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Indian Journal of Community Medicine

Study of Need of Awareness Generation Regarding A Component of Reproductive and Child Health Programme

Author(s): A. Haldar1, R. Rams,2 T. Chatterjee1, R. Misra3, G K. Joardar1

Vol. 29, No. 2 (2004-04 - 2004-06)

Abstract:

Research question: What is the level o1' knowledge on reproductive health among unmarried adolescent girls?

Objectives: 1. To collect some basic information about reproductive health from the unmarried adolescent girls. 2. To make them aware about reproductive health care.

Study design Cross-sectional.

Setting: Slums of Howrah Municipal Corporation.

Participants: Unmarried girls in the adolescent age group.

Sample size: 156

Study variable: Socio-economic status, Personal hygiene during menstruation, Knowledge on family planning methods, Care seeking behaviour.

Statistical analysis: Chi-Square test.

Results: 93% of the study population experienced menarche at the time of study, 8.75% of lower age group did not know the use of clean cloth or any cloth during menstruation. Older girls use sanitary napkins more than younger one. Significant number knew the marriageable age. 37.92% did not know how long after marriage they should have children. 36.71 % had no idea on spacing. 41.67% like bilateral decision regarding child bearing. 57.69% favour two child family norms. 78.51% favoured hospital doctors for abortion. 46.79% did not favour family planning methods. 32.05% get knowledge of reproductive health from television.

Keywords: Reproductive health, care seeking behaviour, adolescent unmarried girls, maternal morbidity and mortality, Information Education and Communication (IEC).

Introduction:

World health organization has defined 'Adolescence' as the period. between 10 and 19 years, encompassing the entire continuum of transition from childhood to adulthood'. The childhood years of a girl in India is often crowded with domestic duties, they are considered as a burden to the family and the society. Their education is considered as expendable option and their low social status is reflected in their lesser entitlement to care and attention. They are often compelled into early marriage and child bearing. Considering the various facets of girls' problem, the decade 1991­ 2000 was declared the SAARC decade of the girl child.

The international Conference on population and Development (ICPD) 1994, placed fresh emphasis on the need to ensure comprehensive reproductive health for women including the adolescents'. Reproductive and child health is defined as "a state when people have ability to reproduce and regulate their fertility, women are able to go through pregnancy and child birth 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 of fear of pregnancy and of contracting diseases" 4. Knowledge about reproductive health and its practical implementation play a very important role in healthy development of adolescent girls, reduction of maternal morbidity, mortality and child survival. The present study was carried out with the following objectives: l . to gather information about some aspects of reproductive health from unmarried adolescent girls. 2. to find out the scope of awareness generation regarding its improvement.

Materials and Methods

Cross-Sectional study was conducted during Sept 1997- Feb 1998 in Ward No. 38 of Howrah Municipal Corporation.

From 50 Wards of 'Howrah Municipal Corporation, Ward No.38 was selected by simple random sampling method using random number table. More than one ward could not be selected because of resource constraint All unmarried girls in the age group of 10-19 years in all the slums of the ward were interviewed and data were recorded in predesigned and pretested proforma.

In the study area total population was 4094, total number of girls interviewed was 156 (i.e. 3.8% of the total population). Socio- economic status (SES) was calculated by modified Kuppuswamy scales 5. ( The girls were divided into two age groups viz, lower age group (L) 10-15 years and higher age group (H)16-19 years, for studying different parameters). Data was thus collected and analysed manually, Chi-square test was applied as and when required.

Results

In the sample, 75.6% belonged to lower-middle (LM) and upper­ lower (UL) socio-economic strata (SES). The Upper-middle (UM) and lower (L) SES were 23.1% and 1.3% respectively. Illiterates andjust literates were 8.33% and 5.13% respectively and the rest were studying from Class-II to graduate standard

Out of 156 girls 93% had already experienced their menarche. The age at menarche was 12 years among 50% of them, 1.92% had menarche at 10 yrs and 3.20% had menarche after 15 years of age and 4.49% had not attained menarche and rest had menarche between 13-14 yrs of age. Irrespective of SES 60.9% had menstrual cycle of 30 days and only 1.28% had 21 days cycle, rest varied from 26 to 29 days.

