0
3.6
15.7
74.0
9.9
0.4
34.5
42.6
21.1
1.8
3.1
47.5
39.0
10.3
0.0
10.8
38.1
43.0
7.6
0.4
16.6
44.4
3.6
12.1
4.5
7.2
97.8
0.0
91.0
0.4
3.2
40.1
3.1
58.7
32.8
24.8
33.6
4.5
Strongly agree
54.5
4.9
Agree
43.2
46.6
Disagree
1.4
39.9
Strongly disagree
0.9
8.5
against wife even if she does not follow instructions given by
her husband
Total Number Couples
72T
124
Table 9.3 Differences in Reporting Information related to Family Violence
Particulars of Domestic Violence
As Reported By
Women
Men
21.5
56.1
Shouting/yelling
81.3
89.6
Slapping/pushing
68.8
23.2
Punching/kicking
50.0
0.8
Use of stick/weapon
6.3
0.0
Yelled and shouted
16.7
0.4
Hit and slapped
4.2
0.0
Cried
75.0
100.0
Did nothing
27.1
100.0
Wife sought Help from others
n
T7
Woman being ever physically hit, slapped, kicked or tried to
hurt by her Husband
Types of Violence Occurred
Reactions of Wife after she was hit last time
Was she required to seek Medical help after family violence
Total Number Women and Men
TT4
48
125
125
Table 9.4 Background Characteristics of Couples with Family Violence
Socio-economic
Characteristics
Education
Illiterate
Up to primary
Above primary
High school
Above high school
Work status
Not working
Daily wage
Skilled worker
Business
Clerical
Cultivation
Current age
<=15
16-20
21-25
26-30
31-35
36-40
40+
Duration of marriage
<=2
3-5
6-10
11-15
16-20
21 +
Parity
0
1
2
3
4+
Religion
Hindu
Muslim
Christian
Caste/Tribe
Scheduled caste
Scheduled tribe
Other backward caste
Others
Type of family
Nuclear
Non nuclear
** No observations
*** Not Categorized
Percent of
women
Total
Number
Percent of
men
Total
Number
30.7
15.2
6.3
127
33
63
54.7
67.8
64
59
***
**♦
♦ **
54.3
31.6
81
19
**
1
88
39
25
37
33
♦ ♦♦
82
68
26
47
17.1
23.5
23.1
25.5
***
♦ **
0.0
9.9
24.6
23.1
26.7
40.0
40.0
6
71
57
39
15
15
20
47.1
40.0
69.0
64.7
75.0
2
68
50
42
17
44
5.8
17.0
24.3
27.3
16.7
44.4
52
47
37
33
18
36
38.5
42.6
62.2
63.6
83.3
72.2
52
47
37
33
18
36
13.3
4.4
17.9
29.5
40.0
45
45
39
44
50
33.3
44.4
64.1
65.9
72.0
45
45
39
44
50
22.7
7.1
16.7
203
14
6
56.7
64.3
16.7
203
14
6
19.1
37.5
25.0
3.6
47
8
140
28
59.6
37.5
60.0
35.7
47
8
140
28
22.2
19.7
162
61
54.3
60.7
162
61
59.1
48.7
52.0
54.1
63.6
**♦
**
126
Table 9.5 Differences in Reporting Information related to Violence and
Reproductive Health
As Reported By
Women
Men
Women experienced violence While pregnant
TO
O'
Husband insisted on Wife for forcible sex
rn
7T7
Husband had forcible sex with wife
7TT
T7.’O
Violence Related to Reproductive Health
1^3
Total Number Couples
Table-9.6 Impact of Domestic Violence on Various Aspects of
Reproductive Health
KE?
Exp (B)
TT
UT5T
4.999
Delivery *
-0.907
0.551
0.404
Postpartum Morbidities *
-0.322
0.244
0.725
Various Aspects of
Reproductive Health
Contraceptive Morbidity **
Decision by Husband on Place of
**lndicates significance at 0.001 percent level
^Indicates significance at 0.1 percent level
127
Summary and Gender Inference
The new perspective looks at men as the potential partners in and advocates for good
reproductive health rather than bystanders, barriers, or adversaries. In this context the
study focuses on how men’s participation promote women to utilize health services
for improving one’s own reproductive health. Reproductive health covers an array of
issues, however the present study examines reproductive health of women from three
approaches: contraceptive health, obstetric health, and reproductive tract health.
The study is part of the Ford grants project. It is sponsored by Achuta Menon Centre
of Sree Chitra Tirunal Institute of Medical Sciences, Thiruvanantapuram.. The study
is carried out in few villages of Rangareddy district of Andhra Pradesh. The current
study is intended to focus on utilization of reproductive health services by women,
therefore a few villages which are covered under Shamirpet Round the Clock Women
Health Centre is considered as universe. Out of total nine sub-centres, three sub
centres are selected at random. From each of the sub-centres, one village is selected at
random. For selection of the couples, ‘duration of marriage’ is assumed as an
important variable in deciding power differences between the couples. Based on
house listing exercise, all the categories of couples in the reproductive age group are
grouped into five-year intervals, and then randomly ten percent of couples are
selected for the study. Thus the selected number of couples for the study is 223.
Principal findings of the study broadly concentrate on couples’ (i) exposure and
access to reproductive health services, (ii) psychological perspectives on family
planning, its use, contraceptive morbidity and utilization of services, (iii) fertility
behaviour and obstetric health, (iv) sexual practices and reported sexual morbidity,
and (v) family violence and reproductive health of women.
Exposure and access to reproductive health services
Exposure to reproductive health information is not uniform among couples in the
villages covered under Round the clock Women Health Centre. In the present study
more husbands (75 percent) are exposed to various components of reproductive health
than the wives (59 percent). Though in 87 of the families at least one of the couples
128
are exposed to iniormation, only 35.4 percent of both the couples are exposed. More
wives are exposed to messages related to obstetric health, while husbands are more
exposed to information related to AIDS. Wives received largely messages through
interpersonal communication, where as husbands received the messages through
media. It is interesting to note that despite huge expenditure on AIDS awareness
program, spread of messages is not uniform between both sexes in a community.
Information based on focus group discussions of women and men reveals that, wives
feel comfortable to discuss or make efforts to learn about obstetric care, as it is always
considered as an area confined to women. Similarly it is not approved to discuss on
contraception or AIDS or gynaecological health. It is because these are the subjects on
whom if women discuss they are pointed as ‘uncultured’ or ‘lacks women’s modesty’.
Thus many women themselves do not wish to take additional interest to know on
aspects other than obstetric care. If women are genuinely interested to know on these
aspects then they feel it is convenient to rely on media for such information. Even
though most of the women do get exposed to mass media, especially television, they
actually do not get exposed to reproductive health information. This is because
women prefer to watch particular channels, which do not carry any of these messages.
A couple of women did mention that they had an opportunity to watch billboards or
wall posters informing about AIDS but they felt embarrassed to stand and read the
complete message. Husbands on the other hand get exposed more through media find
it interesting to know more about messages like AIDS. A majority did not take
interest to learn about obstetric health, because they opine that it is not a subject
related to men.
Similarly gender differences are reported on knowledge about cognitive as well as
physical access to various reproductive health services. Every woman is aware of
availability of obstetric care, gynaecological health problems and availability of
sterilization facilities. On contrary only few women are aware of availability of
temporary methods of contraception, medical termination of pregnancy, and about
STDs. Cognitive levels of husbands on access of reproductive health services reveal
that, 96 percent is aware of sterilization facilities. Knowledge about obstetric care is
known to nearly three-fourths of husbands. Even though knowledge about temporary
129
methods of contraception, STDs and AIDS is known to more husbands compared to
wives, only half of the husbands are aware of them.
Perspectives on family planning, its use, contraceptive morbidity and
utilization of services
Psychological perspectives of couples are examined on locus of control over
pregnancy, the couples’ efficiency related to usage of contraception and pregnancy
avoidance. Perceptions of wives and husbands differed on locus of control over
pregnancy. Many women assume that they have no control on their body whereas
men think they have a control on wives’ body. Thus even though 94 percent of
women think that if a couple is careful an unwanted pregnancy will rarely happens,
yet they rely largely on luck. Whereas men rely less on luck, but they opine that
women is meant to be pregnant and one fifth of husbands still believe that an
unwanted pregnancy can happen.
Information on self-efficiency is addressed to only those who have not used any
method of contraception. The results reveal that a majority of the wives expressed
their inability to obtain and use a method of contraception as well as to refrain from
sex unlike husbands. In other words these women find extremely difficult to cross the
barrier of gender to obtain and use a temporary method. In addition they confessed the
lack of self-control on their bodies. These perceptions of women are further reiterated
by their opinions on value of pregnancy. A majority of the women agreed that they
could convince their husbands on limiting the children but lack efficiency in
postponing or spacing of pregnancy either by usage of contraception or by abstaining
from sex.
Fifty eight percent of couples had a communication related to planning of their
family. However there are differences in reporting between wives and husbands on
certain topics. More couples had a discussion if they are from forward castes, nuclear
families, and recently married. Though some of the socio-cultural aspects facilitated
husband and wife communication, however initiation to the discussion was laigely
determined by the gendered behaviour. Perceptions of women and men related to
discussion revealed that all women wanted to have a discussion and preferred men to
130
initiate a discussion because they are cautious of being named as promiscuous. Half of
the men never felt necessary to discuss, but those who had a discussion never
perceived that a woman could initiate.
A little more than half of the couples (53.5 percent) were using contraception at the
time of survey; a majority of them are adopters of tubectomy. Even though only a few
couples (6.8 percent) used temporary methods of contraception, there is a difference
in reporting between the couples. More men reported about usage of condoms and
periodic abstinence than women. The reason for using condoms by the couples is not
for avoiding pregnancy; rather because the husbands were suffering from STDs.
Probably for this reason the wives did not want to reveal. The cultural restrictions
compel women not to disclose the illnesses related to STDs where as men are not so
conditioned to conceal. Motivating person to use a method of contraception differs
between couples. Women depended more on others rather than self for usage of
contraception, thus women opine that with out husbands’ approval they cannot use a
method of contraception. This is more so if they have to use temporary methods of
contraception.
Seventeen percent of contraceptive users reported to have suffered from illness after
its adoption. All of these women are adopters of tubectomy. Generally tubal ligation
need not result into any complications after surgery. However women living in joint
families especially married to non-relative where women ‘s relative position is less is
not likely to have adequate rest for self after a tubectomy. This is more likely in
deprived communities where working outside home does not empower her position in
the family rather becomes a requirement at the cost of health. Similarly the
relationship between husband-wife communication and presence of the morbidity
probably indicates differently that is, the couple might have had a communication to
go for tubectomy. Thus the low gendered position as well as poor financial situation
might have resulted in ill health after tubectomy for these women. There is strong
notion with in the community among both men and women that, women S health
would deteriorate after tubectomy. Yet all men as well as women want only wives to
go for sterilization. While men perceive that women have to take the burden of ill
health in the interest of family’s financial situation vis-a-vis number of children,
131
women in addition to this opinion, also expressed that they feel secured against
repeated pregnancies as many a time to become pregnant is beyond their control.
Three out of four women those suffered from contraceptive morbidity, have sought
treatment. Non-seeking care by the remaining health care is influenced by both social
and the relatively low position of woman in the family.
Fertility behaviour and obstetric health
Median age at marriage for the women and men in the sampled villages is 15 and 21
years respectively. Twenty one percent of women belong to zero parity. Median
number of children ever bom per woman is 3. Differentials in reporting about
particulars related to fertility experiences of the couple reveals that there is a
coherence between the couples with respect to living children, however variation is
noted with number of stillbirth and abortions. Women’s unsecured position in the
family, perceived unsupportive behaviour of husbands compels them to hide the
unsuccessful outcome of pregnancies.
Forty two percent of total women had experienced pregnancy during the reference
period of two years. A high rate of antenatal care utilization by these women (96.8
percent) is reported in the villages. More than half of the husbands decide whether his
wife should seek antenatal care or not and where she should go it. When husbands
decided about the need for antenatal care, they want wives to go to a private allopathic
doctor or a Government maternity hospital. When women decided on by themselves
they went to the RCWHC. Though The RCWHC comprises of equally qualified
medical personnel, when decision are made by men, women perceive in terms of
physical, nutritional, and emotional; otherwise such a support is missed when decision
are made by themselves. Antepartum morbidities were experienced by 47.8 percent of
the women. Most of the husbands (64.4 percent) are not aware of the morbidities
faced by their wives during recent pregnancy. When husbands’ are not aware about
the type of illness, health care seeking behaviour of wives during this period did not
really influence, as women received support from other elder members of the family.
132
Seventy five percen* of wives delivered at an institution. To decide in favour of
institutional delivery is determined by husbands’ initiation. At the same time other
socio-economic conditions such as if women are living in nuclear families, with a
better standards of living especially in terms of procession of vehicle helped women
to seek institutional delivery in these villages. Awareness of husbands about
intrapartum morbidities suffered by their wives is low. It is because, culturally most
of the problems are never revealed to men excepting incase of a caesarean section.
After the delivery only 12 percent of them had a postpartum checkup. A majority of
the women (85 percent) who had been pregnant resumed to domestic work two weeks
after the delivery. Women opined that cooking is inevitable, however women from
joint expected some kind of help from other family members but women from nuclear
families perceived no alternative.
Expectations of women about husbands’ support during three distinctive phases of
obstetric period reveals that, all women opine husband should extend support to wives
with respect to medical, health, nutritional as well as emotional. Relatively less
percent of women expected physical help from husbands. Most of the husbands never
realized the need to support wives during obstetric period.
Sexual practices and reported sexual morbidity
Premarital is higher than extramarital sexual activity among husbands; 28. / percent
reported premarital sexual contact and 13 percent after marriage. Median age at first
sexual contact of these men is 19 years. Before marriage 11.7 percent had sexual
relationship with multiple partners; after maniage it is declined to 2.8 percent. Prior to
marriage only 1.3 percent of men always used condoms. Men who had premarital
sexual relations, 17.2 percent suffered from STDs. Only 6.2 percent sought treatment.
Median age at first sexual intercourse for women is 16 years. Many of the women
were ignorant or had partial knowledge about coitus before first sexual contact. There
have been differences in reporting between women and men on information related to
sexual practices of the couples. A majority of the women opine that their duty is to
oblige husbands’ sexual desires. At the same time they consider that having coitus
once in a day is an acceptable practice. Where as, men differ their opinion with
133
i
women. Men think that there is no ideal number of times a couple should involve in
coitus per day and also opine that a husband has every right on wife’s body, thus wife
should not deny husbands’ sexual demands.
Sexual practices are very much constructed by gender. Unlike men, women opine
certain restrictions are necessary in frequency of coitus. Women feel ashamed to
declare if it is beyond the ‘accepted frequency’. Again women are made to perceive
that they have to oblige the ‘needs’ of husbands rather than self-physical need.
Regarding beliefs about STD risks and behaviour considerable variations are noticed
between men and women. Eighty five percent of men and 35 percent of women
agreed that ‘venereal disease can be passed from a mother to her baby before or
during birth’. A majority expressed ignorance for the remaining aspects; such as
‘some people who have venereal diseases show no symptoms at all’, ‘it is harmful for
a man to have sex with another man’, ‘a person contacts gonorrhea only once, after
that he or she becomes immune to the diseases’, and ‘syphilis can be treated with
penicillin and other antibiotics .
Out of the total women, 29.6 percent of them have suffered from menstrual related ill
health prior to marriage. One out of four wives (24.7 percent) were suffering from
reproductive tract infections at the time of survey. Only one half of them discussed
with husbands about illness. The remaining women felt comfortable to discuss about
illness with women. Only 27 percent of these women sought treatment. For seeking
health care however 64 percent of women felt it is necessaiy take husbands’
permission. It is evident from findings that those women who could discuss with
husbands had higher probability to seek treatment.
Husbands in this study are most willing to spend on health care of then wives, even
though they did not have correct awareness of their wives health situation. More than
four fifths of husbands spent towards wives’ during pregnancy. Often husbands have
spent more towards wives’ health care than on any one else in the family.
134
Family violence and reproductive health of women
Husbands hold strong and appropriate behaviours of wives towards themselves and
elders/in-laws. More than husbands, wives also opine such a feeling about their
behaviour. Nearly nine out of ten both husbands and wives think that, a wife should
show respect towards husbands and elders/in-laws. Two thirds think that they should
follow instructions; nearly three fourths believe that wife should be perused to obey
instructions. While no wife wants to be either verbally or physically beaten for not
listening, one third of the husbands do not mind implementing these measures. More
women prefer to have a free relation with husband, while more husbands expects
wives to be more obedient and obliging towards them.
