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REPRODUCTIVE HEALTH OF RURAL MARRIED ADOLESCENT GIRLS

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									REPRODUCTIVE HEALTH OF RURAL
  MARRIED ADOLESCENT GIRLS




                  Thesis submitted to the
     University of Agricultural Sciences, Dharwad
     in partial fulfilment of the requirement for the

                       Degree of

        MASTER OF HOME SCIENCE

                           IN

           HUMAN DEVELOPMENT



                           By

               NETRAVATI, H.S.




   DEPARTMENT OF HUMAN DEVELOPMENT
COLLEGE OF RURAL HOME SCIENCE, DHARWAD
  UNIVERSITY OF AGRICULTURAL SCIENCES,
             DHARWAD-580 005

                     JUNE, 2006
                 ADVISORY COMMITTEE



DHARWAD                                    (K. SAROJA)
JUNE, 2006                                MAJOR ADVISOR

             Approved by    :


             Chairman           : ____________________________
                                      (K. SAROJA)


             Members          :
                            1. ____________________________
                                  (PUSHPA KHADI)



                                2. ____________________________
                                       (D.M. CHANDARAGI)



                                3. ____________________________
                                      (S.N. MEGERI)
                       CONTENTS



CHAPTER                   TITLE   PAGE
  NO.                              NO.



   I.     INTRODUCTION             1



  II.     REVIEW OF LITERATURE     10



  III.    MATERIAL AND METHODS     43



  IV.     RESULTS                  56



  V.      DISCUSSION              100



  VI.     SUMMARY                 135



  VII.    REFERENCES              149



          APPENDICES              160
                        LIST OF TABLES

TABLE                             TITLE                             PAGE
 NO.                                                                 NO.
4.1.1   Socio-economic characteristics of the respondents            59
4.1.2   Socio-demographic characteristics of the respondents         61
4.2.1   Age and time interval variables related to initiation of     63
        reproductive life
4.3.1   Prevalence of child wastage among respondents                65
4.3.2   Type of child wastage          by   ordinal   number   of    66
        pregnancies/live births
4.3.3   Association between age and child wastage                    68
4.3.4   Number of pregnancies and age of the respondents at          69
        pregnancy
4.3.5   Distribution of number and type of child wastage by          71
        age at which it occurred
4.3.6   Nutritional status of the respondents                        73
 4.4    Distribution of respondents by their knowledge and           73
        practice of family planning method
4.4.1   Distribution of respondents by reasons for adopting          75
        and not adopting sterilization as family planning
        method
4.4.2   Distribution of respondents by prevalence of child           76
        spacing methods adopted in the past and continuing at
        present
4.4.3   Reasons for discontinuation of child spacing methods         78
4.5.1   Prevalence of problems faced during prenatal period          79
4.5.2   Prevalence of problems faced during perinatal period         81
4.5.3   Prevalence of problems faced during postnatal period         82

4.5.4   Relation between body mass index and maternity               83
        problems

4.6.1   Prevalence of health problems unrelated to maternity         84
4.7.1   Prevalence of violence                                       86
4.7.2   Prevalence and types of mental cruelty faced by              87
        respondents
TABLE                                TITLE                                PAGE
 NO.                                                                       NO.
 4.7.3     Prevalence of bad habits of husband and feelings of             89
           respondents about the bad habits
 4.7.4     Respondent’s reasons regarding restrictions to visit            91
           their parents
 4.7.5     Physical violence faced by respondents and reported             92
           reasons
 4.8       Correlation between problems related to maternity and           94
           the illnesses suffered after marriage
 4.9       Distribution of respondents covered by immunization             95
           and anaemia prophylaxis programme
 4.9.1     Utilization of IFA tablets and reasons for non-utilization      95
 4.9.2     Distribution of childbirths by the place of delivery and        97
           the assistance received
 4.10      Accessibility of government health services and                 99
           utilization of health services
 4.11      Frequency of ANMs visit as reported by respondents              99




                      LIST OF APPENDICES


APPENDIX                             TITLE                              PAGE NO.

   NO.


    I          Interview schedule                                         160


    II         Composition of female population of selected               171

               villages and samples by caste
                       LIST OF FIGURES


MAP NO.                         TITLE                          BETWEEN
                                                                PAGES

  1.      Map of Haveri district showing all the villages in    46-47
          Ranebennur taluk the study area

  2.      Map of Ranebennur taluk showing villages              47-48
          selected for the study

  3.      Prevalence of child wastage by ordinal number         66-67
          of pregnancies/live births

  4.      Type of child wastage by age at which it              71-72
          occurred

  5.      Prevalence of violence                                86-87
                 LIST OF ABBREVIATIONS
AANM     :   Advised by Auxiliary Nurse Midwife
AANMS    :   Available ANM Services
ACOM     :   Age at Consummation of Marriage
Adv.     :   Advantages
AEH      :   Adverse Effect on Health
AEP      :   Age of Each Pregnancies
AFM      :   Acceptance of Family Member
AFP      :   Age at First Pregnancy
AGHS     :   Accessible Govt. Health Services
AgMa     :   Age of Marriage
AgMe     :   Age of Menarche
AH       :   Advised by Husband
RIFAP    :   Receipt of Iron and Folic Acid Tablets during Pregnancy
AIACOM   :   Acute Illness After Consummation of Marriage
AIAM     :   Acute Illness After Menarche
AICH     :   Acute Illness during Childhood
AL       :   Agricultural Labourer
AM       :   Advised by Mother-in-Law
AOY      :   Allowed Once in Year
AP       :   Anaemia Prophylaxis
ARBM     :   Husband’s Relation Before Marriage
AW       :   Anganawadi Worker
Im       :   Immunization
IFA      :   Iron and Folic acid Tablets
H        :   Hygeine
AP       :   Anaemia Prophylaxis Prog.
AV       :   Advantages of Vaccines
AHV      :   ANM take to the Hospital to give Vaccines
FP       :   Family Planning Method
P        :   Polio
AT       :   Ayurvedic Treatment
B        :   Bagging
Ba       :   Backache
BFB      :   Belief of Fetus Growing Big
BH       :   Battering by Husband
BIC      :   Bad habits Influence on Children
BM       :   Battering by Mother-in-law
BMI      :   Body mass Index
BP       :   Back Pain
C        :   Caste
Co       :   Cooking
Con      :   Condom
Col      :   Cold
CAH      :   Can’t get Affection from Husband
CCI      :   Childhood Chronic Illness
CF       :   Cattle Feeding
CFC      :   Cleaning Floor with Cowdung
CFF      :   Carrying Food to Farm
Ch       :   Chalavadi
CIACOM   :   Chronic Illness suffered After Consummation of Marriage
CIAM   :   Chronic Illness Suffered after Menarche
CP     :   Chicken Pox
Cu     :   Cough
D      :   Drinking
DAdv   :   Disadvantages
OH     :   Obstetric History
DMC    :   Don’t Want More Children
EdH    :   Education of the Respondents Husband
EdR    :   Education of the Respondents
EuP    :   Ending Unwanted Pregnancy
Fo     :   Forward
Fev    :   Fever
Fa     :   Father
Fe     :   Fees
BLD    :   Bringing Less Dowry
FFI    :   Finding Faults by Inlaws
FS     :   Family Size
FW     :   Field Work
G      :   Goiter
GH     :   Government Hospital
GJ     :   Government Job
Hi     :   Hindu
Ha     :   Harijan
Har    :   Harvesting
He     :   Headache
HBl    :   Heavy Bleeding
HB     :   Healthy Baby
HuBH   :   Husband’s having Bad Habits
HBH    :   Hurt due to bad habits of Husband
HDW    :   Hard to be called as Drunkard’s wife
HFWM   :   Hard to run the family as he wastes money
Hlt    :   Husband did not like to seek treatment
Ho     :   Home
HOC    :   Having One Child
NPHS   :   No Permission till the Health Problem become Severe
Hus    :   Husband
HW     :   House Wife
Hwo    :   Household Work
HWK    :   Hours of work Done
I      :   Infirtility
IC     :   Irregular Consumption
ICo    :   Immunized Completely
ID     :   Infant Death
ImI    :   Immunized Incompletely
Im     :   Immunization
INR    :   If Not Sterilized Reason
ISR    :   If Sterilized Reason
J      :   Joint
Ja     :   Jaundice
K      :   Kuruba
Li     :   Lingayat
La     :   Lambani
Lap    :   Laproscopy
LBF       :   Limited Bus Facility
LBWB      :   Low Birth Weight Baby
LF        :   Lack of Freedom
LFMT      :   Lack of freedom to seek Medical Treatment
LK        :   Lack of Knowledge
LM        :   Loose Motion
LP        :   Leg Pain
M         :   Masonry
Mu        :   Muslim
Mi        :   Minority
Ma        :   Malaria
Mag       :   Magazine
Mo        :   Mother
Mis       :   Miscarriage
M/Y       :   Months/Year
MCSR      :   Mental Cruelty Suffered by Respondents
MHTT      :   Mother-in-law and husband did not get Time to take her for
              Treatment
MIL       :   Mother-in-Law
MP        :   Menses Problems
MT        :   Method of Treatment
N         :   Nuclear
NACONP    :   Number of Antenatal Checkup by Ordinal Number of Pregnancy
NACR      :   Number of Antenatal Checkup Done by Respondent
NBS       :   Non-Cordial Behaviour of Staff
NC        :   No regular Consumption
NCWR      :   Number of Children Wanted by Respondent
ND        :   Neonatal Death
NED       :   Not bringing Enough Dowry
Ne        :   Neighbour
NF        :   Not allowed during Festival
NFH       :   No Feel towards Husband
NIP       :   Need In-laws Permission
NMC       :   Not having Male Child
No. CFP   :   Number of Children as Family Planning
NP        :   No. of Pregnancy
Np        :   Newspaper
NPH       :   No permission from Husband
NPI       :   No Permission from in law
NRT       :   Not at all Received Tablets
O         :   Other
OccH      :   Occupation of the Husband
OccR      :   Occupation of the Respondents
ODOM      :   Obeying Despotic Orders of mother in law
OF        :   Once in Fortnight
OM        :   Once in a Month
ONP       :   Ordinal Number of Pregnancy
P         :   Pre-mature
PaccT     :   Person Accompanied for Treatment
PATACOM   :   Person Accompanied for Treatment After Consummation of
              Marriage
PATAM     :   Person Accompanied for Treatment After Menarche
PATCH     :   Person Accompanied for Treatment During Childhood
PB        :   Petty Business
PC        :   Playing cards
PDT       :   Person’s Decision for Treatment
PFPM      :   Permanent Family Planning Method
PHC       :   Primary Health Centre
PIA       :   Pain in Abdomen
PM        :   Polyagamous Marriage
PM        :   Poor Quality Medicines
PNC       :   Present Number of Children
PP        :   Problem During Pregnancy
PRRE      :   Perception that Respondent is not giving Respect to Elders
PT        :   Place of Treatment
PTrACOM   :   Treatment After Consummation of Marriage
PtrAM     :   Treatment After Menarche
PTrCH     :   Place of Treatment in Childhood
PU        :   Pain in Uterus
PV        :   Prevalence of Violence
PVD       :   Parents should visit their Daughter
R         :   Religion
Re        :   Results
RB        :   Respondents who Bothered
RC        :   Regular Consumption
Rea       :   Reason
RLD       :   Restricted since she brought less dowry
RNT       :   Reasons for Not taking tablets
RNUS      :   Reasons for not Utilizing Services
RP        :   Results of Pregnancy
RPPer     :   Respondents Problems Suffered During Perinatal Period
RPPos     :   Respondents Problems Suffered During Postnatal Period
RPPre     :   Respondents Problems Suffered During Prenatal Period
RPV       :   Respondents who faced Physical Violence
RRVP      :   Respondents who faced Restriction to Visit Parents
RW        :   Reasons for worrying
So        :   Sowing
S         :   Sub-caste
Sm        :   Smoking
SB        :   Still Birth
SBCAR     :   Spacing Between Children According to Respondent
SC        :   Severe Cough
Si        :   Sister
SM        :   Scolding for Miscarriage
SP        :   Still Pregnant
SRP       :   Scolded for taking rest during pregnancy
SRSD      :   Should return on specified date and day
SSW       :   Semi-Skilled Worked
ST        :   Scared to Sterilize
STE       :   Sterilization
SU        :   Swelling of the Uterus
T         :   Talavar
Ty        :   Typhoid
Tr        :   Transplantation
T         :   Type
TC        :   Treatment considered Costly
TF        :   Type of Family
TFPM      :   Temporary Family Planning Method
Tre       :   Treatment
TR        :   Types of Restrictions
TrTCI     :   Treatment taken for Chronic Illness After Consummation of
ACOM          Marriage
TrTCIAM   :   Treatment Taken for Chronic Illness After Menarche
TrTCICH   :   Treatment taken for Chronic Illness in Childhood
Tu        :   Tubectomy
TV        :   Television
TWE       :   Taking Wife’s Earning
UCH       :   Usage of Contraceptives by Husband
UGHS      :   Utilized Govt. Health Services
UP        :   Uterine Problems
UT        :   Unsuitable Timings
V         :   Vaddar
Vo        :   Vomiting
Va        :   Vasoctomy
VANM      :   Visit by ANM
VP        :   Vaginal Problems
We        :   Weeding
Wo        :   Workload
W         :   Weekly
Wk        :   Weakness
WC        :   Woughing Cough
WCl       :   Washing Cloth
WD        :   White Discharge
Wi        :   Winnowing
WMB       :   Want Male Baby
WRDH      :   Worry of Running Family due to Drunkard Husband
                                I.      INTRODUCTION
           In India, adolescent girls account for a little more than one-fifth of the population
(21.4%). Out of an estimated 200 million adolescents, girls account for slightly less than 100
million due to disproportionate sex ratio (Census, 2001). In our country 31 per cent of the girls
aged between 15 and 19 years were married. Large numbers of girls from poor households
are pushed into early marriage, which is consummated almost immediately after menarche.
Of the 4.5 million marriages that take place in India every year, three million marriages involve
girls in the age range of 15-19 years (Census, 1991). In general, the low level of female
educational attainment and low status of young women and adolescent girls cause high rate
of adolescent marriage.
           Where early marriage is prevalent, resultant early child bearing is associated with
serious health problems to adolescent mothers and their offspring. The health related
experiences of adolescent girls and their attitudes are intimately linked to their social,
educational and economic status. Education has been recognized as an essential agent of
social change and development in any society. Hence, to think of harmonious development
without educating young women and adolescent girls is impossibility. Therefore, the emphasis
with regard to young women’s and adolescent girl’s education should be to equip them for
their multiple role as citizens, housewives, mothers, contributors to family income and builders
of the new society (Health Dialogue, 2002). At the same time the education should empower
the girls to be assertive and to take decisions on their own behalf regarding their health and
fertility.
           Marriage is one of the reasons that force adolescent girls to discontinue their
education. Poverty of the family is found to be an important reason which forces parents to
withdraw girls from school and make them work to support the family. In addition, early
marriage is an important factor forcing girls to drop out of school. Social prejudices and
cultural attitudes towards the girls not only contribute to school drop out rate among girls but
also keep many girls from joining the schools in the first place. Lack of education among girls
was found by many studies to be closely related to their health status (Sharma 1992).
           Thus health is a function not only of medical care but also of economic and cultural
factors. In India married adolescent girls especially those from rural areas do not have the
time, mobility, childcare assistance and leisure to travel to health centers for treatment. In
addition, an ideology of culture that glorifies self-effacement and suffering for young women
and adolescent girls makes them more inclined to put up with pain and ill-health rather than
demand treatment and rest.
           Empowerment in such a context calls for modalities other than mere economic status.
Because much of young women’s and adolescent girl’s powerlessness stems from non-
quantifiable subordination rather than monetary impositions. Conventional strategies for
development, address only poverty not powerlessness or subordinate status, which are the
crucial issues in the reproductive health context.
           World Health Organization (WHO) has defined reproductive health as a “state of
complete, physical, mental and social well-being and not merely the absence of disease or
infirmity, reproductive health addresses the reproductive processes, functions and system at
all the stages of life. Reproductive health, therefore, implies that people are able to have the
capacity to reproduce and the freedom to decide if, when and how often to do so. Implicit in
this last condition are the right of men and women to be informed of and to have access to
safe, effective, affordable and acceptable methods of fertility regulation of their choice and the
right of access to appropriate health care services that will enable women to safely go through
pregnancy and child birth and provide couples with the best chance of having a healthy infant.
           WHO definition implicit the reproductive health of adult men and women. In the Indian
context of adolescent girls enter into reproductive life, with the early marriages, pregnancies
and child bearing resulting in damaging effects to their general and reproductive health.
Moreover, all the requirements to maintain proper reproductive health with reference to adult
men and women also applies to adolescent girls who are in greater need of such health
facilities, counseling related to reproduction and family planning services.
           Thus the present study focuses mainly on reproductive health of adolescent girls. It is
generally believed that, in rural areas, there is a practice of marrying girls at an early age and
forcing them to consummate their marriage while they are still teenagers. These girls
experience lower autonomy compared to older women. In rural areas early onset of sexual
activity and the pressure on young married women to prove their fertility as soon after
marriage as possible, results in high rates of adolescent fertility. Also a ‘family size’
preference forces the married adolescent girls not to use contraceptives, which are used
comparatively more by the older women. Fertility rate was found to be increasingly
concentrated among the adolescent girls (Jejeebhoy, 1998). However, not much research
data is available on the reproductive health of adolescent girls especially in India. All these
factors contribute to health problems of the adolescent girls. Therefore, the reproductive
health of married adolescent girls needs urgent attention. Special attention is required for the
married adolescent girls in rural areas where the fertility rates and child marriage rates are
high as compared to urban areas. In this context of early marriage and high fertility
expectations, most of these girls have to live in the conditions of rural poverty. It must be
noted that, the married adolescent girls are not only burdened with poverty but also have to
depend on their husbands for social status and economic support. These young girls have
increased responsibilities and workload to meet their family’s basic needs. Thus, the young
girls suffer multiple disadvantages of being young, dependent, powerless and poor.
          The young girls are so fatigued by their multiple roles that they neglect their own
health and nourishment. Hence in the present study, their nutritional status was taken as an
important variable affecting the health status of adolescent girls. Poor nutrition is often
mentioned as the major reason for the delay in the onset of menarche among Indian
adolescent girls and their inability to reach their genetic potential for height and weight. The
poor nutritional status has intergenerational effects. The most visible manifestation of
nutritional deficiency is the high prevalence of anaemia and stunted growth among
adolescents. The Indian adolescent girls aged 15-19 years were reported to have mild
(36.2%) and moderate (17.9%) anaemia (Anonymous, 2001).
          Similarly modern contraceptive use among adolescents is generally low but increases
with economic status. It was reported from (Health dialogue, 2002) that, only seven per cent
of the married adolescent girls were used to modern contraception. Most of the adolescent
girls are not aware of the family planning methods and even if they know, they do not have
the power to access the contraceptive health services or fail to utilize them due to inhibitions
or pressure to attain motherhood to satisfy their mother-in-law and husband. They have been
relatively caught in a cycle of early marriage and child bearing with the consequent negative
effects on their reproductive health and sometimes they may have to pay with their life in the
form of maternal deaths.
          In India, it is estimated that about 437 women for every 1,00,000 women die every
year due to pregnancy and its related causes. It is also estimated that 4,00,000 maternal
deaths occur every year in the world and out of these 1,00,000 deaths occur in India (NFHS
1992-93). The major causes of maternal deaths are bleeding, severe anaemia and obstructed
labour. Early marriages, early pregnancies and short spaced pregnancies are some of the
factors underlying such high rates of maternal deaths. Lack of nutrition, health education, lack
of adequate maternity services and underutilization of health services have further aggravated
the problem. Therefore, the safety of the life of women in her reproductive age depends on a
number of factors, such as number of pregnancies, number of miscarriages and stillbirths.
The antenatal, natal and post-natal care she receives during pregnancy and childbirth are
other important factors determining her health.
          Adolescent mothers appear to have higher risks than adult women during child
bearing with poor obstetric outcome. In India, adolescent pregnancy rate varies from 8 to 14
per cent. The problem of adolescent motherhood is linked with child survival and maternal
mortality. Even today in rural areas untrained persons attend more than 60 per cent of
deliveries in India (WHO, 1990).
          In recent years, much effort has gone into training the traditional or village birth
attendants and into the use of trained mid wives in the community. But there are still many
areas, where trained personnel are not available. In this context adolescent mothers who are
at greater risk of perinatal complications than adult women were also forced to deliver
unaided or are attended only by untrained midwives or close relatives. Serious complications
thus many times go unrecognized till it is too late.
          Hence presence of skilled attendants is important for the health of the mother and child,
particularly when there are delivery complications. Younger the mother, greater the chance that she will
face complications during pregnancy and childbirth. Also, adolescents who are poor have the least
access to health care and suffer increased risk of problems in pregnancy and delivery. This
affects both infant and maternal morbidity and mortality.
          Thus, adolescent motherhood adversely affects child survival and maternal life
because of high incidence of fetal wastage. Maternal mortality among mothers aged 15-19
years is also very high as compared to that among mothers in 20-24 years. Due to frequent
pregnancy the health of the mother is badly affected. She becomes anaemic and gives birth
to an underweight child who faces the risk of death. Adolescent mothers are at risk of having
anaemia in pregnancy, which is considered to be mainly responsible for prevailing high
maternal mortality and high incidence of low birth weight babies in India. Adolescent
pregnancies were proved by research to be associated with low birth weight, pre-maturity,
birth injury, stillbirths and infant mortality (WHO 1989).
          Under the economic conditions prevailing in rural areas, and the poor utilization of
health services, the problem of adolescent motherhood is linked with child survival and
maternal mortality. Untrained persons attend more than 60 per cent of the deliveries in rural
areas. This affects both infant and maternal mortality rates. The maternal mortality rate in 15-
19 years age group is one of the highest in India. It appears that over 3,00,000 children of
adolescent (15-19 years) mothers die in infancy. This is due to frequent pregnancy, which
affect the health of the adolescent mother who becomes anaemic with the consequence of
delivering underweight child (Santhya and Jejeebhoy, 2003).

