Maternal and social factors associated with abortion in India: a population-based study

CONTEXT: A cultural preference for sons may be a factor driving recourse to abortion in India, as women carrying female fetuses may decide to terminate their pregnancies. To assess this hypothesis, more information on the incidence of abortion, and on maternal and social correlates of the procedure, is needed.METHODS: Birth order-specific abortion ratios were calculated using the birth histories of 90,303 ever-married women aged 15-49 who participated in India's 1998- 1999 National Family Health Survey. For the first four births, the association between abortion and various maternal and social variables, including the sex of the respondent's last child, was assessed using logistic regression. RESULTS: The overall abortion ratio was 17.0 per 1,000 pregnancies. The ratio increased from 5.3 per 1,000 pregnancies for first-order births to 25.8 per 1,000 pregnancies for third-order births and then declined. The strongest predictor of abortion was maternal education: Women with at least a primary education were more likely than those with no education to have had an abortion (odds ratios, 1.9-6.7). Rural residence was associated with a reduced likelihood of abortion (0.6). There was no association between the sex of a woman's previous child and the odds that she subsequently had an abortion.CONCLUSION: At the national level, it is likely that unintended pregnancy, rather than the sex of the previous child, underlies demand for abortion in India. Rising educational attainment among women may lead to an increase in the demand for abortion

Doctors and the chronic pelvic pain patient

Many women with chronic pelvic pain (CPP) turn out not to have any identifiable pathology despite having undergone multiple investigations. There is no consensus as to the best management for women in this group. Although a multidisciplinary approach to diagnosis and care has been advocated as best practice, it is costly and not practical in most units in the United Kingdom, and many other countries. Clinicians need to be aware of the importance of attitude and medical consultation as factors influencing patients' outcome from investigation and treatment. While consulting styles reflect the individual personality of the doctor, we need to be aware of our own underlying attitudes and how these might enter into the dynamics of the consultation. Some patients may want to have open, non-directive consultations, some more directive consultation styles. It is, therefore, essential for the physicians to identify patients' expectations or preferences and then try to meet them, in order to attain "concordance" in communication. In this chapter, we will examine some studies that relate to the doctor-patient relationship in women with CP

Safer pregnancies for all in rural India

A mother's access to antenatal care, between conception and birth, is crucial to a healthy birth. In parts of India, many women are not using antenatal services despite government and NGO efforts to improve services. Extending the role of nurses and midwives, and providing more care within communities are key to increasing access to care and limiting pressure on local services.Researchers from ‘Opportunities and Choices’ programme at the University of Southampton, UK, drew on data on 11,369 women of reproductive age from the Indian states of Bihar, Madhya Pradesh, Rajasthan and Uttar Pradesh in the 1998-99 Indian National Family Health Survey. The researchers examined the factors associated with the use of antenatal care facilities in rural areas, and with access to specific components of antenatal care. They also looked for differences in the pattern of use between health clinics and home visits. The study uses data on antenatal check-ups for women during their last pregnancy. The variables included were: education level, socio-economic status, demographic characteristics, including age and parity, and level of exposure to the media, such as regular television viewing. The researchers considered the following components of antenatal care: urine testing, taking of blood pressure, blood testing, abdomen examination, internal examination, tetanus vaccination and being given iron and folic acid supplements.Research findings include:Overall, 3 out of every 5 women (62.8 percent) did not receive any antenatal check-up during their last pregnancy. Among those women who did attend a clinic, the average number of visits was two. In Uttar Pradesh and Bihar more women were seen by a doctor than by a nurse or midwife. Overall 55 percent of women attending antenatal check-ups were seen by a doctor. The most commonly received services were tetanus vaccination and iron and folic acid supplements. Women visited at home by health workers received fewer services. Women who married at an older age and watched television each week were more likely to use antenatal services, whereas the association between a woman’s religion or caste and access to services varied between states. In all states, women and their husbands who had a higher standard of living and education levels were more likely to visit a health clinic and receive a more specific type of care Women from poor and uneducated backgrounds with at least one child were least likely to receive antenatal care. To overcome the socio-economic and cultural barriers that prevent women in rural India accessing antenatal services, policy-makers should:take into account the diverse social conditions between states and between communities within each state consider whether the uptake of services for second and subsequent pregnancies may be due to a reduced perception of need, or practical difficulties associated with caring for young children plan health policies that take into account that decisions to access antenatal care are based on an individual's or a community's perception of need, and the cost and quality of different health care providers provide further training and supervision for health workers to ensure all the components of antenatal care are provided increase the role of nurses and midwives so that specialised clinical staff can treat those with complications expand the provision of iron or folic acid supplements in communities to reduce dependence on the health service for these simple interventions. Contributor(s): Saseendran Pallikadavath, Mary Foss, R. William StonesSource(s): ‘Antenatal care: provision and inequality in rural north India’, Social Science and Medicine 59: 1147-1158, by S. Pallikadavath, M. Foss and R.W. Stones, 2004 More information.'Obstetric care in central India', Southampton: University of Southampton Press, A. Ranjan and R.W. Stones (eds.), 2004 'A framework for the evaluation of quality of care in maternity services', Southampton: University of Southampton Press, L.A. Hulton, Z. Matthews and R.W. Stones (eds.), 2004Funded by: UK Department for International Development id21 Research Highlight: 16 February 2005Further Information:R William Stones Level F (815) Princess Anne Hospital SouthamptonSO16 5YAUKTel: +44 (0) 23 8079 6033Fax: +44 (0) 23 8078 6933Email: [email protected]

