Evidence of Sex Selective Abortion from Two Cultural Settings of India: A Study of Haryana and Tamil Nadu

By: Sayeed Unisa,C.P.Prakasam,R.K.Sinha and R.B.Bhagat

2003

Acknowledgement
We would like to thank first and foremost, the respondents of selected villages of Jind` and Salem districts of Haryana and Tamil Nadu respectively, for their good will, support and sparing time for this project work. We have been overwhelmed to observe the deep sense of affection, and warmth of the respondents and the village community for our research team with a remarkable sense of hospitality. Without this, the work could not have been completed. We therefore acknowledge gratefully the contribution of the many such persons whose unflinching support to the cause of women is indubitable. The Chief Medical Officers and Medical Officers at the PHCs/CHCs of Jind and Salem districts have been very helpful. We sincerely thank them. Dr Pramod Gauri, Director, State Resource Centre, Rohtak, and his associates namely Mr Sunil, Mr Sohan Das, and Mr Hooda took keen interest in this project and helped us in data collection in Jind district of Haryana. We are extremely thankful to them. The research team apart from the Principal Investigators consisted of Ms Sutapa Aggrarwal, Mr Kailash Lakhara, Ms Usha, Mr Murugesan, and Ms Smita, who helped us in data collection, tabulation and the statistical analysis. We highly appreciate their hard work and sincerity. Ms Sucharita Pujari has been immensely helpful in getting the manuscript ready in the present form. Thanks are due to her. Ms Shushila, an M. MPhil student, M.D. University, Rohtak, and her family has been very kind to us for extending all help at Jind. We thank Ms Shushila and her family for their kind hospitality. We would like to thank Professor N. Audinarayan and Dr N. Kabitha, Department of Population Studies, Bhartiar University, Coimbatore, and Dr Rita Garg and Dr C. L. Garg, Maya Devi Hospital, Jind for providing their valuable time in different stages of this project.

We would like to express our deep sense of appreciation for Professor T. K. Roy, Director of the Institute and Professor G. Rama Rao for their keen interest in this project and their time-to-time help and encouragement to us.

September 11, 2003

Principal Investigators

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CHAPTER - I INTRODUCTION
1.1 Introduction
Several studies have reported high preferences for son in different states of India. Recent improvement in medical technology and easy availability of sex determination test has resulted in high incidence of female foeticide. Availability of abortion services in private nursing homes has exacerbated the incidence of abortion as well as sex selective abortions in India. Demographically sex selective abortion can affect the sex ratio of the population. In Indian context, particularly the decline of sex ratio in the last century was a matter of great concern among social scientists. The Indian census has brought out that the sex ratio has declined from 972 females per thousand males in 1901 to 927 in 1991. The declining trend has reversed only twice during this period, once during 1941-51 and again in 1971-81.The most recent census results of 2001 indicate that the sex ratio has improved by 6 points in favour of females, from 927 females per thousand males in 1991 to 933 in 2001. However the recent increase during 1991-2001 was completely offset by the fact that the sex ratio of child population (0-6 years) declined substantially. The 2001 census shows that there are 927 girls (0-6 years) per thousand boys of the same age group, lower than the overall sex ratio (933). The severe deficit of females among child population and overall lower sex ratio has become a matter of great concern among demographers and social scientists. (Kundu and Sahu, 1991 and Srinivasan 1994). In large parts of the Indian sub continent there is an age-old tradition of preferring sons to daughters. Since early 1970s amniocentesis has been used in the country for sex determination at clinics that often offer abortion services. In 1986, in Mumbai, 85 per cent of 50 gynaecologists interviewed carried out amniocentesis for sex determination, considering it a humanitarian gesture, although many of them performed it because it was highly lucrative. In Punjab, a survey showed that 66 percent of families with 3 daughters and no sons wanted more children compared to only 13 percent of those with 3 sons and no daughters. (Krassmy and Besrgstrom, 1992 and Parasuraman, et al., 1998). Sons often increase family income, while daughters dowry cause family indebtedness, which explains why there are fewer girls than boys.

Sex selective abortion has been documented in India as early as 1970s when amniocentesis for genetic screening became available. (Ramanama and Bambawale 1980 and Patel 1989). It was only with the increasing availability of ultrasound technology during late eighties that the practice of sex selective abortion became wide spread. In response to growing practice of sex determination tests followed by selective female foeticide, the Government of India enacted an act known as Prenatal Diagnostic and Prevention Act (1994) to prevent the sex determination test. Many states have taken steps on this issue., Also the opponents of the legislation have pointed to the social and economic factors that underlie the strong son preference in India. They argued that social prejudices cannot be overcome simply by legislation, and that legislation will only drive the banned action underground and lead to bribery and malpractices.

Recent studies have shown high prevalence of abortion in the states of Punjab, Haryana, Tamil Nadu and Rajasthan. It has been reported that there are widespread sex selective abortions taking place in these states despite the laws prohibiting them. In many instances sex selective abortion takes place after 12 weeks of gestation, which is quite risky for the health of the women. This can lead to obstetric morbidity and infertility among women, an area hardly explored in the Indian context.

Abortion by itself is a life-threatening act. Under what circumstances do women resort to abortion is a matter of enquiry. There are few studies available on this aspect and very little is known about the reasons and circumstances under which women go for sex selective abortions. Further, unsafe abortion is one of the most neglected problems of health care in developing countries (Mishra, 2001).

Hence the objective of this study is to document the evidences of sex selective abortions from two different cultural settings in India, namely, Haryana and Tamil Nadu which are in the news for the practice of sex selective abortions. Knowing the causes and circumstances under which women go for abortions would facilitate in the long run in framing suitable policy and programs for interventions.

1.2 Objectives
1. Mapping of abortion /sonography facilities in the selected district of Haryana and Tamil Nadu. To find out the prevalence and incidence of sex selective abortions To study the causes and consequences of sex selective abortions and obstetric morbidity.

2. 3.

Keeping this in mind the following conceptual framework is developed.

CONCEPTUAL FRAMEWORK OF CAUSES AND CONSEQUENCES OF SEX SELECTIVE ABORTION FAMILY LEVEL VARIABLES CONSEQUENCES

Demographic Factors Economic Factors Religious Factors

Family Size Preference Abortion/ Sex Selective Abortion Gender Preference

Obstetric Morbidity Secondary Infertility Mental Health

Sex Ratio Availability of Medical Technology

1.3 Methodology
In this study as a first step, in order to identify the clusters of high incident areas of induced abortion, a secondary data analysis of child population (0-4 and 5-9) was done for 1981 and 1991 censuses by districts. The district that exhibited a very high sex ratio (Male /Female) in 1981 and 1991 was selected for the study. These districts were Jind in Haryana and Salem in Tamil Nadu. The district maps were then prepared using child sex ratio (0-6 years) at the village level. There were many villages with sex ratio of 125 and above. One of the concentrations of such cluster was selected in both the districts. Subsequently mapping of abortion and ultrasound facilities in the 20 km diameter of this cluster was carried out. For this purpose, identification of facilities such as hospitals/ nursing homes/clinics (allopathic, ayurvedic, and RMP) was done in all the nearby towns (towns with population below one lakh) as well as in the villages. Data was also collected from health care providers offering services of antenatal care, MTP and deliveries. In the first phase of the study prevalence rate of sex selective abortions was calculated and in the second phase of the study incidence rate was calculated, to satisfy the objectives of the study. In case of Jind district, 42 healthcare facilities and in Selam 28 health care facilities were found in the vicinity of those villages with high sex ratio. Out of these facilities 22 facilities in Jind and 10 in Salem were providing antenatal care, MTP, and delivery facilities whereas nearly 10 hospitals in Jind and 5 in Salem also had the ultrasound facility. It may be mentioned here that the idea was to do complete census of the villages but due to budgetary constraint only 5 villages in Jind and Selam were chosen for the study. Besides in one cluster 5 villages were sufficient to carry out the study. However at the time of data collection the five villages in Selam district were divided into seven and that is how the number of villages in the Salem district have been increased to seven. From the cluster of villages with a sex ratio of 125 and above, five villages in Jind and seven villages in Salem were selected randomly for the study. Complete household enumeration was done in the selected villages. A total of 2,590 households in Jind and 1,791 households in Salem were covered. The total number of ever-married women in reproductive ages who were interviewed in the selected villages was 2,646 in Jind and 1,706 in Selam district. Detailed information was collected on household characteristics, pregnancy history, antenatal care, deliveries, abortion history, reasons for abortion, place of abortion and obstetric morbidity for each pregnancy starting from marriage.

The second phase of the study, followed by a gap of 6 months, was repeated by interviewing a subset of women with either one or some of the following characteristics: 1) had an abortion 2) had a still birth 3) death of a female child occurred 4) undergone ultrasound test

Medical camps were organized in the selected villages with the help of a team consisting of one gynaecologist and a physician. In-depth interviews as well as clinical investigation reports by medical doctors (Gynaecologist) were collected with the consent of the women.

CHAPTER - II HEALTH INFRASTRUCTURE

The survey on infrastructure of medical facilities was carried out in government and private hospitals/nursing homes and clinics during October 2000 in the Jind district of Haryana with population below ninety thousand (1991). The study included infrastructure survey of the town and the selected five villages, for which complete census was done. In the selected town and its periphery, all together 40-health facilities were found. Out of this, 18 were small RMPs (Registered Medical Practitioners), homeopathic clinics and some allopathic clinics, like orthopaedic and dental clinics. In the remaining 22 health facilities, data on infrastructure was collected from medical doctors who were in-charge of the nursing homes. There were four government health facilities and private practitioners ran the remaining health care centres. Out of 18 private nursing homes, 12 were established very recently during 1991-2000. Most of these clinics were run by the doctors from neighbouring states. NFHS II survey has shown that in Haryana, only 60 percent of the pregnant women go for antenatal care or for at least one ANC check-up. Percentage of births assisted by health professional is only 42 percent for Haryana, 62 percent for Punjab and 90 percent for Kerala. So, when these towns are not serving to a very large population and where the level of antenatal and natal care is low, then the question arises as to why have so many nursing homes and clinics come up in many small towns in Haryana?

2.1 Sex determination technologies

The prenatal diagnostic technique involves the use of technologies such as ultra sonography, amniocentesis, choroin villi biopsy, foetoscopy, maternal serum analysis etc. In the study area, only ultra sonography was being used and according to doctors, it is safe and does not require any special training, extra staff and expenditure for operation. Out of 22 allopathic nursing homes/clinics, 10 provide ultrasonography and 3 of them have colour sonography machines. Most of them use generators in their nursing homes. Apart from regular nursing homes providing the ultra sonography, mobile ultrasound facilities are also available in the villages. The charge for ultrasound is Rs.300/- to Rs.500/-, which is quite affordable for the villagers.

2.2 Antenatal care and sonography

As shown in table 2.1 in comparison to total antenatal cases, use of sonography was found to be around 20 percent for all women visiting these clinics. The percentage for blood and urine test is quite high (above 60 percent) but those are routine checkups whereas sonography should be done only under special situation. In any case, 20 percent of women visiting these clinics for antenatal care will not require this test (ultrasound) for the health of the baby or mother, unless the motive is to know the sex of the foetus. The number of antenatal cases, attended the clinic where sonography is available was also very large. This could be both due to womens motive to undergo sonography or better facilities in these nursing homes. Table 2.1: Number of cases served during last six months for different medical services, JIND, October 2000 No. of clinics With Sonography facilities (10) Without Sonography facilities (12) Total (22) Antenatal Care* Sonography* Urine Test* Blood Test*

10118

2192 (21.7%)

6668 (65.90%)

6458 (63.8%)

3236 13354

2192 (16.4%)

148 (4.6%) 6816 (51.0%)

190 (5.9%) 6648 (49.8%)

*Information about number of antenatal, sonography and other tests are based on doctors self-reporting about the care given by them daily/weekly/monthly.

2.3 Medical termination of pregnancies

Apart from ultrasound facilities, the nursing homes also provide abortion services to their clients irrespective of the fact whether they are recognized as MTP centre or not (as shown in table 2.2) and most of the abortions are done after 3 months of gestation period only when the sex of the foetus becomes recognizable. Doctors revealed these facts during their informal talks with the researcher; although they admitted that it could pose serious health hazards for females. It was revealed that in comparison to 100 deliveries done at the nursing homes with sonography facility, about 64 cases of MTP were done. In terms of proportions nearly one-third cases were for MTP and two third for deliveries. In case of

clinics/nursing homes without sonography facility, a higher proportion of women were going for MTP services. In general, the procedure adopted for abortion is usually DNC in the nursing homes where operation theatres are available. In case of clinics with no such facilities, some of the doctors reported that they administer certain abortion inducing injections, which has effect only after several hours, and ask the client to go to their homes. In villages, the quacks/trained dais and ANMs are practicing induced abortions at premium fees. The cost of abortion ranges from Rs. 1200/- to Rs 4000/- depending upon the clients status, as well as the status of the nursing home and the risk period. Table 2.2: Number of deliveries and MTP cases served during last six months, JIND, October 2000 No. of clinics With Sonography facilities (10) Without Sonography facilities *No. of delivery cases 2475 *No. of MTP (Abortions) 1578 Ratio of MTP to No. of deliveries 63.8

103

305

296.1

*Information about number of deliveries and MTP are based on doctors self-reporting about the natal care given by them daily/weekly/monthly. In a small town like Jind with population of 85 thousand in 1991 census, 10 nursing homes were providing the ultra sound facility. These nursing homes are run by medical doctors usually husband wife team with or without a gynaecologist. Some of the B.A.M.S. degree holders and nurses are also providing the ultra sound facility (they have not admitted this openly but the clients sitting in the waiting room reported this). Apart from this, mobile ultra sound (Maruti van with ultra sound machine) facilities are available in the villages of Haryana. The charge for an ultra sound in Haryana is Rs. 300 to 500.

In Selam, 28 health care facilities were found in the vicinity of those villages with high sex ratio. Out of these health facilities, ten were providing antenatal care, MTP, and delivery facilities and another five health facilities had the ultrasound facility as well.

CHAPTER - III SOCIO ECONOMIC AND DEMOGRAPHIC BACKGROUND OF THE HOUSEHOLD POPULATION
The present chapter presents a profile of the socio economic and demographic characteristics of the household population.

3.1 Age and sex composition

Table 3.1 presents the percentage distribution of household population by age and sex for Jind district in Haryana and Selam district in Tamil Nadu. The total household population for Haryana is 15,171 and 7183 for Tamil Nadu. Thirty seven percent of the population in Haryana is below 15 years of age of which 36 percent are females and 39 percent are males and 8 percent are aged 60 or more. In Tamil Nadu 28 percent of the population are below 15 years of age of which 26 percent are females and 31 percent are males where as only 8.2 per cent of the total population are aged 60 and above. The sex ratio (number of females per 1000 males) is an important measure that indicates the balance of the sexes in the population. The sex ratio as shown in the table is 832 in Haryana and 867 for Tamil Nadu, the sex ratio being highly unfavourable towards females in both the states.

3.2 Marital status

Table 3.2 shows the marital status of the household population according to age and sex for the state of Haryana and Tamil Nadu. In Haryana among females 60 percent are currently married and 34 percent are never married. In Tamil Nadu 64 percent of the females are currently married and 24 percent are never married. The percentage never married is higher among males (48.2 percent) than for females in Haryana. In Tamil Nadu the percentage never married among males is highest in 15-19 age group (97.8 percent) and lowest in 3049 age group (3.1 percent). Percentages of separated/ deserted/ widowed and divorced are small in both the states for both the sexes. Twenty seven percent of females aged 50 plus, 5.3 percent

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women aged 30-49 are widow in Haryana. The corresponding percentages for males are 13 percent and 1 percent respectively. Similarly in Tamil Nadu 39 percent of the females, aged 50+ and 7.8 percent aged 30-49 years are widow. The corresponding percentages for males are 2.3 percent and 1.1 percent only.

With regard to the proportions of persons marrying young, it is observed that in Haryana in the age group 15-19, the proportion of married is 5.1 percent for males and 38.4 percent for females. In Tamil Nadu, the proportion of ever-married in 15-19 age group is 2 percent for males and 43.5 percent for females. By age 25-29, the proportion of females marrying is virtually universal in both the states. The corresponding percentages for males are 84.1 percent in Haryana and 71.1 percent in Tamil Nadu. Overall the table shows that a large percentage of females marry at a relatively younger age in Tamil Nadu than in Haryana. The number of females marrying at a young age is much lower when compared to males in both the states.

3.3 Household composition

Table 3.3 shows the percent distribution of households by various characteristics of the household head like sex, age, religion, caste, household type and the number of members usually living in the household for the state of Haryana and Tamil Nadu. The table shows that ninety three percent of households in Haryana are male-headed households and only seven percent constituting female-headed households. In Tamil Nadu 53.6 percent of the household heads are male. This shows that in Haryana the households are predominantly dominated by males, which is not in case of Tamil Nadu. The median ages of the head of the household in Haryana and Tamil Nadu are 42 and 43 years respectively having very little variation. Household heads seems to be somewhat more concentrated in 30 44 age group in both the states.

Overall 98 percent of the households head in Haryana are Hindus and 2 percent of the heads of the households are Muslims. Similar is the picture in Tamil Nadu, where almost 100 percent of the household heads are Hindus. Less than one percent of the head of the household belong to Muslim, Christian and other communities.

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With regard to household type, 62 percent of the households in Haryana are of the nuclear type corresponding to 75 percent in Tamil Nadu. The average household size is slightly higher in the state of Haryana (5.8 persons per household) than in Tamil Nadu (4.1 persons per household).

3.4 Educational level

Tables 3.4a & 3.4b show the percent distribution of household population aged 6 and above by literacy and level of education and median number of years of schooling according to age and sex for Haryana and Tamil Nadu respectively.

The tables show that 34.6 percent of the population aged 6 and above are illiterate in Haryana. 49 percent females and only 22.6 percent males are illiterate indicating a wide gender disparity in literacy in Haryana. Correspondingly in Tamil Nadu 44 percent of the population aged 6 and above are illiterate. Fifty five percent females and 35 percent males are illiterate. In 20-29 age group, nearly 26 percent males are higher secondary complete, corresponding to only 7.6 percent in case of females in Haryana. The corresponding figures for Tamil Nadu are 17 percent for males and 11 percent for females. A higher percentage of males than females have completed each level of schooling in both the states. The proportion illiterate is lowest at age 10-14 years and highest at age fifty and above for both males and females in Haryana. In Tamil Nadu the proportion illiterate is lowest in 6-9 age group and highest at age fifty and above. In both the sexes, the proportion illiterate is lowest in 10-14 age group and highest among persons aged 50 and above.

The median number of years of schooling for males in Haryana is 6 years and 4 years in Tamil Nadu. For females the median number of years of schooling in Tamil Nadu is zero as more than half of the females are illiterate. In Haryana, it is even less than 2 years for females, as slightly less than half of the female population have never attended school.

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3.5 Housing characteristics

Table 3.5 provides information on household characteristics such as source of drinking water, sanitation facility, type of house, and type of fuel used for cooking for the state of Haryana and Tamil Nadu.

The table shows that 89 percent households in Haryana have electricity corresponding to 78 percent households in Tamil Nadu. With regard to water sources and sanitation facilities, in Haryana 30 percent of the household use tap located inside the house, 42 percent use tap located out side the house, 24 percent use hand pump bore well and well; and less than one percent use other sources of drinking water. In Tamil Nadu 68.5 percent of the households use tap located outside the residence and only 5 percent use tap located inside the residence. Twenty six percent of the households use hand pump bore well and well.

As far as sanitation facility is concerned 77 percent of the households in Haryana have no toilet facility corresponding to 95 percent of households in Tamil Nadu. Thirteen percent households in Haryana and four percent of the households in Tamil Nadu have own toilets with flush facility. The percentage of household using public toilets with flush facility is less than one percent in both the states.

Regarding type of house construction, 50 percent of the houses in Haryana are pucca houses corresponding to 14 percent in Tamil Nadu. Forty three percent of the houses are semi pucca and 7.5 percent are kachha houses in Haryana where as in Tamil Nadu 44 percent of the houses are semi pucca and 41 percent of the houses are kachha. The proportion of houses, which are kachha, is much higher in Tamil Nadu than in Haryana.