Aim
       The present       study was aimed at thorough examination of the reproductive health
problems of the rural married adolescent girls belonging to low-income families with the
following objectives.
     1. To study the socio-economic and demographic profile of the respondents.
     2. To investigate the problems of respondents in adopting family planning methods.
     3. To examine the health problems of respondents related to maternity.
     4. To find out the health problems of respondents other than those related to maternity
     5. To study the prevalence of gender violence suffered by the respondents.
     6. To examine the relation between the health history before conception and problems
          related to maternity, and
     7. To study the extent to which the respondents seek government health services.
                       II. REVIEW OF LITERATURE
          Maternal age is an important factor in determination of obstetric outcome. There are
only limited studies on teenage pregnancy in India. There is a need to do further research on
teenage pregnancy and review of the past research is also essential to develop conceptual
model for the investigation. This helps to develop clear understanding of the present study,
which can be formulated with appropriate research methodology according to the objectives
of study.
          Adolescent reproductive health status is not only influenced by the economic context
but also very much by social, cultural, political and individual factors.
          Reproductive health covers all aspects of adolescent health. It is an umbrella
concept, consisting of several distinct, yet related issues such as abortion, child birth,
sexuality, contraception and maternal mortality. Biological, social, cultural, economical and
behavioral factors play an important role in determination of reproductive health (Singh et al.,
1996).
          Thus the concept marks the shift towards a more holistic approach. In this respect, in
the present study, all the related concepts and variables are reviewed to get a clear
understanding of the present study. This study focuses on married rural adolescents and their
reproductive health problems. As such all the literature available regarding the various
aspects of the rural adolescents are reviewed and presented in this chapter under the
following headings.
2.1 Socio-economic characteristics
2.2 Socio-demographic characteristics
2.3 Age variables related to initiation of reproductive life
2.4 Variables related to maternity
2.5 Adoption of family planning methods by adolescent girls
2.6 Prevalence of obstetric problems
2.7 Prevalence of menstrual problems
2.8 Prevalence of gender/domestic violence
2.9 Utilization of antenatal care services
2.10 Utilization of government health services.
2.1 SOCIO-ECONOMIC CHARACTERISTICS
        As the socio-economic status influence the reproductive health of adolescents,
studies on rural married adolescent’s socio-economic status variables were reviewed.
2.1.1 Education
2.1.1.1 Education of the respondent
          Sharma (1992) conducted a study on reproductive morbidity and health seeking
behavior of adolescent women in rural areas, in Indore district of Madhya Pradesh belonging
to the age group of 13-19 years; results found that only 47 per cent of them attended school.
          Chaturvedi et al. (1994) assessed the nutritional status of married adolescent girls in
rural Rajasthan, results reported that 57 per cent of the subjects were illiterates.
          Singh et al. (1995] conducted a study on psycho-social, cultural and service factors
affecting morbidity among rural adolescent women in Maharashtra stated that almost half of
the respondents (49%) had educational attainment up to primary, only 8 per cent reported to
have education above secondary school.
          Gupta and Khan (1996) conducted a study on baseline survey in Uttar Pradesh on
teenage fertility, found that the educational level of the married teenage girls was very poor
with 40 per cent of them being illiterate, 14 per cent were primary and above.
          Roy et al. (2000) indicated according to NFHS, that only 7 per cent of married women
in the age group of 15-19 years have attained a higher secondary level of education. As many
as 55 per cent were illiterate in this age group and only 17 per cent have completed primary
schooling.
          Center for Development and Population Activities (2001) conducted a study on
adolescent girls in India stated according to world youth report 1996,that the total percentage
of girls enrolled in India at the secondary level in the 15-19 age group was 38 per cent.
          Kilaru et al. (2002) conducted a study on maternal health care among adolescent
women. Results found that, 44.1 per cent of the adolescents were illiterates. Only 12.4 per
                                                              th
cent of the adolescents completed their education up to 5 standard as compared to women
20+ years (23.1%). The adolescents who completed their middle school education were 21.1
per cent which was lower in women (17.2%) with 20 + years, and 22.4 per cent of the
adolescents completed their higher secondary education as compared to the women (25.1%)
with 20 + years.
          Nanda (2002) carried out a study on determinants of motherhood in teenagers and
fate of their pregnancy outcome. Evidence from national family health survey stated that, 48.1
per cent of teenagers were illiterate.45.1 percent completed primary school education, 39.3
per cent completed their middle school education and 33 per cent completed their high school
education.
          Sharma et al. (2002) undertook a study on determinants of pregnancy in adolescents
at BP Koirala Institute of Health Sciences. They found that, majority (65.7%) of the
adolescents completed their education up to primary, followed by those who were illiterate
(18.6%). Only 2 per cent of them completed their higher secondary school education and no
one completed the higher education.
          Dhak’s (2003) seminar paper on complications in pregnancy among teenage women
revealed that 61.4 per cent of the illiteracy which was found in adolescent group (15-20 years)
                                                                                                th
as compared to the age group of >20 years (27%). Only 30.45 per cent of teenagers had 5
      th                                        th
to 8 standard and 1.52 per cent had above 8 standard.
          Malviya et al. (2003) conducted a study on Anthropometric profile and perinatal
outcome of babies born to young women (<18 years) in the hospital of obstetrics department.
Results revealed that, illiteracy was high (24%) among study group [<18 years] as compared
to control (9.4%) group.
          Sharma et al. (2003) undertook a study on pregnancy in adolescents, a community-
based study conducted by department of community medicine. Results revealed that illiteracy
among (41.1%) adolescents was more common as compared to the adult group (32.3%).
43.8 per cent of the adolescents completed their primary education as compared to the adult
group (33.5%). Only 15.1 per cent of the adolescents completed their higher education, which
was higher among the adult (34.2%) group.
          From above studies, it may be concluded that, majority of the adolescents were
illiterates and rest of them completed their education up to primary level and secondary
school level followed by those who studied beyond secondary school level.
2.1.1.2 Education of the husband
          Kilaru et al. (2002) mentioned earlier, in their study, results revealed that, 49.1 per
cent of the adolescent’s husband were illiterate as compared to those husbands of women
with 20 + years of age. The education up to primary and middle school was higher in
husbands (11%, 12.3% respectively) of women with 20 + years as compared to the
adolescent’s husband (9.3%, 9.3%) respectively.
          Sharma et al. (2003) mentioned earlier, results revealed that 10.8 per cent of the
adolescent’s husbands were illiterate which was lower in case of adult women’s husband
(8.3%). It was also found that 58.4 per cent of the adult women’s husband completed their
high school education where as 47.3% adolescent’s husband were found to have completed
high school education.
2.1.2    Occupation
2.1.2.1 Occupation of the respondent
         Singh et al. (1995] mentioned earlier, their results revealed that majority (86.7%) of
adolescents were housewives followed by those who were unskilled workers (9.4%) and
skilled workers (3.9%) respectively.
         Kilaru et al. (2002) mentioned earlier, they found that majority (91.3%) of the
adolescents do the housework and tended livestock, followed by those who were agricultural
labourers (6.8%). Less than 2% (1.8%) were doing small business and government
jobholders.
         Sharma et al. (2003) mentioned earlier, stated that, majority of the (83.1%)
adolescents were housewives. Only 16.9 per cent of the adolescents were employed.
         Thus from the above studies it become apparent that majority of teenage mothers
were housewives.
       As no studies on teenage mothers investigated husband’s income and occupation, no
review related to these variables was presented here.
2.2     SOCIO-DEMOGRAPHIC CHARACTERISTICS
        Socio-demographic characteristics such as type of family, size of the family, religion,
caste and number of children were reviewed here, as they may influence the reproductive
health.
2.2.1 Type of family
        Type of family has its influence on decision-making, regarding contraceptive
practices, number of children and access to health services, which in turn can affect the
reproductive health.
        Sharma et al. (2002) mentioned earlier reported in their study that majority (67.1%) of
the adolescent respondents lived in joint families which was slightly high compared to the
adult group (64%).
         In the study by Malviya et al. (2003) which was mentioned earlier, it was reported
that 62.5 per cent of the study group (<18 years) were lived in joint family as compared to
adult group.
        Thus from these studies it may be concluded that, majority of the adolescent female
respondents resided in joint families as compared to adult female respondents.
2.2.2 Size of the family
         The distribution of resources among the family members has its impact on
reproductive health of the adolescent girls. As such studies related to size of the family were
reviewed.
         Lingaraju (1998) conducted a study on utilization of MCH and family planning
services by scheduled caste community. Results of this study found that, the average
household size was 6.5.
         Earlier mentioned study by Malviya et al. (2003) reported that, among study
group(<18 years) 61.5 per cent had the family size with less than 5 members as compared to
control group (44.8%) which was above 18 years of age.
         Thus from these two studies it was found that most of the adolescent respondents
came from families having more than five members.
2.2.3 Number of children
           Number of children determines the health status of the mother to a great extent. The
mothers who have high parity which is closely spaced are likely to face more reproductive
health problems.
           Audinarayana (1986) conducted a study on the influence of age at marriage on
fertility and family planning behaviour. This cross-cultural study revealed that the mean
number of children ever born and surviving was 4.37 and 3.57 respectively for those who had
married when they were 13-18 years of age. Whereas the number of children significantly
decreased to 3.35 to 2.98 respectively when the woman’s age at marriage was 20 years and
above.
           Sathe (1987) conducted a study on, the adolescents in India, a status report revealed
that the adolescent mother has at least 2 children by the time she reached 20 years of age.
           Pal et al. (1997) conducted a study on adolescent pregnancy. Their results inferred
that, majority (65.0%) of the adolescents had 4 children at the age of 18 years, followed by
those who had 3 children (27.50%) at the age of 18 years, followed by 2 children (5.0%) at
the age of 17 years, followed by 1 child (2.5%) at the age of 16 years.
           Pandey et al. (2000) conducted a study on some aspects of social factors affecting
fertility behavior of Gond women. Their results revealed that, the mean number of children
born was 0.65 to the mothers when they were 15 years of age and it increased to 1.65 at the
age of 20 years.
           Thus from these studies it may be concluded that most of the adolescent mothers
had at least two children.
2.2.4 Religion
        Singh et al. (1995) mentioned earlier, their results found that, 86.7 per cent of the
respondents were Hindu. The proportion of Muslims and others were 6 per cent and 8 per
cent respectively.
        Gupta and Khan (1996) mentioned earlier, results revealed that 26 per cent of the
married teenage girls were Hindus, 18 per cent were Muslims.
        Bhatia et al. (1997) studied the health problem of adolescent women in Karnataka.
They found that, majority (88%) of them were Hindus, 11 per cent were Muslims and 1 per
cent was found to be Christians.
        Sivaram et al. (1997) conducted a study on early marriage among rural and urban
females of South India, in rural areas of Tamil Nadu state where comparison was done
between rural and urban areas. They found in their study that, 42.4 per cent of those who
married early in rural area were Muslims, 36.9 per cent of them were Hindus, 9.1 per cent
were Christians, which was less in urban areas (39.9 per cent, 24.2 per cent and 12.0 per
cent) respectively.
         Barua (2000) conducted a study on reproductive health needs of married adolescents
in rural Maharashtra.Results showed that, about 90per cent of the population was Hindu as
compared to other religion.
         Nanda (2002) mentioned earlier, stated that, 51 per cent of the respondents were
Muslims, followed by Budhist (50.1%), Christians (47.3%), Hindu (45.2%), Sikh (34.6%)
respectively, 48.2 per cent of the respondents were from other religion.
2.2.5 Caste
         In Singh et al. (1995) study conducted in rural Maharashtra, which was mentioned
earlier revealed that, 46 per cent of the respondents belonged to the category of OBC
followed by general category (34.0%) and SC/ST category (20.0%).
         Nanda (2002) mentioned earlier results revealed that, majority (52.4%) of the
teenagers were ST, followed by SC (46.2%), and other caste (45.1%).
2.3     AGE VARIABLES RELATED                                  TO       INITIATION            TO
        REPRODUCTIVE LIFE
         Age variables such as age at menarche, age at marriage, age at first
pregnancy/delivery, age at consummation of marriage and time interval between pregnancies
or birth spacing are reviewed here as they exert their impact on the reproductive health status
of the adolescents. As such the related studies were reviewed here.
2.3.1 Age at menarche
        In rural areas, the parents think that their daughters are ready to start reproductive life
as soon as the daughters attain menarche, which hinders all the opportunities like education
employment in their life. Hence they will be deprived from these opportunities and face many
problems in their future life as they were sent to the husband’s house by the parents as soon
as they reach menarche. Thus age at reaching menarche decides her future reproductive life.
Thus the related studies were reviewed here.
        Pendse and Giri (1989) conducted a study on pregnancy care practices in rural
Rajasthan in 6 villages of Udaipur district. It was found that the respondents attained
menarche at the age of 13-15 years.
        Study conducted by Chaturvedi et al. (1994), which was mentioned earlier, revealed
that mean age at attainment of menarche was 13.54 years.
        According to the study conducted by Agarwal et al. (1997) in rural areas of Delhi, that
the mean age at menarche was found to be 12.8 years.
        Center for Development and Population Activities (2001) mentioned earlier, quoted
that according to the nutrition foundation of India, the average age at menarche among
adolescent girls was 13.4 years.
        The results of Malviya et al. (2003) reported that, average age of menarche in India
was 12.6 years.
        Sharma et al. (2003) mentioned earlier, stated that the mean age at menarche was
13.81 years among adolescents.
2.3.2 Age at marriage
         Age at marriage is an important variable, because early age at consummation of
marriage leads to early child bearing, which is considered as a risk factor. As such studies
noticing the age at marriage were reviewed here.
         Bhalerao et al. (1990) conducted a study on outcome of teenage pregnancy, results
found that 24.70 per cent of adolescent’s mean age at marriage was 17-19 years, 3.10 per
cent adolescent’s mean age at marriage was 11-13 years.
         Adhikari (1991) conducted a study on early marriage and childbearing risks and
consequences. Results revealed that, the mean age at marriage has increased from 15.4
years in 1961 to 18.1 years in 1991.
         Bhargava et al. (1991) conducted a study on identification of high risk mothers and
outcome of their off springs. Results revealed that the age at marriage among adolescent girls
was 13.8 years.
         Sharma (1992) mentioned earlier, the results inferred that 53 per cent of the
respondent’s age at marriage was below 13 years, 42.6 per cent of respondent’s age at
marriage was between the age of 14-16 years and few respondent’s age at marriage was
between the age group of 17-19 years (4.33%).
         Pathak and Ram (1993) conducted a study on problems and consequences of
adolescent motherhood. Results found that 75 per cent of the total married women’s age at
marriage was in the age group of 10-14 years from the study areas of Bihar, Madhya
Pradesh, Rajasthan and Uttar Pradesh.
         Chaturvedi et al. (1994) mentioned earlier, results revealed that the mean age at
marriage was 14 years among adolescents.
         Singh et al. (1995) mentioned earlier, results inferred that 84 per cent of the
adolescents reported their age at effective marriage was before 19 years.
         Gupta and Khan (1996) mentioned earlier, revealed in their results, as the mean age
at marriage was ranging from 15.2 years in Jaunpur to 17.9 years in Ghaziabad and Meerut.
         Barua (2000) mentioned earlier, results found that the median age at marriage among
adolescent girls was 16 years and up to 40 per cent of girls aged 15-19 years were already
married.
         Center for Development and Population Activities (2001) mentioned earlier, revealed
that the median age at marriage among rural adolescent was 16 years as compared to urban
areas i.e. 18.7 years.
         Sahay (2001) conducted a study on cultural determinants of maternal and infant
mortality in Madhya Pradesh. Results revealed that, the mean age at marriage in the state
was below 16 years; while in 20 out of 45 districts the mean age at marriage was below 15
years.
         Sharma et al. (2003) mentioned earlier, quoted according to census (1991) that,
average age at marriage in adolescents in India was 14.7 years.
         Mehra and Agrawal (2004) conducted a study on adolescent health determinants for
pregnancy and child health outcomes among the urban poor stated that, the mean age at
marriage among adolescents was 14.7 years.
         Hence from the above studies it can be inferred that the mean age at marriage
among adolescent girls was below 18 years.
2.3.3 Age at consummation of marriage
        Bhargava et al. (1991) mentioned earlier, their results revealed that the mean age at
consummation of marriage among adolescents was 16 years.
        Nanda (2002) mentioned earlier, study found that consummation of marriage for 14.6
per cent was before the age of 15 years.
        The study by Mehra and Agrawal (2004) mentioned earlier, reported in their results
that, mean age at consummation of marriage among adolescent was 15.5 years.
        From the above studies it can be inferred that in case of majority of the adolescents
the marriage was consummated before they reached 18 years of age.
2.3.4 Age at first pregnancy/first delivery
        Sooner the adolescent become pregnant, higher the complications she has to face
during pregnancy and delivery. Thus studies, which investigated this aspect, were reviewed
here.
         Pandse and Giri (1989) their study found that, majority (54.5%) of the married
adolescent respondents experienced the first birth within one to three years of menarche i.e.
between 15 to 17 years, while 38 per cent and 7.5 per cent were achieved motherhood 4-6
and 7-9 years after attaining menarche respectively.
        In a study conducted by Nanda (2002) which is mentioned earlier, results revealed
that majority (14.5%) of the respondents experienced the first birth when they were 15-17
years of age, followed by those (4.8%) who experienced at the age of 18-19 years and 3.4
per cent at the age of below 15 years.
        Thus from the above two studies it was found that most of the married adolescent
mothers experienced their first pregnancy and child birth before they reached 18 years.
2.3.5 Time interval between pregnancies/birth spacing
          Study carried out on infant mortality as related to mother’s reproductive history by
Prakasam (1980) reported that, the birth interval was 23.8 months between first and second
child among rural adolescents, where as 26.1 months for fifth and sixth birth which was
shorter period as compared to urban women.
          James et al. (2000) who reviewed research studies on neonatal mortality in India
found that, more than 20 per cent of the births occur before 24 months interval in all the states
of India.
          Nanda (2002) mentioned earlier, results indicated that one-fourth of all mothers had
birth interval of less than 17 months.
       Santhya and Jejeebhoy (2003) reported NFHS (1992-93) data that the median closed
birth interval among adolescents was below 24 months as compared to 29 months among
those aged 20-29 years.
         From the above reviews, it can be inferred that majority of the adolescent mothers
had birth interval of less than or equal to two years. One study reported the birth interval to be
less than 17 months.
2.4     VARIABLES RELATED TO MATERNITY
2.4.1 Prevalence of child wastage
          Health status of the adolescent is very important to have a healthy baby. There is
higher number of child wastage among adolescents than older women. It is due to immaturity
of the reproductive organs among adolescents. Poorer the health of the mother more is the
likelihood of the child wastage, occurring in the form of miscarriages, stillbirths, neonatal
deaths and infant deaths were reviewed here.
          Prakasam (1980) studied in Ananthpur district of Andhra Pradesh and found that, the
percentage of stillbirths and abortions were high among the mothers aged 15-19 years.
          Murthy et al. (1987) carried out a study on pregnancy wastage in rural areas of
Haryana, in Ballabgarh block. Results revealed that the pregnancy wastage was high among
the mothers below 19 years of age.
          Chatterjee et al. (1991) cross- studied the article of Podder (1975) reported that, the
child wastage was high among younger mothers i.e., adolescents as compared to adult
mothers.
2.4.1.1 Abortions/Miscarriages
          Sharma et al’s (2003) study mentioned earlier found that abortions were higher
among adolescent mothers as compared to adult mothers.
          Thus from the above study it may be concluded that, the abortion rate was higher
among adolescent mothers as compared to adult group.
2.4.1.2 Stillbirths
          Pal et al. (1997) mentioned earlier their results showed that 1.25 per cent of stillbirths
occurred among adolescent mothers.
          Secondary data was analyzed by Khandait et al. (2000) in their study on maternal
age as a risk factor for stillbirth. They reported that, the maternal age less than 20 years lead
to 1.6 times risk of delivering the stillborn baby.
          Sharma et al. (2003) mentioned earlier, found that 15.6% of adolescents has
stillbirths as compared to adult mothers (1.3%).
2.4.1.3 Neonatal deaths
           Pandey (1980) conducted a study on some aspects of neonatal and post-neonatal
mortality in a rural area of Uttar Pradesh.The results showed that the neonatal deaths were
higher (86.4 per 1000 live births) among children born to the mothers aged below 20years as
compared to the children born to mothers of age group of 20-24yrs (52.8) and 25-29yrs
(71.0%) respectively.
          Adhikari (1991) mentioned earlier, stated according to NFHS data that neonatal
mortality among children of adolescent mothers was 73 per cent, which was higher than
children of older mothers and also stated that in a hospital based study the neonatal mortality
rate was twice as high among children of adolescent mothers i.e. 40.5 per 100 births
compared to the children of those mothers who belonged to the age group of above 19
years (i.e. 18 per 1000 births).
          Awasthi and Pande (1998) conducted a study on cause-specific mortality under fives,
in urban slums of Lucknow in north India, found that 70.8 per cent of adolescent mothers as
compared to 45 per cent of mothers aged 20-29 years and 51 per cent of mothers aged 30-39
years had experienced neonatal mortality.
          Das et al. (1998) conducted a study on early neonatal morbidity and mortality in
Calcutta. Their results found that, the early neonatal mortality rate was 44.15/1000 live births
among adolescent mothers as compared to the age group of 20-29 years (28.51/1000 live
births).
          James et al. (2000) mentioned earlier, reported on the data from NFHS (1992-93)
that, India shows higher risk of neonatal mortality rate, which was 70.8/1000 live births seen
among the mothers less than 20 years of age.
          Kulkarni (2000) mentioned earlier, reported that the risk of neonatal mortality rate was
higher for children of adolescent mothers (63 per 1000 live births) compared to children of
mothers aged 20-49 yeas (48 per 1000 live births).
         Nanda (2002) mentioned earlier, who also reported on NFHS data that 63.1 per cent
of married women in the survey experienced neonatal deaths, which was highest among
teenage mothers.
         Santya and Jejeebhoy (2003) mentioned earlier, in their review of concerned studies
revealed that, the neonatal mortality rate was 63.1 per 1000 live births among infants of
adolescent mothers as compared to 40.7 per 1000 live births among women aged 20-29
years.
      From the above studies it may inferred that, the neonatal deaths were higher among
adolescent mothers as compared to adult groups.
2.4.1.4 Infant deaths
         Sathe (1987) mentioned earlier, in his status report on Indian adolescents reported
that the infant mortality (141/1000 live births) among mothers below 18 years was higher as
compared to the mothers in the age group of (18-20 years (112/1000 live births).
         NFHS-1 survey (1992-93) shows infant mortality rates to be higher for the first birth
order (93/1000 live births) as compared to second and third birth order (77 and 72/1000 live
births) respectively.
           Pathak and Ram (1993) mentioned earlier, results revealed that, the higher levels
of infant mortality rates were seen in the children of adolescent mothers who experienced 24
per cent, which was high-risk group as compared to children of mothers in the age group of
20-24 years.
         Kulkarni (2000) mentioned earlier, results found that the infant mortality rate was
higher among the children born to the adolescent mothers (83 per 1000 live births) as
compared to those born to adult mothers aged 20-49 years (73 per 1000 live births).
         Asian Population studies (2001) were reviewed by the population reference Bureau.
Data tabulated from the demographics and health survey report revealed that, in India the
infant mortality rate was 107.3 per 1000 live births among the mothers aged less than 20
years as compared to the mothers aged 20-29 years (79.3 per 1000 live births) during the
NFHS (1992-93) survey.
         Nanda (2002) mentioned earlier, results found that 92.8 per cent of the teenage
mothers experienced infant deaths.
         Mehra and Agrawal’s (2004) study results showed that the mother’s age was found to
be the risk factor for infant death as the infant mortality rate for adolescent mothers was 40
per cent higher than for older mothers (107.3 and 75.8 per 1000 live births respectively). The
same authors quoted that according to the NFHS (1992-93) data the infant mortality rate was
higher for first birth order among adolescents (93/1000 live births) as compared to second
and third order i.e. 77/1000 live births and 72/1000 live births respectively.
2.4.1.5 Nutritional status
       Nutrition exerts an important influence on outcome of pregnancy and has implications
for lactation also. Nutrition helps in growth of the fetus and also for the physical growth of
adolescent mothers. But malnutrition among adolescent girls in rural area is widespread due
to deficient diet, which affect in their future reproductive life.
       Begum (2001) conducted a study on prevalence of malnutrition among adolescent girls,
a case study in Kalliyoor panchayat, Thiruvanantapuram. Her results revealed that 53 per
cent of the adolescents in 14 years age group and 33 per cent in 15 years age group’s BMI
was below 18.5.
         Begum (2001) mentioned earlier, reported that 49 per cent of adolescent girls were
under-height and 67 per cent were under weight.
         Center for Development and Population Activities (2001) mentioned earlier, 15 per
cent of ever-married adolescent girls were stunted, 40 per cent have body mass index below
18.5 indicating mild malnourishment.
         Santhy and Jejeebhoy (2003) in their review pointed out that, nearly 15 per cent of
ever-married adolescent women were stunted and about one-fifth had moderate to severe
anaemia.
2.5     ADOPTION OF FAMILY PLANNING METHODS
2.5.1 Prevalence of family planning
         Utilization of family planning measures both temporary and permanent methods
influence the health status of the young women by delaying the future child bearing or stop
the child bearing. As such, in order to know their use, the studies were reviewed.
         Adhikari’s (1991) study showed that contraceptive use among adolescents in India
was only 7 per cent.
        Pathak and Ram (1993) stated that according to All India Survey of family planning
practices, it was found that, only 8.6 per cent of women in the age group of 15-19 years were
using contraception.
        Islam (1995) conducted a study on adolescents contraceptive use in Bangladesh
revealed that a quarter of the married adolescents have ever tried any method and the current
use of contraception was only 15.3 per cent as compared to adults (48.4 per cent and 34.4
per cent) respectively.
        In Lingaraju’s (1998) study, the results revealed that, older couple in 21-35+ age
group adopted permanent method while younger couple opted for spacing methods. Thus
there was no sterilization among the respondents below 19 years of age.
     Kulkarni (2000) found in her study that about 13 per cent of the adolescents ever used
contraception and 8 per cent were current users at the time of survey.
        Nanda (2000) reported that according to NFHS (1992-93) data no more than 5 per
cent of married women aged 13-14years and no more than 7 per cent of married women
aged 15-19years were practicing contraception as compared to 21 per cent of women aged
20-24yrs and 61 per cent of women aged 35-39yrs.
        Kalita et al. (2002) conducted an econometric study of some selected socio-
demographic variables on fertility based on NFHS data. They reported NFHS (1992-93) data
of India revealed that contraceptive use rate was highest in the age group of 30-39 years,
whereas very low use rate was observed among married women aged less than 20 years.
        Study conducted by Sharma et al. (2002) reported that, only 7.1 per cent of the
adolescents used contraception and 14.3 per cent of the elder women (control) ever used any
contraception.
        Sharma et al. (2003) mentioned earlier, their results showed that among 74
adolescent pregnant women only 64 were registered, among these adolescents only 8.1 per
cent were found to be using contraceptives.
        Mehra and Agrawal (2004) mentioned earlier, quoted data from NFHS-1 stated that
nearly 58 per cent of the adolescents have commenced child bearing. But only 7 per cent
adolescent females used contraception.
2.5.2 Reasons for not adopting sterilization
       Lingaraju (1998) in his study found that, 73 per cent of the respondents were not
practicing family planning because they wanted a male baby. The next most cited reason was
the fear of complications during pregnancy (10%) and 7 per cent mentioned objection by their
husband as a reason for not-adopting sterilization, remaining 10 per cent gave reason as
desire for more children.
2.6     PREVALENCE OF OBSTETRIC PROBLEMS
         Majority of the obstetric problems are resulting from the traditionally early marriage of
girls that still prevails especially in rural areas of the developing world.
2.6.1 Problems during the prenatal/antenatal period
        Dhak’s (2003) study revealed that, teenage women faced more complications
compared to the women aged 20-24 years. Weakness and dizziness was a common problem
among teenagers as compared to women aged 20-24 years.
        Sharma et al’s. (2003) Study mentioned earlier, found that 25 per cent of the
adolescent respondents reported edema during their first pregnancy as compared to adult
group (16.7%).
        From the above studies it may be inferred that problems reported during pregnancy
were more among adolescents than among adult women.
2.6.2 Problems during the perinatal period
      Chhabra (1992) conducted a study on perinatal outcome. His results revealed that,
prolonged labor was reported more in teenage mothers.
         Begum et al. (1998) conducted an analysis of factors affecting complication during
delivery from NFHS data. They found that the women below 20 years of age experienced the
maximum pregnancy related complications.
         Nanda (2002) pointed out that, according to NFHS (1992-93) data long period of
labor and use of forceps were the complications during childbirth observed more among
teenage mothers.
Dhak’s (2003) in his seminar paper on complication in pregnancy among teenage women
stated that, 16.1 per cent of adolescent women in India had prolonged labor.
        Sharma et al. (2003) stated that 82.8 per cent of the adolescent mothers had long
labor period of up to 12 hours during delivery as compared to adults (70.8%).
      From the above reviews it can be concluded that, the problems reported during delivery
were prolonged labor and caesarean sections.
2.6.3 Problems during the postnatal period
        Kulkarni (2000) mentioned earlier, found that 13 per cent of adolescents reported
massive vaginal bleeding and high fever.
        Dhak (2003) mentioned earlier, results stated that 27.5 per cent of teenage mothers
                                       st
reported lower abdominal pain after 1 week of delivery, followed by those who reported
(19.9%) high fever, followed by dizziness, headache (19.4%), excessive bleeding (14.7%),
swelling and vaginal discharge (10.6%) respectively.
        From the above study it may be inferred that, most of the reported problems after
delivery were lower abdominal pain, headache, excessive bleeding, swelling and vaginal
discharge.
2.7     MENSTRUAL PROBLEMS
         Menstrual problems constitute one class of the major gynecological problems. Hence
in the present study, an attempt was made to find out the prevalence of menstrual disorders
in the study area.
      Ghosh and Mohanty (2005) in their study found that, 18 per cent of the young married
women reported abdominal pain during menses.
             Rahman and Shahidullah (2005) conducted a study on adolescent self-reported
reproductive morbidity and health care seeking behaviour in Bangladesh. The results
revealed that, 58.6 per cent of the adolescents reported lower abdominal pain.
2.8     GENDER/DOMESTIC VIOLENCE
         Violence in the form of mental and physical cruelty if exists in the matrimonial home
will have a profound negative influence on health in general and reproductive health in
particular. Some of the studies related to violence are reviewed under here.
      Study on reproductive health seeking behaviour of married adolescent girls in
Maharashtra (2001) by Barua and Kurz showed that adolescent wives observed had very little
autonomy and decision making authority in their homes.
      Center for Development and Population Activities (2001) in its review of researches
conducted in India stated that among married young women aged 15-19 years, decision
making and freedom of movement were very low with only 38.6 per cent involved in decision
making about their own health and 86 per cent needing permission even to go to the market.
             George (2003) conducted a study on “Newly married adolescent women,
experience from case studies in urban India”, stated that, the young married women were
dependent on their husbands for social status for economic reasons. They had limited contact
with their maternal home. During the early days of marriage, newly married adolescent
women and their husbands had been under the authority of the husband’s parents and other
older relatives, and thus had a limited autonomy to make decisions about their personal lives.
         Santhya and Jejeebhoy (2003) analyzed NFHS (1992-93) data and found that,
among those adolescents who were married for two or more years 16 percent were beaten or
mistreated in the 12 months of preceding the survey as compared to 13 per cent of older
women.
         Ghosh and Mohanty (2004), who conducted a study on domestic violence among
young married woman in India, found that 11 per cent of ever-married young women in their
reproductive age reported that reported that they were physically beaten or mistreated by
their husband and in- laws.
2.9     UTILIZATION OF ANTENATAL CARE SERVICES
         Effective utilization of the antenatal care services has a positive influence on the
health of the mother and child.
         Nanda (2002) in her study reported that, more than one-third of all teenage mothers
did not received antenatal care.
         Dhak (2003) in his study reported that 55.7% of the adolescent mothers had utilized
antenatal services as compared to 75% mothers in the age group of 20-24 years.
      Thus from the above review it may be concluded that teenage mothers utilized antenatal
services less as compared to adult mothers.
2.9.1 Utilization of iron and folic acid tablets
         Mondal (1997) reported that according to NFHS report (1992-93) in Rajasthan, only
29.2 per cent of the births occurred to the mothers who received iron and folic acid tablets.
        Kulkarni (2000) mentioned earlier, study stated that 59 per cent of adolescent
mothers received an adequate supply of iron and folic acid tablets.
        Dhak (2003) in his study found that only 46.7 per cent of the adolescents were
received IFA tablets as compared to the mothers in the age group of 20-24 years (60.2%).
        Mehra and Agrawal (2004) who analyzed the NFHS-1 data stated that, among
mothers less than 20 years, only 7 per cent received antenatal care.
        Thus from the above studies, it may be concluded that many adolescent mothers did
not receive iron and folic acid tablets. But none of the studies quoted reasons for not receiving
IFA tablets.
2.9.2 Immunization
       Dhak (2003) in his seminar paper stated that, 71 per cent of adolescents received
immunization as compared to the adult mothers (82%) in the 20-24 years.
       Sharma et al. (2003) in their study found that 87.5 per cent of the pregnant
adolescents received immunization as compared to (91.7%) pregnant adult women.
       From the above studies, it is evident that adolescent mothers who received
immunization was low as compared to adult group.
2.9.3 Place of delivery
        Kulkarni (2000) mentioned earlier, stated that 80 per cent of all births takes place
outside the health institutions.
        Kilaru et al. (2002) in their study found that majority of (91.1%) the adolescents
delivered at home and only 8.9 per cent of the adolescents delivered in the hospitals.
        Nanda (2002) who reviewed to NFHS data inferred that majority (68.2%) of teenage
mothers delivered in home while only 31.8 per cent delivered in health centers.
        Sharma et al. (2003) as mentioned earlier, stated that 37.6 per cent of adolescents
opted for institutional delivery whereas more than half of adults opted for institutional delivery
(66.8%). It was pointed out that 62.5 per cent of the deliveries occurred at home among
adolescents as compared to adults (44.2%).
        Mehra and Agrawal (2004) mentioned earlier stated that over 2/3rd of deliveries occur
outside the health care institutions among the adolescents.
        From the above studies, it may be concluded that, majority percentage of adolescent
mothers delivered at home in India.
2.9.4 Person who assisted the delivery
         Kilaru et al. (2002) mentioned earlier, stated that Institutional deliveries were reported
by 38.1 per cent of the adolescents, followed by those adolescents who were assisted by lay
person or untrained dai (36.9%), and 25 per cent of the adolescents were assisted by
ANM/nurse during childbirth.
                                                                        rd
         Nanda (2002) mentioned earlier stated that, majority (2/3 ) of all deliveries are not
assisted by trained personnel
         Sharma et al. (2003) mentioned earlier, quoted that untrained Dai conducted the
deliveries in case of 35 per cent of adolescents. Only 17.2 per cent of the deliveries were
conducted by doctor.
         Mehra and Agrawal (2004) mentioned earlier quoted that according to NFHS data
that only 41.6 per cent of the adolescents get assistance at delivery by a skilled birth
attendant.
         From these studies, it may be concluded that majority of the adolescents assisted
were by untrained persons during childbirth.
2.10 UTILIZATION OF GOVERNMENT HEALTH SERVICES
2.10.1 extent of utilization of government health services
          Poverty, lack of freedom, ignorance, lack of knowledge about the benefits of
utilization of health services are the main factors which prevents adolescents from using
government health services. Utilization of the health services can greatly reduce the maternal
morbidity and mortality, as the health worker can identify the high- risk pregnancies.
          The study on reproductive health seeking of married adolescent girls in Maharashtra
(2001) by Barua and Kurz reported that majority of the adolescent wives were observed to
have little autonomy and decision-making authority regarding utilization of health services.
CONCLUSION
         The following conclusions can be drawn from the reviews of recent studies conducted
on married Indian adolescent girls during 1990-2006.
         Regarding socio-economic characteristics, it can be concluded in most of the studies
that, majority of the married adolescents were illiterate and rest of them completed their
education upto primary and secondary level. These girls married young men who were
educated upto secondary school level or even less. Majority of girls were housewives.
         Regarding socio-demographic characteristics it was very apparent that majority of the
teenage mothers were married into joint families and living in the large sized families with
more than five members.
         Reviews on age variables related to initiation to reproductive life showed that, the
girls married at an early age as soon as they attained menarche. In almost all studies
reviewed it was found that, the marriage was consummated before the girl reached 18 years
of age. All these studies experienced their first pregnancy soon after the consummation of
marriage with the minimum birth interval of less than 17 months.
         Regarding variables related to maternity, it was found that, the prevalence of child
wastage was high among teenage mothers. Miscarriages and neonatal deaths were more
followed by stillbirths and infant deaths. Another important variable found in the reviews was
nutritional status. Majority of the teenage mother’s BMI was found to be 18.5 indicating mild
malnourishment being prevalent among teenage mothers.
         The utilization of family planning method was very low among adolescent girls. The
prevalence of obstetric problems revealed that adolescent girls reported more problems
during pregnancy than during delivery and after delivery. Regarding menstrual problems, it
was found that, lower abdominal pain was the common problem reported by the girls.
         The prevalence of domestic/gender violence was high among adolescent girls.
Majority faced the problem of subordination and physically beaten by their in-laws and
husband.
         From the studies it was fond that few teenage mothers regularly used antenatal
services. Majority of them delivered their child at home with the assistance of untrained
persons.
         The utilization of government health services was low among adolescent mothers due
to lack of autonomy to make decisions regarding their own health.
         Since this review is, highly focused on general and reproductive health of the teenage
mothers in India, it provides a fairly clear picture of their bleak health status.
                     III. MATERIAL AND METHODS
        This study was conducted in Ranebennur taluk of Haveri district of Karnataka state
during the year 2004-05. The methods and procedures used in conducting this research study
are presented under the following headings:
      3.1 Locale of the study
     3.2 Population of the study
     3.3 Selection of the sample
     3.4 Variables studied
     3.5 Pilot study
      3.6 Collection of data
      3.7 Methods and Tools used
    3.8 Classification of variables and operational definitions
    3.9 Analysis of the data.
3.1        LOCALE OF THE STUDY
         Ranebennur taluk of Haveri district was selected as the locale of the study.
Ranebennur taluk consists of 106 villages and from those, 14 villages were randomly selected
by lottery method, which constituted 13.2 per cent of the total villages. The selected villages
were Karur, Sannasangapur, Kodiyal, Nalavagal, Kusagatti, Devaragudda, Aladakatti,
Ankasapur, Chaudadanpura, Teredahalli, Yaklasapur, Hospet, Kusagur, and Kuppelur.
3.2        POPULATION OF THE STUDY
         All the adolescent girls who were married and staying with their husband in the
villages were taken as the population of the study.
3.3        SELECTION OF THE SAMPLE
          Sample was selected in multi stages. First, villages in Ranebennur taluk were listed.
Thus total 106 villages were listed.14 villages were selected randomly by lottery method. In
each selected village the total number of married adolescents from low-income group families
in their reproductive years who were staying with their husband were listed to form sampling
frame. Thus 14 sampling frames were prepared for each village. From these sampling frames
10 per cent of married adolescents were selected using proportionate random sampling
method. Thus a total of 150 adolescents were selected who formed the final sample.
3.3.1 Selection of the samples from each village.
 Village           Name of the village             Population of the        Selected samples
  code                                            married adolescents
                                                      (<20 years)
   A        Karur                                         130                      13
   B        Ankasapur                                     103                      10
   C        Devaragudda                                   100                      10
   D        Chaudadanpur                                  113                      11
   E        Kusagatti                                     108                      10
   F        Teredahalli                                    85                       8
   G        Yaklaspur                                     100                      10
   H        Nalavagal                                     104                      10
   I        Kodiyal                                       106                      10
   J        Hospet                                        116                      11
   K        Kasgur                                        133                      13
   L        Kuppelur                                      120                      12
   M        Sannasangapur                                 125                      12
                                Total                                              150
      LIST OF VILLAGES