Womens' reproductive health, sociocultural context and AIDS knowledge in Northern India

This paper identifies sociocultural and reproductive health correlates of knowledge about HIV among ever-married women using 1998–99 National Family Health Survey data from two low HIV prevalence Indian states, Madhya Pradesh (MP) and Uttar Pradesh (UP). Logistic regressions were undertaken modelling women’s awareness of HIV, of whether the disease can be avoided and of effective means of protection. In MP 22.7 per cent women were aware of HIV; 56.4 per cent (of 22.7 per cent) knew that the disease can be avoided; and 47.5 per cent (of 56.4 per cent) possessed correct knowledge about effective means of protection. In UP 20.7 per cent women had awareness of HIV; 59.2 per cent (of 20.7 per cent) knew that the disease can be avoided; and 45.7 per cent (of 59.2 per cent) were informed about effective means of protection. In both states older, uneducated, rural, poor, those not exposed to television, and those who had never used a modern family planning method were less likely to possess HIV awareness. However, for women who were aware of HIV, acquisition of further knowledge about it had fewer socioeconomic barriers. These barriers were state specific so interventions to overcome them need to be highly focused

Sources of AIDS awareness among women in India

Sources of AIDS awareness among rural and urban Indian women were analysed using data from the National Family and Health Survey (1998–2000). Two measures were developed to study the impact each source had on knowledge. ‘Effectiveness’ was defined as the proportion of women who had heard of AIDS from only one source, from among women who had heard of AIDS from that particular source and other sources. ‘Independent effect’ was the proportion who had heard of AIDS from only one source in relation to all women who had heard of AIDS. Television was the most effective medium, and also had the highest independent effect. Radio and print had very low effectiveness and independent effect. Although television and print audiences are growing in India, it is likely a sub-group of women will continue to lack media access. There is an urgent need to disseminate AIDS awareness to this ‘media underclass’. Since the media will not reach this group, other sources including health workers, community level activities such as adult education programmes, and networks of friends and relatives need to be explored

Factors influencing outcome in consultations for chronic pelvic pain

We aimed to document the demographic and clinical characteristics of women referred by primary care physicians for investigation of chronic pelvic pain to a university hospital gynecology outpatient clinic and to test the hypothesis that specific patient features and the quality of doctor/patient communication at the initial consultation would influence pain outcomes. A clinical questionnaire, visual analog scales for pain, and instruments for hostility and the experience of the consultation were administered at the initial clinic attendance to 105 consecutive women. Follow-up pain scores were obtained 6 months later from 98 women. The mean hostility score was highly significantly elevated compared with normative data (