An exploratory study to assess reproductive morbidities and

treatment seeking behaviour among married women in a selected

community, Ludhiana, Punjab
Sandeep Kaur, Reena Jairus, Glory Samuel
Abstract : Gynecological disorders have a substantial impact on female reproductive
ability, mental health ability to work and to perform routine physical activities. Health seeking
behavior depends upon the perception of individual about the disease. The present study was
undertaken to determine prevalence of reproductive morbidities and identify treatment seeking
behaviour towards reproductive morbidities among married women. An exploratory study
was conducted on conveniently selected 200 married women from Jamalpur Awana rural
health center of Christian Medical College and Hospital Ludhiana, Punjab. The research tool
consisted of following part: part I- Sociodemographic profile sheet, part-II Structured interview
schedule to assess reproductive morbidities, treatment seeking behaviour and reasons for not
seeking treatment.A house to house survey was conducted and 200 women were interviewed
at their homes as per interview schedule. The study explored that one fourth of the woman
(24.5%) suffered from excessive vaginal discharge, followed by pain during menstruation
18%, other reported morbidities were frequent micturition 9%, frequent menses 9%. Only
31.5% of subjects sought allopathic treatment to combat reproductive morbidities followed by
Ayurvedic 10%, home remedies 7%, homeopathic treatment taken by 3% and only 2% married
woman consulted faith healers. The prevalence of reproductive morbidities are high among
married women hence the nurses should be vigilant about the same at the time of routine
assessment and should made appropriate referrals.
Keywords
Reproductive Morbidities, Treatment
Seeking Behaviour, Married Women
Correspondance at
Mrs Sandeep Saini
College of Nursing, DMC & Hospital,
Ludhiana

Introduction
Reproductive health has been defined
by the WHO as the state of complete physical,
mental and social wellbeing and not merely
the absence of disease or infirmity in all
matters relating to the reproductive system
and to its functions and processes (UN, 1994).
Several hospital and community based
studies conducted in the country during last

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decade offer into the methodological

challenges in a diverse range of geographical
and cultural setting in India. These studies
indicate that approximately 26-77% of woman
clinically observed to be suffering from one
or more gynecological morbidities (2001)1
Health seeking behavior or treatment
seeking behavior depends upon the
perception of individual and when they think
it is normal or non-serious they do not take
treatment (1991)2. WHO reported that nearly
one third of all healthy life lost among adult
woman, because of reproductive health
problems. Gynecological disorders have a
substantial impact on female reproductive
ability, mental health ability to work and to
per form routine physical activities.
Leucorrhoea, uterine prolapse are most
common causes of gynecological morbidity
(2000 & 2005)3-4.
Woman carries a disproportionate and
growing share of economic and domestic
responsibility for the family. Despite the fact
of this, they do not have the decision making
power to determine when they are to start a
family and at what time intervals they will have
children (2002)5. Reproductive health has
gained considerable attention throughout the
world. Even in India we have well established
RCH programme but still many reproductive
morbidities are present as per report of NFHS
who conducted survey in over 25 states and
UT of India during 1998-99. Data was
collected from 84862 currently married
woman aged 15-44 years (2008)6

Reproductive tract infection is a

common problem among women and
represents serious threat to their health and
wellbeing. The exact prevalence however is
often not known since woman either does not
consider that significant health problems or
else are reluctant to talk about them. Illiteracy,
ignorance, gender discrimination and poor
social status further compounds the problem,
especially in socially and economically
backward areas (2004)7
In India, married woman are reluctant
to seek medical advice because of lack of
privacy, lack of female doctor at the health
facility the cost of treatment and their
subordinates social status (2005) 8. The
prevalence of lower reproductive tract
infections in Omani was 22.4%, upper
reproductive tract infections 2.7% and cervical
dysplasia was very rare. Genital prolapses
were present in 10%, 11% had a urinary
infections. 27% anemic, 23%were
hypertensive and 54% either over-weight or
obese (2004)9
The gynecological morbidity found
among women in Delhi were vaginal discharge
57%, lower abdominal pain 42%, menstrual
problem 26%, urinar y complaints 20%,
infertility 8% and vaginal ulcers 3% (1999)10
In Indonesia study was conducted in a
mobile clinic and reported overall 55.1% had
at least one reproductive tract infection and
19.2% had at least one sexually transmitted
disease. The study emphasized the need for
improved services for sexually transmitted
infection, prevention and management. There

