Distorted Lives: Women's Reproductive Health and Bhopal Disaster

Media

Title: Distorted Lives: Women's Reproductive Health and Bhopal Disaster
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Distorted Lives
Women’s Reproductive Health and Bhopal Disaster

sS
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ted

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medico friend circle
October 1990

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te
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*
V

/

Distorted Lives
Women s Reproductive Health and Bhopal Disaster

I

A community based epidemiological study of the effect of the
toxic gases on the menstrual pattern and pregnancy outcomes in
women affected by the Bhopal gas leak disaster

MEDICO FRIEND CIRCLE
(Regd. Off) 150, LIC Quarters
University Road, Pune 411 015

October
1990.

Contribution
Rs. <2.0/—

I

!

I
i

'' -no

f

I

:I

I

COMMUNITY HEALTH CELL
326, V Main, I Block
Koramongcla
Bangalore-560034
India

THIS STUDY IS DEDICATED TO THE GAS

AFFECTED WOMEN OF BHOPAL

WHOSE SPECIAL SUFFERINGS HAVE BEEN NEGLECTED AND WHO
CONTINUE TO SUFFER SILENTLY.

CONTENTS

1

1.

Acknowl edgements

2.

Preface

3.

The Study Team

iv

4.

Background

1

5.

Chapt er

I

Survey Design & Methodology

4

6.

Chapt er

11

Observations & Results

18

7.

Chapt er

III

Discussion

29

8.

Annexure

I

Sample from the Indigenous

11

Calendar

33

prepared for the survey

9.

Annexur e

11

34

Study Proforma
(Translated from Hindi)

10 .

Annexure

III

Effects of the toxic gases on

the

41

health of the women

(clinic based data)
11.

Annexure

IV

Problems in Deliveries post gas leak

44

12.

Annexure

V

A critique of the ICMR study on

46

pregnancy
Health

of

outcomes and
women

Reproductive

exposed

to

toxic

gases in Bhopal.
13.

References.

51

ACKNOWLEDGEMENT

The

gas-affected women of Bhopal who rendered total co-

and generous hospitality to the survey team.

operation

ft

Mr.R.Dayal of Central Stores, Bhopal;
J agori

Delhi;

Workers

of

Jaimini

Action India, Delhi;
Bhopal;

Dharamsala,

Doctors from Jaimini Nursing Home and Bhopal Eye Hospital,
Ekalavya, Bhopal;

Bhopal;

SEUA, Bhopal;

and

Centre for

Education and Communication, Delhi.

ft

Ram Badan Dubey,

Chella Rajan and Arvind Rajgopal for help

with library Research.

ft

Devan, Anita, Ashok and Sunitha for typing the manuscript.

*

Spec1al
Delhi,

to Dr.G.V.Sathyanaraya

thanks

of

Al IMS,

rural

thesis "A study on pregancy wastage in

whos e

community"

Murthy

was

of

great

help to

us

in

designing

the

prof orma.

*

Jana Vigyan Samitl,

Kanpur and numerous

other

gave donations for the Bhopal work

people

who

Friend

Circle.

concerned
of

Medico

1
—

■

PREFACE

The

Bhopal gaa tragedy,

the biggest and the worst man-made

disaster In the history of human kind,

compl et e

toll.

Thousands

has not as yet taken

Its

are still going through the hell

of

Incapacitating

health

1 oak.

argued by Union Carbide circle as well

was

It

local

problems created by

this

as

some

medical experts that the gases that leaked on the night of

2nd

December,

skin ,

eyes

chemical

1984 produced only local Irritant effects on

and the lungs;

cannot

produce

that MIC (methyl iso cyanate)
systemic

ef f ects.

mounting evidence to give a lie to this claim.

There

the

gas

gas

exposed women and significantly Increased the

as

has

been

It shows that

leak considerably altered the menstrual pattern of

spontaneous abortions and still births.

brought

the

The present study

is one more significant addition to this evidence.

gas

gas

poisonous

forward

af f ect ed

spontaneous

the

Incidence

of

This study has not only

the neglected aspect of the health problems

people,

abort 1one

but has used the

sensi 11ve

to assess damage to the

of

indicator
pregnancies t

compared

to

studies.

The increase in spontaneous abortions also point out to

other less sensitive indicators used

the possible mutagenic effect of the gas leak.

11

in

the

ICMR

It

mus t

be

made

cl ear

that

this

study

covers

reproductive health of gas-affected women in Bhopal
suffer

also

from

only

and

many other health problems related

the

that they

to

other

systems of their bodies.

It

is

hoped

that serious implication of

this

study

wou 1 d

be

in

the

appreciat ed.

Ue

have

no words to apologise for the inordinate delay

publication of this study.

I

Anil

Ir

Pi]gaok ar

Convenor

Medico Friend Circle

I
I

>•

iii
■

' i

THE

STUDY

TEAM

Chi ef Investigator and Coordinator:

C.Sathyamala, MFC (Delhi)

Survey Design:

Anil Patel (Mangrol),

Survey Tearn;

Devi Krlpa, Gyanwati, Mary Teresa,

Rani ,

Rama,

R eshma,

Sumi tra,

Sushi 1a,

Chaya,

Runu ,

Rukmani,

Jyot ika,

(All

from

(Ra j asthan),

Imrana Qadeer (Delhi)

Parvati, Raj

Shanti, Shashi, Sudha,

Vidya,

Urmila,

Bharat i,

Mai1ika,

Shanta,

Devinder,

Snehlata

and

Pr eet i

Delhi ) ,

Vi jayendra

and

Dhanjira and Umraj

Art! (Hoshangabad),

Nirmala

(Sewapuri),

Chayanika (Bombay), Hina

(Baroda).

Clinic Tearn:

Rani Bang (Gadchiro1i), Mira Sadgopal

(Bankheri),

Sanjeev Kulkarni (Bangalore).
Coding and Analysis:

Bharat i, Farida and Snehlata (Delhi), Arti

(Hoshangabad),
Tripti

and

Ani1 Pat el,

Daxa

(Gadchiroli),

(Ahmedabad),

Ambarish,

(Mangrol),

Ashok

and

Abhay
Leela

Thelma and Ravi (Bangalore)-,

Ashvin (Baroda), Anant (Pune).

iv

Moot

of

the

above participants

r epr es ent ed

one

of

the

following orgnisatlona :
Medico Friend Circle,

India,

Ankur,

(Ra Jasthan),

ARCH (Mangrol),

Sabla Sang, Action
f rom

Saheli

and

Jagori,

(All

Mahila

Mukt i

Morcha

(Sewapuri ),

Delhi),

Prayaa

Nar i

Atyachar

Virodhi Manch (Bombay), Sahiyar (Baroda).
I
Further details of this study are available with

DR. C. SATHYAMALA
F 20 (GF) Jungpura Ext ens i on,
NEU DELHI

110 014.

I.j 11

V

BACKGROUND

In

F ebruary

Bhopal,
have

1985,

women

a fact finding team of four doctors observed that

suf f er ed

movements,

in

three months after the gas leak disaster

£rom abortions,

suppression of lactation,

and menstrual disturbances (1).

£ etal

diminished

still births,

abnormal vaginal discharge

Lat er,

based on the information

on women from two affected bastis attending Gynaecological Clinic,

two

women doctors reported the presence

menstrual and gynaecological disorders.
wer e

pelvi c

inflammatory

die ease,

1 arge

of a

The clinical conditions

(2).

£ act

on

int erviewe,

and

t earn * s

excessive

endocervicitis,

menstrual bleeding and suppression of lactat ion
finding

observations were

bas ed

While the
unstructured

and the clinic based survey on a self -selected sample

they

therefore needed to be interpreted with caution,

both

of

number

were

required

indicative of an important area of morbidity that

detailed and sustained epidemiological investigation.
In March 1985,

organ!z ed
showed

a study,

by the Nagarik Rahat Aur Punarvas

that

out of the 198 women examined,

symptoms.

gynaecologleal

discharge

done between 104-109 days after exposure,

Leucorrhoea

or

Comm!11 ee,

persist ent

100 had

vaginal

excessive

from

was the commonest symptom noticed both in groups

severely exposed area and mildly exposed area.
had

Bhopal,

Majority of these

no local or pelvic factor responsible for this symptom.

26.51 of women from the severely exposed area the examination

cervi cal

smear

showed

pr eaenc e

of

inflammatory

evidence of dysplasia in a small number of them.

pregnan t

at

the time of the disaster,

trimester abortions
sectional,

(3).

In
of

with

cells

Of the 38 women

29 had first

or

second

The study organized by NRPC was cross

community based, using random sampling.

1

However,

this

the

had to be Interpreted with caution because of

study

clinic

nature of the aurvey which expected the surveyed people to "walk"
upto the clinic thus introducing

self-selection into the sample.

•

In

a socio-medlcal survey carried out

same month,

the

focused on the continued effects of

friend circle (mfc),

medico

the

by

The study showed that between 50-

the toxic gases in Bhopal (4).

70t of the ambulatory population in the severely exposed areas of

Bhopal continued to have one or more serious symptoms implicating
r eproduct ive

Among women in the

systems.

age

di f f erent

body

group ,

significant alteration in the menstrual cycle had taken

place.

The

alteration

was in the form

abnormalities in the menstrual f 1 ow,
and

lactation

dysmenorrhoea,

1eucorrhoea,

a

population

The mfc study was

suppression.

cycles,

shortened

of

bas ed, cross sectional survey comparing a severely exposed area

mildly exposed one through a

with a
with

defined

findings

parameters and the use of

too

The

sampling.

random

of this study were therefore of greater epidemiological
However

sign!f icance.

I

quest ionnalre

pre-designed

the

number

was

of women in the sample

small to comment on the effect of toxic gases

on

pr egnancy

outcomes.

the

Although,

above mentioned studies/surveys were not designed

to systematically explore the effect of the leak on the menstrual

pattern of women and on the pregnancy outcomes,

way,

corroborat ed

they had,

in

the experience of social activists working in

these bastis and had underlined the urgent need to systematically
study

this

important

aspect of the health status

of

the

gas

exposed women.

urgent

Despite

this

official

established

need,

there

was no

institutions

research

2

indication that the
were

planning

to

respond

in

an

adequat e

sponsorship

of

the Indian Council of Medical

approprlate

and

the

Under

manner.

(ICMR),

Research

0 ever^l research studies had been launched in Bhopal to look into

However, none

the e f f ects o £ the gases on the different systems.

o£

the

gas es

toxic

studies was designed to explore the effect of the
on

women.

Further,

preliminary

f Indings

of the study on pregnancy

outcornea,

least upto

May 1985,

indicated that there had been no

impress!ons

held

popu1ar1y

of

the
at

advere e

Thia seemed to contradict the

following the disaster.

out cornea

the

of

menstrual health

the

an

increase

spontaneous

in

aborti ons in the post gas leak period and it was not possible

the

ass ess

of the data because

authent i c i ty

the

o£

to

Official

Secrets Act imposed on all matters concerning the disaster.
There

the

was thus a need for an independent study that would assess

effect o f the toxic gases on pregnancy outcomes and

menstrual

h ealth

undertake this
Sine e

gynaeco1og i cal

the

women in Bhopal and

the

e f f ect of the

gas

1 eak

ob J ectIves

the

mf c

decided

to

on

the

spontaneous abortions

overal1

and pregnancy outcomes was beyond

morb i d1ty

financial and other resources capacity of mfc,

limit

the

task.

study

to

of

on

to

and

a

study

o£

the

it was decided to

menstrual

still births in the period

patterns,

following

the gas 1 eak.
Once the decision was made,
wer e

s ent

carrying
women

letters announcing the proposed study

to s everal women’s organisations for

out

o f the survey.

help

with

the

The overwhelming response of

activists to this announcement indicated that

was a realistic and feasible proposition.

