Original
Research Article
Year: 2014 | Month: July | Volume: 1 | Issue: 1 | Pages: 29-41
A Cross Sectional Study on the Pattern of Male Participation in
Utilization of Reproductive Healthcare in Kamalapur Primary Health Centre Area
of Gulbarga District, Karnataka
Riyaj
Ahmad. H. Kalaburgi
Data
Analyst, Bijapur, Karnataka, India.
ABSTRACT
Introduction: One of the important barriers to seeking an appropriate treatment by
women for their illness is the lack of support by their husbands and family
members.
Research
Question: What are the health seeking behaviours of women about their
reproductive health and the extent of participation of their spouses ?
Aims and
Objectives: 1. To know the health seeking behavior of women about
reproductive health. 2. To study the
male participation and factors influencing the utilization of RCH services by
their wives.
Materials and
Methods: A cross sectional study was done in 2013 among 300 currently
married women of age 15 to 49 years, residing at Kamalapur PHC area, Gulbarga
district using pre-designed and pre-test questionnaire. Statistical analysis
was done by using percentages and chi square test.
Results: 40% of women did not seek any treatment for their gynaecological
problems, 30% visited PHC, 16.7% visited private clinics10% of them had taken
home care and 3.3% of them got medicines from medical stores. 20% of the
husbands accompanied women for ANC visits and in 80% of cases mother or mother
in law accompanied her. Only in 6% of the couples decision about family planning
was taken by both partners. Decision maker of woman’s health expenditure was
her husband in 76.7% of the cases, 8.3% of cases her mother and in 10% of the
cases her mother in law and in 5% of the cases women alone took decision.
Conclusion: Participation in reproductive health of woman is very less in rural
India. Poverty, illitercy and gender roles are the main influeincing factors
for the utilization of reproductive health services by the women.
Key words: Reproductive Health, Male participation, Health expenditure, Health
seeking behaviour.
INTRODUCTION
Traditionally
health care providers and researchers in the field of reproductive health have
focused almost exclusively on women when planning programs and services,
especially with regard to family planning, prevention of unwanted pregnancy and
of unsafe abortion, and promotion of safe motherhood. In recent years, efforts
have been made in many countries to broaden men’s responsibility for their own
reproductive health as well as that of their partners. Measures are also being
taken to improve gender relations by promoting men’s understanding of their
familial and social roles in family planning and sexual and reproductive health
issues. [1]
The International
Conference on Population and Development (ICPD, 1994) and the Fourth World
Conference on Women at Beijing (1995) emphasized the importance of reproductive
rights and reproductive health both for men and women and the greater
involvement of men in reproductive health. In post-ICPD era the world has seen
a paradigm-shift away from focused family planning programs towards more
general reproductive and sexual health. Specifically, the focus is on key
concepts and programmatic implications for locating men’s involvement within a
reproductive health framework. During the ICPD, the program of action endorsed
emphasized the need for equity in gender relations with a special focus on
men’s shared responsibility and active involvement to promote reproductive and
sexual health. [2]
Need
for Men’s Involvement: The two above mentioned international conferences
and a dozen survey studies clearly emphasized the central role of men in
sharing reproductive responsibility, promoting responsible parent-hood and safe
sexual behavior in the advent of the AIDS epidemic. Studies have shown that a
supportive male spouse facilitates women's contraceptive use, reduces risks of
spiraling rates of sexually transmitted diseases (STDs) and reduces sexual
violence directed towards female partners (UNFPA, 1995; Verma and Ray, 1997). [2]
In a patriarchal
society where men have an all encompassing involvement in decisions pertaining
to family and society, it is most important to involve men in reproductive
health decisions in order to achieve small family norm, observance of safe sex,
contraception use, provide support for women during antenatal and postnatal
period, healthy abortion management, prevention of STD/AIDS, gynecological and
other health complications and establishing stronger bonds between men and
their off springs. Survey data have shown that failure to involve men in family
planning programs can have serious implications. Even when contraceptive
technologies are available for women, even when they are educated and motivated
to practice contraception, they may not practice at all, have little say and
control over fertility decisions because negative attitudes of their husbands
inhibit their wives from taking action. [2]
Male
Responsibility for Reproductive Health: "The objective is to
promote gender equality in all spheres of life, including family and community
life, and to encourage and enable men to take responsibility for their sexual
and reproductive behavior and their social and family roles."
