Academic journal article Bulletin of the World Health Organization

The Contribution of Reproductive Ill-Health to the Overall Burden of Perceived Illness among Women in Southern India

Academic journal article Bulletin of the World Health Organization

The Contribution of Reproductive Ill-Health to the Overall Burden of Perceived Illness among Women in Southern India

Article excerpt

Voir page 1068 le resume en francais. En la pagina 1068 figura un resumen en espanol.


During the 1980s there was a growing perception that women's health was being neglected in developing countries. Maternal and child health care programmes were criticized for paying inadequate attention to the needs of women, in contrast to those of their children (1); and family planning programmes were attacked for their tendency to regard women as pawns in the battle to reduce birth rates (2). One initiative aimed at overcoming the apparent neglect of women's health involved renewed emphasis on obstetric mortality and morbidity, as was demonstrated at the Safe Motherhood Conference held in Nairobi in 1986. This initiative quickly evolved into a broader concern with women's reproductive health, culminating in 1994 in the International Conference on Population and Development, at which an ambitious programme of action was devised in order to make reproductive health services more widely available in developing countries. The improvement of reproductive health subsequently became a major international priority, partly as a consequence of the human immunodeficiency virus (HIV) pandemic.

Simultaneously, there have been attempts to estimate the burden of reproductive ill-health in certain regions and large countries. In 1990 the Global Burden of Disease study, using a narrow subset of possible reproductive morbidities, estimated that 21.9% of the disability-adjusted life years (DALYs) lost by women aged 15-44 years were attributable to reproductive ill-health (3). The range was from 39.7% in sub-Saharan Africa to 8.6% in Established Market Economies; the value for India was 27.4%. Subsequent studies on the burden of reproductive ill-health have used six alternative definitions of reproductive health and a correspondingly wide range of estimates was obtained (4).

An obvious weakness of the DALY approach to reproductive health is the difficulty of incorporating the adverse consequences of unwanted pregnancy into the measures of premature death and disability. Many other problems have been identified, including an excessive reliance on expert judgement for disability weights and a corresponding neglect of people's own perceptions of the seriousness of different conditions (5-7). The latter concern is examined in this paper, in which we attempt to gauge the contribution of perceived or self-reported reproductive ill-health to the overall burden of illness in a population-based sample of young women in south central India.

Data and methods

The data used in this analysis were derived from the findings of a larger research project that was designed to investigate the pathways through which mothers' education influences their children's survival. This project included ethnographic studies, investigations in primary schools in three Indian states, a cross-sectional survey of young mothers, a smaller prospective study in which a subsample of mothers was interviewed monthly for one year, and a final phase of clinical and laboratory assessment. Details of the methodology have been reported elsewhere (8, 9). The cross-sectional survey was based on a sample of 3600 married women aged under 35 years who lived in a subdistrict about 70 km from Bangalore, Kamataka State. The women were asked about symptoms of obstetric and gynaecological morbidity and about a range of other topics. Some months later, a smaller prospective study was started on a subsample comprising 440 women with children aged 6-12 months. A quarter of the subsample lived in a small town and the rest came from 48 villages; 88% were Hindus; 56% had never attended school; 16.8% had severe anaemia (haemoglobin < 10g/dl); and 12.2% had chronic energy deficiency grade III (body mass index (BMI) <16). In these and other ways the sample was representative of young married women in Karnataka State.

The women were interviewed at monthly intervals for a year by specially trained female lay interviewers. …

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