More than half of the husbands, and one fifth of the wives have reported physical
violence towards wives. While a 89 percent of husbands reported of occurrence of
shouting/yelling during differences of opinion, 68 percent of wives reported that
slapping/pushing and half of them have mentioned punching/kicking was also
experienced. Despite high level of family violence very few women sought help from
others, because women do believe that to publicize family violence by themselves
brings disrespect to women. A few women also had to seek medical help after family
violence. Nearly ten percent of women experienced violence while they were
pregnant. More women (21 percent) reported forcible sex than husbands (17 percent)
with in marriage.
An impact of domestic violence on certain aspects of reproductive health care is
observed in the study. Findings revealed that violence is negatively associated with
contraceptive morbidity, home delivery and postpartum morbidity. In other words it
suggests that when men involve in matters related to women’s health, the chances of
them to utilize better health services is likely to increase, especially in a gender based
society.
135
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(E/CN.9/2000/3), New York: United Nations.
United Nations Fund For Children, 1998, The state of the world's children: Focus on
nutrition. New York, UNICEF, p 131.
Unnithan-Kumar, M, 1999, ‘Households, kinship and access to reproductive health
care among rural Muslim women in Jaipur’, Economic and Political Weekly, 34 (10 &
11), 621-29.
US Agency for International Development, 1997, Notes and minutes from 1997
meetings of the Men and Reproductive health subcommittee of the interagency
Gender working Group, (Unpublished).
V.„ Der Smten. A, King. R. Grinstead, O. Seruf.lira, A. and Allen. S, 1995. 'Couple
communication, sexual coercion, and HIV risk reduction in Kigali, Rwanda', AIDS
9(8): 935-944.
Vitenf, E, 1994, The consequences of iron deficiency and anemia in pregnancy on
maternal health. The Foetus Infant Science News (11) 14-18.
Warner, 1999, Increased participation of men in reproductive health programmes,
resource document for the ICPD+5 follow-up process final draft, Feb 21, 1999.
West K Jr, 1998, (Johns Hopkins School of Public Health, Division of Nutntion,
Department of International Health) Effects of Vitamin A supplements on women
during pregnancy, Personal communication.
,
r, Dphrman 1 1994 Vasectomy decisionWilkinson, D, Ward, V, Landry, E, and Behrman, L,
making in Kenya, New York, AVSC International, Mar, p 32.
World Health Organization, 1991, Infertility: A tabulation of available data on
prevalence ofprimary and secondary fertility, Geneva, WHO, p 72.
X
Salway, S, 1994, ‘How attitudes toward family planning and discussion between
wives and husbands affect contraceptive use in Ghana’, International Family
Planning Perspectives 20(2): 44-47, 74.
Sargent, Carolyn, 1982, The Cultural Context of Therapeutic Choice: Of stetrical
Care Decisions Among the Bariba ofBenin, Boston: D. Reide Publishing.
SEWA-Rural Research Team? 1998, Enhancing roles and responsibilities of men in
women s health', workshop on men as Supportive Partners in Reproductive and Sexual
Health, Kathmandu, Nepal, June 22-26, New Delhi: Population Council.
Sharma, R, 1992, ‘Vitamin A in pregnancy: A review’, Indian Journal of maternal
and child health 3 (2): 36-40.
Sherpa, H, and RAI, 1997, Safe motherhood it is a family responsibility, Report on
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ix
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xi
■
MEN’S PARTICIPATION IN REPRODUCTIVE HEALTH
HOUSELISTING FORM
(Confidential for Research Purposes only)
1
Name of the Village
2
Household number
3
Name of the head of the household
4
How many people live in your
household?___________ _________
How many women live in your
household?
5
6
S.
No
How many married women live your
house?
(Included widowed, divorced, and
separated)______
Age
Name of the
married women
(Completed
Years)
8
7
i
Marital status
Currently Married
Widowed
Separated/Divorced
Never Married
1.
2.
3.
4.
11
10
9
1
2
3
4
ii
1
2
3
4
iii
1
2
3
4
iv
1
2
3
4
V
1
2
3
4
12
Total number of married women
13
Total number of women selected
Duration of Marriage
(Ask only currently
married women)
(Completed years)
House listing result
Completed in
One visit
Two visits
More than two visits
1
2
3
Date
Name
Investigator
Supervisor
CENTER FOR ECONOMIC AND SOCIAL STUDIES
Nizamia Observatory Campus, Begumpet, Hyderabad - 500 016,
Andhra Pradesh.
MEN’S PARTICIPATION IN REPRODUCTIVE HEALTH
HOUSEHOLD SCHEDULE
(Confidential for Research Purposes only)
IDENTIFICATION
1
Name of the Village
2
Household number
3
Name of the head of the household
Interviewer's
Name
INTERVIEWER’S VISIT AND RESULT
Interview Result
Completed....................................
No competent respondent at home
Household absent.........................
Postponed......................................
Refused..........................................
Others
(Specify)
4
____ ______________________ CHECK
Total members in the household
5
Total number of eligible women selected
Interview Date
.1
.2
.3
.4
.5
6
VERIFIED BY
Date
Name
Supervisor
Field Editor
Office Editor
CENTER FOR ECONOMIC AND SOCIAL STUDIES
Nizamia Observatory Campus, Begumpet, Hyderabad - 500 016,
Andhra Pradesh
Please name all the persons in your household
SWT
1
r-
Name of the
household
member
2
Relationship to
head of the
household
Whether
resident or
visitor
R-l
V-2
3
“T"
2~'
Sex
Age in
Completed
Years
Marital status
M-l
F-2
5
T
2
1
2"
7
"3
~4
2J
1
2
3
4
2“
T
2
3
1
2
T
7
1
2
2
4
~4~
1
7
T
2'
T
2
3
4
5
T
2
T
2
T
2
J
4
T
7
I
7
T
7
4
7
T
7
T
7
T 7
7
K
T
7
T
7
T
2
7
2
7
T
2
T
2
T
2 "3
~4
T7
T
7
T
“2
I
7
7
4'
FT
I
7
T
7
T 7
7
4
T2
T
2'
I
2
T 7
7
3
17
I
2
T
2
T
2
7
4
13
T
2
I
7
T
2
3’
4
15
T
2
I
2
T 7
7
4
2
Code: Q3
Code: Q6
1 Head
2 Wife or Husband
3 Son or Daughter
4 Son-in-law or Daughter-in-law
5 Grandchild
6 Parent
7 Parent-in-law
8 Brother or Sister
9 Brother-in-law or Sister-in-law
10 Niece or Nephew
11' Other relative
12 Not related
00 Age less than one year
95 Age 95 years or more
Code: Q7
1 Currently married
2 Widowed
3 Separated/Divorced
4 Never married
8
9
10
11
12
13
3
What is the highest level of
education any of your household
members has?_____
What is the main source of drinking
water for members of your
household? ■
How long you have to go to get the
water?
Piped water
Piped into residence/yard/plot
11-^Qll
Public tap
12
Ground water
Hand pump in residence/yard/plot..,21-^Q] 1
Public hand pump
22
Well water
Well in yard/plot
31->Q11
Public well
32
Surface water
Pond...................
.43
Rain Water
.51
Tankerffruck
.52
Others
96
(Specify)
Kms.
What do you do to purify drinking
water?
Strain by cloth
Water filter
Boiling
Electric Purifier (Acquaguard)
(Probe: Record all mentioned)
Nothing
.......
Others
(Specify)
What kind of toilet facility does your Flush toilet
household have?
Own flush toilet
Shared flush toilet
Public flush toilet
Pit toilet/latrine
Own pit toilet/latrine
Shared pit toilet/latrine
Public pit toilet/latrine
What is the main source of lighting
for your household?
No facility/Bush/Field
Others__ _________
(Specify)
_
Electricity
Kerosene
Gas
Oil
O th e rs __________
(.Specify)
..a
,.b
.c
d
.e
x
11
12
13
.21
22
23
.31
96
.1
2
.3
.4
6
14
How many rooms are there in your
household?
15
Do you have a separate room
Which is used as kitchen?
What type of fuel you use for
cooking /heating?
16
17
18
19
20
21
22
23
Type of house
(Observe and record)
Does your household own any of the
following
A cot
A pressure cooker
A clock or watch
An electric fan
A radio or transistor
A television
A bicycle
A moped, scooter or motorcycle...
A car
A bullock cart
. .................
A tractor....................... ....................
Does this household own any
agricultural land?________________
Do you get income from agricultural
land?_____________________ ___
Does this household own any
Livestock?______________ _
What is the religion of the head of
the household?
What community does the
household belongs to?
L
4
|
Yes
No..............................
Wood
Crop residues
Dung cakes
Coal/coke/lignite
Charcoal
Kerosene
Electricity
Liquid petroleum gas
Bio-gas
Others
{Specify)__________
Hut...........................
Kutcha
Pucca
Yes
..1.
1
1
1
1
1
1
1
1
1
1
Yes
No....................
Yes...................
No....................
Yes
No...................
Hindu
Muslim
Christian
Others
Specify)
Scheduled caste
Backward caste,
General caste...
Scheduled tribe.
Not applicable..
.1
.2
.a
.b
.c
d
.e
,f
•g
.h
..i
x
.1
2
3
No
.2
.2
.2
.2
.2
.2
.2
.2
.2
.2
2___
..1
..24>Q21
...1
..2____
...1
..2____
..1
..2
..3
6
1
.2
.3
4
.8
MEN’S PARTICIPATION IN REPRODUCTIVE HEALTH
WOMEN’S SCHEDULE
(Confidential for research purpose only)
IDENTIFICATION
I
Name of the Village
7
Household Number
3
Name of the head of the household
7
Woman’s name and line number
Interviewer’s Name
INTERVIEWER’S VISITS AND RESULT
Interview Date
Interview Result
Completed............
T
Respondent absent
2
.3
Postponed
.4
Refused
Others
(Specify)
VERIFIED BY
Name
Date
Supervisor
Field Editor
Office Editor
L______________
INFORMED CONSENT
Namaskaram. My name is
_______ • I am from Centre for
Economic and Social Studies. We are conducting a survey on Men’s Participation on
Reproductive Health. We appreciate your participation in this survey. As per research ethics,
' your name and identity of your household and all other information will not be revealed to
| anybody.
i We hope that you will participate in the survey since your views are important. Do you want to
ask me any thing about the survey?
Respondent does not agree for the interview
i Respondent agrees for the interview.
1
Q101.
-.2
END
CENTRE FOR ECONOMIC AND SOCIAL STUDIES
Nizamia Observatory Campus, Begumpet, Hyderabad - 500 016,
Andhra Pradesh.
101
102
SECTION: 1 BACKGROUND CHARACTERISTICS
Currently married...
What is your current marital status?
Widowed
Separated/Divorced.
Never married
What is your birth date?
Month
DK month
Year
97
97
103
What is your current age?
DK year................
In completed years
104
At what age you attained puberty?
In completed years
How many years after puberty you were
married?________ _____________________
106 Prior to marriage is your husband a relative?
In completed years
107
Who was mainly responsible for settling your
marriage?
108
Was your consent taken prior to settling your
marriage?
Self ..................
Parents
Relatives
Oth e r s
(Specify)________
Yes
No
Not necessary. .■...
In completed years
105
How many years after marriage you started
living with your husband?_________________
How
many years have passed since you are
110
married?
________
111 What is the minimum legal age at marriage for
a boy in India?_______________________
112 What is the minimum legal age at marriage for
a girl in India?__________________________
113 Have you ever become pregnant?
109
114
115
116
6
s
Yes
.1
No........................
2_
.1
.2
.3
6
,1
2
.3
In completed years
Age
Age
.1
How many live births you have had?
Yes
No.............
Total births
00->Q120
How many are now surviving?
None...............
Total surviving
00
How many are now not surviving?
None......................
Total not surviving
None
00
,2->Q125
117
How many years after your marriage you had
your first child?
In completed years
118
What is the present age of your first child?
In completed years
119
When was your last child born?
Month
DK month
97
Year
120 Have you ever had a stillbirth?
121
How many times you ever had stillbirth?
122
Have you ever had an abortion?
123
How many times you ever had abortion?
124
Last time when you had an abortion, was it
spontaneous or induced?_______________
Are you pregnant now?
125
Yes
No.....................
Number of times
.1
2^Q122
Yes
No.....................
Number of times
J
Spontaneous
Induced.......
Yes
No
2-»Q125
...1
...2
DK
QI 27 T
126
How many months pregnant are you now?
Month
DK month
127
Have you ever attended school
128
Can you read and write?
Yes
No...........
Yes
No
97______
..1->Q129
..2______
A
Q130*
How many years of schooling have you
completed?____
130 Some women work, which helps them to earn
some income. Do you do any of such
activities?_____________________________
131 What type of work do you do?
129
Years of schooling
(completed years)
Yes
No
.1
2->Q 132
.1
Yes
During past one year did you do any such
2^Q134
work?___________________________________ No.
133 What type of work did you do?______________
134 CHECK: Q130 and Q132, if ‘YES’ in any one of them, ask Q135 or skip to Q201
Number of days
135 How many days in a year you work?
132
136
How much do you earn per day?
In Rs.
In kind
7
95
SECTION: 2A MEDIA EXPOSURE
had for different reproductive health aspects
Now I would like to ask some questions about media exposure you
AIDS
After child birth
Delivery Care
Pregnancy Care
Family Planning
sTNo?
i
201
202
Have you heard or
seen any message
in the last one
month?
Where did you see
or hear any
message about it in
the last one-month?
Circle all
responses
mentioned
203
What was the
message mostly
about?
Yes
No.
.1
2^Q204
Interpersonal visit...a
Group Meeting
b
Youth club
Orientation
training camps... c
Mass Media
.d
Radio
.e
Television
,.f
Cinema/film
Print material.... g
Hoarding/wall
.h
painting
i
Oth ers
(Specify)
How many
1
children to have
To stop having
children
2
To space children....3
To postpone first
.4
birth
.5
Do not recall
Yes
No.
Interpersonal visit...a
Group Meeting
b
Youth club
Orientation
training camps... c
Mass Media
.d
Radio
.e
Television
,.f
Cinema/film
Print material.... g
Hoarding/wall
.h
painting
i
Others^
(Specify)
How many
1
children to have.
2
Health of foetus
Health of mother....3
Vaccination of
.4
women
5
Do not recall
I
8
n
,..l
..2-»Q204
Yes
No.
..2-^Q204
Interpersonal visit...a
Group Meeting
b
Youth club
Orientation
training camps
.c
Mass Media
.d
Radio
.e
Television
..f
Cinema/film...
Print material.
g
Hoarding/wall
.h
painting.........
i
Others_
(Specify)
Place of
1
delivery
How many
children to have
2
Health of new born..3
Health of mother....4
Vaccination of
.5
new bom
6
Do not recall
Yes
No.
...1
..2-»Q204
Interpersonal visit...a
Group Meeting
b
Youth club
Orientation
training camps
,c
Mass Media
.d
Radio
.e
Television
..f
Cinema/film...
Print material.
g
Hoarding/wall
,h
painting..........
i
Others
_
(Specify)
Need for postpartum
care
1
Vaccination
of new bom
2
Health care of new
3
borne
Health of the
.4
mother
Breastfeeding
.5
.6
Do not recall.
vi_________
v
iv
in
Other Reproductive
Health Problems
Yes
No.
Ti
,.2->Q204
Interpersonal visit...a
Group Meeting
,b
Youth club
Orientation
training camps
,c
Mass Media
.d
Radio
.e
Television
,.f
Cinema/film...
Print material.
g
Hoarding/wall
,h
painting..........
i
Others^
(Specify)_______
Prevention............. 1
Curative facility....2
Social acceptance...3
Spread of disease...4
Do not recall
5
Yes
No.
.1
2AQ204
Interpersonal visit...a
Group Meeting
b
Youth club
Orientation
c
training camps
Mass Media
.d
Radio
.e
Television
..f
Cinema/film...
Print material.
g
Hoarding/wall
.h
painting
i
Others
(Specify)
Prevention............ I
Curative facility....2
Social acceptance...3
Spread of disease...4
Do not recall
5
J
Sl.No.
204
205
206
How many
contacts have you
had in the last six
months with any
female health care
provider (from
both government
and private
sectors)?_______
How many
contacts have you
had in the last six
months with any
male heath care
provider (from
both government
and private
sectors)?