-- Programme of
Action, UN International Conference on Population and Development, 1994
Reproductive Health was defined during the International Conference on
Population and Development (ICPD) in Cairo in 1994 as “A state of complete
physical, mental and social well-being and not merely the absence of disease or
infirmity, in all matters relating to the reproductive system and to its
functions and processes. Reproductive health therefore implies that people are
able to have a satisfying and safe sex life and that they have the capability
to reproduce and the freedom to decide if, when and how often to do so. It also
includes sexual health, the purpose of which is the enhancement of life and
personal relations”. [3]
Decision
Making:
Married women were asked who makes decisions about their own health care,
making large household purchases, making household purchases for daily
household needs, and visiting their own family or relatives. Although half or
more of currently married women (51-56%) in Karnataka participated in each of
these decisions, only 35 percent participated in making all four of these
decisions. [4]
Women in nuclear
households were more likely than women in non-nuclear households to participate
in these decisions; similarly, women who were employed for cash are more likely
than women who did not earn cash or were not employed. Other women who were
more likely to participate in all four decisions were women in urban areas,
women with 10 or more years of education, Christian women, and women in the
highest wealth quintile. [4]
Gender-Role
Attitudes: Two-thirds
of women in Karnataka believed that it is justifiable for a husband to beat his
wife under some circumstances. Women were most likely to say that wife- beating
is justified if a woman shows disrespect for her in-laws (52%) or if she
neglects the house or children (49%), goes out without telling her husband
(41%), and argues with husband (35%). A similar proportion of men in Karnataka
(63%) agreed that wife-beating is justified in some circumstances, including 47
percent who believe that disrespect for in-laws and 45 percent who believe
neglecting the house or children were justifications for wife-beating. Even
among women and men who had completed at least 10 years of schooling, about
half (48-51%) agreed that a husband is justified in beating his wife for one or
more specified reasons. [4]
Two-thirds of women and men (67-68%) in
Karnataka believed a woman is justified in refusing to have sex with her
husband, if she knows he has a sexually transmitted disease, if she knows he
has intercourse with other women, or if she is tired or not in the mood.
However, more than one in ten women and men (12-16%) did not agree that a woman
is justified in refusing her husband sex for all three of this reasons. [4]
Men’s
Attitudes: Most
men in Karnataka rejected the idea that contraception is a woman’s business and
a man should not have to worry about it (83%) and rejected the idea that women
using contraception may become promiscuous (90%). However, 32 percent of men
incorrectly believed that women who are breastfeeding cannot become pregnant.
Only 62 percent of men knew that a condom, if used correctly, protects against
pregnancy most of the time. [4]
Antenatal
Care: Among women who
gave birth in the five years preceding the survey, 89 percent received
antenatal care from a health professional, including 79 percent from a doctor.
About one in ten women (5% in urban areas and 13% in rural areas) received no
antenatal care at all. Although antenatal care coverage in Karnataka was among
the highest in the country, it was the lowest among all the four southern
states. [4]
Male
Involvement in Maternal Care (Karnataka): About two-thirds
(65%) of men with a child under three years said they were present during at
least one antenatal check-up received by the child’s mother; and 60 percent
were ever told by a health provider or health worker what to do if the mother
had a major complication of pregnancy. Fathers in rural areas were less likely
to have been present at an antenatal care visit than fathers in urban areas. [4]
The majority of
fathers in Karnataka with a child less than three years of age were provided
information related to delivery care by a health provider or worker. About
three-fourths (73%) were told about the importance of proper nutrition for the mother
during pregnancy and 70 percent were told about the importance of delivering
the baby in a health facility. [4]
Among fathers
whose child was not delivered in a health facility, 51 percent were told about
the importance of using a new or unused blade to cut the umbilical cord, 55
percent were told about the importance of cleanliness at the time of delivery,
56 percent were told about the importance of breastfeeding the baby immediately
after the birth and about keeping the baby warm immediately after birth. Urban
and rural fathers were about equally likely to be provided this information. [4] Present
study will explore the Male participation in reproductive and child health.
Objectives
1.
To study the male participation
in availing reproductive Health services as perceived by their wives.
2.
To know the health seeking
behavior of women about reproductive & child health.
3.
To study the factors influencing
the utilization of reproductive Health services by women.