3

the

survey

CHAPTER

I

SURVEY DESIGN * METHODOLOGY

STUDY POPULATION AND CONTROL

Our study set out to find answers to three questions.

1. what was the effect of the toxic gases on the

menstrual cycle of the non-pregnant women?

2. what was the effect on the spontaneous abortion and
still birth rates of the women pregnant at the time
of disaster?

3. what

abort 1on

the effect on the spontaneous

was

rate of the women conceiving after the disaster?

j
11

It

decided to undertake a retrospective study

was

population

exposed

for

purpose.

this

For

purpose

the

of

a

f or

"controlR,it was decided to study the same population

a

gas

the

of

period of one year before the toxic exposure took place.
The reasons for selecting this form of historic control were :
The

studies

population,

both

institutions

had

1.

p'

the

carri ed

out

ear 1i er

governmental

by

on

the

and

gas

expos ed

non-governmental

used distance from the Carbide factory

as

exposur e

selected

indicator

of

populat ion

from the low socio-economic strata residing 8 10

from

the

Carbide

differential

f actory

as

the

to

seemed

control

selection

also

be

Justified

mortality

rates in these areas.

However,

4

and

had

populat i on.

by

the

an

kma
The

di f f erential

the results

from the

both the mfc & NRPC studies had revealed significant symptoms
gas

exposure in the control population as well.

In fact,

of

the mfc

study had concluded that ” a control population selected like Anna

Nagar

(colony

10

kina

from Carbide factory)

speaking a

'non-exposed’

a

population by virtue of being

control

JP

is

strictly

no t

population as it should be but serves as

expos ed

minimally

in

compar i son

to

f ac tory).

This also implies that even in our control population

on e

wou 1 d

expect

Nagar (colony across the

to

obs erv e

some

of

road

f rom

Carbide

d i sabi1i t i es

the

or

debilitating morbidities in a higher proportion of the population
than

woui d be the case in an unexposed cont or1

this

is what we did observe” (5).

find

a

Bhopal

socio-economi cally matched,
as

Carbide

Thus ,

all

such colonies were

f actory

and

area .

Actual1y

it was not possible to

control

popu1at 1on

wi th i n

s i tuat ed

down-wind

to

therefore could not

be

the

considered

non-

expofled’

2.

Selecting a control population outside of Bhopal would have

cr eat ed

the

aval 1ab i111y.

unpaid
two

important

probl erne

of

logis tics

and

resource

The survey was being carried out with the help

volunteers and with limited financial support.

large samples in two different cities would

have

of

To sutdy

stretched

the organisation’s resources beyond a limit.
However,
by
the

whl 1 e

the problem of matched control could be resolved

studying the same population before and after the

gas

1 eak,

potential disadvantage of this survey design was the problem

of differential recall.

It

will be discussed later.

5

The

tIne-flcale

of

the

represented

be

could

design

study

diagranatlcally as foil owe:

December

(Gas Leak)

3rd December

1983

1984

12 months

22-29

Sept ember

1985

Survey

Gas exposed women

10 months
/
(Study Population)

Of

all

the abnormal outcomes of

be covered could

not be too large.

a

anomali es

apecif i c
(6).

and

sensit ive

indi cator

chromosomal

o£

order to asses the effect of the

In

menstrual pattern,

d i f f erent

o f the

Further,

spontaneous abortion rates are considered to

pregnancy outcomes,
both

spontaneous

only

still births were selected since the population to

abortions and

be

pregnancy,

gas es

on

cycl e

it was decided to study the changes in

length, menstrual flow and to study the occurrence of delayed and
i

missed periods.

I
Sampling the atudy population:

the basis of post gas leak morbidity and/or mortality

On

areas adjacent to the Carbide factory

three

I

study.

out

in

rat es,

were chosen for the

figures were available to us from a study carried

Thea e

January

Community Health”,

1985

by the "Centre

of

Social

Medicine

and

Jahawarlal Nehru University JNU which covered

population of 68,000 in 29 mohallas through a systematic random

sampling

of

6.66% households (7).

The areas selected

f or

the

study were:

6

i

I

JP Nagar

mortality rate 65.3/1000
morbidity rate 66\

Kazi Camp

mortality rate 46.7/1000
morbidity rate 54.60*

Kenchl Chola

mortality rate 35.7/1000

morbidity rate 91.9%

The

three areas selected for the study

13,

on e

fell

into Municipal

ward

of the officially recognized severely exposed wards

in

Bhopal.

Each of

the three areas selected consisted of more than one baa t i

but were given area codes and were

largest

bast i

in

identified by the name o f

that area by the

Ind i an

Counci 1

of

the

Medical

Research.

Thus ,

JP

Nagar

( ar ea

cod e

01)

Risaldah Colony,

cons i st ed

of

JP

Nagar,

Chola Naka, Shakti Nagar

and Rajgarh Colony.

Kazi

Camp

(area code 02) consisted of Kazi Camp,

Sindhl

Colony,

Phoota

Old

Maqbara & part

of

Chola Road upto the Naliah.

Kenchl Chola

(area code 07) consisted of Kenchl Chola

&

houses along the North of the railway track

(Bhopal-Delhi

Each

line) upto Nishad Pura Yard.

hous eho1d in these gas exposed areas has an ICMR plate and

using this ready made list of houses,

study could be drawn.
women

the random sample for the

Since random selection of the individual

was not possible,

it

was

7

decided

to

select

random

households

and

cover all the women

in the reproductive age

group in the selected household. The number of households in each
were (according to the ICMR sample framework) JP Nagar area-1998,

Kazl Camp - 1950 and Kenchi Chola

The total

1300 .

in these areas was between 31,000 to 35,000 (8).

population

This formed our

study population.

I
-■

Sample Size :.■

A

review of literature shows that there are very f ew

based

studies on pregnancy outcomes.

avallable,

Even in the

population
f ew

stud!es

estimates of spontaneous abortion rate vary widely both

because of the definition selected and because o f the methodology

adopt ed.

i

The

data

obtained

in Khanna study in

Punjab

rural

through prospective field observations over a per i od o f 3 -5 years

p-

f rom

I]

the

vi11age

population of

study

pregnancy

on

between

December

k.

in a rural

wastage

1983

r eport ed

pregnane!es

an

May 1984

&

(9).

coinmun i t y

showed

by the respondents,

2.09*

Delhi

near
of

that

Another

3351

the

ended in

still

births & 8.12* in spontaneous abortions (10).

For

the

purposes of our study we assumed the ’’normal

spontaneous

abort ion

pregnane!es.

To

in

det ect

spontaneous abortions i.e..

of

260

10* ,

Assuming

size

of

communi t y

a

the

rat e

of

be

10*

of

all

two

fold incr ease i n

the

rate

of

20* ,

with an error o f

the

to

pregnant women needed to appear i n

a birth rate of 35/1000 population,

observations

sample population that would

8

5* and error
the

sample.

with the period of

for the post gas leak period being 10

number of pregnant women would be 9000.

I

Ind i cat ed

12,000

overall rate of 100 abortions per 1000 pregnancies

!

I

rough1y

‘

yield

months,

the

the

required

A random sample.

using

the random numbers t able,
the

of 301 of the total households yielded

necessary number of 1586 households.

high

rat e

non-r esponse

of 29%

the

mind

Keeping in

mf c

In

Bhopal (11) another 10% of households were selected randomly

and

the interviewers

In the earlier study of

were specifically instructed in the criteria of

replacement should the need arise.
from each area selected was

Kenchl Chola

Thus the number of households

596 ,

: JP Nagar

585 and

Kazi Camp

390 households.

METHODOLOGY

The World Health Organisation defines spontaneous abortion as
any

non-doliberat e

before
dead

interruption of an

intra-uterine

pregnancy

the twenty eighth week of gestation in which the f et us

when expelled.

According to embryological

greatest loss la during the week following

these

evidence,

implantat i on.

is
the

Since

early losses are not associated with any clinical signs or

symptoms,

they

abort 1ons.

Since no previous study has been reported concerning

largely

r emain

unrecognized

the poss i b 1 e incidence

of this ev ent,

as

which

defined

a

implantat 1 on

pregnancy

that

its

as

spontaneous

an occult abortion

so

aborts

existence is

not

after

soon

cl ini cal1y

a f ew days,

delay in the onset of an otherwise

menstrual

per 1od.

The

approximat ely

37.5%

of

Block

SK

def ined

as

gestat ion,

fetal

normal

i nd i cat e

of those cycles which would otherwise

been thought to represent a prolonged luteal phase.

occult abortions (12).

i ts

suspect ed

except by

data

is

In this study,

spontaneous abortion was

by the passing of products

9

have

were actually

loss occurlng between 8 weeks and 28 weeks

sign!fled

that

of

of

conception

/

with

or without abdominal cramps.

Since there is no equivalent

in Hindi for the term "products of conception", descriptions such
as "pieces of blood".

something

or the experience

"pieces of tissue",

All

"expelled” were taken to signify products.

of

£ etal

loss after 28 weeks of gestation was defined as still births.

i.e.,

By taking a cut off point of 8 weeks

the lol/er margin of gestation,

two missed periods as

we were missing out on the

early

occult abortions of gestational period of less than 8 weeks. This
was inevitable,

al one

because to diagnose

Further ,

is insufficient.

available

to

occult

history

abort ions,

was

rlo authentic information

help with the estimation of occult abortion
secondary amenorrhoea following the

thos d

reporting

Hence

secondary amenorrhoea of less than 8 weeks

among

1 eak.

gas

tabulat ed

was

A

and analysed separately from recognized spontaneous abortions.

delayed period was defined as one missed period while only if two

I

periods were missed (without the history of spontaneous abortion)

In order to asses the changes in

it was termed a missed period.

the
i

menstrual pattern following the gas

regularity

alteration in cycle length,

flow,

duration of menstrual

■

changes

1 eak ,

of cycle were studied;

in

the

and the

here Irregularity was def ined

as unpredictability of cycle.

For the purpose of analysis of spontaneous abortions,

ratio (FDR) and cumulative incidence rate have been used.

death

FDR

is

defined as the number of spontaneous abortions

pregnancy

outcomes

(live

birth +

abortion) .

Incidence

spontaneous

abortions per 100

rat e

has

still

cone ept1ons.

10
I

birth

been calculated as

have been removed from all the tables.

. I

both fetal

Induced

per

100

spontaneous

number

of

abortions

By its very timing to the gae leak,
retrospective

data.

