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Title: Self-reported symptoms of gynecological morbidity and their treatment in south India.
Author: Bhatia JC, Cleland J.
Journal: Stud Fam Plann; 1995; 26(4):203-16. PubMed ID: 7482678.
Abstract:
This article presents an analysis of self-reported symptoms of gynecological problems among 3,600 recent mothers in Karnataka State, India. Approximately one-third of all women reported at least one current symptom; the most common were a feeling of weakness and tiredness (suggestive of anemia); menstrual disorders; white or colored vaginal discharge (suggestive of lower reproductive tract infection); and lower abdominal pain and discharge with fever (suggestive of acute pelvic inflammatory disease). Obstetric morbidity, associated with the last live birth, was strongly predictive of current gynecological symptoms. Women who delivered their last child in a private institution were significantly less likely to report symptoms than were those who delivered at home or in a government hospital. Nonusers or users of reversible contraceptive methods were also less likely to report symptoms of morbid conditions than were sterilized women. These associations persisted in analyses controlling for potentially confounding economic and demographic characteristics, and have far-reaching policy implications. Health planners and policymakers in India had virtually no information about reproductive morbidity and its determinants on which to base efforts to improve the reproductive health of women and the acceptance of family planning programs. Thus, a study of self-reported symptoms of reproductive morbidity was undertaken in 1993 in the state of Karnataka as part of a larger research project investigating the pathways through which maternal education affects child survival. Data were gathered through a cross-sectional survey of women living in one subdistrict who were younger than 35 and had at least one child younger than five. Eligibility was limited to 3600 women living in the town and 48 villages with a population over 500. Experienced female interviewers achieved a more than 95% response rate. Disorders associated with the reported symptoms included: menstrual disorders, dyspareunia, hemorrhoids, prolapse, fistula, lower reproductive tract infection (RTI), urinary tract infection, acute pelvic inflammatory disease (PID), infertility, and anemia. Bivariate analysis revealed the significant variations in reports made by women of different socioeconomic, cultural, and demographic backgrounds; a parallel analysis was performed on the proportions seeking treatment for each condition; and logistic regression analysis estimated the net effect of each factor on the likelihood of reporting specific symptoms and the probability of seeking treatment. Independent variables were composed of socioeconomic background, demographic, last live birth and contraceptive usage, and cognitive and behavioral factors. A third of the women reported symptoms of at least one gynecological morbidity, and about half of these sought treatment. A tenth of menstruating women reported menstrual problems, a sixth reported symptoms of lower RTI, 5% reported symptoms indicative of acute PID, and 23% reported symptoms of anemia. Morbidity was influenced by the presence of complications during the pregnancy, delivery, or postpartum period of the last live birth; the location of the last delivery, with less problems reported by those who delivered in a private institution; and whether or not a woman had undergone tubectomy, which increased reporting of all symptom categories except menstrual problems. This points to the urgent need for longterm follow-up studies of sterilized women. Since most women sought private medical treatment, the primary health care facilities should be subject to a radical review and the private sector should undergo systematic evaluation.

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