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Obstetric Morbidities and Treatment Seeking Behaviour Among Tribal Women in India

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Obstetric Morbidities and Treatment Seeking Behaviour Among Tribal Women in India OBSTETRIC MORBIDITIES AND TREATMENT SEEKING BEHAVIOUR AMONG TRIBAL WOMEN IN INDIA Snigdha Banerjee1, Apyayee Sil 2 Abstract: This study is aimed at understanding the types and factors associated with obstetric morbidities and treatment seeking behavior among currently married scheduled tribe women in India in the age-group of 15-49 as identified from DLHS-4 (2012-13) data. Emergency obstetric care plays a vital role in the reduction of obstetric risk as most of the maternal deaths are result of lack of obstetric emergencies. Majorly reported obstetric problems were swelling of hands and feet followed by excessive vomiting and prolonged labor. Women with severe obstetric morbidities had normal deliveries by untrained personnel's irrespective of their place of residence. The results revealed that around 52% and 72.9% women did not seek any treatment during their pregnancy and post-delivery period respectively. The results from logistic regression analysis suggest significant association of the socio-economic and demographic factors with pregnancy-related complications. This study concluded that scheduled caste women are living with a very poor standard of health as a result of lack of education, unemployment and fewer health care centers. Key words: Pregnancy complications, treatment-seeking behavior, tribal population. INTRODUCTION pregnancy or its management but not 1 Good health and well-being are from accidental or incidental causes” . among one of the main indicators of Child birth is a significant event in Sustainable Development Goal (SDG woman's life, but this could be dangerous 2015). The International Conference on in the absence of adequate medical Population and Development (1994) care and ignorance in times of indicated the importance of women's complication during pregnancy. Re- health, especially reproductive and productive morbidity in general is not only sexual health for overall development. the result of biological factors but also Obstetric morbidity is one of the major could be attributed to women's poverty, reproductive health problem and is lack of economic or financial indepen- defined as “morbidity in a woman who has dence, malnutrition, infection, early and been pregnant (regardless of site or repeated childbearing and high fertility 2 duration of the pregnancy) resulting from poor maternal health conditions in India . any cause related to or aggravated by the Women especially from backward 1 Ph.D. Scholar of International Institute for Population Sciences, Mumbai Email id: [email protected] 2 Ph.D. Scholar of International Institute for Population Sciences, Mumbai E-mail : [email protected] 1 Tribal Health Bulletin : Vol. 25 No.1&2, January & July 2018 sections in the developing countries have of obstetric morbidity are not diagnosed limited access to skilled obstetrical care. properly at right time which may cause a India is home to more than half of the vulnerable situation and result in world's tribal population. Approximately women's death5. Given the common more than five hundred tribes are spread prevalence of the obstetric morbidity, it is across different parts of India 3. Thus, it is essential to understand and identify the plausible to argue that women belonging underlying correlates which place to scheduled tribes have higher chance of women's life at perpetual risk. Therefore obstetric morbidities and less health- in this study, an attempt has been made seeking behavior as a result of their living to shed light on obstetric morbidity in difficult or isolated areas where modern situations and identification of socio- health facilities are scarce. Obstetric demographic determinants and health- morbidity of women was not of significant seeking behavior among the tribal importance and rarely addressed in a women in India. country like India where it is considered DATA AND METHODS as a part of natural process. Therefore, The District Level Household and the obstetric health problems of tribal Facility Survey (DLHS) provided women deserve special attention as tribal opportunities to study obstetric morbidity groups have existed on the fringe of status of married women. So, DLHS-4 Indian society4. These groups are (2012-2013) data for tribal women was ignorant and insensitive towards used for the analysis. Currently married reproductive morbidities compared to the women in the age group 15-49 who gave non-tribal population. From the footsteps birth after 2008 were selected for the of Cairo conference, attention is gathered analysis. on the general health and morbidity The surveys collected information status of women in India, however on various types of complications during reproduction morbidity of tribal women pregnancy, delivery and post-delivery has not yet received the desired attention. period. The complications were divided Earlier studies