In

auch

our study had to be based on

study,

a

methodological problems become aparent.

retrospective,

it

has

population studied;

to

secondly,

no supportive objective data;

Menstrual

Period

rely

(LMP)

immediately

F i ratly,

on the memory

and thirdly,

becomes

aince it ia

recal1

it has to rely on

of

the

histories'

with

determination of Last

crucial.

aspects

Thee e

discussed below with reference to spontaneous abortions,

the Important variables in the study.

data,

a everal

ident i f1ed.

f actors

Thea e

relating

include

are

of

one

In studies using recalled

to recall

time

three

elaps ed

f ailure
a ince

have

the

been

event,

gestational age of the fetus at the time of abortion,

the timing

of

life,

the abortions to a particular event in a

total

number

life,

a woman’s age at the time of pregnancy,

of

woman’a

births and spontaneous abortions in a

woman’s

medical treatment

and hospitalisation related to abortion and the social class

the educational level of the women (

the

and

13 & 14) .

These factors have been identified in long term studies where the
1 ength

of time elapsed aince the abortion have played a

role in recall of the event.

crucial

The period for recall in our study

was only 21 months,which was not considered long enough to affect
recal 1

appreciably .

This

also meant that the total number

of

births and spontaneous abortions in a woman's life and her age at
the

time

of

pr egnancy

affecting recall.
incid en t

the

would not

However,

have

in these 21 months,

major

factors

an unforgettable

of the gas leak disaster had taken place and unlike

period prior to the disaster,

women were more likely to

hospitalised in the post gas leak period.

more

f ormed

11

be

Therefore a relatively

accurate reporting of spontaneous abortion in the post

leak period could not be ruled out.

in

o HzV'

gas

COMMUNITY HEALTH
CELL
326. V Main, I Block
Korambngala
Bangalore-560034 India

A final methodological problem o £ recall was that relating to the

J'

respondents’ motivation in answering the proforma.

In surveys of

this

nature,

kind

which consists of questions of intimate

the

women respondents feel embarrassed or more importantly wonder how

the

collection of such information will be of benefit

Often

to

them.

of

this reluctance is expressed in the form of "inability

recal1".

While this was not considered a major constraint in the

cont ext

of

the

disast er,

the

real problem

a£

was

possible

f

exaggerat i on

because

compensation.

Car e

of incorrect association

individual

with

was therefore taken to explain

Hindi pamphlet,the need for accuracy.

through

a

the random nature

Further,

of the selected houses together with the decision of not giving a
copy

of the proforma to the respondents helped in disassociating

the

survey from the process of assess ing

compensation

monetary

for the individuals affected by the disaster.

1

With regard to the determination of the last menstrual period.
efforts were made to make the dates as accurate as possible.

The

population

and

Hindus

in the selected bastis consisted of both

Muslims who follow different indigenous yearly calendars.

the

di f f erent

calendars,

■

was

phas es

of

the moon,

and the different fest ivals,

prepared.

all

Hindu

a 'local

events ’

survey

was

the relevant dates (LMP,

completed,

English months and dates,
tranaferred

into

thes e

calendar

assessing

the survey team was asked to write

date of

abort 1on,

delivery) in the same words as that of the respondent.

I

Muslim

the

&

To be doubly sure that the mistakes in

LMPs were kept to the minimum,

down

the

Using

dates were

convert ed

dat e

of

After the
into

the

using the local events calendar.,

and

the box provided for it in

the

(Annexure

I).

sample of the clendar is annexed.

12

proforma.

(A

History Taking:

A

pr e-deaigned,

pre-teated proforma in Hindi consisting of five
saxnple.

sections was administered to the eligible members in the

Sect i on

I containing family composition and income levels

be administered to the head of the family.

specifi cal1y

adminis t er ed

all

to

reproductive age group in the sample.

to

at

Section II was

marr i ed

in the post gas leak

the time of the survey.

to be

in

women

the

IV & V were

Section III,

aborted

be administered depending on whether a woman had

delivered

could

or

period or was currently pregnant

(See Annexure II

f or a copy of

the

proforma).

Section

This

I

each household:

the

gas ,

the

included

following information about

composition of the family, history of exposure to

gas 1 eak,

dead or missing members in the family since

and the income of the family before the gas leak.

Section

II

This

marr i ed

women

in

was
the

r eproduc t ive

age group.

history

in

the

period

following

the

number

missed.

of

year

to be administered to all the

households
It

get

the menstrual period had been delayed or

informat1on.

regularity of menses the

in the

Specific questions related to

The question were formulated in such

accurat e

were

preceding the gas leak as well as in the

to the least amount of confusion and yet

to

who

included details of the menstrual

the gas 1 eak.
times

seiect ed

For

a way that it led

enabled the survey team

instance

to

determine

proforma contained six questions.

13

f

The

section

history

the women i . e . ,

of

past

also included information on the

abortions, still births,

obstetrical

conceptions,

number of

number

of

chiIdr en

live births and the number of

The family planning statue and

alive at the time of the survey.

the changes In libido were also recorded.

Section
i

III:-

This was for those women who had aborted after

the gas leak. Both spontaneous abortions and induced abortions
were Included.

Activity

pregnancy,

during

the

last menstrual

period date of abortion, description of abortion (onset,
changes

symptoms),

fetal movements after gas leak in those who

in

after 20 weeks of gestation

as well as reasons

aborted

for induct i on

in

case of Induced abortions were recorded.

Section

IV:-

This was for women who had delivered a child

llve or still birth) after the gas 1 eak.

included details of

the antenatal, delivery and poet natal period.

J

i

h

Special attempts

were made to find out if any significant changes had been noticed

by the women after the gas leak (e.g.
and significant

changes between

changes in fetal movement)

this

delivery

previous

and

deliveries.

Section V:-

during
that

it

This was for women who were currently pregnant

the time of the survey.

int ended

Although the proforma

at least a minimum of physical

out,

examination be carried

was not possible to do so because the majority of the

survey

team consisted of people not trained in such skills.

The data for the study were collected between the 22nd and 29th
of September, 1985.

Throughout the survey,

a constant check was

maintained to assess the coverage of the sample population and to

reduce non response

considered

I

to a

minimum.

A

non-respondent

to be a person/household that could not be

14

was

contacted

oven after two repeated visits.

not contactable,

If only the woman respondent vae

Information was taken from other members of the

family (husband, mother-in-law,

aia ter-in-law).

Thia Information

was however not used for the purpose of analysis.

from the door to door survey of the selected population,

Apart

With facilities
was

examination

for Internal

run in the bastis by qualified gynaecologists from our

reporting

Women

sample

not,

or

gynaecological/symptoms ,

whether part

were referred to the clinic.

t earn

of

the

A report of

the

findings in the women attending the clinic is annexed

(Annexure

III).

Training of the survey team:

The

survey team

belonging

consisted of two types of women,

the

to

ma Jorlty

the

working class who had undergone

training

Community Health and were working as health workers for the

in
last

three years;

the other group consisted of middle class women with

or

medical

wi thout

coll ection.

conversant

prepared

the

All

with

only

Hindi.

in

background

but

members

Hindi,

with

were

lit erat e

and therefore

in

data

mos t

were

pro f orma

was

experi ence

the

bu t

The team members had volunteered

for

the

survey and were not paid any remuneration for their participation
in the survey.

About a month prior to the survey,
the

health

sc ept1c ism

the proforma was explained to

workers and was tested out

gave

ability to recall.

on

them.

The

way to a somewhat realistic assessment

initial
of

the

The proforma was then administered to several

15

4
households In the slums of Delhi and Bhopal and necessary changes

/

were

made.

briefing

The

spent

in

the partlcipanta and in giving practical experience

in

During

the

£ irst

day of the survey period was

administering the proforma in the bastis in Bhopal.

briefing,

column

each

the need to fill

question was explained,

every

emphasised and the survey team was asked to write out

of

on

the

revers e

that

they felt was relevant but which could not fit neatly

into

the

columns

was

explained

side

the

provided.

The

proforma

concept

any

of

information

other

random

sampling

and emphasis was placed on the fact that on no account

were the sample numbers to be changed.

CONSTRAINTS IN THE STUDY:

As

a consequence of the political climate prevailing

after the disaster,

i

Although

thee e

they need to be

I

in

Bhopal

the study was constrained by several factors.

data,

did not affect the overall quality of the

stated to emphasis the tensions under which the

survey team had to function.

To begin with,

it was impossible to get any information from the

medical establishment in Bhopal.

was extended to

This conspiracy of secrecy

such ridiculous

information such as the ICMR

1engths

innocuous

maps of the bastis was treated like

the intervention of

ICMR*s

It was only at

head office in Delhi,

that we were finally able to get some help

the

various

department

of

hospital.

16
i

even

classified documents.

from

I

that

Gandhi

Medical

College

and

The

However,
in

f irst

the dates had to be postponed because on June 25,

1985,

activists
Clinic)

in

1985.

was

sudden move,

a

conducted

to have been

July

survey

Bhopal

and

det ent ion.

pr ev ent 1ve

seized

their

medical

under

These activists and doctors were branded
issued

strict

against

the

a£ fected

'outs iders’

entering

warnings

in

t ens e

local people from the slums had also been

the bastis following the

arrests

The

area.

atmosphere

as

and

Health

records

as terrorists and the MP Government
any

doctors

in the Jana Swasthya Clinic (People’s

working
of

the MP Government arrested the

was

extremely

picked

up.

Even previously sympathetic doctors from the medical community of

Bhopal refused help because of the media reports.

The dates for

data

The change

collect ion

dat es

and

number

the repression by the MP Government led

of drop outs

survey.

the

survey was

Once the

therefore had to be postponed.

to

in

large

a

from those who had agreed to participate

in

Thus the number of volunteers available during the

far less than that required.

survey began,

the third

problem

was the

constant

harraataent from the police. Since the safety of the proforma
was of concern,
filled

proforma

every night after the day’s work was completed,the
had to be

spirited *

away to some

safe

place.

This resulted in the loss of some of the completed proforma.

j

17

i

I

11

CHAPTER

OBSERVATIONS AND RESULTS

Non-Respondents

Out

of the total 5248 households,

a random sample of 1571

eelected for the study from the three areas viz.,
JP

Nagar

response rate,
Of

In order to compensate

and Kazi Camp.

Kenchi

f or

another 523 households were chosen as

the total 2094 households selected,

non-response rate of 22.06%.

were
Chola,

the

non-

reserves’.

1632 responded giving

a

Table I gives the reasons for non-

response.

1

TABLE

Reasons for non-response (Figs.

in parentheses % of total)

Kazi

Kenchi

JP

Chola

Nagar Camp

Total

(%)

1.

House locked

34

70

49

153

(33.11)

2.

House not located

11

14

87

112

(24.24)

3.

Migrated/shlfted out

13

26

10

49

(10.5)

4.

Form missing/incomplete

2

33

20

55

(11.9)

5.

Out of station

12

24

14

50

(10.8)

6.

Miscellaneous reasons

3

5

9

17

(3.67)

(converted into sewing
centre, temple, shop).
7.

Empty house

5

5

5

15

(3.24)

8.

Disappeared with ICMR plate 5

4

1

10

(2.16)

9.

Refused to be surveyed

1

1

(0.21)

10.