Regarding type of fuel used, 83.8 percent of the households in Haryana use cow dung cakes for cooking, whereas in Tamil Nadu 87 percent of the households use wood for cooking. Electricity as a method of cooking is used by 2 percent of the households in Haryana and less than one percent in Tamil Nadu. LPG is used by 31.5 percent of the households in Haryana corresponding to 13.5 percent in Tamil Nadu.

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3.6 Households owning agricultural land/house/livestock

Table 3.6 gives the percent distribution of household owning land, owning a house and owning livestock. About 51 percent of the households in Tamil Nadu own no land, corresponding to 37 percent in Haryana. Overall 61.5 percent of the households in Haryana own agricultural land as compared to 25 percent in Tamil Nadu. Non-agricultural land is owned by less than one percent of the households in Haryana compared to 18.2 percent in Tamil Nadu. Ownership of house is nearly universal in Haryana. The proportion of households owning a house in Tamil Nadu is 95.3 percent. The proportion of households owning a livestock is 80 percent in Haryana and 42 percent in Tamil Nadu.

3.7 Households owning selected durable goods

It is said that the possession of consumer durable goods is an important indicator of a households economic status. Table 3.7 shows the percentage distribution of households owning selected durable goods. It is observed from the table that in the state of Haryana, as a whole, majority of the households have cot/bed, electric fan, clock watch, mattress (98.2 percent, 88.0 percent, 86.9 percent and 60 percent respectively).

Other consumer durable goods often found in most of the households are black and white television (45 %), bicycle (42%), chair (45.5%), radio/ transistor (31.2%), pressure cooker (28.3 %), water pump (20%), scooter/motorcycle/tractor (10%), telephone (9.5%) and thresher (7%).

In Tamil Nadu majority of the households have mattress (96%), cot / bed (88%), clock / watch (62%) and bicycle (55%). Other consumer durable goods often found in the household are radio (36.7%), electric fan (35%), television (19%), motorcycle / scooter (16%).

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Table 3.1: Percent distribution of household population by age and sex Age 0-4 5-9 10-14 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69 70-74 75-79 80+ Total Percent Number of persons Sex Ratio HARYANA (Jind) Female Total 11.4 12.2 12.5 10.3 10.0 9.4 7.2 6.2 3.9 2.4 4.1 2.0 3.7 2.4 1.4 0.3 0.7 100.0 11.1 13.2 12.8 10.7 9.8 8.9 6.8 6.0 4.4 2.8 3.2 2.1 2.9 2.4 1.7 0.5 0.7 100.0 TAMILNADU (Salem) Male Female Total 11.2 10.2 9.2 9.4 8.7 9.4 7.5 7.0 5.8 4.8 4.9 3.8 3.6 1.7 1.6 0.7 0.6 100.0 9.4 9.1 7.2 9.1 11.1 10.1 7.9 8.1 6.4 6.2 3.4 4.2 3.5 2.0 1.1 0.4 0.7 100.0 10.4 9.7 8.3 9.2 9.8 9.7 7.6 7.5 6.0 5.4 4.2 4.0 3.6 1.9 1.4 0.6 0.7 100.0

Male 10.9 13.9 13.0 11.1 9.5 8.4 6.6 5.9 4.9 3.2 2.4 2.2 2.3 2.5 1.9 0.7 0.6 100.0

8,280

6,891

15,171 832

3,848

3,335

7,183 867

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Table 3.2: Marital status of the household population Percent distribution of household population age 6 and above by marital status, according to age and sex Marital status Age Currently Separated Widowed Divorced Never Total married /Deserted married percent HARYANA Male 13-14 0.3 0.0 0.0 0.0 99.7 100.0 15-19 5.1 0.1 0.0 0.0 94.8 100.0 20-24 44.3 0.5 0.5 0.0 54.7 100.0 25-29 84.1 0.3 0.1 0.0 15.5 100.0 30-49 96.2 0.1 1.7 0.0 1.9 100.0 50+ 85.0 1.2 12.8 0.1 0.9 100.0 Female 13-14 3.1 0.0 0.0 0.0 96.9 100.0 15-19 38.4 0.3 0.4 0.1 60.8 100.0 20-24 92.9 0.3 0.3 0.3 6.2 100.0 25-29 98.9 0.2 0.5 0.0 0.5 100.0 30-49 94.0 0.5 5.3 0.1 0.1 100.0 50+ 71.5 0.9 26.7 0.4 0.5 100.0 TAMILNADU Male 13-14 0.0 0.0 0.0 0.0 100.0 100.0 15-19 2.0 0.3 0.0 0.0 97.8 100.0 20-24 26.7 0.3 0.3 0.9 71.8 100.0 25-29 71.1 0.3 0.3 0.0 28.3 100.0 30-49 95.5 0.7 1.1 0.0 3.1 100.0 50+ 88.9 0.4 2.3 0.1 41.7 100.0 Female 13-14 0.0 0.0 0.0 0.0 100.0 100.0 15-19 43.1 0.7 0.7 0.0 55.5 100.0 20-24 86.4 0.5 0.3 0.0 12.7 100.0 25-29 92.9 2.4 2.1 0.3 2.4 100.0 30-49 87.7 3.2 7.8 0.5 0.8 100.0 50+ 57.9 1.8 39.2 1.0 0.2 100.0

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Table 3.3: Percent distribution of households by selected characteristics of the household head, household type and household size
Background Characteristics Sex of the head of the household Male Female Age of household head <30 30-44 45-59 60+ Median age Religion of household head Hindu Muslim Christian Other Missing Caste of household head Schedule caste Schedule tribe General & others Household type Nuclear household Non-nuclear household Number of usual members 1 2 3 4 5 6 7 8 9+ Mean household size Total percent Number of households Haryana (Jind) Tamil Nadu (Salem)

93.0 7.0

53.6 46.4

20.3 30.8 23.9 24.9 42.0

19.1 32.9 29.8 18.2 43.0

97.9 2.0 0.1

99.7 0.1 0.1 0.1 -

25.4 1.9 72.7

15.8 0.2 84.0

62.1 37.9

75.3 24.7

0.3 2.7 7.3 19.2 23.9 17.8 11.1 6.6 11.0 5.8 100.0 2,590

4.2 13.5 18.6 28.4 19.7 9.0 3.7 1.4 1.6 4.1 100.0 1,791

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Table 3.4a: Percent distribution of household population age 6 and above by literacy and level of education, according to age and sex (Haryana)
Education level
Age Illiterate Literate, <Primary school complete Primary school complete Middle school complete High school complete Higher secondary Complete and above Total percent Number of persons Median number of years of schooling

HARYANA (Jind)
Male

6-9 10-14 15-19 20-29 30-39 40-49 50+ Total 6-9 10-14 15-19 20-29 30-39 40-49 50+ Total 6-9 10-14 15-19 20-29 30-39 40-49 50+ Total

10.2 3.1 5.2 11.8 25.6 36.5 72.3 22.6 13.4 5.3 17.4 44.7 76.4 91.4 95.6 49.0 11.6 4.1 10.6 27.4 49.5 58.0 83.7 34.6

89.8 35.4 4.4 3.0 3.3 2.7 2.2 19.1 86.6 33.1 6.0 3.3 2.4 0.5 1.8 16.9 88.4 34.4 5.1 3.3 2.4 1.8 2.0 18.1

0.0 46.6 22.7 19.3 17.5 13.6 7.9 18.9 0.0 45.1 26.2 19.5 11.1 4.4 1.7 16.4 0.0 45.9 24.2 19.4 14.5 10.0 4.9 17.8

0.0 14.0 24.0 17.3 16.5 16.8 5.9 13.6 0.0 15.6 18.0 12.8 4.9 1.9 0.5 8.3 0.0 14.7 21.4 15.2 11.0 10.9 3.3 11.2

0.0 0.9 29.2 22.8 24.1 20.4 7.8 15.2 Female 0.0 0.9 21.5 12.1 3.8 1.2 0.4 6.2 Total 0.0 0.9 25.8 7.7 14.5 12.8 4.2 11.1

0.0 0.0 14.6 25.8 13.1 10.0 3.7 10.6 0.0 0.0 10.8 7.6 1.4 0.7 0.0 3.3 0.0 0.0 13.0 17.1 7.6 6.4 1.9 7.3

100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0

913 1076 918 1483 1033 668 1045 7136 685 861 711 1340 921 430 1000 5948 1598 1937 1629 2823 1954 1098 2025 13084

2.0 5.0 9.0 9.0 8.0 7.0 0.0 6.0 2.0 5.0 8.0 5.0 0.0 0.0 0.0 1.0 2.0 5.0 8.0 8.0 2.0 0.0 0.0 4.0

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Table 3.4b: Percent distribution of household population age 6 and above by literacy and level of education, according to age and sex (Tamil Nadu)
Education level
Age Illiterate Literate, <Primary school complete Primary school complete Middle school complete High school complete Higher secondary Complete and above Total percent Number of persons Median number of years of schooling

TAMILNADU (Salem)
Male

6-9 10-14 15-19 20-29 30-39 40-49 50+ Total 6-9 10-14 15-19 20-29 30-39 40-49 50+ Total 6-9 10-14 15-19 20-29 30-39 40-49 50+ Total

6.4 4.2 11.7 25.1 44.1 51.7 68.7 34.7 5.5 10.0 25.1 47.1 67.5 80.0 91.3 54.6 6.0 6.6 17.8 36.2 55.6 66.1 78.7 44.0

92.9 21.8 7.8 8.5 11.0 8.4 7.6 17.9 93.2 18.0 8.3 5.4 7.3 4.5 3.1 13.5 93.0 20.2 8.0 6.9 9.2 6.4 5.6 15.9

0.6 54.8 28.6 23.2 17.8 20.0 11.8 21.2 1.3 51.5 23.4 17.3 12.6 6.9 2.1 14.4 0.9 53.5 26.2 20.2 15.3 13.3 7.5 18.2

0.0 18.9 20.6 13.3 8.3 4.9 5.5 10.0 0.0 20.1 16.2 11.5 6.0 3.8 2.1 8.0 0.0 19.4 18.6 12.4 7.2 4.4 4.0 9.1

0.0 0.3 20.3 13.0 8.1 9.1 4.4 8.2 Female 0.0 0.4 16.8 8.1 4.3 3.8 1.4 5.3 Total 0.0 0.3 18.7 10.5 6.3 6.4 3.1 6.8

0.0 0.0 11.1 17.0 10.6 5.9 2.0 7.6 0.0 0.0 10.2 10.6 2.3 1.0 0.0 4.1 0.0 0.0 10.7 13.8 6.5 3.4 1.1 6.0

100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0

311 354 360 694 555 406 655 3335 235 239 303 705 533 419 516 2950 546 593 663 1399 1088 825 1171 6285

2.0 5.0 8.0 6.0 3.0 0.0 0.0 4.0 2.0 5.0 7.0 3.0 0.0 0.0 0.0 0.0 2.0 5.0 7.0 5.0 0.0 0.0 0.0 2.0

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Table 3.5: Percent distribution of households by housing characteristics Housing characteristics Electricity Yes No Source of drinking water Tap (Inside residence) Tap (Outside residence) Hand pump, bore well, well Pond Other Sanitation facility Own toilet (flush) Public toilet (flush) Own toilet (pit) Public toilet (pit) No facility Type of house Pucca Semi-pucca Kachha Main type of fuel used for cooking Electricity LPG / Bio-gas Charcoal Wood Crop residue Cow dung cakes Others Haryana (Jind) Tamilnadu (Salem)

89.3 10.7

77.8 22.2

30.4 41.6 24.3 3.1 0.3

5.3 68.5 26.2 0.0 0.0

13.2 0.2 1.5 7.6 77.5

4.1 0.2 0.0 0.4 95.3

49.6 43.0 7.5

14.2 44.4 41.4

2.0 31.7 18.7 78.4 9.8 83.8 -

0.2 13.5 19.2 87.6 37.2 15.1 0.1

21

Table 3.6: Percent distribution of households owning agricultural land/ house/ livestock, Haryana & Tamil Nadu Asset No land Agricultural land only <1 acre 1-5 acres 6+ acres Non-agricultural land only <1 acre 1-5 acres 6+ acres Both Agricultural and Non-agricultural land <1 acre 1-5 acres 6+ acres Missing Total percent Percentage owning a house Percentage owning livestock Number of households Haryana (Jind) 37.1 Tamil Nadu (Selam) 50.9

19.1 31.3 11.1

11.5 12.6 0.9

0.0 0.2 0.1

11.5 6.3 0.4

0.1 0.5 0.3 0.2 100.0 99.0 79.9 2,590

0.8 4.2 0.9 0.0 100.0 95.3 42.2 1,791

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Table 3.7: Percentage of households owning selected durable goods Asset Durable goods Mattress Pressure cooker Chair Cot/ bed Electric fan Clock/ watch Telephone Bicycle Radio/ transistor Television (B&W) Television (Colour) Moped/ scooter/motorcycle Water pump Thresher Tractor Other items 60.1 28.3 45.5 98.2 88.0 86.9 9.5 41.7 31.2 44.9 3.2 10.1 19.7 6.9 10.1 11.0 96.6 9.6 53.5 88.3 34.9 61.9 4.7 55.5 36.7 19.2 5.6 16.2 3.8 0.2 0.2 0.2 Haryana (Jind) Tamil Nadu (Salem)

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CHAPTER - IV SOCIOECONOMIC AND DEMOGRAPHIC BACKGROUND OF THE RESPONDENTS

Womens health seeking and demographic behaviour is virtually linked with several other characteristics including their age, marital status, religion, and caste. This chapter presents a profile of the demographic and socioeconomic characteristics of ever-married women age 15-49 who were identified by the Household Questionnaire as eligible respondents for the present study.

4.1 Background characteristics of the respondents

Table 4.1 presents the percentage distribution of all women interviewed by age, marital status, co-residence with husband, education, husbands education and employment for Haryana and Tamil Nadu. The table shows that in Haryana, the proportion of respondents in 5-year age groups increases from 7.5 percent in 15-19 age group to 23.1 percent in 25-29 age group and then falls down to 5.3 percent in 45-49 age group. In Tamil Nadu the proportion of respondents in the 5-year age group increases from 9.1 percent in 15-19 to 18.9 percent in 25-29 age group. It decreases to 14.8 percent in 30-34 age group and increases to 15.4 percent in 35-39 age group after which it falls down to 11.4 percent in 45-49 age group.

A large number of the respondents fall in the high fertility age group of 20-29 in both the states. More than half of the respondents in Haryana (51.6 percent) are in the early reproductive age group of 15-29 years. In Tamil Nadu more than half of the respondents are concentrated in the higher age group of 30-49 (53.8 %). Only 5.3 percent of women in Haryana are in the 45-49 age group compared to 11.6 percent in Tamil Nadu.

As far as marital status is concerned, 97.1 percent women in Haryana reported to be currently married and 2.9 percent women are widowed. In Tamil Nadu, around 93 percent women reported to be currently married. The percentage of women who reported to be divorced/separated is 4 percent each. Two to three percent women said that they were widows. Nearly ninety nine percent of the respondents reported to be living with their

25

husbands in Haryana compared to 95.3 percent in Tamil Nadu. A very small percentage of women were not living with their husbands in both the states. The literacy levels of the respondents and their husbands have an important bearing on their health care and health seeking behaviour. More than 60 percent women in Haryana (64.7%) and Tamil Nadu (62.7%) are illiterate. Among women who are literate, large proportions are those who have completed primary but not middle school. Only 14.2 percent women in Haryana and 16 percent women in Tamil Nadu reported to have completed primary level of education. Although 64.7 percent women in Haryana are illiterate, only 31.2 percent of their husbands are illiterate. On the other hand, a higher percentage of husbands in Tamil Nadu (53.4 percent) are illiterate. Again in Haryana, 21 percent women have husbands who are high school complete, compared to 7.3 percent in Tamil Nadu.

Considering the fact that the employment/work status has an important influence on a womens overall development as it nurtures her personality and helps her gain a sense of economic independence, it would be interesting to see the work participation rate in any kind of economic activity in any kind of economic activity either inside or outside house in both Haryana and Tamil Nadu. The table shows that 49 percent of respondents in Haryana have not been working in the past 12 months. The corresponding figure for Tamil Nadu is 41 percent. Nearly 35 percent women in Tamil Nadu are employed with someone else compared to only 13.2 percent in Haryana. The figures have been just the opposite in case of women, who reported to be working in their own family farm or running their own business. The table shows that 35 percent women in Haryana compared to only 11 percent in Tamil Nadu work in their respective family farm/business. The percentage of women who are self employed is 2.7 percent in Haryana and about 12 percent in Tamil Nadu. Thus more women in Tamil Nadu are seeking employment elsewhere compared to women of Haryana who are more involved in family farm or business.

4.2 Exposure to mass media

In a country like India, where a large number of women are illiterate and have attained little or no formal school education, informal channels such as mass media plays an important

26

role in bringing about modernization and thereby influencing and motivating women about their reproductive rights and choice.

Table 4.2 provides information on the percentage of ever-married women age 15-49 who read a newspaper or magazine, watch television or listen to radio at least once a week, who visit a theatre once in a month by selected background characteristics for Haryana and Tamil Nadu.

In Haryana regular exposure to media is higher among younger women below age 30, in comparison to Tamil Nadu where the exposure to mass media is more among women in the higher age group of 30 and above (except in case of visits to cinema theatre). In Haryana television has the greatest reach among women in all the age groups whereas in Tamil Nadu listening to radio seems to be more popular among women in all the age groups. However exposure to mass media is more in case of Tamil Nadu as compared to Haryana.

Exposure to each of the media increases with education. The percentage of illiterate women who are exposed to any kind of media is quite low in Haryana compared to illiterate women of Tamil Nadu. On the whole, women of Tamil Nadu have wider exposure to mass media than women of Haryana.

4.3 Perceived educational need for sons and daughters

Table 4.3 provides information on the womens educational aspirations for their children for Haryana and Tamil Nadu. Investing in childrens education is not only an important factor in bringing about a transition from uncontrolled fertility to controlled fertility, but is also an indicative of the degree of son preference prevalent in the respective places. In Haryana, 57 percent women believe that a son should be given as much education as he desires compared to 48.5 percent of women who believe that a girl should be given as much education as she desires. In Tamil Nadu only 33 percent women report that a son should be given education till he desires and 24 percent women report the same for girls. A very noticeable feature is that in Haryana, the percentage of women who believe that an education above higher secondary school and above is appropriate for boys is 9.7

27

and 7.9 percent for girls compared to 24.2 percent and 27.3 percent in Tamil Nadu. Thus the percentage of women who are desirous of educating their girl child beyond higher secondary school is more than what it is for boys in Tamil Nadu. This percentage in Haryana is significantly low for both boys and girls. On the whole the data show that women in Haryana and Tamil Nadu are more desirous of educating their male child beyond graduation than they are interested for educating their daughters for higher education.

4.4 Perceived age at marriage for sons and daughters

Table 4.4 shows the awareness and knowledge about the women in Haryana and Tamil Nadu regarding the legal age at marriage for boys and girls. It is surprising to see that around 40 percent of the respondents in Haryana believe that a boy should marry below 21 where as only 35 percent believe that a boy should marry above 21 years of age. In Tamil Nadu women are however better informed about the legal age at marriage for boys and girls as more than 80 percent gave the correct response regarding the legal age at marriage for boys and girls.

4.5 Perceived duration of breastfeeding (in months) for sons and daughters
Table 4.5 shows the duration of breastfeeding in months for sons and daughters as reported by respondents in Haryana and Tamil Nadu. In Haryana nearly 68 percent of women say that boys and girls should be fed for 13 to 24 months in contrast to Tamil Nadu where only 57 percent women are in favor of feeding boys and girls for 2 years. When mean duration in months is calculated it is seen that in Haryana boys and girls are fed for little more than two years where as in Tamil Nadu the mean duration in months is nineteen months.