1.    - Chandapur
2.    - Choudadanapur
3.    - Chikkakuravatti
4.    - Mallapura
5.    - Kudarihala
6.    - Chikkarattihalli
7.    - Yattinahalli
8.    - Gudaguru
9.    - Maidur
10.   - Gangapur
11.   - Bevinahalli
12.   - Nukapur
13.   - Honnalli
14.   - Hanumapur
15.   - Devaragudda
16.   - Hadaganal
17.   - Kajjari
18.   - Kakol
19.   - Gudadanaveri
20.   - Konbevu
21.   - Hullatti
22.   - Medleri
23.   - Ankasapur
24.   - Heeladahalli
25.   - Belur
26.   - Udagatti
27.   - Konanatambigi
28.   - Somalapur
29.   - Yellapur
30.   - Hirebidari
31.   - Airani
32.   - Aremallapur
33.   - Yakalaspur
34.   - Rahutanakatti
35.   - Hunasikatti
36.     Chapparadahalli
37.   - Chalagere
38.   - Karur
39.   - Vadeyarhalli
40.     Nadiharalalli
41.     Khanderayanahalli
42.   - Nelavagal
43.   - Kodiyal
44.   - Kavalettu
45.   - Makanur
46.   - Nagenhalli
47.   - Mudenur
48.   - Holeanveri
51.   - Krishnapur
52.   - Mushtur
53.   - Manakur
54.   - Teredhalli
55.   - Itagi
56.   - Yannihosalli
57.   - Devagondankatti
58.   - Kamadod
59.   - Magod
60.   - Nandihalli
61.   - Yalavagal
62.   - Hingadahalli
63.   - Kotihal
64.   - Nitavalli
65.   - Lingadahalli
66.   - Sannasangapur
67.   - Badabasapur
68.   - Ukkadagatri
69.   - Kuppelur
70.   - Kammur
71.   - Malanayakanahalli
72.   - Timmenhalli
73.   - Menasinahal
74.   - Tumminkatti
75.   - Kusagatti
76.    - Shidaganahala
77.    - Hooli
78.    - Doddamaganur
79.    - Chikkamaganur
80.    - Dandagihalli
81.    - Konantambige
82.    - Nittur
83.    - Godihal
84.    - Bilahalli
85.    - Saragoppa
86.    - Aladkatti
87.    - Hediyal
88.    - Kusagur
89.    - Guddad bevinahalli
90.    - Sankalbidari
91.    - Guddad hosalli
92.    - Ukkund
93.    - Khanapur
94.    - Joyisarahalli
95.    - Rattihalli
96.    - Yaraguppi
97.    - Lakmapur
98.    - Tirumala devarkoppa
99.    - Benakanakond
100.   - Halagere
101.   - Asundi
102.   - Hoolihalli
103.   - Ranebennur
104.   - Bankapur
105.   - Siddapur
106.   - Basalikatti tanda
Fig 1. Map of Haveri district showing all the villages in Ranebennur taluk the study area
Fig 2. Map of Ranebennur taluk showing villages selected for the study
3.4        VARIABLES STUDIED
           In this research, reproductive health of the married adolescent was studied in relation
to the following variables.
I. Dependent variables
       1. Knowledge of respondents regarding family planning.
       2. Practice of family planning among the respondents.
       3. Health problems related to reproduction reported by respondent.
II. Independent variables
       1. Socio-economic characteristics of the respondents
       2. Socio-demographic characteristics of the respondents
       3. Variables related to maternity
       4. Variables related to health services.
1. Socio-economic characteristics of the respondents
                a. Education of the respondent
                b. Occupation of the respondent
                c. Annual income of the family
                d. Education of the respondent’s husband
                e. Occupation of the respondent’s husband
2. Socio-demographic characteristics of the respondents
                a. Religion
                b. Caste
                c. Type of family
                d. Size of family
                e. Number of children
                f. Age variables
                          • Age at menarche
                          • Age at consummation of marriage
                          • Age at each pregnancy.
3. Variables related to maternity
       a.    Number of miscarriages
       b.    Number of stillbirths
       c.    Number of neonatal deaths
       d.    Number of infant deaths
       e.    Number of healthy babies
     f. Total parity
     g. Time interval between pregnancies
        h. Extent of gender violence
4. Variables related to health services
       a. Family planning methods practiced by the respondent
       b. Availability and accessibility of health services
       c. Frequency and type of health services received.
3.5     PILOT STUDY
         Pilot study was conducted to test the appropriateness of methods and tools. The
study was conducted in Devanagondanakatti village, which was 10 km away from the taluk
place. The respondents of this village were not included for the main study. 10 samples were
randomly selected with the help of anganawadi teacher and these respondents were
interviewed for pilot study.
3.6     COLLECTION OF THE DATA
        Personal interview was the method used to collect the data, many times, it was not
possible to collect the information at a time, because most of the respondents were afraid to
give the information to an outsider i.e. researcher. This fear took sometime to disappear and
took several visits by the researcher to build the proper rapport with the respondent. Another
problem was that, the respondents at times felt shy to express their problems. However all
these difficulties were overcome by building enough rapport contacting them for more than 2
times for actual interviewing.
        Using the anthropometrical instruments with the help of Anganawadi worker, the
height and weight of the respondents was measured. Then Body Mass Index (BMI) was
calculated by using the formula given by Michael (1997).
                                  Weight (kg)
       Body Mass Index = --------------------
                                       2
                              Height (cm)