Total

462

(100)

85

18

182

195

A

non-r eapond ent

even

after

two

respondenta

repeat ed

whoa e

via ita .

house waa locked had gone out

households

could

no t

be located and

for

missing

work

and

thea e

o£

50%

The reaaon for these

as told to ua by th ICMR field

houa eholda,

the

In Kazi Camp,

about

households belonged to consecutive numbers.

of

30%

Approximately

could be contacted only very late in the evenings.
87

contacted

household waa one that could not be

ataf f,

that while the houses were being numbered in Jan/Feb 1985,

was

about

100-150 families had put up their huta in the vacant land (Khabar
Khana)

ahi f t ed out o f the area.
1 <lak ,

gas

Pro f oriha

they

<1

in Kazi Camp and after a £ ew months,

their

these famili ea

had

Since these families moved in after the

non-response

af f ect

would not

the

reaults.

o £ 55 households were removed from the analysis because

wer e

either missing or Incomplete.

As mentioned

in

the

chapter on methodology, during the survey period, due to constant
harrassment,

the completed proforma had to be shifted every night

to a safe place to prevent them being seized,

misplacement of some .

thus leading to the

10% of the non-respondent households had

shifted out of Bhopal permanently after the gas leak and

10%

were

out

of Bhopal on social via its.

one

Only

another
household

refused to be surveyed.

A.

GENERAL CHARACTER1STICS OF STUDY AND CONTROL POPULATION

A

total

popu1at i on

of 8165 in

1632

hous eholds

waa

surveyed

between the 22nd and 29th September,

1985 .

the toxic gases on 2/3 December 1984,

253 (30.98/1000 population)

individuals

individuals,

the

gas

had

only

1 eak.

died

following

the

Of thoae exposed

exposure.

Of

to

the

8165

43 individuals had moved into the area

since

Unlike

the

g eneral

s 1 urn ’

situations,

the

population in the area under aurvey i a a stable population with a

19

relatively "new”

residents of the

in

generations b a c k .

of realdence going several

history

for more than ten

area

this

*patta’

received

JP Hagar,

b anti
yearn

and

Even

are settlers

April

1n

the

1984 ,

had

for their residential plots declaring them

as

permanent residents.

J
i

not

261

in the reproductive age group.

women

be

contacted during the survey as

1225 married women formed our

the

women

to

belonged

religlons

other

than

respondents were between the ages o £
20-29,

30%

between

the ages of

either

15-19

30-39

a

years

9.45%

and

of

0.65%
the

of

between

53.3%

years,

total

and

7 . 2%

these

on

59.76%

Kus lima,

39.6%

could

out

Thus

hone.

population.

sample

respondents were Hindus ,

1486 married

these women

Gf

they were

work or had gone on a visit to the maternal

of

were

there

In the population covered in the survey,

were more

than 40 years of age.

I i
373 of the women had a pregnancy outcome

■!

or

spontaneous abortion) in the year prior

368

women

had a pregnancy outcome

the

birth,

gas

1 eak

and

still

birth

or

in the period

1 eak.

The

control

the period before gas leak (DGL) was

from

period 1.e . ,

December

1983 to 2nd December

(ACL) ve« from 3rd December 1984
y'ribi

r

t

not

•gf!' v

following

1984 ,

Important

smoking

la u t r ong J y » ft J u t «*d

In

a t udy popu I

smoking and cultural

from smoking.

i I on ,
I h - ' I i) i n

the gas

22-29 September,
women who

in AGL period

period

s t udy

and the

1985.

had a pregnancy
comparable

are

History of

t tt.*gr ft v J d I t y and r el i g1on.

considered

our

to

th® sample of

period and

OUtCOM *

variable although

is

th or <»

powerful

mr o

Ikncti hlulory of

in strong taboo

with

smoking was

known

that

(15).

to upon tanecus abortion rate
against

women

enough to prevent women

Minoking was

2(1
■■

(live

to

birth

spontaneous abortion)

let

I

still

(livebirth,

not

enquired

into.

11

TABLE

Comparison

of

characteristics

outcome (live birth.

o£

still birth.

women who

pr egnancy

a

had

be £ ore

spontaneous abortion)

and after gas leak (Figs in parentheses are the \ of the total)

Ago

gas

Before

After

leak*

ftas

leak**

n

373

n - 368

15-19

17

(4.56)

31

(8.42)

20-29

247

(66.2)

237

(64.4)

30-39

102

(27.34)

88 (23.9)

(1.87)

12

7

40 +

(3.26)

Gravidity
132

(35.86)

&

2

155 (41.55)

3 &

4

120

(32.17)

5 & 6

63

(16.89)

7

35

(9.38)

43 (11.68)

210

(56.3)

207

(56.25)

161

(43.75)

1

130 (35.32)
63

(17.11)

Religion
Hindu

(43.7)

163

Hua 1i m

Others
*

The

control

December

period i.e.

1984

£ rom

now

from 1st December

on to be

1983

to

2nd

to

as

BGL.

ref erred

(Before Gas Leak)

The study period i.e.

from 3rd December 1984 to

Sept ember

now on to be

1985

from

ref erred

as

22-29
AGL.

(After Gas Leak)

VUMrV
21

^'•■^0034 -/

CEix

the current marital status was not

For the purpose of the study,

i

lost

had

because the number of women who

necessary

considered

husbands in the gas leak would not affect fertility status

their

1 eak.

as

only

ten months had passed since

the

Contraceptive

usage

was enquired into as both

tubectomies

adversely

lUCDs can disturb the menstrual pattern.

gas

and

between

In the period

■

to

1984

January

September 1985,

tubectomy and only 4 had

only 19 women

had

undergone

lUCDs inserted.

II

B.

EFFECT OF THE GAS LEAK ON THE MENSTRUAL PATTERN:

In

order

assess the effect of the gases

to

the

on

menstrual

pattern, only those women who were menstruating in the year prior

to as well as in the period following the gas leak were taken

that

.1 ! h
Fp

menstural

the

histories could be

compared

period before and the period after the gas leak.

individual

number of days menstrual flow

terms of regularity of the cycles.

describes

before

and

the

changes

after

gas

in

cycle

the

1 eak.

were taken.

duration
The

Table

III

of menstrual flow

changes

in blood

flow

AGL is significantly different from that in BGL (p < 0.01).

A-

22

each

Detailed history in

women served as her own control.

and the length of the

the

571 women (46.6

of the woman respondents fitted this category and

percent)

lasted

between

so

in

I

III

TABLE

Comp&rlaon of menstrual blood f1ow before and after gas 1eak:
Duration of menstrual

AGL

BGL

blood flow

9 (1.57)

19 (3.32)

2-3 days

191 (33.45)

179 (31.34)

4-7 days

329 (57.61)

316 (53.34)

8+

17 (2.97)

33 (5.77)

Irregular

25 (4.37)

17 (2.97)

1 day

7 (1.22)

Stopped

in blood flow significantly different between AGL &

Changes

BGL

(p < 0.01).

From each of the women.
enqulr ed

into

for

the length of the menstrual cycle was

the BGL and AGL period and

changes

Ln

the

length of the cycle in thia group of women is shown in Tabla IV.

Thia

t abl e

has been computed on the basis of

the alteration

cycle length of each individual woman after the gas leak
her

women

cycle length bfore the gas leak as normal

reported a shortening of cycle by

significantly different from

for her.

keeping
14*

of

5 days or more which is

the BGL period (p < 0.05).

23

in

IV

TABLE

Alteration In cycle length after

as leak

n « 571
ease

Remained

429

(75.13)

Increased by 5 or more than 5 days

21 (3.67)

Decreased by 5 or ■ore than S days

80 (14.01)

Irregularly irregular

34 (5.95)

Stopped

7

(1.22)

Alteration In cycle length significant p < 0.05

Table V describes the cyclical regularity of the aenatrual cycle.

In

i

11.56%

women the menstrual cycle was

after gas leak

irregularly

irregular

compared to 5.6% women before the gas leak.

I
y

TABLE

Change in the cyclical regularity of the menstrual cycl e
gas 1eak
571

n

BGL

AGL

Cyclically regular

539 (94.39)

498 (87.21)

Irregularly irregular

32 (5.6)

66 (11.56)

Stopped

7 (1.22)

*

Change

in

the

cyclical

regularity

■

*,

( p < 0.01).
1

24

sign!fleantly

di f f erent

histories

Menstrual

also

tried to ascertain

missed

periods

before

the

number

of

delayed

and

Table IV

shows

and

after

with

women

at

of

epieodea

the

gas

1 eak.

one

1 east

episode of missed/delayed periods.

TABLE

VI

Uomen experiencing at ]east one episode of
BGL

miased/delayed periods

&

AGL

n = 571
BGL

AGL

Delayed period*

11

52

Missed period**

10

62

*

Delayed period

amenorrhoea of 5 to 7 weeks.

Hr *

Missed period

amenorrhoea of more than 8 weeks.

Di f f er enc e is significant

C.

( p < 0.001)

EFFECT OF THE TOXIC GASES ON THE REPRODUCTIVE OUTCOMES:
births: Table VII shows that the number of still

1.Still

bi rths in
in BGL

the

AGL period is

statistically

hlgher

than

(p < 0.01) period.

VII

TABLE

St ill births in BGL and AGL Population

BGL

AGL

No.

o f live births

348

240

No.

of still births

1

13

Difference is significant

(p < 0.01)

25

that

2.Fetal Death Ratio

In

studies

that use retrospective case histories to assess

incidence of spontaneous abortions in populations,

the measure of

such an incidence is the fetal death ratio (FDR).

Table

gives

The increase

the overall fetal death ratio BGL & AGL.

the

VIII

in FDR, after gas leak is statistically significant.

I
I )

TABLE

VIII

Fetal Death Ratio before and after gas 1 eak .

BGL (n = 373)

AGL (n - 368)

No. of live births + Still births

349

253

No.

24

115

6.43

31.25

of spontaneous abortions

Fetal death ratio*
*

FDR

No. of spontaneous abortions

x 100
of

No.

spontaneous abortions

Live births

Still births

Increase in FDR in AGL period is highly significant.

Table IX

like

wi th

1985

to

compares

like

June

FDR

i . e. ,

1985.

for the same calendar month periods,
between

The

d i f f er enc e

At

between BGL and AGL periods.

I

I

b

26

• i

January 1984 to June 1984
in

and

FDR i s s i gni f i cant

IX.

TABLE

Comparleon of FDR for elmllar periods in BGL and AGL

Jan.1984-June 1984 Jan.1985-June 1985
Total No.

of live births

still births

131

143

spontaneous abortions

17

51

FDR

11.49

26.29

Total No.

of

Difference in FDR significant (p < 0.001).

3.Cumulative

Risk

of

spontaneous

abortions

in

the

exposed population.

F etal

Death Ratio is basically a ratio and the denominator

does

not belong to the same population and therefore the risk involved

cannot be estimated.

In order to work out the risk involved.

cumulative risk has been worked out in the exposed and

population.
strength

the

unexposed

This would also give the relative risk, measure the

of casual relationship and the attributable risk

which

can help in measuring the magnitude of the problem in the exposed

population.

27

For thia purpose,

selected

the conceptions of Jan.

1984

to April 1984 are

because they form a cohort whose outcome in the form of

spontaneous

abort ion

occurrence

o f exposure on 3rd December 1984.

will not be modified or distorted

by

the

Hence concept!ons

in this period forms a cohort for the unexposed population.