have shown very little idea during pregnancy, delivery and post- about the several dimensions of obstetric delivery period. For subsequent detailed morbidity, though the magnitude of the analysis 3 dichotomous variables were problems associated with this morbidity is computed: women with any pregnancy, not properly understood. On the other delivery and post-delivery complications. hand, the problems of obstetric morbidity With the help of these 3 dichotomous have been reported by many tribal variables, dependent variable "obstetric women, but due to lack of social morbidity" was computed. Another awareness and low decision-making dependent variable was treatment- power, the use of healthcare facilities seeking behavior for these morbidities. remain indifferent. Mostly, the problems 2 Tribal Health Bulletin : Vol. 25 No.1&2, January & July 2018 The independent variables were birth delivery; RTI, etc. Bi-variate and order, age at marriage caste, place of multivariate analysis were carried out residence, place of delivery, type of using STATA-13.0. RESULTS Figure 1: Types of Obstetric Morbidity among Tribal Women in India Delivery Problems Among Tribal Women in India Breech presentation 211 High blood pressure 443 No. of women Excessive bleeding 653 Obstucted labor 1020 Premature labor 1230 Prolonged labor 1311 Pregnancy Problems Among Tribal Women in India Jaundice 122 Excessive bleeding 163 No. of women Malaria 226 Abnormal position of foetus 274 Vaginal discharge 284 No movement of foetus 352 Convulsion not from fever 355 Visual disturbances 492 High blood pressure 529 Excessive fatiuge 1102 Paleness/giddliness/weakness 1764 Excessive vomiting 2132 Swelling of hands and feets 2498 3 Tribal Health Bulletin : Vol. 25 No.1&2, January & July 2018 Post Pregnancy Problems Among Tribal Women in India Convulsion 226 Foul smelling of vaginal discharge 323 No. of women Execessive bleeding 428 Headache 687 High fever 826 Lower abdomen pain 970 Types of Obstetric Morbidity pregnancy. Other problems also place an Different types of pregnancy important role like high blood pressure problems were reported by currently (3.28%), weakness and paleness (10%). married tribal women in the selected state The major delivery complications (Figure 2) Obstetric morbidities are experienced by women who had still or classified into 3 parts – first part depicts live births in the three years preceeding that women have complication during the survey includes prolonged labor partum time; second part depicts women (7.8%), premature labor (7.4%), facing problems at the time of ante obstructed labor (6.24%), excessive partum and last part depicts women bleeding (3.3%) etc. Around 12% women having complications during post- had at least one complication during post- partum period. Swelling of hands and partum delivery. A higher number of feet (15.09%) was most commonly women reported lower abdomen related reported followed by excessive vomiting. problem (5.8%), high fever and headache Excessive fatigue (6.6%) was another (4.9%) as major post-partum problems. major problem which women face during 2.0 % of women reported foul smell from vaginal discharge. 4 Tribal Health Bulletin : Vol. 25 No.1&2, January & July 2018 Figure 2: State Wise Distribution of Obstetric Morbidity of Tribal Women in India State wise distribution of pregnancy problem of tribal women in India Legend Pregnancy problem in (%) N A Below - 15 500 0 500 1000 km 15 - 30 30 - 45 45 - 60 60 - Above State wise distribution of delivery problem of tribal women in India Legend Delivery problem in (%) N A Below - 15 500 0 500 1000 km 15 - 30 30 - Above State wise distribution of post delivery problem of tribal women in India Legend Post delivery problem in (%) N A Below - 5 500 0 500 1000 km 5 - 10 10 - 15 15 - 20 60 - Above 5 Tribal Health Bulletin : Vol. 25 No.1&2, January & July 2018 Table 1: Odds Ratio of the Likelihood of Obstetric Morbidity among Currently Married Tribal Women in India. Variables Odds Ratio Women's Age 15-19® 20-24 0.94 25-29 0.97 30-34 0.99 >35 1.02 Women's Education Illiterate® Up to Primary 0.99 Upper primary 1.03 Secondary 1.15* Graduate and over 1.20* Husband's Education Illiterate® Up to Primary 1.12 Upper primary 1.10 Secondary 1.08 Graduate and over 1.01 Place Of Residence Rural® Urban 1.09* Wealth Index Poorest® Poorer 1.01 Middle 0.98 Richer 1.05 Richest 1.20 Age At First Marriage Less Than 15 Years® 16-30 0.90 >30 0.86 Birth Order First® Second 0.83** Third 0.76*** Forth 0.80** Age At First Birth Less Than 15 Years® 16-24 1.08 25-34 1.20 35-44 0.96 Reproductive tract infection Yes® No 0.32*** ANC Visit Last Pregnancy Less Than 3 Visits® 3-6 Visits 0.90 More Than 6 Visits 1.04 Working Status Of Women Yes® No 1.05 6 Tribal Health Bulletin : Vol. 25 No.1&2, January & July 2018 Seventy-nine percent currently rural women. The likelihood of obstetric married tribal women in Puducherry and morbidity is decreasing with increment in 53% women in Tamil Nadu have reported birth order. Odds of women having at least one pregnancy-related problem.
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