Reproductive morbidity, sexual desires and abuse among young widows of farmer who committed suicide in Vidarbha region, Maharashtra

Introduction The women’s reproductive health problems in India is immense. The componant of healthy reproductive life is important for the general health and well-being of the woman. The problem of reproductive health found the leading cause of ill health in women of reproductive age group in developing country (Abraham, et.al. 2014). Reproductive morbidity is a wide concept that covers health problems related to reproductive organs and functions. It can be broadly categorized into three subgroups: obstetric morbidity, gynecological morbidity and contraceptive morbidity. Obstetric morbidity refers to ill health about pregnancy and childbirth. Gynecological Morbidity includes health problems outside pregnancy such as RTIs, menstrual problems, cervical ectopic, infertility, cancers, prolepses and problems related to intercourse. Contraceptive morbidity includes conditions, which result from efforts to limit fertility, whether they are traditional or modern methods. General, women’s reproductive problem is an outcome of not only biological factors but also socieconmic condition, powerlessness, and lack of control over resources (Dangal, 2008). In the context of India, women reproductive and sexual health is the neglected area from the decade. The impetus for bringing these and related issues in to the public domain began with community based epidemiological study of gynecological morbidity in Maharashtra (Bang et al., 1989). After, The ICPD international conference focus on women’s reproductive and sexual health as a development goal during 1994. According to WHO (1995) over one third of all healthy life lost among adults women is due to reproductive health problems. But, there is a group of widows, who are more deprived of their health, wellbeing, and human rights than another group of society (Chen, 2000). Widowhood is identified primarily by elderly women in developed countries, whereas it experienced by younger women in developing countries, and also, it affect many of women, who are widows in young age, still whom rearing children and some girls have become widows before reaching adulthood (UND, 2000). In low- resource countries, widowhood is a stigma for women, and she has lived in restrict scripted by cultural and ritual norms including India. Widow lost their identity with the loss of her husband; she excluded from the community, social event and difficult to access the services (Owen, 2002). Widows also face the challenges because of the social restriction and lack of social security, the life of a widow is sanctioned only for restrictions of every movement. India has the largest number of widows in the world. According to the census 2011, 5.6 crore widows who covered about 4.6 percent of the total population in India, which is one of the few developing countries. Nearly 245 million women lives as widowed across the world in reproductive age (Dutt, et.al., 2010). The study found that in rural India fifty-four per cent of widows aged 60 and over and 12 percent of widows aged 35-39. Only about 10 percent of widow’s remarried again (Chen, 2000). The high proportion of widows is agriculture labour in total female population. The reproductive and sexual health of the widows are extremely neglected, and their sexuality rarely addressed (Owen, 1996 & UND, 2000). In the society, still windows have need reproductive and sexual health care services. The study conducted by (Mohindra et. al.,2012) found that widows suffered from gynecology problem despite facing health issues they had difficulty to get health services because of medical expense is high and financial insecurity. Widow perception regarding sexual and the reproductive problem linked with sexual intercourse, this attitude create challenges for women to consult to doctor and seek medical treatment from health care provider. However, the widow unable to speak about their reproductive problem with anyone because of stigma and feared being suspected of she is having a sexual relationship (Haviland, et.al, 2014). The young widows are often vulnerable to sexual exploitation and abuse by family members as well as outsiders (UND, 2000). The chances of getting remarriage for Indian widows less compared to the widower, and young widow’s remarriage is prohibited (Chen, 1998). Hence, the prohibition of widow’s remarriage was not scripted by Vedas, but it's the exit due to men to maintain caste hierarchy and to suppress women in every walk of life (Malik, 2013). Studies on young widows and their reproductive and health problems often neglected in research. The interventions were needed to focus on the widowed reproductive and sexual problems. Therefore, here the attempt has been made to explore the dark side of the widowed women reproductive health issues with special reference widows of farmer’s who committed suicide. Objective: • To examine the reproductive morbidity with a specific emphasis on the menstrual problem, reproductive tract infection and treatment seeking behavior among young widows. • To understand the widow’s sexual desire and abuse in the family and from outsiders.