The

when compared to the abortion

rat e

abortion rate in this period

in the period following exposure

January 1985

shown in table X is significantly less,
1.94,

the

attributable

fraction is 48.5%
conceived

risk is

7.44,

of all abortions

the

April 1985,

as

relative riok is

and the otiologic

occurring in conceptions

after the gas 1 eak .

i
TABLE

X

Cumulative incidence o f_ spontaneous abort ions BGL & AGL
i

Month of conception

Total no. of
concept ions

Total No. o f
abort i ons

Cumu1at i v e
incidence

Jan.

1984

April 84

139

11

7.9%

J an.

1985

April 85

163

25

15.34%

Cumulative incidence calculated by

No.of spontaneous abort i ons
-------- -xl00
No . o f concept i ons

Cumulative incidence significantly different ( P < 0.05

4

28

k

)

Ill

CHAPTER

DISCUSSION

The

prea ent

disast er
sample
the

carried out ten months after

e tudy

in Bhopal,

is community baaed in a

the

1 eak

gas

a elected

randomly

of families and focusses on the effect of toxic gases

menstrual pattern and pregnancy outcomes in the gas

populat ion.

The

on

exposed

same population one year prior to the gas leak

has formed the control.

In

the immediate aftermath of the disaster,

Corporat i on,

the

responsible for the disaster.

USA,

that the effects of the gases were local.

Carbide

Union

had maintained

affecting only the eyes

and lungs and that these effects were temporary.

This attempt at

minimizing the effect of the gases had been countered as early as
three months after the disaster on the basis of

March 1985 i.e.,
obtained

dat a

through epidemiological studies which showed

the

gas es to have a multlsystemic effect.

The results of the present study support the contention that

gas es

have

af f ect ed

organs

other

than

eyes

lungs

and

Indicating damage to the reproductive system also of the
women.
be

expos ed

temporary as it could be discerned even ten months after

bleeding and in the

increased

durat i on

cycli cal

rhythm of the menstrual

of

the

The results of our study show a significant alteration

the menstrual pattern in the form of decreased cycle

number

by

The results also indicate that the effect was unlikely to

disast er.

in

the

women

of

cycle.

disruption
Sign!fleantly

have reported episodes of delayed

periods.

29

and

1ength,
of

the

higher

missed

.

I

The

effect of the toxic gases on the pregnancy outcomes

have

shown that both still births and spontaneous abortions

significantly higher in the post disaster period.

in

spontaneous

s tudi ed

The

are

increase

abortions is not confined to the immediate

post

gas leak period but the rates have continued to remain high

even

ten

months

spontaneous

after

the

disaster.

Further,

the

increas e

in

abortions are not confined to only those pregnancies

conceived before the gas leak but pregnancies conceived after the

gas leak have also experienced a significantly higher termination
as spontaneous abortions.

j

The more refined indicator of cumulative incidence shows that the

expos ed

population

is

at

attributable

risk being 7.44.

conceptions

after gas leak,

a

relative

r i sk

1.94,

o£

the

Of the spontaneous abortions

48.5% are a result of

exposure

in
to

toxic gases.

Thus,

contrary

to the hypothesis that the effects of the

toxic

gases are temporary and limited to the organs directly exposed to

them,

the

results

of the present study indicate

a

systemic poisoning along with a direct toxic effect.

to this,

continuous

In addition

the increase in spontaneous abortions suggests a strong

possibility that the gases are potentially mutagenic.

Spontaneous abortions as an index for detection of mutagens:

Ml

In assessing hazards posed by chemical agents,

are those agents that might cause cancer,
mutation, since

even

birth defects,

their defects may not be detected for

generations and the damage caused is usually

30
!

of special concern
or gene

years

or

i rr everslble.

i

H ence

whl 1 G

mutat ion

aaeeafllng genetic risks,

ia

with

which

to

detect

and the ability of the system

detect ed

increases in the mutation rates ar e two important

flnial 1

seiect ing

for

the rapidity

procedures

as

the

indicator.

aids

in

r evi ew

The

studi es

populat i on

cr i t eria

of

epidemiologic

for

detect!on

of

mutagens conclude that monitoring population for fetal deaths is
of

one

with

the most important surveillance methods

more

sped f ic

tests

such

as

in

biochemical

con J unct i on

cytogenetic

analys i s.

et

St eln

al .

have pointed out that "most inferences about the

specific congenital anomalies

dlfltribut i on

of

caus es

relied on observation made at birth or

wi sh

have

that observations made at

emphaai s e

to

geetat ion

are

inf ormat 1 on

about congenital anomalies.

a

valuable

and

and

about their
Ue

stages

of

source

of

early

untapped

1argely

later.

Obs ervat ions on

f etal

d ea t hs are ess ent i al to an understanding of congenital anomalies;

to

rely

their natural history...

of

cohorts

months

view

solely on data from birth can lead to a false

Infanta born at term are the survivors

which have suffered morbidity and

since conception.

loss

dur ing

ear 1 y

geatat 1on

the

The incidence of a defect at birth is

thus a function of the incidence of that defect at conception
in

of

and of the probability of

or

f etal

survival"

applying

currently

(17).
Using the model of Stein

avai1ab1e
poasible

et

al., and by

estimates to the model,
to

Buffler has shown that it

evaluate the utility of monitoring for

spontaneous

abortions as an indicator of chromosomal anomalies in an
population (18).

among

1 i ve

births

is

exposed

Current estimates of all chromosomal anomalies
ar e

fairly consistent

31

as

ar e

spontaneous

Using the probabilities

abortions among recognized pregnancies.

of

anomali ee

with

fetuaefl

aborting

of

and

f etus es

pregnancies ,

anomalies aborting in a hypothetical series of 1000
Buf f1 er

has

detected

or

chromosomal

def ect ive

the

f etus es

would

be

by

spontaneous

only 5.3% of the estimated total

infants with

screened

1eavlng

abortion,

that 94.7% of

shown

without

of

out

to be

anomali es

populat i on

detect ed

Spontaneous

birth.

at

also appears to be highly specific in that only 6.6% of

abortion

all fetuses without anomalies are aborted compared to an abortion
rate of 94.7% for fetuses with anomalies.

Thus ,

spontaneous

abort ion

rat es,

whi 1 e

indirect,

sensitive

and

specific indicators for assessing

pot ent ial

of

a

hazardous

chemical

agen t

ar e

the

in

bo th

mutagenic

the

expos ed

population.

The results of our study would indicate that the toxic gases that

leaked on the night of 2nd December 1984 from the UCIL factory in
Bhopal

are

increased

however r

spontaneous

needs

to

be

cytogenetic analysis.
population
years

and

This indirect

potentially mutagenic.

f or

abortions

in

substantiated

exposed

the

through

ev i d enc e

popu1at i on,

biochemical,

There is also need to monitor the exposed

delayed long term effects for the next 20 or

spontaneous

of

abortion rates could

Important surveillance methods.

32

form

one

of

30

the

Annexure

!

I

Sample from the indigenous calendar prepared for the survey
Indigenous

Their Equivalent in

Calendar

Engliah

Calendar

Amavafl

3.1.84

Rabial awful

upto 4 Jan 84

Rabial akhir

5.1.84

Makar Sankranti

14.1.84

Purnima

18.1.84

Magh (month beginning)

19.1.84

Amavas

2.2.84

J amadi1 awf u 1

4.2.84

Basant Panchami

7.2.84

Purn i ma

16.2.84

Phalgun (month beginning)

17.2.84

Hahashlvaratri

29.2.84

Amavas

29.2.84

Jamadil akhir

5.3.84

Holi

16.3.84

Purnima

16.3.84

Chaltin (month beginning)

18.3.84

j

Amavas

1.4.84

Ra jat

4.4.84

Purnima

15.4.84

Baishaki

16.4.84

Amavas

30.4.84

Shabhan

3.5.84

33

JS«
II

Annexura

Study Proforma (Translated from Hindi)

i

Information regarding Household.

Section

I

1.

Date

2.

Area/Basti

3.

ICMR number

4.

Head of household

5.

Religion

6.

Composition of family :

(Start with the household head;

Include members vho are dead and missing since gas leak)

I

No

Name

Age

Sex

Marital

Exposed to

status

gas

yoa/no

If ill,

symptoms

1.

2.
3.
4.

10.

7.
No.

Economic status before gas leak
Name of the

Daily

No. of days

If on regular

earning member

wage

of work

salary monthly

1.
2.

3.

♦

4.

h ■

10.

k

34

r
I
Section

II

: Menatural History (All married women between
15

44 yeare)

1.

ICMR No.

2.

Woman’s name

3.

Did you have a period this month?

a.

I f yea, how long did it last?

b.

If no, when was your last menstrual period?

c. And how long did it last?
Did you have a period in

4.

month?

(Investigator

to mention the month prior to the LHP)
a.

If yes, how long did it last?
Did you have a period in

5.

■

month?

(Investigator

to mention the month prior to that in question 4)

a.

6.

If yea, how long did it last?

Can

you tell me,

after how many days do you get

your

period ?

Does your period usually come after

7.

days?

(Investigator to quote answer to question 6)
Has your period been ever delayed since the gas leak?

8.
a.

If yes, how long was the delay?

b.

How many times did this happen?

Has your period been ever missed since the gas leak?

9.
a.

If yes, how many times?

Did you get your period every month in the year

10.

before

the gas leak?
11 .

In

the year before the gas leak did you ever miss your

period?
a.

If yes, how many times?

35

Uaa your period ever delayed in the year before the gas

12.

1 eak?
a.

I £ yea, how long waa the delay?

b. How many times did thia happen?

13.

Age of the youngest child?

14.

Did you conceive after this child?

a.

If yea, month and year of conception

b.

Uhat was the reault of the conception?

I

I1

(Investigator to take complete information)
15.

P1eaa e

tell me the names of all your children who

are

living at this time; start with the oldest.

>!
No.

Name

Age

Sgx

1.

2.
3.

4.
10.

16 .

Now

I

will read out to you the names of your

who are still living.

Is anyone missing? (If

ch i1 dr en

yes r

add

the name to the list)

17 .

18.

Tell me about

the children who were born alive but died

subs equent1y.

If there were any. give details.

Have

you ever given

birth to a child that was dead

birth?
If yea, give details.

19.

Did any of your conceptions end in an abortion?
(give details)

36

at

Family Planning statue:

20.

Tubectomy

(

)

Vasectomy

(

)

IUCD

(

)

Other

(

)

I

Date

None

Has

21 .

there been

any change in the libido since the

gas

1 eak?

Yours/husband’s

Signature of Investigator

Dat e

Section

III

1 .

ICMR No.

2.

Woman’s name

3.

Occupat1 on

4.

Were you engaged in heavy labour during your pregnancy?
Yes/No

:For those women who aborted after the gas 1 eak.
Bast i

a.

Fetching water (Uptill which month)

b.

Fetching firewood (

)

c . Any other heavy work (
5.

The

last

)

period

menstrual

(Write in the same way as

before

the

abortion

the woman states)

6.

When did you abort:

7.

Did you abort spontaneously or was it induced?

8.

If

date and month

it was spontaneous, give details about the abortion

(Complete information is to be taken)

37

■

9.

If there were fetal movements before the gas leak, was
there any change after the gas leak?

10.

If the abortion was Induced give reasons
Where was it done and who performed It?

Signature of Investigator

Dat e :

I
Section

For those

IV t

women who delivered a live/dead

child after gas leak.

1.

ICMR No.

2.

Woman's name

3.

Occupation

4.

Were you engaged in heavy labour during your pregnancy?