         He has given the classification as follows:
              <16.0        Severely malnourished
              16.0-17.0     Moderately malnourished
              17.0-18.5     Mildly malnourished
              18.5-20.0     Low weight normal
              20.0-25.0     Normal
3.7      METHODS AND TOOLS USED FOR THE STUDY
         In-depth interview method was used for conducting the study. An interview schedule
used by Pawar (2004) in her study was modified and used as the tool for data collection.
Pawar conduced study on knowledge and practices regarding reproductive health of lambani
women. This interview schedule was modified to suit the objectives of the present study. This
modified interview schedule was pre-tested in the pilot study. After further modification the
finalized schedule was used.
3.8      CLASSIFICATION   OF    THE                                       VARIABLES   AND
         OPERATIONAL DEFINITIONS
A. Classification
1. Socio-economic characteristics of the respondents
       a. Education of the respondent classified as
             Illiterate
             Primary education
             5th TO 7th standard
               th      th
             8 to 10 Standard
          PUC and above PUC
       b. Occupation of the respondents are classified as
                   i.   Agricultural labourers
                  ii.   House wife
                 iii.   Government jobholders
   c. Education of the respondent’s husband
                   i.   Illiterate
                  ii.   Primary education
                 iii.   5th to 7th standard
                          th       th
                iv.     8 to 10 standard
                  v.     PUC and above PUC
   d. Occupation of the respondents husband are classified as
             i.         Agricultural laborers
            ii.         Semi-skilled workers
           iii.         Masonry
          iv.           Petty business
       v.           Government jobholders
    e. Annual income of the family
           Rs7000-Rs 8900
           Rs 9000-Rs 9900
           Rs10000- Rs11000
 2. Socio-demographic variables
a. Religions are classified as
    i.       Hindu
   ii.       Muslim
b. Caste is classified as
    i.       Forward caste - Lingayat
   ii.       Minority           - Muslim
  iii.       SC/ST                 - Vaddar, Harijan, Kuruba, Chalavadi
  iv.        OBC                          - Lambani.
c. Type of family
    i.       Nuclear family
   ii.       Joint family
d. Size of the family is classified as
     i.     Family with 2-4 members
    ii.     Family with 5-7 members
   iii.     Family with 8-10 members
   iv.      Family with 11-13 members
    v.      Family with 14-16 members
e. Number of children
      1 child
      2 children
      3 children
    4 children
f. Age at menarche
     i.     10-12 years
    ii.     13-15 years
   iii.     16-18 years
g. Age at marriage
   i. 11-13 years
  ii. 14-15 years
  iii. >16 years
h. Age at consummation of marriage is classified as
    i          13-15 years
    ii.        16-17 years
    iii.       18-20 years
i. Age at first pregnancy
          15-17 years
          18- 20 years
j. Time interval between consummation of marriage and first            pregnancy
    Within one year of consummation of marriage
      One year after consummation of marriage
      Two years after consummation of marriage
II. Operational definitions
1.       Nuclear family: is composed of single married couple and their unmarried children
2.       Joint family: Family composed of 2 or more married couples and their unmarried
         children who are related either lineally or collaterally.
3.       Miscarriage : If delivery occurs prior to the end of 20 weeks of gestation, the term
         abortion must be applied.
4.       Prenatal period : Period from conception to birth of the baby (Dorlands, 1967)
5.       Perinatal period : Concerning the period beginning after the 28th week of pregnancy to
         7th day of birth (Perk and Perk, 1983).
6.       Postnatal period : Happening after birth (Dorlands, 1967).
7.       Stillbirth : Birth of a dead fetus.
8.       Infant death : Number of infants dying after the first month of life and before the first
         birthday.
9.       Neonatal death : The number of newborn babies dying in first month of life.
10. Child wastage : Number of children dying due to abortion, still birth neonatal death and
         infant death.
11. Menarche : Very first menstrual period.
12. Low birth weight baby : The baby, which is <2500 gms at birth.
13. Premature Baby : Baby is born before the gestation period completed.
3.9     ANALYSIS OF THE DATA
        As data collected were mainly descriptive and objectives of the study being
exploratory in nature, the data were mainly analyzed in frequencies and percentages.
Quantified data collected were analyzed by statistical methods of association and correlation.
                                    IV. RESULTS
         The results of the present study are given under the following headlines.
  4.1      Profile of the respondents
 4.1.1     Socio-economic characteristics of the respondents
 4.1.2     Socio-demographic characteristics of the respondents
 4.2.1     Age and time interval variables related to initiation of reproductive life
 4.3.1     Prevalence of child wastage among respondents
 4.3.2     Type of child wastage by ordinal number of pregnancies/live births
 4.3.3     Association between age and child wastage
 4.3.4     Number of pregnancies and age of the respondents at pregnancy
 4.3.5     Distribution of number and type of child wastage by age at which it occurred
 4.3.6     Nutritional status of the respondents
  4.4      Distribution of respondents by their knowledge and practice of family planning
           method
 4.4.1     Distribution of respondents by reasons for adopting and not adopting sterilization as
           family planning method
 4.4.2     Distribution of respondents by prevalence of child spacing methods adopted in the
           past and continuing at present
 4.4.3     Reasons for discontinuation of child spacing methods
 4.5.1     Prevalence of problems faced during prenatal period
 4.5.2     Prevalence of problems faced during perinatal period
 4.5.3     Prevalence of problems faced during postnatal period
 4.5.4     Relation between body mass index and maternity problems
 4.6.1     Prevalence of health problems unrelated to maternity
 4.7.1     Prevalence of violence
 4.7.2     Prevalence and types of mental cruelty faced by respondents
 4.7.3     Prevalence of bad habits of husband and feelings of respondents about the bad
           habits
 4.7.4     Respondent’s reasons regarding restrictions to visit their parents
 4.7.5     Physical violence faced by respondents and reported          reasons
  4.8      Correlation between problems related to maternity and the illnesses suffered after
           marriage
  4.9      Distribution of respondents covered by immunization and anaemia prophylaxis
           programme
 4.9.1     Utilization of IFA tablets and reasons for non-utilization
 4.9.2     Distribution of childbirths by the place of delivery and the assistance received
 4.10      Accessibility of government health services and utilization of health services
 4.11      Frequency of ANMs visit as reported by respondents
4.1      PROFILE OF THE RESPONDENTS
4.1.1 Socio-economic characteristics of the respondents
           The examination of Table 4.1.1 revealed that, 52.0 per cent of the respondents were
                                       th       th
found to have education between 5 and 10 standard. 34.7% of the respondents were found
to be illiterates. 11.4 per cent of the respondents completed their primary education. Only 2.0
per cent studied above PUC.
           From the table it was found that, majority (74.7%) of the respondents were found to
be agricultural labourers, followed by (24.7%) housewives. Only less than one per cent of the
respondents were government jobholders.
           Regarding education of the respondents’ husbands results revealed that, majority
                                                       th      th
(70.1%)of their husbands education ranged from 5 to 10 standard. 15.3 per cent of them
were illiterates 13.3 per cent of them had studied PUC and above. Only few (1.4%)
respondents’ husband had primary education.
           The table also revealed that, majority (70.7%)of their husbands depend on agriculture
as they were found to be agricultural labourers, followed by those who were (10%) semi
skilled workers. Others were masonry (9.3%)workers, petty businessmen (8.7%) and
government jobholders (1.4%).
           About annual income of the family, 90.7 per cent of the households had annual
income between Rs9000–9900.Where as 8.8 per cent households had income between
Rs7000-8900 and only 0.7 per cent of the family had income of Rs10000-11000.
                        Table 4.1.1 Socio-economic characteristics of the respondents
                                                                                            N= 150
Sl.                              Particulars                    Frequency      Percentage
No.

1.    Education of the respondents
      Illiterate                                                    52            34.7
      Primary education                                             17            11.4
      5th to 7th standard                                           39            26.0
                                                                                               52.00%
       th          th
      8 to 10 standard                                              39            26.0
      PUC and above PUC                                              3             2.0
2.    Occupation of the respondents
      Agricultural laborers                                         112           74.7
      House wife                                                    37            24.7
      Government job holders                                         1             0.7
3.    Education of the respondents husband

      Illiterate                                                    23            15.3
      Primary education                                              2             1.4
      5th to 7th standard                                           38            25.4
                                                                                               70.10%
       th          th
      8 to 10 standard                                              67            44.7
      PUC and above PUC                                             20            13.3
4.    Occupation of the respondents husband

      Agricultural laborers                                         106           70.7
      Semiskilled workers                                           15            10.0
      Masonry                                                       14             9.3
      Petty business                                                13             8.7
      Government job holders                                         2             1.4
5.    Income of the family/year
      Rs.7000 – Rs. 8900                                            13             8.8
      Rs. 9000- Rs.9900                                             136           90.7
      Rs.10000 – Rs.11000                                            1             0.7


             Thus the socio-economic status reflects that majority of the respondents and their
      husbands had education ranging from 5th to 10th standard and majority of the respondents
      and their husbands were found to be agricultural labourers. Overwhelming majority of the
      (90.7%) households had annual family income of Rs9000-9900 and hailed from poor family.
      Only one respondent had annual family income of more than Rs10000.Hence all the
      respondents in this study were found to be low annual family income.
                 Table 4.1.2. Socio-demographic characteristics of the respondents
                                                                                     N = 150
Sl.                      Particulars                   Frequency        Percentage
No.
I.     Present age of the respondents
       17 years                                             6               4.0
       18 years                                             40              26.7         60.10%
       19 years                                             44              29.4
       20 years                                             60              40.0
II     Type of family
       Nuclear                                              17              11.3
       Joint                                               133              88.7
III.   Size of the family
       Family with 2-4 members                              11              7.4
       5-7 members                                          56              37.4
                                                                                         81.40%
       8-10 members                                         66              44.0

       11-13 members                                        14              9.3
       14-16 members                                        3               2.0
IV.    Number of children
       1 child                                              65              43.3
       2 children                                           74              50.0
       3 children                                           10              6.7
       4 children                                           1               0.7
V.     Religion
       Hindu                                               140              93.3
       Muslim                                               10              6.7
VI.    Caste
       Forward                                              27              18.0
       SC/ST                                                95              63.3
       Minority                                             10               6.7
       OBC                                                  18              12.0
       Table 4.2.1 Age and time interval variables related to initiation of reproductive life
                                                                           N=150

Sl.                  Age Variables                   Frequency       Percentage          Mean
No.
I.       Age at menarche
         10-12 years                                      56              37.3
         13-15 years                                      86              57.3           13.07
         16-18 years                                      8                5.4
II.      Age at marriage
         11-13 years                                      8                5.3
         14-15 years                                      72              48.0           15.37
         >16 years                                        70              46.7
III.     Age at consummation of marriage
         13-15 years                                     33               22.0
         16-17 years                                     115              76.7           16.07
         18-20 years                                      2                1.3
IV.      Age at first pregnancy
         15-17 years                                     146              97.3           16.47
         18-20 years                                      4               22.7
V.       Time          interval  between
         consummation of marriage and
         first pregnancy
         Within one year of consummation                  88              58.0
         of marriage
         One year after consummation of                   53              35.0
         marriage
         Two years after consummation of                  11              7.0
         marriage


 4.1.2 Socio-demographic characteristics of the respondents
          An examination of Table 4.1.2 revealed that, majority (60.1%) of the respondents
 were found to be below 19 years of age and remaining 40 per cent were in their 20 years at
 the time of survey.
           Regarding type of family, it was noted that majority of them (88.7%) lived in joint
 families followed by those living in nuclear family (11.3%).
          From the same table, it was found that majority of the families (81.4%) were found to
 have 5-10 members.9.3 per cent of the families were having 11-13 members.
          When the number of children to the respondents was examined, it was found that half
 of the respondents (50.0%) were having two children, followed by those (43.3%) who had one
 child.
          Regarding religion and caste, it was noticed that majority (93.3%) of the respondents
 were Hindus. SC/ST’s were higher (63.3%) as compared to other castes.
 4.2.1 Age and time interval variables related to initiation to reproductive life
        An examination of Table 4.2.1 revealed regarding age at menarche that, higher
percentage (57.3%) of respondents reached menarche when they were in the age group of
13-15 years and mean age at menarche was found to be 13.07 years among the
respondents. Most of the respondents (48.0%) were married between the age group of 14-15
years compared to those who married in the age group of 16-18 years (46.7%) with mean age
at marriage of 15.37 years. But there was no wide variation of age at marriage between these
two age groups. In the present study majority (76.7%)of the marriages consummated when
the respondents were in the age group of 16-17 years. The mean age at consummation of
marriage was found to be 16.47 years.
        Regarding age at first pregnancy, it was found that majority of the respondents
(97.3%) became pregnant for the first time when they were 15-17 years of age as compared
to those who were pregnant at the age of 18-20 years (2.7%).
        Regarding time interval between consummation of marriage and first pregnancy, it
was found that majority of the respondents (58.0%) were pregnant within one year of
consummation of marriage, followed by those who were pregnant after one year of
consummation of marriage (35.0%). Only few respondents (7.0%) were pregnant after two
years of consummation of marriage.
4.3.1 Prevalence of child wastage among respondents
        From the Table 4.3.1, it was found that, all of the respondents experienced first
pregnancy. Out of these respondents, 53.3 per cent experienced child wastage. Regarding
outcome of total pregnancies, it was found that out of 357 pregnancies, 69.3 per cent of
successful pregnancies experienced by the respondents and 30.7 per cent of child wastage
occurred to the respondents.
4.3.2 Type of child wastage by ordinal number of pregnancies/live births
        From the table 4.3.2 it was noticed that the occurrence of child wastage was higher in
  st
1 pregnancy followed by second and third ordinal number of pregnancies/live births.
Miscarriages were found to be higher in their first ordinal number of pregnancy (43.3%)
compared to second ordinal number of pregnancies. Stillbirths were more in third (8.6%)
ordinal number of pregnancy compared to second (4.8%) ordinal number of pregnancy.
Neonatal deaths were slightly more (2.7%) among the respondents who experienced first
pregnancy compared to second (2.4%) and third (1.4%) pregnancies. Infant deaths were
more among the respondents who experienced second and third pregnancy. Fig. 1 showed
that, majority of the child wastage occurred when the respondents mean age at 1st pregnancy
                                                                                nd  rd       th
was 16.5 years. The child wastage was decreased as the mean age at 2 , 3 and 4
pregnancy increased among the respondents.
4.3.3 Association between age and child wastage
         When the age and number of miscarriages by ordinal number of pregnancy was
examined from the Table 4.3.3 it was found that, majority of the miscarriages occurred in their
first pregnancy when they were below 18 years of age and it was found to be significant at 5%
level. Stillbirths were found to be more in third and second order of pregnancy. These
stillbirths were also occurred more among the respondents when they were below 18 years of
age and it was found to be significant at 5% level. Neonatal deaths were slightly more in first
and second order of pregnancy when they were below 18 years of age and infant deaths
were more in second order of pregnancy when they were below 18 years of age. Neonatal
and infant deaths were found to be non-significant. From this table one can inferred that, most
of the child wastages occurred to the respondents when they were below 18 years of age and
child wastage was reduced as the age of the respondents increased.
4.3.4 Number of pregnancies and age of the respondents at                  pregnancy
  From the Table 4.3.4, it was found that, more than half (55.3%) of the respondents were
found to be below 18 years of age. Nearly 45 per cent were in the age group of 18-20 years.
4.3.5 Distribution of number and type of child wastage by age at which it
       occurred
          The results of Table 4.3.5 revealed that, except one case, almost all the child
wastage occurred to the respondents when they were below 18 years of age. All the
miscarriages (68.2%) were occurred to the respondents when they were below 18 years of
age. There was no occurrence of miscarriages in the age group of 18 and above. Stillbirths
were more among the respondents who were below 18 years of age. In one case stillbirth
was occurred when the respondent was above 18 years of age. Infant deaths were found to
be more (10.9%) among the respondents who were in the age group of 17-18 years. Neonatal
              Table 4.3.1. Prevalence of child wastage among respondents
                                                                          N=150

                                Variables                                  Frequency        Percent


I     Prevalence of child wastage


1.    No. of respondents who underwent pregnancy                               150           100.0


2.    No. of respondents with child wastage                                     80            53.3


II.   Outcome of total pregnancies


      No. of successful pregnancies                                            247            69.3


      No. of child wastage                                                     110            30.7


      No. of total pregnancies                                                 357           100.0


        deaths were high (4.5%) in the age group of 17-18 years as compared to the age
group of 15-16 years (2.7%). There was no occurrence of neonatal deaths in the age group of
18 and above.
4.3.6 Nutritional status of the respondents
       From the Table 4.3.6 it was found that, Slightly more than half of (52.7%) the
respondents height was ranging from 146cms-149cms.Nearly one third (32.7%) of the
respondents’ height was below 145cms and 32 per cent were under weight i.e. below
38Kg.One-fourth (25.5%) of them were found to be suffering from mild to moderate
malnourishment.
4.4     DISTRIBUTION OF RESPONDENTS    BY  THEIR
       KNOWLEDGE AND PRACTICE OF FAMILY PLANNING
       METHODS
         Data from the Table 4.4 revealed that majority (72.0%) of the respondents had
knowledge of female sterilization as compared to male sterilization (43.3%). 28.0 per cent and
56.7 per cent of the respondents had no knowledge of female and male sterilization
respectively.
          Regarding practice, it was found that 6.7 per cent of them sterilized and only 26.0 per
cent of the respondents were using child spacing methods (temporary methods) as compared
to those respondents who were not using child spacing methods (74.0%).
4.4.1 Distribution of respondents by reasons for adopting and not adopting
       sterilization as a family planning method
          The results of the Table 4.4.1 found that, 6.7 per cent of the respondents adopted
sterilization as a family planning method. These respondents reported reason for adopting
sterilization as they don’t want more than 2 children (5.3%) and 1.3 per cent reported that
their family members accepted sterilization after birth of third child.
          Reasons regarding non-adoption of sterilization from the same table revealed that,
93.3 per cent of the respondents reported reasons for not adopting sterilization. 43.8 per cent
of the respondents reported that they want male baby, 25.82 per cent and 16.2 per cent of
                      Table 4.3.2: Type of child wastage by ordinal number of pregnancies/live births




Ordinal no.                     Type of child wastage                       Total            Child            Total
     Of                                                                   number of         survived
pregnancy/                                                                  child
 live births     Miscarriage Still births     Neonatal       Infant        wastage
                                               deaths        deaths


                  F       %       F     %      F      %     F      %       F       %        F       %    F        %


1st N = 150      66      43.3     3     2.0    4     2.7    2     1.3      74     49.3     76     50.7   150    100.0


2nd N        =   10      8.2      6     4.8    3     2.4    6     4.8      25     20.2     99     79.8   124    100.0
124


3rd N = 70        -        -      6     8.6    1     1.4    3     4.3      10     14.3     60     85.7   70     100.0


4th N = 14        -        -      -      -      -     -     1     6.7      1       6.5     12     80.0   14     100.0
                             60


                                                                                                   Total No.of child wastage
                             50
                                                                                                      I - First pregnancy
                                                                                                      II - Second pregnancy
                                                                                                      III - Third pregnancy
                                                                                                      IV - Fourth pregnancy
                             40
Total No. of child wastage




                             30




                             20




                             10




                              0

                                  16.5 (I)                17.5 (II)                   18.5 (III)            19 (IV)

                                                           Mean age at each pregnancy in years



                                  Fig. 3 : Type of child wastage by ordinal numer of pregnancies/live births


                                    Fig. 3 : Type of child wastage by ordinal numer of pregnancies/live births
                 Table 4.3.3.Association between age and child wastage

I. Association between age and number of miscarried pregnancy by ordinal
   position
            Age          Ordinal number of pregnancy    Total     χ2
                             1st          2nd          3rd
   15-17 years               61            8            0          69    28.8*
   18-20 years                4            2            0           6
            Total             65          10            0          75
   Significant at 5% level
   χ2 0.05 table value 7.815.

   II. Association between age and number of stillbirths by ordinal position of
        pregnancy
           Age            Ordinal number of pregnancy       Total         χ2
                             1st          2nd          3rd
   15-17 years                1            5            5          11    16.4*
   18-20 years                1            1            2           4
            Total             2            6            7          15
   Significant at 5% level
   χ2 0.05 table value 7.815.

   III. Association between age and number of neonatal deaths by ordinal
         position of pregnancy
           Age             Ordinal number of pregnancy Total      χ2
                             1st          2nd          3rd
   15-17 years                3            2            1          6     2.00ns
   18-20 years                1            1            0          2
            Total             4            3            1           8
   NS – Not significant
   χ2 0.05 table value 7.815.