MATERIALS &
METHODS
Study
Design: A
Community based Cross Sectional Study was undertaken to study the pattern of
male participation in utilization of reproductive health care & factors
influencing utilization of reproductive health care services.
Place
of Study: Kamalapur PHC
area of Gulbarga district, Karnataka was selected. Population of Kamalapur was
6,900. Currently married women residing in this area were the study subjects.
Sample
Size Calculation
Sample n
= 4pq/d2
Where n = sample size
p
= prevalence of RCH morbidity (p= 25%)
q
=100-p (q= 75%)
d
= error in the estimation of p (5%)
n
= 4χ25x75
5x5
= 300
So the sample
size was 300 currently married women of age 15 to 49 years.
Total number of women aged 15-49 years
old living in Kamalapur PHC area was 1100 as per the data of 2012 household
survey.
Duration
of Study: The present
Cross Sectional study was conducted for a period of 8 months from April 2013 to
November 2013. 300 women were selected randomly for the study.
Inclusion
Criteria
a.
Currently married women of age 15
to 45 years and
b.
Residing in study area for at
least one year preceding the date of survey
Exclusion Criteria
a.
Married women who were divorced
or separated or widowed
b.
Unmarried women in the
reproductive age group
Method
of Data Collection: A pre-designed
pre-tested questionnaire was used to collect information on socio-demographic
variables, self reported symptoms by the subjects and treatment seeking
behavior of subjects for same problems and participation of husbands’ about
Reproductive and Child Health as perceived by the women. Ethical Clearance was
taken from District Health Officer (DHO), District Health and Family Welfare
office, Gulbarga. Questionnaire was administered to eligible women by house to
house visit by the investigator after obtaining informed consent (Annexure I).
Assent of woman and consent of adult family member was taken when woman’s age
was below 18 years.
Data
Analysis: Data
entry was done in Microsoft Excel and analysis was carried out by SPSS
software. Statistical analysis was done by using rates, proportions and chi
square test.
Measurement
of Study Variables:
1.
Age
- Age was recorded to the nearest completed year.
2.
Type
of Family
•
Nuclear family – Married couple
and their children while they were still regarded as dependents.
•
Joint family – A number of
married couples and their children who were living together in same house.
•
Extended family – It consisted
three generations related to each other by their direct descent living
together.
3.
Religion - was recorded
as reported by the head of the family
4.
Education
•
Illiterate – a person who could
neither read or write
•
Primary – a person who had
studied till or less than VII std
•
Secondary – a person who had
studied between VII to X std
•
Degree – a person who had
completed graduation
•
PUC/Diploma - a person who had
attended college
5.
Occupation
•
Agriculture – one who was
employed in large scale cultivation of land
•
Self employed– one who was
employed in commercial establishment
•
Labourer – one who earned his
daily wages
•
Government employee – one who
worked for employer in govt sector
•
Private employee– one who worked
for employer in private sector
6.
Socio
economic status as per Per capita income in Rs. / Month was classified using
modified
Prasad’s classification
Social
class
|
Prasad
classification in 1961
as
per Per Capita Income in
Rs
/ month
|
Modified
Prasad’s classification
in
2009 as per Per Capita Income
in
Rs./ month
|
Class
I
|
100
and above
|
2500
& above
|
Class
II
|
50-99
|
1250
- 2499
|
Class
III
|
30-49
|
750
- 1249
|
Class
IV
|
15-29
|
375
- 749
|
Class
V
|
Below
15
|
Below
375
|
Modification was done with aid of
multiplication factor, which was obtained as follows
Multiplication factor = (Value of All
India Consumer Price Index 2009 X 4.93)/ 100
= 450/100 X 4.93
= 22.185
RESULTS
Socio Demographic Characteristics
Of Study Subjects
Table
1: Distribution of Study Subjects & Their Husbands According to their Age
(N=300).
Age
in years
|
Women’s
age
|
Their
Husbands’ age
|
||
Number
|
Percentage
|
Number
|
Percentage
|
|
<
18
|
8
|
2.7
|
0
|
0
|
18-20
|
60
|
20
|
46
|
15.3
|
21-25
|
52
|
17.3
|
60
|
20
|
26-30
|
62
|
20.7
|
46
|
15.3
|
31-39
|
68
|
22.7
|
59
|
19.7
|
41-49
|
49
|
16.7
|
59
|
19.7
|
55-60
|
NA
|
NA
|
30
|
10
|
Total
|
300
|
100
|
300
|
100
|
In the present study among 300 couples, highest range was 22.7% in age group of 31-39 years and least was the 2.7% in age group of <18 years in women.