Baa t i

Y ea/No
a. Fetching water

(uptlll which month)

b. Fetching firewood (

)

c. Any other

)

(

5.

Laat menstrual period

6.

Date of delivery

7.

Fetal movements:
Same

Increased

Deereas ed

Remarks

Before gas leak
During gas leak

After gas leak
6.

Any problem/complaint after the gas leak?

9.

Was

there

delivery as

I

any

difference between the labour

compared to your

complete information)

I

38
!

previous

ones?

in

the

(Give

Delivery

10 .

a. Vert ex

b.

Breech

c.

Forceps

d.

Caesar ean

End result

11 .

a.

Live chi Id

b.

Dead child

(Fresh)

c.

Dead child

(Macerat ed)

12 .

Single / Twine

13 .

Did the child cry immediately after birth?
a.

How long was it after birth ?

b.

Colour of the skin

c . Other reflexes

14 .

Any problem in breast feeding?

15 .

Any congenital deformity?

16 .

Sex of the child

a.

F emale

b. Male
c.

I f i t was a live birth,

17 .

a.

Is the child still alive and well?

b.

If

c.

If dead,

ill, give details

give cause of death

Health of the mother

18.

c.

Indeterminate

a.

Alive and well

b.

Ill (give details)

C•

Dead (give cause of death)

Signature of investigator

Dat e:

39

r

Section

V:

For those women who are pregnant at the time of
the survey

u

1.

ICMR No.

2.

Woman’s name

3.

Occupat ion

4.

Were you engaged in heavy labour ? Yes/No

a.

I1

Fetching water

Bast i

(uptill which month)

b. Fetching firewood (

)_

c. Any other

)

(

5.

Last menstrual period

6.

I s there fetal movement?

7.

Any complaint during this pregnancy?

K,k
Signature of the Investigator

Dat e :

8.

Examination (to be carried out by a doctor)
a. Abdominal girth

b.

Fetal heart sounds

c.

Per abdomen

d.

Oed ema

e. Blood Pressure

f.

Other

Signature of the examining
Date of examination

40

doctor

Ill

Annoxure

Ef f octt of toxic gases on the health o£ the women (clinic baaed

data)

During the survey period (22-29 September 1985), a gynaecological

clinic

was run simultaneously by qualified gynaecologists in the

survey

t earn

to

examine

wi th

women

problems.

gynaecological

Depending on the area where the survey team was carrying out
1nt ervi ews,

Choia,

clinics were held at all the three areas viz . ,

JP Nagar and Kazi Camp selected for the study.

the

Kenchi

The clinic

was housed in rooms provided by the basti women and the necessary

equipment was loaned to us by voluntary organisations and private
dispensaries in Bhopal.
nurs es

two

women

or

Bhopal,

working with them.

offered us the services of

The clinic was open to al 1

in the survey area whether they formed part of the

not .

clinic

SEUA,

sample

Women in the area had been informed earlier about

through the pamphlet and the members of the

the

survey

the

t earn

wer e encouraged to refer women with gynaecological or obstetrical
problems.

Detailed

including

a

gynaecologists.
clinic.

history was taken and physical

pelvic
A

examinat i on

total

of

was

done

343 women were

examination

by

examined

quailf1ed
in

the

The characteristics of these 343 women were as follows.

41

Age

No. of women

%

(n = 343)
10 “ 14 yrs.

15

19 yrs.

20

29 yrs.

30

39 yrs.

2

0.58

23

6.7

183

53.35

95

40 *

27.7

34

Not recorded

9.9

6

1 . 75

ii

Religion
Muslim

152

Hindu

44.3

191

The findings

5 5.68

on clinical examination
were no

Total No. of
Pregnant women examined
Clinically

foil ova:
159

suspected malformed babies

Clinically

:

6(3.77k)

:

10(6.3%)

:

5(3.14%)

euspectedd Intra uterine
growth

retardation

Thr eat ened / i nev 11 ab le/missed/incompl ete
abort i on

Total No. of

non-pregnant women examined

Complete abortion
since

184

leak

:

51

(27.7%)

:

21

(11.4%)

Pelvic Inflammatory Disease

Menorrhagla/Polymenoechoea
Cervical

:

Vagin1tis/Leucorcohoea
:
Besides

neonatal

these, there

was

history of still births

deaths in chiIdren
born after gas
women who had
lost their
children in the
recanalisation as they had been
sterilized.

, /

17

(9.24%)

ecosion/Endocervicit is

42

in

26

(14.1%)

45

(24.46%)

6

women,

leak in 11

cas es.

gas

r equested

1 eak

4

■

Since these data are on a self selected sample of women attending
the c1 ini c,

they need to be interpreted with caution. The clinic

euggeat that probably the overall morbidity with regard

data

to

gynaecological problems in the exposed women has decreased in the

10

months

fol lowing

the gas leak as compared
However,

clinical studies in Bhopal.

to

the

ear11 er

it continues to remain high

as compared to clinic based studies in unexposed population; with

24 .45%

erosion/endocervicitis,
dis ease.

f rom

and

11.4%

any

inflamatory

the

discharge

whit ish

yellow,

f oul smel1 or local irritation unlike any

commonly

the case of women with leucorrhoea,

In

cervical

with

pelvic

wi th

thi ck,

the vagina was typically profuse,

without
f ound

14.1%

vaginitis/1eucorrhoea,

having

vaginal discharge of infective

aetlologleal

d iagnos i s,

gynaecological

problems

For

the

above

with

women
need

origin.

to be

Invest igat ed

appropriate treatment needs to be suggested.

populat 1on

baa ed

examinat1on

at the field level and

epidemiological

Investigations when needed.

43

study

f or

establishing
mentioned
f urther

and

There is a need for

with

f acl111 i es

1aboratory,

f or

diagnostic

: IV

Annexur*

Problems In Deliveries Post Gas Loak

surveyed

the

From

was

history

ext ensive

population,

A total

regarding deliveries that took place after the gas 1 eak .
I

Of this only 18 women

of 253 women delivered in the AGL period.

(7.1V)

had

whereas

the rest i.e.,

conceived

the month of disaster,

in December 1984

235 women (92.9V) were already

when the disaster occurred.

At the time of gas

f etal

incr eas e,

22

women

a decrease and in 13 women (14.6V)

the

fetal

gas leak in these women was change

movements.

21

women

(23.6V)

reported an

movements had completely stopped.

1

also

noticed

The

fetal

Changes in fetal movements were

as

were also considerably

gestat ion.

of

by women who entered the 20th week

movements

pregnancies

women

the

of

reported

89

1n

time

(24.7V)

1 eak ,

pr egnant

A major symptom at

had entered the third trimester of pregnancy.
the

taken

r educed

Only

compared to previous pregnancies.

thes e

in

IV

of

women reported painful contractions unlike fetal movements.

Post

maturity appeared to be another probl em.

who

delivered in the AGL period,

have

given

Of the 253 women

32 women (12.65V) appeared

birth to post term babies as calculated

last menstrual period.

Almost all the women reported

f r om

to

their

pro1onged

Since culturally labour is not divided into first stage

labour.

4

and

J ill t

labour

had been prolonged.

labour

in

second stage,

it was difficult to ascertain which stage

of

’ i-l

■

their

earli er

However ,
pregnanci es

even women who had normal

r eport ed

pro1onged

difficult labour with labour lasting for more than 48 hours.

44

or

This was in

Women reported a decrease in breast milk production.

fed their earlier infants.

Of

223 women with a living child at the time of the survey,

45

women who had successfully breast
the
women

(20.18V)

noticed a considerable decrease in

breast

milk

product 1on.

All

t h es e

s ymptoms

d evelopmen t

could indicate an

of

the child.

cou 1 d

Ind i cat e

advers e

ef f ect

on

Changes in fetal movement and

the
post
■

mat ur11 y

Insuf £ iciency
r etardat1 on,

and

intrauterine

ther ef ore

probable

hypoxia,

intrauterine

placental
growth

while suppression of breast milk could have had

advers e effect on the growth of the infant.

an

Further studies are

needed to explore these findings systematically.

45

J

Annexurt

V

A critique of the ICMR study on pregnancy outcomes and

reproductive health of women exposed to the toxic flasea
in Bhopal

Complete neglect of gynaecological problems.

The

Indian

Council

their

Gandhi

have attempted to collect data on

the

outcomes in the gas affected population as part

of

Medical College,

reproductive

the

of Medical Research (ICMR) and

longt erm

Bhopal,

epidemiological study.

ent i 11ed

prof orma

The

"ICMR/GMC study on longterm effect of MIC gas"collects morbidity

data

under conditions affecting the following organs viz.

lung,

eye, GIT, skin, hearing and mental. No Information is collected
regarding the gynaecological disorders following the gas

I

Questions

No.

1 eak.

the

49 to 54 to be administered to women between

ages of 15 to 49 years age group

outcomes

only.

pregnancy

status”

and

"pregnancy

status

on 3.12.84”.

Question

ar e

r e1at ed

to

pregnancy

No. 49 enquires about the ’’present

question

into

the

Since it is not c1 ear a t

what

No.

enqu i res

51

point of time this proforma was administered 1. e . ,

in relation to

the gas leak, and the date by which the collection of information

was completed,
gap

in

information

administering

the

between
proforma.

from the proforma

the

time

of

1 eak

and

the

Since even as

1 at e

as

the

gas

Sept ember

the

field

workers of ICMR were still administering their proforma on

long-

1985,

I,

it is not possible to tell

when

data were being collected for our study,

46

t erm e £ f ecta, we could say that the gap in information was for
This gap would relate to those women who were

at least t en months.

not

at the time of the ICMR survey,

pr egnant

and who were

not

pregnant on 3.12.84 (their response to questions 49 & 51 being in
the negative) but who had conceived between these two periods and

had aborted before the proforma was administered to

is

the first

ICMR

GMC

stage

where

under

(See ICMR

study.

reporting

them.

This

occurs in the

GMC study proforma in

Annexure

VI).

The

women who were pregnant at the time of the gas ]eak or

pr egnant

at the time of the administration of the

then referred to a team from the Oby

visit

proforma
of

MIC

the

women

a

entitled ’’Epidemiological study of teratogenic
af f ect ed

population

14 to 24 relate to

gas

Questions

1 eak.

at

are

Members of this

admini s t er

thus referred and

Questions

curr ent

proforma

Gynaecological department

of GMC involved in the ICMR sponsored research.
t earn

were

Bhopal”

pregnancy

(see

ef f acts

Annexure

VI).

outcomes following the

15 & 17 relate to the LMP &

EDD

of

the

pregnancy whereas for events occuring after the gas leak

but prior to the administration of the proforma, only gestational
age is enquired into.

This is for abortion. still birth and live

birth following the gas leak.

prepared

an

indigenous

As the study team of ICMR had not

events

calendar ,

possible that

this point.

these

may be very difficult.

It

a second stage of misreporting takes place

at

Important dates and gestation periods,
is

rechecking

Since there were no written guidelines or report, we

are not in a position to comment on methodology of the ICMR - GMC
Btudy.

47

4

second

I

I*

albeit

contain information,

Both these proforma

insuf f ici ent,

to pregnancy outcome events only and do not attempt

relating

to

collect information on either the gynaecological disorders in the

nonpregnant women or on the health problems related to pregnancy.

perceives

women

progeny.