CHECK:
RESPONSES TO
Q204 and Q205.IF
‘NO’CONTACTS
MADE, skip to
0212___________
In how many of
those total contacts
(mention each of it)
was discussed?
Family Planning
Pregnancy Care
Delivery Care
After child birth
AIDS
Number of contacts
ii
Number of contacts
________ Hi______
Number of contacts
________iv
Number of contacts
_________v______
Number of contacts
Other Reproductive
Health Problems
________ yi_______
Number of contacts
If none
If none
If none
If none
If none.
If none.
Number of contacts
.00
Number of contacts
00
Number of contacts
.00
Number of contacts
.00
Number of contacts
.00
Number of contacts
o
If none
00
Number of times
None
9
.00
If none
.00
None
.00
Number of times
Number of times
.00
If none
.00
None
If none
.00
Number of times
.00
None.
If none
.00
Number of times
.00
None
If none
.00
Number of times
.00
.00
None.
6
207
When was the last contact made?
208
With whom was your last contact made?
209
Where you satisfied with the
information/services this person provided?
Reasons for satisfaction?
210
Circle all responses mentioned
211
Reasons for dissatisfaction?
Circle all responses mentioned
10
Days
a
b —
Months
Do not remember..................... ..97 —
Govt, allopathic doctor............
11
12
Govt. ISM practitioner............
13
MPHA......................................
14
Male health worker..................
15
Pvt. allopathic doctor...............
16
Pvt. ISM practitioner...............
17
Voluntary organization worker
18
Industry/ESI clinic worker.....
19
Anganwadi worker..................
20
Village health guide................
21
Dai (TBA)................................
22
Medical shop...........................
23
General merchant/kirana shop.
Teachers/informal and
24
formal leaders.......................
96_____
Others
_____________
..1
Yes
,.2-^Q211
No............................................
..a
Complete information given...
.b
No physical complication
..c
Services available when needed
..d
Side effects attended to
...f
Supplies available
Inexpensive
■••g
..h
Convenient to reach
...i
Attended promptly
...j
Courteous staff...?
..k
Staff available...........................
...1
Female health staff available....
..m
Service site open
x
OthersfS'pec/y)_____________
' ->Q212
..a
Inadequate information
Physical complication at
,..b
the time of service
,.c
Was asked to come another time
.d
Side effects not attended to
..e
Supplies not available
..f
Expensive
Too far
••g
..h
Too much time spent
. .i
Staff was discourteous...............
...j
Staff not available
..k
Service site not open
Others (ypecZy/
__________ x
SECTION: 2B INFORMATION ON ACCESS
S.No.
212
I would like to ask some questions about where information and services can be obtained for different reproductive aspects
Postpartum
Women’s other
STDs
Sterilization
Pregnancy care
Delivery care
Medical
Oral
care
health problems
contraceptives/ termination of
pregnancy
condoms/IUD
(abortion)
vi
v
iii
vii
viii
I
iv
Tell me all the
places you
know that
provide
(service)?
- If no source
! mentioned —I
- If one source
mentioned^
Q214
- If more than
one source
I mentioned"^
CHECK:
- If no source
mentioned —►
- If one source
mentionedT^
Q214
- If more than
one source
mentioned^
- If no source
mentioned —►
- If one source
mentioned
Q214
- If more than
one source
mentioned"^
- If no source
mentioned —►
- If one source
mentioned^
Q214
- If more than
one source
mentionedy
- If no source
mentioned —►
- If one source
mentionecTV
Q214
- If more than
one source
mentioned"^
- If no source
mentioned —►
- If one source
mentioned V
Q214
- If more than
one source
mentionedy
- If no source
mentioned —I
- If one source
mentioned^
Q214
- If more than
one source
mentioned^
- If no source
mentioned —►
- If one source
mentioned-^
Q214
- If more than
one source
mentionedy
J_____________
213
What is the
nearest source I
for the
i
------- ------- ------------------(service)?_____|__________________________
Codes for Q212&Q213
Govt./Medical college hospital........
PHC/Additional PHC
Sub-centre
Pvt.hospital
Voluntary agencies
Industrial units/ESI clinics/hospitals
Allopathic doctors (p)
11
.1 1
12
13
14
15
16
.17
ISM practitioners (p)
MPHAs
Anganwadi workers.
TBAs(Dais)
Medical shops
Pan shops
18
19
20
.21
,22
23
Depot holders
General/Kirana merchant shops
Camps
Others
(Specify)
DK........................................
NA.............................................
24
.25
,26
96
97
98
AIDs
ix
- If no source
mentioned —►
- If one source
mentioned^
Q214
- If more than
one source
mentionedy
Oral
conttaceptives/
condoms/IUD
S.No.
214
Where is the
source
located?
Village
1
Name of the
Village
Town/
City
2
Name of the
Town
215 I How far is this
I place from
I where you
I live?
216 ! How long (in
minutes) does
it take to reach
this source?
12
Kms.
Code 998 if in
this village
STDs
AIDs
Village
1
Name of the
Village
viii
Village 1
Name of the
Village
xi
.Village
1
Name of the
Village
Town/
City
2
Name of the
Town
Town/
City
2
Name of the
Town
Town/
City
2
Name of the
Town
Town/
City
2
Name of the
Town
Kms.
Kms.
Kms.
Kms.
Kms.
Code 998 if in
this village
Code 998 if in
this village _
Code 998 if in
this village
Code 998 if in
this village _
Code 998 if in
this village
Sterilization
Pregnancy care
Delivery care
Postpartum
care
Women’s other
health problems
iv
Village
1
Name of the
Village
Village
1
Name of the
Village
v
Village
1
Name of the
Village
vi
Village
1
Name of the
Village
vii
iii
Village
1
Name of the
Village
Town/
City
2
Name of the
Town
Town/
City
2
Name of the
Town
Town/
City
2
Name of the
Town
Town/
City
2
Name of the
Town
Kms.
Kms.
Kms.
Code 998 if in
this village _
Code 998 if in
this village
Code 998 if in
this village _
Medical
termination of
pregnancy
(abortion)
I
301
302
303
304
305
SECTION: 3 CURRENT AND FUTURE USE OF FAMILY PLANNING
Prior to first pregnancy did you and
.1
Yes
2
No.
your husband ever discussed on number
of children you should have?_________
.1
Yes
Did you and your husband ever
discussed on usage of a family planning No.
2
method? _______ ________________
Did you and your husband discuss on
No
Yes
the following aspects at any time?
Postpone children
Gap between children
Number of children
What FP method to use
Who should use
Source of FP method
Side effects of FP method
To seek health advice prior to use of FP
method...................................................
Are you or your husband cuirently using
a family planning method?___________
What method are you or your husband
using?
1
1
1
1
1
1
1
1...................
Yes
No.........................
Male sterilization...
Female sterilization
IUD
Oral pills
Condoms
,2
.2
2
,2
.2
.2
,2
..2______
..1
■..2->Q324
11
12
q
Q310
Periodic abstinence
Withdrawal
Any other
(Specify)
■in
96
Q314
306
How long ago were you (your husband)
operated for sterilization?
Months
.a n
Years
b
Less than one month
DK...........................
307
Have you (your husband) visited any of
the health facilities for follow up
services after sterilization?
Yes
No
DK
00
.97____
...1
...2---- ,
...7—t
Q309
13
308
309
310
311
312
313
314
Which health facility did you (your
husband) visit?
Has any one from health department
visited you (your husband) after
sterilization for follow up services?
For how long have you (your husband)
been using the method continuously?
From where do you (your husband)
usually obtain FP services?
At your last visit, did you receive any
counseling about different FP methods?
Has any health worker visited you for
follow up services or supplies?
For how long you have been using this
method continuously?
Medical college hospital
Govt.hospital
PHC
Sub-centre
Pvt.hospital/clinic
Voluntary agency/industry/
ESI hospital/clinic
Govt.ISM hospital/clinic...
Pvt.ISM hospital/clinic
Others^
(Speciy)_______________
Yes.....................................
No
DK.....................................
16
17
18
96
n
Months
Q3I5
aI
Years
b
Less than one month
DK......................................
Medical college hospital....
Govt, hospital
PHC/Sub-centre
Govt.ISM hospital/clinic....
Pvt.hospital/clinic
Pvt.ISM hospital/clinic
Voluntary agency/industry/
ESI hospital/clinic
MPHA
Dai (TBA)
Medical shop
kirana shop/Pan shop
Others_
(Speciy)_______________
Yes.....................................
No......................................
Yes
No
.00
97
.11
12
.13
14
.15
.16
17
18
19
.20
21
96
1
.....2
Q315
Months
a
Years
b
Less than one month
DK........................
14
11
12
13
14
15
00
.97
Postpone pregnancy........
Gap between pregnancies
Stop further pregnancies..
Health concerns
O thers
(Specify)
Self
TT6 "Who mainly motivated you (your
Husband
husband) to use the family planning
Both
method?
Parents
Parents-in-law
Other relatives
O thers
(Specify)
Self
Who decided about the usage of this
Husband
particular method?
Both
Parents
Parents-in-law
Other relatives
Others
_
(Specify)
CHECK:"Q305
if
coded
41
’
skip
to
Q331
3 TH
if coded 45’ skip to Q329
_____________
Yes
Did
you
any
time
experience
any
healtlT
TT7
No.
problems because of use of a family
planning method? ________ _______
Yes......................................
Did you seek treatment for it?
No.......................................
Medical college hospitaITT
Where
did
you
seek
treatment
for
it?
T2T
Govt.hospital
PHC
Sub-centre
Pvt.hospital/clinic
Voluntary agency/industry/
ESI hospital/clinic
Govt.ISM hospital/clinic...
Pvt.ISM hospital/clinic
Others
_____
(Speciy)
_
Self
Who assisted you to go for a treatment?
Husband
Both
Parents
Parents-in-law
Other relatives
O thers
__
(Specify)
TT5
15
What is the main reason for using the
family planning method?
IT
12
13
.14
96
11
12
.13
.14
15
,16
96
IT
12
.13
.14
15
16
96
T"
2-2>Q323
7T..2-2>Q323
IT"
12
13
14
.15
16
17
.18
96
IT
12
.13
.14
15
16
96
CIIECKFQSOS if coded HI’ skip toTplTif coded ‘13’ or ‘14’ skip to Q329
What
is
a
main
reason
you are not using Husband away
32*4'
Fertility-related reasons
it to delay or avoid pregnancy?
Not having sex
12
Infrequent sex
13
Menopausal/had hysterectomy. ...14->Q3 31
Sub-fecund/In-fecund
15
Postpartum/breastfeeding
16
Wants more children
17
Opposition to use
..18
Opposed to FP
..19
Husband opposed
.20
Other people opposed
..21
Against religion
Lack of knowledge
22
Knows no method
.....
.23
Knows no source................
Method related reasons
Health concerns................... ...24
F.25
Worry about side effects....
...26
Hard to get method
...27
Cost too much
...28
Inconvenient to use.............
Afraid of sterilization.......... ....29
Don’t like existing methods ...30
96
Others
(Specify)_______________
77 r*
Yes......................................
Do you plan to use any family planning
...2^Q329
No
method in future?
TH
Postpone
pregnancy
32F Why do you want to use a family
.12
Gap between pregnancies..
planning method?
..13
Stop further pregnancies....
.14
Health concerns
96
O thers
(Specify)
_________
TF'
Male
sterilization
.
What
methods
will
you
or
your
husband
327
12
Female sterilization
use?
13
IUD...................................
14
Oral pills
.15
Condoms
96
Any other
(Specify)
97
Not sure/undecided
n
16
o
328
When do you or your husband plan to
begin using it?
| Months
a
Years
b
Less than one month
Undecided.....
329
How many more children would you
like to have?
Number of additional children
None
Undecided
330
331
17
When would you like to have the next
child?
During a woman’s monthly menstrual
cycle, that is, from the beginning of one
period to the beginning of the next,
when would you say a woman is most
likely to become pregnant if she has
intercourse?
00
.97
.00->Q331
97
After months
Undecided.......................
Right before her period...
During her period............
About one week after her
periods begins.................
About two week after her
periods begins.................
All limes are the same,
it makes no difference....
Others_______________
(Specify)
DK..............................
97
.11
..12
13
14
15
96
97
SECTION: 4 OBSTETRIC HEALTH
ZbinXhh ttiX^'gathteJXm^ -men for
use in health report without any personal identification. If the meaning of any question
unclear, please ask me.
400
CHECK QI 13: If YES, ask if she ever been pregnant since Depavali 2001
.1
,2->Q460
Yes
No.
! would like to ask you about your pregnancies in the past two years, whether the child was
born alive, born dead, or the pregnancy was lost before full-term, that is, as a miscarriage or
an abortion. I would like to start with your latest pregnancy before Depavali 20UJ.
RECORD TWINS AND TRIPLETS ON SEPARATE LINES
Think back to your (last/previous) pregnancy before Depavali 2003 .
--------------- "
402
403
404
405
406
407
408
409
S.
No.
What was
your age al
that (last/
previous)
pregnancy?
Was that a
single or
multiple
pregnancy?
Was the baby
born alive, bom
dead, or lost
before full term,
that is, as a
miscarriage or an
abortion?
Did that baby
cry, move, or
breath when it
was bom?
What name
was given to
that child?
Is/was
(Name)
a boy
or a
girl?
Is
(Name)
still
alive?
1
Age
Single....!
Multiple..2
DK........ 7
Born alive... 1
Q406’
Born dead....2
Yes..l
Boy..l
In what
month and
year was
(Name)
born?
PROBE:
What is
his/her
birthday?
Month
No...2-“1
Q412V
Girl ..2
401
2
Age
N0-2”^
Single....!
Multiple..2
DK........ 7
_________ Q412
Born alive... 1 I
Q4061
Born dead....2
Boy..l
Yes..l
No...2“
Lost before full
(completed
years)
3
Girl...2
m.
Yes.l
No-2-^
Q41 1
term.............. 3-
Single....!
Multiple..2
DK........ 7
_________ Q412
Born alive... 1 |
Q4061
Born dead....2
Lost before full
term............. 3Q412
18
Month
Year
Name
Boy..l
Yes..l
Month
Yes.l
No.2-^
No...2“
Girl...2
Q412
(completed
years)
Q411
term.............. 3-
Q412
Age
Year
Name
Lost before full
(completed
years)
Yes.l
Name
Year
□
Q411
RECORD TWINS AND TRIPLETS ON SEPARATE LINES
410
Still alive
If Alive, How old
was (Name) at
his/her last
birthday?
Record in YEARS.
1
Age in years
□
->Q412
2 Age in years
->Q412
Age in years
->Q412
19
I
411
412
413
Born dead.
How many months
did the pregnancy
last?
Was that
baby a boy or
a girl?
If bom alive
Now dead
If Dead, How old was
he/she when hc/she died?
If “1 Yr”, PROBE: How
many months old was
(Name)?
Record DAYS if less than
month, MONTHS if less than
two years, otherwise record
only in COMPLETED
YEARS.___________________
Need a prefix (1 to 3) in
front of box
Days...
Months,
Years...
.1
.2
.3
Need a prefix (1 to 3) in
front of box
Days...
Months.
Years..
.1
.2
.3
Need a prefix (1 to 3) in
front of box
Days...
Months
Years..
.1
2
414
If bom dead or
lost before full
term___________
In what month
and year did this
pregnancy end?
415
If lost before full
term
Did this
pregnancy end
by itself or did
you or someone
else do some
thing to end it?
Record in
COMPLETED
MONTHS.
Boy
1
Girl
2
If LIVE BIRTH go
to next pregnancy
or skip to Q 416
DK
7
Year
Month
Boy
1
Month
Girl
2
If LIVE BIRTH go
to next pregnancy
or skip to Q 416
DK
7
Year
Month
Boy
1
Month
Girl
2
Month
If LIVE BIRTH go
to next pregnancy
or skip to Q 416
DK
7
Month
Year
Spontaneous.!
Induced........ 2
(Go to next
pregnancy or IE
NO MORE skip
to Q416)
Spontaneous.!
Induce........... 2
(Go to next
pregnancy or IE
NO MORE skip
toQ416)
Spontaneous.!
Induced........ 2
(Go to next
pregnancy or IE
NO MORE skip
to Q416)
o
CHECK: Q40T for LAST PREGNANCY PRIOR TO b'EPA VALI2003 he. written in the first
row. I would like to ask you some further questions about the last pregnancy you had.
When you learned of this pregnancy, did you want
416
Then.............................................. 1 _>Q418
to become pregnant then, did you want to wait until Later
2
later, or did you want no (more) children at all?