Methodology: The study based on the primary data collected using qualitative approach (Case studies). It provides a more comprehensive information on widow’s reproductive and sexual health issues. We conducted twenty-three case studies with widows of the farmers who committed suicide, age group of 15-49 in the four villages of Yavatmal district in Maharashtra during 2014-2015. In reproductive health, we covered problem related to menstrual problem and RTI problem: The detail information is given below the table Type of menstrual problem RTI problems White Vaginal discharge No period Itching and pain of the vulva. Painful Periods Infection in genital Irregular Periods Pain in lower Abdomen Scanty bleeding Low backache Menopause before time Treatment seeking behavior among widows

In the sexual health, we focused on whether widows are sexual desired or not, still she is sexually active in their life after husband death and abused in the family or from outsiders. For the purpose of the study, we have selected Kalamb Taluka (a subdivision of district) in the Yavatmal district. Keeping in view that it has the highest number of suicide cases, predominantly villages such as Kalamb, Donoda, Kotha, and Tirzada (this taluka is second most farmer’s suicide area after Yavatmal taluka). The survey instrument, the interview guide were approved by our institutional review board for the study. Oral informed consent obtained before the interview. The interview conducted at the home of participates. Interviews lasted between 45 and 1 hours. The case studies were recorded in the local language and translated into English. All records were read line by line by two in depended researchers to ensure the quality and consistency of the themes.

Result and Discussion: Profile of widowed women: Table 1 shows that characteristic of widows in Vidharbha region, Maharashtra. It found that the current age of widowed women in between 30 to 49. The majority of women became widows when they were at the age 20 to 35. Almost all widows belonged from backward caste (21 out of 23 widows) only one widow from SC and ST Caste. It shows that age at marriage, five women got married at the age less than 18 years it means before reached their legal age of marriage. Widows have completed their education, at least, primary and secondary level. Most of the widows were now living with their children in the nuclear family and having between three and four children boy and girls. Widows were working as labour in others farm and Anganwadi helper and only two widows currently not working after husband death. Reproductive Morbidity: Reproductive morbidity constitutes an important health problem among women of reproductive age group in India. In response to the study question, three themes emerged: reproductive problem and treatment seeking behavior, sexual desire and abuse. All widows were of reproductive age group 15- 49. As an entry to the health dimension of widows, the researcher asked them to their current health status. This study was carried out by cover 23 case studies from villages in Yavatmal. Menstrual problem The beginning of menarche is a significant event in every women’s life, which marks her capability for marriage and reproduction. Although the belives of menarche are different from society to society and problems are various from women to women. Some of the problems related to menstrual cycles. But women do not take seriously as a problem and actual illness. The result of the present study indicates that many widows age 15-49 who reported that they suffered from the menstrual problem, usually regular in term of duration, intensity and interval between cycles. From twenty three widows, some of them reported that excessive pain during period followed by most of widows were suffering from irregularity of the menstrual cycle and scanty bleeding. The study by Singh & Singh from Maharashtra found that among the one fourth of the women suffering from any menstrual problem, nearly half of them are suffering from painful periods followed by scanty bleeding, delayed period and excessive bleeding. The present study also found that widows were reported premature menopause before reaching their menopause age and suffered from back pain and sleeplessness. Reproductive tract infection problem Reproductive Tract Infection is a serious problem in public health and most of the women are suffering from this problem in India. These RTI illnesses progress as a chronic problem and remain with the women for the rest of their life. RTI is often going undiagnosed and untreated because the problem is not recognised as a health problem among women. The present study analysis found that most of the widows who were suffering from white vaginal discharge, mentioned that this symptom was accompanied by itching and pain over vulva and infection of the reproductive system. From some of them having lower abdomen pain which is not related to the menstrual cycle. Widows express that “I have white discharge problem with etching in urine. My menstrual is regular but no bleeding. For this problem I did not concern to the doctor because already I have the burden of others expenditure and, how I can say to the doctor about this problem. And I do not have that much money to spend on it” (Age 32). The study conducted in Gadchiroli district in 1989 by Bang & Bang also found that an average number of women suffered from one or more symptoms of infection of the genital tract contributed diseases related to reproductive system. Treatment seeking behavior: The people perception is important regarding treatment seeking behaviour for any disease, which of courses depend on their socio-economic characteristics. This section deals with the perception of respondents on different dimensions of reproductive health problems such as, whether they consider these problems like disease or not, their seriousness, whether they are shameful, whether there is any need for treatment, and asses health care facility. From the analysis of this study, the number of widows who took medical treatment for their problem. However, only two widowed women reported have sought treatment for their problems. It was found that the most of the widowed reported that difficulties in seeking the health care due to lack of health care facilities available in the community. Frighten or shy of consultation or unable to speak about their gynecologic problems with others because they feared being suspected of having a sexual relationship, financial problems and problem did not necessitate. One widow illustrated that “My period stopped at the age of 39. I am feeling feeble, suffering from body pain and fever therefore now I could not work, I totally depend on my children for my health care. But my children’s income is not sufficient for running the full family, and now elder son also got married in that I am always ill therefore I am not able to spend money on health, and I do not like to ask children for money every time. Hence, I am not taking care of my health” (Age 47). The only case no. 16 and 18, sought treatment from government hospital for their white discharge problems with the support of their parents because they were suffered from severe back pain, legs and knee pain. Sexual desire and abuse: Write the definition of abuse and type of abuse Sexuality is identified of individual’s biological constitution, life experiences, knowledge and attitude (Lief, 1972). Human sexuality is frequently misunderstood and particularly in the women and widows, neglected. In particular, women sexual desire is lag behind than men sexual desire in India. In fact the sexual matter is not discussed within the family and it is considered as a taboo in society. The study conducted on sexual desire and sexual activity of men and women revealed that all women below the age of 40 years were sexually active with zero percent reporting no sexual active. Sexual abuse is a common problem among widows. The result from this study indicates that young widows in the age group of 30 to 40 reported that having a desire for sexual intercourse. It observed that most of the widows were sexually active but they control their excitement due to the status of widows and burden of responsibilities. After husband death women do not have a sexual right therefore, they could not express their sexual fantasy in life. The participate (widow) narrated “Still I am feeling excitement for the sex whenever, I miss my husband; I could not sleep because of this feeling” (Respondent, age 32). The community culture, stigma attached with widowhood does not allow them to be active in sex life. However, most of the women not got remarriage due to the cultural practices of one marriage practices. Some of the women do not want to get married for their children future.