This

Information
reported

the dominant view of modern

reflect

thus

They

medicine

as vehicles for the production of tho

view

has

led to

loss

the

the specific toxic

regarding

such as leucorrhoea,

of

valuab1e

effects

will ch

While

the failure to record such crucial

enough

from the medicolegal and scientific poiiits

also

reflects the

health

4

expect ed,

as

to an under estimation of adverse pregnancy outcomes

ICMR

study.

During

a meeting of

in

ICMR in Delhi

preliminary

results of the pregnancy outcome study of

sponsored

research

according

to

these

it

res earch to the

1 ead

these,

in

Bhopal

were

the

pr es ent ed.

had

Of

the still birth rate was

21

was

the gas

Comparing

1.4%.

in which spontaneous

abortion rate was 25

30% , still birth rate 1.8

3.5%,

malformation

it

al though

abortion

rat es

concluded

that

congenital

had increased dramatically

immediate post gas leak period,

dat e,

Till

1 eak.

results with hospital based studies,

was

ICMR

the

3 2 59

been recorded at the time of

2%,

1985,

June

a total number

rate of congenital malformation

1.5

in the

of

the Chief Investigators,

15J; had ended in abortions,

spontaneous

I

v i ew,

of

problems of women.

pregnanci es

Ji

s erioue

inf ormat ion i s

in medical

inherent bias

1 act at i on etc.

The inadequate and faultily designed proforma did,

and

women

changes in the menstrual pattern,

dysmenorrho ea, prolonged labour and suppression of
*

which

the
in

the

it had fortunately stabilized and

the current rates were all within normal.

In the meeting it was

48

i

also

during

fio

"always"

dramat1 cally

up

war,

of social and environmental stress such as

periods

£ 1oods ,

abortion rates

that

stated

because of

earthquakes

psychological

The

f actors.

participants of the meeting also expressed a sense of relief that

time

to watch was

deliver.

these statements may sound unexceptional
to

be

placed

in

impli cat ions.

the context of

Firstly,

While

they have

in themselves,

to

Bhopal

understand

their

there was enough evidence to point

to the

mortality rate after the leak.

spontaneous

abort i one

H enc e i t was more likely that the

and still briths in

the

immedlate

disaster period were due to the direct toxic effect on the

u t ero.

But

to

the gas 1 eak .

adverse outcomes were due to "stress” al on e,

the ICMR team,

post
f e tus

this was insufficient to explain the effect

pregnancies aborting several months after

high

both

toxic nature of the gases as could be seen by the high

ext r erne1y

1n

the

"now" when the women who had been in the first

at the time of gas leak would

trimester

that

malformation had not gone up but cautioned

congenital

in

the

If

as stated

by

neither was the statement substantiated by studies

support this

view

point,

nor were

abl e

we

supportive evidence through library research.

to

find

Secondly,

any

it must

also

be remembered that these statements were being made at

the

t ime

when

gas es

had

controversy

was raging about whether the

temporary local effects only or whether they affected organs other

than lungs and eyes.
embryo

to the

Thirdly,

and

f etus

ICMR’s emphasis for assessing damage

seemed to rest

on the

assessment

of

congenital malformations alone, spontaneous abortion on the other

hand

was

without

considered

grave

a regrettable and unfortunate

implications.

49

f etal

loss

r<

1

By

concentrating

terminating

atudy.

malf ormati on

alone,

in spontaneous abortions was lost

Thia was regrettable on two counts.

in

the

Firstly,

have pointed to the systemic efect of the toxic gases,
probable

period

potential (as the conceptions

mutagenic

after

studies.

the

exposure)

Secondly,

by

spontaneous

abortion

monitor

continuing

the

to

be

continuing

rates,

it

conf i rmed

the

4

'1

I

rd

Nil

50

by

would have

been

the

1 eak

ICMR

it would

and their

were

long term

environmental risk

Bhopal waa being exposed to.

■

valuable

pregnancies conceived after the gas

regarding

information

and

congenital

on

in

the

cytogenetic
studies

on

poss ible

to

popu1 at i on

in

REFERENCES

1 .

the realities and recommendations, Medico

in Bhopal,

February 1985.

Friend Circle Report,

2.

3.

Bang ,

Medical Relief and Research

Abhay et al (1985),

Bang ,

Rani

Effects of the Bhopal disaster on

(1985),

epld emi c

women’s

health

dis eas es,

Part

Pregnancy

Outcome Survey

an

16th

gynaecologi cal

II Mimeograph.

’’Medical Survey

on

Bhopal

to 109 days after exposure

Gas Victims between 104

MIC Gas”,

of

March to 21st March

1985,

to

NagrIk

by

Rahat Aur Punarvas Committee.
4.

Med i co

Fr1 end

Aft ermath

Ci rcle

(1985) ,

The

Bhopal

: An epidemiological and socio

Disaater

I

medical

survey.

5.

Ibid, MFC

6.

Bora KC et al.

(editors)

(1982)

Progress in Mutation Research, Vol 3,
Elsevier Biomedical Press,

7.

PP 225

24 7 .

Jawaharlal Nehru University (unpublished data),

An

epidemiological

and

sociological

study

(1985)
of

the

Bhopal Tragedy,
Centre for Social Medicine and Community Health,

JNU,

New Delhi.

8.

Personal communications,

coordinator of ICMR sponsored

0/6^7
51

COMMUNITY HEALTH CELL
326, V Main, I Block
Koramcngala
Bangalore-56003^ *
India

projects on gas leak disaater, Bhopal.

9.

SP (1986),

Mohanty

A review of some selected studies

on abortion In India, Journal of family welfare,

10.

14 (4)

Satya Narayana Murthy (1985),

A fltudy of pregnancy wastage in a rural community,

Department of Social and Preventive Medicine,

thesis,

All India Institute of Medical Sciences,

11.

Op Cit, MFC

12.

Block

13.

SK (1976),

Occult Pregnancy

study,

Oil cox

Accuracy of

spontaneous

of

Epidemiology,

and

120:

727

Neet

JV

Horney (1984),

recal1,

8.

65

American Journal

733.
et

al .

(ed1 tors),

Genetics
DHEU,

1163, Washington.

Kline et

(1977 ) ,

Smoking

abortion.

N ew

al .

Medicine,

297 : 793

16.

Op cit Bora KC et

17.

Stein

et

Screening

al .

the

A risk factor for

:

England

Journal

of

796 .

al .

( 1982) .

(1975) ,

Spontaneous Abortion as

a

fetal survival

on

American Journal

of

The effect of

Device :

the incidence

and

Public Health

Service Publication, No.

spontaneous

18.

A pilot

3,

epidemiology of chronic diseases;

15.

New Delhi .

Obstetrics and Gynaecology,

abortion

14.

MD

of birth defects,

Epidemiology, 102 :

4,

Op cit Bora KC et

al.

52

275 .

(1982).

yi

Ann«xur* s

l.C.M.R. - G.M.C., STUDY ON LONG TERM EFFECT OF MIC GAS ;
DEPARTMENT OF PREVENTIVE & SOCIAL MEDICINE,

GANDHI MEDICAL COLLEGE, BHOPAL.

NAME of

head

OF HOUSE HOLD :

(IN CAPITALS)

NAME OT INDIVIDUAL :
(IN CAPITALS)
ADDRESS :

I

1•
’ B |O

nun

2.6

R

1.

JOB NO.

2

TYPE OF HOUSE HOLD

(Key- House hold old. interviewed

1 I.

AGE (IN COMPLETED YEARS
(AS ON 3-12-1984)

12.

5 ex
(Key- Male

House hold old, not interviewed

F cmale

New house hold, interviewed
New house hold, not interviewed
7
9

3.
4.

9|---------------

SL. NO. OF MEMBER

6.

TYPE OF HOUSE

EDUCATION
1

Literate

2

Primary

J

'3

a
Secondary5
Midale

College

16

Canvas

PUCCA

14.

0
1

Canvas

5.

Thatched

6.

I!!r

5

T!!r

Concrete

4

Concrete

etched

6

Technical 7)

Key- KUTCHA

a.

12

2)

(Key-^liter.ile

'.5

14

5.

7.

1}.

LOCALITY
SL. NO. OF FAMILY

31

3<>
OCCUPATION
(Key in instru

ction manual)

15.

9.

PRE5ENT/ABSENT IN
THE HOUSE ON THE
NIGHT ON GAS -

TOTAL NO. OF FAMILY MEMBERS
(AS ON 3-12-84)

LEAKAGE
Key- Present

i

Absent

2)

NO. Of GUESTS (IF ANY, ON

(3-12-84)
9.

24

PER CAPITA MONTHLY INCOME

16.

YOU-

(Key-Not in Bhopal
1.5

RELIGION
Key- Hindu

33

IF ABSENT FROM

HOUSE WHERE WERE

(IN RUPEES)

10.

o

In Bhopal

1
2)

1
If IN BHOPAL WHICH AREA

Muslim

2

Christian

3

(MENTION THE AREA BY

Sikhs

4

NAME) NOT TO BE CODED)

Others

5

17.

55

27

n 2s

I
18.

LIVING STATUS ON THE
DAY OF INTERVIEW
4
(Key- Alive

26.

34

PROBLEMS
(Key-Breathlessness

2
3

Dead

Ab-ent

Missing

r

DATE OF DEATH

1

i I

• NAME Of INFORMANT

1

Chest Pain

2

Fatigue

3
a

Blackout

40

35
19.

46

If NOT WHAT ARE YOUR

(1*2)

5

(1*3)

6

( 1*4)

7

Any other corroination 8
(Specify Combination)

20.

i:

TYPE Of EXPOSURE

(Key-Sleeping

41

i

Outside

27.

Sleeping -

2

inside

21.

(Key-Yes

42

If SLEEPING INSIDE

(Ke>-Open

28.

1

Closed

WHAT DID YOU DO WHEN

29.

f--14-’

Went ouWde 2

30.

Protected by
foce»

31.

Covered with

sheet/

IF YOU RAN AWAY, WHAT
MODE DIE YOU TAKE
(Key-J9y -Foot

Both
2<k

No

2

ALCOHOL
(Key-Y<?%

EVER

No

2

48

49

1

AlCQHOL-CURREHT

50

1
2

DIO YOU CONSUME

15‘

(MIGHT Of ^PlSCCE

1
fiy vehicfe

1

ALCORbCEON THE

(Please specify)

Ji

(Key-Yes

>

Stayed indoor a

ti

SMOKING CURRENT

(Key-Yes
ho

wet ctoBn to

1

2

2)

THE GAS LEAKAGE OCCUREO
(Kev-Ran awoy
1

I

I

No

. WHERE WINDOWS OPEN
OR CLOSED

22.

47

HABITS

.SMOKING - EVER

32.

44

1

2
3)

NATURE Of WQRK ODKE

33.
45

(Key-Vos

1

No

2

CHEW TOBACO-OJRRENT
(Koy-Yes

1

No

2

CHEW TGRACQ-EVER
(Key-Yes

1

No

2

^2.

53

er XOU BEFORE THE

34.

EPtfQDE CtPKffY)
i

IMMEDIATE EFFECTS
DID THE GAS EXPOSURE

have any effect
21

i

ARE YOU ABLE TG 00

immediately on*

ths SMe wcr* now

113.6*.

