Health Seeking Behaviour and Utilisation of Reproductive Health Services for Gynaecological Problems -- A Study Among Rural Women in Central India

Abstract

Background/Significance: Gynecological problems that include sexually transmitted diseases, endogenous infections, and iatrogenic infections, pose both acute chronic risks to women's health. The research and available evidences in this direction from developing world has identified and stressed "Culture of Silence" or "Silence Endurance" as the major barrier for treatment seeking for Gynaecological and menstrual morbidity. The control of Reproductive Tract Infections (RTIs) is recognized as a global problem (World Bank 1993). Whether a woman is really silent or she does something to manage her problem herself has not been studied thoroughly. Women who avoid health facility may however adopt alternative strategies to manage their symptoms. Yet the assumption that women do not actively manage their morbidity symptoms persists and may be based on generalizations about women's behaviour. More over, whether women are "silent" only with health care providers and not others has not been studied. In this paper an attempt has been made to understand the health care seeking behavior among young women in rural parts of central India. Methodology: The study focused on ever-married youth women in the age group of 15-29 years; prime reproductive ages. A blend of quantitative as well as qualitative techniques was used to gather the information on health care seeking. Findings: Approximately two-third (67%) women reported suffering from at least one symptom of menstrual disorders. Women reporting one or more reproductive problems were alarmingly high (56 %). Almost 32 % of those reported morbidities have at least three or more conditions. The finding clearly indicates that the women’s experience of symptoms of gynecological diseases in rural India is not a "silent endurance". Women in rural India reach out to each other with a variety of treatment strategies for gynecological diseases learned from and shared with their peers. Women’s peer groups play an important role in forming illness representations and choosing treatment behaviors. The collaborative formation of illness representations among women is an aspect of the psychosocial process that deserves further consideration in other cultural contexts. For India, it suggests that interventions aimed at changing women’s perceptions about RTI should work through the social norm; how behavior is modeled on actions of peers. Hence, individual behavior change strategies may not be appropriate. Women in this study adhered to the behaviors of the group when confronted with symptoms of gynecological diseases. Therefore, health educators in India should work through naturally occurring group of women to change perceptions and behaviors about gynecological diseases. Program lessons learned: This very clearly shown that for any health educational program to be promoted, "Peer Group Diffusion" concept can be effectively used. Leadership development in peer group to spread the knowledge about reproductive life and healthy practices could be good intervention. In order to increase the proportion of people with reproductive tract diseases who seek effective treatment and counselling, programme planners need to know more about factors that influence health-seeking behaviour in relation to various reproductive morbidities. Qualitative data on beliefs, attitudes, and behaviors related to gynaecological morbidities could be especially useful in the development of women's health education programs. Strengthening the infrastructure, this constitutes of community resources to make treatment seeking more effective and prevalent.