Clean cloth, sanitary napkins and any cloth during menstrual period were used by 61.54%, 28.21% and 4.49% respectively. In the lower age groups (L) 21.25% use sanitary napkins where as 35.5% in higher age group use this, clean cloth users are more (65%) in 'L' age group than those in 'H' age group (57.85%). Abut 8.75% of lower age group did not know the use of these materials as they are yet to attain menarche.

91.67% of the total girls used to take bath during menstruation, 1.28% in each age group did not have that practice and the rest were unaware of this personal hygiene.

Though 75% of the study population were aware about legal age at marriage as 18 yrs, only 8.96% favoured that. Only a few (4.49%) girls preferred the first childbirth after one year of marriage and 57.59% would like to have childbirth after 2 yrs., rest (37.92%) had no opinion. Spacing of 3 yrs. and more was favoured by 52.56% and less than 3 yrs. by10.73% whereas 36.71% had no idea about spacing. Decision making regarding child birth by both husband and wife was favoured by 41.67% and that by husband alone, wife alone or elderly persons in the family was supported by 15.38%, 3.21% and 3.85% respectively. The rest 35.89% of girls were indecisive, among them 26.28% were in, 'L' age group and 9.62% in 'H' age group.

1.92%, 57.69%, 16.03% and 2.56% of girls favoured one, two, three or four children respectively. Rest (21.8%) were indecisive regarding the number of children they should have. Delivery in hospital and home was favoured by 78.85% and 9.23% respectively. However 1.92% was decisive regarding the place of delivery.

Family planning methods were preferred by 53.21% whereas 46.79% zither did not know or favour any family planning method. Among the total girls 77.56% would like abortion and 12.82% would like to have the child in case of unwanted pregnancy occurs and percentage of ignorants were 9.62%.

AIDS, syphilis and gonorrhoea were known to 32.05%, 3.85% and 1.92% respectively. About 62% did not know about these diseases.

It was revealed from Fig-1I that information regarding reproductive health was acquired by 32.05%, 0.64%. 5.77%, 10.26%, 8.97%, 17.32% and 1.28% from TV, radio, health worker, elderly persons in the family, friends, qualified private practitioners and quacks respectively. However 23.71% were ignorant of this.

42.31% girls suffered from dysmenorrhoea. Though in higher SES 47% seek treatment whereas in lower SES only 16.32% attended for treatment. This was statistically significant (P< .05, d.f. -6, X 2 = 20.09). (Table III)

Table I: Age-group wise distribution of different Materials used, during menstruation (N=156)

Age Group
(In years)
Sanitary
Napkins
Clean
Cloth
Any
Cloth
None Not
Known
Total
10 15
(Lower age
group) L
17
(21.25%)
52
(65%)
2
(2.5%)
2
(2.5%)
7
(8.75%)
80
(100%)
16-19
(Higher age group) H
27
(35.5%)
44
(57.85%)
5
(6.57%)
- - 76
(100%)
Total 44
(28.21%)
96
(61.54%)
7
(4.49%)
2
(1.28%)
1
(4.49%)
156
(100%)

Table II : Distribution of Adolescent Girls according to the choice of diff erent family planning methods. (N=156)

Family Planning
Methods
10-15 years
(L)
16.19 years
(H)
10-19 years
(Both)
Condom 10(12.5%) 20(26.3%) 30(19.23%)
O.C.R 10(12.5%) 10(13.16%) 20(12.82%)
Tubectomy 8(10%) 10(13.16%) 18(11.54%)
Other Methods 4(5%) 5( 6.58%) 9(5.77%)
None 26(32.5%) 17(22.38%) 43(27.56%)
Not Known 18(22.5%) 12(15.78%) 30(19.23%)
TOTAL 80(100%) 76(100%) 156(100%)

Table III : Care-seeking behaviour of adolescent girls suffering from dysmenorrhoea. (N=66)

  Choice of treatment
Socio
economic
status
Allopathic Homoeopathic Kaviraji
or
Indigenous
No
Treatment
Total
Upper Middle 1 (5.88%) 6 (35.29%) 1 (5.88%) 9 (52.94%) 17 (100%)
Lower Middle 4 (14.81%) 3 (11.12%) - 20 (14,07%) 27 (100%)
Upper Lower - 1 (4.54%) - 21 (95.45%) 22 (100%)
TOTAL 5 (7.58%) 10 (15.15%) 1 (1.52%) 50 (75.76%) 66 (100%)

FIGURE-I: Place of abortion favoured by the adolescent girls in case of unwanted pregnancy.