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is scarcity of literature in this area of

reproductive health among married women
therefore, The present study was conducted
with the objective to determine prevalence of
reproductive morbidities and identify
treatment seeking behaviour towards
reproductive morbidities among married
women.
Methodology:
An exploratory study was conducted in
the Jamalpur Awana the rural health centres
of CMC & Hospital, Ludhiana. Population of
this field area is approximately 3819, with
approximately 825 eligible couples. 200
married women, in the age group of 15-44
years were conveniently selected. The
pregnant women and widows were excluded.
Structured interview schedule was developed
and validated by experts in the field of nursing
and community health. The research tool
consisted of following par t: par t ISociodemographic profile sheet, par t-II
Structured interview schedule to assess
reproductive morbidities, treatment seeking
behaviour and reasons for not seeking
treatment. Reliability of the tool was
established through test re-test method on 10
subjects. r=0.95 indicating highly reliable tool.
The study is limited to married women
between age group of 15-44 years, who have
problems of reproductive tract. A house to
house survey was done to register 200
women and they were interviewed as per
interview schedule. The collected data was
compiled and analyzed by descriptive and
inferential statistics.

Results:
Sample Characteristics
Table 1 reveals that half of (51.5%)
woman were in the age group of 25-34 years,
nearly 30% were educated up to primary
standard, whereas 34% of the woman
repor ted their husband's educational
standards as matric. Majority of women( 80%)
were house wives and 54% belong to Hindu
religion, 71% from nuclear families and 38.5%
had family income between Rupees 5001/- to
10000/-.
Table 2 reveals that nearly 60% of the
women got married in the age group of 1923 years with mean age at marriage of 20
3.5years with range 12 - 30 years. Regarding
number of children 42.5% women had two
children at the time of interview, 44% were
not using any family planning method. Nearly
half of the women stated their place of delivery
at institute and 47.5% reported that their last
delivery was conducted by doctor.
Table 3 depicts that one fourth of the
woman (24.5%) suffered from excessive
vaginal discharge, followed by pain during
menstr uation (18%), other repor ted
morbidities were frequent micturition (9%),
frequent menses (9%). Mass protruding out
through vaginal wall was reported by 8% of
woman whereas burning micturition, perineal
itching, pain during coitus reported by 7.5%
of the woman each. Excessive bleeding with
prolonged duration of >5 days was reported
by 6.5% of woman followed by scanty
bleeding (6%) fur ther followed by delayed
menses more than 30 days and dribbling of
urine while sneezing, coughing (4%).
Associated factors were also reported by
woman i.e., backache (15%), lower abdominal
pain (9%) and fever (6.5%).

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Table 1 : Socio demographic profile of the

subjects
N = 200
Characteristics

n (%)

Age (In years)

a) 15-24
b) 25-34
c) 35-44
Illiterate
Primary
Matric
10+2
Graduate or more
Illiterate
Primary
Matric
10+2
Graduate or more

60(30.0)
119(59.5)
19(9.5)
02(1.0)

30(15.0)
59(29.5)
55(27.5)
32(16.0)
24(12.0)

Number of children
a) None
b) One
c) Two
d) Three
e) More than Three

15(7.5)
34(17.0)
85 (42.5)
64 (32.0)
02(1.0)

12(6.0)
39(19.5)
68(34.0)
45(22.5)
36(18.0)

Family Planning Method Used

a) Condom
41(20.5)
b) Oral pills
07(3.5)
c) IUCD
08(4.0)
d) Tubectomy
48(24.0)
e) Hysterectomy
08(4.0)
f) No method used
88(44.0)

Occupation
a)
b)
c)
d)

Housewife
Labourer
Service
Business

160(80.0)
26(13.0)
10(5.0)
04(2.0)

Religion
a)
b)
c)
d)

Hindu
Sikh
Muslim
Christian

108(54.0)
87 (43.5)
03(1.5)
02(1.0)

Type of family
a) Nuclear
b) Joint
Income per Month (In Rupees)
a)
b)
c)
d)

5000/5001-10,000/10,001-15,000/> 15000/-

n(%)

29 (14.5)
103(34.0)
68(51.5)

Education (Husband)
a)
b)
c)
d)
e)

Characteristics
Age at Marriage (In years)
a) 1 8
b) 19-23
c) 21-28
d) 29

Education
a)
b)
c)
d)
e)

Table-2: Reproductive Aspects of Women

N = 200

142(71.0)
58(29.0)
75(37.5)
77(38.5)
26(13.0)
22(11.0)

Place of Last Delivery

a) Not applicable
b) Home
c) Institution

15(7.5)
86(43.0)
99(49.5)

Last Delivery conducted By

a) Not applicable
b) Untrained personnel
c) Trained Dai
d) Nurse
e) Doctor

15(7.5)
18(9.0)
44(22.0)
28(14.0)
95(47.5)

Husband Suffering from

STD/RTI
a) Yes
b) No

200 (100.0)

Mean 20 SD 3.5 Range 12-30 yrs

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Table-3: Reproductive Morbidities Among

Women
N = 200
Reproductive Morbidities

Women
n(%) Rank

1. Excessive Vaginal Discharge

49(24.5)