In many parts of India widows are faced sexual abuse, physically and mentally torture because of the burden of family and for the property rights. Another part of the study focus on young widow’s experience of harassment by outsiders such as tehsil officer, village men who was show have concern about women, or who were stand with their group in village premises. Widows who experienced physical and sexual harassment were reported that the people might touch them inappropriately, given an indication by seeing with evil eyes and used bad words, and indirectly invite on odd time with bad intention. The case of Anganwadi helper, a Hindu woman, had two sons, is illustrative “I had a bad experience with the tehsil offices from tehsil officer. I went for documents work of land title transfer in my name. The officer asked me for the party at my home in the evening and he promise me, will do my job without obstacles, and it was with bad intentions, I felt that he would harass me because I always go there alone” (Respondent, age 43). Widows faced sexual harassment because of living alone in the household. Other household members were also not supportive to widowed women. Discussion and conclusion: In India, most young widows are desertion and due to that, they are living in poverty and ill-health. After husband, death widows depend on others, and they have to play multiple role and responsibility. Therefore, they are not able to take care of their health and widows are less concentrated about their health related problem due to family burden and lack of income sources. It was noted that in the study has conducted in Maharashtra that found that most prevalent reproductive problem experiences by women were low back pain, lower abdominal pain, white discharge, excessive bleeding, irregular menstrual cycles and uterine prolapse (Kulkarni et.al., 2009). The present study results indicate that widows in Vidarbha region face several problem related to reproductive health and sexual life. Widowed women also, suffered from the menstrual problem such as irregularity, painful period and less bleeding due to weakness. The widowed women did not seek treatment for this problem because it is not necessitate compared to others family problem and unable to talk about their problem to the doctors. Moreover, widows are more vulnerable especially during the early stage of age, and they have a fight with an accumulation of challenges such as stigma of widows, high level of restriction and responsibility, limited resources and lack of right. Most of the women were become widows in the age 20 to 35, and they started work after husband suicide as labour in others farm on the fewer wages Rs. 80-100 a day that also depended on the work. Some of the widows having white vaginal discharge with the itching and infection in the reproductive system. But their fear of begin accused of accessing sexual and reproductive health care because of having a sexual relationship is pervasive. The result also found that became widows and living alone, most likely to experience physical and sexual harassment. Hence, they may not express their abused due to stigma, confidentiality and attitude of people. Advancing the agenda for improving reproductive health and sexual life of widows is of even greater important at the national level.

Reference

Abraham, A., Varghese, S., Satheesh, M., Vijayakumar, K., Gopakumar, S., & Mendez, A. (2014). Pattern of gynecological morbidity, its factors and Health seeking behavior among reproductive age group women in a rural community of Thiruvananthapuram district, South Kerala. Indian Journal of Community Health, 26(3), 230-237.

Bang, R., & Bang, A. (1989). A community study of gynecological diseases in Indian villages in Zeidenstein and Moore (eds.) Learning about Sexuality: A Practical Beginning. New York: Population Council.

Chen, M., (1998). Widow in India: Social Neglect and Public Action, Sage Publications.

Chen M, 2000. Perpetual mourning: Widowhood in Rural India. Oxford: Oxford University Press.

Census of India, (2011), Social and Cultural Tables India, Registrar General and Census Commissioner of India, New Delhi.

Dutt, V., & Harma, R. F. (2010). Invisible Forgotten Sufferers: The Plight of Widows Around the World. Konark Publishers.