Missing ImageMissing Image

  • TV. - 32.05%
  • RADIO - 0.64%
  • H.W. - 23.71%
  • ELDERLY - 10.26%
  • FRIEND - 5.77%
  • R.M.P. - 17.31%
  • QUACK - 1.28%
  • UNAWARE - 8.97%

Discussion:

The present study was performed in slum area of Howrah Municipal Corporation in West Bengal. Majority of the girls belonged to low socio-economic group and only 8.33% were illiterate. 93% had experienced menarche and 50% of them had achieved by 12 yrs of age. This finding corroborates with the observation of other study 6 where 46.4% of the girls experienced menarche by 12 years and 96.9% by the age of 14 years. It was found in the present study that decision making regarding child birth by both husband and wife was favoured by 41.67% but it was quite higher (75.4%) in the findings of study conducted by D Dash. 35.89% of girls were indecisive about any opinion, among them 26.28% were in 'L' age group indicating that maturity of thought was more in the higher age group. So reproductive health education among lower age group should be emphasised further.

The present study showed that 50% the total girls favoured family planning methods, which did not corroborate with the findings of earlier study by Wasta MC7 where majority (90.8%) of the girls aged 15-19 yrs favoured family planning methods. This discrepancy of findings may be due to more awareness of elder girls.

It was found that 1.66% preferred quacks and 4.13% were ignorant out of total abortion-pleaders. So 5.79% girls would require proper reproductive health education. Majority of the study population were unaware of the sexually transmitted diseases requiring Information Education Communication (IEC).

Almost one fourth of the girls were ignorant about source of information regarding reproductive health would require proper IEC and majority (32.05%) get it from television (Fig-Ill). D Das also observed similar findings in 2000 in rural West Bengal 6 .

Conclusion:

Improvement of general educational level along with awareness generation in reproductive health through Information Education and Communication by the help of mass media & health workers

are of utmost importance. It is particularly important to maintain personal hygiene and to have knowledge about marriageable age, age at first childbirth, spacing, 2 child family. norms, joint decision regarding family planning, importance of seeking proper care for Reproductive Tract Infection, scope of safe abortion in unwanted pregnancy which in the long run will reduce the morbidity and mortality of girls in reproductive age group.

References

  1. WHO: The reproductive Health of Adolescence, Strategy for action, A Joint WHO I UNFPA I UNICEF I statement. l989.
  2. Grover, D. Glimpses of Girlhood in India country office, New Delhi, 1994
  3. WHO: Adolescence: The critical phase: The challenges and the potential; WHO, Regional office of the South East Asia, New Delhi 1997.
  4. Swasth Hind, special issue (50th years Health & Family Welfare) Central Health Education Bureau, Directorate General of health Services, Ministry of Health & Family Welfare, New Delhi, Reproductive & Child Health programme, January, 1998; 116.
  5. Mahajan, B.K.Gupta, M.C. Text book of Preventive and Social Medicine (2nd edition), May 1995; 135.
  6. Das D; A study of Health Status of Adolescent Girls in a Rural Community of West Bengal, Thesis Submitted To the University of Calcutta for MD (PSM), 2000.
  7. Wasta MC: A study of KAP and beliefs among urban educated Indian Youth; Youth Sexuality, FPAI, 1993. Cited in: Usha Krishna: Adolescent Sexuality and Premarital Counselling; J. Obstet. Gynaecol. India, October 1999, 49 (5): 136-139.

1. Deptt. of Community Medicine, Medical College, Calcutta. 2. Deptt. of Community Medicine, National Medical College, Calcutta 3. Deptt. of Community Medicine, R.G. Kar Medical College, Calcutta

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