Table 2: Distribution of Study Subjects And Their Husbands According to Their Education Status (N=300).
Educational status
|
Women
|
Their Husbands
|
||
|
Number
|
Percentage
|
Number
|
Percentage
|
Illiterate
|
200
|
66.7
|
150
|
50.0
|
Primary School
|
60
|
20
|
80
|
26.7
|
Secondary School
|
30
|
10
|
52
|
17.3
|
PUC / Diploma
|
10
|
3.3
|
12
|
4.0
|
Graduation
|
0
|
0
|
4
|
2.0
|
Total
|
300
|
100
|
300
|
100
|
Among the study participants, 66.7% of the women were illiterate, 20% subjects were educated up to primary level, and no one had completed Graduation.
Among husbands of the study subjects 50% were illiterate
and only 2% had completed graduation.
Table-3: Distribution of Study Subjects & their Husbands
According To Their Occupation (N=300).
Occupation
|
Women
|
Their husbands
|
||
|
Number
|
Percentage
|
Number
|
Percentage
|
Agriculture
|
100
|
33.3
|
140
|
46.7
|
Self employed
|
14
|
4.7
|
20
|
6.7
|
Private job
|
8
|
2.7
|
23
|
7.7
|
Govt. job
|
3
|
1.0
|
4
|
1.3
|
Labourer
|
70
|
23.3
|
113
|
37.7
|
House wife
|
105
|
30.0
|
NA
|
NA
|
Total
|
300
|
100
|
300
|
100
|
Among the study participants 33.3% were farmers by occupation, 30% were housewives 4.7% were self employed, and only 1% were government employees. Majority of the husbands’ occupation was agriculture 46.7%.
General Health Information
Table 4: Distribution Of Study Subjects According To Self Reported General Sickness By The Women (N=300).
SELF REPORTED
SICKNESS
BY THE WOMEN
|
Number
|
Percentage
|
Fever
|
100
|
33.3
|
Cold & Cough
|
50
|
16.7
|
Joint pain
|
30
|
10
|
Hypertension
|
6
|
2
|
Diabetes mellitus
|
4
|
1.7
|
Depression
|
3
|
1
|
Vomiting
|
24
|
8
|
Body ache
|
10
|
3.3
|
Headache
|
2
|
0.3
|
Diarrhoea
|
1
|
13
|
Abdominal pain
|
39
|
3.3
|
Acidity
|
10
|
3.3
|
Weakness
|
10
|
3.3
|
Urticaria
|
10
|
0.3
|
TOTAL
|
300
|
100
|
Majority of the women reported fever in 33.3% of cases, 16.7% of women reported cold and cough, 10% of women reported joint pain, 2% of them reported hypertension, 1.75 reported diabetes, 1% of them reported depression, 8% of them reported vomiting, 3.3% of them reported body ache, 0.3% reported head ache, 3.3% of them reported diarrhea, 3.3% of them reported abdominal pain, 3.3% of them reported acidity, 3.3% of them reported general weakness and 0.3% of them reported Urticaria.
Table 5: Distribution Of Study Subjects According To Treatment Seeking Behavior Of Women For General Sickness (N=300).
TYPE OF TREATMENT TAKEN
BY WOMEN
|
Number
|
Percentage
|
HOME CARE
|
150
|
50.0
|
MEDICINE FROM PHARMACY
|
10
|
3.3
|
PRIMARY HELATH
CENTRE
|
80
|
26.7
|
PRIVATE CLINIC
|
60
|
20.0
|
TOTAL
|
300
|
100.0
|
50% of the women had taken home care only, 20% of the women had visited private clinics, 26% of them had visited PHC, 3.3% of the women had taken medicines directly from the medical store without consulting a doctor.
Table 6: Distribution Of Study Subjects According To Women Who Underwent Any Surgery And The Person Who Took Care After The Surgery.