   IV. Association between age and number of infant deaths by ordinal position
        of pregnancy
            Age           Ordinal number of pregnancy      Total        χ2
                             1st          2nd          3rd
   15-17 years                2            4            1          7     0.34ns
   18-20 years                2            2            1          5
            Total             4            6            2          12
   NS – Not significant
   χ2 0.05 table value 7.815.
     Table 4.3.4: Number of pregnancies and age of the respondents at pregnancy


     Age of the respondents                        No. Of pregnancies
       at pregnancy (years)

                                         Frequency           Per cent


                   15                         12                3.4

                                                                              55.3%
                   16                         58               16.3


                   17                        127               35.6


                   18                        100               28.0

                                                                              44.7%
                   19                         49               13.7


                   20                         11                3.0


                 Total                       357               100.0


        them reported, as they did not get permission from their husband and in-laws. 14.18
per cent of the respondents reported as they scared of sterilization.
4.4.2 Distribution of respondents by prevalence of child spacing methods
       adopted in the past and continuing at present
        Data from Table 4.4.2 revealed that majority (80.7%)of the respondents knew about
child spacing methods. 64.7 per cent of the respondents were adopters of child spacing
methods in the past which was decreased to 26.0 per cent at present. Only 35.3 per cent of
the respondents were non-adopters in the past, which was increased to 74 per cent at
present. The users of IUDs (16.0%)and pills (48.7%) were higher in the past and were
decreased to 4.7 per cent for IUDs and 21.3 per cent for pills at present.
4.4.3 Reasons for discontinuation of child spacing method
        From Table 4.4.3 it was evident that majority of the respondents reported reasons for
discontinuation of child spacing method.34.0 per cent of the respondents reported that their
mothers-in-law did not like the use of spacing method after coming to know that they were
using spacing methods. 25.8 per cent of the respondents reported that their husbands
scolded after knowing. 17.5 per cent reported that as IUDs caused irritation and they were
discontinued 16.5 per cent of the respondents reported due to work load they were not able to
continue using spacing method.6.9 per cent of the respondents had belief that pills will cause
health problems.
      Table 4.3.5. Distribution of number and type of child wastage by age at which it
                                          occurred
                                                           Total child wastage N = 110


                                            Age groups                                 Total


                           15-16 yrs         17-18 yrs           >18 yrs


                           F       %         F        %         F        %         F           %


Miscarriages              39      35.5      36       32.7       -         -       75       68.2


Still births               6       5.5       8       7.3        1       0.9       15       13.7


Infant deaths              -        -       12       10.9       -         -       12       10.9


Neonatal deaths            3       2.7       5       4.5        -         -        8        7.2


Total                     48      43.7      61       55.4       1       0.9      110      100.0



4.5      OBSTETRIC PROBLEMS
4.5.1 Prevalence of problems faced during prenatal period
       Results of Table 4.5.1 revealed that majority (57.3%) of the respondents suffered
many problems during prenatal period. Lower abdominal pain (59.3%), vomiting and fever
(58.1%), cough and cold (48.8%), slight bleeding (48.8%) and severe bleeding (34.8%) were
the common problems reported by majority of the respondents.
4.5.2 Prevalence of problems faced during perinatal period
        From Table 4.5.2, results found that 48 per cent of the respondents faced problems
during perinatal period. Majority of the respondents reported problems were vomiting before
delivery (70.8%), fever (54.2%), swelling in feet (52.8%), lower abdominal pain (43.0%),
prolonged labor (43.0%) and heavy bleeding after delivery (41.7%).
4.5.3 Prevalence of problems faced during postnatal period
        Table 4.5.3 revealed that, 43.3 per cent of the respondents had problems during
postnatal period. Majority of the problems reported by the respondents were lower abdominal
pain (70.8%), excessive bleeding (66.1%) and cough and cold (47.7%). Nerve pain (10.8%)
and pain in operated area (7.7%) were the other problems reported by the respondents.
4.5.4 Relation between body mass index and maternity problems
    When the relation between body mass index and maternity problems were examined from
the Table 4.5.4 it was found that, the nutritional status of the respondents which was
calculated by the body mass index was found to be negatively and significantly correlated
with the incidence of pre and perinatal problems.
4.6.1 Health problems other than those related to maternity
         From the Table 4.6.1 it was found that 76.7 per cent of the respondents faced one or
the other menstrual problems. Irregular menses was the major problem reported by 24.7 per
cent of the respondents. Pain in body and legs (18.0%), white discharge (15.3%), excessive
                                                                                                     15-16 years     17-18 years         >18 years
                              40
                                       35.5

                              35              32.7



                              30



Percentage of child wastage
                              25


                              20


                              15
                                                                                              10.9


                              10                                      7.3
                                                              5.5
                                                                                                                            4.5
                               5                                                                                     2.7
                                                                             0.9
                                                     0                                   0              0                            0

                               0
                                      Miscarriages            Still births             Infant deaths               Neonatal deaths


                                                                        Age group in years


                                    Fig. 4 : Distribution of number of type of child wastage by age at which it occurred



                                   Fig. 4 : Distribution of number of type of child wastage by age at which it occurred
                Table 4.3.6 Nutritional status of the respondents
                                                      N=150
      Sl.                   Variables                   Frequency        Percentage
      No.

      I.     Height of the respondents

             < 145 cms                                       49              32.7

               146 cms –149 cms                              79              52.7

              >150 cms                                       22              14.7

      II.    Weight of the respondents

             <38 kg                                          51              32.0

             39kg – 45 kg                                    30              22.0

             46kg – 55 kg                                    69              46.0

      III.   BMI of the respondents

             <16.0    Severely malnourished                   -                -

              16.0-17.0 Moderately                           6                4.2
             malnourished

              17.0-18.5 Mildly malnourished                  32              21.3

              18.5-20.0 Low weight normal                    51              34.0

              20.0-25.0 Normal                               61              40.7

         bleeding (13.3%), lower abdominal pain (12.7%), long period of menses (12.7%) and
backache (10.7%) were the other problems reported by the respondents.
         Regarding vaginal or uterine problems 23.3 per cent of the respondents had
problems, among them 13.3 per cent had vaginal problems. Burning sensation during
urination (11.3%) and itching (2.0%) were the vaginal problems reported by the respondents.
10 per cent had uterine problems, among them 5.3 per cent of them reported as pain in
uterus and 4.6 per cent reported swelling of the uterus.
4.7         FAMILY/GENDER VIOLENCE
4.7.1 Prevalence of violence
        Results of the Table 4.7.1 showed that, 80 per cent of the respondents reported
violence. When the type of violence was examined it was found that, 36.6 per cent of the
respondents suffered mental cruelty followed by those who suffered physical (33.3%) cruelty
and those who suffered both mental and physical (30.9%) cruelty.
4.7.2 Prevalence and types of mental cruelty faced by respondents
         Table 4.7.2 revealed that, 56.75 per cent of the respondents faced mental cruelty.
Fault finding by in-laws (31.8%) was the main type of cruelty faced by the respondents. Lack
of freedom to express (25.9%) was the second type of cruelty faced by the respondents.
Worry of running the family (23.5%), ridiculing for taking rest during pregnancy (17.6%),
obeying the despotic orders of the mothers-in-law (15.3%), scolding for having
      Table 4.4. Distribution of respondents by their knowledge and practice of family
                                      planning method
                                                                         N=150


Sl.                       Knowledge                            Frequency        Percentage
No.


 1.      Know about female sterilization                           108              72.0


         No knowledge                                               35              28.0


 2.      Know about male sterilization                              65              43.3


         No knowledge                                               85              56.7


                            Practice


 1.      No. of respondents sterilized                              10               6.7


         No. of respondents not sterilized                         140              93.3


 2.      No. of respondents          using temporary                37              26.0
         methods


         No. of respondents not using temporary                    111              74.0
         methods


abortion/miscarriage (15.3%) and got hurt due to bad habits of their husband (14.1%) were
the other types of mental cruelty reported by the respondents.
4.7.3 Prevalence of bad-habits of husband and feelings of respondents about
        the bad habits
        From Table 4.7.3 it was found that majority (90.0%) of the respondents reported as
their husband having bad habits. Only 10.0 per cent of the respondents reported, as their
husband had no bad habits.
        Regarding types of bad habits majority (48.9%) of the respondents reported as their
husbands had habit of drinking followed by those who had habit of smoking (48.1%) and
playing cards (44.4%). Majority (59.3%) of respondents bothered very much about the bad
habits of their husband. 30.7 per cent were so much used to suffering that they stopped
bothering about the bad habits of their husband. The respondents who really bothered about
bad habits of their husband reported that, 33.7 per cent of the respondents felt it was hard to
run the family as he wastes his earnings. 22.5% of the respondents reported as those who
feel no more affection towards him. 16.9 per cent bothered, as they have to be called by
others as the drunkard’s wife.15.7 per cent reported, as they did not get affection from their
   Table 4.4.1. Distribution of respondents by reasons for adopting and not adopting
                          sterilization as family planning method
                                                                                      N= 150

 Sl.                        Knowledge                          Frequency        Percentage
 No.

          Respondents who were sterilized                           10                6.7

          Respondents who were not sterilized                      140               93.3

   I.     Reasons for adopting (N = 10)*

          Family members accepted after birth of                    2                 1.3
          3rd child

          Don’t want more than 2 children                           8                 5.3

  II.     Reasons for not adopting(N = 140)

          Have one child                                            24              17.14

          Afraid of sterilization                                   16              11.42

          No permission from in laws                                17              12.12

          No permission from husband                                28              20.06

          Want male baby                                            55              39.28


* All respondents were above 18 years when they were sterilized.

        husband and 11.2 per cent were bothered as their husband’s bad habits had bad
influence on children.
4.7.4 Respondents’ reasons regarding restrictions to visit their parents
    Data from Table 4.7.4 revealed that majority (63.3%) of the respondents faced one or the
other restrictions to visit their parents. 45.3 per cent of the respondents reported that they
were not allowed to visit their parents during festival, as nobody was there to attend the
household work. 26.3% reported that they could not able to visit their parents without in-laws
permission.15.8 per cent of the respondents reported that, they were allowed only once in a
year. Some (15.8%) of their mothers-in-law demanded that, parents themselves should come
and visit their daughters instead of their daughter-in-law going to visit their parents.14.7 per
cent of them reported that, they should return on the day and date specified by their in-laws
and another 14.7 per cent of the respondents reported that their mothers-in-law restricted to
visit their parents as they brought less dowry.
4.7.5 Physical violence faced by respondents and reported reasons
        It is obvious from Table 4.7.5 that half (52%) of the respondents faced physical
violence. Out of 51.2 per cent of the respondents, 29.5 per cent of them battered by their in-
laws for their perception that respondent was not giving enough respect to them followed by
(21.7%) those who battered by their mothers-in-laws for not bringing enough dowry. Similarly
Table 4.4.2. Distribution of respondents by prevalence of child spacing
        methods adopted in the past and continuing at present



Sl.                             Frequency   Percentage
No.


I.    Knowledge about spacing     121           80.7
      methods


      No knowledge                 29           19.3




II.           Prevalence                Past                     Present


                                Frequency      Percent   Frequency    Percent
                                                age                    age


I.    Adopters                     97           64.7        39             26.0


      Non adopters                 53           35.3       111             74.0


      Total                       150          100.0       150         100.0


II.   Methods


A.    Temporary methods


a.    IUD                          24           16.0        7              4.7


b.    Oral pills                   73           48.7        32             21.3


      Total                        97           64.7        39             26.0
            Table 4.4.3. Reasons for discontinuation of child spacing methods

                                                                                  N = 97

Sl.                         Reasons                       Frequency      Percentage
No.


1.      Mother-in-law did not like after knowing              33                34.0


2.      Husband scolded after knowing                         25                25.8


3.      Irritation from IUD                                   17                17.5


4.      Due to work load                                      16                16.5


5.      Belief that pills will cause problem                   6                 6.9


        Total                                                 97                100.0


       Table 4.5.1. Prevalence of problems faced during prenatal period
                                                                      N= 86

Sl.                Prevalence of problem                  Frequency       Percentage
No.

 i.      Respondents without problems                          64               42.7

 ii.     Respondents with problems                             86               57.3

         Problems reported

a.       Lower abdominal pain                                  51               59.3

b.       Vomiting and fever                                    50               58.1

 c.      Cough and cold                                        42               48.8

d.       Slight bleeding                                       42               48.8

e.       Swelling in feet                                      38               44.9
 f.      Severe bleeding                                             30              34.8

 g.      Leg pain, backache                                          15              17.4


Note. Respondents reported more than one problem


       Table 4.5.2 Prevalence of problems faced during perinatal period

                                                                                       N = 72
Sl.                Prevalence of problems                       Frequency        Percentage
No.

  i.     Respondents without problems                                78              52.0

 ii.     Respondents with problems                                   72              48.0

         Problems reported

 a.      Vomiting before delivery                                    51              70.8

 b.      Fever                                                       39              54.2

 c.      Swelling in feet                                            38              52.8

 d.      Lower abdominal pain                                        31              43.0

 e.      Prolonged labor                                             31              43.0

 f.      Heavy bleeding after delivery                               30              41.7

 g.      Breech presentation                                         4                5.6

 h.      Fits during delivery                                        2                2.8

  i.     Placenta came out first during delivery                     1                1.4

Note. Respondents reported more than one problem

         out of 71.7 per cent of the respondents, 39.7 per cent of them battered by their
husband for bringing less dowry and 32.0 per cent were battered for not having a male child.
         From the same table, results regarding lack of freedom to seek treatment revealed
that, 53.8 per cent of the respondents reported that their mothers-in-law did not permit to take
treatment followed by those (38.5%) who reported the reason of considering the treatment will
be costly by their mothers-in-law and husband. Nearly 40 per cent reported, as their husband
did not permit to seek treatment often. 33.3 per cent of them reported, as they did not get
permission till the health problem become severe.
       Table 4.5.3. Prevalence of problems faced during postnatal period

                                                                      N = 65

Sl.               Prevalence of problems           Frequency     Percentage
No.

 i.      Respondents without problems                  85           56.7

 ii.     Respondents with problems                     65           43.3

         Problems reported

 a.      Lower abdominal pain                          46           70.8

 b.      Excessive bleeding                            43           66.1

 c.      Cough and cold                                31           47.7

 d.      Nerve pain                                    7            10.8

 e.      Pain in operated area                         5             7.7


Note. Respondents reported more than one problem

Table 4.5.4. Relation between body mass index and maternity problems


                Variables                    ‘r’ values body mass index


Prenatal problems                                     -0.186*


Perinatal problems                                    -0.171*


Postnatal problems                                   -0.072 NS


* Significant at 5% level
NS-Not-significant
         Table 4.6.1 Prevalence of health problems unrelated to maternity
                                                                     N = 150


Sl.                   Types of problems             Frequency    Percentage
No.
     I    Menstrual problems
 A.       Respondents with problems                    115           76.7
          Respondents without problems                  35          23.3
 a.       Irregular menses                              37           24.7
 b.       Pain in body and legs                         27           18.0
 c.       White discharge                               23           15.3
 d.       Excessive bleeding                            20           13.3
 e.       Lower abdominal pain                          19           12.7
 f.       Long period of menses                         19           12.7
 g.       Back ache                                     16           10.7
 II       Vaginal or Uterine problems
          Respondents with vaginal or uterine           35           23.3
          problems
          Respondents without vaginal or uterine       115           76.7
          problems
 A.       Vaginal problems                              20           13.3
 a.       Burning sensation during urination            17           11.3
 b.       Itching                                       3             2.0
 B.       Uterine problems                              15           10.0
 a.       Pain in uterus                                8             5.4
b.        Swelling of the uterus                        7             4.6

Note. Respondents reported more than one problem
                               Table 4.7.1. Prevalence of violence
                                                                               N=150
            Number of respondents                                        Frequency        Percentage

I.          Reporting violence                                               120              80.0

            Not reporting violence                                            30              20.0

            Total                                                            150              100.0

II.         Types of violence suffered* N = 120

            Respondents who suffered mental cruelty                           45              36.6

            Respondents who suffered physical cruelty                         41              33.3

            Respondents who suffered both mental and                          38              30.9
            physical cruelty

      Note. * Respondents reported more than one type of cruelty/violence.


      4.8 CORRELATION BETWEEN PROBLEMS RELATED TO
          MATERNITY AND THE ILLNESSES SUFFERED AFTER
          MARRIAGE
         When the relation between the illnesses suffered after marriage before conception and
      maternity problems were examined it was found that the prenatal and postnatal problems
      were found to be significant. It revealed that, as the illnesses before conception increases the
      prenatal and postnatal problems also increases.
      4.9. DISTRIBUTION OF RESPONDENTS                                       COVERED BY
           IMMUNIZATION   AND  ANAEMIA                                        PROPHYLAXIS
           PROGRAMME
          From the Table 4.9 it was found that, majority (58.7%) of the respondents received
      immunization completely and 41.3 per cent of them did not receive the immunization
      completely.
              Regarding receipt and consumption of iron and folic acid tablets revealed that 54.7
      per cent of the respondents received tablets. 45.3 per cent of the respondents not at all
      received IFA tablets.
      4.9.1 Utilization of IFA tablets and reasons for non-utilization
                Results of the Table 4.9.1 revealed that, 48.8 per cent of the respondents consumed
      IFA tablets regularly. 36.6 per cent of the respondents not at all consumed IFA tablets 14.6 of
      them were irregular in consumption of these tablets. Those who were not at all consumed IFA
      tablets reported, as adverse effect on their health (12.2%) was the main reason for not taking
      IFA tablets followed by those who had lack of knowledge they did not take the tablets (9.8%),
      belief of problem during pregnancy reported by 8.5 per cent, belief of fetus growing too big
      and husband’s advice to not to take tablets were the reasons reported by 6.0 per cent each.
      Work load (4.9%) and advice received by their mothers-in-law (3.7%) were the other reasons
      for not taking IFA tablets.
                                              80




Percentage of respondents suffered violence
                                              70


                                              60


                                              50


                                              40


                                              30


                                              20


                                              10


                                              0
                                                   Reporting violence   Not reporting   Respondents who Respondents who Respondents who
                                                                          violence       suffered mental suffered physical  suffered both
                                                                                              cruelty         cruelty        mental and
                                                                                                                           physical cruelty
                                                                                         Type of voilence faced


                                                                                  Fig. 5 : Prevalence of violence




                                                                               Fig. 5 : Prevalence of violence
Table 4.7.2 Prevalence and types of mental cruelty faced by respondents
                                 N=85

                                                               Frequency    Percentage

 I.      Number of respondents reporting                           85         56.75

 II.     Types of mental cruelty

 1.      In-laws finding faults in her work                        27          31.8

 2.      Lack of freedom of expressing                             22          25.9

 3.      Worry of running the family due to drunkard               20          23.5
         husband

 4.      Scolded/ridiculed    for   taking    rest   during        15          17.6
         pregnancy

 5.      Should obey the mother-in-laws despotic orders            13          15.3


 6.      Scolding because she had abortion                         13          15.3

 7.      Get hurt due to bad habits of husband                     12          14.1


Note. Respondents reported more than one problem.


        Table 4.7.3. Prevalence of bad habits of husband and feelings of
                        respondents about the bad habits


Sl.                                                           Frequency    Percentage
No.
 I.      Husbands having bad habits                             135           90.0
         Husbands having no bad habits                           15           10.0
 A.      Bad habits
 i.      Drinking                                                66           48.9
 ii.     Smoking                                                 65           48.1
 iii.    Playing cards                                           60           44.4
 iv.  Taking wife’s savings without her             15                        11.1
      knowledge
Note. Respondents reported more than one bad habit.
 II.     Worrying about bad habits

         Respondents who were worried                                 89        59.3
       Respondents who were not worried                   46       30.7

III.   Reason for worrying N = 89

1.     Hard to run the family as he wastes his            30       33.7
       earnings

2.     No more feel any affection towards him             20       22.5

3.     It is hard to be called as the drunkard’s wife     15       16.9

4.     Cant get affection from him                        14       15.7

5.     His habits are having bad influence on             10       11.2
       children




 Table 4.7.4. Respondent’s reasons regarding restrictions to visit their
                                   parents
                                                                   N = 95
Sl.         Restriction on visiting parents*     Frequency      Percentage
No.
 I.    No. of respondents who were free to visit         55       36.7
       their parents

       No. of respondents who faced restrictions to      95       63.3
       visit their parents

       Total                                             150      100.0

 II.   Types of restrictions **

1.     Not allowed during festival due to lot of work    43       45.3

2.     Have to visit parents only when in-laws
       permit which was rare                             25       26.3

3.     Allowed only once in a year to visit parents      15       15.8

4.     In-laws say “let your parents only visit you if   15       15.8
       they want

5.     Told to return on the day and date specified      14       14.7
       by in-laws

6.     In-laws restrict since she brought less dowry     14       14.7
Note. * Restrictions referred to visits during festivals/marriages/
        functions
     ** Respondents gave more than one response.
    *** 133 respondents lived with their in-laws

      Table 4.7.5. Physical violence faced by respondents and reported
                                           reasons
                                                                    N=78
Sl.                                                   Frequency   Percentage
No.
I.    No. of respondents who faced physical              78          52.0
      violence
      No. of respondents who did not report              72         48.00
II.   Type of violence and reasons reported
      Battered by mothers-in-law
         1. Not bringing enough dowry                    17          21.7
         2. Perception that respondent is not            23          29.5      51.2%
             giving enough respect to elders
      Battered by husband
         1. Bringing less dowry                          31          39.7      71.7%
         2. Not having a male child                      25          32.0
      Lack   of   freedom      to   seek    medical
      treatment
         1. Mothers-in-law and husband did
             not get time to take her for
             treatment                                   42          53.8
         2. Treatment considered to be costly
             by mothers-in-law and husband               30          38.5
         3. Husband did not like to seek
             treatment often                             28          35.9
         4. No permission is granted till the
             health problem become severe                26          33.3


Note. Respondents reported more than one reason.
     Table 4.8. Correlation between problems related to maternity and the
                        illnesses suffered after marriage


                                                     ‘r’ values

  Problems of maternity
                                 Chronic illness before        Acute illness before
                                     conception                    conception


 Prenatal problems                      0.184*                        0.069NS


 Perinatal problems                     0.091NS                       0.095NS


 Postnatal problems                     0.366**                       0.024NS

 * Significant at 5% level
 ** Significant at 1% level
 NS – Non significant

      Table 4.9. Distribution of respondents covered by immunization and
                         anaemia prophylaxis programme
                                                                    N = 150

                   Services received                      Frequency        Percentage

     Immunized completely                                     88              58.7

     Immunization incomplete                                  62              41.3

     IFA tablets received                                     82              54.7

     IFA tablets not at all received                          68              45.3

      Table 4.9.1. Utilization of IFA tablets and reasons for non-utilization


                 Mode of utilization              Frequency        Percentage
       Regular consumption of IFA tablets            40               48.8
       Irregular consumption of IFA tablets          12               14.6
                                                                                     51.2%
       No consumption of IFA tablets                 30               36.6
       Total                                         82              100.0
Reasons for not taking IFA tablets N = 30
1.     Adverse effect on health                      10             12.2
2.   Lack of knowledge                                    8               9.8
3.   Problem during pregnancy                             7               8.5
4.   Belief of fetus growing too big                      5               6.0
5.   Advised by husband                                   5               6.0
6. Due to workload                                        4               4.9
7.   Advised by mother-in-law                             3               3.7

Note. Respondents reported more than one reason.


4.9.2 Distribution of childbirths by the place of delivery and the                assistance
        received
         From the Table 4.9.2 it was found that, 64.7 per cent of the births occurred at home
which was higher percentage followed by those births occurred at government hospital
(24.7%) and private hospital (10.6%).
         Regarding the person who assisted during delivery noted that, 41.1 per cent of the
deliveries assisted by their mothers. Each 20 per cent of the deliveries assisted by the doctor
and mothers-in-law respectively. Relatives/neighbours (10.6%), trained dai (4.2%), and
untrained dais (3.5%) were the other persons who assisted deliveries.
4.10. ACCESSIBILITY OF GOVERNMENT HEALTH SERVICES
      AND UTILIZATION OF HEALTH SERVICES
        Clear examination of Table 4.10 revealed that majority (66.7%)of the respondents
have no access to government health services, only 33.3per cent of the respondents have
access to health services. 77 per cent of the respondents did not utilize the available
government health services. Only 22.7 per cent of the respondents utilized health service.
43.1 percent of the respondents reported as they have limited bus facility, which was the main
reason for not utilizing the health services effectively. Non-cordial behavior of the staff
(28.4%), unsuitable timings   (11.3%), fees (10.3%) and availability of poor quality medicine
(6.9%) were the other reasons reported by the respondents
4.11 FREQUENCY OF ANMs VISIT AS REPORTED BY THE
      RESPONDENTS
        Close examination of the Table 4.11 showed that, 50.7 per cent of the respondents
reported that the ANM has visited once in 15 days followed by those (25.3%) who reported
that ANM visited their house once in a month, 24 per cent of the respondents reported that
ANM visited their house weekly once.
 Table 4.9.2. Distribution of childbirths by the place of delivery and the
                           assistance received

                                                                         N = 283

Sl.                                                       Child births
No.
                                                 Frequency       Percentage

A.    Place of delivery

a.    Home                                          203              64.7

b.    Government hospital                            50              24.7

c.    Private hospital                               30              10.6

B.    Person assisted during delivery

a.    Mother                                        116              41.1

b.    Doctor                                         58              20.2

c.    Mother in law                                  57              20.1

d.    Relatives/Neighbors                            30              10.6

e.    Trained dai                                    12                  4.2

f.    Untrained dai                                  10                  3.5
Table 4.10. Accessibility of government health services and utilization of
                              health services

Sl.                                                   Frequency   Percentage
No.