4.6 Mean Time spent by women on household chores and other activities
Table 4.6 provides information on the average time spent by women in Haryana and Tamil Nadu for cooking, collecting drinking water, cleaning and mopping the house, washing clothes, milking animals, collecting fuel/wood and collecting food for animals.

28

The amount of time spent by women in various household activities determines their status and autonomy in the household and their freedom of movement, which may likely have an impact on her health seeking behaviour.

In Haryana, the mean time spent in collecting food for animals is 106.53 minutes, which has been the highest, followed by time spent in herding cattle (101.63) The meantime invested for cooking is 76.73 minutes, for cleaning and mopping the house 77.47 minutes and the average time spent for washing clothes is 79.03 minutes. The mean time spent for collecting drinking water is 56.97 minutes and for milking animals is comparatively much less as against other activities (97.04 mins.) Thus, women in Haryana seem to spend a longer duration of time working outside home.

In Tamil Nadu, the mean time spent has been the least for collecting drinking water. (45.12 minutes), collecting food for animals (122.38 minutes) and for making cow dung (124.49 minutes) is more or less equally distributed. The mean time spent for cooking is 89.61 minutes, for cleaning and mopping the house is (56.55 minutes), and washing clothes is (92.69 minutes) in Tamil Nadu.

The average time spent by women for other activities is 262.77 minutes. The average time spent outside home is high in comparison to time spent in activities inside home.

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Table 4.1: Percent distribution of the respondents by their background characteristics

Background Characteristics Age Groups 15-19 20-24 25-29 30-34 35-39 40-44 45-49 Marital Status Currently Married Widowed Separated Divorced Co-residence with Husband Living with husband Not living with husband Education Illiterate Literate<primary school complete Primary school complete Middle school complete High school complete High secondary complete and above Husbands Education Illiterate Literate<primary school complete Primary school complete Middle school complete High school complete High secondary complete and above Working Status Working in family farm/business Employed with someone else Self employed Not worked in the past 12 months

Haryana (Jind) 7.5 21.0 23.1 18.0 15.5 9.6 5.3

Tamil Nadu (Salem) 9.1 18.2 18.9 14.8 15.4 12.0 11.6

97.1 2.9 0.0 0.0

92.8 2.3 4.0 4.6

98.7 1.3

98.3 1.7

64.7 2.2 14.2 8.1 7.2 3.6

62.7 3.8 16.1 8.2 5.3 4.0

31.2 2.8 16.3 16.0 20.9 12.8

53.4 5.0 20.0 7.6 7.3 6.6

35.1 13.2 2.7 49.0

11.0 35.2 12.3 41.5

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Table 4.2: Exposure to Mass Media

Reads news paper or magazine once a week Haryana (Jind) Watches TV at Listens to least once a the radio at week least once a week Visit a cinema theatre at least once a month 1.6 1.9 1.4 0.4 0.5 0.4 0.0 Reads news paper or magazine once a week Tamil Nadu (Salem) Watches TV at Listens to least once a the radio at week least once a eek Visit a cinema theatre at least once a month 27.7 21.0 21.6 17.2 21.2 14.0 9.6

Background Characteristics

Age 15-19 20-24 25-29 30-34 35-39 40-44 45-49 Education Literate<primary School complete Primary school complete Middle school complete High school complete Higher secondary complete and above
* All figures are in terms of percentage

8.4 12.7 10.5 7.2 3.8 4.5 3.7

45.3 47.2 38.0 30.2 30.6 31.4 29.6

29.3 27.6 22.2 16.9 15.9 16.7 11.9

10.2 8.4 10.0 8.0 11.2 7.7 7.1

59.1 51.8 51.6 49.0 51.5 50.0 43.1

61.3 58.6 53.8 52.2 53.5 48.5 41.1

0.0 8.5 15.9 33.9 57.3

35.6 46.0 57.9 69.3 80.2

11.9 27.2 31.3 47.1 61.5

0.0 0.8 2.3 2.6 9.4

7.9 11.7 15.2 36.0 50.7

66.7 64.6 67.1 72.2 72.5

60.3 65.3 68.6 74.4 78.3

22.2 22.3 26.4 30.0 34.8

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Table 4.3: Perceived educational need for sons and daughters, Haryana and Tamil Nadu Education for Children No Education Less than Primary Primary School Middle School High School Higher Secondary school and above Graduate and above As much as he/she desires Depends on the economic condition
* All figures are in terms of percentage

Haryana (Jind) Boys 0.0 0.2 0.5 0.6 18.6 9.7 Girls 0.2 0.5 3.5 6.9 25.2 7.9

Tamil Nadu (Salem) Boys 0.0 0.0 0.0 3.0 18.2 24.2 Girls 0.0 0.0 6.1 12.1 24.2 27.3

12.4 57.1

6.6 48.5

21.2 33.0

6.1 24.2

0.8

0.8

0.0

0.0

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Table 4.4: Percent distribution of women regarding age at marriage for boys and girls Age Haryana Tamil Nadu

Boys Below 21 At 21 Above 21 Girls Below 18 At 18 Above 18 13.3 65.4 21.3 12.9 13.1 74.0 39.7 25.3 35.0 5.9 7.7 86.4

Table 4.5: Percent distribution of women regarding duration of breast milk (in months) to be given to boys and girls for Haryana and Tamil Nadu Haryana Duration in months Boys 1-5 6-12 13-24 25+ 1.6 3.6 67.4 27.4 Girls 1.5 3.7 68.1 26.7 Boys 0.5 35.6 57.4 6.5 Girls 0.8 35.8 57.2 6.2 Tamil Nadu

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Table 4.6: Mean time spent by women on different household chores and other activities (Time in minutes)
Time spent in Washing Milking Collecting Collecting clothes animals fuel/wood food for animals

Name of the district

Collecting drinking water

Cooking

Cleaning and mopping the house 77.47 2495 40.75

Making Herding Other cow cattle activities dung

Jind Mean N Std. deviation Selam Mean N Std. deviation

56.97 2432 32.39

76.73 2515 38.05

79.03 2368 43.20

49.95 1996 40.74

91.19 1839 64.12

106.53 1888 58.18

74.68 1778 51.02

101.63 1380 62.42

97.04 275 76.38

45.12 1680 34.36

89.61 1679 44.39

56.55 1672 31.96

92.69 1619 43.01

52.81 365 56.84

125.86 996 63.81

122.38 403 61.53

124.49 99 103.78

200.82 416 89.88

262.77 94 95.16

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CHAPTER - V PREGNANCY AND ANTENATAL CARE

5.1 Pregnancy history

One of the ways to determine the prevalence of sex selective abortions is to see what percentage of live birth and abortions (induced) have occurred to women (ever married) starting from their first pregnancy till their fifth pregnancy and above. The analysis below shows the number and percentage of women according to outcome of pregnancy by order of pregnancy for ever married and currently married women of Tamil Nadu and Haryana.

Tables 5.1 and 5.2 show that in Selam (Tamil Nadu), 91 percent of women have had a live birth in their first order of pregnancy. This percentage has shown a decline with higher orders of pregnancy. As is observed from the table, with a higher order of pregnancy there is a subsequent decline in the percentage of women giving live birth with a corresponding increase in the percentage of women going for induced abortions, thereby resulting in a large number of foetus wastage. The percentage of women having stillbirth or spontaneous abortions are lesser than the percentage of women having induced abortions in all the orders of pregnancy. The percentage of women having induced abortion has increased from less than 2 percent in the second order of pregnancy to more than 20 percent in the fifth order and above. The analysis shows that there are less and less number of live births and more incidence of induced abortions at higher orders of pregnancy which could be perhaps to limit the family size or could be due to high son preference.

Tables 5.3 and 5.4 show that in Haryana 91.4 percent of women have had a live birth in their first order of pregnancy. Unlike Selam, this percentage has shown an increase till the third order of pregnancy and then there has been a decline. Percentage of women having had a live birth has been the highest in the third order of pregnancy. Percentage of induced abortions has been less than one percent in the first, second, and third order of pregnancy. In Haryana because of the preference for bigger family size, the percentage of induced abortions is perhaps low till the first three order of pregnancy.

35

5.2 Influence of previous pregnancy outcome on the present pregnancy outcome

It is said that the outcome of a pregnancy to a large extent is determined by the outcome of the previous pregnancy. A woman who has had a live birth is more likely to deliver a live baby in her next pregnancy than a woman who has had a stillbirth or an abortion in her previous pregnancy. On examining the influence of the outcome of the previous pregnancy on that of the present birth, table 5.5 shows that in Selam, 90 percent of the second pregnancy was a live birth when the previous pregnancy was also a live birth. The proportion of live births in the subsequent deliveries slowly declined, even though the outcome of the previous pregnancy was a live birth. The percentage of abortions (spontaneous and induced) has increased from 5.7 percent in the second pregnancy to 22.2 percent in the seventh and above confinements for women whose previous pregnancy was a live birth. In Haryana, as shown in table 5.6 more than 90 percent of the cases resulted in a live birth when the previous pregnancy outcome was also a live birth in all the subsequent deliveries. When we look at the percentage of abortions that occurred, it is seen that the percentage of abortion in Haryana has increased from 3.4 percent in the second pregnancy to 7 percent in the seventh pregnancy for all those women whose previous outcome was also a live birth.

The analysis shows that in Selam district in Tamil Nadu the incidence of abortion is more at higher orders of pregnancies in comparison to Jind district in Haryana. As has been reiterated earlier, the preference for a smaller family size could perhaps be one of the reasons leading to high-induced abortions in Selam in Tamil Nadu.

5.3 Antenatal Care (ANC)

Antenatal care refers to pregnancy related health care provided by a doctor or a health worker in a medical facility or at home. Ideally, antenatal care should monitor a pregnancy for signs of complications, detect and treat pre-existing and concurrent problems of pregnancy and provide advice and counselling on preventive care, diet during pregnancy, delivery care, post natal care and related issues. The Reproductive and Child Health programme recommends that the pregnant women should have at least three antenatal checkups that include blood pressure checks and other procedures to detect pregnancy complications.

36

Tables 5.7 and 5.8 provide coverage of ANC for women by birth orders for Tamil Nadu and Haryana. Three components such as antenatal checkups, blood test and urine test were studied to ascertain to what extent women give importance to antenatal care during pregnancy.

Table 5.7 shows that in Selam, out of 1563 pregnant women, 49 percent of women went for antenatal checkups during their first pregnancy. This percentage has declined to 40 percent for women in their second pregnancy, 32.3 percent women in the third pregnancy and 24.4 percent women in the fourth pregnancy. Thus, we see, that with the increase in the order of pregnancy, there is a subsequent decline in the percentage of women going for ANC checkups. This shows that in case of live births of earlier pregnancies, there is more anxiety among women regarding their health and their babys health, which gradually diminishes for births at higher order pregnancies. In Haryana as table 5.8 shows out of 2398 women in the first birth, 21 percent reported having gone for ANC checkups. There was a constant decline in percentage in the second (18.5 %), third (15.8%) fourth (12.4%) and fifth birth and above (12.6%).

In Selam, 40 percent women reported to have done a urine test during their first birth and this percentage declined to 11.8 percent for women in the fifth birth and above. Similarly, 18.2 percent of women out of 2398 women in their first pregnancy in Haryana reported to have done urine test and this percentage further declined for women in higher births. With regard to blood test, the percentage of women who reported to have done a blood test is higher in the first birth order and there is a corresponding decline in the percentages in both the states with the increase in parity.

In Selam though 49 percent of women in their first birth reported to have done ANC checkups only 39 percent reported to have gone for a blood and a urine test. This shows that the women of higher parities are in general ignorant and less conscious about their health as compared to women of first and second births in Haryana as well as in Tamil Nadu.

Tables 5.9 and 5.10 provide the percentage distribution of women, who went for a sonography test, who motivated them to go for the test, and whether the sex of the baby was revealed to them after doing the sonography.

37

In Selam, out of 49 percent women in their first pregnancy who went for ANC checkups, only 5 percent reported to have done the sonography test. Out of these 5 percent women, nearly one third of them have reported that the sex of the baby was revealed to them during sonography. In the second birth, out of 1290 women, 39.8 percent went for ANC check-up and only 2.7 percent women reported to have gone for sonography test, out of which nearly one-fifth have reported that the sex of the baby was revealed to them during the test. In the third pregnancy slightly more than 3 percent of women reported of going for a sonography test, higher than what it was in the second pregnancy. This shows that the inquisitiveness to know the sex of the baby is more after the birth of the first two children among women in Selam.

In Haryana, out of 21.1 percent women who went for ANC checkups in their first birth, 4.6 percent women went for a sonography test out of which nearly one sixth of women reported that the sex of the baby was revealed to them during the test. The percentage of women who said that they were told about the babys sex during sonography increased from the third birth and onwards. Whereas the percentage was 14.2 in the first birth it rose to 35.9 percent in the fourth birth. Correspondingly there has also been an increase in the percentage of women who reported of having done the sonography test from the third birth onwards in Haryana.

With regard to persons who suggested these women to go for a sonography, the data shows that in Selam out of the five percent women who reported to have gone for sonography during their first birth confinement, the proportion of women who said they went by doctors suggestion was 44 percent. This percentage decreased in the third birth to 36 percentage. The proportion of women who went out of their own interest or the husbands/ family interest was less than 20 percent in all the births.

5.4 Health problems during pregnancy

Tables 5.11 and 5.12 provide information about the proportion of women who suffered from any disease during pregnancy, and specific health problems during pregnancy by order of confinement for Tamil Nadu and Haryana. In Selam 78.6 percent of women reported that they are suffering from one or the other health problems during the first pregnancy. The percentage of women suffering from any disease has declined in the higher order

38

pregnancies. Only 51 percent of women in the 5th pregnancy and above reported to have some health problems. Similarly in Haryana, the percentage of women who had any health problem has been the highest in the first pregnancy (64.2 percent). This percentage has declined to 58.6 percent for women in the fifth pregnancy and above. This shows that women in their first birth are more likely to suffer from various health problems, which decrease considerably in case of deliveries at higher parities. Nausea and vomiting as a health problem was reported by maximum percentage of women during the pregnancies at all parities both in Jind and in Selam. Seventy-three percent women in Selam and 54 percent women in Haryana reported to have suffered from nausea and vomiting during their first pregnancy. This percentage showed a decline with the increase in the order of pregnancies. The percentage decline between the first and the 5th and the above pregnancy is more than 20 percent in Selam and around 10 percent in Haryana. Apart from Nausea and vomiting, weakness and dizziness seems to be a common problem among women in both the states.

More than 30 percent women reported the above two problems in the state of Haryana during all the pregnancies. In Selam, the percentage of women who reported suffering from dizziness and paleness was more than 30 percent in the first birth but declined slowly with the increase in the order of the pregnancy. Less than 10 percent women in Selam reported having problems of paleness, bleeding, visual disturbance, hypertension, swelling etc. during all the pregnancies.

In Haryana, the proportion of women who reported bleeding to be a problem has increased from 6 percent in the first birth to 18 percent in the second birth. After seeing a decline in the third there is a sudden rise from the fourth and onwards. The overall picture shows that women in Selam in Tamil Nadu are in better health conditions than women of Jind in Haryana.

5.5 Type of doctor visited

Tables 5.13 and 5.14 show the proportion of women who consulted a doctor for their health problems and the type of doctor visited according to order of pregnancy for Tamil Nadu and Haryana.

39

Out of the 78.6 percent women in Selam who reported to have suffered from any health problems in their first birth order, only 25 percent women reported visiting a doctor for their health problems. Twenty one percent women in their first and second births went for doctors consultation. This percentage further declined to 18 percent for women during the fourth and above pregnancies.

In Haryana, out of 64 percent women who had health problem of any kind, 31 percent reported having visited a doctor in their first birth order. This percentage further declined to 26 percent during the higher pregnancies. The percentage of women who reported having consulted a doctor for their health problem is highest among women of the first order of pregnancy.

The analysis shows that at the time of first pregnancy women are more conscious about their health status than they are in the higher orders of pregnancies.

In Selam, out of the 25 percent women who visited doctor during their first pregnancy, 40 percent of the women referred a Government doctor, whereas 64 percent of women went to a private doctor. Only 17 percent women went to other health care providers such as (ANM, Nurse Homeopathic/ Ayurvedic/Unani doctors etc). In the second and third pregnancies, this percentage has shown an increase in case of visit to Government doctors, but the percentage of women who went to private doctors has shown a decline from 64 percent in the first birth to 62 and 60 percent during the second and third order of pregnancies respectively.

In Haryana, the percentage of women visiting private health care providers is highest in the second order of pregnancy (65.1%) than the percentage in the first. A very striking feature observed in Haryana is that the percentage of women visiting private doctors is lowest during the third pregnancy (19.1%) as compared to 41 percent of women who visited the Govt. doctors during the same order of pregnancy.

40

Table 5.1: Percentage and number of women according to outcome and order of pregnancy (Ever married women, Selam District, Tamil Nadu) Order of pregnancy 1 2 3 4 5 6&above Live Birth No. 1402 1132 697 359 142 89 % 91.2 88.9 82.8 80.1 71.0 61.8 Still Birth No. 40 35 31 11 5 2 % 2.6 2.7 3.6 2.4 2.5 1.3 Spontaneous Abortion No. % 93 6.0 82 6.4 48 5.7 31 6.9 12 6.0 6 4.1 Induced Abortion No. % 1 0.06 23 1.8 65 7.7 47 10.4 41 20.5 47 32.6

Total 1536 1272 841 448 200 144

Table 5.2: Percentage and number of women according to outcome and order of pregnancy (Currently married women, Selam District, Tamil Nadu) Order of pregnancy 1 2 3 4 5 6&above Live Birth No. 1313 1063 655 334 136 83 % 91.6 89.2 82.9 79.3 70.8 60.5 Still Birth No. 37 32 30 10 5 2 % 2.58 2.69 3.80 2.38 2.60 1.46 Spontaneous Abortion No. % 82 5.72 75 6.30 43 5.4 31 7.3 12 6.2 6 4.3 Induced Abortion No. % 1 0.07 21 1.7 62 7.8 46 10.9 39 20.3 46 33.5

Total 1433 1191 790 421 192 137

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Table 5.3: Percentage and number of women according to outcome and order of pregnancy (Ever married women, Jind District, Haryana) Order of pregnancy 1 2 3 4 5 6&above Live Birth No. 2159 1932 1437 805 416 365 % 91.4 92.9 93.2 90.4 87.9 89.0 Still Birth No. 67 33 23 16 11 8 % 2.8 1.5 1.4 1.8 2.3 1.9 Spontaneous Abortion No. % 135 5.7 106 5.1 77 5.0 60 6.7 38 8.0 33 8.0 Induced Abortion No. % 1 0.04 7 0.34 4 0.26 9 1.01 8 1.6 4 0.98

Total 2362 2078 1541 890 473 410

Table 5.4:Percentage and number of women according to outcome and order of pregnancy (Currently married women Jind District, Haryana) Order of pregnancy 1 2 3 4 5 6&above Live Birth No. 2088 1864 1388 772 395 348 % 91.3 92.8 93.2 90.6 88.1 89.0 Still Birth No. 64 32 22 15 11 6 % 2.8 1.5 1.4 1.7 2.4 1.5 Spontaneous Abortion No. % 133 5.8 104 5.1 75 5.0 56 6.5 36 8.0 33 8.4 Induced Abortion No. % 1 0.04 7 0.3 3 0.2 9 1.0 6 1.3 4 1.0

Total 2286 2007 1488 852 448 391

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Table 5.5: Influence of previous pregnancy outcome on present pregnancy outcome, Selam District, Tamil Nadu

Outcome of the subsequent pregnancy

Order of pregnancy Live Birth Percentage/Number 91.5(976) 91.1(31) 51.4(35) Still Birth Percentage/Number 2.6(28) 8.8(3) Abortion Percentage/Number 5.7(61) 2.9(1) 47.0(32)

First
*LB-1066 *SB-34 *A-68

Second
LB-676 SB-25 A-68 83.1(562) 80.0(20) 70.5(48) 3.5(24) 16.0(4) 2.9(2) 12.1(82) 4.0(1) 22.0(15)

Third
LB-339 SB-16 A-51

83.0(282) 50.0(8) 58.8(30)