2. Frequent micturition

18(9.0)

3. Burning micturition

15(7.5)

4. Perineal itching

15(7.5)

5. Pain during menstruations

36(18.0)

6. Excessive bleeding with

prolonged duration of more
than 5 day

13(6.5)

7. Scanty bleeding or duration

less than 3 days

12(6.0)

8. Frequent menses less than

21 days duration

18(9.0)

9. Delayed menses more than

30 days

10(5.0)

10. Pain during coitus

11. Post coital bleeding

15(7.5)
-

6
-

8(4.0)

10

16(8.0)

13(6.5)
30(15.0)
18(9.0)

7
3
4

12. Unexplained vaginal bleeding

13. Dribbling of urine during
14. Leading of faeces or urine from
the vaginal or soiling of clothes
15. Mass protruding out through
vaginal wall
16. Associated factors
*
*
*

Fever
Backache
Lower abdominal pain

Table 4 reveals that 31.5% of subjects

sought allopathic treatment to combat
reproductive morbidities followed by
ayurvedic 10%, home remedies 7%,
homeopathic treatment taken by 3% and only
2% woman consulted faith healers. The reason
for not seeking treatment among 45% women
was that they did consider these symptoms
as normal followed by 16.5% "can'nt afford
the treatment"
Table-4: Treatment Seeking Behavior for
Reproductive morbidities among women
N = 200
Treatment Seeking
Behaviour* (n=105)

Women
n(%)
Rank

1. Allopathic

61(31.5)

2. Ayurvedic

20(10.0)

3. Homeopathic

6(3.0)

4. Home Remedy

14(7.0)

5. Faith Healer

4(2.0)

Total

105(52.5)

*More than one treatment taken by women

Table- 5 depicts that in all the prevalence

of reproductive morbidities increased with
age but this difference in age wise prevalence
of reproductive morbities was statistically not
significant. As per educational status of
women it was observed that prevalence of
reproductive morbities was higher among
illiterate women as compared to literate one
but this difference was was statistically not
significant. Hence there is no association of
age and educational status of women on the
prevalence reproductive morbidities as per chi
square test (p<.05)

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Table-5 : Association of Reproductive

Morbidities among married women with
age and educational status of women
Reproducive Morbidities
Socio demographic Suffered Not-Suffered Chi-square
profile of women n=127
n=73
Age (in years)
15-24

17(58.6)

12(41.3)

x2=.515

25-34

65(63.1)

38(36.9)

p=.773NS

35-44

45(66.2)

23(33.8)

df=2

Illiterate

21(70.0)

09(30.0)

x2=1.625

Primary

37(62.7)

22(37.3)

p=.804NS

Matric

32(58.2)

23(41.8)

df=4

10+2

22(68.8)

10(31.2)

Graduate

15(62.5)

09(37.5)

Education of women

NS=Non-Significant

Discussion:
Health in the broad sense of the world
does not merely mean the absence of the
disease or provision of diagnostic, curative
and preventive services. The state of positive
health implies the notion of perfect functioning
of the body and mind. Reproductive tract
infections are a major public health problems
among women especially in developing
countries. The women tend to suffer more
because of the synergetic effect of infection,
malnutrition and reproduction. Many women
considered most reproductive morbidities to
be normal and may not seek treatment.The
present study is done to find prevalence of
reproductive morbidies and associated
factors.

The findings revealed that, the most

frequent morbidities reported by woman was
excessive vaginal discharge (24.5%) followed
by frequent micturition (9%) and mall
protruding out through the vaginal wall (8%).
These findings are in concordance with
research study conducted by Palai P. et al.
(1992) and Singh Sauravh (2006)11 showed
that (21.6% and 18.6%) married woman were
suffering from vaginal discharge, burning
micturition (34.5%) of the respondents in
study conducted by panda, (2007). Regarding
prevalence of menstrual problems among
married woman 18% were found to be
suffering from pain during menstruation,
frequent menses >21 days 9%, scanty
bleeding of duration>3 days 6% and
excessive bleeding with prolonged duration
more than 5 days 6.5%. Singh Sauravh
(2006)11 in his study states that among 7200
rural woman in Maharashtra one fourth of the
woman suffering from menstrual problems,
nearly half were suffering from painful periods
(45%), followed by scanty bleeding (39%),
delayed period (29%), and excessive bleeding
(14%). A study conducted by Rathore M et
al. (2003)12 in Rajasthan revealed that only
2.01% of the married woman had prolapsed
uter us whereas in the present study
prevalence of mass protruding out through
the vaginal wall was quite high (8%) but on
the contrary a very high prevalence of
prolapse of uterus of different degrees was
reported by Niayer Tanya (1997)13 in Delhi
(18.2%).
In the present study none of the woman
complained of leaking of faeces or urine from