WOMEN WHO UNDERWENT SURGERY
|
Number
|
Percentage
|
YES
|
240
|
80.0
|
NO
|
60
|
20.0
|
TOTAL
|
300
|
100.0
|
PERSON WHO TOOK CARE AFTER
SURGERY
|
Number
|
Percentage
|
HUSBAND
|
10
|
3.3
|
MOTHER IN LAW
|
70
|
33.3
|
MOTHER
|
150
|
60.0
|
OTHER RELATIVES
|
10
|
3.3
|
TOTAL
|
240
|
100.0
|
80% of the women told that they had undergone surgery. Out of 240 women who underwent surgery only 3.3% of the cases husband took care after the surgery, in the rest 96.7% of cases other persons took care of her health. In 96.75% mother in law took care in 33.3% of the cases, in 60% of cases by woman’s mother and 3.3% cases by other relatives.
Obstetric Care and Family Planning
Table 7: Distribution Of Study Subjects According to Antenatal Care Received By the Women, Husbands Accompanied For ANC Visit and Husbands Accompanied In The Room During A.N.C. Consultation (N=180).
ANTENATAL CARE RECEIVED BY WOMEN
IN LAST FIVE YEARS (N=180)
|
Number
|
Percentage
|
YES
|
36
|
20
|
NO
|
144
|
80
|
HUSBAND ACCOMPANIED WIFE FOR ANC VISIT (N=180)
|
Number
|
Percentage
|
YES
|
36
|
20
|
NO
|
144
|
80
|
HUSBAND ACCOMPANIED WIFE INSIDE ANC
CONSULTATION
ROOM (N=36)
|
Number
|
Percentage
|
YES
|
10
|
25
|
NO
|
26
|
75
|
Out of 300 women only 180 were pregnant or delivered within 5 years preceding the survey. So out of 180 women 20% of the women had received ANC for the last pregnancy. Out of 36 only 10 (20%) of the cases husbands accompanied their spouses for ANC visit during last pregnancy. Out of 36 only in 25% of the husbands accompanied wife inside the consultation room during ANC visit and no husband accompanied his wife in the examination room.
Table 8: Distribution of Study Subjects According to Decision Making Regarding Family Planning by Both the Partners (N=164).
DECISION OF FAMILY PLANNING
BY BOTH PARTNERS
|
Number
|
Percentage
|
YES
|
10
|
6.0
|
NO
|
154
|
94.0
|
TOTAL
|
164
|
100.0
|
When women were asked about decision regarding the family planning decision had taken by both the partners, then only 6% of the women told that decision had been taken by both the partners and 94% of the cases decision regarding family planning had not been taken by the partners.
Gynecological Problems
Table 9: Distribution of Study Subjects According to Gynecological Problems Reported by the Women within One Year Preceding the Survey (N=300).
GYNECOLOGICAL PROBLEMS
REPORTED BY THE WOMEN
|
Number
|
Percentage
|
DYSMENORHOEA
|
98
|
32.7
|
LEUCORHOEA
|
64
|
21.0
|
HAEVY MENSES
|
50
|
16.7
|
BURNIG
MICTURATION
|
43
|
14.3
|
IRREGULAR MENSES
|
25
|
8.3
|
SCANTY BLEEDING
|
20
|
6.7
|
TOTAL
|
300
|
100.0
|
Among 300 women all the women had some gynecological problems within one year preceding the survey. 32.7% of the women had dysmenorrhoea and 6.7% had scanty bleeding during menses.
Table 10: Association between Social Category and Male Participation in M.C.H. Care.
Social category
|
Accompanied
to ANC
|
Nearby during
delivery
|
Care and help during pregnancy and delivery
|
|||
|
Yes
|
No
|
Yes
|
No
|
Yes
|
No
|
General (22)
|
20
(90.9%)
|
2
(9.1%)
|
8
(36.4%)
|
14
(63.6%)
|
13
(59.1%)
|
9
(40.9%)
|
OBC (6)
|
4
(66.7%)
|
2
(33.3%)
|
4
(66.7%)
|
2
(33.3%)
|
4
(66.7%)
|
2
(33.3%)
|
SC (66)
|
6
(9.1%)
|
60
(90.9%)
|
6
(9.1%)
|
60
(90.9%)
|
2
(3%)
|
64
(97%)
|
ST (86)
|
6
(7%)
|
80
(93%)
|
2
(2.3%)
|
84
(97.7%)
|
1
(1.2%)
|
85
(98.8%)
|
TOTAL
|
36
(20%)
|
144
(80%)
|
20
(11.9%)
|
160
(88.9%)
|
20
(11.9%)
|
160
(88.9)
|
|
χ2 =122.723, d.f = 3, p=0.000
|
χ2 = 37.381, d.f = 3, p=0.000
|
χ2 = 16.847, d.f = 3, p=0.001
|
|||
General category husbands were more participating in MCH care of their wives compared to other categories. There was significant association between social category and male participation (p=0.001).