0.8(3) 12.5(2) 1.9(1)

1.1(4) 37.5(6) 39.2(20)

Fourth
LB-148 SB-4 A-32

80.4(119) 50.0(2) 37.5(12)

2.0(3) 25.0(1) 3.1(1)

17.5(26) 25.0(1) 59.3(19)

Fifth
LB-57 SB-3 A-19

78.9(45) 33.3(1) 31.5(6)

33.3(1) -

21.0(12) 33.3(1) 57.8(11)

Sixth
LB-18 SB-1 A-7 77.7(14) 28.5(2) 1 22.2(4) 57.1(4)

Abbreviations: LB: live birth SB: Still birth A: Abortion * Absolute numbers are given in parentheses

43

Table 5.6: Influence of previous pregnancy outcome on present pregnancy outcome, Jind District, Haryana

Outcome of the Subsequent Pregnancy

Order of pregnancy First LB-1764 SB-53 A-103 Live Birth Percentage/Number 95.0(1683) 81.0(43) 63.0(65) Still Birth Percentage/Number 0.96(10) 15.0(8) 2.0(2) Abortion Percentage/Number 3.4(60) 4.0(2) 34.0(35)

Second
LB-1305 SB-25 A-75 95.3(1244) 80.0(20) 74.6(56) 1.1(15) 12.0(3) 2.6(2) 3.4(46) 8.0(2) 22.6(17)

Third
LB-731 SB-16 A-44 92.6(681) 68.7(11) 68.1(30) 0.2(2) 12.5(2) 2.2(1) 4.8(36) 18.7(3) 29.5(13)

Fourth
LB-355 SB-9 A-32

91.8(326) 77.0(7) 65.6(21)

2.5(9) 11.0(1) -

5.5(20) 11.0(1) 34.3(11)

Fifth
LB-164 SB-8 A-20

93.2(153) 87.5(7) 83.3(15)

0.6(1) 13.0(1) -

6.0(10) 20.0(4)

Sixth
LB-70 SB-9 A-

92.8(65) 44.4(4) -

7.0(5) 55.5(5) -

Seventh
LB-38 SBA-4

94.7(36) 25.0(1)

5.2(2) 75.0(3)

Eighth
LB-14 SBA-2
Note: Same as of table 5.5

100(14) 50.0(1)

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Table 5.7: ANC information for women by order of pregnancy, Salem District, Tamil Nadu Percentage of Women who reported of doing ANC check up, Urine Pregnancy test and have undergone blood test by order of pregnancy First Second Third Fourth Fifth and above 48.9 39.8 32.3 24.4 16.7

Details

Whether gone for ANC check-up Undergone Urine Pregnancy test Undergone blood test

39.9

31.0

23.5

16.1

11.8

39.4

30.7

22.5

15.7

11.8

Table 5.8: ANC information for women by order of pregnancy, Jind District, Haryana Percentage of Women who reported of doing ANC check up, Urine Pregnancy test and have undergone blood test by order of pregnancy First Second Third Fourth Fifth and above 21.1 18.5 15.8 12.4 12.6

Details

Whether gone for ANC check-up Undergone Urine Pregnancy test Undergone blood test

18.2

15.7

13.5

10.9

12.4

16.3

14.3

11.9

10.1

11.1

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Table 5.9: Percentage of women who went for sonography, who motivated them to go and whether the sex of the baby was revealed to them by order of pregnancy, Selam District (Tamil Nadu) Order of Pregnancy % of women who went for Sonography Persons who suggested them to go Self Husband Family & relatives Nurses Doctors Others Sex of the baby revealed 1st 5.0(79) 2nd 2.7(35) 3rd 3.5(30) 4th 0.9(4) 5+ 2.4(8.0)

6.3 17.7 10.1 3.8 44.3 74.6 39.2

8.5 17.1 8.5 45.7 28.5

10.0 16.6 16.6 6.6 36.6 20

25.0 75 25

25 25 50 25

Table 5.10: Percentage of women who went for sonography, who motivated them to go and whether the sex of the baby was revealed to them by order of pregnancy, Jind District (Haryana) Order of Pregnancy % of women who went for Sonography Persons who suggested them to go Self Husband Family & relatives Nurses Doctors Others Sex of the baby revealed 1st 4.6(112) 2nd 3.7(78) 3rd 3.8(59) 4th 4.3(39) 5+ 5.4(42)

28.5 23.2 7.1 11.6 47.3 14.2

29.4 19.2 5.1 10.2 37.1 15.3

32.2 27.1 5.0 13.5 32.2 28.8

23.0 25.6 7.6 12.8 30.7 35.9

30.9 28.5 16.6 7.1 19.0 42.8

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Table 5.11: Proportion of women suffering from any health problems and specific health problems during pregnancy by order of pregnancy, Selam District (Tamil Nadu)

Order of pregnancy Percentage of women suffering from any disease Proportion of women suffering from specific health problems Nausea/vomiting Weakness Dizziness Paleness Bleeding Pain in abdomen Visual disturbance Hypertension Swelling Weak foetus Abnormal presentation Others

First 78.6

Second 70.3

Third 65.5

Fourth 61.1

Fifth & above 51.3

73.0 47.0 35.0 6.2 2.0 10.3 3.0 8.4 1.3 0.3 0.1 0.2

64.9 38.4 24.6 3.6 1.0 6.9 2.2 6.2 0.7 0.2 -

60.0 35.7 23.1 3.7 1.5 1.7 2.2 5.6 0.8 0.2 0.2 -

52.5 32.9 20.2 6.4 1.1 4.8 3.1 6.4 1.1 0.4 -

45.0 23.2 18.9 4.0 2.1 2.8 2.4 7.4 0.6 0.3 -

Table 5.12: Proportion of women suffering from any health problems and specific health problems during pregnancy by order of pregnancy, Jind District, (Haryana) Order of pregnancy

First
64.2

Second
61.3

Third
59.9

Fourth
56.9

Fifth & above

58.6

Percentage of women suffering from any disease Proportion of women suffering from specific health problems
Nausea/vomiting Weakness Dizziness Paleness Bleeding Pain in abdomen Visual disturbance Hypertension Swelling Weak foetus Abnormal presentation Others

54.0 38.2 33.5 23.5 6.0 17.8 8.2 6.0 10.6 4.9 1.5 2.6

50.8 37.9 33.2 23.1 17.9 16.8 8.7 6.4 9.6 4.6 1.1 2.1

48.6 37.7 33.4 21.6 7.7 16.2 8.6 6.3 9.9 4.7 0.9 2.3

45.8 35.0 32.2 20.9 8.1 15.0 8.3 6.7 9.3 4.0 1.0 1.6

43.9 35.5 32.3 21.3 9.1 17.5 9.8 8.8 9.4 2.3 0.9 1.6

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Table 5.13: Proportion of women who consulted a doctor for their health problem, type of doctor consulted by order of pregnancy, Selam District, (Tamil Nadu) Order of pregnancy No. of women with any disease Percentage of women who consulted doctor 25.6(314) 21.8(198) 21.4(117) 18.3(50) 18.8(29) Percentage of women visiting govt. doctor 39.8(125) 44.4(88) 52.9(62) 52.0(26) 41.3(12) Percentage of women who visited pvt. doctor 64.3(202) 62.1(123) 59.8(70) 66.0(33) 68.9(20) Percentage of women who visited other healthcare providers 17.5(55) 16.6(33) 11.9(14) 12.0(6) 6.9(2)

First Second Third Fourth Fifth&above

1226 905 545 272 154

Table 5.14: Proportion of women who consulted a doctor for their health problem, type of doctor consulted by order of pregnancy, Jind District, (Haryana)

Order of pregnancy

No. of women with any disease 1524 1279 925 507 437

% of women who consulted doctor 31.0(471) 28.6(367) 26.8(248) 26.8(136) 25.8(113)

% of women visiting govt. doctor 47.5(224) 41.1(151) 43.1(107) 37.5(51) 41.5(47)

% of women who visited pvt. doctor 55.4(261) 65.1(239) 19.7(49) 63.9(87) 60.1(68)

First Second Third Fourth Fifth & above

% of women who visited other healthcare providers 7.2(34) 5.7(21) 9.2(23) 7.3(10) 11.5(13)

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Chapter - VI ABORTION AND SON PREFERENCE

Abortion can be linked to son preference in two ways. First, the prevalence of abortions may differ according to the sex of the living children in the family, even if the sex of the foetus is not known. Secondly, sex selective abortions may be used to avoid birth of children of an undesired sex after the sex of the foetus has been determined. The following analysis shows whether abortion in Haryana and Tamil Nadu is related to son preference or not.

During data collection, it was observed that there is a clandestine practice of aborting female foetuses in Jind city. Nursing Homes have put up signboards disseminating the availability of colour ultrasound with them. Female foetuses are aborted after three and half months when the sex of the foetus becomes recognizable as reported by doctors. During the last few years cases of abortion has raised significantly and people of rural areas are flocking in large numbers for induced abortions. The cost of abortion ranges from Rs.1200/- to Rs.4000/- depending upon the clients status as well as the status of the nursing home. It has been reported by the doctors that a couple with one or two daughters mostly go for abortion, as they dont want additional daughters. Abortion is rarely resorted to in respect with the first child and the birth of the daughter is tolerated also. There is a pressure for abortion by the neighbours and friends who advise the couple for resorting to abortion. This has become an accepted practice among the people as well as the doctors. There are three types of medical Institutions in Jind City apart from Civil Hospitals. They are:

Private Nursing Homes Charitable Hospitals and Private Clinics

Private Nursing Homes usually admit pregnant women for deliveries as well as abortion. They have bed facility and conduct tests like ultrasound. Blood, Urine, and Stool tests are also conducted. Generally a team of nurses or midwives run this type of nursing homes. Some of them have just B.A.M.S. Degree. Very few have M.B.B.S. degree with specialization in Gynaecology. The conditions of these Nursing Homes are deplorable as several women are seen crowded in a large size room or lobby. Abortions are frequently

49

conducted in these nursing homes as was revealed to the researcher after deep probing. Most of these Private nursing homes conduct 2-4 abortions daily. The cost of sonography is Rs.500/- and is done in selected laboratories in Jind City apart from some nursing homes.

Some lady doctors with M.B.B.S degree have been conducting sonography at their residence. Most of the nursing homes are a part of the residential buildings of the practitioners, and a few of them do not have separate rooms for the doctors. The toilet facilities were bad in condition. One could see several women being administered drips lying on the cots in a hall. The male doctor, usually the husband is the in charge of the Nursing Home and the lady doctor usually the wife supports him in his work. The women do not hesitate to get themselves examined by male doctors nor do their husbands demand them to be examined by lady doctors whenever they accompany them.

The charitable hospitals mostly maintained by Jain and Bania communities reported that they do not practice abortion usually. However, in complex cases such as bleeding or risk to the life of the expected mother they resort to abortion as it is considered to be good from their religion point of view.

Private clinics where there is no bed facility also practice sex selective abortion. Some of the doctors reported that they administer certain drugs and medicines for abortion including injections, which has effect only after several hours, and ask the client to go to their homes. In some cases villagers themselves administer drip to the women to induce abortion. In villages trained dais and ANMs are also practicing induced abortions.

Some of the villagers openly admitted that they are aborting female foetuses because it is very difficult to get their daughters married to a suitable boy. They consider them a liability. Some villagers who were desirous of male children are also duped by few footloose doctors by giving some tablets or injections to the women on the pretext that a male child will be born to them.

The Prenatal Diagnostic and Prevention Act, 1994, is mostly flouted. This has accentuated recently because of the factors such, as proximity of towns to villages in the wake of increased accessibility by roads.

50

The demographic characteristics of the sample of 2646 women in Haryana and 1706 women in Tamil Nadu are broadly similar. Interestingly, mean age of respondents in both the sample was more or less same (29.3 and 31.6 years) but mean age of husbands was lower by 4 years in Haryana compared to Tamil Nadu (33.9 and 38.1 years). Most of the women in Haryana were currently married (97percent) and in case of Tamil Nadu, the proportions of currently married women were found slightly lower (92.8 percent). Literacy rate of respondents were 36.5 and 37.8 percent in the state of Haryana and Tamil Nadu respectively. Literacy rate of males in Haryana were significantly higher than in Tamil Nadu.

6.1 Abortion by socioeconomic and background characteristics

Tables 6.1a&b presents abortion by socio economic and background characteristics for the state of Haryana and Tamil Nadu.The table shows very minimal differences with regard to the type of women who go for abortions. In Tamil Nadu majority of the women who have had abortion were from medium SLI, were literate, but had not completed primary school education, and in majority of the cases husband 's occupation was cultivation. In Haryana however no such significant differences are observed.

6.2 Abortion incidence

Table 6.2 shows all abortions, reported by women (spontaneous as well as induced). In the state of Haryana, 486 women and in Tamil Nadu 496 women reported that they had abortions. Abortion reported by women, revealed that the rate of abortions per 100 live births increased markedly from 1971 to 2001 in both the states. Overall reporting of abortion in Tamil Nadu is almost double to that of Haryana. In the recent period, difference in abortion rate has narrowed down in both the states. In case of Tamil Nadu, rate of abortion since 1984 is more or less constant.

6.3 Frequency of abortion

Abortion rates calculated for the women show that one- third of Tamil Nadu women and one-fifth of Haryana women had abortions. From the frequency of abortion presented in table 6.3 it is noticed that around 15 per cent women in Tamil Nadu and 8 per cent in

51

Haryana had at least one abortion. A noticeable percentage of women in both the states had undergone two abortions. A small proportion of women have also undergone three and more abortions. From the frequency of abortion, it can be concluded that a significant number of women are undergoing repeated abortions, which points to the practice of abortion in both the states.

Nearly eight per cent of all reported abortions in Haryana and 45 per cent in Tamil Nadu were induced. Data of first phase was collected during the month of January - March 2001 when the hearing of Public Interest Litigation about the enforcement of Pre-natal Diagnostic Techniques (prevention and regulation misuse) Act 1996 (PNDT Act) was in Supreme Court. In Haryana 72 percent of the respondents husband were literate and quite a few were graduates and postgraduates. Low reporting of induced abortion in north India could be due to existing socio-cultural factors as well as many people seemed to be aware about the Pre-natal Diagnostic Techniques (prevention and regulation misuse) Act 1996 (PNDT Act) as many of them have said that sex selective abortions are illegal. Under such prevailing condition at the time of data collection, direct evidence of sex selective abortions was almost non-existent in both the states. Respondents in Tamil Nadu at least reported induced abortions whereas respondent in Haryana although reported abortion during pregnancies, but avoided to report it, as induced. Using pregnancy history, antenatal care, and abortion histories, following six conjectures can be drawn.

6.4 Distinction of spontaneous and induced Abortion

In up to 60 per cent of spontaneous abortions, the foetus is absent or grossly malformed, and in 25 to 60 per cent, it has chromosomal abnormalities incompatible with life; thus spontaneous abortion in more than 90 per cent of cases may be a natural rejection of a maldeveloping foetus (The Merck Manual of Diagnosis and Therapy, Chapter 252). In many cases women are not able to differentiate spontaneous abortions from regular delayed menses with heavy bleeding. It will be difficult for her to remember this event and report in her pregnancy history. Chhabra and Nuna (1993) in their study on abortion suggested that three-fifth of the total abortions are induced. Using this conjecture, it can be said that most of the reported abortions are induced in both the states.

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6.5 Distribution of abortions by pregnancies

Table 6.4 shows the distribution of abortions by pregnancy. In the state of Haryana highest number of the reported abortions had occurred during the first pregnancy of the women followed by second and third pregnancies. Tamil Nadu depicts a different story by having highest number of abortions in the third pregnancy followed by second. Abortion during the first and second pregnancy may be spontaneous or sex selective whereas higher order abortion may be induced to control family size. Mean number of children ever born in Haryana was 2.93 and in Tamil Nadu was 2.35, and the abortion before achieving this number may be considered as sex-selective or untimely pregnancies. Based on this analysis it can be concluded that 60-80 per cent of total abortions are induced and around 40 per cent seem to be sex selective abortions.

6.6 Closed Interval between Pregnancies

In the pregnancy history section of the questionnaire, duration between two conceptions was asked starting from marriage to last birth. Table 6.5 presents closed interval between pregnancies with outcome of pregnancies. This analysis is done on the assumption that shorter intervals will lead to induced abortions for birth spacing. T-test is also applied to examine the significance of difference of intervals in two different outcomes of pregnancy. In case of first interval from marriage to first conception, differences are insignificant in two outcomes namely live birth and abortions. The first pregnancies, which had resulted in an abortion, may be spontaneous or to some extent sex selective, among those who had strong desire to have first child as male. It is surprising to note that all other intervals are significantly different in case of live birth and abortion.

A further analysis of duration of intervals in terms of median as well as distribution reveals that nearly 3 percent intervals were very short (less than 12 months) preceding the abortion. Other intervals were same as that of live birth intervals. Based on this evidence it may be estimated that 80 percent of these pregnancies were wanted but were terminated on account of sex selection.

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6.7 Gestation period

In table 6.6 mean period of gestation (in weeks) by type of abortion and number of abortions are presented. Data for mean duration of pregnancy indicate that average gestation period in case of spontaneous abortion in both the states is above 12 weeks (first trimester). According to Merck manual, about 85 percent of spontaneous abortions occur in the first trimester and tend to have foetal causes. Making adjustment with medical evidence and gestation period, it is estimated that nearly 77 per cent of the spontaneous abortions were sex selective abortions.

In Tamil Nadu, reported induced abortions have lower mean duration of gestation compared to spontaneous abortion in all the pregnancies. The reported induced abortions are around 12 weeks of gestation and this may be for spacing and limiting family size. In all cases of abortions, gestation period is well above 12 weeks in Haryana. If abortion is to limit the family size or spacing, women would not wait till 14 to 15 weeks for abortion. The possible reason for second trimester abortion could be linked to sex determination tests. Before twelve weeks of gestation, sex cannot be determined by the ultrasound. This analysis gives indirect evidence that women wait till they can detect the sex of baby before going for abortion. From the gestation analysis it can be concluded that out of the estimated induced abortions 60 to 80 are sex selective abortions in these two states.

6.8 Use of ultrasound

In the antenatal care section of the questionnaire; care for each pregnancy was recorded along with urine, blood test, and ultrasound/sonography. In all, 313 women in Haryana and 155 women in Tamil Nadu had gone for these tests. Most of the respondents who know about ultrasound have also reported that through ultrasound, sex of the baby can be determined. Quite a few have not gone for blood test during pregnancy but had undergone ultrasound. A significant number of women did not have any test in the preceding

pregnancies but have undergone ultrasound in the following pregnancies. Usually antenatal care is better in the former pregnancies than the latter.

54

6.9 Decision making for sonography

Table 6.7 shows that decision to undergo sonography in the state of Haryana by 50 per cent respondents was taken by them or by their family. In case of Tamil Nadu, 35 per cent decisions were taken by respondents or by their family to undergo sonography. Another 24 persons in Tamil Nadu had not mentioned the decision at all. Women mostly had undergone this test around 12 to 15 weeks of gestation of pregnancy.

6.10 Reasons for undergoing ultrasound

All those women who had undergone ultrasound, a battery of questions was asked to know why they had undergone ultrasound. Table 6.8 shows that in case of Tamil Nadu, 30 per cent women have said that they wanted to know the sex of the child, whereas in Haryana 13 percent said the same. Majority of the women in Haryana reported that they wanted to know the babies health, which looks dubious. Except abnormalities and position of baby (to know the position of baby, test is conducted after 7 months of gestation) all other reasons look defensive. Again table 6.9 shows percentage of women who went for sonography by standard of living index. In Haryana mostly women from high SLI have reported of having done a sonography test in all the pregnancies. In Tamil Nadu sonography is reported by high percentage of women in the first pregnancy from high SLI.

6.11 Use of ultrasound with abortion

In a small number of cases women said that the doctor revealed the sex but in many cases reasons for undergoing ultrasound was different and it was not followed by an abortion. Others said that after knowing the sex they had continued the pregnancy. Mean number of abortions were calculated for those who had undergone ultrasound as well those who had not gone for this as is presented in table 6.10. Women who had undergone ultrasound have higher chance of abortions. In case of Haryana, mean number of abortion in both the cases was significantly different.