A.     Accessibility      of   Government    health
       services

 1.    Have accessibility                                50          33.3

 2.    Do not have accessibility                        100          66.7

B.     Utilization of government health services

 1.    Utilized government health services               34          22.7

 2.    Not-utilized government health services          116          77.3

C.     Reasons for not utilizing the Government
       health services

 1.    Limited bus facility                              50          43.1

 2.    Non-cordial behavior of the staff                 33          28.4

 3.    Unsuitable timings                                13          11.3

 4.    Fees                                              12          10.3

 5.    Poor quality medicine                             8           6.9

      Table 4.11. Frequency of ANMs visit as reported by respondents

                                                                     N = 150
Sl.                    Frequency of visit             Frequency   Percentage
No.
 1.    Weekly once                                       36          24.0
 2.    Once in 15 days                                   76          50.7
 3.    Once in a month                                   38          25.3
       Total                                            150         100.0
                                  V. DISCUSSION
        The findings of the study are discussed under the following headings.
5.1 Socio-economic and socio-demographic profiles of the respondents
5.2 Variables related to initiation to reproductive life
5.3 Child wastage, types, age and ordinal number of pregnancy
5.4 Family planning: knowledge, practice and reasons for non-adoption
5.5 Obstetric problems faced during pre, peri and postnatal period
5.6 Reproductive health problems other than those related to maternity
5.7 Domestic/gender violence
5.8 Receipt and consumption of iron and folic acid tablets, reasons for     non-consumption
     and utilization of immunization services
5.9 Frequency of ANMs visit
5.10 Overall conclusion
5.1     SOCIO-ECONOMIC     AND     SOCIODEMOGRAPHIC
        PROFILE OF THE RESPONDENTS
            As the socio-economic and demographic profile of the respondents provide a logical
basis to understand their health. The results regarding these aspects are discussed here
under. These factors were known in the related literature to influence the reproductive and
general health of the adolescent girls. Hence all these aspects of the respondent’s profile are
discussed in this chapter.
            Regarding socio-economic status, with reference to education of the respondents and
their husband, half (52.0%)of the respondents were found to have school education ranging
         th      th
form 5 to 10 standard and more than one-third were found to be illiterate, whereas majority
(70.8%) of their husbands were found to have education ranging from 5th to 10th standard.
Only 15.3 per cent of husbands were found to be illiterate. The reason for the illiteracy rates
among respondents could be that most of them worked as a paid labourer and did unpaid
domestic work during their school age years. As such they did not go to school. These results
corroborate with the results of Nanda (2002) who found 48.1 per cent of teenage girls were
illiterates.
                                                                                        th      th
            NFHS (1992-93) data showed that the school education ranging from 5 to 10
standard was 28.5 per cent and illiteracy was 89.8 per cent among adolescent girls in rural
Karnataka.
            According to census report (2001) it was found that, female literacy was 53 per cent
in rural areas of Ranebennur Taluk where the present study was carried out. Thus the results
of the present study, which revealed that, 52 per cent of the sample had education ranging
from 5th to 10th standard, 11.4 per cent completed their primary education and few of them
studied above PUC, are in line with census figures for female literacy rates.
            Regarding occupation, majority of the respondents and their husbands were found to
be engaged in agricultural labour. However, it must be pointed out that being very young
women and being daughters-in-law, they were not only working in the fields for wages but
also doing household chores at home. Only one-fourth of them were found to be staying
purely as housewives attending to housework only. As compared to their husbands, except
one who was a government jobholder none of the respondents were found to be working
outside the agricultural fields and home. This would be due to their low educational level. In
addition being young and married women they find less opportunity to work outside the home
and fields. Moreover lack of access to information, low education and mainly poverty might
have forced respondents to work as agricultural labourers. Similar results were found by a
study conducted on young women (<18 years) by Malviya et al. (2003).
            About annual income, all the families of the respondents were below the poverty line,
as defined by census 2000. Majority of the families were found to have annual income
between Rs. 9000 to upto Rs. 10,000.
            According to Government of Karnataka IRDP (1998), it was found that majority
(78.66%) of the families in rural areas were living below poverty line.
            Thus it is obvious from socio-economic profile that, majority of the respondents had
some amount of schooling and were working as agricultural labourers. It is not surprising to
find that all families were depending on daily wages, because of their low income. Thus most
of the respondents and their husband were not sufficiently educated to find occupations,
which are better paid.
         Regarding socio-demographic profile, when the present age of the respondents was
examined, it was found that more than half of the respondents were in the age group of 17-19
years and 40 per cent of them were 20 years of age. This kind of sample distribution is due to
the fact that the sample selected were all married adolescent girls below 20 years of age.
         When the type of family was examined, it was found that, majority (88.7%) of the
respondents were living in joint families. The reason could be that being young, married at an
early age, and being powerless in their home, they cannot immediately form a nuclear family.
These results were similar with the results reported by Sharma et al. (2003) who found that;
majority (67.1%) of the married adolescents lived in joint families.
         About size of the family, majority (81.4%) of the respondent’s families were found to
consist of 5-10 members. These results are in line with the study conducted by Malviya et al.
(2003) where the family size was found to be more than five members (61.5%). Moreover
large family is considered ideal in rural areas.
         An examination of the results about the number of children, showed that, half (50%)
of the respondents were found to have two children and 43 per cent of respondents had one
child. The reason could be that still the family planning methods were not completely adopted
by the respondents. These results are similar with the results of the study conducted by
Audinarayana (1986) on influence of age at marriage on fertility and family planning behavior,
which revealed that the mean number of children ever born to the mothers who were in the
age group of 13-18 years was 4.37. Whereas the number of children was significantly
decreased to 2.98 when the mothers’ age at marriage was 20 years.
         Regarding religion, majority (93.3%) of the respondents were Hindu. Majority (63.3%)
were found to be from SC/ST caste. When one examines caste composition of the female
married population below 20 years in selected villages, SC/ST population was found to be
overwhelmingly represented. Thus the high percent of SC/ST population was represented in
the sample also (See Appendix). This results points out the high incidence of early marriages
among SC/ST population than among the general population. Similar results were observed
in the study conducted by Gupta and Khan (1996) where it was found that majority (38%) of
the married teenage girls belonged to SC/ST as compared to higher castes (14%).
5.2     VARIABLES   RELATED                           TO         INITIATION              TO
        REPRODUCTIVE LIFE
         Variables related to initiation to the reproductive life were well established as the
factors influencing the reproductive health of the married adolescent girls.
         Regarding age at menarche, it was observed that, majority of the respondents
(57.3%) reached menarche at the age of 13-15 years followed by more than one-third of
respondents (37.3%) who reached menarche at the age of 10-12 years. The mean age at
menarche for the sample of the study was found to be 13.07 years. Similar results were found
in the study conducted by Chaturvedi et al. (1994) who found that mean age at attainment of
menarche was 13.54 years.
         About the age at marriage, majority (84.7%) of the respondents married at the age of
14-18 year, with the mean age at marriage being 15.3 years. The reason for early marriages
before the girls reached legal minimum age was the belief in the custom and tradition of child
marriage, other reason could be the lack of awareness regarding the legal minimum age at
marriage. It must be pointed out here again that majority of these respondents belong to
SC/ST caste which reflects the strong tradition of child marriage among the SC/ST caste.
Similar results were found in the study conducted by Singh et al. (1995). They found in their
study on morbidity among the rural women in Maharashtra that majority (84%) of their
respondents were married before the age of 19 years.
         Regarding consummation of marriage, it was found that overwhelming majority
(98.7%) of the respondents’ marriage was consummated between the ages of 13-17 years,
with the mean age at consummation of marriage being 16 years. Only in case of two
respondents out of 150, marriage was consummated after 18 years. The reason could be that
the parents think that their daughter is ready to start their reproductive life as soon as she
attains menarche. Similar results were found in the study conducted by Bhargava et al. (1991)
on identification of high-risk mothers and outcome of their off springs, where the mean age at
consummation of marriage was 16 years.
           Results regarding age at first pregnancy revealed that, a very large majority (97%) of
the respondents were pregnant for the first time before they reached 18 years of age. The
obvious reason was the early consummation of marriage before they reached the age of 18
years and the mean age at consummation of marriage being 16 years.
           According to NFHS (1992-93) report it was found that, almost 60.0 per cent of
childbirths occurred when the rural women were between 15-19 years of age. Thus the
results of the present study were in line with the NFHS report.
           When time interval between consummation of marriage and first pregnancy was
examined it was found that, more than half of the respondents conceived within one year of
consummation of their marriage followed by more than one-third of the respondents who
conceived within 2 years of consummation of marriage. The reason for this could be that in
rural areas the first pregnancy is expected to occur soon after the consummation of marriage.
According to Hutter’s (1994) observation if the married adolescent girl does not become
pregnant even after 2 years of marriage her family would start worrying about her lack of
fertility.
5.3     CHILD WASTAGE; TYPES, AGE AND ORDINAL NUMBER
        OF PREGNANCY
         The high prevalence of child wastage among adolescent mothers especially in rural
area is a well-established fact (NFHS 1992-93). Due to repeated pregnancy at an early age,
the health of adolescent mothers is adversely affected. Such pregnancy also increases the
risks of child wastage especially through miscarriage.
         In the present study when child wastage was closely examined, it was found that
more than half of the respondents (53.3%) experienced child wastage. Of the total number of
pregnancies the child wastage occurred in case of more than 30 per cent respondents. These
results are consistent with findings of the study conducted by Chatterjee et al. (1991) who
found that, the prevalence of child wastage was high among adolescent mothers.
         In the present study, the types of child wastage found were miscarriages, stillbirths,
neo-natal and infant deaths. Regarding child wastage due to miscarriages, it was found that,
most of the miscarriages (43.3%) occurred in the first pregnancy and few (8.2%) in second
pregnancy only. These results point out that age factor plays an important role where in
hundred percent of the miscarriages were found to occur when respondents carried their
pregnancy when they were below 18 years of age (table 4.3.5).
         The results of the study conducted by Asundi (2000) on reproductive health of women
belonging to rural landless families in Gadag district of North Karnataka, revealed that the
total prevalence of child wastage among the respondents who were below 18 years of age
was 40 per cent. Of the total pregnancies, child wastage was found to occur in case of 30 per
cent pregnancies. Further it was found that one third (33.63%) of the miscarriages occurred
when the respondents were below 18 years of age.
         Results similar to the present study were found to be in the study conducted by
Pawar (2004). Her study on knowledge and practices regarding reproductive health of
Lambani women in Bijapur taluk of North Karnataka revealed that 52.0 per cent of the
respondents were found to have experienced child wastage. Out of the total pregnancies of
the respondents 20 per cent resulted in child wastage. Further it was found that more than
half (54.0%) of the miscarriages were found to occur when the respondents were below 18
years of age.
         According to Sharma (2003) who conducted a study on pregnancy among
adolescents found that, miscarriages among adolescent girls were mainly due to the pressure
of family’s expectations that the girl should immediately bear the child to prove her fertility
even though she was not yet physiologically ready or mature to bear the child.
         In the present study, the reason for the miscarriages in first and second order of
pregnancy was due to early age at marriage which lead to early child bearing during which
period the girl is not completely ready to carry the baby. It must be noted that almost all the
miscarriages were reported by the respondents who were below 18 years of age.
          Further, impact of nutritional intakes on pregnancy outcome is a fact well
established. In this study it has been found that, one fourth of the respondents were having
moderate to mild malnourishment (BMI <18.5) as indicated by their body mass index. Further,
one third of them were found to be normally nourished but were having low body weight,
which could make them likely candidates to suffer from child wastage. Thus their young age
and varying degrees of malnourishment might have contributed to the high child wastage
when they were below 18 years of age. The malnourishment with a burden of pregnancy can
make the young girls prone to infection, which may further reduce the chances of child
survival.
         It may be noted from the results (Chapter IV, table 4.3.6) that, nearly one third of the
respondents in the present study were having a height less than 145 Cms and one-third were
having a weight less than 38Kg both of which are considered as the risk factors for
pregnancy. As a result of combined effects of shorter average maternal height and
competition for nutrients between mother’s growth needs and growth needs of fetus, the
health of the mother and child may be greatly affected. It is estimated that 47 per cent of the
adolescent girls in India have body weight less than 38 kg and 39 per cent have height less
145 cm which were known as risk factor for pregnancy (ShivaMeera, 2000; Saroja, 2001 and
NFHS 1992-93).
         In addition, it may be noted that, in this study many of the respondents continued to
do household work and hard labour for wages (Table 4.1.1). The cumulative effect of their
malnourished status, young age at marriage, hard physical labour for wages and lack of
antenatal care, food and rest might have lead to miscarriages during their first and second
pregnancies.
         The results of the present study revealed that, more than half of (55.3%) pregnancies
occurred when the respondents were below 18 years of age (Table 4.3.4).
         When stillbirths were examined in relation to the ordinal number of pregnancy and the
age of the respondents it was found that, stillbirths occurred during second and third live
births. Out of total fifteen stillbirths, fourteen occurred when the respondent was below 18
years of age (Table 4.3.2 and 4.3.5).
        Khandait et al. (2000) in their study conducted in Nagpur on stillbirths found that,
teenage women had higher risk of delivering stillborn baby as compared to adult women.
         Study conducted by Asundi (2000) revealed that, half of the stillbirths occurred to the
respondents when they were below 18 years of age.
         Chatterjee et al. (1991) in their results found that, stillbirth was highest for the mother
aged below 18 years of age. According to Dasgupta (1997) non-utilization of antenatal care
services is a major factor responsible for stillbirths. In this study also majority of the
respondents did not use antenatal care services properly (Table 4.10). This might have
contributed to stillbirths. These results were in line with the results of Sharma et al’s (2003)
study in which it was found that, the percentage of stillbirths was higher (15.6%) among
adolescents as compared to adult (1.3%) group.
         In this study, it was found that, most of the neonatal deaths and infant deaths
occurred when the respondent were below 18 years of age.
         Thus the results of the present study revealed that 99 per cent of the child wastage
occurred when the respondents were below 18 years of age. There are several factors, which
contributed to the child wastage. The main reason is early child bearing. Though the girl
attains menarche at 12 or 14 years of age, she cannot bear a child until she attain minimum
of 20 years of age. But most of the respondents’ parents send their daughters to the
husband’s house without knowing the effect of early child bearing on adolescents. Thus early
conception leads to miscarriages and most of the time leads to not only complications during
delivery resulting in stillbirths and the increased risk of infection to infants leading to neonatal
and infant deaths. Further, as found in this study one-fourth of the respondents were suffering
from moderate to mild nourishment. More than one-third of the respondents were normal but
they were with low body weight. Thus their bodies were not fully nourished and ready to bear
the child. Thus it was not surprising to find the high prevalence of child wastage among
adolescent mothers.
         According to Jejeebhoy (1996) not only does early child bearing further deplete the
malnourished adolescent, but it result in severe damage to the reproductive tract which may
affect future pregnancy and childbirth.
         It can be concluded that, the respondents of this study had a very low status in their
families. Further due to their powerlessness in decision-making regarding their own health
especially during their pregnancy and postnatal period, they could not seek medical treatment
whenever it was required. Sharma (2003) has reported that, only 2 per cent of women
participated in decision making with respect to their health. Thus one can draw conclusions
regarding child wastage that, apart from early pregnancy and malnourishment the high
prevalence of child wastage among respondents could be due to various factors such as lack
of decision making power regarding their own health, regarding decision making to seek
treatment and pressure to deliver at home and family pressure to bear the child to prove her
fertility.
5.4    FAMILY PLANNING: KNOWLEDGE,                                     PRACTICE            AND
      REASONS FOR NON-ADOPTION
          Family planning is not merely the regulation of the number of children. It is also a
method for appropriate spacing of children in such a way that the woman conceives with
minimum risk to herself as well as to her off spring’s health. The success of family planning
ultimately depends on decision making at household level.
          Regarding knowledge, the results of the present study revealed that, majority (72.0%)
of the respondents knew about the female sterilization than male (43.3%) sterilization and
majority (80.7%) of the respondents knew about temporary methods.
          According to NFHS (1992-93) data, 99 per cent of the married women knew about
female sterilization than male (81.0%) sterilization. The knowledge of contraceptive was
universal. Thus as compared to NFHS data, the knowledge level of the respondents in the
present study was found to be fairly low. The reason for this could be that, the respondents
being young might have been shy to ask about sterilization and temporary contraceptives
when the ANM or anganawadi workers wanted to inform them about the family planning.
           When the results of the present study were examined it was found that, 6.7 per cent
of the respondents were sterilized. It must be noted that all the sterilized respondents were in
the age group of 19-20 years. Among the rest even though some wanted to undergo
sterilization they were not permitted and some wanted male baby. It must be noted that 50
per cent of them had two living children and the rest had at least one child.
          Similar results were found in the study conducted by Lingaraju (1998) where majority
of the respondents said that, they did not use permanent method, as they wanted a male
baby. Others reported the fear of complication and desire for more number of children and
objection by their husband as reason.
          In the present study it can be noted from the results that, 65 per cent of the
respondents practiced temporary methods in the past without the knowledge of their in-laws
and husband. When in-laws came to know about the use of contraceptives by the
respondents, they had to discontinue temporary contraception. Thus the number of
respondents using contraception was found to be decreased from 65 per cent to 26 per cent.
The other reasons that contributed to sharp decline in the use of temporary contraceptives
were open disapproval of the husband, irritation from IUD and side effects of the pills. At the
time of study only 26 per cent were found to be using temporary methods of
contraception.21.3 per cent were using pills and 5 per cent were using IUD. These results
were consistent with the study conducted by Islam and Islam (1998) on contraceptive use
among married adolescent girls. In their study they found that the husband’s dislike or
unwillingness to contraceptive was reported by 23 per cent of the respondents. More than
one-third reported that they wanted more children. Fear of side effects, religiosity and social
factors were other reasons for not using of contraceptives.
          Thus it may be concluded from results of the present study that, knowledge of family
planning methods was high but the practice was low. Temporary methods, even though
available easily, respondents found it difficult to practice, because of lack of autonomy in their
home to practice family planning. Prevalence of misconceptions about the temporary family
planning methods as cause of illness was another reason to discontinue them. The gap
between awareness and actual use can be due to attitudinal problems or due to a poor
service delivery mechanism. NFHS (1992-93) data also revealed that, the awareness about
contraceptive method was quite high in the state and yet the actual use of contraceptives was
low.
        These results imply the need to promote contraceptive use among the women below
20 years of in the rural areas by creating an awareness regarding ill effects of early and
frequent child bearing on both the young women and their babies. There is also a need to
educate and involve the young married men and the older female members of the family in an
active campaign to popularize temporary contraception, as they happen to be the important
decision makers in the family.
5.5     OBSTETRIC PROBLEMS FACED DURING PRE, PERI
        AND POSTNATAL PERIOD
         Maternal age plays an important role during pregnancy that influences the outcome of
the delivery and health of the adolescent girl after the delivery. Adolescent girls are at risk for
complications during all these three periods. Only the degree of complications varies from one
adolescent girl to other adolescent girl. Failure to meet the nutritional requirements during
pregnancy may also pose an additional risk to the adolescent mothers.
          In the present study-more than 55 per cent of the respondents reported one or more
problems during pregnancy. This indicates the high prevalence of maternal morbidity. The
problems faced by the respondents were, lower abdominal pain, vomiting and fever, cough
and cold, bleeding, swelling in feet, leg pain and back ache (Table 4.6.1). Bleeding during
pregnancy is the sign of threatened abortion. Hence the adolescent mothers require
immediate treatment to overcome these problems. The above discussion show high
prevalence of problems during prenatal period. These results are in line with the study
conduced by Dhak (2003) on complications of pregnancy among teenagers. He found that,
the prevalence of prenatal problems among teenagers were high. His respondents also
reported the same problems like swelling in feet, vomiting, fever, cold and cough. Even
though there were number of studies on prenatal problems, they were all either carried out on
the adult women or on a sample where the problems were not analyzed by classifying the
respondents into different age groups. As such no detailed discussion in comparison with
such studies could be presented here.
                                                                    th                       th
          Perinatal period can be defined as the period from 28 week of pregnancy to 7 day
of birth. During this period proper care is absolutely necessary. Poor nutritional status among
adolescent mothers shows high incidence of complications, which put them under risk. It was
found in the present study that, nearly half (48%) of the respondents faced problems during
perinatal period. Among them majority faced problem of vomiting before delivery. Fever, lower
abdominal pain, which existed during pre-natal period continued in perinatal period also.
Prolonged labour and heavy bleeding after delivery were the other problems reported by the
respondents (Table 4.5.2). Few respondents faced problems of breech presentation, fits and
placenta coming out first during delivery. All these problems were due to the improper or lack
of treatment and care during pre and perinatal periods.
          Child bearing exerts heavy toll on adolescent girls. The NFHS (1992-93) data,
reported that births to mothers less than 20 years of age at the time of delivery are more likely
to result in complications than among mothers belonging to higher age group. It may be noted
that as already mentioned in the previous section that all the respondents selected were
below 20 years of age. Hence this child bearing at an early age might be the reason for their
suffering the observed complications.
          In the present study one third (43.0%) of the respondents had long labor period.
Similar result was found in the study conducted by Sharma et al. (2003), where in 82.8 per
cent of the adolescent mothers were found to have suffered long periods of labour.
          Regarding use of health services, in the present study nearly 78 per cent of the
respondents did not utilize the health services. Only less than one fourth (22.7%) of them
utilized health services. Limited bus facility, non-cordial behaviour of the staff, unsuitable
timings, demand for fees and poor quality of medicine (Table 4.10) were the reasons reported
by the respondents for not utilizing the health services. These results are consistent with the
results of the study conducted by Vijay Kumar and Chakrapani (1995). In their study, they
found that, most of the adolescent women did not use the health services due to
inaccessibility of the health center, poor transportation facilities and poor quality of medicines.
Poor quality of medicines resulted in poor recovery and dissatisfaction among the
respondents, which lead to subsequent non-utilization of the facility.
          Regarding place of delivery in the present study majority of the respondents were
found to have delivered at home (64.7%) (Table 4.9.2). Among these respondents nearly 76
per cent were assisted by their mothers, mothers-in-law, and relatives/neighbours and
untrained dais during their deliveries. These categories of persons were usually will not be
aware of complications, which may arise during delivery. As such it was natural for the
respondents of this study to have suffered complications during childbirth as already
discussed. In this context adolescent mothers were likely to be exposed to unhygienic
delivery, which lead to the risk of morbidity and mortality of the mother and child during and
after the childbirth.
          Regarding the problems faced during postnatal period 43.3 per cent of the
                                                                                       th
respondents reported one or more problems. Post-natal period is a period from 7 day of the
                  th
childbirth to 45 day of childbirth. When the post natal problems as reported by the
respondents was closely examined, it was found that, majority of the respondents mainly
reported problem of lower abdominal pain, followed by excessive bleeding, cough, cold, nerve
pain and pain in operated area (Table 4.5.3.) in that order of occurrence. Similar results were
found in the study conducted by Dhak (2003) on adolescent mothers, who reported high
incidence of lower abdominal pain and excessive bleeding.
         Regarding the effect of nutritional status on the incidence of problems during pre and
peri-natal periods it was found that there was a close and significant negative relationship. In
the present study the nutritional status, which was calculated by calculating the body mass
index, was found to be negatively and significantly correlated with the incidence of pre and
peri natal problems.
          From these discussions one may infer that, pregnancy complications among teenage
mothers in the locale of the study. Pregnancy complications differs from place of residence,
education, age at birth of child, antenatal care are also important factors, which influence the
health of pregnant teenage mothers.
         In this study, it may be noted that, majority of the respondents did not receive proper
antenatal care services and most of them were delivered at home with the assistance of those
persons who were not able to identify the high-risk deliveries. Due to these reasons many of
them were unaware of the dangers of pregnancy complications. As such these problems
carried to the peri and postnatal periods also.
         It can be concluded that many of the respondents who had problems during delivery,
had neglected to seek medical assistance till the delivery became highly complicated and
dangerous to their life. Thus the problems that have developed during deliveries continued in
the postnatal period also. From these results one can conclude that maternity problems are
highly prevalent among teenage mothers residing in rural areas without proper facilities and
especially among those who are not having any decision making power within their family
regarding their own reproductive health. It may be noted that the adolescent mothers being
married at an early age had less autonomy in decision making regarding adopting family
planning, regarding seeking and taking treatment, having less nourishing food or having low
nutrient intake have all of which contributed to making these adolescent mothers highly
vulnerable.
5.6 REPRODUCTIVE HEALTH PROBLEMS                                        OTHER THAN
    THOSE RELATED TO MATERNITY
        Health problems unrelated to maternity form one class of reproductive health
problems. The problems, which come under this category, are menstrual, vaginal and uterine
problems. Usually married adolescents are shy to discuss these problems with anyone due to
social stigma attached to these problems and also due to their powerless position in their
marital home. Thus the adolescent girls are at risk when they suffer these problems
frequently. Hence an attempt was made in this study to investigate the prevalence of these
problems.
        Results of the present study found that almost all the respondents had one or more
reproductive health problems unrelated to maternity. Majority reported problems related to
menses followed by vaginal and uterine problems.
        When menstrual problems of the respondents were examined, it was found that,
nearly one fourth of the respondents suffered from irregular menses, 18 per cent of them had
pain in body and legs. 15.3 per cent had white discharge, 13.32 and 12.7 per cent had
excessive bleeding and lower abdominal pain. Similar results were found in Inamati’s (2001)
study on menstrual problems of school students in rural and urban areas. She reported that
64 per cent of the respondents, who reported problems, were found to be suffering from lower
abdominal pain (dysmenhorrea) and 55 per cent of them reported irregular periods
(secondary amenorrhea). Nearly 40 per cent of them reported heavy bleeding (menorrhagia).
        Similar results regarding menstrual disorders and lower abdominal pain were found in
Rahman et al’s. (1995) study, conducted on adolescent girls. Their study found that,
menstrual disorders were reported by nearly 64 per cent. Nearly 60 per cent of the
respondents reported problem of lower abdominal pain.
        Regarding vaginal problems in the present study most of the respondents complained
of burning sensation during urination. Similar problem was reported in the Rahman et al’s.
(1995) Study. They found that 46.1 per cent of the adolescent girls reported burning sensation
during urination. The high prevalence of this particular problem could be due to the poor
personal hygiene and sanitation among the respondents. Similar explanation was given by
Rahman et al’s (1995) study also.
        Some respondents in the present study suffered uterine problems. The problems
suffered by these respondents were pain in the uterus and swelling of uterus. No studies were
available regarding uterus problems among adolescent girls. Hence no comparative
discussion could be presented here.
        Thus, from the above discussion, it may be concluded that, the prevalence of
menstrual problems among adolescent girls was high. The reason could be that, most of the
girls were from the low socio-economic status families and found to be malnourished.
Moreover when the adolescents attain menarche in their parental home, the mothers of the
adolescents who should become a source of knowledge regarding process of menstruation to
make their daughters enlightened regarding their menarche were found to be not giving this
information to their daughters. With this lack of knowledge about menstruation, process of
menstruation, association between menstruation and reproduction along with the necessity of
maintaining hygiene, girls get married and were sent to their marital homes. All these factors
cumulatively contribute to the high prevalence of menstrual problems among adolescents.
Hence, the menses problems like irregular menses, pain in body and legs, white discharge,
excessive bleeding, which can lead to anaemia, were found to be highly prevalent (76.7%)
among the respondents.
5.7     DOMESTIC/GENDER VIOLENCE
         Domestic violence is the most pervasive yet least recognized human rights abuse. It
is also a profound health problem, damaging the physical health of the victims and eroding
their self-esteem. Violence against women/adolescent girls refers to any type of harmful
behaviour directed at women/adolescent girls. The effects of violence can be devastating to
the victim’s reproductive health as well as to other aspects of physical and mental well being.
Women/married adolescent girls with a history of physical abuse or any other type of gender
violence are also at increased risk for unintended pregnancy, adverse pregnancy outcomes
and sexually transmitted infections. In the present study, the data were collected on mental
cruelty in the form of lack of freedom to visit their parents, worry cum shame suffered by the
respondents regarding bad habits of their husband and physical violence.
         In the present study the prevalence of violence was found to be extremely high
(80.0%). Respondents suffered either mental cruelty or physical cruelty or both. Only 20 per
cent of them did not face any type of cruelty/violence (Table 4.7.1).
         When the prevalence of mental cruelty faced by the respondents was closely
examined, it was found that, more than half (56.8%) of the respondents reported one or more
type of mental cruelty. Mothers-in-law were reported to be finding faults with respondents in