No more........................................ 3
TF7
When you later/no more wanted to become
Accidental
11
pregnant, how did this happen?
Did not know how to prevent. ..12
Could not oppose husband
from sex
..13
Husband wanted a child..
.14
In-laws wanted a child....
.15
O thers
96
(Specify)
TTK
During this pregnancy, did you see? Any one for
Allopathic doctor............
..a
antenatal care?
MPHA(F)
..b
Any other health personal
..c
If YES, whom did you see? Any one else?
Dai
.d
Others
x
Record all persons seen
(Specify)
No one
f->Q427
W Did you see a doctor, nurse or midwife for an
Yes....................................
71
antenatal check up during the last month of this
No.....................................
.2
pregnancy?
42U Who advised you to show yourself for an antenatal
Husband......................
TIT
check-up?
Mother/Mother-in-law
.12
Relative
.13
Neighbour
14
Dai
.15
Nurse/doctor
16
Self
17
O thers
96
(Specify)
”421
Who decided abouI whether you should go for an
Husband
antenatal check up or not?
Mother/Mother-in-law
.12
Relative
.13
Neighbour
14
Dai
15
Nurse/doctor
16
Self
17
Others
96
(Specify)
471
Where did you go for the antenatal check-ups?
.a
PHC/Sub-centre..........
.b
Govt, hospital
.c
Pvt. Hospital
,d
Pvt. Doctor/clinic
.e
RMP/compounder
Dai
x
0 thers
Circle all responses mentioned
(Specify)
20
:rr
4W
TZ5
TZU
TH
Did you have the following performed at least
once during any of your antenatal check-ups
during this pregnancy?
Weight measured
Height measured
Blood pressure checked
Blood test
Urine test
Abdomen measured with tape
Listened to baby's heartbeat
Internal exam
X-ray taken
Scanned/seen baby on a TV screen
Amniocentesis
Did you receive advice on any of the following
during at least one of your antenatal check-ups
for this pregnancy?
Diet
Danger signs of pregnancy
Delivery care
Newborn care
Family planning
When you were pregnant, have you given an
injection in the arm to prevent you and the baby
from getting tetanus?
When you were pregnant have you given any
iron folic tablets or syrup?
What is the main reason you did not receive an
antenatal check-up?
Circle all responses mentioned
21
Yes
..1..
1
1
1
1
1
1
1
1
1
1
Yes
..1..
..1..
1
Yes
No.
DK.
No
..2
..2
..2
..2
..2
..2
..2
..2
..2
..2
..2
No
2
2
2
2
2
T2
7
Yes
No.
Q42?
Always felt well/Not necessai y...a
Don't know where to
go /where it is
.b
c
Not customary
d
Too far away
.e
No transportation
.f
Cost too much
No time to go
•g
,.h
Not open when I could go
Attitude of doctors/nurses
..i
not good
Service not good/no medicine
•J
.k
Family did not allow
.1
No one to care children
x
Others
(Specify)
42K
Did you have any of these illness or problems
during last/current pregnancy?
Swelling of hands & feet
Blurred vision
Giddiness
Fits
Urinary problem
Varicose veins
Fever >3 days
High blood pressure
Severe vomiting whether treatment required....
Tuberculosis
Malaria
Heart disease
Diabetes
No movement of fetus
Bleeding
Others
(Specify)
What type of care and cooperation did your
husband extend to you when you were
pregnant?
Circle all responses mentioned
In your opinion when a wife is pregnant shoulB
a husband extend the following
care/cooperation?
Talk affectionately
Express concern towards health
Take her to an antenatal checkup
Arrange with someone to go to antenatal
checkup
Arrange/Assist in transportation
Get fruits/sweets for her
Take interest towards her diet
Monitor on intake of medicines
Manage older children
Assist in household work
Any other (Specify)
22
No
2
2
2
2
2
2
.2
,2
.2
.2
.2
.2
.2
.2
.2
.2
Yes
..1..
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
'Falk affectionately....................... a
Express concern towards health.. .b
Take you to an antenatal checkup.c
Arrange with someone to go
to antenatal checkup
d
Arrange/Assist in transportation...e
Get fruits/sweets for you
f
Take interest towards your diet.. .g
Monitor on intake of medicines.. .h
Manage older children.
i
Assist in household work
j
Any other
x
(Specify)
k
Not necessary
Yes
No
1
2
2
2
1
1
1
1
1
1
1
1
1
1
2
2
2
2
2
2
.2
.2
TO
TO
TO
TO
“TO
23
CHECK: Q404 if coded 1 or 2 then ask Q432 or skip to Q448
PHC/Sub-center............
Where did you originally plan to have your
Govt.hospital................
delivery?
Private hospital..............
Home.............................
Home of birth attendant.
Others______________
(Specify)____________
PHC/Sub-center............
Where did you finally have your delivery?
Govt.hospital................
Private hospital.............
Parent’s home...............
Natal home...................
Home of birth attendant
Others_____________
(Specify)
__
No one..........................
Who attended you at the time of delivery?
Relative........................
Untrained Dai...............
Trained Dai...................
MPHA (F)....................
Doctor...........................
Nurse............................
Others_____________
(Specify)__ ________
“Husband.......................
Who was the person most responsible for
Mother/Mother-in-law..
having the delivery at (Q433)?
Father/Father-in-law....
Elder female relatives...
Neighbours...................
Others______________
(Specify)
4i
12
.13
.14
15
96
TIT
.12
.13
.14
.15
.16
96
TIT
..12
..13
..14
.15
.16
.17
96
TT
12
13
14
.15
96
436
437
Did you experience any of the following at the
time of delivery?
Labour more than 18 hours
Use of forceps
Excessive bleeding (More than 3 sarees stained)
Sac burst and even after 5 hours child was not
born
Sac burst and the fluid was greenish colored...
Fainted during labour
Fits or convulsions
Baby was in breech position/not in normal
position
Placenta was down
Twins/multiple births
High BP
Caesarean
Others
(Specify)_______________________________
In which way your husband extended help at
the time of childbirth?
Circle all responses mentioned
438
439
440
24
In your opinion at the time of a wife’s delivery
should a husband extend the following help?
Calling persons to assist her
Arranging transportation
Bringing necessary items/medicines
Financial help
Emotional help
Husband has no role to play
Any other (Specify)_________________ _
Did you have a health check done during first
six weeks after childbirth?
With in how many days after childbirth did you
have a check-up?
1
No
..2
..2
..2
1
1
1
1
2
2
2
.2
I
2
2
2
2
2
,2
Yes
1
1
1
1
1
1
Called for an assistant/health
personnel
Arranged transportation
Getting necessary items/
medicines
Financial help
Emotional support
Did not help at all
Any other
(Specify)
Not necessary.......................
Yes
...1.
I
1
I
I
1
1
Yes
No.
Days
.a
b
.c
.d
.e
.f
x
£
No
...2
...2
...2
...2
...2
...2
...2
....1
...2-3>Q442
441
Where did you go for a health check-up?
Record all persons seen
442
443
Did you face any of these problems/illnesses
during first two months after the delivery:
Pus formation in tare
Fever >3 days
Loss of consciousness for >15 minutes
Pain in lower abdomen
Painful, burning feeling when urinating
Changes in mental make-up
Fits/convulsions
Discharge that smells
Breast abscess
Excess bleeding
Depression
Backache
Others
(Specify)_____________________________
In general, what type of care a woman is
supposed to take after childbirth?
Circle all responses mentioned
444
445
How many days after childbirth did you start
doing household work?_________________
Did you do any of the following with in six
weeks after the childbirth?
Carrying older children...,
Rinsing clothes
Bring water from distance
Lifting heavy items
25
I PHC/Sub-centre...
Govt, hospital
Pvt. hospital
Pvt. doctor/clinic..
RMP/compounder.
Dai
Traditional healers
Others
(Specify)
Yes
1
1
1
1
1
1
1
I
1
1
1
1
Nutritional diet
Restricted diet
Adequate rest
Not to indulge in heavy work
Abstaining sex
Feeding practices
Regular health checkup........
Any other
(Specify)________________
Days
----------
..a
,.b
.c
d
..e
.f
•g
x
No
..2
..2
..2
..2
..2
..2
..2
..2
.2
,.2
.2
.2
.2
.a
,b .
.c
.d
.e
.f
#g
x
Yes
No
1
1
I
2
2
2
1
2
What kind of assistance did your husband
provide to you after the childbirth?
Circle all responses mentioned
447‘
In your opinion should a husband support his
wife after the childbirth in following ways?
Arrange/take you for a health
checkup
Managing older children
Not allowing you to strain
physically
Providing physical help
Extending emotional support.
Any other
(Specify)
Yes
a
b
.c
.d
e
f
No
Arrange/take her for a health checkup
2
1
Managing older children
2
1
2
1
Not allowing her to lift objects
2
1
o Providing physical help
Extending emotional support
2
1
2
Any other
1
(Specify)
~44K ■CHECK: Q404 If she had ABORTION, go to Q449 or skip to Q457
■CHECK: Q415 If she had iNDUCETTABOTiTTON, ask (JTsO or skip to Q45T
Advised by doctor....................... ;a
|'TO AVhat circumstances led you to have the (last)
Postpone/space/limit children
.b
abortion?
,c
In-laws
wanted
it
I
.d
Husband wanted it
.e
After
sex
determination
test
PROBE
A ny other___________________ x
Circle all responses mentioned
(Specify)
“ Self............................................ ir
Who ma Inly decided for the (last) abortion77
Husband
12
Parents-in-law
13
Parents
14
Doctor/Nurse
15
Informal health care providers. 16
Others
96
(Specify)
HI
'THC............ .
Where did you have the (last) abortion?
TO'
Govt.hospital
.12
.13
Pvt.hospital..
.14
Dai
.15
RMP
.16
Pharmacy....
96
Others
(Specify)
TO
Yes.. . ..........
Was your husband willing for the (last)
TO
2
No
abortion?
71TO
Yes.............
Did you seek health care after the (last)
TO’
2->Q456
No
abortion?
26
^55
Where did you go for the health care?
Why did you not seek health care after the (last)
abortion?
Circle all responses mentioned
■457
In your opinion at the time of a wife’s delivery
should a husband extend the following help?
Calling persons to assist her
Arranging transportation
Bringing necessary items/medicines
Financial help
Emotional help
Husband has no role to play
Any other
(Specify)
In your opinion should a husband support his
wife after the childbirth in following ways?
Arrange/take her for a health checkup
Managing older children
Not allowing her to lift objects
Providing physical help
Extending emotional support
Any other
(Specify)
27
TT
PHC.....................
Govt.hospital
Pvt.hospital
Pvt.clinic
Dai
RMP
Traditional healers
Others
(Specify)
12
.13
.14
.15
16
17
96
->Q457
Did not want others to know....a
Husband did not allow
b
Family did not allow
c
Service not good/no medicine.. ,d
Attitude of doctors/nurses
.e
not good
.f
Don’t know where to go..
Not necessary
g
h
Too far away....................
..i
No transportation
Cost too much
•j
.k
No time to go...................
Not open when I could go
..1
,.m
No one to care children...
x
Others
(Specify)
No
Yes
1
1
1
1
1
1
2
2
2
2
2
2
2
Yes
No
1
1
1
1
2
2
2
2
2
2
1
1
137
After delivery/abortion did you experience any
of these problems?
Yes
No
Feeling of heaviness in the abdomen or feeling
of uterus coming down
1
2
Experienced problem of passing of urine such
as passing urine all the time or when coughing,
sneezing
1
2
Passing stools through the vaginal
1
2
Piles
Any other
(Specify)
At any time did you become pregnant prior to
Depavali 2001?
At any time during your previous pregnancies
did you face any of the following health
problems?
460
Swelling of hands & feet
Blurred vision
Giddiness
Fits
Urinary problem
Varicose veins
Fever >3days
High blood pressure
Severe vomiting whether treatment
required
Tuberculosis
Malaria
Heart disease
Diabetes
No movement of fetus
Bleeding
Others
(Specify)
...2
...2
-2>Q467
T
2->Q467
1
1
Yes
No.
Yes
No
1
2
2
2
2
2
2
2
2
.2
.2
,2
.2
.2
.2
.2
.2
.2
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
28
i
13T
^61
464
In your opinion when a wife is pregnant should
a husband extend the following
care/cooperation?
Talk affectionately
Express concern towards health
Take her to an antenatal checkup
Arrange with someone to go to antenatal
checkup
Arrange/Assist in transportation
Get fruits/sweets for her
Take interest towards her diet
Monitor on intake of medicines
Manage older children
Assist in household work
Any other
___________________
(Specify)
At any time during your previous deliveries, did
you experience any of the following?
No
1
1
2
2
2
2
2
2
2
2
2
2
2
2
1
1
1
1
1
1
1
1
1
1
Yes
No
1
1
2
2
1
2
1
2
Labour more than 18 hours
Use of forceps
Excessive bleeding (More than 3 sarees
stained)
Sac burst and even after 5 hours child was not
bom
Sac burst and the fluid was greenish
colored
Fainted during labour
Fits or convulsions
Baby was in breech position/not in normal
position
Placenta was down
Twins/multiple births
1
1
1
2
2
2
1
1
1
2
2
2
In your opinion at the time of wife’s delivery
should a husband extend the following help?
Yes
No
1
2
2
2
2
2
2
2
Calling persons to assist her
Arranging transportation
Bringing necessary items/medicines
Financial help
Emotional help
Husband has no role to play
Any other
_
(Specify)
29
Yes
1
1
1
1
1
1
Did you face any of these problems/illnesses
during first two months after any of the
deliveries?
^5
Yes
1
Pus formation in tare
1
Fever >3 days
1
Loss of consciousness for >15 minutes
1
Pain in lower abdomen
Painful, burning feeling when urinating....
1
1
Changes in mental make-up
1
Fits/convulsions
Discharge that smells
1
i
Breast abscess
Excess bleeding
i
i
Depression
1
Backache
1
Others
(Specify)
Th your o pi n i o n sh o u 1 d~Yh u sli a nd support his
'46(7
Yes
wife after the childbirth in following ways?
....1
Arrange/take you for a health checkup
Managing older children
1
1
Not lifting you to strain physically
1
Providing physical help
1
Extending emotional support
1
Any other
(Specify)
__________ __________
Now, woulcl like to ask some general qucstionsAvlncli are not related to you
Yes....................
In your opinion can a woman go for an
No
abortion?
Yes
For reasons related to woman’s health, can she
No
go for an abortion?
To stop further children, can a woman go for an Yes....................
No
abortion?
Yes:...............
'470 “To'postpdh'eTirst'child can a woman go for an
No
abortion?
W" To space between children can a woman go for Yes................... .
No......................
an abortion?
Husband............
If a woman wants to go for an abortion, is she
T7T
In-laws
required to seek permission?
Parents
Health personnel
If YES, from whom?
Others
(Specify)
Circle all responses mentioned
Not necessary....
.
Should husband and wife discuss prior to taking Yes
T7T
No
a decision related to abortion?
30
No
2
2
2
2
2 '
2
2
2
2
2
2
.2
,2
No
.2
.2
..2
.2
..2
..2
T
.2
T
.2
7F
.2
.1
.2
TT
.2
..a
.b
.c
.d
x
,e
.T”
2->Q475
~A7A
Dn what aspect should they discuss prior to
abortion?
Circle all responses mentioned
^T5
T7F
If husband is un willing for abortion, do you
think a woman should go ahead?
PROBE
Due to health or other genuine reasons
Who should accompany a woman while going
for an abortion?
PROBE
Record all persons mentioned
■477
H7R
177
31
Do you think is it essential for a husband to be
present when woman undergoes abortion?
Why do you think so?
Is it necessary to seek health personnel’s advice
prior to deciding on to have an abortion?
To decided on abortion
Place of abortion
Method of abortion
Health consequences...
Future fertility
Social consequences....
Ethical consequences...
Financial aspects
Any other
(Specify)
Yes...............................
No................................
.a
,b
c
.d
,e
Husband..... 7.
Mother
Mother-in-law
Sister
Relatives
Others
(Specify)
Yes................
No.................
.a
.b
c
d
.e
x
Yes
No.
7
2
.f
g
,h
x
7
2
J
2
SECTION: 5 REPRODUCTIVE KNOWLEDGE AND HEALTH
I would like to ask you some questions about reproduction and pregnancy
50T Since puberty and until marriage did you
Irregular periods....................
a
face any kind of problems related to
Prolonged menstruation
.b
menstruation vaginal discharge?
Abdominal pain
c
Nausea
,d
Any other vaginal discharge
.e
Any other
x
Circle all responses mentioned
(Specify)
No problem
..f-2>Q504
Whom did you consult?