Table 11: Association between Education of Women and Decision Making Regarding Family Planning By Both Partners.
Women’s Education
|
Decision regarding family planning
|
|
|
Yes
|
No
|
Illiterate (91)
|
42 (46.2%)
|
49 (53.8%)
|
Primary (70)
|
68 (97.1%)
|
02 (2.9%)
|
Secondary (52)
|
50 (96.2%)
|
02 (3.8%)
|
PUC/ Diploma(10)
|
08 (80%)
|
02 (20%)
|
Degree (2)
|
02 (100%)
|
0 (0%)
|
TOTAL (225)
|
170
(75.6%)
|
55
(24.4%)
|
|
2 =36.319, d.f. =4, p =0.000
|
|
Educated women were taking more decision regarding family planning with their husbands than the illiterate women. So there was a significant association between the education of the women and their decision making power regarding the family planning with their husbands (p=0.000).
DISCUSSION
The present study was conducted in 300 married women residing in
primary health center area of Kamalapur, Gulbarga district, during April 2013
to November 2013.
Socio – Demographic Characteristics of study population (Tables 1-3)
In the present study there were 300 married women among them, highest range was 22.7% in age group of 31-39 years in women and least was the 2.7% in age group of <18 years in women. Among the study participants, 66.7% of the women were illiterate, 20% subjects were educated up to primary level and 10% were educated up to secondary level. Among husbands of study participants 50% of them were illiterate. Among the study participants a major proportions were farmers (33.3%) by occupation and 30% of them were housewives. Majority of the husbands’ occupation was agriculture 46.7% and 37.7% of them were laborers.
In a study done in Chandigarh 19 wives were aged 15-24 yrs, 46 were 25-34 yrs and 35 were above 35 yrs. Literacy rate of husbands was 79% and of wives was 59%. Most of the women (87%) were housewives. Almost half of the husbands (49%) were laborers or farmers.
Discussion regarding General health status of women (Tables 4-6)
In present study majority of the women reported fever in 33.3% of cases, 2% of them reported hypertension, 1.75 reported diabetes, 1% of them reported depression, 3.3% of them reported abdominal pain and 3.3% of them reported general weakness. 50% of the women had taken home care only, 20% of the women had visited private clinics, and 26% of them had visited PHC.
When women were asked about their husbands’ opinion regarding their health seeking behaviour, women told 16.7% of the husbands were ignorant about the health of their wife, 20% of them told to take home care, 13.3% of husbands told to take
medicines from the medical store, 34% of husbands told to visit PHC, 16% of the husbands told to visit private clinics. 80% of the women told that they had undergone surgery. Only 3.3% of the cases husbands took care of woman after the surgery.
Similar study done in Chandigarh results showed that, some of the symptoms were reported more by wives as compared to their husbands’ perception about illness of wives. Symptoms like tension and irritability/anger were reported more by the husbands for their wives who reported these less frequently.
Similar study done in Gujarat in 1997 reported considerable inconsistency between husbands' and wives' responses on reporting of pregnancy in preceding 24 months. They also reported that at least half of the men were not aware of their wives' health status or the prenatal care services received by them during last pregnancy. Weakness, diet, heat and stress were told by many of husbands as the cause of their wives' illness.
Discussion regarding the Antenatal Care (Tables
7)
Out of 300 women only 180 were recently pregnant or delivered within 5 years (preceding the interview). So out of 180 women 20% of the women had taken the antenatal care for the last pregnancy and 80% of them did not receive antenatal care during their pregnancy. 80% of the cases husbands did not accompany for the ANC visit with their wives for the last pregnancy and only 20% of the cases husbands accompanied their wives for ANC visit during last pregnancy. 75% the husbands did not accompany in the room during ANC consultation with their wife.