whatever work they did (31.8%). This was the major type of mental cruelty reported by the
respondents. Respondents worried regarding running the family’ as their husband was a
drunkard (23.5%). This worry was due to the heavy responsibilities, respondents shouldered
to earn money for running the family. Other forms of cruelty reported by the respondents were
ridiculing/scolding by mother-in-law whenever they tried to take rest. They were also scolded
whenever they miscarried. Respondents felt bad because they were not allowed to express
their opinions and decisions. Thus being ruled by despotic mothers-in-law was the main
reason for them to adjust to life at in-laws family (Table 4.7.2).
         Respondents were also emotionally hurt by the bad habits of their husband. In the
present study, overwhelming majority (90.0%) of respondent’s husband was found to have
bad habits. Drinking, smoking, playing cards were found to be the common bad habits of their
husband. Few husbands were found to be taking away the wife’s savings without her
knowledge to pursue their bad habits. Nearly 60 per cent were really bothered about the bad
habits of their husband. More than one-fourth (30%) were so much used to suffering that they
stopped bothering about the bad habits of their husband (Table 4.7.3). Those of the
respondents who bothered about their husband’s bad habits did so due to the fact that the
husband wasted most of his earnings on bad habits. Some respondents felt that, because of
his bad habits they were no more feeling, any kind of affection towards him (22.5%). Few of
them felt very much ashamed to be called as a drunkard’s wife. Few respondents worried
about the bad habits of their husband because they could not get affection they craved to
have from him (15.7%). Few others worried about the bad influence, these habits may have
on their children.
         Another kind of mental cruelty/violence suffered by the respondents was that, they
were prevented from visiting their parents whenever they wanted and even during festivals or
marriages or functions. When the reasons for such restrictions were examined, it was found
that, majority (63.3%) of the respondents were restricted mainly by their mothers-in-law. The
major excuse given by the mothers-in-law as reported by the respondents was that, if she
was allowed to visit her parents there would be none to attend the household chores.
However respondents were allowed only once in a year to visit their parents. Some of their
mothers-in-law demanded that, parents themselves should come and visit their daughters
instead of their daughter-in-law going to visit their parents. Few of the respondents reported
that they should return on the day and date specified by their in-laws. These respondents
reported that, their mothers in law restricted their visit to parents as they brought less dowry.
           Other form of violence found was physical violence. When the prevalence and
reasons for such violence was examined, it was found that, half of the respondents (52.0%)
were battered by their mothers-in-law and their husband. More than one fourth (26.6%) of
mothers-in-law beat the respondents for not having brought enough dowry. Nearly one third
(32.00%) of the respondents of them were battered by their mother-in-law on the pre-text of
not showing enough respect to the elders. More than one-third (43.0%) of them were battered
by their husband for having brought less dowry. More than one-third of them (34.7%) were
beaten by their husband for not having a male child. Thus on more than one pretext
respondents were beaten.
          The denial of freedom to seek treatment was another form of physical violence. When
results were examined, it was found, majority (61.3%) of the respondents had no freedom to
seek medical treatment as their husband and mother in laws had no time to take them to
health center. Seeking treatment on her own by going to health center all by herself was not
allowed. Treatment was considered by these two people as costly. More over the husband did
not like her to visit health center often even when accompanied by others. Some of them did
not get permission till the health problem become severe (Table 4.7.5). The reasons could be
that all the respondents of the present study were young, married at an early age and had no
freedom to discuss the health problems with their in-laws and husband. In addition,
respondents did not have enough knowledge about the pregnancy, delivery and problems of
postnatal period. All these factors made them to suffer quietly.
          CEDPA’s (2001) study found that, among married young women aged 15-19,
decision making and freedom of movement is very low with only 38.6 per cent involved in
decision making about their own health.
          Santhya and Jejeebhoy (2003) in their report based on the analysis of data taken
from NFHS data on violence stated that, the prevalence of domestic violence was more in
case of married adolescents (16%) as compared to the older (13%) women. This low
prevalence of violence as compared to the results of the present study was due to the fact
that NFHS data was collected from both the urban and rural areas. However in the present
study the data was collected only in rural areas by personal interview after establishing
enough rapport, which might not have been possible in a big survey of NFHS.
          Thus the results of this discussion revealed that, the prevalence of violence was very
high (80.0%). The respondents were faced one or the other type of cruelty from their mother-
in-law and husband. This was due to lack of freedom of respondents to show any kind of
resistance to the violence. More over they lacked freedom to take any kind of decision or
action on their own behalf. Moreover being young, married at an early age they could not
discuss their opinion in front of their family members. Poverty may also be a factor to making
them suffer such violence. Population reports (2000), which analyzed the related studies
stated that, although domestic violence occurs in all socio-economic groups, it was found that
women/adolescent girls who live in poverty are more likely to experience violence than
women belonging to all other classes. In the present study almost all of the respondents lived
in low-income joint families where their status was low. They had no freedom to visit their
parents whenever they required parental attention, i.e., during pregnancy, or during their
sickness or whenever they miscarried or during festivals, marriages and functions. They were
not usually allowed either by their mothers - in -law or by their husband to visit their parents.
In addition majority of the respondents were not allowed to seek the medical treatment. This
kind of not giving freedom and imposing restrictions on her mobility was a direct way of
controlling her life.
5.8 RECEIPT AND CONSUMPTION OF IRON AND FOLIC ACID
    TABLETS, REASONS FOR NON-CONSUMPTION AND
    UTILIZATION OF IMMUNIZATION SERVICES
       Immunization and anaemia prophylaxis programme are the important components of
antenatal care. These can contribute significantly to the reduction of maternal morbidity and
mortality. Antenatal care includes advice on correct diet, necessary immunization and
provision of iron and folic acid tablets to pregnant women. Improved nutritional status,
coupled with antenatal care can help to reduce the incidence of low birth weight babies and
thus reduce perinatal, neonatal and infant mortality (NFHS, 1992-93).
          It was found that, more than half (54.7%) of the respondents received IFA tablets and
45.3 per cent did not receive the IFA tablets Among those respondents who received IFA
tablets, nearly 49 per cent consumed them regularly. Nearly 15 per cent were irregularly
consumed them and nearly 37 per cent did not consumed IFA tablets. Regarding regular
consumption of IFA tablets, the present study result was in line with the study conducted by
Dhak (2003) on adolescent mothers who reported that 47 per cent consumed IFA tablets.
          The reported reasons for the non-consumption of IFA tablets were the number of
misconceptions regarding the effect of IFA tablets on their health. Few respondents reported
that they were prevented from taking IFA tablets by mother-in-law and husband (Table 4.9.1).
Thus this indicate an urgent need to educate and convince the pregnant women and the
elderly women in the family regarding the benefits of IFA tablets and to remove the
misconceptions regarding this anaemia prophylaxis programme.
          According to NFHS (1992-93), the percentage of women covered by anaemia
prophylaxis in Karnataka was 75 per cent. But their actual utilization and reasons for non-
utilization is no-where mentioned in this report. Thus there is a need to conduct a fallow-up to
know the percentage of women who actually consumed the IFA tablets.
           Regarding immunization, it was found that, more than half (58.7%) of the
respondents were immunized completely and 41.3 per cent were immunized partially.
          NFHS (1992-93) data, reported that, 66.1 per cent of the married women below 20
years of age were immunized completely and 6.9 per cent were immunized partially.
          This NFHS (1992-93) data reported regarding IFA tablets and immunization of
women but there was no explanation regarding adolescent mothers as just divided the age
group in the tables. According to this report, three fourths of births in Karnataka were to the
mothers who consumed IFA tablets. It should be noted that even in the cases where women
received these nutrition supplements, it is not always certain that the pregnant women took
the tablets regularly. Hence there is a need to investigate the follow-up by the study
group/women.
          NFHS (1992-93) report also found that, the women who did not utilize antenatal care
services considered it unnecessary, reflecting the traditional notion that child bearing is not a
event worthy of medical attention, and the women’s willful neglect.
           From the discussion of this part, it may be noted that, non-consumption of IFA tablets
was due to misconception about the effect of these tablets as discussed earlier and also due
to powerlessness and restrictions by the mothers-in-law and their husband, young
adolescents were deprived of these services. In addition, the respondents considered
immunization also as not         important. It may be due to lack of knowledge about the
advantages of immunization. Hence one can conclude that adolescent women in the study
area have not yet realized the importance of antenatal care.
5.9     FREQUENCY OF ANMS VISIT
         The auxiliary midwives are the gross root level workers of the primary health services
provided in rural areas. The specified duties of the ANMs are, understanding the health
problems of the women, counseling giving preventive treatment and making the rural women
to understand the importance of both the immunization and the consumption of IFA tablets
during pregnancy. They are also responsible for giving information regarding family planning
and to motivate them to adopt family planning. All these are possible only when the ANMs
develop good rapport by regularly visiting the women.
         Based on the population, villages were allotted to the ANM’s. According to the duties
specified, ANMS have to visit the houses in the villages. But one-fourth of the respondents
reported that, ANMs visited them once in a month and nearly 51.0 per cent pointed that ANMs
visited them once in 15 days. When few ANMs were interviewed to get supplementary
information, they reported that, they could not reach some of the villages in time due to lack of
regular bus facility. But the researcher felt that if ANMs started early in the day they could
reach the village and may be able to visit the number of houses they have to cover. However,
the ANMs made some good effort to make the adolescent mothers to practice family planning
and to be immunized. It has been found that, nearly 59 per cent of the respondents received
immunization completely. Nearly 65 per cent were found to have practiced temporary family
planning methods for a period of time. At present, most of the respondents who were
practicing temporary family planning method have stopped once it was found out by their
mother-in-law and or husband (Table 4.4.2). This is not because, they were lacking in
counseling or advise from the ANM but because they were prevented by their mother-in-law
and husband. This shows that, ANMs were able to convince only the respondents and make
them to adopt family planning method. But it appears that ANMs were unable to convince
mother-in-law and men folk or they might not have approached these two important people in
the family to help the young teenage mothers to adopt the family planning.
          The ANM’s interviewed complained about the respondents in general that it was very
difficult to motivate the respondents to use all the health services especially family planning
services. They pointed out that, one or the other problems or restrictions were created by the
mother-in-law and menfolk in the families of the respondents. In such cases after facing the
problems of disapproval from the family members, most of the respondents lost interest in
availing the health services due to their own powerless position in the family.
          Thus from this discussion, it can be inferred that, whatever the efforts ANM’s made to
motivate the adolescent mothers to adopt family planning and other health services has failed
because the adolescent mothers did not have the authority for making decisions to either
practice family planning methods or to get immunized. This observation was made by the
researcher is in conformity with the observations made in the report prepared by Council for
Social Development This report observed that, population control projects in India have not
brought desired results as they placed overwhelming responsibility of family planning in the
hands of women without giving actual power to make decision about their own health (Deccan
Herald, 2006).
          From this discussion, it can be concluded that, ANM’s might have carried out good
work in motivating the adolescent mothers to practice family planning and to have antenatal
immunization because most of the respondents in the present study knew about family
planning methods (Table 4.4.2). But adolescent mothers did not have freedom or authority to
make decisions regarding family planning methods. The adolescent mothers being young,
powerless, could not oppose the decisions made by their family members, which was
discussed in the previous section of this chapter.
5.10 OVERALL CONCLUSION
          From the discussion of the present study it can be concluded that, the early age at
marriage, early consummation, early pregnancy, economic dependence, lower education,
denial of decision making power, inequality within the home were found to have adverse and
serious impact on the health of the mother. These results were in line with the findings of
Leyla Gulcur (2000) on evaluating the role of gender inequalities and right’s violation in
women’s mental health. Similarly Barua and Kurz (2001) in their study found that adolescent
wives were observed to have little autonomy and decision making authority in their homes,
exposing them to other risks including violence.
          The results of this study noted that half of the respondents had education from
primary to higher secondary school. They were married at an early age. The young married
women were dependent on their husbands for social status and economic support. They had
limited contact with their natal families and may have had limited social contacts and support
in their marital home. These young adolescent girls have been under the authority of the
husband’s parents and thus had a relatively limited autonomy to make decisions abut their
personal lives.
          Majority of the respondents in this study knew about the family planning methods and
practiced temporary methods without the knowledge of their mothers-in-law and their
husband. But most of these respondents discontinued when their in-laws and husband came
to know about them. Moreover even though they knew about the family planning methods,
they did not have an easy access to different health care services including family planning
services and failed to utilize them due to inhibitions or pressure to obtain motherhood to
satisfy their mothers-in-law or husbands.
          In addition they were found to have relatively poor health and limited access to good
nutrition. All of them were caught in a cycle of early marriage and child bearing. All
respondents married before they attained 18 years of age and were mother by the age of 18
years. According to NFHS (1992-93) data, 40 per cent of all young women aged 15-19 in
India are already married, 17 per cent aged 13-19 are already mothers or are pregnant with
their first child.
          Thus in the present study, it becomes clear that, majority of the married adolescent
girls faced huge constrains on their mobility to access the health services and also to visit
their parents. In addition majority of them were subjected to both physical and mental violence
in their marital home. These factors i.e. constrains on mobility and violence directly or
indirectly affected their reproductive health. In addition they were found to have a no say in
deciding whether to have sex or not to have sex with their husband and when to bear
children. The young married girl’s responsibilities to carryout household work, expectations of
fertility and silencing influence of embarrassment and lack of freedom to discuss their
reproductive health problems with their husband or anybody were the strongest influences in
deciding whether their reproductive health needs were addressed or not. The respondents
were found to be under lot of family pressure to conceive in the first year of marriage itself, as
it was borne out by the fact that, those who miscarried in the first year of marriage were
ridiculed and ill-treated by their parents-in-law. Menstrual problems and other health problems
were not considered to be as illness and thus were left untreated. Husbands made the
decisions whether their wives could seek medical care and mothers-in-laws sometimes
influenced these decisions. Girls had neither decision-making nor influencing power. The
desire for spacing between pregnancies was also widely felt by adolescent girls but mothers-
in-law were against the use of contraceptives. Due to their powerlessness and constrains on
mobility and violence meted out to them whenever they practiced family planning, were the
reasons for non adoption of temporary family planning methods by the respondents.
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                                    VI. SUMMARY
          World Health Organization (WHO) has defined reproductive health as a “state of
complete, physical, mental and social well-being and not merely the absence of disease or
infirmity, reproductive health addresses the reproductive processes, functions and system at
all the stages of life. Reproductive health, therefore, implies that people are able to have the
capacity to reproduce and the freedom to decide if, when and how often to do so. Implicit in
this last condition are the right of men and women to be informed of and to have access to
safe, effective, affordable and acceptable methods of fertility regulation of their choice and the
right of access to appropriate health care services that will enable women to go safely through
pregnancy and child birth and provide couples with the best chance of having a healthy infant.
          There are few studies on the reproductive health problems of rural married
adolescent girls. Thus, in order to fill up the gap regarding reproductive health, the present
study was taken up in Ranebennur taluk of Haveri district with the following objectives.
     1. To study the socio-economic and demographic profile of the respondents.
     2. To investigate the problems in adopting family planning methods.
     3. To examine the health problems of respondents related to maternity.
     4. To find out the health problems other than those related to maternity
     5. To study the prevalence of gender violence.
     6. To examine the relation between the health history before conception and problems
           related to maternity, and
     7. To study what extent the respondents seek government health services.
          This study was conducted in Ranebennur taluk of Haveri district during 2004-05.
First, all the villages in Ranebennur taluk were listed. From this list, 14 villages were
randomized by lottery method. In each selected village the total number of married adolescent
girls from low income group families in their reproductive years and staying with their husband
were listed and 10 percent of this population were selected. Thus a total of 150 respondents
were selected.
          The data was collected by pre-tested, personal interview schedule. As the data
collected were nearly descriptive and objectives of the study being exploratory in nature, the
data were analyzed in frequencies and percentages with appropriate statistical method.
          The results of the present study were summarized and presented here under.
1. Socio-economic characteristics
     - Majority of the respondents and their husbands had education from primary to higher
                                 th
          secondary school (10 standard)
     - Nearly three-fourth of the respondents and 70.7 per cent of their husband were
          agricultural labourers
     - Overwhelming majority of the respondents’ annual family income was ranging
          between Rs9000 and 9900.
2. Socio-demographic characteristics
     - All the respondents belonged to the age group of 17-20 years. Among them 60 per
          cent belonged to the age group of 17-19 years and 40 per cent were 20 years of age
          at present.
     - Majority (88.7%) hailed from joint family
     - 81.4 per cent of the respondents had family size of 8 to 13 members.
     - All the respondents experienced first pregnancy. Half of the respondents had 2
          children.
     - Overwhelming majority (89.3%) were Hindu
     - Higher percentage (71.3%) of the adolescent girls belonged to SC/ST caste
3. Age and time interval variables related to initiation to reproductive life
     - 57.3 per cent reached menarche in the age group ranging 13-15 years.
     - 48.0 per cent were married by the age of 14-15 years.
     - Age at consummation of marriage was 16-17 years in majority (76.7%) of the
          respondents.
     - Majority of them (97.3%) conceived before they reached 18 years.
     - Most of them (58%) conceived within a year of their consummation of marriage.
4. Child wastage; prelevance, ordinal number of pregnancies/live births
    Number and age at pregnancy and nutritional status.
     - Slightly more than half (53.3%) of the respondents had child wastage.
   -    Of the total number of pregnancies 30.7 per cent resulted in child wastage.
   -    Out of the total number of child wastage, majority were due to miscarriages (51.5%).
        Stillbirths (15.4%), neonatal deaths (6.5%) and infant deaths (16.1%) were the other
        type of child wastage experienced by them.
    - 49.3 per cent of child wastage occurred in the first pregnancy itself as most of the
        respondents (43.3%) miscarried their first pregnancy.
    - 55.3 per cent of them were pregnant before they reached 18 years of age.
    - Except one case, almost all of them experienced child wastage before they were 18
        years old.
    - One-third of the respondents’ height was less than 146 cm, which indicates risk in
         childbearing.
    - 32 per cent were below 38 kg, which again indicates an important risk factor in
        carrying the pregnancy.
    - One fourth of them were found to suffering from mild to moderate malnourishment.
5. Family planning; knowledge, practice and reasons
    - Majority (72%) knew about female sterilization than male (43.3%) sterilization
    - Totally 6.7 per cent were sterilized because they did not want more children as they
        were already having two to three children
    - Majority were (93.3%) not sterilized. Of these majority wanted to have a son.
    - 80.7 per cent knew about spacing methods.
    - Majority (65%) adopted child spacing methods in the past, which was decreased to
        26 per cent because their mothers-in-law and husbands did not like the use of
        contraceptives.
    - 21.3 per cent used pills and 4.7 per cent used IUD’s at present.
6. Problems faced during pre, peri and postnatal period
    - More than half (57.3%) of respondents had problems during prenatal period
    - Lower abdominal pain (59.3%) was the major problem reported by the respondents.
    - 48 per cent faced problems during perinatal period
    - Vomiting before delivery was the common problem reported by (70.8%) them.
    - More than one-third (43.3%) experienced problem during postnatal period
    - Lower abdominal pain (70.8%) was the common problem faced by the respondents
7. Reproductive health problems unrelated to maternity
    - Majority (76.7%) of the respondents reported problems related to menstruation.
        Among these, irregular menses was the main problem.
    - 57.1 per cent reported vaginal problem. Burning sensation during urination was the
        major problem suffered by them.
    - More than one-third (42.6%) of the respondents had uterine problem. Among these,
        pain in uterus was the major problem.
6. Gender/domestic violence
1. Prevalence of violence
        Majority of the respondents (80.0%) suffered either physical or mental or both
physical/mental cruelty/violence.
2. Mental cruelty: Types and reasons
Nearly 57 per cent of the respondents faced one or the other type of mental cruelty reported
below.
    - Mothers-in-law were reported to be finding faults in almost every task carried out by
        the respondents (31.8%)
    - More than one-fourth (26.0%) of the respondents had lack of freedom to express.
    - Slightly less than one-fourth (23.5%) of the respondents worried about running the
        family, as their husband was a drunkard.
    - Other forms of cruelty reported were ridiculing/scolding whenever the respondent
        tried to take rest (17.6%). Respondents were also scolded whenever they miscarried
        (15.3%).
    - Few respondents (14.1%) were emotionally hurt by the bad habits of their husband.
b. Prevalence of husband’s bad habits and feelings of respondents
    - Overwhelming majority (90.0%) of the respondents reported one or more bad habits
        of their husband
    - Drinking (48.9%), smoking (48.1%) and playing cards (44.4%) were the most
        common bad habits reported.
    -     Few of their husbands (11.1%) were found to be taking away the wife’s saving
          without her knowledge.
     - Nearly 60 per cent of the respondents really worried about the bad habits of their
          husband. The reported reasons for their worry were as follows.
                     More than one-third (33.7%) of the respondents worried that their husband
                     wasted earnings on his bad habits.
                     Some respondents felt that (22.5%) due to his bad habits. They have no
                     feelings of affection towards him.
                     Few of them (16.9%) were ashamed to be called as drunkard’s wife.
c. Restrictions to visit their parents during festivals/ marriage/functions
     - Majority (63.3%) of the respondents were restrained from visiting their parents.
     - More than one-third of the respondents (45.3%) were restrained because nobody was
          there to attend the household chores.
     - Some of (15.8%) the respondents were allowed to visit parents only once in a year
     - In case of some respondents, mother-in-law demanded that, respondents’ parents
          themselves should come to visit her (15.8%)
     - In few cases (14.7%) mother-in-law imposed restrictions on the respondents to visit
          her parents for having brought less dowry.
3. Physical violence and reasons for such violence
     - More than half of (52.0%) the respondents suffered physical violence.
     - More than one-fourth (26.6%) of them were battered by their mother-in-law for not
          bringing enough dowry.
     - More than one-fourth (31.9%) of them were battered by their mother-in-law on the
          pre-text of not showing enough respect to the elders.
     - More than one-third (43.0%) of them were battered by their husband for having
          brought less dowry
     - More than one-third (34.7%) of them were beaten by their husband for not having a
          male child.
     - Majority of the respondents (61.3%) had no freedom to seek medical treatment
     - More than one-third of respondents reported that, their husband and mother-in-law
          had no time to take them to health center
     - Nearly in case of one-third (32.6%) of respondents, mothers-in-law considered
          treatment as costly.
     - More than one fourth (30.4%) of the respondents’ husband did not like to take her for
          treatment often.
     - More than one-fourth (28.6%) of the respondents did not get permission till their
          health problem become severe.
9. Utilization of antenatal care services
     - 54.7 percent of the respondents received iron and folic acid tablets, 45.3 percent did
          not receive iron and folic acid tablets and 14.6 percent were irregular in consuming
          iron and folic acid tablets.
     - Over half of the respondents were completely immunized.
     - Majority (65%) delivered at home
     - 41.1 per cent of the deliveries were assisted by their mother.
10. Accessibility of Government health services, their use of services and reasons for non-
           utilization of these services
     - The government health center was accessible for only 33.3 per cent of the
          respondents
     - Only 22.7 per cent of the respondents utilized the Government health services
     - Most (43.1%) reported the limited bus facility as the reason for the non-utilization of
          Government health services.
11. Frequency of ANMs visit
     - Half of the respondents reported that ANMs visited them once in 15 days.
     - Only 24 per cent reported that ANMs visited them once in a week.
IMPLICATIONS
          These results imply the lack of autonomy for the adolescent girls regarding their
general and reproductive health. Based on the results of the present study, following
conclusions and implications were suggested to improve the reproductive and general health
of the rural adolescent girls.
1. The respondents got married at an early age and their marriages were also
   consummated as soon as they attained menarche. They experienced many pregnancies
   during teenage years, which made them to suffer a number of child wastage. Majority lost
   their babies due to miscarriages. From these results it can be pointed out the lack of
   awareness regarding the legal age at marriage and health consequences of such
   marriages. These results imply that there is a need to educate both adolescent girls and
   their parents regarding the legal age at marriage, ill effects of early marriage and early
   pregnancies. Respondents faced many problems due to early marriage. Hence there is a
   need to prevent early marriages (before 18 years) at all costs by making use of both legal
   and educational means.
2. Many respondents remained unprotected by family planning method. Those respondents
   who used spacing methods discontinued mainly because of the restrictions made by their
   mothers-in-law and their husband. Some of them discontinued due to lack of knowledge
   about the advantages of family planning methods. Regarding utilization of antenatal care
   services, it was found that 58.7 per cent of the respondents were immunized completely
   and slightly more than one fourth consumed IFA tablets. One fourth of the respondents
   found to have moderate to mild malnourishment. These results imply that there is a need
   for intensive health education for respondents to remove the misconceptions regarding
   immunization, consumption of IFA tablets and antenatal care services. An awareness
   programme for the mothers-in-law and the men folk in the village regarding the negative
   effects of malnutrition, lack of rest and antenatal care on the adolescent girls need to be
   undertaken.
3. With reference to results regarding the obstetric problems most of the respondents faced
   more problems during pre and perinatal periods. The main reason for this could be that
   most of the deliveries (64.7%) were conducted at home by the inexperienced persons or
   untrained persons. This implies the risk for the adolescent mothers and lack of
   awareness regarding complications that arise during pregnancy and delivery. Hence
   there is a need to educate the adolescent girls and their family members regarding the
   importance of hospital delivery.
4. Regarding reproductive health problems unrelated to maternity, it was found that most of
   the respondents (76.7%) complained about menstrual problems. These imply the
   prevalence of menstrual problems and negligence regarding hygiene and sanitation.
   Hence, ill effects of this problem have to be explained to the respondents to seek medical
   treatment in the initial stage itself.
5. Regarding utilization of government health services it was found that, majority of the
   respondents failed to utilize the government health services effectively. The results
   indicate the need to make respondents aware about the advantages of the utilization of
   government health services.
6. As the result of being denied of proper nutrition, rest, health care and freedom to express
   their needs and their health problems respondents faced many problems. This is very
   evident by the high prevalence of domestic violence (80%), which is used as a means to
   control their freedom. Hence one should point out the damaging effect of domestic
   violence on mental and physical health of married adolescent girls.
7. Over all gender sensitive awareness / educational programmes regarding the importance
   of general and reproductive health of married adolescent girls needs to be conducted for
   the rural society in general and family members of these girls in particular.
SUGGESTIONS FOR INTERVENTIONS
         No reproductive health programme for adolescent girls really succeed unless it is
comprehensive. To improve the reproductive health it is necessary for any intervention
programme to involve adolescent girls, their parents, if married their in-laws, the young men
who married them and the community. The specific health services like antenatal checkup,
immunization, anaemia prophylaxis programme and family planning services are to be
directed to the adolescent girls. All educational awareness and counseling programmes
regarding the importance of reproductive health for the health of whole community should
target the family members, young men and village community. The specific programmes that
form this comprehensive intervention can be listed as follows :
    1. As a part of the intervention programmes aimed at improving the awareness of
         adolescent girl’s parents should include information regarding the legal age at
         marriage, ill effects of early marriage and early pregnancies. Since respondents faced
         many problems due to early marriage there is a need to prevent early marriages at all
         costs by making use of both legal and educational means.
     2. Adolescent girls and their family members have to be educated regarding the
         importance of hospital delivery. Similarly the health personnel need to be trained to
         be more responsive to the problems of adolescent girls. Higher authorities should
         make sure that good quality health services are provided freely to the poor
         adolescent girls whenever needed.
     3. Explanation of ill effects of problems related to menstruation should form an important
         part of the awareness programme to be given to adolescent girls and their parents to
         make them seek medical treatment in the initial stage itself.
     4. In the present study the prevalence of domestic violence was found to be high.
         Hence there is a need for an awareness programme for in-laws and young men
         regarding the damaging effect of domestic violence on mental and physical health of
         married adolescent girl and her progeny.
         The present study suggest that adolescent girl’s health has to be addressed in a
comprehensive and multifaceted manner in the policy itself. Further health of the adolescent
girls should become an integral part of the health policy of the central governments.
LIMITATIONS OF THE STUDY
    1. In the present study only the prevalence of domestic violence and its causes were
       studied, but there was a need to study the effect of gender/domestic violence on both
       the reproductive and general health.
    2. Data on the presence of anaemia was collected through secondary source is from the
       records of anganawadi workers. It could have been better if the data were collected
       by the researcher by using simple methods to test Hb level.
                                     APPENDIX I
                             INTERVIEW SCHEDULE
                  REPRODUCTIVE HEALTH OF RURAL MARRIED
                           ADOLESCENT GIRLS
    a. General Information Regarding Respondent