Allopathic doctor.7...............
MPHA....................................
.b
Any other health personal...
.c
Record all persons seen
Dai
.d
O thers
x
(Specify)
None.........................................
.f
5UJ Were you cured of these problems?
Yes..........................................
T
No............................................
2
504 Even though most pregnancies are normal,
some women do experience complications, Vaginal bleeding during pregnancy
a
which can lead to sickness and even death,
High fever
.b
if untreated. Can you tell me some of the
Abdominal pain
.c
symptoms a woman can experience during
Swelling of hands and face
d
pregnancy and childbirth, which should be
Prolonged labour for more than 12 hours.e
viewed as a warning that such problems
Convulsions
f
might occur?
Other
x
(Specify)
PROBE
DK
g
Circle all responses mentioned
505 During the past three months, have you
Yes
J
had a problem with an abnormal vaginal
No.
2
discharge?
303 Have you had any itching or irritation in
1337775
T
your vaginal area with this discharge?
No
2
307 Have you noticed a bad odour in your
Yes....
T
vaginal area with this discharge?
No
2
50K In the past three months, did you have any
Ves....
I
severe lower abdominal pain with the
No
2
discharge, not related with menstruation?
507 TDid you have fever along with the
¥77
T
discharge?
No.
2
3HJ Did you have giddiness along with
Yes
I
discharge?
2
No.
31 r ■During the past three months have you had Ye?
T
a problem with pain or burning while
No.
2
urinating, or have you had more frequent
or difficult urination?
32
I
T
Yes
512 Another problem some women have is
2^Q514
feeling pain in their abdomen or vagina
No.
during intercourse. Do you often
evp jrience this kind of pain?
Yes
No
5T5 Where did you experience this pain?
..1..
Mouth of birth canal
.2
1
.2
Interior of birth canal
Yes
TT"
5R Do you ever see blood after having sex, at
No.
.2
times when you are not menstruating?
5T5 CHECK: Q505 to 514 if ‘YES’ to any of the questions ask Q516 or skip to Q520
.a
Husband.....................
5T5 When you have the problem could you
Mother/Mother-in-law
,b
discuss about it to any one?
.c
Elder female relatives..
.d
Neighbours
x
Others
Record all persons mentioned
(Specify)
1
Yes..............................
517 In your opinion when a wife suffers from
2
No
such problems, is it necessary for her to
discuss about it with her husband?
T"
Yes
5TX Have you seen anyone for advice or
2^Q520
No.
treatment to help you with these
problem(s)?
.a
Allopathic doctor............
5T7 Whom did you see?
,.b
ANM/LHV/midwife
Any
other
health
personal
.c
Record all persons seen
d
Dai
Other
x
(Specify)
1
“Yes...............Y................
520' Are you having menstruation regularly?
Menopause
Hysterectomy
Q52Z
No
-"
Yes
Did
you
notice
any
of
the
following
related
52T
to menstruation in your case?
.2
1
Cycle occurs in less than 21 days
.2
1
Cycle occurs in more than 40 days
.2
1
Volume of menstruation is heavy
.2
1
Duration is more than 7 days
.2
1
Spotting between the cycle
T
522 Did you ever notice a prolapsed of uterus? Yes....................
2
No
522 CHECK: Q520 if coded 2’ or ‘V ask Q524 or skip to Q526
T
522 Did you experience health problems after
Yes
2^Q526
menopause/hysterectomy?
No.
525 What type of problems did you face?
525 How many times in a week do you take
At least once a day...
.2
Twice a day
bath?
3
Alternate days
.4
Twice or less a week
33
SECTION: 6 PSYCHOLOGICAL BEHAVIOUR
Now I am going to mention few statements. Please tell me if you strongly agree, agree,
disagree or strongly disagree with the following statements.
A: LOCUS OF CONTROL
uirr
If one of the couple does not desire, they
cannot have sex.
w
Most often it is not possible to prevent a
pregnancy. If a woman is meant to be
pregnant, she will be pregnant
w
A couple can limit the number of children
they have
■COT
Luck plays a big part in determining
whether a woman can keep from getting
pregnant.
C05
If a couple is careful, an unwanted
pregnancy will rarely happen.
Strongly agree....
Agree...................
Disagree...............
Strongly disagree.
Strongly agree....
Agree...................
Disagree...............
Strongly disagree.
Strongly agree....
Agree...................
Disagree...............
Strongly disagree
Strongly agree....
Agree...................
Disagree...............
Strongly disagree
Strongly agree....
Agree...................
Disagree...............
Strongly disagree
T
2
.3
.4
T
2
.3
.4
7T
2
.3
.4
7T
.2
.3
.4
7T
.2
.3
.4
B: SELF EFFICACY
cue
C07
COK
w
w
34
Ask only those NOT CURRENTLY USING CONTIGkCEP FIVES
CHECK: Q304 if ‘YES’ skip to Q612
Strongly agree....
1 am capable of obtaining a method of
Agree...................
family planning
Disagree...............
Strongly disagree.
"Strongly
agree....
I would have great difficulty always
Agree...................
remembering to use contraception in
Disagree...............
order to avoid getting pregnant.
Strongly disagree.
Strongly agree....
If I could not get contraception, I could
Agree...................
still keep myself from getting pregnant
Disagree...............
by refraining from sexual activity.
Strongly disagree
’
Strongly agree....
1 am capable of using contraceptive
Agree..................
method every time I need.
Disagree...............
Strongly disagree
T
2
.3
.4
T
.2
.3
.4
7T
.2
.3
.4
7T
.2
.3
.4
I
I
FTT Negotiating with my husband about the use
of a method of family planning would be
impossible for me.
KT7 1 am capable of persuading my husband
not to have extra-marital sexual contacts.
1 am capable of seeking treatment if 1 have
any gynaecological health problems
Strongly agree....
Agree.................
Disagree.............
Strongly disagree
Strongly agree....
Agree.................
Disagree.............
Strongly disagree
Strongly agree....
Agree.................
Disagree.............
Strongly disagree.
771
..2
...3
..4
Tur
..2
..3
..4
TTT
..2
..3
..4
C: VALUE OF PREGNANCY AVOIDANCE
Now I am going to ask few questions. Please tell me how important you feel towards
each of these questions. That is whether you feel very important, moderately important,
mildly important or unimportant.
UU4
UTS
UTS
617
FT8
35
CHECK: Q305 if STERILIZED...skip to Q701
CHECK: Q329 if woman wants ONE OR MORE CHILDTTEN, skip to Q618
How important is it to you to have no
Unimportant.............
more children?
Mildly important.......
Moderately important
Very important.........
Tell me how you respond to this
Unimportant.............
statement:
Mildly important.......
Moderately important
Because I do not want to have more
children, I make sure that I am protected
Very important.........
from getting pregnant.
How important is it to you to delay the
Unimportant.............
birth of your next child?
Mildly important.......
Moderately important
Very important.........
Tell me how you respond to this
statement:
Unimportant.............
Mildly important.......
Because I want to delay having more
Moderately important
children, I make sure that I am protected
Very important.........
from getting pregnant.
T
.2
3
.4
.1
.2
.4
^Q701
TT"
.2
3
.4
.1
.2
3
.4
SECTION: 7 FAMILY VIOLENCE
701
702
Thinking back to your childhood or
adolescence, did you at any time see or
hear your father physically beat or
mistreat your mother?______________
Did you at any time see your mother
physically beat or mistreat your father?
703
Were you ever physically hit, slapped,
kicked or tried to hurt by your husband?
704
How many times did your husband
behave this way with you?________
How long ago was the first time your
husband behaved this way with
(physically hit/harmed) you?
Number of times
CHECK/ Q704 if number of times is
<1 ...skip to Q707________________
How long ago was the last time your
husband behaved this way with
(physically hit/harmed) you?
Less than one month
705
706
Month
a
Year
b
708
709
a
Year
b
00
Did any of the following happen during
the latest incident?
Shouting/yelling
Slapping/pushing
Punching/kicking
Use of stick/weapon
Other_ ___________________
(Specify)___________________
Were you pregnant at that time?
At the time of the last physical fight, how
did you react?
Circle all responses mentioned
36
00
Month
Less than one month
707
.1
2
3
7____
.1 "
2
3
7____
.1
2-----3
7-----Q7121
Yes
No
No response
DK/Do not remember
Yes.............................
No..............................
No response
DK/Do not remember
Yes.............................
No..............................
No response
DK/Do not remember
Yes
1...
1
1
1
1
Was pregnant
Was not pregnant
DK............................
Yelled and shouted...
Hit and slapped
Cried
Kan away from house
No
...2
...2
...2
...2
...2
.1
.2
2
.a
.b
.c
.d
Did nothing
.c
Other
X
710
Did you seek help or support from any
one after that?
711
Was it necessary for you to seek medical
care afterwards?
712
Did your husband ever have sex with you
even if you were not willing?
.1
Yes......................
No
Do not remember,
Yes......................
No.......................
Yes
......................
No
Do .......................
not
remember
Do not remember
,2
7_____
.1
.2
7_____
.1
i__
.7
Q71
.1
.2____
.7----Q71
713
Did your husband ever physically forced
you to have sex with you?
Yes......................
No
Do not remember
714
How long ago was the last time this
happened?
Month
a
Year
b
| Less than
00 on
ATTITUDES TOWARDS PHYSICAL CONTROL OF WIFE
715
716
Wife should always show respect to elders
particularly her in-laws in the family.
Wife should always follow instructions
given to her, whether liked or not, by
elders particularly her in-laws in the
family.
717
If necessary one should use force to make
wife listen to all instructions of elders
particularly her in-laws in the family.
718
If wife disobeys instructions of elders
particularly her in-laws in the family, the
following measures should be used.
Verbal insults
Physical isolation
Physical beating
Persuasion
Other
(Specify)
DK/can’t say.........................................
Strongly agree....
Agree
Disagree
Strongly disagree
.1
.2
.3
.4
DK......................
2
Strongly agree....
Agree
Disagree
Strongly disagree
.1
.2
.3
.4
DK.....................
2
Strongly agree....
Agree
Disagree
Strongly disagree
.1
.2
.3
.4
.7
DK.....................
37
1
No
,..2
...2
...2
...2
...2
1
2
Yes
...1.
1
1
1
,T
2
.3
.4
7
T
.2
.3
.4
.7
T
.2
.3
.4
.7
7T
.2
.3
.4
.7
7T
.2
.3
.4
.7
7W There is no harm if wife sometimes
Strongly agree....
disagrees with instructions given to her by Agree
elders particularly her in-laws in the
Disagree
family.
Strongly disagree.
DK
Strongly agree....
W No verbal insults and/or physical beating
should be used against wife even if she
Agree
Disagree
does not follow instructions given to her
by elders particularly her in-laws in the
Strongly disagree.
DK
family
Strongly agree....
721 Wife should always show respect to her
Agree
husband.
Disagree
Strongly disagree.
DK
’"Strongly agree....
722 Wife should always follow instructions
given to her, whether she likes or not, by
Agree
Disagree
her husband.
Strongly disagree
DK
Strongly agree....
722 If necessary wife should be forced to
listen to all instructions given to her by
Agree
Disagree
her husband.
Strongly disagree
DK
722 If wife disobeys instructions of her, the
following measures should be taken.
Verbal insults
Physical isolation
Physical beating
Persuasion
Other
(Specify)
DK/can’t say
Strongly agree....
725 There is no hammf wife sometimes
Agree
disobeys instructions given by her
Disagree
husband.
Strongly disagree.
DK
Strongly agree....
725 No verbal insults and/or physical beating
Agree
should be used against wife even if she
Disagree
does not follow instructions given by her
Strongly disagree
husband.
DK
38
Yes
...1.
1
1
1
1
No
..2
..2
..2
..2
2
1
.2
T
2
.3
.4
.7
7T
.2
.3
.4
.7
SECTION: 8 SEXUAL ACTIVITY
Information about one’s sexual behaviour is necessary for understanding their
reproductive health. All that you tell me will be kept strictly confidential and combined
with the information gathered from other women for use in health report without any
personal identification. In this section of the interview, I would like to talk with you
about your sexual experiences.
801
802
803
How old were you at the time of your first
sexual contact?________________________
Were you aware about it before you actually
participated in it?______________________
How did you feel about it when you first
had an experience?
Circle all responses mentioned
In completed years
Yes
No............
Liked
Disliked....
Felt shy....
Felt Scared
Other
(Specify)
Yes...........
No
After marriage, the first time you had
intercourse did you or your husband use a
family planning method?_______________
Did you and your husband ever talk about
the risk of having an unwanted pregnancy?
During your married life did you become
pregnant at a time when you were not ready
for it?
Yes.......
No........
Yes......
No
No child
807
How many times did this happen?
Number of times
808
How often have you had sex with your
husband during menstrual period?
804
805
806
.1
2
.a
.b
.c
.d
x
.1
2^>Q806
..1
..2___
...1
Q808~
809
810
811
812
813
814
39
Never
1
Rarely
2
Some times
3
Frequently
4
Always......................................5
CHECK: QI 14, Q120, Q122 if she EVER GAVE BIRTH or HAD ABORTION,
ask Q810 or skip to Q811_____________
How many days after (last)
Number of days
delivery/abortion you had participated in
coitus?_______________________
Did your husband stay with you in the last
Yes
.1
four weeks?_________________________
No.....................
2^Q814
For how many days, did your husband stay
Number of Days
with you in the last four weeks?_________
How many times you had sex with your
Number of times
husband in the last four weeks?
None.................
00
Usually how many times per day you have
Number of times
sex with your husband?
c
How lonj’ ago cik! you and your husband
ast have intercourse?
815
Days
a
Months
b
□□
Years
sex?
Does your husband have any sexual health
problems?----------------------- ------- Did he ever consult any one for treatment?
817
818
..1
2
Yes
No
Does your husband go to other women for
816
DK
-
Yes
No
Yes
J Self treatment
I No..................................
I DK.................................
i
819
Whom did he consult for treatment?
Record all persons seen
820
Did he ever discuss about this with you?
821
Since he had problems, did he stop having
sex with you?
822
I will now read you some statements about
venereal diseases and sex behaviour. Please
tell me if you agree or disagree with each of
the statements (DO NOT PROBE).
A person contacts gonorrhea only once,
after that he or she becomes immune to the
disease
.
Syphilis can be treated with penicillin and
other antibiotics
Venereal diseases can be passed from a
mother to her baby before or during birth....
Some people who have venereal diseases
show no symptoms at all
......
It is harmful for a man to have sex with
another man
• —12—
Allopathic doctor
ISM doctor...................
Medical shop................
Friends
Self treatment...............
| Other
(Specify)
Yes...............................
No.................................
Stopped
Less frequent
No change
Regularly uses condom
..7_______
...1
..2->Q822
...1
...2
|
..3
1
..7
Q820t
...a
....b
.. ..c
...d
....e
x
.1
,2
.1
.2
.3
.4
Yes
No
DK
1
2
7
1
2
7
1
2
7
1
2
7
1
2
7
THANK THE RESPONDENT FOR THE COOPERATION EXTENDED
40
c
MEN’S PARTICIPATION IN REPRODUCTIVE HEALTH
MEN’S SCHEDULE
(Confidential for research purpose only)
IDENTIFICATION
I
Name of the Village
2
Household Number
1
Name of the head of the household
Interviewer’s Name
INTERVIEWER’S VISITS AND RESULT
Interview Result
Interview Date
"Completed............
T
Respondent absent
.2
Postponed
.3
Refused
4
Others
5
(Specify)
VERIFIED BY
Name
Date
Supervisor
Field Editor
TJffice Editor
INFORMED CONSENT
Namaskaram. My name is
_
, am from Centre for
Economic and Social Studies. We are conducting a survey on Men’s Participation on
Reproductive Health. We appreciate your participation in this survey. As per research ethics,
your name and identity of your household and all other information will not be revealed to
anybody.
We hope that you will participate in the survey since your views are important. Do you want to
ask me any thing about the survey?
Respondent agrees for the interview.
-1
Respondent does not agree for the interview
Q101.
CENTRE FOR ECONOMIC AND SOCIAL STUDIES
Nizamia Observatory Campus, Begumpet. Hyderabad - 500 016,
Andhra Pradesh.
101
102
__________ SECTION: 1 BACKGROUND CHARACTERISTICS
Currently married..
What is your current marital status?
Widowed
Separated/Divorccd
Never married
What is your birth date?
103
What is your current age?
104
Are you married once or more than once?