Dangal, G. (2008). A study of reproductive morbidity of women in the Eastern Terai Region of Nepal. Nepal Journal of Obstetrics and Gynaecology, 3(1), 29-34.

Haviland, M. J., Shrestha, A., Decker, M. R., Kohrt, B. A., Kafle, H. M., Lohani, S., & Surkan, P. J. (2014). Barriers to sexual and reproductive health care among widows in Nepal. International Journal of Gynecology & Obstetrics, 125(2), 129-133.

International Conference on Population and Development: Context and Characteristics. Policy and Research Paper, no. 7, Cairo; 1994.

Kulkarni, K., & Chauhan, S. (2009). Socio-cultural aspects of reproductive morbidities among rural women in a district of Maharashtra, India. J Fam Welf, 55(2), 27-33.

Lief, H. I., & Reed, D. M. (1972). Sex knowledge and attitude test. University of Pennsylvania, Department of Psychiatry.

Malik, V., (2013). Problems of Widow Remarriage In India: A Study. Journal of Business Management & Social Sciences Research (JBM&SSR) ISSN No: 2319-5614 Volume 2, No.2,

Mohindra, K. S., Haddad, S., & Narayana, D. (2012). Debt, shame, and survival: becoming and living as widows in rural Kerala, India. BMC international health and human rights, 12(1): 12-28.

Ministry of Widows, Bolga, Ghana.

Owen M., (2002). Widows in third word nation. Woodbridge: Macmillan reference.

Owen, M. (1996). A world of widows. Zed Books. UND, 2000. Widowhood invisible women seclude or excluded. United Nations Division for the Advancement of Women, Department of Economic and Social Affairs.

World Health Organization (1995): “Safe motherhood: Maternal Health and Safe Motherhood Programme”, Progress Report, 1993-1995, Division of Reproductive Health (Technical Support), World Health Organization.

Table.1 Profile of participants (widows) characteristic in Vidarbha region, Maharashtra, 2014-15. Age Current Age at when Type of Case No. Age marriage widow Caste Education family Occupation No. of children Case Agriculture & Aganwadi No.1 31 18 29 OBC 10 Nuclear helper 2 son Case Agriculture& agriculture 2-son , 1 married No.2 48 17 OBC 9 joint labour daughter Case Agriculture& agriculture No.3 48 20 39 OBC 0 Nuclear labour 2 son+ 1 others Case No.4 33 18 28 OBC 4 Nuclear Agriculture labour 2 son Case 2-son , 1 married No.5 49 17 40 SC 4 joint Agriculture labour daughter Case No.6 32 18 23 OBC 10 Nuclear Agriculture labour 1-son+ 1 daughter Case Agriculture & Aganwadi 1-son+ 2daughter, 1 has No.7 44 20 37 OBC 9 Nuclear helper married Case No.8 32 18 32 OBC 7 joint Agriculture labour 2-son , 1 daughter Case No.9 38 19 30 OBC 3 Agriculture labour 2 son Case No.10 45 17 37 OBC 2 joint Not working 2 son Case Agriculture labour & No.11 40 16 32 OBC 5 Nuclear domestic cook 2-son , 1 daughter Case No.12 32 19 30 OBC 9 Nuclear Agriculture labour 1-son+ 1 daughter Case Cultivation and agriculture 1-son+ 2 married No.13 45 17 34 OBC 3 Nuclear labour daughter Case No.14 38 22 35 OBC 9 Nuclear Agriculture labour 1-son+ 1 daughter Case No.15 48 19 39 OBC 10 joint Not working 1 son Case No.16 34 18 30 OBC 10 Nuclear Aganwadi helper 2 son Case No.17 36 18 31 OBC 9 Nuclear Agriculture labour 1-son+ 1 daughter Case Agriculture & Aganwadi No.18 49 20 40 OBC 11 Nuclear helper 2 son Case No.19 31 18 25 OBC 12 Nuclear Agriculture labour 1-son+ 1 daughter Case No.21 35 18 28 OBC 8 Nuclear Agriculture labour 2 son Case No.22 40 18 31 OBC 11 Nuclear Agriculture labour 2 son Case No.23 45 18 35 ST 1 Nuclear Agriculture labour 1 son

Table 2. Different Menstrual Problems in Vidarbha region, Maharashtra

Type of menstrual problem Frequency Percent 17.39 No period 4 26 Painful Periods 6 39.13 irregular Periods 9 39.13 Scanty bleeding 9 17.39 menopause before time 4

Table 3. Different RTI/STI Problems in Vidarbha region, Maharashtra

Type of RTI/STDs problems Frequency Percent 26 White Vaginal discharge 6 30.43 Itching and pain of the vulva. 7 17.39 Infection in genital 4 21.73 Pain in lower Abdomen 5 17.39 Low backache 4