6.12 Abortion by standard of living and duration of pregnancy

Table 6.11 and 6.12 show abortion by standard of living and duration of pregnancy for women in Haryana and Tamil Nadu. It is observed that women from high SLI were going for

55

abortions more than women from other SLI. Where as in Tamil Nadu more percentage of women from medium and high SLI have reported of high abortions in their first pregnancy. In Haryana more number of women from high SLI have reported of abortions. In Tamil Nadu abortions have been reported by quite a significant number of women in all the three groups which is not so in Haryana where women particularly from high SLI have sought abortions. The percentage is generally high for the first abortion in both the states.

When we see abortion by duration of pregnancy as shown in table 6.12 for Haryana and Tamil Nadu it is found that in Haryana as well as in Tamil Nadu most of the women have reported of abortions (could be spontaneous as well as induced) within the first trimester of pregnancy where as only a few number of women have reported of having had an abortion after the first three months. Among those who have had abortions in the second trimester of pregnancy 85% of them were spontaneous abortions and hence it is assumed that remaining 15 percent of the abortion may have been induced. However in booth the states the percentage of women reporting abortions is more during the first trimester of pregnancy.

6.13 Places of induced abortion

Tables 6.13 to 6.16 provide information about the places where induced abortion took place among the ever-married and currently married women of Haryana and Tamil Nadu according to the order of pregnancy.

The tables show that maximum number of induced abortions in Haryana and Tamil Nadu have taken place in private health facility. A total of 223 induced abortions have taken place among ever married women in Tamil Nadu in different orders of pregnancy, of which 164 (73.5%) have been in private health facility, 41(18.3%) in government health facility and 18 (8%) at other places. The percentage of abortions in the private clinic has been the highest in the fifth pregnancy (85.1%). The Govt. health facility has remained the highest in the fourth birth order (23%). Only 8 percent of the abortions have been done through other channels such as through ANM, non-trained dais, trained dai, traditional healer, pharmacist etc.

56

In Haryana, out of the 33 induced abortions among ever-married women, 23 (69.6%) were in private clinics, 7 (21.2) in govt. clinics and 3 (9%) through other channels. Among the currently married women, out of the 31 induced abortions 67.7 percent was conducted in private clinics, 22.5 percent in government clinics and 9.6 percent through other traditional methods. The percentage of induced abortions was highest in the fourth order of pregnancy among both the groups of women. This is in sharp contrast to what was observed for Tamil Nadu where the number of induced abortions was maximum in the second order of pregnancy. The probable reason for this could be preference for a smaller family size among couples in Tamil Nadu than in Haryana. Over all private health facility seems to be a more preferred place for seeking abortion than government health facility in both the states.

6.14 Sex ratio

Estimated sex ratio and actual sex ratio has been calculated for the period 1996-2000 for Haryana and Tamil Nadu. From table 6.17 if assuming that 33 sex selective abortions have taken place in Haryana and all the abortions are that of female foetuses, then the expected number of female births should be like 814 (781 female births+33 induced abortions) births. And hence sex ratio without sex selective abortions would be 113 males per 100 female births. (918 males/781 females+33*100). From the table actual sex ratio is 117 males per 100 female births. (918/718*100). This is much higher than the expected sex ratio of 105 male births per 100 female births as normally accepted there by indicating that there have been sex selective abortions. In the recent past i.e. between the year 1996-2000 estimated sex ratio is 113 males per 100 live births which means it has come closer to 105 but is still on the higher side. In Tamil Nadu however there is very little difference in actual and estimated sex ratio.

If we take into consideration sex ratio in all pregnancies as shown in Table 6.18 for Haryana the estimated sex ratio comes to 121 males per 100 female births, assuming that 39 induced abortions have taken place and all that are female abortions. For Tamil Nadu 224 induced abortions have taken place and the estimated sex ratio is 114 males per 100 female births.

57

In Haryana assuming that number of sex selective abortions among those who went for sonography is 44 and all the abortions are that of female fetuses table 6.19 shows that, the estimated sex ratio comes to 121 males per 100 female births. The sex ratio is almost same as for women in all the pregnancies. In Tamil Nadu the estimated sex ratio is 129 males per 100 female births. This ratio is also considerably higher than the expected sex ratio of 105 males per 100 live births.

When sex ratio is estimated based on duration of pregnancy as shown in table 6.20 the sex ratio is 116 males per 100 female births for Haryana assuming that 174 abortions were induced and are that of the female foetuses. All this reflects the attitudes of the people in Haryana towards female children and the strong bias against female child. In Tamil Nadu the estimated sex ratio after assuming that 294 female abortions have taken place is 110 females per 100 live births.

Sex ratio at birth (Male / Female) for all pregnancies was calculated for those women who had undergone sonography. Table 6.21 shows that overall sex ratio is much in favour of males among those who had undergone ultrasound compared to those who had not. Pregnancy wise analysis of sex ratio gives contrasting results in both the states.

Sex ratio at birth is also calculated by children ever born with and without pregnancy wastage as is shown in table 6.22. For example those women who had first live birth in the first pregnancy and second live birth in the second pregnancy come under the category of without wastage. Women who had two live births but have undergone more number of pregnancy comes under the category of with wastage of pregnancies. Sex ratio at birth is much higher than reported by SRS and other sources. This needs further analysis by other sources to examine the sex ratio at birth.

However, it seems that women are compensating their family size with the desired sex of the pregnancy outcome and balancing with sex selective abortions.

58

Table 6.1(a): Abortions by socioeconomic background characteristics for Haryana Number of women Background No. SLI Low Medium High Womens Education Illiterate Literate<primary Primary school complete Middle school complete High school complete Higher secondary complete and above Husbands occupation Cultivator Labour or wages Other Total 1246 720 680 2646 143 91 95 329 11.5 12.6 14.0 12.4 1712 34 400 214 190 96 182 6 63 29 32 17 10.6 17.6 15.8 13.6 16.8 17.7 Women with at least one abortion No. %

512 1123 1011

64 126 139

12.5 11.2 13.7

59

Table 6.1(b): Abortions by socio economic background characteristics for Tamil Nadu Background Number of women No. SLI Low Medium High Womens Education Illiterate Literate<primary Primary school complete Middle school complete High school complete Higher secondary complete and above Husbands occupation Cultivator Labour or wages Other Total 207 1049 450 1706 46 190 94 330 22.2 18.1 20.9 19.3 1069 104 234 140 90 69 203 35 41 31 15 5 19.0 33.7 17.5 22.1 16.7 7.2 Women with at least one abortion No. %

800 722 184

135 157 38

16.9 21.7 20.7

60

Table 6.2: Abortion Ratios Haryana (Jind) Year 1971-1984 1985-1994 1995-2001 Total* Live birth 1482 3419 2103 7106 Abortions 70 172 188 486 Rate 4.72 5.03 8.93 6.84 Tamil Nadu (Salem) Live birth 1501 1296 982 3818 Abortions 148 178 132 496 Rate 9.80 13.70 13.44 12.70

* Abortion Ratio: (No. of abortions/live births)*100 *Total includes all those women who had not indicated the year of abortion.

Table 6.3: Frequency of abortion Haryana (Jind) No. of Women Abortion rate who had abortions 199 83 19 14 486 8.43 3.51 0.80 0.59 20.59 Tamil Nadu (Selam) No. of Women Abortion rate who had abortions 230 75 26 8 496 14.98 4.88 1.69 0.50 32.30

No. of times Abortion

1. 2 3 4+ Total

* Abortion Rate: (No. of Women who had abortion/Total no. of women)*100

61

Table 6.4: Abortion rate by order of pregnancy Haryana (Jind) No. of Abortion rate Abortions 136 5.75 113 81 69 87 486 2.92 5.40 5.26 7.71 9.85 100.0 Tamil Nadu (Selam) No. of Abortion rate Abortions 94 6.12 105 113 78 106 496 2.35 8.25 13.44 17.4 30.8 100.0 -

Pregnancy No. 1 2 3 4 5+ Total Mean CEB

Abortion Rate: (No. of abortions/ No. of pregnancies)*100 Note- CEB Children ever born

Table 6.5: Mean Closed Interval between two Pregnancies with Outcome of following Pregnancy (months) Haryana (Jind) Live Birth Abortion Total Tamil Nadu (Selam) Live Abortion Total Birth 18.94 29.52 28.46 29.84 29.16 18.09 19.48 19.81 18.84 19.84 18.89 (1518) 28.69* (1265) 27.32* (828) 27.98* (442) 26.79* (197)

Pregnancy No.

1 2 3 4 5

36.69 27.90 26.80 26.04 26.33

32.10 18.37 16.88 15.17 16.10

36.44 (2334) 27.33* (2047) 26.35* (1517) 25.32* (870) 25.45* (464)

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Table 6.6: Mean gestation period of pregnancy before abortion (weeks) Pregnancy No. 1 2 3 4 Haryana (Jind) IA 13.9 18.5 17.1 10.7 Tamil Nadu (Selam) SA IA Total 14.6 10.8 12.8* 13.5 14.9 15.7 12.4 12.3 11.4 12.4* 12.3* 11.4*

SA 15.9 15.7 15.9 16.4

Total 15.7 15.9 16.1 15.6

* Significant at 5% level of significance Abbreviations: SA - Spontaneous Abortion, IA - Induced Abortion

Table 6.7: Decision for undergoing Ultrasound Haryana (Jind) No. Percentage 95 * 102 * 158 313 32.94 32.58 50.47 Tamil Nadu (Selam) No. Percentage 11 46 74 24 155 7.1 29.7 47.7 15.5 -

Decision taken by Self Husband/In Laws Doctor/ANMS Not Stated Total

* Multiple responses

Table 6.8: Reasons for ultrasound Haryana (Jind) Reasons Sex of Child Position of Baby Childs Health Abnormality Mothers Health Not Stated Total No. 41 6 162 31 60 13 313 Percentage 13.1 1.9 51.8 9.9 19.2 4.2 100.0 Tamil Nadu (Selam) No. 45 65 28 8 3 6 155 Percentage 29.0 41.9 18.1 5.2 1.9 3.9 100.0

63

Table 6.9: Percentage of women who went for sonography in each pregnancy by standard of living index for Haryana and Tamil Nadu Order of pregnancy 1P 2P 3P 4P 5+P Haryana Medium 3.2 2.6 3.3 3.1 16.5 Tamil Nadu Medium 4.9 2.6 3.7 1.0 3.6

Low 2.4 2.0 1.6 3.9 3.7

High 7.5 6.0 5.8 6.5 24.7

Low 3.0 1.7 3.5 1.0 6.6

High 14.6 7.9 3.8 0.0 11.8

Table 6.10: Use of ultrasound and abortion Haryana (Jind) Mean no. of abortions 0.4189 0.1605 Sig. Tamil Nadu (Selam) Mean no. of abortions 0.3876 0.2828 Insig.

Ultrasound Yes No Significance

Table 6.11: Percentage of women who had abortions by standard of living index for Haryana and Tamil Nadu No. of abortions 1A 2A 3A 4A 5A 6A Haryana Medium 3.7 1.2 0.5 0.1 0.1 0.3 Tamil Nadu Medium 21.3 6.5 1.5 0.4 0.4 0.3

Low 11.7 3.3 0.6 0.4 0.2 0

High 13.1 5.2 2.1 0.9 0.4 0.1

Low 16.6 6.0 2.0 0.5 0.25 0.0

High 19.6 7.1 2.7 0.5 0.0 0.0

Table 6.12(a): Abortion by duration of pregnancy (Haryana) Spontaneous abortion Upto After 85% of 3 months 3 months spont. abortion 83 98 169 39 46 52 9 10 22 3 4 8 1 1 4 0 0 2 257 159 135

Abortion

Induced abortion 26 7 4 2 0 0 39

I abortion II abortion III abortion IV abortion V abortion VI abortion Total

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Table 6.12(b): Abortion by duration of pregnancy (Tamil Nadu) Spontaneous abortion Upto After 85% of 3 months 3 months spont. abo 56 66 111 20 23 37 5 6 8 2 2 1 0 0 1 0 0 0 158 97 82 Induced abortion Upto After 3 months 3 months 13 130 7 38 1 15 0 3 0 3 0 2 191 21

Abortion I abortion II abortion III abortion IV abortion V abortion VI abortion Total

Table 6.13: Places where induced abortions took place among ever married women, Selam, Tamil Nadu Order of Pregnancy 1 2 3 4 5 6+ Total Private Clinic % 50 71.4 79.0 76.9 85.1 80.9 73.5 Government clinic% 13.3 20.6 16.2 23.0 14.8 19.0 18.3 Others % 36.6 7.9 4.6 8.0 Total No. 30 63 43 39 27 21 223

Table 6.14: Places where induced abortions took place among currently married women Selam, Tamil Nadu Order of pregnancy 1 2 3 4 5 6+ Total Private Clinic % 46.4 73.3 80.0 78.3 85.1 85.0 73.5 Government clinic % 14.2 18.3 17.5 21.6 14.8 15.0 17.4 Others % 39.2 8.3 2.5 8.0 Total No. 28 60 40 37 27 20 212

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Table 6.15: Places where induced abortions took place among ever-married women, Jind, Haryana Order of pregnancy 1 2 3 4 5 6+ Total Private Clinic % 16.6 66.6 75.0 80.0 100.0 100.0 69.6 Government clinic % 50.0 16.6 25.0 20.0 21.2 Others % 33.3 16.6 9.0 Total No. 6 6 4 10 3 4 33

Table 6.16: Places where induced abortions took place among currently married women, Jind, Haryana Order of pregnancy 1 2 3 4 5 6+ Total Private Clinic % 16.6 66.6 66.6 80.0 100.0 100.0 67.7 Government clinic % 50.0 16.6 33.3 20.0 22.5 Others % 33.3 16.6 9.6 Total No. 6 6 3 10 2 4 31

Table 6.17: Estimation of Sex Ratio for the period 1996-2000 for Haryana and Tamil Nadu States Abortions assumed to be sex selective 33 2 Actual Live births Expected births (if sex selective abortions had not occurred) M F 918 781+33 =814 459 358+2=360

Haryana Tamil Nadu

M 918 459

F 781 358

Actual sex ratio for Haryana = 918/781*100=117.54 per 100 female births Actual sex ratio for Tamil Nadu = 459/358*100=128.2 per 100 female births Estimated sex ratio for Haryana = 918/814*100=112.97 males per 100 female births Estimated sex ratio for Tamil Nadu = 459/360*100=127.5 males per 100 female births

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Table 6.18: Estimation of sex ratio in all pregnancies for Haryana and Tamil Nadu States Haryana Actual Live births M 3899 F 3189 Induced Abortions 39 Actual sex ratio 3899/3189*100= 122.3 males per 100 female births Estimated sex ratio 3899/(3189+39)* 100=120.7 males per 100 female births 2158/(1673+224)* 100=113.7 males per 100 female births

Tamil Nadu

2158

1673

224

2158/1673*100= 128.9 males per 100 female births

Table 6.19:Estimation of sex ratio among those who went for Sonography for Haryana and Tamil Nadu No. of women who went for sonography 313 No. of sex selective abortions among those who went for sonography 44

States Haryana

Estimated sex ratio 3899/(3189+44)*100 =120.6 males per 100 female births 2158/(1673+6)*100 =128.5 males per 100 female births

Tamil Nadu

156

Table 6.20: Estimation of sex ratio based on duration of pregnancy for Haryana and Tamil Nadu Induced and late spontaneous abortions (85% of spontaneous after 3 months) 174

States Haryana

Live birth Male 3899 Female 3189

Estimated sex ratio 3899/(3189+174)*100 =115.9 males per 100 female births 2158/(1673+294)*100 =109.7 males per 100 female births

Tamil Nadu

2158

1673

294

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Table 6.21: Sex ratio at birth (100*Male/Female) by ultrasound Haryana (Jind) No 126 121 120 122 Tamil Nadu (Selam) No Total 111 127 142 125 113 129 138 126

Abortion No. First Second Third+ Total

* Less than 25 cases

Yes 89 110 240 140

Total 124 121 122 122

Yes 143 220 222* 173

Table 6.22: Sex ratio at birth (100*Male/Female) by children ever born

CEB Haryana (Jind) Without Preg. Wastage With Preg.wastage 1 2 3 Total 1 2 3 Total 202 139 124 217 146 121 198 125 208 159 122 139 229 320 94 183 205 156 Tamil Nadu (Selam) Without Preg. Wastage With Preg. Wastage 1 2 3 Total 1 2 3 Total 152 100 113 180 101 129 156 128 163 119 126 192 111 188 137 185 190 114 -

CEB=2 CEB=3 Total*

*For all CEB with and without wastages

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CHAPTER VII OBSTETRIC AND GYNECOLOGICAL MORBIDITY

Obstetric and Gynaecological morbidity largely determines women's over all health and may often lead to spontaneous abortions. Hence in the present chapter a woman's Obstetric and gynaecological morbidity is analysed taken into consideration various interrelated factors.

7.1 Health problems during delivery by order of pregnancy

In tables 7.1(a) and (b) it is seen that in Haryana cases of obstructed labour and prolonged labour is reported by most of the women. Out of 2236 women who were pregnant for the first time nearly 48 percent women suffered from the above two problems. However in the fifth pregnancy out of 447 women nearly 50 percent women on the whole reported of prolonged and obstructed labour. This shows that in the later pregnancies the health problems during delivery is more serious compared to initial two or three pregnancies. The other problems are not very noticeable. But in Tamil Nadu, apart from prolonged and obstructed labour around 20 percent women have also reported about breech presentation during delivery especially during their first pregnancy. But in comparison to Haryana the kind of health problems suffered by women during delivery in Tamil Nadu is very less.

7.2 Health problems during first week after delivery

In tables 7.2(a) and (b), it is observed that fever, tiredness, palpitation, guarding of the abdomen and lower abdominal pain are common health problems of women till their fifth order of pregnancy in Haryana.In Tamil Nadu guarding of abdomen is reported by less than 10 percent of women. Fever, tiredness and palpitation are more prominent health problems that women in Tamil Nadu suffer from during the first week of their delivery.

7.3 Menstruation related problems

Table 7.3 shows the menstruation related problems among the currently menstruating women in Haryana and Tamil Nadu.Women in both the states reported normal menstrual bleeding and had no major problems regarding menstruation.

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7.4 Contraceptive use and related health problems

Table 7.4 shows the contraceptive use by the respondent or her husband. It is seen that in Haryana 45.1 percent respondents report of not having used any contraception and 64.8 percent women in Tamil Nadu are not using any contraceptive methods. Among the current users of contraceptive method female sterilization is the most popular method in both the states. Table 7.5 (a) and (b) show the health problems related to contraceptive use .It is seen that in Haryana more than 10 percent of women who are either sterilized or are using IUD or are taking pills are suffering from some or the other health problems. Usually headache, body ache, backache, nausea and vomiting and abdominal pain are associated with the usage of IUD and pills. In Tamil Nadu backache and body ache was reported by women who were already sterilized. The other kind of health problems related to contraceptive use such as cramps, white discharge, reduced sexual satisfaction breast tenderness etc. was reported by very few respondents, which shows that these problems are not very serious.