105
How old were you at the time of your (current)
marriage?______________________________
How old were you when you started living
with your wife? ______________________
How many years have passed since you are
married?__________________________ _____
What is the minimum legal age at marriage for
a boy in India?__________________________
What is the minimum legal age at marriage for
a girl in India?__________________________
How many children (live births) have you had
with your (present) wife?
106
107
108
109
110
Month
DK month
Year
97
DK year................
In completed years
97
Once
More than once....
In completed years
.1
2
In completed years
m
In completed years
Age
Age
Total births
OO^Ql 14
How many are now surviving?
None...............
Total surviving
00
112
How many are now not surviving?
None
. ......
Total not surviving
113
None..
Month
00
When was your last child born?
DK month
97
HI
Year
114
Did your wife ever have a stillbirth?
115
How many times she ever had stillbirth?
116
Did your wife ever have an abortion?
42
Yes
No......................
Number of times
.1
2-3>Q116
Yes
No.
.1
2^Q 119
How many times she ever had abortion?
Number of times
118
Last time when she had an abortion, was it
spontaneous or induced?
DK..............
Spontaneous
Induced
119
Is your wife pregnant now?
117
Yes
No
DK
.97
...1
...2
■■q
Q12i
120
How many months pregnant is she?
Month
DK month
121
Have you ever attended school
122 Can you read and write?
How many years of schooling have you
completed?
________ ________
What
kind
of
work
do
you do most of the
124
time?
123
43
Yes
No
I Yes
i No
I Years of schooling
: (completed years)
97______
,.1->Q123
..2
Q124t
SECTION: 2A MEDIA EXPOSURE
Now I would like to ask some questions about media exposure you had for different reproductive health aspects
!■ Sl.No.
Family Planning
I
Pregnancy Care
n
i
! 201
202
Have you heard or
seen any message
in the last one
month?
Where did you see
or hear any
message about it in
the last one-month?
Circle all
responses
mentioned
203
44
What was the
message mostly
about?
Yes
No.
J
2->Q204
Interpersonal visit...a
Group Meeting
Youth club
-b
Orientation
training camps
c
Mass Media
Radio
d
Television
e
Cinema/film
f
Print material.
g
Hoarding/wall
painting.........
h
Others
(Specify)
How many
children to have
1
To stop having
children
2
, To space children....?
To postpone first
.4
birth
Do not recall
.5
Delivery Care
Yes
No.
. ,2-}Q204
Interpersonal visit...a
Group Meeting
Youth club
b
Orientation
training camps..
c
Mass Media
Radio
d
Television
c
Cinema/film....
.f
Print material...
g
Hoarding/wall
painting
h
Others
i
(Specify)
How many
children to have
1
Health of foetus
2
Health of mother....?
Vaccination of
women
.4
Do not recall
5
After child birth
in
Yes
No.
..2->Q204
Interpersonal visit...a
Group Meeting
Youth club
b
Orientation
training camps
c
Mass Media
Radio
d
Television
e
Cinema/film...
.f
Print material..
g
Hoarding/wall
painting
h
Others
(Specify)
Place of
delivery
I
How many
children to have
2
Health of new born..?
Health of mother.. . 4
Vaccination of
new born
.5
Do not recall
6
Yes
No.
AIDS
iv
...1
I Yes
71
,.2^Q204
J No.
..2-^Q204
Other Reproductive
Health Problems
v
Interpersonal visit...a
Interpersonal visit...a
Group Meeting
Group Meeting
Youth club
b Youth club
b
Orientation
Orientation
training camps
training camps
c
c
Mass Media
Mass Media
Radio
d
Radio
d
Television
e | Television
e
Cinema/film...
.f 1 Cinema/film...
.f
Print material..
g I Print material..
g
Hoarding/wall
I Hoarding/wall
painting
h painting
h
Others
i
Others
(Specify)_________
(Specify)
Need for postpartum I Prevention............. 1
care......................... 1 j Curative facility....2
Vaccination
! Social acceptance...?
of new bom
2 i Spread of disease.. .4
Health care of new
Do not recall
5
3
borne
Health of the
mother
4
Breastfeeding
.5 ;
Do not recall..
6 I
vi
Yes
No.
..2->Q204
Interpersonal visit...a
Group Meeting
Youth club
b
Orientation
training camps
c
Mass Media
Radio
d
Television
e
Cinema/film...
.f
Print material..
g
Hoarding/wall
painting
h
Others
i
(Specify)
Prevention
I
Curative facility....2
Social acceptance...?
Spread of disease.. .4
Do not recall
5
| Sl.No.
204
205
206
How many
contacts have you
had in the last six
months with any
female health care
provider (from
both government
and private
sectors)?_______
How many
contacts have you
had in the last six
months with any
male heath care
provider (from
both government
and private
sectors)?
CHECK:
RESPONSES TO
Q204 and Q205.IF
‘NO’CONTACTS
MADE, skip to
0212___________
In how many of
those total contacts
(mention each of it)
was discussed?
Family Planning
Pregnancy Care
Delivery Care
After child birth
AIDS
Number of contacts
________ n______
Number of contacts
________ in______
Number of contacts
________ Iv
Number of contacts
________ v______
Number of contacts
If none
Number of contacts
If none
.00
If none
00
Number of contacts
If none
00
.00
None.
If none
00
Number of contacts
If none
.00
.00
None
If none
.00
Number of contacts
If none.
.00
.00
None
If none
.00
Number of contacts
If none
.00
.00
None
If none.
.00
Number of contacts
If none.
00
Number of times
Number of times
Number of times
Number of times
Number of limes
Number of times
None
45
.00
Other Reproductive
Health Problems
________ vj_______
Number of contacts
.00
None
.00
[107
When was the last contact made?
With whom was your last contact made?
208
209
210
Where you satisfied with the
information/services this person provided?
Reasons for satisfaction?
Circle all responses mentioned
211
Reasons for dissatisfaction?
Circle all responses mentioned
46
a
Days
b
Months
Do not remember..................... 97
Govt, allopathic doctor
Govt. ISM practitioner
MPHA
Male health worker
Pvt. allopathic doctor
Pvt. ISM practitioner
Voluntary organization worker
Industry/ESI clinic worker
Anganwadi worker
Village health guide
Dai (TEA)
Medical shop
General merchant/kirana shop.
Teachers/informal and
formal leaders
OthersfSpec/y)______
Yes
No
Complete information given..
No physical complication
Services available when needed
Side effects attended to
Supplies available
Inexpensive
Convenient to reach.................
Attended promptly
Courteous staff.........................
Staff available
Female health staff available...
Service site open......................
Others (Specify)
Inadequate information
Physical complication at
the time of service
Was asked to come another time
Side effects not attended to
Supplies not available
Expensive
Too far
Too much time spent
.
Staff was discourteous
Staff not available
Service site not open
Others (Specify)
11
.12
.13
.14
.15
16
.17
.18
.19
.20
..21
..22
..23
24
96______
..1
■ .2->Q211
..a
..b
..c
..d
...f
...h
...i
...j
...k
...1
. ...m
x
->Q212
...a
.b
.c
d
,e
T
g
h
.i
-j
.k
x
SECTION: 2B INFORMATION ON ACCESS
I would like to ask some questions about where information and services can be obtained for different reproductive aspects
S.No.
o
212
Medical
termination of
pregnancy
(abortion)
Sterilization
Pregnancy care
Delivery care
Postpartum
care
Women’s other
health problems
STDs
AIDs
_____ii____
lii
iv
v
vi
vii
viii
ix
- If no source
mentioned —►
- If one source
mentionecTV
Q214
- If more than
one source
mcntioncdv
- If no source
mentioned —►
- If one source
mentioned^
Q214
- If more than
one source
menlionedy
- If no source
mentioned —►
- If one source
mertionecF^
Q214
- If more than
one source
mentioned"^
- If no source
mentioned —►
- If one source
mentionecTV
Q214
- If more than
one source
mentioned"^
- I f no source
mentioned —►
-If one source
mentionecTV
Q214
- If more than
one source
mentioned^
- If no source
mentioned —►
- If one source
mentionedT
Q214
- If more than
one source
mentioned^
- If no source
mentioned —►
- If one source
mentioned’^
Q214
- If more than
one source
mentionedv
- If no source
mentioned —I
- If one source
mentioned-^
Q214
- If more than
one source
mentionedv
Tell me all the
places you
know that
provide
(service)?
- If no source
mentioned —►
- If one source
mentionecTV
Q214
- If more than
one source
mentioned-^
CHECK:
213
Oral
contraceptives/
condoms/IUD
What is the
nearest source
for the
------ ------- ------------------(service)?_____ _________________________
Codes for Q212 & Q213
Govt./Medical college hospital........
PHC/Additional PHC
Sub-centre
Pvt.hospital
Voluntary agencies
Industrial units/ESI clinics/hospitals
Allopathic doctors (p)
47
. 11 ISM practitioners (p)
12 MPHAs
13 Anganwadi workers.
14 TBAs(Dais)
15 Medical shops
16 Pan shops
17
18
19
20
.21
.22
23
Depot holders
General/Kirana merchant shops
Camps
Others
(Specify)
24
.25
.26
96
DK
NA
97
98
S.No.
214
215
216
Where is the
source
located?
How far is this
place from
where you
live?
How long (in
minutes) does
it take to reach
this source?
48
Oral
contraceptives/
condom s/IUD
Medical
termination of
pregnancy
(abortion)
Village.... 1
Name of the
Village
Sterilization
Pregnancy
care
Delivery care
Postpartum
care
Village.....!
Name of the
Village
_____ iii
Village..... 1
Name of the
Village
_____ iv
Village..... I
Name of the
Village
______ v
Village..... 1
Name of the
Village
vi
Village..... 1
Name of the
Village
Town/
City....... 2
Name of the
Town
Town/
City....... 2
Name of the
Town
Town/
City....... 2
Name of the
Town
Town/
City....... 2
Name of the
Town
Town/
City....... 2
Name of the
Town
Town/
City....... 2
Name of the
! Town
Kms.
Kms.
Kms.
Kms.
Kms.
Code 998 if in
this village
Code 998 if in
this village
Code 998 if in
this village
Code 998 if in
this village
Code 998 if in
this village
Women's
other health
problems
STDs
AIDS
Village..... I
Name of the
Village
____ viii
Village..... 1
Name of the
Village
xi
Village..... 1
Name of the
Village
Town.
City....... 2
Name of the
Town
Town/
City........ 2
Name of the
Town
Town/
City........ 2
Name of the
Town
Kms.
Kms.
Kms.
Kms.
Code 998 if
in this
village
Code 998 if
in this
village
Code 998 if in
this village
Code 998 if in
this village
nr
VII
301
302
303
304
305
SECTION: 3 CURRENT AND FUTURE USE OF FAMILY PLANNING
Yes
Prior to first pregnancy did you and
.1
No.
2
your wife ever discussed on number of
children you should have?___________
Yes
Did you and your wife discussed on
.1
No.
usage of a family planning method prior
2
to first pregnancy?_________________
Did you and your wife discuss on the
Yes
following aspects at any time?
No
Postpone children
Gap between children
Number of children
What FP method to use
Who should use
Source of FP method
Side effects of FP method
To seek health advice prior to use of FP
method
Are you or your wife currently using a
family planning method?____________
What method are you or your wife
using?
,2
.2
,2
,2
,2
2
2
1
1
1
1
1
1
1
........ 1....................
Yes
No.........................
Male sterilization...
Female sterilization
...2______
...1
...2^Q329
.11
12
qq
IUD
Oral pills
Condoms
Q310
Periodic abstinence
Withdrawal
Any other
(Specify)
96—
Q314
306
How long ago were you (your wife)
operated for sterilization?
Months
a
Years
b
Less than one month
DK...........................
307
Have you (your wife) visited any of the
health facilities for follow up services
after sterilization?
Yes
No
DK
00
.97____
...1
...2---- .
...7—4
Q309
49
1
308
Which health facility did you (your
wife) visit?
309
Has any one from health department
visited you (your wife) after sterilization
for follow up services?
310
For how long have you (your wife) been
using the method continuously?
311
312
313
314
50
From where do you (your wife) usually
obtain FP services?
At your last visit, did you receive any
counseling about different FP methods?
Has any health worker visited you for
follow up services or supplies?
Medical college hospital....
Govt.hospital
PHC
Sub-centre
Pvt.hospital/clinic
Voluntary agency/industry/
ESI hospital/clinic
Govt.ISM hospital/clinic....
Pvt.ISM hospital/clinic
O t h e rs________________ _
(Speciy)________________
Yes
No
DK......................................
11
12
13
.14
15
.16
.17
18
96
n
Q315
Months
a
Years
b
Less than one month
DK.....................................
Medical college hospital....
Govt, hospital
PHC/Sub-centre
Govt.ISM hospital/clinic...
Pvt.hospital/clinic
Pvt.ISM hospital/clinic
Voluntary agency/industry/
ESI hospital/clinic
MPHA
Dai (TEA)
Medical shop
kirana shop/Pan shop
Oth e rs
(Speciy)________________
Yes......................................
No........................................
Yes
No
.00
.97
11
12
.13
14
15
16
.17
.18
.19
.20
..21
96
1
..... 2
Q315
For how long you have been using this
method continuously?
Months
a
Years
b
Less than one month
| DK
........
00
.97^Q334
315
315
3T7
3T3
315
320
32T
333
What is the main reason lor using the
family planning method?
Postpone pregnancy........
Gap between pregnancies
Stop further pregnancies..
Health concerns
Others
(Specify)
Self..................................
Who mainly motivated you (your wife)
Wife
to use the family planning method?
Both
Parents
Parents-in-law
Other relatives
Others
(Specify)
Self..................................
Who decided about the usage of this
Wife
particular method?
Both
Parents
Parents-in-law
Other relatives
Others
(Specify)
CHECK: Q305 if coded ‘11’ skip to Q336
if coded ‘13’ or ‘14’ skip to Q321,
if coded ‘15’ skip to Q334
Why did not you opt for sterilization?
instead of your wife?
In general between the couple who do
you think should go for sterilization?
WHY?
Did you any time use a family planning
Yes
method?
No.
Why are you not using it now?
TT
12
13
14
96
TT
12
13
14
.15
16
96
TT
12
13
14
.15
16
96
->Q324
,T“
2^Q323
-5Q324
323
325
51
Why you never wanted to use a family
planning method?
Did your wife any time experience any
health problems because of use of the
family planning method?
Did she seek treatment for it?
' 3 es
No.
,T"
2^Q328 1
Yes
No.
1-------- 1
2^Q328 |
TZU
Where did she seek treatment for it?
Medical college hospital....
Govt.hospital
PHC
Sub-centre
Pvt.hospital/clinic
Voluntary agency/industry/
ESI hospital/clinic
Govt.ISM hospital/clinic...
Pvt.ISM hospital/clinic
O thers
(Speciy)
Seif......:...:...................
Both
Parents
Parents-in-law
Other relatives
(Others
(Specify)
327
Who assisted her to go for a treatment?
~378
CHECK: Q305 if coded ‘12^ skip to
if coded ’13’ or ‘14’ skip to Q334
What is a main reason you or your wife
Wife away. .7
.......
are not using it to delay or avoid
Fertility-related reasons
pregnancy?
Not having sex
Infrequent sex
Wife attained Menopausal/
had hysterectomy
Sub-fecund/In-fecund,
Postpartum/breastfeeding...
Wants more children
Opposition to use
Opposed to FP
Wife opposed
Other people opposed
Against religion
Lack of knowledge
Knows no method
Knows no source
Method related reasons
1 lealth concerns
Worry about side effects....
Hard to get method
Cost too much
Inconvenient to use
Afraid of sterilization
Don’t like existing methods
Others
(Specify)
TZT
52
11
12
13
.14
.15
16
17
.18
96
.11
12
13
.14
15
96
11
12
.13
14->Q336
.15
16
17
18
.19
20
.21
22
.23
.24
.25
.26
.27
.28
29
.30
96
330
331
332
333
Do you or your wife plan to use any
family planning method in future?
Why do you want to use a family
planning method?
What methods will you or your wife
use?
When do you (your wife) plan to begin
using it?
Yes
No...................................
Postpone pregnancy
Gap between pregnancies
Stop further pregnancies..
Health concerns
Others
(Specify)
________ _
Male sterilization
Female sterilization
IUD
Oral pills
Condoms
Any other
(Specify)
Not sure/undecided
Months
335
336
53
How many more children would you
like to have?
When would you like to have the next
child?
During a woman’s monthly menstrual
cycle, that is, from the beginning of one
period to the beginning of the next,
when would you say a woman is most
likely to become pregnant if she has
intercourse?
