The Influence of Gender on Rural Women's Illness Experiences and Health-seeking Strategies for Gynaecological Symptoms

Abstract

Community-based research on reproductive tract infections (R TI) has shown that many women in India suffer a significant burden of morbidity from gynaecological symptoms, accept these as normal and delay seeking treatment. This paper describes how gender inequalities influence women's experiences of gynaecological morbidity and health-seeking strategies. Data for this paper are obtained from three villages in Gujarat, India, through in-depth interviews with 18 women who reported symptoms of R TI. The sample was selected form women participating in savings groups operated by the collaborating non-governmental organisation. Women describe how they give priority to fulfilling their work responsibilities over their discomfort. They explain normative pressures to remain with the husband and produce children with two years of marriage. Women exposed to violence report that they did not reveal their symptoms to their husbands. Where there is a better marital communication, they describe their strategies to refuse sex in relation to their symptoms. Women also express helplessness with their social and health situations in context of seeking treatment. We conclude that gender inequalities, manifested through fertility, marriage and work norms, violence in marital relationships and poor psychological health, have resulted in rural Indian women accepting high thresholds of suffering, and not seeking treatment for their symptoms. We recommend that RTI prevention and treatment efforts be part of a larger process of empowering women and men in which there is a discussion of reproductive, sexual and health rights. 1. The study was conducted as part of a doctoral research on women's perceived morbidity and treatment-seeking behaviours for gynaecological symptoms. The results describing perceived morbidity and treatment-seeking behaviours are reported in forthcoming papers. 2. The terms 'morbidity' and 'symptoms' refer to medically defined categories that were used to identify women reporting gynaecological disease. In this paper we focus on 'illness', which refers to the meanings women give to health, experiences and perceptions of gynaecological symptoms (Zurayk et al. 1993). 3. Other than urban and rural population statistics, 2001 census data are not available for any other parameters, including tribal population and development indices. Therefore, we have used 1991 census data for these statistics. 4. The women's health programme has trained local women as traditional birth attendants and as barefoot gynaecologists who can use speculums, conduct pelvic examinations and provide treatment with validated local plant-based medicines. 5. Women who perceived infertility were included in the sample regardless of whether they had biomedically defined infertility or were trying to get pregnant soon after marriage. This selection criteria for infertility is based on women's perceptions because, based on previous research in this community, we felt that it was an im portant concern for women, impacting all other health-seeking behaviours related to gynaecological symptoms and, therefore, should be defined as such. 6. The sect known by the name of gayatri parivar has followers from several villages in the area. We are not aware of its reach in other parts of the state. Several women mentioned books published by the sect with guidelines on dietary and sexual practices. Three respondents explained sexual practices and drinking alcohol of their husbands based on the teachings of this sect.