1. Name of the respondent                  :
2. Name of the village                     :
3. Age                                     :
4. Education                               :
5. Occupation                              :
6. Income                                       :
7. Height (normal/risk)                    :          cm
8. Weight                                       :             kg

             Wt (kg)
9. BMI = ------------
                   Ht2(m)

b. Family Information

Sl. No.    Name of      Relation     Age       Sex     Education   Occupation   Monthly
           the          with                                                    income
           family       respondent
           member




2. Type of family                          :
3. Size of family                          :
c. Personal Information (History)

       1. Caste                Forward               SC/ST                 OBC

2. Age at menarche                             :
3. Age at marriage                             :
4. Age at consummation of marriage     :
5. Age at first pregnancy                              :
6. Number of pregnancies                       :
7. Whether the husband related to you before marriage Y/N
8. Polygamous marriage                         :
9. What work is done by you during pregnancy :
10. How many hours you work when not pregnant or lactating.
d. Health History

11. Type of illness and treatment taken

   Type of   Childhood        After          After         Treatment           Who          Whose
   disease                  menarche     consummation        taken        accompanied       decision
     and                                  of marriage      Yes   No         you to get     was that ?
 treatment                                                                the treatment
Chronic
illness
Treatment
taken
Acute
illness
Treatment
taken
Other
illness

e. Obstetric History (a)

13. Ordinal no. of pregnancy         Age at each pregnancy              Results of pregnancy*




Total
    * Aborted, premature, low birth weight, still birth, neonatal death, infant death, full term
    baby, child surviving, healthy delivery.

14. Obstetric history (b)
                            Age          Ordinal         Treatment      Treatment to      Reasons
                                        number of        during this      prevent
                                        pregnancy         problem         problem
Still birth
Abortion
Neonatal death
Infant death
Premature delivery
Low birth weight



15. Complications during periods of maternity

a. Prenatal period
  Ordinal no. of    Complications              Type of          Who got her          Results of
   pregnancy       faced if any and          treatment           treatment           pregnancy
                       type of
                     complication




b. Perinatal period
 Ordinal no. of       Complications if         Type of        Who got her             Results
   childbirth         any and type of        treatment         treatment
                       complication




c. Postnatal period

 Ordinal no. of       Complications if         Type of        Who got her             Results
   childbirth         any and type of        treatment         treatment
                       complication




16. Do you have any other reproductive health problem

          Problems                  Yes/No        If Yes,      Who got      Results       If No,
                                                treatment     treatment                    why
                                                   taken
Menses problem
Vaginal problem
Uterine problem
Other reproductive health
problem specify

                                             PART-II

a. Questions about knowledge regarding family planning

1. Do you know about permanent family planning methods

         Tubectomy                Yes/No
         Laproscopy               Yes/No
         Vasectomy                Yes/No
         If Yes, Describe
         a. Advantages
         b. Disadvantages
2. Do you know temporary methods                                                  Yes/No
         if yes, specify
     a. Advantages
     b. Disadvantages
3. Indicate the different sources of your information regarding family planning
4. As per family planning the number of children should be,
5. According to you what should be the spacing between children.
                                             PART-III

a. Practices followed for family planning
1. Have you undergone steritlization ?
          Yes/No.

                    If Yes why                                      If No why




2. Health problems reported after undergoing sterilization
3. Have you used any temporary methods                                     Yes/No
    If yes, type of method used
4. Have you continued its use ?
           If yes, how long (months/years) ? And how do you find this method
           If no, why
5. Whether your husband has used any kind of contraceptives
   If yes, its type and since when (months/Yr)                     Yes/No.
6. How many children did you wanted to have ?
7. How many children you have ?
8. If extra, why did you have ?
b. Practices followed for reproductive health
1. Do you use traditional methods of treatment for health problem
                      Problems                                 Method of treatment
Menses problem specify
Infertility specify
Prevent abortion specify
To end unwanted pregnancy specify
Any other health problem specify
                                             PART-IV
   Health seeking behaviour, knowledge about the antenatal care services and use of health
                                              services

       1. How often one needs to have antenatal check up ?
          Why antenatal checkup ?

2. Whether you had gone for antenatal checkup during pregnancy
                        If yes, why                                        If not, why
Ordinal number of pregnancy Number of antenatal checkup




3. Whether the ANM services are available to you and accessible to you ?

4. If accessible to you what ANM do for you.

5. Have you received iron and folic acid tablets during pregnancy
                                                                                         Yes/No.
                                   If yes                                       Give reasons
         Regular                 Irregular            Discarded




6. Were you got immunized during pregnancy ?             Yes/No.

 Sl.       Ordinal number of          Immunization schedule         Whether         If you were
No.         pregnancies             I dose          II dose     ANM advised           not
                                                                  or not          immunized
                                                                                    reasons




7. How do you maintain hygiene during menses ?
8. How do you maintain hygiene after abortion ? If you have aborted.
9. Any infection faced after abortion
10. Whether the abortion was spontaneous or induced.
                                                PART-V
               Availability, accessibility and frequency of health services at present
1. Does ANM visit your home ? If yes how frequently
     a. Weekly
     b. Once in fortnight
     c. Once in a month
     d. Never
     e. Any other
2. Is there government hospital/PHC/sub center in your village ?
         Yes/No.
If no, how far it is from your village ?
3. Do you visit Govt. Hospital?
         Yes/No
         If yes, when do you visit.
4. When did you visit the Government PHC last
         Why did you visit.
                                                PART-VI
     1. Do you suffer from any mental cruelty in your home ?
     2. Do you face any problems from any family member regarding taking treatment for
         your health problem ?
     3. Whether you feel that you were taken care in your family ? Very well/ fairly well/
         family members indifferent/ treated badly.
     4. Whether you are allowed to visit your parents whenever you are supposed to visit
         home during festivals/ marriages/functions ?
     5. Are you subjected to any physical cruelty ?
     6. Do you feel that you are ill treated by your in-laws/ husband / other members of family
         Yes/No.
         If yes, Please explain.
     7. At any time have you undergone scanning ?
         Yes/No.
         If yes, were you forced to undergone scanning to detect the sex of child.
     8. Whether the child was aborted after scanning
         Yes/No.
         If yes, was the abortion forced on you ?
     9. Did you face any verbal violence/harassment by your in-laws/husband/other
         members.
     10. Does your husband drink ?
     11. Does he become violent in his behaviour ?
     12. Does it bother you to have husband who drinks alcohol ?
     13. Does your husband have any extra marital relations ?
     14. Does he have any habits, which you consider bad ?
                                                                 APPENDIX II
                COMPOSITION OF FEMALE POPULATION OF SELECTED VILLAGES AND SAMPLES BY CASTE
 Name of the        Total       Total      Total population of     Samples     Samples of SC/ST   Other than SC/ST         Total
   village         female      female      married adolescent      selected
                 population    SC/ST        girls (<20 years)
                 other than   population       recorded by
                   SC/ST                   anganwadi workers
                                              F          %                       F        %         F        %       F             %
Karur              3683          334         130        3.53         13          8       61.50      5       38.50    13            100
Ankasapur           589          302         103       17.50         10          7       70.00      3       30.00    10            100
Devaragudda        2011          509         100        4.50         10          6       60.00      4       40.00    10            100
Chaudadanpur        653          51          113       17.30         11          8       72.80      3       27.27    11            100
Basagatti           41           41          108        2.63         10          7       70.00      3       30.00    10            100
Teredahalli         301          94          85        28.23          8          5       62.50      3       37.50    8             100
Aladakatti          757          189         124       16.38         10          4       40.00      8       80.00    12            100
Yaklaspur           408          258         120       29.41         12          9       75.00      3       25.00    12            100
Nalavagal           997          722         125       12.54         12          8       66.67      4       33.33    12            100
Bodiyal            3239          654         143        4.42         14          10      71.43      4       28.57    14            100
Busagur             774          174         133       17.18         13          11      69.23      4       30.77    13            100
Kuppelur           1972          508         140        7.09         14          9       64.29      5       35.71    14            100
Sannasangapur       242          80          115       47.52         11          5       45.45      6       54.54    11            100
Total                                                                            95                55                150           100
      REPRODUCTIVE HEALTH OF RURAL MARRIED
               ADOLESCENT GIRLS
NETRAVATI, H.S.                              2006                         K. SAROJA
                                                                        Major Advisor
                                       ABSTRACT


         This study was conducted in Ranebennur taluk of Haveri district during 2004-05. 150
samples were selected from 14 villages by lottery method. Interview schedule was the tool
used for data collection. Results revealed that, 52% of the respondents were literate having
education from primary to high school level. Majority (89%) hailed from joint family. 81% had
family size of 8-13 members. All of them experienced first pregnancy, 50% had two children.
Majority (97.3%) were conceived before they reached 18 years, 54% had child wastage.
Miscarriage (51.5%) was the main type of child wastage. Half of the child wastage occurred in
first pregnancy. One-fourth of them suffered from mild to moderate malnourishment. 80%
knew about spacing methods. Only 26% were using spacing methods during survey. 57%,
nearly 48% and 43% had health problems during pre, peri and postnatal period respectively.
Menstrual (77%), vaginal (55%) and uterine (43%) problems were common among
respondents. Less than one-fourth utilized government health services. Lack of bus facility
was the main reason for non-utilization. More than half (55%) of them received IFA tablets.
Only 48.8% consumed regularly. However, nearly 60% were immunized completely. Nearly
65% delivered at home and of these 41 per cent were assisted by untrained family members.
Majority (80%) reported either physical or mental violence. 57% reported mental cruelty.
Almost all of them reported bad-habits of their husband (90%). One third of those suffering
mental cruelty worried too much as their husband wasted their earnings on bad habits. 43%
suffered battering by mother-in-law for not having brought enough dowry. 61% were
prevented by in-laws and husband from seeking medical treatment. As such there is a need
to educate adolescent girls and especially family members regarding the importance of
general and reproductive health of girls during adolescence.

								
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