.11
12
13
14
.15
96
.■■97
a
Years
b
Less than one month
00
.97
Undecided.....
334
..1
,.2->Q334
11
12
13
14
96
Number of additional children
None
Undecided...
After months
.00-»Q336
97
Undecided.........
97
.11
..12
Right before her period...
During her period
About one week after her
periods begins
About two week after her
periods begins
All times are the same,
it makes no difference....
Other
(specify)
DK..................................
13
14
.15
96
97
SECTION: 4 OBSTETRIC HEALTH
I would like to ask you now some questions about your wife’s health. All that you tell
me will be kept strictly confidential and combined with the information gathered from
other women for use in health report without any personal identification. If the
meaning of any question is unclear, please ask me.
Yes
Has your wife ever been pregnant since
No......................
Depavali 2001?___________________
Number of times
402 How many times did she become
pregnant since Depavali 2001?_______
Now would like to ask you some questions related to her last pregnancy
Live birth
403 What was the out come of the
Stillbirth
pregnancy? .
Spontaneous abortion
Induced abortion
401
.1
2->Q433
1
,2-----3
Q405V
404
405
406
407
How old was the child at his/her last
birthday?_________________________
When you learned of this pregnancy, did
you want to have a baby then, did you
want to wait until later, or did you want
no (more) children at all?____________
When you later/no more wanted a child,
how did this happen?
During this pregnancy did your wife see
any one for antenatal care?
If YES, whom did she see? Any one
else?
408
Record all persons seen_______
Is it essential for a wife to go for
antenatal checkup?
If Yes, Why do you think so?
Circle all the responses mentioned
409
410
I___
I
54
Did you go anytime with your wife for
antenatal checkup?________________
Why you never went with her?
In completed years
Then
Later......................................
No more
Never thought about it...........
Accidental
Did not know how to prevent
Wife wanted a child
Parents wanted a child
Others
(Specify)________________
Allopathic doctor
MPHA(F)
Any other health personal
Dai
Other
(Specify)
No one
DK.........................................
Maintain good health
To have healthy baby
To avoided complications....
Others
(Specify)
Not necessary
..l-^Q407
..2
..3
■ .4-^Q407
.11
12
13
.14
96
Yes
No.
,1->Q411
2
a
.b
.c
d
x
..f
■X
.a
.b
.c
X
d
ITT
TTZ
TTT
55
Swelling of hands & feet............
Blurred vision
Giddiness
Fits
If YES, specify
Urinary problem
Varicose veins
Fever >3days..............................
High blood pressure
Severe vomiting whether
treatment required
Tuberculosis...............................
Malaria
Heart disease...............................
PROBE
Diabetes
Circle all the responses mentioned
No movement of fetus
Bleeding
Others
(Specify)
None...........................................
DK
In your opinion when a wife is pregnant Talk affectionately......................
Express concern towards health..
in which way should a husband help
Take
her to an antenatal checkup
her?
Arrange with someone to go
to antenatal checkup
Arrange/Assist in transportation.
Get fruits/sweets for her
Take interest towards her diet....
Monitor on intake of medicines..
Manage older children................
.Assist in household work
Any other
Circle all the responses mentioned
(Specify)
CHECK: Q403“if coded
ask Q414. or skip to
THC/Sub-center
Where diH your wife have the delivery
Govt.hospital
Private hospital
Parent’s home
Natal home
Home of birth attendant
Others
(Specify)
Did your wife have any health
complications during this pregnancy?
.a
.b
.c
d
.f
•g
.h
.i
••j
,.k
,.I
m
.n
,.o
..p
x
•q
...r
.a
.b
c
..d
...e
...f
g
...h
. ...i
...j
x
.11
12
.13
.14
.15
16
96
4TS
'TO'
Who was the person most responsible
for having delivery at (Q414)?
Did your wife experience any health
problems at the time of delivery?
If YES, specify
PROBE
Circle all the responses mentioned
TT7
In your opinion at the time of a wife’s
delivery in which way should a husband
help her?
Circle all the responses mentioned
Did she have a health check done during
first six weeks after childbirth?
56
■SelL 777............................
Mother/Mother-in-law
Father/Father-in-law
Elder female relatives
Neighbours
0 thers
(Specify)
DK
Labour more than 18 hours......
Use of forceps
Excessive bleeding (More than
3 sarees stained)
Sac burst and even after 5 hours
child was not bom
Sac burst and the fluid was
greenish colored
Fainted during labour
Fits or convulsions
Baby was in breech position/
not in normal position
Placenta was down
Twins/multiple births
Any other
(Specify)
None...........................................
DK
Call lor an assistant/health
personnel
Arrange transportation
Getting necessary items/
medicines
Financial help
Emotional support
Any other
(Specify)
Not necessary
Yes.............................................
No
TT
12
13
14
.15
96
97
Ta.b
c
d
.e
f
g
h
.i
•J
x
k
1
.a
b
.c
d
.e
x
.f
T
2
419
4^T
422
42T
57
Tus formation in tare
~~
Fever >3 days
Loss of consciousness
for >15 minutes
Pain in lower abdomen
If YES, specify
Painful, burning feeling
when urinating
Changes in mental make-up...
Fits/convulsions
Discharge that smells
Breast abscess...........................
Excess bleeding
Depression.................................
PROBE
Backache
Circle all the responses mentioned
Others
(Specify)
None............................................
DK
In general, what type of care a woman is Nutritional diet........................
supposed to take after childbirth?
Restricted diet
Adequate rest
Not to indulge in heavy work
Abstaining sex
Feeding practices
Regular health checkup
Any other
Circle all responses mentioned
(Specify)
In your opinion during first two months
Arrange/take her for a health
after a wife’s delivery in which way
checkup....................................
should a husband help her?
Managing older children
Not allowing her to strain
physically
Providing physical help
Extending emotional support.
Any other
Circle all the responses mentioned
(Specify)
CHECK: Q403 if coded ‘4’ ask Q423
if coded ‘3’ ask Q427
if coded ‘1’ or ‘2’ skip to Q432
What circumstances led your wife to
Advised by doctor..................
have an abortion?
Postpone/space/limit children
Parents wanted it
Wife wanted it
PROBE
After sex determination test..
Circle all the responses mentioned
Any other
(Specify)
After the delivery dlcl your wife
experience any health problems?
a
b
.c
d
e
.f
g
,h
,.i
••J
.k
J
x
.m
.n
Za..b
..c
.d
..e
.f
•g
x
.a
b
,.c
.d
.e
x
1
.a
.b
..c
.d
e
x
Who mainly decided for an abortion?
^25
Where did your wife have the abortion?
42F
Was your wife willing for the abortion?
42K
Did she seek health care after the
abortion?
Where did she go for the health care?
Why did not she seek health care after
the abortion?
Circle all responses mentioned
58
Beir ...............
rr
Wife
•'•••
Parents
Parents-in-law
Doctor/Nurse
Informal health care providers
O ther s
(Specify)
12
.13
14
.15
.16
96
phc........................ .
IT
Govt.hospital
Pvt.hospital
Dai
RMP
Pharmacy
0 th e rs
(Specify)_________________
"Yes..........................................
No..........................................
Yes
No..........................................
PHC........................... ............
Govt.hospital
Pvt.hospital
Pvt.clinic
Dai
RMP
Traditional healers
Others
___________
(Specify)
Did not want others to know..
Family did not allow..............
Service not good/no medicine
Attitude of doctors/nurses
not good.................................
Don’t know where to go
Not necessary
Too far away
No transportation
Cost too much.......................
No time to go
Not open when I could go
No one to care children
Others____ _____________
(Specify)
_________
12
13
.14
..15
16
96
TT
...2
ZT"
...2->Q429
TTT~
..12
.13
.14
.15
.16
17
96
_>Q430
...... a
b
c
d
.e
.f
•g
.h
. .i
■j
.k
.1
x
rw
In your opinion at the tim^ of a wife’s delivery
in which way should a husband help her?
Circle all the responses mentioned
TH-
In your opinion during first two months after a
wife’s delivery in which way should a husband
help her?
Circle all the responses mentioned
I
ray
i
59
Call for an assistant/health
personnel
.a
b
Arrange transportation
Getting necessary items/
.c
medicines
d
Financial help
.e
Emotional support
x
Any other
(Specify)
Not necessary
f
Arrange/take her lor a health
.a
checkup
Managing older children.
b
Not allowing her to strain
physically
c
Providing physical help
d
Extending emotional suppor... .e
Any other
x
(Specify)
After delivery/abortion did she experience any
of these problems?
Yes
No
Feeling of heaviness in the abdomen or feeling
of uterus coming down
1
7
Experienced problem of passing of urine such
as passing urine all the time or when coughing,
sneezing
1
7
Passing stools through the vaginal
1
7
Piles
Any other
(Specify)_
1
7
At any time did your wife become pregnant
prior to Depavali 2001?
Yes
No.
DK
7
->Q440 )
T"
2->Q437 i
TAt any time during her previous pregnancies
did she face any of the health problems?
■^3?
If YES, specify
PROBE
Circle all the responses mentioned
T35
At any time during her previous deliveries, d:d
she experience any of the health problems?
If YES, specify
PROBE
Circle all the responses mentioned
60
.a
Swelling onfamds’^Heet..77...
.b
Blurred vision
.c
Giddiness
d
Fits
,f
Urinary problem
•g
Varicose veins
,h
Fever >3days
.i
High blood pressure
Severe vomiting whether
••J
treatment required
.k
Tuberculosis
.1
Malaria
m
Heart disease
.............
.n
Diabetes.................................
,.o
No movement of fetus
...p
Bleeding
x
Others
(Specify)
q
None
..r
DK...................... ••••...........
aLabour more than 18 hours..
.b
Use of forceps
Excessive bleeding
(More than 3 sarees stained).........
c
Sac burst and even after 5 hours child
was not bom
Sac burst and the fluid was
e
greenish colored
f
Fainted during labour
g
Fits or convulsions
Baby was in breech position/not in
,h
normal position
.i
Placenta was down
■J
Twins/multiple births
x
Others
(Specify)
q
None...............................................
,.r
DK
Did she face any of the problems/illnesses
during first two months after any of the
deliveries?
If YES, specify
PROBE
Circle all the responses mentioned
In your opinion when a wife is pregnant should
a husband extend care/cooperation?
If YES, which way?
Circle all responses mentioned
438
In your opinion at the time of wife’s delivery
should a husband extend help?
If YES, which way?
Circle all responses mentioned
61
Pus formation in tare...........
a
Fever >3 days
b
Loss of consciousness
for >15 minutes
.c
Pain in lower abdomen
d
Painful, burning feeling
when urinating
e
Changes in mental make-up
.f
Fits/convulsions
•g
Discharge that smells
.h
..i
Breast abscess.....................
Excess bleeding..................
•J
Depression
.
.k
J
Backache.............................
x
Others
(Specify)
None...................................................... m
DK
n
Talk affectionately.................................a
Express concern towards health
b
Take her to an antenatal check up
c
Arrange with someone to go
,d
to antenatal checkup
Arrange/Assist in transportation
,e
.f
Get fruits/sweets for her
Take interest towards her diet...
g
.h
Monitor on intake of medicines.
.i
Manage older children
Assist in household work..........
•J
x
Any other
(Specify)
k
Not necessary
Called for an assistant/health
.a
personnel
b
Arranged transportation
Getting necessary items/
.c
medicines
.d
Financial help
.e
Emotional support
x
Any other
(Specify)
f
Not necessary
Arrange/take her for a health
checkup
Managing older children
Not allowing her to strain
physically
If YES, which way?
Providing physical help
Extending emotional
support
Circle all responses mentioned
Any other
(Specify)
Not necessary
Vaginal bleeding during
WT Even though most pregnancies are normal,
Pregnancy
some women do experience complications,
High fever
which can lead to sickness and even death, if
Abdominal pain
untreated. Can you tell me some of the
Swelling of hands and face
symptoms a woman can experience during
Prolonged labour for
pregnancy and childbirth, which should be
more than 12 hours
viewed as a warning that such problems might
Convulsions
occur? Any others?
DK
Other
_____
Circle all responses mentioned
(Specify)
________
Now, I would like to ask some general questions wliiclii are not related to yourTamily
Yes
441 “ In your opinion can a woman go for an
No
■•••
abortion?
Yes
For reasons related to woman’s health, can she
No
go for an abortion?
i
To stop further children, can a woman go for an Yes
■^43
No
abortion?
Yes
To
postpone
first
child
can
a
woman
go
for
an
WT
No
••••
abortion?
Yes................................................
To space between children can a woman go for
~W5
No..................................................
an abortion?
' Husband....... ...............................
If a woman wants to go for an abortion, is she
In-laws
required to seek permission?
Parents
Health personnel
If YES, from whom?
Others ___________ ______
(Specify)
Record all persons mentioned
Not necessary
^37
62
In your opinion should a husband support his
wife after the childbirth?
a
,b
.c
d
.e
x
f
..a
,b
.c
d
e
,f
•g
x
IT
.2
7T
.2
7T
.2
7T
2
7T
.2
.a
.b
.c
d
x
e
147
W
Should husband and wife discuss prior to taking
a decision related to abortion?
On what aspect should they discuss prior to
abortion?
Circle all responses mentioned
W
4517
If husband is un willing for abortion, do you
think a woman should go ahead?
PROBE
Due to health or other genuine reasons
Who should accompany a woman while going
for an abortion?
PROBE
Record all persons mentioned
45T
452
455
63
Do you think is it essential for a husband to be
present when woman undergoes an abortion?
Why do you think so?
Is it necessary to seek health personnel’s advice
prior to deciding on to have an abortion?
Yes..............................
No
To decided on abortion
Place of abortion
Method of abortion
Health consequences...
Future fertility
Social consequences....
Ethical consequences...
Financial aspects
Any other
(Specify)
Yes...............................
No
2->Q449
a
.b
,.c
.d
,e
.f
g
h
x
.4
2
Husband........
Mother
Mother-in-law
Sister
Relatives
Others
(Specify)
Yes...............
No..................
.a
b
.c
d
,e
x
Yes
No.
I
.1
2
2
SECTION: 5 EXPENDITURE AND SUPPORT FOR FAMILY HEALTH CARE
I would like to ask you some questions about your expenditure on your family’s health
needs. By health expenses, I mean payments for fees of medical and health provider (in
all systems of medicine), and for medicines and drugs. Payments can be monetary or
in-kind exchange of goods or services.
501 Did you spend anything for
Yes
1
health/medical care in the past oneNo.
2^Q505
year?____________ e
502 Did you spend anything for
health/medical care of the following
family members in the past oneYes
No
year?
Self
1
.2
Wife
1
,2
Children
1
2
Parents
1
2
Others
1
2
(Specify)
503
Circle all responses mentioned
How much in total did you spend for
medical health care in the past oneyear?
Total expenditure on health care
Rs.
504
How much of the total amount did
you spend on health or medical care
for yourself and your family
members?
Interviewer: be sure total amount
reported in Q503 is same as Q504
505
506
Did any of your family member
including yourself require more
money for health and medical care
in the last one year than you could
afford to spend?______________
Which family members needed
additional health and medical care
expenses beyond what you could
spend?
Circle all responses mentioned
64
Self.
a. Rs
Wife
b Rs
Children
c Rs
Parents
d Rs
Others
(Specify)
x Rs.
Yes
No.
I
2->Q509
Self
Wife
Children.
Parents..
Others
(Specify)
.a
.b
.c
d
x
507
Have you borrowed any amount from others fo meet your
own or family members medical and health care
expenses?
If all answers are ‘NO’, skip to Q509
508
c
How much money did you borrow for medical and health
care expenses?
Self.....
Wife.....
Children.
Parents..
Others
(Specify)
Yes
.1....
1
1
1.
1
No
..2
...2
..2
..2
2
Amout
Rs. F
CHECK: whether this amount was included in total
---- ---- ---- ---- ---- ----amount mentionedfor Q503 and correct if necessary______________________________
509 CHCEK: Q501............ IF‘YES’... ask Q510,orskip to Q511______________________
510 How much of each type of health expense went for care for the following family members?
(Record the amount in rupees in each cell)
CHECK: Responses to Q502 & Q504
Self
Wife
Various items
Children Parents Other
Relatives
Hospitalization expenses___________
Doctor’s fees______________________
Medicine/drugs____________________
Laboratory tests____________________
Other expenses____________________
Total amount____________________
511
CHECK: QUO if HAS CHILDREN... skip to Q514
CHECK: Q304 if ‘YES’ skip to Q514
.1
512 Do you have any reason to believe that your wife has any Yes
problem bearing children (infertility problem)?