(Key- Yes

(Key-Yes

No

1

No

2)

1
2)

IF YES. CONTINUE If NO.
PROCEED TO QUESTION 4-1.

I

54

54

1F YES
Condition

Effect

Were vou

Dates of hospi

I Name of hospital

hosoital-

! Duration of
(hospitalisation

Duration of

Key-Yes 1

illness in

talisation

ised

in days

days

(Not to be coded)

(Not
I coded)

2

No

to

be

Key-Yes 1

No

I

2

1

1
1

36.

SI

SB

15P

ET

<A,

-65

54

35. Lung.

At-

Eye.

5

4

3

2

7

6

-

l^7

66r

1

I

nr

37. GIT

□7S

n«

Skin

“91

So

39. Hearing

76

77 73

7$>

to-

83 84?

~85

I

ET

40. Mental

I

I

■89 $to<-

r—:87

1

LATER EFFECTS (ON Seton 4-12.1994 or later)
41. DID YOU DEVELOP ANY COMPLICATIONS
ON 4.12.1984 OR LATER.
(Key-Yes

1

No

2)

91

If YES, CONTINUE, IF NO, CLOSE INTERVIEW. PROCEED TO ITEM 49 ONLY FOR MARRIED WOMEN BETWEEN 15-49 YEARS.

Condition

o

Effect

After how-

Duration of

Duration of

Dates of hospita

Key-Yes 1

many weeks hospita

hospitali

illness in

lisation

Key ♦

lised

sation

weeks

(Not to be coded)

Key-Yes 1

Key •

Key •

5

6

No

2

Were you

No

1

2

3

2

4

7

42. LUNG

9**

94

35

46

97

43. EYE

se I

99

loo

lot

101

44. GIT

11Q3

------ 104

-----1^5

45. Skin

---- 1’°8

47.

Mental

------ |IU?

106

------- »•’

------- 1,07

------ ”1

—in

46. Hearing

2.1

12-1

----

Name of hospital

14

55

-----1-5

/8

r
s 4 a
Within 1 week
Week
1- 2
Week
2- 3
Week
3- 4
Week
4- 8
Week
8-12
More* than 12 Week
Still Continuing

i

PREGENANCV STATUS (ASK
15-49 YEARS AGE GROUP)

1

2
3

Key-Yes
No

•5

i
!
i
I

Tiredness
Key-Ye« i
No
2

b)

fatigue
Key-Yes
No

1
1

c)

Giddiness! Chakkar)
Key-Yes 1
No
2

d)

Anxlcly(Ghotharat)
Key-Yes 1
Nu
2

•)

Headache
Koy-Ves 1
No
2

0

Bodyache
Key- Yes 4

i

No
g)

52.

rr
*8

cr
30

35

36

1
2

OUTCOME OF PREGNANCY
1
Key- Live Birth
2
Still Birth
3
Abortion
M.T.P.
4
Continuing
5

37

33
DURATION CF GESTATION AT THE
TIME OF OUT COME OF PREGNANCY [
(IN WEEKS)
40f
DATE OF OUTCOME

39

r

53.

54.

46

I

NAME CP INTERVIEWER
SIGNATURE- OF INTERVIEWER

31

2

Pain in the. limbi
Key-Yes 1
No
2

*3

PREGNANCY STATUS ON 3.12.1984

Key-Yes
No
ZG

IN

1
2

34

DID YOU OEVELOI ANY OTHER
COMPLAINTS AFTtft 4.12.84.

')

WOMEN

PERIOD OF GESTATION IN WEEKS

50.
51.

48.

MARRIED

PRESENT PREGNANCY STATUS

49.

•5
7
8

ONLY

DATE
NAME OF A.R.O.

3X

NAME OF STATISTICIAN

DATE OF SCRUTINIES

Key lor occupation (No. 14)_________________ ______________________________________________
01. No. occupation
02. Professional technical and related worker.
03. Sales worker
04. Farmers, fisherman, hunters, Lumperman. related worker. 0$. Worker in mines quarry
transport occupation.
07. Craftsmen labour not. elsewhere clarified. 08- Service Workers.
09. Occupation unreported.
10. Members of armed forces.
11. Housewife.

i;

}
i |

ii
56

i

i

T

06.

Worker in

EPIDEMIOLOGICAL STUDY OK TERATOGENIC EFFECTS OF KIC
IN EXPOSTED POPULATION AT BHOPAL
.JiSTRATTON

Name of head of House hold

Husband

Name of Woman
Address

1.
2.

S.NO. OF HOUSEHOLDS

3.

S.NO. OF WOMAN

(O

II

AREA CODE

12-

i5

ICMR PROJECT NO.

I

5.

DATE OF VISIT

6.

AGE OF WOMAN

AO

7.

RELIGION

24

9

19.

IF YES, GESTATIONAL AGE AT
THE TIME OF ABORTION

20.

DID SHE DELIVER AFTER
DEC.3, 1984

1.

-21

si

IF DELIVERED ACE OF GESTATION

22.

IF LIVE BIRTH

£5

1. Is child alive 2. Died within
one week 3. Died within 7-28 days
4. Died later on
SEX OF CHILD

23.

EDUCATION

1. Male 2. Fecjle 3. •Indeterminate

1. None 2. Primary 3. Secondary
4. Graduate 5. Postgraduate/
Professional
9.

i- 2. Live birtfc 3.Still birth

21.

1.Hindu 2.Muslim 3.Sikh
4.Christian 5. Others
8.

No

DATE OF BIRTH

24.

Months

ACE:

CURRENT MARITAL STATUS

1. Single 2. Married 3. Widow
4. Separated 5. Divorced

25.

AGE AT CONSUMMATION OF MARRIAGE (yrs)

26.

ACE AT FIRST CONCEPTION (yrs)

10.

PER CAPITA INCOME PER
MONTH

27.

11.

TYPE OF HOUSE

28.

ANY TREATMENT TAKEN FOR FTEKILITY
1. Ye6 2. No.
63
NO. OF PREGNANCIES

1. Thatched hut 2. Masonary
3. Block of huts 4. Banglov
5. Tents 6. Others

29.

NO. OF LIVE BIRTHS

30.

NO. OF STILL BIRTHS

31.

KO. OF SPOK. ABORTIONS

32.

NO. OF INDUCED ABORTIONS

33.

NO. OF INFANT DEATHS
(LESS THAN’ 12 MONTHS)

7/

34.

NO. OF LIVING CHILDREN

7X

44

12.

HISTORY OF CONSANGUINITY

1. Yes 2. No.

13.

‘—i
DURING THE PERIOD OF GAS [
LEAK WHERE HAVE YOU BEEN

CURRENTLY PREGNANT

[

16.

DURATION OF PREGNANCY(wks)|

17.

E.D.D.

18.

DID SHE ABORT AFTE'
DEC.3, 1984

73

female

35.

TIME ELAPSED SINCE LAST DELIVERY(mths)
(EXCLUDE /PORTION)

36.

TOBACCO CONSUMPTION
1. No 2. Chewing 3. Smoking 4. Both 5. Other

37.

38 CONSUMPTION
ALCOHOL

7C

1. Yet. 2. No

IF YES, L.M.P.

S9

MALE

|

15.

4B

70

5° i—i

1. Inside house sleeping no
symptoms 2. Inside house,
came out no symptoms
3. Inside house, symptoms ♦
4. Outside house, symptoms ♦
5. Outside area 6. Others

14.

67

C? 7?

1. No 2. Regular 3. Occassional
|

|

"EEEEm

fa0

1.
3.
o

abortion
2. Spontaneous
L
Induced Abortion

78

38.

WORKING STATUS

39.

1. Housewife 2. Work in a office
3. Work in a Industry
?9
TYPE OF WORK
1. Desk job 2. Labourt: 3. Domestic

57

I I

MEDICO FRIEND CIRCLE

Th©

Medico

Friend Circle (MFC) is a
and

prof ess 1onala

health

activists

national

organlaation

who

the

share

of

common

conviction that the preaent system of health services and medical
education la lopsided in the Interest of the privileged few.

interea ta

bell eves that thia system must be changed to serve the

of the large majority,

upholding

human

the poor.

values;

health

care and medical

aclence

and

a

MFC fosters a 'thought current’
and community

people
education;

above,

with

of

Interventions

medical

guided

goals

out1ined

and for taking up issues of common concern for action.

34-B, Noshir Bharucha

Anil Pilgaokar, Convenor,

Road, Bombay - 400 007.

59

by

sharing of experience

the aim of realising the

Details about MFC can be had from :

of

Int eresta.

MFC off ers a forum for dialogue and debate,

experiments

or1entatIon

demyst1f1catIon

commitment to medical

peoples’ needs and not by commercial

and

MFC

Tel. 368608.

MFC Bulletin;

A monthly Medico Friend

Circle Bulletin,

now in its fourteenth year of publication,

is the medium through

which we communicate our ideas and experiences.

The bulletin

publishes articles broadly reflecting pro-people perspective

on

health - problems.

I
Subscription: Annual Rs.30/-, Life Subscription Rs.300/-,

Editor - S.P.Kalantrl,

B/8 Vivekanand Society, Sevagram, Uardha

442 102.

Selected

articles from the MFC

Bulletin have been published in

the form of three anthologies mentioned below.
»
Current MFC Publications

1.

(analys i s of present system of

IN SEARCH OF DIAGNOSIS

health

care) Ed.

Includes

Ashvin J Patel,

Health Service Evolution,

Price Rs.12.00 or US $

Nat i onal

Medical Education,

Health Policy,

Alternatives in Health Care,

Drug Industry,

Nutritional problem in India,

5.00.

Population Problem,
Protein Gap

myth,

Tonics and Community Health Care.

2.
and

HEALTH

alt ernat1ves)

CARE WHICH WAY TO GO?

Ed.

Rs.15.00 or US $ 6.00.

SuppIy,
Heal th

Abhay

Bang &

i ssu es

Pat el,

Price

Lathyrism,

Water

Ashvin

Includes Drug Issues,

Dal training.

J

Problems of Nurses,

Community

Government Rural Health

Scheme,

Oral Rehydratlon Therapy,

Workers ,

(examination of

Political Dimensions of Health and mfc debate on which way to go.

60

J

3.

and

Ed.

HEALTH AND MEDICINE-UNDER THE LENS:
J Pat el ,

Ashvin

Research,

Includea

People’s Participation,

Critical Examination of Community Health,

Health for All by 2000 AD,

6.00.

19.00 or US 3

Price Rs .

Kamala J Rao

Health Education,

Drug Misuse, Medical

BCG vaccination, Supplementary Feeding Programmes,

Policy and Therapentica,

Drug

Family Planning and the

Minimum wages,

Kerala Model.

4.

THE BHOPAL DISASTER AFTERMATH

Gocio-medical survey
$ 5.00

art idea

summary

(b)

5.

MEDICAL

on

alt ernat i ve

Price:
Rs .

(a)

med i cal

Rs.30.00 (paper back),

an epidemiological and

complete report Rs.

8.00/US

2.00/US $ 1.00

EDUCATIOIN

current

:

RE-EXAMINED:

medi cal

educat i on

educat i on.

and

61

critical

suggest i ons

Edited by Dhruv

Rs . 100.00 hard cover.

V

Select ed

Mankad,

for
Price

J

\

I

s4r
I

5

£

*

2

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