In a similar study conducted in Ahmed Nagar district in Maharashtra state revealed that young women had limited mobility and depended on husbands or other family members to take them to a health centre. While77% said that women should seek antenatal care, only one third knew about all the antenatal care services that can be provided. A high 85% said care was needed during delivery, but for most reported the need for institutional deliveries (72%) rather than care during home deliveries. Most husbands felt responsible for routine care and treatment of problems. [5]
Discussion regarding Family planning practices (Tables 8)
Out of 180 women only 92.7% of the women were using family planning practices and of the 7.3% women were not using any family planning methods. Out of
164 women who were using family planning practices, only 8.6% of them had accompanied for the family planning consultation room with their wife and 91.4% of the cases husbands had not accompanied for family planning consultation room with their wife. When women were asked about decision regarding the family planning decision had taken by both the partners, then only 6% of the women told that decision had taken by both the partners.
In a study done among women in Nigeria in 1997 revealed that women were increasingly taking active decisions on matters affecting their daily lives. More women than ever before believed that they can take decisions on family size, when to have a baby and choice of spacing period. The cultural barriers against short postpartum abstinence seem to have diminished while sex during lactation is not considered a major cultural and religious taboo. Knowledge of contraception had also become universal in recent years and the majority of women taken decisions on method and timing of family planning. When husbands were infected, nearly all women would refuse to have unprotected sexual relations with them. Nevertheless, 45 percent of urban women compared to 50 percent of rural women would ask their infected partners to use condoms, while 30 percent urban and 35per cent rural were undecided. [6]
A multicentric Study done in all over India in 2002 based on focus group discussion results showed that all the participants agreed on need for family planning, most participants endorsed the idea that FP should be a joint responsibility. A majority of men preferred that their wives should consult them before making decisions about FP. And almost all preferred that their wives should undergo sterilization. Higher number of participants from the north old age group and non users of FP believed that the use of contraceptives by males would create problems including loss of strength, and libido. [7]
Discussion regarding Gynecological problems reported (Table 9)
In the present study among 300
women all the women had some gynecological problems within one year preceding the survey. 32.7% of the women had dysmenorrhoea, 21% of women reported leucorrhoea, 16.7% of them reported heavy menses, 14.3% of them reported burning micturation, and 8.3% of them reported irregular menses and 6.7% had scanty bleeding during menses. Out of 300 women 40% of them did not taken any treatment for their gynecological problems. 10% of them had taken home care, 30% of them had visited PHC, 16.6% of them had visited private clinics and 3.3% of them had taken medicines from the medical store without doctor’s consultation.
Similar study done in Chandigarh reported that when asked ‘what were common health problems of women in general’ there was reasonable concordance in responses of husbands and wives. However, there were some diseases which were enumerated more by wives e.g. menstrual problem, pain in abdomen, vaginal discharge, uterine prolapse, backache and abortion. Some diseases were, however, enumerated more frequently by husbands as compared to their wives viz. mass in uterus, anemia, AIDS, cancer of uterus. [8]
Similar study done in Mumbai in 1994 reported that husbands often did not allow their wives to go for gynecological check up. Women often become frustrated and depressed due to lack of concern shown by husbands for their health and gradually become used to not to show any interest in seeking health care. They summarized their respondents' views that men folk often felt that women's health needs should be limited to care during pregnancy, childbirth and Peurperium. There was no concept of preventive care for general illnesses or gynecological problems in particular. [9]
Factors influencing on utilization of RH services (Tables 10-11)
In the present study there was an association between social category and male participation. General category families’ husbands were more participating in MCH care of their wives compared to other categories. Among study participants there was an association between social category and male participation which was statistically significant (p=0.000). [10]
Care during
pregnancy and delivery of husbands was good in OBC’s and it was very less in ST
category which was statistically significant (p=0.001).
Decision making regarding family planning by both the partners was seen in educated husbands as compared to illiterates. A strong association was seen between the education of husband and decision regarding family planning by both the partners, which was statistically significant (p=0.000). Educated women were taking more decision regarding family planning with their husbands than the illiterate women. There was a good association between the education of the women and their decision regarding the family planning with their husbands which was statistically significant (p=
0.000).