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Table 7.1(a): Percent distribution of women who had experienced problems in each pregnancy during delivery for Haryana Problems Premature labour Obstructed labour Prolonged labour Breech presentation Cord/Hand prolapse Cesarean section Others Total 1P 19.1 27.0 21.5 5.1 1.7 0.4 0.8 2236 2P 15.2 25.0 21.0 4.5 1.6 0.4 0.5 1961 Order of Pregnancy 3P 4P 14.9 14.1 23.9 19.8 4.7 2.2 0.5 0.6 1456 23.4 19.6 4.8 1.5 0.2 0.5 820

5P 15.9 27.1 23.3 5.1 2.2 0.4 0.2 447

6P 13.6 24.8 21.0 3.3 0.9 0.5 0.0 214

Table 7.1(b): Percent distribution of women who had experienced problems in each pregnancy during delivery for Tamil Nadu Problems Premature labour Obstructed labour Prolonged labour Breech presentation Cord/Hand prolapse Cesarean section Others Total Order of Pregnancy 3P 4P 3.0 1.9 2.8 7.3 14.3 1.8 0.0 0.0 726 2.5 7.7 15.9 1.1 0.0 0.3 365

1P 2.1 11.9 17.7 20.2 2.9 0.0 0.3 1439

2P 1.8 4.8 10.4 17.8 2.2 0.0 0.2 1159

5P 1.4 2.1 9.0 21.4 1.4 0.0 0.0 145

6P 3.4 0.0 10.2 18.6 1.7 0.0 0.0 59

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Table 7.2(a): Percent distribution of women who had experienced health problems first week after delivery for Haryana Health Problems Fever, tiredness, palpitation Guarding of abdomen Lower abdominal pain Foul smelling vaginal discharge Excessive bleeding Problem in the expulsion of placenta Others Total 1P 28.7 23.2 24.4 12.3 9.3 3.3 2.5 2236 Order of Pregnancy 2P 3P 4P 5P 28.2 25.5 23.4 24.6 24.5 24.4 12.4 8.5 4.0 1.7 1961 24.3 24.2 12.8 7.8 3.2 2.2 1456 24.4 24.6 12.7 9.1 2.7 2.2 820 24.8 23.7 13.9 8.9 2.5 2.0 447

6P 24.3 12.1 24.8 14.5 7.9 2.8 2.3 214

Table 7.2(b): Percent distribution of women who had experienced health problems first week after delivery for Tamil Nadu Health Problems Fever, tiredness, palpitation Guarding of abdomen Lower abdominal pain Foul smelling vaginal discharge Excessive bleeding Problem in the expulsion of placenta Others Total 1P 34.6 3.5 17.8 11.9 17.2 0.6 0.8 1439 Order of Pregnancy 2P 3P 4P 5P 28.0 24.8 22.5 17.9 2.6 14.8 11.3 14.8 0.8 0.9 1159 1.9 13.8 10.3 12.8 0.6 0.7 726 2.7 15.9 7.1 10.1 0.5 0.5 365 1.4 20.0 6.9 10.3 1.4 0.7 145

6P 20.3 3.4 15.3 3.4 10.2 0.0 1.7 59

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Table 7.3: Percent distribution of women having menstruation related problems among currently menstruating women for Haryana and Tamilnadu Haryana Problems Percent (N=2033) Tamilnadu Percent (N=1309)

Menstrual Regularity Normal (25 - 35 days) Abnormal (> 35 days) Abnormal (< 25 days) Type of menstrual bleeding Normal Abnormal Pain before menstruation Yes No Pain during menstruation Yes No Pain after menstruation Yes No 3.5 96.5 1.8 98.2 21.1 78.9 30.0 70.0 35.4 64.6 31.0 69.0 82.6 17.4 90.8 9.2 82.2 5.9 11.9 93.8 5.1 1.1

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Table 7.4: Percent distribution of current use of contraception by the respondent or her husband for Haryana and Tamilnadu Method Not using contraceptive methods Currently using contraceptive methods Female sterilization Male sterilization IUD/ Copper-T/ Loop Daily Pills Weekly pills Condom/Nirodh Rhythm/ Periodic Abstinence With drawl Other method Haryana Percent No. of women 45.1 1193 Tamilnadu Percent No. of women 64.8 1106

54.9 42.6 0.8 4.7 1.5 0.3 3.2 1.1 0.5

1453 1128 21 124 40 8 84 29 14

35.2 33.7 0.6 0.7 0 0 0.1 0.1 0

600 575 11 12 0 0 1 1 0

Table 7.5(a): Percentage of women having problems in using the current method of contraception for Haryana Contraceptive Method IUD/ Copper-T/ Daily/ Weekly Loop Pills 2.1 7.3 2.1 10.5 8.3 6.5 10.4 13.7 15.3 10.5 8.1 9.7 3.2 0.8 3.2 4.8 7.3 11.3 11.3 3.2 2.4 0.0 2.4 4.8 124 18.8 8.3 2.1 8.3 4.2 6.3 2.1 4.2 10.4 8.3 6.3 0.0 2.1 2.1 0.0 10.4 48

Problems Weight gain Weight loss Too much bleeding Hypertension Headache/body ache/backache Nausea/vomiting No menstruation Weakness/tiredness Fever Cramps Spotting Inconvenient to use Abdominal pain White discharge Irregular periods Breast tenderness Allergy Expulsion Reduced sexual satisfaction Others Number of users

Female Sterilization 5.6 7.5 8.0 8.8 18.6 9.4 4.7 13.6 5.2 4.0 2.0 2.8 12.0 14.8 9.7 3.3 2.5 0.6 0.5 6.0 1128

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Table 7.5 (b): Percentage of women having problems in using the current method of contraception for Tamilnadu Contraceptive Method IUD/ Copper-T/ Daily/Weekly Loop Pills 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 100.0 0.0 0.0 0.0 0.0 0.0 1 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0

Problems

Female Sterilization 1.4 2.4 2.8 2.8 19.8 0.9 1.0 3.7 1.0 0.0 0.2 2.3 9.2 5.0 1.4 0.0 0.2 0.3 0.3 0.5 575

Weight gain Weight loss Too much bleeding Hypertension Headache/body ache/backache Nausea/vomiting No menstruation Weakness/tiredness Fever Cramps Spotting Inconvenient to use Abdominal pain White discharge Irregular periods Breast tenderness Allergy Expulsion Reduced sexual satisfaction Others Number of users

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Chapter - VIII CONCLUSION

Pregnancy termination with sex selection depends upon social and cultural setting prevailing in a society. The selected communities belonging to Haryana (Jind District) and Tamil Nadu (Salem District) exhibit evidences of sex selective abortions. The information related to sex selective abortion became a hidden fact with the enforcement of law on abortion. In the present study, an attempt was made to document the evidences of sex selective abortions. The objective of the study was firstly, mapping of abortion and sonography facilities in the selected districts of Haryana and Tamil Nadu. Secondly to find out the prevalence and incidence of sex selective abortions in the above two districts and thirdly to study the causes and consequences of sex selective abortions and obstetric morbidity.

The study was conducted in two phases. As a first step to identify the clusters of high incident areas of induced abortion a secondary data analysis of child population (0-4 and 5-9) was done for 1981 and 1991 census by districts. The districts that exhibited very high sex ratio in both the time periods were selected for the study. District maps were subsequently prepared using child sex ratio of (0-6 years) at the village level. There were many villages with sex ratio of 125 and above. One of the concentrations of such cluster was selected in both the districts. Mapping of abortion and ultrasound facilities in the 20 km diameter of this cluster was carried out. From the villages having sex ratio of 125 and above five villages in Jind district and seven villages in selam district was selected for the study. Five to seven villages in one cluster were found to be sufficient for a study of this kind. Ideally the intention was to do complete census of all the villages but because of budgetary constraints only a few villages was selected for the study. A total of 2590 households in jind and 1791 households in selam were covered. A total number of 2646 ever married women in jind and 1706 ever-married women in selam were interviewed. In the second phase of the study followed by a gap of 6 months a subset of the women were interviewed for detailed information. This was followed by doctors visit to the villages, medical camps were organized and clinical examination was carried out by gynaecologists with the consent of the women.

77

The analysis of abortion data of two selected states reveals that: 1. The abortion rate has increased from 1971 to 2001 in both the states. 2. Among the study women one-third in Tamil Nadu and one-fifth in Haryana have under gone abortion in their reproductive life. 3. In the study area of Tamil Nadu, induced abortions have lower mean duration of gestation (12 weeks of gestation) compared to spontaneous abortions, and in Haryana it was observed to be more than 12 weeks. 4. In case of Tamil Nadu women may be going for abortion as a method of family planning whereas in Haryana women are more likely going for sex selective abortions.

Indirect evidences drawn from pregnancy history, antenatal care, abortion history reveals that out of the estimated induced abortions, 60 to 80 percent are sex selective abortions or in other words out of total abortions, 40 to 75 percent could be attributed to sex-selective abortions.

From the above analysis it can be concluded that out of the total estimated induced abortions 60 to 80 percent are due to sex selective abortion in the study area.

78

BIBLIOGRAPHY
Beliappa, J. and Rama, S. 1994. Declining Sex Ratio and the Problems of Female Infanticide: A Study in Salem district of Tamil Nadu, New Delhi: Department of Women and Child Development, Govt. of India. Bose, C. and Sethna, N. J. 1980. Study on Induced Abortion in Married women in an Urban Area, Journal of Family Welfare 26(4): 40-49. Centre for Operation Research and Training.1977. Situational Analysis of Medical Termination of Pregnancy (MTP) Services in Tamil Nadu, Monograph, Baroda, India. Charles, S. X. and Charles V. 1979. Medical Termination of Pregnancy: Public Opinion in an Urban Population, International Journal of Gynecology and Obstetrics 16(5): 408-411. Chhabra, R. and Nuna S.C. 1993. Abortion in India: An Overview, Ford Foundation. New Delhi, India. *George, Sabu, M., Dahiya, and Ranbir, S.1998. Female Foeticide in Rural Haryana, Economic and Political Weekly Vol XXXIII, No. 32: 2191-2198. Government of India. 1998. Report of the National Consultation on Safe Abortion Services, Ministry of Health and Family Welfare, New Delhi, India. *Grewal, S. 1976. Medical Termination of Pregnancy - Its Status, Achievement and Lacunae, Journal of Obstetrics and Gynecology of India 23 (4) Gupta, A. S. 1976. A Dialogue with MTP Patients in Hospital Ward, Journal of Family Welfare 2(4): 23-28. Henshaw, Stanley K. 1990. Induced abortion: A World Review, Family Planning Perspectives 22(2): 76-89. ICMR. 1989. Illegal Abortion in Rural Areas: A Task Force study, New Delhi. *Khan, M. E. Barge, S. and Philip, G. 1996. Abortion in India: An Overview, Social Change 26(3&4): 208-225. Krassmy, C. and Bergstrorm S. 1992. Abortion of Female Fetuses In India- Prenatal Sex Discrimination Akartidningen 89(24): 220-222.

Kundu, A. and Sahu M. K. 1991. Variation in Sex Ratio: Development Implications, Economic and Political Weekly Vol 40, No. 40: 2341-2342. Mishra,Y. 2001 Unsafe Abortions and Womens Health, Economic and Political Weekly, October 6, 2001: 3814-3816.

79

Nathanson, C.A. 1984. Sex Differentials in Mortality, Annual Review of Sociology 10: 191-213. Parsuraman, S., Roy, T.K., Devi,R.D., Paswan, B., Arokiawamy, P. and Unisa, S.1998.Role of Womens Education in Shaping Fertility in India: Evidence from NFHS, Himalaya Publishing House, Mumbai. Patel, V. 1989. Sex Determination and Sex Preselection Tests in India: Modern Techniques for Femicide, Bulletin of Concerned Asian Scholars 21(1): 2-11. Ramanama, A. and Bambawala V, 1980. The Mania for Sons: An Analysis of Social Values in South Asia, Social Science and Medicine 14 B (2): 107-110. Saha, A. and S. Taneja. 1991. What do Males and females of Delhi City think about Female Foeticide, Journal of Family Welfare 37(2): 28-29. Soonawala, R.P. 1986. Induced Abortion Services In Asia, in Uta Landy and S.S. Ratnam (eds.), Prevention and Treatment of Contraceptive Failure. New York: 187-189. Srinivasan, K. 1994. Sex Ratios: What They Hide and What They Reveal, Economic and Political Weekly, 29: 3233-34.

80

BIBLIOGRAPHY
Beliappa, J. and Rama, S. 1994. Declining Sex Ratio and the Problems of Female Infanticide: A Study in Salem district of Tamil Nadu, New Delhi: Department of Women and Child Development, Govt. of India. Bose, C. and Sethna, N. J. 1980. Study on Induced Abortion in Married women in an Urban Area, Journal of Family Welfare 26(4): 40-49. Centre for Operation Research and Training.1977. Situational Analysis of Medical Termination of Pregnancy (MTP) Services in Tamil Nadu, Monograph, Baroda, India. Charles, S. X. and Charles V. 1979. Medical Termination of Pregnancy: Public Opinion in an Urban Population, International Journal of Gynecology and Obstetrics 16(5): 408-411. Chhabra, R. and Nuna S.C. 1993. Abortion in India: An Overview, Ford Foundation. New Delhi, India. *George, Sabu, M., Dahiya, and Ranbir, S.1998. Female Foeticide in Rural Haryana, Economic and Political Weekly Vol XXXIII, No. 32: 2191-2198. Government of India. 1998. Report of the National Consultation on Safe Abortion Services, Ministry of Health and Family Welfare, New Delhi, India. *Grewal, S. 1976. Medical Termination of Pregnancy - Its Status, Achievement and Lacunae, Journal of Obstetrics and Gynecology of India 23 (4) Gupta, A. S. 1976. A Dialogue with MTP Patients in Hospital Ward, Journal of Family Welfare 2(4): 23-28. Henshaw, Stanley K. 1990. Induced abortion: A World Review, Family Planning Perspectives 22(2): 76-89. ICMR. 1989. Illegal Abortion in Rural Areas: A Task Force study, New Delhi. *Khan, M. E. Barge, S. and Philip, G. 1996. Abortion in India: An Overview, Social Change 26(3&4): 208-225. Krassmy, C. and Bergstrorm S. 1992. Abortion of Female Fetuses In India- Prenatal Sex Discrimination Akartidningen 89(24): 220-222.

Kundu, A. and Sahu M. K. 1991. Variation in Sex Ratio: Development Implications, Economic and Political Weekly Vol 40, No. 40: 2341-2342. Mishra,Y. 2001 Unsafe Abortions and Womens Health, Economic and Political Weekly, October 6, 2001: 3814-3816.

79

Nathanson, C.A. 1984. Sex Differentials in Mortality, Annual Review of Sociology 10: 191-213. Parsuraman, S., Roy, T.K., Devi,R.D., Paswan, B., Arokiawamy, P. and Unisa, S.1998.Role of Womens Education in Shaping Fertility in India: Evidence from NFHS, Himalaya Publishing House, Mumbai. Patel, V. 1989. Sex Determination and Sex Preselection Tests in India: Modern Techniques for Femicide, Bulletin of Concerned Asian Scholars 21(1): 2-11. Ramanama, A. and Bambawala V, 1980. The Mania for Sons: An Analysis of Social Values in South Asia, Social Science and Medicine 14 B (2): 107-110. Saha, A. and S. Taneja. 1991. What do Males and females of Delhi City think about Female Foeticide, Journal of Family Welfare 37(2): 28-29. Soonawala, R.P. 1986. Induced Abortion Services In Asia, in Uta Landy and S.S. Ratnam (eds.), Prevention and Treatment of Contraceptive Failure. New York: 187-189. Srinivasan, K. 1994. Sex Ratios: What They Hide and What They Reveal, Economic and Political Weekly, 29: 3233-34.

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APPENDIX : SURVEY INSTRUMENTS

CONFIDENTIAL (For Research Use only)

International Institute for Population Sciences

Govandi Station Road, Deonar, Mumbai 400 088.
RAPID HOUSEHOLD SURVEY (REPRODUCTIVE MORBIDITY) (Household Questionnaire)
IDENTIFICATION State District Tehsil /Taluk Village Head of the Household Name ____________________________________________________ Address ____________________________________________________ ____________________________________________________ (Detailed Landmarks) ____________________________________________________ Respondent Male (Age 20 54) Male (Age 55 +) Female (Age 15 +) 1 2 3 Coding categories

Serial Number of the Household Questionnaire Date of interview Date ___________ Month________ Year________

Number of Eligible Women in the Household Interviewed INS: IF THERE IS MORE THAN ONE ELIGIBLE WOMEN IN THE HOUSEHOLD, INTERVIEW ALL INTERVIEWERS VISIT
1 _______________ DATE 2 _______________ 3 _______________ FINAL VISIT Days Month Year Name Code Result Code* TOTAL NUMBER OF VISITS NEXT VISIT: DATE TIME __________________ __________________ _________________ __________________ _________________ __________________

INTERVIEWERS NAME RESULT*

________________ ____________________ ________________

*Result Codes of the Household Questionnaire

1. 2. 3. 4. 5. 6. 7.

Completed Household present but no respondent at home Household absent for extended period Postponed Refused Dwelling vacant Others (specify) ________

Total persons in Household

Total Eligible women

Line no. of Resp to Household Schedule

____________________ Name of the Investigator: Starting time of the Interview__________________________

______________________ Signature of the Investigator

81

82

SECTION I (HOUSEHOLD COMPOSITION)

Line No Q.101 Usual residents and visitors Q.102 Relationship to head of the household What is the relationship of (name) to the head of the household? * Q.103 Sex Q.104 Age Q.105 Marital status What is the current marital status of (name)** Q.106 Education Q.107 Occupational Status Is She/ He Working? Q.108 If Yes, Please name the Occupation Q.109 Eligibility

Please give me the names of the persons who usually live in your household starting with the head of the household

Is (name) male or female?

How old is (name)?

How many years of schooling (name) has?

If No, Mention the status of the non working member

M 1. 2. 3. 4. 5. 6. 7. 8. 9. 10 11 12
*Codes for relationship with the head of the household
01 02 03 04 05 06 07 08 09 10 11 12 Head Wife or husband Son or daughter Son or daughter in law Grandchild Parent Parent in law Brother or sister Brother or sister in law Neice or nephew Other relatives Not related

F 2 2 2 2 2 2 2 2 2 2 2 2

In years

Y 1 1 1 1 1 1 1 1 1 1 1 1

N 2 2 2 2 2 2 2 2 2 2 2 2

Workers

*** Non workers

Circle Line No. of ever married females aged 15-49 years (exclude never married)

1 1 1 1 1 1 1 1 1 1 1 1

** Marital Status
1 2 3 4 5 Curently Married Seperated/Deserted Widowed Divorced Never Married 1 2 3 4 5 6 7

***Non Workers
Unemployed House wife Studying Sick/disabled Retired Small child Others (specify)

Total no. of Eligible women ________________

Type of Family________________________

83

SECTION I (HOUSEHOLD COMPOSITION)

Line No Q.101 Usual residents and visitors Q.102 Relationship to head of the household What is the relationship of (name) to the head of the household? * Q.103 Sex Q.104 Age Q.105 Marital status What is the current marital status of (name)** Q.106 Education Q.107 Occupational Status Is She/ He Working? Q.108 If Yes, Please name the Occupation Q.109 Eligibility

Please give me the names of the persons who usually live in your household starting with the head of the household

Is (name) male or female?

How old is (name)?

How many years of schooling (name) has?

If No, Mention the status of the non working member

M 13 14 15 16 17 18 19 20 21 22 23 24
*Codes for relationship with the head of the household
13 14 15 16 17 18 19 20 21 22 23 24 Head Wife or husband Son or daughter Son or daughter in law Grandchild Parent Parent in law Brother or sister Brother or sister in law Neice or nephew Other relatives Not related

F 2 2 2 2 2 2 2 2 2 2 2 2

In years

1 1 1 1 1 1 1 1 1 1 1 1

Y 1 1 1 1 1 1 1 1 1 1 1 1

N 2 2 2 2 2 2 2 2 2 2 2 2

Workers

*** Non workers

Circle Line No. of ever married females aged 15-49 years (exclude never married)

** Marital Status
1 2 3 4 5 Curently Married Seperated/Deserted Widowed Divorced Never Married 1 2 3 4 5 6 7

***Non Workers
Unemployed House wife Studying Sick/disabled Retired Small child Others (specify)

Total no. of Eligible women ________________

Type of Family________________________

84

SECTION- II HOUSEHOLD CHARACTERISTICS

Q. No. Q.201 Questions and Filters What is your religion? Coding categories Hindu........................................1 Sikh......................................... 2 Muslim.....................................3 Christian...................................4 Others (specify)...................... 5 Scheduled caste....................... 1 Scheduled tribe....................... 2 Other backward classes.......... 3 General................................... 4 Do not know........................... 5 Pucca...................................... 1 Semi-pucca............................. 2 Kachcha.................................. 3 Own.........................................1 Rented.................................... 2 Rooms Tap (inside residence/yard/plot)......1 Tap (public)............................. .......2 Hand pump/bore well/well............. 3 River...................................... ........ 4 Pond.................................................5 Others (specify)____________.......6 Yes..................................................1 No.................................................. 2 Electricity...................................... 1 Kerosene........................................2 Gas.................................................3 Oil (castor/groundnut)...................4 Others (specify)______________5 Yes 1 1 1 1 1 1 1 1 2 2 2 2 2 2 2 2 No

Q.202

What is your caste/tribe?