2
No.
J__
DK.
.1----513 Do you have any reason to believe that you yourself have Yes
..2
infertility problem?
No.
DK.
..7----Q5181
I would like to ask you some questions about your wife’s needs for health and medical care at
the time your last child was born.______________________
514 Did your wife receive any medical and health care while
Yes No DK
she was pregnant/during delivery/in the 6 weeks after
While pregnant. ...1....2
7
birth?
During delivery. ...1....2
7
In 6 weeks after
birth..................
1
7
2..
515 Do you think, you should provide money or
...1
Yes
goods/services in any kind for medical and health care of No
...2->Q518
your wife during the last pregnancy?_________________
516 Did you provide money or goods/services in any kind for
Yes No DK
While pregnant
11.. ..2.........7
medical and health care of your wife during the last
During delivery
1 ....2
7
pregnancy?
In 6 weeks after
birth
1
2
7
65
517 Did your wife need any health or medical care for the last
live birth that she could not receive due to its expenses?
5TK Has your wife needed any other health or medical care
this past year for a gynecological or obstetric condition?
Yes
No.
DK.
Yes
No.
DK.
7771
....2
...7
777
Q601T
577 Has she been able to receive it?
520
66
Do you think you should provide money or
goods/services in any kind for medical and health care of
your wife for gynecological or obstetric problems?
Yes
No.
DK.
Yes
No.
771r~
..2
.7
771
..2
o
kh
My wife would have difficult time
negotiating with me about the use of a
method of family planning
CT2
My wife is capable of persuading me to
not to have extra-marital sexual contacts.
My wife is capable of seeking treatment if
she has any gynecological health
problems
Strongly agree....
Agree
Disagree
Strongly disagree.
Strongly agree....
Agree
Disagree
Strongly disagree
Strongly agree....
Agree
Disagree
Strongly disagree
T
.2
.3
.4
T
.2
.3
.4
7T
.2
.3
.4
C: VALUE OF PREGNANCY AVOIDANCE
Now I am going to ask few questions. Please tell me how important you feel towards
each of these questions. That is whether you feel very important, moderately important,
mildly important or unimportant.
TR
MT
MT
FT7
W
68
CHECK: Q305 if STERILIZED skip to QVffTCHECK: Q334 if MAN WANTS ONE OR MORE CHILDREN
Unimportant
How important is it to you to have no
Mildly important........
more children?
Moderately important.
Very important...........
Tell me how you respond to this
Unimportant..............
statement:
Mildly important
Because I do not want to have more
Moderately important
Very important
children, I make sure that my wife is
protected from getting pregnant.
Unimportant..... ........
How important is it to you to delay the
Mildly important
birth of your next child?
Moderately important
Very important
Tell me how you respond to this
Unimportant
statement:
Mildly important
Moderately important
Because I want to delay having more
children, I make sure that I am or my wife Very important
is protected from getting pregnant.
skip to Q618
..................... 1
2
3
4
.1
.2
3
.4
_>Q701
T
.2
3
.4
.1
.2
3
.4
SECTIONS PSYCHOLOGICAL BEHAVIOUR
Now I am going to mention few statements. Please tell me if you strongly agree, agree,
disagree or strongly disagree with the following statements.
A: LOCUS OF CONTROL
W
If one of the couple does not desire, they
cannot have sex.
w
Most often it is not possible to prevent a
pregnancy. If a woman is meant to be
pregnant, she will be pregnant
w
A couple can limit the number of children
they have
604
Luck plays a big part in determining
whether a woman can keep from getting
pregnant.
W
If a couple is.careful, an unwanted
pregnancy will rarely happen.
Strongly agree....
Agree.................
Disagree.............
Strongly disagree.
Strongly agree....
Agree.................
Disagree.............
Strongly disagree.
Strongly agree....
Agree.................
Disagree.............
Strongly disagree.
Strongly agree....
Agree.................
Disagree.............
Strongly disagree
Strongly agree....
Agree.................
Disagree.............
Strongly disagree
T
2
.3
.4
T
.2
.3
.4
7T
.2
.3
.4
rr
.2
.3
.4
7T
.2
.3
.4
B: SELF-EFFICACY
60"
’60^
W
67
Ask only those NOT CURRENTLY USING CONTRACEPTIVES
CHECK: Q304 If ‘YES’ skip to Q612
Etrongly agree....
I am capable of obtaining a method of
Agree.................
family planning
Disagree.............
Strongly disagree.
Strongly agree....
I would have great difficulty always
remembering to use contraception in order Agree.................
Disagree.............
to avoid my wife getting pregnant.
Strongly disagree.
Strongly agree....
If my self or my wife could not get
Agree.................
contraception, I could still keep her from
getting pregnant by refraining from sexual Disagree.............
Strongly disagree
activity with her
My wife is capable of using contraceptive Strongly agree....
Agree.................
method every time she needs to.
Disagree.............
Strongly disagree
2
.3
.4
1
2
.3
.4
T
.2
.3
.4
7T
.2
.3
.4
701
702
703
704
705
706
707
708
_________________ SECTION: 7 FAMILY VIOLENCE
Yes
Thinking back to your childhood or adolescence,
No
did you at any time see or hear your father
No response
physically beat or mistreat your mother?
DK/Do not remember
Yes.............................
Did you at any time see your mother physically
No..............................
beat or mistreat your father?
No response
DK/Do not remember
Yes.............................
Have you ever physically hit, slapped, kicked or
No..............................
tried to hurt your wife?
No response
DK/Do not remember
How many times did you behave this way with
your wife?_______________________________
How long ago was the first time you behaved this
way with (physically hit/harmed) your wife?
CHECK: Q704 if number of times is <1
skip to Q707_____________________________
How long ago was the last time you behaved this
way with (physically hit/harmed) your wife?
Did any of the following happen during the latest
incident?
Shouting/yelling
Slapping/pushing
Punching/kicking
Use of stick/weapon
Other (Specify)___________________________
Was your wife pregnant at that time?
.1
2
,3
7____
.1
2
3
2___
.1
2------3
7-----Q7121
Number of times
Month
a
Year
b
Less than one month
Month
a
Year
b
00
Less than one month
00
Yes
No
..2
..2
..2
..2
..2
1...
1
...............1..................
............... 1.................
Was pregnant............
Was not pregnant
...1
...2
DK......... ?...........
709
At the time of the last physical fight, how did your
wife react?
Yelled and shouted....
Hit and slapped
Cried..........................
Ran away from house
Did nothing
Circle all responses mentioned
710
Did your wife seek help or support from any one
after that?
711
Was it necessary for your wife to seek medical care
afterwards?
69
Other
(Specify)__________
Yes............................
No..............................
.............................
No
DK..............................
Yes............................
...a
..b
. .c
...d
...e
x
.1
,2
2
.1
,2
7
712
Have you ever had sex with your wife even if she
was not willing?
Yes
No.
DK.
713
Have you ever physically forced your wife to have
sex with you?
Yes
No.
DK.
714
How long ago was the last time this happened?
Month
a
Year
b
.1
.2-----.7-----Q715*
00
Less than one month
ATTITUDES TOWARDS PHYSICAL CONTROL OF WIFE
715
716
717
718
719
70
Strongly agree....
Agree
Disagree
Strongly disagree.
DK......................
Strongly agree....
Wife should always follow instructions given to
Agree
her, whether liked or not, by elders particularly her
Disagree
in-laws in the family?
Strongly disagree.
DK....................
Strongly agree....
If necessary one should use force to make wife
listen to all instructions of elders particularly her in Agree
Disagree
laws in the family?
Strongly disagree
DK....................
If wife disobeys instructions of elders particularly
her in-laws in the family, the following measures
Yes
should be used.
1...
Verbal insults
1
Physical isolation
1
Physical beating
1
Persuasion
1
Other
_
(Specify)
1
DK/can’t say
Strongly
agree....
There is no harm if wife sometimes disagrees with
Agree
instructions given to her by elders particularly her
Disagree
in-laws in the family.
Strongly disagree
DK..?...............
Wife should always show respect to elders
particularly her in-laws in the family?
.1
.2
.3
.4
7
.1
.2
.3
.4
.7
.1
..2
.3
.4
.7
No
..2
..2
..2
..2
...2
2
..1
..2
..3
..4
..7
c
720
No verbal insults and/or physical beating should be
used against wife even if she does not follow
instructions given to her by elders particularly her
in-laws in the family
ife shou
always show respect to ler husband.
Wife should always follow instructions given to
her, whether she likes or not, by her husband
If necessary wife should be forced to listen to all
instructions given to her by her husband.
72-4
If wife disobeys instructions of her husband, the
following measures should be taken.
Verbal insults
Physical isolation
Physical beating
Persuasion
Other
(Specify)
say......... ■-•••■.................. ........... •;•••................
72S
Phere is no harm if wife sometimes disobeys
instructions given by her husband
726
No verbal insults and/or physical beating shouldTe
used against wife even if she does not follow
instructions given by her husband
71
Strongly agree.....
Agree
Disagree
Strongly disagree.
DK
Strongly agree...
Agree
Disagree
Strongly disagree.
DK
Strongly agree...?
Agree...................
Disagree
Strongly disagree.
DK....
Strongly agree...?
Agree
Disagree
Strongly disagree
DK
Yes
.1...
1
1
1
1
1
Strongly agree
Agree
Disagree
Strongly disagree.
DK
Strongly agree. ~
Agree
Disagree
Strongly disagree
DK
1
.2
.3
.4
7
.2
.3
.4
7
y
.2
.3
.4
.7
y
..2
.3
..4
.7
No
..2
..2
...2
...2
...2
...2
T
.2
.3
.4
7
7T
..2
.3
.4
.7
SECTION: 8 SEXUAL ACTIVITY
Information about men’s sexual behaviour is necessary for understanding their
reproductive health and that of their female partners. In this section of the interview, I
would like to talk with you about your sexual experiences.
801
802
803
804
Have you ever had any sexual contact with any women
before marriage?
___________________
o
How old were you at the time of your first sexual
contact with these women?
Yes
No....,........
Age in years
.1
Have you had sexual contact with more than one
woman before marriage?_____________________
Have you ever used condoms at the time of sexual
intercourse with this woman/these woman?
Yes
No............
Always....
Sometimes
Never.......
Yes
.1
.2
1
.2
Before marriage have you ever had:
805
Any discharge from your penis?
1
Any sore on your genital or anal area?
1
Positive syphilis blood test?
I
Difficulty urinating?
1
Pain with urination?
1
Very frequent urination?
1
Swelling of your testes or in your groin area (penis)?...
1
CHECK: Q805 If ‘YES’ to any one ask Q807 to Q814
Q812_________________________
How many months before your marriage did this
Months
happen?
806
807
808
Have you consult any one for treatment?
809
Who did you consult for treatment?
Record all persons seen
810
At the time of your marriage, were you completely
cured of this problem?__________________________
Have you ever discussed this problem with your wife?
811
812
After marriage, the first time you had intercourse with
| your wife, did you or your wife use a family planning
; method?
72
2a>Q805
.3
No
............................ 2
............................ 2
............................ 2
............................ 2
............................ 2
............................ 2
............................ 2
If ‘NO’ to all skip to
Yes
Self treatment....
No.......................
Allopathic doctor
ISM doctor
Medical shop
Friends
Self treatment
Other
(Specify)_______
Yes......................
No.......................
Yes......................
No.......................
Yes......................
No
..1
..2A>Q810
.3-^Q81 1
a
.b
.c
d
.e
x
1
,2
r2______
i
2->Q814
813
814
815
What is the method?
Did you and your wife ever talk about the risk of having
an unwanted pregnancy?
During your married life had your wife become pregnant
at a time when you were not ready for it?
.1
2
Condoms
Oral pills.
Other
(Specify)
Yes........
No..........
Yes
No
No child.
6
.1
2________
.1
•’3
Q81 ?▼
816
How many times did this happen?
Number of times
817
How often have you had sex with your wife during her
menstrual period?
818
Did your wife stay with you in the last four weeks?
819
For how many days, did your wife stay with you in the
last four weeks?____________________ __________
How many times you had sex with your wife in the last
four weeks?
Never
Rarely
Some times
Frequently
Always..............
Yes
No.....................
Number of days
820
821
822
823
824
825
Usually how many times per day you have sex with your
wife?____________
_________________
How long ago did you and your wife last have
intercourse?
ml
1
2
.3
.4
.5
J
.2-»Q821
Number of times
00
None..................
Number of times
Days
a
Months
b
Years
c
Have you had sex with any women other than your wife
since you were married?
____________ _________
How many women?
Yes
No...............
Number of women
.1
2->Q826
Have you ever used condoms at the time of intercourse
with this woman/these woman?
Always
Some times
Never........
1
2
73
m'l
827
W
After marriage have you ever had:
Yes
No
Any discharge from your penis?
Any sore on your genital or anal area?
Positive syphilis blood test?
Difficulty urinating?
Pain with urination?
Very frequent urination?
Swelling of your testes or in your groin area (penis)?...
.1
1.
1
1
.2
.2
.2
.2
2
2
2
CHECK: Q826 If ‘YES’ to any one ask Q828 to Q834
Have you ever consulted any one for treatment?
Whom did you consult for treatment?
Record all persons seen
Have you ever discussed about this with your wife?
8TT
Since you had problems, did you stop having sex with
your wife?
“837
"CHECK: Q823 if the ansu’er is 'YES'....ask this
question otherwise skip to Q833
733
Since you had problems, did you stop having sex with
other women?
Did you start using condoms?
833
Did you make any other changes in your habits (Specify)'l
74
1
1
1
If4NO’to all skip to Q835
Yes
1
Self treatment
No
.3----Q830y
Allopathic doctor
Ta
ISM doctor
.b
Medical shop
.c
Friends
.d
Self treatment
.e
Other
x
(specify)
Wes......................
.T
No
2
Stopped...............
T
Less frequent
.2
No change
3
Stopped
Less frequent
No change....
Wife
Yes............ ...L.
No............. 1
Stopped sex 1
Yes............
No..............
1
.2
3
Other women
........ 2
........ 2
........ 2
........ 1
2
Are you currently having
Yes
No
Any discharge from your penis?
Any sore on your genital or anal area?
Positive syphilis blood test?
Difficulty urinating?
Pain with urination?
Very frequent urination?
Swelling of your testes or in your groin area (penis)?
1
1
1
1
1
1
2
2
2
2
2
2
2
W
CHECK: Q835 If ‘YES’ to any one ask Q837 to Q838
Have you ever consulted any one for treatment?
W
Whom did you consult for treatment?
Record all persons seen
I will now read you some statements about venereal
diseases and sex behaviour. Please tell me if you agree or
disagree with each of the statements (DO NOT PROBE).
W
A person contacts gonorrhea only one, after that he or has
becomes immune to the disease
Syphilis can be treated with penicillin and other
antibiotics
Venereal diseases can be passed from a mother to her
baby before or during birth
Some people who have venereal diseases show no
symptoms at all
It is harmful for a man to have sex with another man
1
Tf TNO5 tbalTskip to Q839
Yes
................................ 1
Self treatment
No
Q838
Allopathic doctor
.b
ISM doctor...
Medical shop.
.c
d
Friends
.e
Self treatment
x
Other
(Specify)
DI<
No
Yes
1
2
7
1
2
7
1
2
7
1
1
2
2
7
7
THANK THE RESPONDENT FOR THE COOPERATION EXTENDED
75
a
Number of Sub-Centres and Villages Covered under the Round The Clock
Women Health Centre — Total Universe and the sampled Villages
T
Name of
Sub-centres
Shamirpet
7
Thumukunta
J
Kesavaram
7
Devaryamjal
5
Jaganguda
7
Lakshmapur
7
Aliyabaci
7
Uddamarri
KNo?
Name of the village with Hamlets
Shamirpet village*
Babaguda
Upparapally
Thumukunta village
Mandaipally
Anthaipally
Singaipally
Hakeempet
Kesavaram
Koltur
Anantaram
Nagisettipally
Devaryamjal
Pothaipally*
Yelligalguda*(Harn|ct of Pothaipally)
Jaganguda
Sampanbole
Laligadimalkpet
Lakshmapur
Modichintalapally
Narayanapur
Potharam
Lingapur
Aliyabad
Majidpur
Turukapally*
Turukapally Thanda (Hamlet of
Turkapally)
Kesavapur
* Sampled Villages
Uddamarri
Usharpally
Adraspalli
Kesavapur
Ponnal
Bommaraspet
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