Selected Annoted Bibliography Sunita Bandewar and Shelley Saha
Total Page：16
File Type：pdf, Size：1020Kb
Studies in Reproductive Health Services in India (1990-1991) : Selected Annoted Bibliography Sunita Bandewar and Shelley Saha Centre for Enquiry into Health and Allied Themes, Research Centre of Anusandhan Trust, Survey No. 2804 & 2805, Aaram Society Road, Vakola, Santacruz East, Mumbai – 400055, Maharashtra, India; Ph:(+91-22) 26673154, 26673571; Fax : 26673156; Email :[email protected]; Website:www.cehat.org INTRODUCTION BACKGROUND This annotated bibliography is a compilation of studies carried out during 1990-1999 on reproductive health services in India. It is one of a series of annotated bibliographies that is being brought out as part of the Gender and Reproductive Health Research Initiative. In September 1998, activists and researchers involved in women’s health issues came together to share about their concerns regarding the future of reproductive health research in India. The meeting was hosted at New Delhi by the Ford Foundation, which over the past few years, has funded several studies on Reproductive Health Practices in India. After a day’s sharing of experiences and briefly reviewing the content, nature and geographical distribution of such studies, the meeting decided on a process for (a) identifying gaps in research on Reproductive health and (b) promoting future research on hitherto unaddressed issues. This process was to have the following stages: 1. Preparing annotated bibliographies of social science research or clinical studies referring to social dimensions on seven major areas of reproductive health, drawing mainly on published research over the period 1990-99. 2. Based on the annotated bibliographies, preparing critical reviews of literature on each of the seven areas of reproductive health. The purpose of this review would be to examine, from a gender-sensitive perspective, the entire body of research covered by the annotated bibliographies, to identify the content gaps, methodological issues and ethical concerns. 3. Disseminating the critical reviews as widely as possible to encourage the participation of a broad cross-section of individuals in future research in the area. Dissemination to be aimed at women’s groups, NGOs, those involved in women’s studies and university departments dealing with health/population issues and reproductive health. 4. Inviting research proposals (brief) for carrying out studies that will address the gaps in research identified by the reviews. Proposals will be short-listed by a team of experienced activists and researchers. The next step may consist of a workshop to help develop these proposals into full-fledged research plans. 5. The importance of involving a wide cross-section of people working for women’s health and women’s reproductive health from a gender perspective would govern the short-listing of proposals. Every effort would be made to encourage first-time researchers and activists to participate in the process, and to counter the notion that research is a ‘specialist’ concern and activity. The subject areas chosen for the annotated bibliography are as follows: 1. Selected aspects of reproductive health: maternal health, reproductive tract infections and contraceptive morbidity. 2 2. Selected aspects of general morbidity in women, including the interface between communicable and non-communicable diseases and reproductive morbidity 3. Sexuality and sexual health 4. HIV/AIDS 5. Reproductive health services In addition, researches in infant-feeding and breast-feeding practices in India are also annotated. Critical review papers on each of the themes mentioned above are being prepared and would be published separately. These papers would contain Summary findings Critical analysis of methodologies used Content analysis of the literature reviewed and Research gaps in the existing research. We hope this would facilitate the process of developing the short and long term research agenda and advocacy priorities as regards health care services and women’s health. SCOPE & STRUCTURE OF THE VOLUME As stated earlier, of the set of six selected annotated bibliography volumes on aforesaid aspects of reproductive health, this particular volume contains selected annotations of studies in India during 1990s, on Reproductive Health Services. At the outset we must clarify that no such category of ‘Reproductive Health Services’ exists, especially in the public health services. Apart from maternity services and family planning services, the services for reproductive health must be accessed as part of the general health care services. Thus a review of reproductive health services must also include review of literature on general health care services. The volume presents 132 annotations. We structured this volume around five sub- themes: 1. Health care service providers (22), 2. Quality of health care services (23), 3. Women’s health care needs (18), 4. Health care: access, utilisation and expenditure (33), 5. Policy: Analysis, critique and alternative perspectives (36). These sub-themes evolved while doing the literature search and annotating them. This primarily was based on the quantum of the accessed research material with focus and thrust on a particular aspect of health care services. Often, a particular piece of research work dealt with more than one sub-theme, which made it difficult to categorise. For example, health care service providers constitute an essential part of health care service delivery system and yet they are presented separately for there was substantial research material on them, though mostly the grassroots level health workers. The exercise of ordering material around these sub-themes enabled us to recognise the research issues involved therein and identify the research gaps in a more focused manner. 3 The research classified under sub-themes ‘1’ and ‘2’ cover the issues regarding health care services from the delivery point of view while those under sub-theme ‘3’ and ‘4’ have primarily looked at health care services from users’ perspective, which in addition to others also may have used socio-economic lense while examining people’s access to and utilisation of health care services. The sub-theme ‘5’ being policy analysis and critique have addressed both these aspects. Under each of these sub-themes, the volume carries an overview of the annotations, actual annotation and references. The annotations under each sub-theme are arranged in an alphabetical order of name of the first author. The serial numbers in the theme- wise overview tables coincide with that of annotations as well as references under each theme. This forms the key for readers to locate a particular piece of work in the overview table, in the set of annotations and in the reference list under each theme. LITERATURE - SEARCH The Guiding Framework It was essential to draw up the conceptual framework, which would facilitate the literature search and selection of the material. The various components of the reproductive health on the one hand and different aspects of health services on the other hand helped us to lay down such a guiding framework. For the former, we relied upon the definition of what constitutes reproductive health. Reproductive health is defined as “a state in which people have the ability to reproduce and regulate their fertility; women are able to go through pregnancy and childbirth safely; the outcome of pregnancy is successful in terms of maternal and infant survival and well- being; and couples are able to have sexual relations free from fear of pregnancy and contracting disease.”1 The various elements or the key reproductive health issues are: RTIs/STDs/HIV; Adolescent health Maternal health Mental health; Gynaecological health; Older women’s health; Alternative health care; Anaemia/nutrition; Sexuality; sex education; sexual health; violence; sexual abuse; Male involvement, responsibility, needs; Infertility/Sterility; Abortion, contraception; Access to socio-economic rights; Occupational health.1 The key tenets underlying above issues are: 4 Empowerment, Right to information, Women’s political participation, Accountability, Access to Primary Health Centres.2 While the definition of reproductive health limits itself to needs related specifically to reproductive health of women and couples, the issues that underlie should be wide ranging to cover the complexities stated above. At operational level, we primarily relied on the above definition of reproductive health while selecting the material. However, we searched for material which designed the research to look beyond the clinical aspects of women’s reproductive health and carried the analysis to understand the above mentioned tenets those underlie women’s reproductive health. Such an understanding ultimately would enable to design, plan and operationalise woman-centred and gender sensitive health care services. The various important dimensions of health care services could be comprehensively summarised in terms of: Structure: Physical access (availability, approachability and adequacy); physical standards (instruments, equipment, drugs etc.); and human power (various service providers). Process: Provider-client interactions, providers’ competence, provider-client relationship and continuity. And lastly, Outcome: Bio-medical and socio-behavioural consequences of health care service provision. In addition, subject matters such as access to and utilisation of health care services and health expenditure are some of the other important aspects while studying health care services. These aspects interface