Q.203

Type of house (Record by observation) Does this household own this house or is it rented? How many rooms are there in your household? What is the main source of drinking water for your household?

Q.204 Q.205 Q.206

Q.207 Q.208

Do you have separate room for cooking? What is the main source of lighting for your household?

Q.209

What type of fuel does your household mainly use for cooking? 1. Electricity 2. Liquid petroleum gas 3. Biogas 4. Kerosene/coal/charcoal 5. Wood 6. Crop residue 7. Cow dung cakes 8. Others (specify)_____________ What type of toilet facility does your household have?

Q.210

Own toilet (flush).....................1 Public/shared (flush) toilet.......2 Own pit toilet.......................... 3 Shared/public pit toilet........... .4 No facility (bush/field)........... .5

85

Q. No. Q.211 Q.212

Questions and Filters Does this household own any agricultural land? How much agricultural land do you possess?

Coding categories Yes ....................................1 No......................................2 (skip to Q.214)

Agricultural land in acres ___________ Non agricultuiral land in acres_______

Q.213

Out of this how much is irrigated?

Irrigated land in acres__________ Non irrigated land in acres_______

Q.214 Q.215

Does this household own any livestock? If yes, what type and number of livestock do you own?

Yes ...........................................1 No............................................ 2 Number of Bullocks ______ Number of Cows ______ Number of Buffaloes______ Number of Goats ______ Number of Sheeps ______ Number of poultry ______ Others (specify) ______ Yes 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 Yes 1 1 1 1 No 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 No 2 2 2 2

Q.216

Does your household own any of the following? Number 1. Mattress ___________ 2. Pressurecooker _______ 3. Chair ______________ 4. Cot/bed _____________ 5. Electric fan __________ 6. Clock/ watch_________ 7. Telephone ___________ 8. Bicycle _____________ 9. Radio/transister _______ 10. T.V (B&W) ________ 11. T.V (colour) _________ 12. Moped/Scooter/motorcycle_____ 13. Water pump ________ 14. Thresher __________ 15. Tractor __________ 16. Any other (specify)_____ What is the main source of your income? 1. 2. 3. 4. Salary/wages Agricultural activities Business Others(specify) ______________

Q. 217

86

CONFIDENTIAL (For Research Use only)

International Institute for Population Sciences

Govandi Station Road, Deonar, Mumbai 400 088.
RAPID HOUSEHOLD SURVEY (REPRODUCTIVE MORBIDITY) Ever Married Womans (15 49) Questionnaire
IDENTIFICATION State District Tehsil /Taluk Village Head of the Household Name ____________________________________________________ Address ____________________________________________________ ____________________________________________________ (Detailed Landmarks) ____________________________________________________ Name and line no of the Eligible Women Serial Number of the Household Questionnaire Serial Number of the Womans Questionnaire INTERVIEWERS VISIT
1 DATE _______________ _______________ _______________ 2 _______________ ______________ ______________ 3 _______________ ________________ __________________ FINAL VISIT Days Month Year Name Code Result Code* TOTAL NUMBER OF VISITS NEXT VISIT: DATE TIME __________________ __________________ _________________ __________________ _________________ __________________

Coding categories

INTERVIEWERS NAME RESULT*

*Result Codes of the womens questionnaire

1. 2. 3. 4. 5. 6.

Completed Not completed Postponed Refused Partly Completed Other (specify)_______________

_____________________

______________________

Name of the Investigator:

Signature of the Investigator

87

Section 1

(BACKGROUND CHARACTERISTICS)
Q.No. Questions and Filters Q.101 How old were you at your last birthday? Codes Age in completed years

Q.102

What is your marital status?

Currently married..1 Separated...2 Divorced3 (Skip to Q.105) Widowed4 Age in completed years

Q.103

How old was your husband on his last birthday? (Only for currently married women)
Are you living with your husband now or is he staying elsewhere? (Only for currently married women)

Q.104

Living with Husband .1 Staying elsewhere..2

Q.105

How old were you at the time of your Age in completed years marriage? Have you ever attended school? Yes.1 No..2 (Skip to Q.108) Number of years of schooling

Q.106

Q.107

How many years of schooling you have?

Q.108 Q.109

Did your husband ever attend school? How many years of schooling does your husband have?

Yes1 No.2 (Skip to Q.110) Number of years of schooling

Q.110

How much time do you spend for the following works?

Time spent Hours Mins

1. Collecting drinking water 2. Cooking 3. Cleaning or mopping house 4. Washing clothes 5. Milking animals 6. Collecting fuel/ wood 7. Collecting food for animals 8. Make cow dung cakes 9. Herding cattle 10.Others (specify) _____________

88

Q.No. Q.111 Q.112 Q.113

Questions and Filters Aside from your own housework, are you currently working? Have you done any work in the last 12 months for remuneration? If yes, what is your occupation i.e., what kind of work you do/did mainly? Do you work for your familys farm or business, or for someone else, or are you selfemployed? Do you usually work throughout the year, or do you work seasonally, or only once in a while? Are you paid in cash or kind for this work or are you not paid at all?

Codes Yes..1 No..2 Yes.1 No..2 (Skip to Q.117) Name of the Occupation

Q.114

Q.115

Familys farm or business 1 Employed with someone else 2 Self employed 3 Throughout the year..1

Seasonally/part of the year.2 Once in a while..3

Paid in cash 1 Paid in cash and kind 2 Paid in kind 3 Not paid 4 Respondent decides1

Q.116

Q.117

Who mainly decides how the money you earn will be used?

Husband decides2 Jointly with husband..3 Someone else decides.4 Jointly with someone else.5
Type of work

Q.118

Q.119 Q.120 Q.121 Q. 122

What kind of work does/did your husband mainly does? (Only for currently married women) Do you usually read a newspaper or a magazine at least once a week? Do you usually listen to radio at least once a week? Do you usually watch television at least once a week? Do you usually go to cinema hall or theatre to see a movie at least once a month?

________________
Yes.1 No..2 Yes.1 No..2 Yes.1 No..2 Yes.1 No..2

89

SECTION II - REPRODUCTION
Q.201.Have you ever been pregnant? Yes.1 No.2 (Skip to section VI) Q.202. If yes, how many times you have been pregnant? Number of times ___________(Include current pregnancy also and for current pregnancy ask only ANC information) Q.203 Q. 204 Order of What is the Pregnancy duration between each pregnancy? If first pregnancy, duration between marriage and first pregnancy 01 Month Q.205 What is the out come of Pregnancy? Q. 206 If Live Birth, what is the sex of the baby? Q. 207 If Live birth, in what month and year (Name) born? What is his/ her birthday? Q.208 If live birth, is still alive? Q.209 If alive how old was (Name) at his/ her last birthday? (Age in years) Q.210 If dead, how old was (Name) when he/ she died? If one year, probe: How many months old was (Name)? Record days if less than one month, months if less than 2 years or years Days Are you pregnant now? Yes1 No..2 Unsure.3 If yes, how many months pregnant are you? Months_________ Q.211 If SA, did you have any health problems when you were pregnant? Q.212 If SA, in which month of the pregnancy does the abortion took place? Q.213 If IA, where did the abortion took place? (Name of the clinic) Q.214 If IA, in which month you aborted? What was the reason to terminate the pregnancy?

Now I would like to ask some questions about your Pregnancy History

M
LB-1 SB-2
(Skip to next preg.)

F
2 Month

Y
1 2

Y N
1 2 Month Pvt.H..1 Govt.H2 ANM/VHN.3 Trained dai.4 Untrained Dai.5 Ayurvedic6 Homeopathy7 Traditional Healer..8 Govt. Mobile Cl.9 Pharmacy/Drugstore10 Other (specify).11 Pvt.H..1 Govt.H...2 ANM/VHN3 Trained dai.4 Untrained Dai.5 Ayurvedic..6 Homeopathy..7 Traditional Healer..8 Govt. Mobile Cl.9 Pharmacy/Drugstore10 Other (specify).11 Week Month

*SA-.3 Year
Skip to Q.211

Months Year Year (Skip to next preg) Week

**IA-4
(Skip to Q.213)

Reason:

02

Month

LB-1 SB-2
(Skip to next preg.)

2 Month

Days

2 Month

Week Month

SA-3 Year
Skip to Q.212

Months Week Year Years

IA-4
(Skip to Q.211)

Reason:

(Skip to next preg)

90

03

Month

LB-1 SB-2
(Skip to next preg.)

2 Month

Days

2 Month

*SA-.3 Year
Skip to Q.211

Months Year Year (Skip to next preg) Week

**IA-4
(Skip to Q.213)

Pvt.H..1 Govt.H2 ANM/VHN.3 Trained dai.4 Untrained Dai.5 Ayurvedic6 Homeopathy7 Traditional Healer..8 Govt. Mobile Cl.9 Pharmacy/Drugstore10 Other (specify).11 Pvt.H..1 Govt.H...2 ANM/VHN3 Trained dai.4 Untrained Dai.5 Ayurvedic..6 Homeopathy..7 Traditional Healer..8 Govt. Mobile Cl.9 Pharmacy/Drugstore10 Other (specify).11 Pvt.H..1 Govt.H2 ANM/VHN.3 Trained dai.4 Untrained Dai.5 Ayurvedic6 Homeopathy7 Traditional Healer..8 Govt. Mobile Cl.9 Pharmacy/Drugstore10 Other (specify).11 Pvt.H..1 Govt.H...2 ANM/VHN3 Trained dai..4 Untrained Dai.5 Ayurvedic..6 Homeopathy..7 Traditional Healer..8 Govt. Mobile Cl.9 Pharmacy/Drugstore10 Other (specify).11

Week Month

Reason:

04

Month

LB-1 SB-2
(Skip to next preg.)

2 Month

Days

2 Month

Week Month

SA-3 Year
Skip to Q.212

Months Week Year Years

IA-4
(Skip to Q.211)

Reason:

05

Month

LB-1 SB-2
(Skip to next preg.)

2 Month

(Skip to next preg) Days

2 Month

Week Month

*SA-.3 Year
Skip to Q.211

Months Year Year (Skip to next preg) Week

**IA-4
(Skip to Q.213)

Reason:

06

Month

LB-1 SB-2
(Skip to next preg.)

2 Month

Days

2 Month

Week Month

SA-3 Year
Skip to Q.212

Months Week Year Years (Skip to next preg)

IA-4
(Skip to Q.211)

Reason:

*SA Spontaneous Abortion **IA Induced Abortion

Total No. of Living children ________ Sons Daughters

Total no. of abortions __________ Total no. of still births __________ SA IA

91

Q.203 Q. 204 Order of What is the Pregnancy duration between each pregnancy? If first pregnancy, duration between marriage and first pregnancy 07 Month

Q.205 What is the out come of Pregnancy?

Q. 206 If Live Birth, what is the sex of the baby?

Q. 207 If Live birth, in what month and year (Name) born? What is his/ her birthday?

Q.208 If live birth, is still alive?

Q.209 If alive how old was (Name) at his/ her last birthday? (Age in years)

M LB-1 SB-2
(Skip to next preg.)

F 2 Month

Y 1 2

Q.210 If dead, how old was (Name) when he/ she died? If one year, probe: How many months old was (Name)? Record days if less than one month, months if less than 2 years or years Days

Q.211 If SA, did you have any health problems when you were pregnant?

Q.212 If SA, in which month of the pregnancy does the abortion took place?

Q.213 If IA, where did the abortion took place? (Name of the clinic)

Q.214 If IA, in which month you aborted? What was the reason to terminate the pregnancy? Week Month

Y 1 2

N Month Pvt.H..1 Govt.H2 ANM/VHN.3 Trained dai.4 Untrained Dai.5 Ayurvedic6 Homeopathy7 Traditional Healer..8 Govt. Mobile Cl.9 Pharmacy/Drugstore10 Other (specify).11 Pvt.H..1 Govt.H...2 ANM/VHN3 Trained dai.4 Untrained Dai.5 Ayurvedic..6 Homeopathy..7 Traditional Healer..8 Govt. Mobile Cl.9 Pharmacy/Drugstore10 Other (specify).11 Pvt.H..1 Govt.H...2 ANM/VHN3 Trained dai.4 Untrained Dai.5 Ayurvedic..6 Homeopathy..7 Traditional Healer..8 Govt. Mobile Cl.9 Pharmacy/Drugstore10 Other (specify).11

*SA-.3 Year
Skip to Q.211

Months Year Year (Skip to next preg) Week

**IA-4
(Skip to Q.213)

Reason:

08

Month

LB-1 SB-2
(Skip to next preg.)

2 Month

Days

2 Month

Week Month

SA-3 Year
Skip to Q.212

Months Week Year Years

IA-4
(Skip to Q.211)

Reason:

09

Month

LB-1 SB-2
(Skip to next preg.)

2 Month

(Skip to next preg) Days

2 Month

Week Month

SA-3 Year
Skip to Q.212

Months Week Year Years

IA-4
(Skip to Q.211)

Reason:

(Skip to next preg)

92

SECTION-III ANC INFORMATION FOR WOMEN BY ORDER OF PREGNANCY

Q.No. Q.301 Questions and Filters When you were pregnant, did you go for antenatal check up? 1st preg. Yes 1 No 2 (Skip to Q.303) Week Month Yes 1 No 2 (Skip to Q.305) Week Month Yes 1 No 2 (Skip to Q.307) Q.306 Q.307 After how many weeks/months of pregnancy you undergone blood test for the first time? Have you undergone Chrion biopsy (test by taking water from the uterus)? Week Month Yes No 1 2 2nd preg. Yes 1 No 2 (Skip to Q.303) Week Month Yes 1 No 2 (Skip to Q.305) Week Month Yes 1 No 2 (Skip to Q.307) Week Month Yes 1 No 2 (Skip to Q.309) Week Month 1 2 Yes 1 No 2 (Skip to Q.315) Week Month 3rd preg. Yes 1 No 2 (Skip to Q.303) Week Month Yes 1 No 2 (Skip to Q.305) Week Month Yes 1 No 2 (Skip to Q.307) Week Month Yes 1 No 2 (Skip to Q.309) Week Month Yes 1 No 2 (Skip to Q.315) Week Month 4th preg. Yes 1 No 2 (Skip to Q.303) Week Month Yes 1 No 2 (Skip to Q.305) Week Month Yes 1 No 2 (Skip to Q.307) Week Month Yes 1 No 2 (Skip to Q.309) Week Month Yes 1 No 2 (Skip to Q.315) Week Month 5th preg. Yes 1 No 2 (Skip to Q.303) Week Month Yes 1 No 2 (Skip to Q.305) Week Month Yes 1 No 2 (Skip to Q.307) Week Month Yes 1 No 2 (Skip to Q.309) Week Month Yes 1 No 2 (Skip to Q.315) Week Month 6th preg. Yes 1 No 2 (Skip to Q.303) Week Month Yes 1 No 2 (Skip to Q.305) Week Month Yes 1 No 2 (Skip to Q.307) Week Month Yes 1 No 2 (Skip to Q.309) Week Month Yes 1 No 2 (Skip to Q.315) Week Month

Q.302 Q.303

After how many weeks/months of pregnancy you went for antenatal check up for the first time ? Have you undergone urine pregnancy test?

Q.304 Q.305

After how many weeks/months of pregnancy you undergone urine pregnancy test for the first time? Have you undergone blood test when you were pregnant?

(Skip to Q.309) Q.308 Q.309 After how many weeks/months of pregnancy you undergone Chrion biopsy test for the first time ? Have you undergone sonogram/ultrasound/sonography test? Week Month Yes No

(Skip to Q.315) Q.310 Q.311 Q.312 After how many weeks/months of pregnancy you undergone sonography test for the first time? Where did you go for sonogram test? (Name of the clinic) What made you to undergo sonography? Week Month

Reason

Reason

Reason

Reason

Reason

Reason

93

Q.No. Q.313

Questions and Filters Who suggested you to undergo sonogram test? 1. Self 2. Husband 3. Family 4. Relatives 5. Nurse/ANM 6. Doctors 7. Others (specify) ____________ Did they reveal the sex of the baby?

1st preg. Yes No 1 2 1 2 1 2 1 2 1 2 1 2 1 2 Yes No 1 2

2nd preg. Yes No 1 2 1 2 1 2 1 2 1 2 1 2 1 2 Yes 1

3rd preg. Yes No 1 2 1 2 1 2 1 2 1 2 1 2 1 2 Yes 1

4th preg. Yes No 1 2 1 2 1 2 1 2 1 2 1 2 1 2 Yes 1

5th preg. Yes No 1 2 1 2 1 2 1 2 1 2 1 2 1 2 Yes 1

6th preg. Yes No 1 2 1 2 1 2 1 2 1 2 1 2 1 2 Yes 1

Q.314

(Skip to Q.316) Q.315 What was the sex of the baby? Male Female 1 2

No 2 (Skip to Q.316) Male Female 1 2

No 2 (Skip to Q.316) Male Female 1 2

No 2 (Skip to Q.316) Male Female 1 2

No 2 (Skip to Q.316) Male Female 1 2

No 2 (Skipto Q.316) Male Female 1 2

Q.316

During your pregnancy did you suffer from any of the following health problems? (If no, then skip to Sec IV) 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. Nausea/vomiting Weakness or tiredness Dizziness Paleness Bleeding Pain in abdomen Visual disturbances Hypertension Swelling of hands and feet Weak foetus No movement of foetus Abnormal presentation Others (specify)__________ Do not know

Yes No 1 1 1 1 1 1 1 1 1 1 1 1 1 1 2 2 2 2 2 2 2 2 2 2 2 2 2 2

Yes No 1 1 1 1 1 1 1 1 1 1 1 1 1 1 2 2 2 2 2 2 2 2 2 2 2 2 2 2

Yes No 1 1 1 1 1 1 1 1 1 1 1 1 1 1 2 2 2 2 2 2 2 2 2 2 2 2 2 2

Yes No 1 1 1 1 1 1 1 1 1 1 1 1 1 1 2 2 2 2 2 2 2 2 2 2 2 2 2 2

Yes No 1 1 1 1 1 1 1 1 1 1 1 1 1 1 2 2 2 2 2 2 2 2 2 2 2 2 2 2

Yes No 1 1 1 1 1 1 1 1 1 1 1 1 1 1 2 2 2 2 2 2 2 2 2 2 2 2 2 2

Q.317

If any, did you consult doctor or any other health worker for your health problems?