Similar study done in Baroda district in Gujarat revealed that, half of the men were not aware of their wives’ health status and prenatal services which their wives had received during their last pregnancy. It reflected the social segregation of the roles and responsibilities of men in which reproductive processes such as ANC and ensuring safe delivery are considered to be women’s affairs in which men have only a limited role to play. [11]
A similar study done among slum dwellers in Andhra Pradesh showed that the overall observation of men’s participation in different aspects of on reproductive health was still not good. Only less than 30 percent of the males were actively participating in promotion of reproductive health and 23 percent were found to have moderately participated. It was disheartening to notice that nearly half of the males were not involving in the promotion of reproductive health. [12]
In a similar study done in 10 locations of India showed that about half of them expressed concern for not having knowledge about women’s health care needs during pregnancy, sickness and child birth. Majority of men did not have much exposure to male and female anatomy, physiology and reproductive system, nor were they aware of their SRH needs, as well as the role sexuality plays in making the marital life satisfying and happy. [7]
In
a study carried out in Andhra Pradesh revealed that many women assumed that they had no control over their bodies, whereas men thought that they had control over their wife’s body. More than half of the couples had communication related to planning of their family. Nearly one-fifth of the women reported suffering from illness after sterilization. One-fourth of the women never sought treatment because of demanding household work and lack of support from husband/family members. [13]
Married women in rural areas show poorer health seeking behavior possibly due to reduced decision making authority and their illiteracy. The role of partners and their family members appear crucial in the access and use of reproductive health services by women. Partner involvement appears crucial to health seeking among married women.
Half of the women had not taken any treatment, one fifth of the women visited private clinics, one fourth of them had visited PHC, and few women had purchased medicines directly from medical stores without consulting a doctor.
Men who were
better educated, married later, and whose wives were educated and were older when they married knew more about and were more likely to participate in all round health care of women.
REFERENCES
1.
Report of the meeting of WHO, Regional Advisers in Reproductive Health WHO/PAHO, Washington DC, USA 5-7 September 2001, Programming for Male Involvement in Reproductive Health.
2.
Kumar, Ananth. Bihar Times “Role of males in reproductive health and sexual health decisions” (February 26, 2009). [Home page on internet] [Updated on 2010 Feb 27] Available from: papers.ssrn.com/sol3/Delivery/SSRN_ID1349894_code1028119.pdf
3.
International Conference on Population and Development (ICPD), Programme of Action, New York: United Nations (UN), 1994.
4.
Male involvement in antenatal care NFHS - 3,
vol. I: 2005-06, page 201 www.nfhsindia.org/NFHS3/Data/.Summary of Findings (6868K).pdf
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Husbands’ Involvement in Maternal Care: Young Couples in Rural Maharashtra [Accessed on 2010 Feb 27] Available from www.jhuccp.
org/igwg/presentations/Monday/SubplenB/CaringMen.pdf
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Shahjahan M, Kabir M. Why males in Bangladesh do not participate in reproductive health: lessons learned from focus group discussions. Int. Q. Community Health Educ. 2006-2007; (1):45-59[Accessed on 2010 Feb 27].Available
from www.ncbi.nlm.nih.gov/pubmed/17686713.
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Sharma ML. Sharing reproductive health responsibilities: men’s perspectives. J. of Family Welfare.2002; 48, Special issue: 66-76.
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Singh AJ. Husbands’ role in wives’ health. Bull. PGI 2003; 37:149-57.
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Agarwal AK. Social Classification: The Need to Update in the Present Scenario. Ind. J of Comm. Med., 2008;
33(1):50-52.
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Mutharayappa R. Reproductive Morbidity of Women in Karnataka: Evidence from National Family Health Survey II and Reproductive and Child Health Survey 1998-99. [Home page on internet] [Accessed on 2010 Feb 27] Available from www.isec.ac.in/prc-abs15.pdf
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Khan ME, Khan I, Mukharjee N. Involving men in safe motherhood. J. of Family Welfare .1997; 43:18-30
ANC :
Antenatal Care
ANM :
Auxiliary Nurse Midwifery
DHS :
Demographic Health Survey
EAG :
Empowered Action Group states
FP :
Family Planning
ICPD :
International Conference on Population and Development
IEC :
Information, Education and Communication
KAP :
Knowledge, Attitude and Practices
MTP :
Medical Termination of Pregnancy
NFHS :
National Family Health Survey
PHC :
Primary Health Centre
RCH :
Reproductive and Child Health
RH :
Reproductive Health
SRH :
Sexual and Reproductive Health
STDs :
Sexually Transmitted Diseases
STI :
Sexually Transmitted Infections
UNFPA:United Nations Population Fund
USAID: United States Agency for
International Development
How to cite this article: Kalaburgi RAH.
A cross sectional study on the pattern of male participation in utilization of
reproductive healthcare in Kamalapur primary health centre area of Gulbarga
district, Karnataka. Int J Res Rev. 2014;1(1):29-41.
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