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vaginal or soiling of clothes, whereas Bhatia

J.C (1994) 14 complained that 5% of the
married woman was suffering from leakage
of urine by sneezing and coughing in
Karnataka.
The findings of the present study
revealed that allopathic treatment was found
to be highly opted for 31.5% followed by
ayur vedic (10%). Very few took home
remedies (7%), homeopathic (3%) and faith
healers (2%) which is consistent with similar
study by Nanda, Satyajeet, Tripathy and
Madhumita (2003)15 reported that 80% of
schedule tribe woman and 91% of schedule
caste woman went to allopathic doctors at
hospital/clinic at least for one health problem,
5-7% received ayurvedic, homeopathic
medicine and rest for treatment from any other
medically unqualified or traditional health
personnel. Only 2% of all schedule tribe went
for self-treatment.
In the present study relationship of
reproductive morbidities with age was not
found to be statistically significant. Similar
trend was also reported in ICMR-task force
study (2003)11 conducted in 23 districts in
India.
Findings related to education of married
woman with reproductive morbidities have not
been statistically significant similar insignificant
association has been reported by Bhanesar
RD and Singh JP (1999)16 in Rapid House Hold
Survey in Punjab.
The study concludes that most of the
married women have multiple reproductive
co-morbidities. Most of the woman preferred

allopathic treatment. Nurse must be sensitive

while assessing the female patient so that
there care needs can be intervened and quality
of life improved. Hence it was recommended
that further study can be done on large study
sample to validate and generalize it's findings.
Prevalence of reproductive morbidities can be
further scrutinizes by means of clinical and
laboratory investigations. There is need to
educate women on different symptoms of
reproductive infection and need for treatment
so that women can themselves identify the
symptoms and seek timely treatment.

References
1.

Aggarwal D. Reproductive tract

infections- challenges and responses. Health for
Millions 2001; 27(3): 21-22.

2.

WHO, Study group of community

involvement in health development challenging
health services Geneva WHO Technical Report
Series, 1991; 810:13-24.

3.

Kulkarni RN, Durge PM. A study of

leucorrhoea in reproductive age group women of
Nagpur city. Quarterly journal of the Indian Public
Health Association; 2005:49(2): 238-239.

4.

Kumari S, Walia I, Singh A. Self reported

uterine prolapse in a resettlement colony of North
India. Journal of Midwifery and women's health.
2000; 45(4):343-344.

5.

Parsad K. Reproductive rights for

women- Human rights issue. Social Welfare.
2002; 49(2):20-23.

6.

Gulati SC. Chaurasia AR, Singh

Raghubansh M. Women's reproductive morbidity
and treatment seeking behaviour in India. 2008
www.iegindia.org/dispap

Nursing and Midwifery Research Journal, Vol-9, No.3, July 2013

97

7.

Gaash B, Kausar R, Bhan SB. Prevalence

of reproductive tract infection in Kargil. Health
and population perspective and issues. JanMarch 2004; 1-7.

8.

Prasad J.H et al. Reproductive tract

infections among young married women in
Tamilnadu, India. International Family Planning
Perspective. 2005; 31(2): 73-82.

9.

10.

Asya AR, Mustafa A, Mohammad MF.

Gynecological and related morbidities among
Ever-married Omani women. Afr Reprod Health
2004;8(3):188-197.
Garg S, Sharma N, Sahay R. Sociocultural aspects of menstruation in urban slum
in Delhi, India. Reproductive Health
Matters.1999; 4(2): 15-22.

11.

Singh Saurabh. Reproductive morbidity

among the rural women in Maharashtra 2006; 4:
1-10 available at www.lips.org retrieved on 14/
3/2008

12.

Rathore M et al., Community based study

of self reported morbidity of reproductive tract
among women of reproductive age in rural area
of Rajasthan, India. Journal of Community
Medicine. 2003; XXVIII(3):117-121.

13.

Nayer T, Mishra SC, Chawla P.

Gynaecological diseases in women of
reproductive age group- unmet needs in MCH
care. Indian Journal Community Medicine. 1997;
12(3):104-109.

14.

Bhatia JC, Clenland J., Health seeking

behaviour and costs incurred.1999. http//
www.ishtm.ac.uk/cps/dfid/g.htm. accessed on
02/06/2007

15.

Nanda S, Tripathi M. Reproductive

morbidity. Treatment seeking behaviour and
fertility: A study of scheduled caste and tribe
women. J. Hum. Ecol.2003; 77-83.

16.

Bhawsar RD, Singh JP, Khanna A.

Determinants of RTs/STIs among women in
Punjab and their health seeking behaviour. 1999;
12(3): 62-67.

Nursing and Midwifery Research Journal, Vol-9, No.3, July 2013

98