Yes 1 No 2 (Skip to Q401)

Yes 1 No 2 (Skip to Q401)

Yes 1 No 2 (Skip to Q401)

Yes 1 No 2 (Skip to Q401)

Yes 1 No 2 (Skip to Q401)

Yes 1 No 2 (Skip to Q401)

94

Q.318

Whom did you consult? 1. Govt.Doctor 2. Pvt.doctor 3. Nurse/ANMs 4. Trained dai 5. Untrained dai 6. Ayurvedic doc. 7. Homeopathy doc. 8. Others (specify)______________

Yes No 1 2 1 2 1 2 1 2 1 2 1 2 1 2 1 2

Yes No 1 2 1 2 1 2 1 2 1 2 1 2 1 2 1 2

Yes No 1 2 1 2 1 2 1 2 1 2 1 2 1 2 1 2

Yes No 1 2 1 2 1 2 1 2 1 2 1 2 1 2 1 2

Yes No 1 2 1 2 1 2 1 2 1 2 1 2 1 2 1 2

Yes No 1 2 1 2 1 2 1 2 1 2 1 2 1 2 1 2

SECTION IV

INFORMATION ABOUT DELIVERY

Q.No. Q.401 Questions and Filters Where did the delivery took place? 1st preg. Pvt. Hosp...1 GovtHosp..2 PHC...3 SubCentre..4 Home.5 Others6 _______________ (specify) Q.402 If home delivery, who conducted the delivery? Self 1 Family.. 2 Relatives3 Friends .4 Untra. Dai 5 Trained Dai. 6 Nurse/LHV/ ANM 7 Doctors 8 Others__________ (specify)9 2nd preg. Pvt. Hosp...1 GovtHosp..2 PHC...3 SubCentre..4 Home.5 Others6 _________________ (specify) Self.. 1 Family. 2 Relatives. 3 Friends 4 Untra. Dai.. 5 Trained Dai 6 Nurse/LHV/ ANM .. ..7 Doctors. 8 Others__________ (specify)9 3rd preg. Pvt. Hosp..1 GovtHosp..2 PHC..3 SubCentre.4 Home5 Others6 ______________ (specify) Self. 1 Family 2 Relatives 3 Friends 4 Untra. Dai ...5 Trained Dai 6 Nurse/LHV/ ANM.7 Doctors. 8 Others__________ (specify)9 4th preg. Pvt. Hosp..1 GovtHosp..2 PHC..3 SubCentre.4 Home5 Others...6 _____________ (specify) Self ..1 Family. 2 Relatives..3 Friends 4 Untra. Dai ..5 Trained Dai 6 Nurse/LHV/ ANM..7 Doctors.. 8 Others__________ (specify)9 5th preg. Pvt. Hosp..1 GovtHosp..2 PHC..3 SubCentre.4 Home5 Others6 ___________ (specify) Self. 1 Family.. 2 Relatives.. 3 Friends. 4 Untra. Dai 5 Trained Dai. 6 Nurse/LHV/ ANM 7 Doctors. 8 Others__________ (specify)9 6th preg. Pvt. Hosp..1 GovtHosp..2 PHC..3 SubCentre.4 Home5 Others6 _______________ (specify) Self .1 Family 2 Relatives. 3 Friends 4 Untra. Dai5 Trained Dai 6 Nurse/LHV/ ANM.. 7 Doctors8 Others__________ (specify)9

95

Q.403

Q.404 Q.405

During delivery, did you experience any of the following problems? 1.Prematurelabour (ask Q.404) 2.Obstructed labour 3.Prolonged labour 4. ssisted labour 5.Breech presentation 6.Cord prolapse 7.Hand prolapse 8.Others (specify) _____________ (If 2-8 skip to Q.405) If premature labour, at which month? During the first week after delivery did you experience any of the following health problems? 1 Fever, tiredness, palpitation 2 Guarding of abdomen 3 Lower abdominal pain 4 Foul smelling vaginal discharge 5 Excessive bleeding 6 Problem in the expulsion of placenta 7 Others (specify)

Yes No 1 2 1 2 1 2 1 2 1 2 1 2 1 2 1 2 Month__________ Yes No

Yes No 1 2 1 2 1 2 1 2 1 2 1 2 1 2 1 2 Month__________ Yes No

Yes No 1 2 1 2 1 2 1 2 1 2 1 2 1 2 1 2 Month__________ Yes No

Yes No 1 2 1 2 1 2 1 2 1 2 1 2 1 2 1 2 Month__________ Yes No

Yes No 1 2 1 2 1 2 1 2 1 2 1 2 1 2 1 2 Month__________ Yes No

Yes No 1 2 1 2 1 2 1 2 1 2 1 2 1 2 1 2 Month__________ Yes No

1 1 1 1 1 1 1

2 2 2 2 2 2 2

1 1 1 1 1 1 1

2 2 2 2 2 2 2

1 1 1 1 1 1 1

2 2 2 2 2 2 2

1 1 1 1 1 1 1

2 2 2 2 2 2 2

1 1 1 1 1 1 1

2 2 2 2 2 2 2

1 1 1 1 1 1 1

2 2 2 2 2 2 2

Q.406

If yes, to any, did you consult doctor/health worker for your health problems? If yes, whom did you consult? 1. 2. 3. 4. 5. 6. 7. 8. Pvt.Doc Govt.Doc ANM/VHNTrained daiUntrained DaiAyurvedic doc Homeopathy doc Others (specify)___________

Yes No

1 2

Yes

Yes

Yes

Yes

Yes

(Skip to Q501) Q.407 Yes No

No 2 (Skip to Q501) Yes No

No 2 (Skip to Q501) Yes No

No 2 (Skip to Q501) Yes No

No 2 (Skip to Q501) Yes No

No 2 (Skipto 501) Yes No

1 1 1 1 1 1 1 1

2 2 2 2 2 2 2 2

1 1 1 1 1 1 1 1

2 2 2 2 2 2 2 2

1 1 1 1 1 1 1 1

2 2 2 2 2 2 2 2

1 1 1 1 1 1 1 1

2 2 2 2 2 2 2 2

1 1 1 1 1 1 1 1

2 2 2 2 2 2 2 2

1 1 1 1 1 1 1 1

2 2 2 2 2 2 2 2

96

SECTION V
Questions for those women who had abortion
Q.No. Q.501 Questions and Filters When was your abortion? (Including current pregnancy if any) (Circle the pregnancy) After how many weeks of pregnancy your pregnancy got aborted or you had aborted it? Was the abortion spontaneous or induced? Abortion I Preg.no.______ 1 2 3 4 5 6 Year_________ Week Month Spon.1 (skip toQ. 505) Induced 2 Abortion II Preg.no.______ 1 2 3 4 5 6 Year_________ Week Month Spon.1 (skip toQ. 505) Induced 2 Abortion III Preg.no.______ 1 2 3 4 5 6 Year_________ Week Month Spon.1 (skip toQ. 505) Induced 2 Abortion IV Preg.no.______ 1 2 3 4 5 6 Year________ Week Month Spon.1 (skip toQ. 505) Induced 2 Abortion V Preg.no.______ 1 2 3 4 5 6 Year________ Week Month Spon.1 (skip toQ. 505) Induced 2 Abortion VI Preg.no.______ 1 2 3 4 5 6 Year________ Week Month Spon.1 (skip toQ. 505) Induced 2

Q.502

Q.503

Q.504

If induced abortion, can you tell me by which method you got aborted? Yes No 1. 2. 3. 4. 5. 6. 7. Seaweed insertion Laminaria tent Dilatation &Curettage (D&C) Suction Injection of Emc. med Mechanical Others (specify)________ (skip to Q.507) 1 1 1 1 1 1 1 2 2 2 2 2 2 2 Yes No 1 1 1 1 1 1 1 2 2 2 2 2 2 2 Yes No 1 1 1 1 1 1 1 2 2 2 2 2 2 2 Yes No 1 1 1 1 1 1 1 2 2 2 2 2 2 2 Yes No 1 1 1 1 1 1 1 2 2 2 2 2 2 2 Yes No 1 1 1 1 1 1 1 2 2 2 2 2 2 2

Q.505

Q.506

Did you go to any health facility after experiencing the first symptom of Spontaneous abortion? Which of the health facilities did you consult?

Yes 1 No 2 (Skip to Q507) Pvt. Doc.1 Govt. doc.. 2 Nurse.3 Ayurvedic doc4 Homeopathy..5 Others______ (specify) 6

Yes 1 No 2 (Skip to Q507) Pvt. Doc.1 Govt. doc.. 2 Nurse.3 Ayurvedic doc4 Homeopathy..5 Others______ (specify) 6

Yes 1 No 2 (Skip to Q507) Pvt. Doc.1 Govt. doc.. 2 Nurse.3 Ayurvedic doc4 Homeopathy..5 Others______ (specify) 6

Yes 1 No 2 (Skip to Q507) Pvt. Doc.1 Govt. doc.. 2 Nurse.3 Ayurvedic doc4 Homeopathy..5 Others______ (specify) 6

Yes 1 No 2 (Skip to Q507) Pvt. Doc.1 Govt. doc.. 2 Nurse.3 Ayurvedic doc4 Homeopathy..5 Others______ (specify) 6

Yes 1 No 2 (Skip to Q507) Pvt. Doc.1 Govt. doc.. 2 Nurse.3 Ayurvedic doc4 Homeopathy..5 Others______ (specify) 6

97

Q.No. Q.507

Questions and Filters Did you face any health problems after abortion? (For both spontaneous and induced abortion) 1. Fever 2. Abdominal tension 3. Abdominal pain 4. White discharge 5. Any discharge 6. Foul smelling Discharge 7. Fast pulse 8. Pus formation 9. Irregular periods 10. Painful inter course 11. Back ache 12. Any other (specify) __________ Did you consult doctor/ health worker for your health problems?

Abortion I
Yes 1 1 1 1 1 1 1 1 1 1 1 1 Yes No No 2 2 2 2 2 2 2 2 2 2 2 2 1 2

Abortion II
Yes 1 1 1 1 1 1 1 1 1 1 1 1 Yes No No 2 2 2 2 2 2 2 2 2 2 2 2 1 2

Abortion III Abortion IV

Yes 1 1 1 1 1 1 1 1 1 1 1 1 Yes No No 2 2 2 2 2 2 2 2 2 2 2 2 1 2 Yes 1 1 1 1 1 1 1 1 1 1 1 1 Yes No No 2 2 2 2 2 2 2 2 2 2 2 2 1 2

Abortion V
Yes 1 1 1 1 1 1 1 1 1 1 1 1 Yes No No 2 2 2 2 2 2 2 2 2 2 2 2 1 2

Abortion VI
Yes 1 1 1 1 1 1 1 1 1 1 1 1 Yes No No 2 2 2 2 2 2 2 2 2 2 2 2 1 2

Q.508

(Skip to Q.601)

(Skip to Q.601)

(Skip to Q.601)

(Skip to Q.601)

(Skip to Q.601)

(Skip to Q.601)

Q.509

Which of the health facilities did you consult?

Pvt. Doc.1 Govt. doc.. 2 Nurse.3 Ayurvedic doc4 Homeopathy..5 Others______ (specify) 6

Pvt. Doc.1 Govt. doc.. 2 Nurse.3 Ayurvedic doc4 Homeopathy..5 Others______ (specify) 6

Pvt. Doc.1 Govt. doc.. 2 Nurse.3 Ayurvedic doc4 Homeopathy..5 Others______ (specify) 6

Pvt. Doc.1 Govt. doc.. 2 Nurse.3 Ayurvedic doc4 Homeopathy..5 Others______ (specify) 6

Pvt. Doc.1 Govt. doc.. 2 Nurse.3 Ayurvedic doc4 Homeopathy..5 Others______ (specify) 6

Pvt. Doc.1 Govt. doc.. 2 Nurse.3 Ayurvedic doc4 Homeopathy..5 Others______ (specify) 6

98

SECTION-VI MENSTRUAL HISTORY (Only for non pregnant women)

Q. No. Q.601 Questions and Filters Are you currently menstruating? Coding categories Yes1 No in Menopause.2(skip to Q.602) No in Amenorrhoea..3 Never Menstruated...4 Month_________ Year___________ Normal (25-35 days) 1 Abnormal (>35 days) 2 Abnormal (<25 days) 3 Number of days Normal Abnormal Yes No Number of days Yes No Number of days Yes No Number of days ______ 1 2 1 2 (skip to q.608) ______ 1 2 (skip to q.610) ______ 1 2 (skip to Section VIII) ______

Q.602 Q.603

If no, since how long you are not menstruating? Menstrual regularity

Q.604 Q.605 Q.606 Q.607 Q.608 Q.609 Q.610 Q.611

What is the length of your menstrual cycle? Menstrual bleeding Do you get pain before menstruation? If yes, how many days before? Do you get pain during menstruation? If yes, for how many days? Do you get pain after menstruation? If yes, how many days do you have pain after menstruation?

SECTION-VII CONTRACEPTION
Q. No. Q.701 (Only for currently married women) Questions and Filters According to you what is the ideal family size? Coding categories

Q.702 Q.703

Are you / your husband currently using any contraceptive method? If yes, which method are you using?

Family size _________ No of sons _______ No of daughters ________ Yes1 No..2 (skip to Q. 709) 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. Female sterilization..1 Male sterilization..2 IUD/ copper-t/ loop.3 Daily pills (cycles)4 Weekly pills.5 Condom/ Nirodh6 Rhythm/ periodic abstinence 7 Withdrawal.8 Other modern method (specify) __________9 Other traditional method (specify) _______ 10

Q.704

How long have you been using the method?

Months_____________ Years ______________

99

Q. No. Q. 705

Questions and Filters Have you had any problem related to the use of (CURRENT METHOD)? (If no, then Skip to Section VIII) What problems have you had related to the use of (CURRENT METHOD)? 1. Weight gain 2. Weight loss 3. Too much bleeding 4. Hypertension 5. Headache/body ache/backache 6. Nausea/vomiting 7. No menstruation 8. Weakness/tiredness 9. Fever 10. Cramps 11. Spotting 12. Inconvenient to use 13. Abdominal pain 14. White discharge 15. Irregular periods 16. Breast tenderness 17. Allergy 18. Expulsion 19. Reduced sexual satisfaction 20. Other __________________ (specify) PROBE: Any other problems? RECORD ALL MENTIONED When you first started having these problems, did you talk to anyone about these problems? Whom did you talk to about these problems?

Coding categories Yes1 No.2

Q.706

YES 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1

NO 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2

Q.707 Q.708

Any other persons?

RECORD ALL PERSONS TALKED TO

Q.709 Q.710

If no, are you planning to use any contraceptive method? If yes, which method are you planning you use?

Yes1 No.2 1. Govt. Doctor 2. Public health nurse 3. ANM/LHV 4. Anganwadi workers 5. Other govt. Health workers 6. Ngo doctors 7. Ngo worker 8. Pvt. Doctor 9. Pvt. Paramedic 10. Compounder / pharmacists 11. Traditional healer 12. Husband 13. Friend/other relative 14. Other ____________ specify Yes 1 No..2 1. Female sterilization..1 2. Male sterilization..2 3. Iud/ copper-t/ loop.3 4. Daily pills (cycles)4 5. Weekly pills.5 6. Condom/ nirodh6 7. Rhythm/ periodic abstinence 7 8. Withdrawal.8 9. Other modern method (specify) __________9 10. Other traditional method (specify) ______ 10

100

SECTION-VIII STATUS OF A GIRL CHILD

Q.No. Q .801 Questions and Filters According to your opinion, whether girls should be educated or not? Coding categories Should be educated 1 Should not be educated 2 (Skip to Q.803) Should be educated 1 Should not be educated 2 (Skip to Q.803) Boys______ Girls______ Marriage age Boys Girls Yes No Years Months Years Months 1 2

Q.802

According to your opinion, whether boys should be educated or not?

Q.803 Q.804 Q.805 Q.806 Q.807 Q.808

Till which standard boys/girls should be educated? According to your opinion, at what age should a girl or boy get married? According to you, whether girls can go for any kind of work, apart from household activities? According to your opinion, how many months/ years should a girl be given breast milk? According to your opinion, how many months/ years should a boy be given breast milk? Usually, what type of weaning food should be given for a girl after breastfeeding? Usually, what type of weaning food should be given for a boy after breastfeeding? How often do you give the following items to your daughter: Daily, weekly, occasionally, or never: Milk or curd? Pulses or beans? Green leafy vegetables? Other vegetables? Fruits? Eggs? Chicken, meat or fish?

Q. 809

Q. 810

Daily weekly occas never Ionally 1 1 1 1 1 1 1 2 2 2 2 2 2 2 3 3 3 3 3 3 3 4 4 4 4 4 4 4 never

Q. 811

How often do you give the following items to your son: Daily, weekly, occasionally, or never: Milk or curd? Pulses or beans? Green leafy vegetables? Other vegetables? Fruits? Eggs? Chicken, meat or fish?

Daily weekly occas ionally 1 1 1 1 1 1 1 2 2 2 2 2 2 2 3 3 3 3 3 3 3

4 4 4 4 4 4 4

101

Confidential (For Research Use Only)

INTERNATIONAL INSTITUTE FOR POPULATION SCIENCES

Govandi Station Road, Deonar, Mumbai- 400088 -------------------------------------------------------------------------------------------------Project: - Reproductive Morbidity in the State of Haryana MEDICAL QUESTIONNAIRE FOR GYNACOLOGICAL AND OBSTETRIC MORBIDITY
Name of the Respondent: Village: Serial No of the questionnaire Date of History taking Day Month Year

Date of Birth Day Month Year

Age at Marriage Day Month Year

FERTILITY HISTORY
1. Number and outcome of previous Pregnancies (a) (b) (c) (d) (e) Viable birth Spontaneous abortion Induced abortion Ectopic Pregnancy Molar ___________ Number ___________ ___________ ___________ ___________ ___________

2. Number of living children in the present union 3. Postpartum or abortion complication(s) in last pregnancy No Yes

4. Methods of fertility regulation used since last child birth/abortion None IUD Hormonal Contraception Sterilization (Female/Male)

102

Menstrual and Ovulation history

Q. No. 1. 2. 3. 4. Questions and Filters Age at menarche Secondary Amenorrhoea Menstrual Regularity Length of cycle (number of days) Coding Categories Years_________ Primary Amenorrhoea Yes.1 No..2 Normal (25-35 days)1 Abnormal.2 Average Shortest Cycle Longest Cycle Normal..1 Abnormal.2 Regular Menses.1 Oligomenorrhoea..2 Secondary Amenorrhoea..3 Polymenorrhoea4 Irregular.5 Day Month Year

5. 6.

Menstrual bleeding Menstrual category

7.

First day of last spontaneous menstrual period

8.

Dysmenorrhoea

9. 10.

Do you suffer from abdominal pain during menses? In which pregnancy you had spontaneous abortion and after how many weeks of gestation and what was the cause?

No or minimal..1 Marked2 Progressive.3 Yes.1 No..2 Pregnancy No______________________ Gestation period (in weeks):__________________ Cause_____________________________________ ________________________________________ Pregnancy No.______________________ Gestation period (in weeks)__________________ Cause_____________________________________ ________________________________________ When:

11.

In which pregnancy you had induced abortion and after how many weeks of gestation and what was the cause?

12.

Do you become sad and cries a lot and cant sleep well any time before menses or after delivery or abortion?

103

History of diseases Q. No. Questions and Filters 1. History of systemic disease Coding Categories No.1 Diabetes2 Tuberculosis.3 Thyroid Disease4 High fever.5 Severe Anemia.6 Heart disease.7 Renal disease..8 Malaria9 Others10 No1 Uncomplicated Appendicetomy.. 2 Complicated Appendicetomy..3 Gynecological..4 Intestinal Obstructions.5 Ectopic Pregnancy...6 Twisted ovarian cysts..7 Anesthesia.8 Others.9 N. Yes No

3.

History of surgery

4.

After any delivery/abortion did you have the history of any of these following problems 1. Excessive bleeding and lower abdominal pain 2. Any itching or irritation in vaginal area 3. Abdominal tension 4. Abdominal pain 5. Any discharge 6. A fever along with discharge 7. Foul smelling discharge 8. Palpitation 9. Pus formation 10. Irregular periods with PID 11. Painful inter course 12. Back ache

Total No. of episodes Abortion Delivery 5. Where did you have your delivery/abortion (Place of delivery/abortion) after which you had the above mention problems? 104 Place of delivery /abortion: _____________________________

6.

During the past three months, have you had any of the following problems? 1. Excessive bleeding 2. Any itching or irritation in vaginal area 3. Abdominal tension 4. Abdominal pain 5. Any discharge 6. A fever along with discharge 7. Foul smelling discharge 8. Fast pulse 9. Pus formation 10. Irregular periods 11. Painful inter course 12. Back ache 13. Burning during urination 14. Frequent or difficult urination

N.

Yes

No

7.

Are you taking any treatment for these problems? If yes where are you taking treatment?

Yes ..1 No.2 Place of treatment_______________ _____________________________

Pelvic Examination Q. No. 1. 2. Questions and Filters External Genitalia Internal Genitalia Coding Categories Normal.1 Abnormal.2 Normal.1 Acquired Abnormalities..2 Congenital Abnormalities3

105