North - South Divide in Reproductive and Child
Health Indicators in Karnataka: An Analysis
Using RCH-RHS Round I Data
S. RAJARAM
PRC Working Paper No. 52
JULY, 2004
Population Research Centre
JSS Institute of Economic Research
Vidyagiri, Dharwad – 58004
KARNATAKA
North - South Divide in Reproductive and Child Health Indicators in
Karnataka: An Analysis Using RCH-RHS Round I Data
Introduction
The years after the Fourth International Conference on Population and
Development (ICPD) in 1994 and the Fourth World Conference on Women in 1995
witnessed dramatic changes in population policies and programs around the world. The
paradigm shift changed the focus of these policies and programs from population control
to reproductive health, particularly in developing countries, emphasizing a holistic
approach to women’s health and well being (Lane, 1994). The ICPD advocated that the
population programs should aim at facilitating couples to have children as they desire in
timing and number, help mothers to go through pregnancy and child birth safely so that
the outcome of pregnancy is successful in terms of maternal and infant survival and well
being. Following the recommendations of ICPD, Indian Family Welfare Program (IFWP)
went through many policy changes towards population control. Prior to this conference,
IFWP was a program targeted to meet demographic goals through increasing
contraceptive prevalence, mostly female sterilization. Unfortunately, similar to other
developing countries, during this era the IFWP was not designed to address causes of
mortality due to labor, delivery and complications during postpartum period (Abou-Zahr
and Wardlaw, 2003). The current national Health and Family Welfare Program, renamed
as Reproductive and Child Health (RCH) Program, combined all related programs of
Child Survival and Safe Motherhood (CSSM) initiated during 1992-93. Under this new
approach, the program intends to take into account the community’s needs and thus aims
at improving quality of services instead of mere fulfilment of targets. As such there are
no targets for various services, the grass-root level workers are expected to assess the
needs of the community, in consultation with the community, and based on their
assessment, goals are formulated to various health and family welfare activities in the
community. Thus the concept of RCH is to provide need based, client centred and
demand driven integrated services to the beneficiaries.
Addressing reproductive health needs means major challenges, such as reducing
reproductive morbidity, maternal, infant and child mortality (Pachauri, 1999). Majority of
the maternal deaths are due to reproductive morbidity and health problems during
pregnancy, delivery and first week after delivery. Similarly, major causes of infant and child
deaths are due to acute respiratory infections and diarrhoea. Thus documenting the
prevalence of health problems during pregnancy, delivery and first week after delivery and
of childhood diseases such as acute respiratory infections and diarrhoea are of importance to
policy and program managers. In this direction Ministry of Health and Family Welfare,
Government of India, New Delhi commissioned Rapid Household Surveys (RHS) to
provide information on various reproductive health indicators at district level. The present
paper addresses some of the reproductive and child health indicators, mainly the prevalence
of health problems during pregnancy, delivery and first week after delivery, self reported
symptoms of reproductive health, acute respiratory infection and diarrhoea in Karnataka
with special emphasis on regional differentials in these indicators using the data collected
under RHS. Considerable regional variations within Karnataka state are reported, with the
districts located in the northern part of the state remain backward in social, economic,
demographic and health indicators (see, Planning Department, Government of Karnataka,
1999). As such, substantial regional variations in the reproductive and child health indicators
are expected.
Review of literature of studies on the prevalence of obstetric and gynaecological
morbidity carried out in India and other countries can be found elsewhere (Oomman, 2000;
Sadana, 2000; Koening et al., 1996; Mamdani, 1999). These studies applied different
approaches, such as self-reported symptoms, clinical examination, laboratory tests or a
combination of these approaches, to examine the prevalence of these morbid conditions
among women in the study population. A detailed description of concepts of the
reproductive tract infections and sexually transmitted infections can be obtained in Zurayk et
al. (1993), Tsui et al. (1997) and UNFPA (no date). Validity and disadvantages of various
approaches adopted in studying the obstetric and gynaecological morbidity is discussed in
Koening et al. (1996), Oommen (2000) and Sadana (2000).
As the realisation grew about the magnitude of these morbid conditions, recently
2
attempt has been made to study the determinants of these conditions in order to effectively
manage the reproductive health problems and thus controlling the maternal deaths. A
number of factors influence the gynaecological morbidity and it is documented that the risk
factors differ not only from nation to nation, but also from community to community (Tsui
et al. 1997). These factors are found to be iatrogenic, endogenous, socio-economic and
cultural in nature. A study based on a cross-sectional survey conducted in a sub-district of
Karnataka state revealed that socio-economic and demographic factors are not consistent
predictors of health problems during antenatal, natal and post-natal periods (Bhatia and
Cleland, 1996). According to Tsui et al. (1997), any woman, regardless of age, parity, socioeconomic status, or education, can develop a complication at any stage of pregnancy,
delivery, or the postpartum period. Some studies identified that the contraceptive use also
significantly influence the risk of reproductive tract infections. A study conducted in
Karnataka shown that reporting of reproductive tract infection is significantly higher among
women who had under gone tubectomy than among those who are not using a method of
contraception or who are using a reversible method (Bhatia and Cleland, 1995). Evidence
also suggests that experience of abortion and obstetric problems were associated with
gynaecological morbidity. Good personal hygiene practices also found to have influence the
gynaecological morbidity (Bhatia and Cleland, 1995). According to a study carried out in
Uttar Pradesh, significant predictors of a woman reporting any symptom of reproductive
tract infection were region, parity, household assets and pregnancy outcome (Maitra et al.,
2001). It is evident from a study carried out among women in a Mumbai slum that
contraceptive use status, age and parity are significantly associated with self-reporting of
gynaecological morbidity (Parikh et al., 1996).
Mosley and Chen (1984) had provided a framework for examining the factors
influencing child mortality and morbidity in developing countries. The framework identifies
five groups of proximate determinants of child health, such as factors related to mother (age,
parity, birth interval); environmental contamination; nutrient deficiency; injury and personal
illness control. It is posited that the effect of socio-economic factors on child mortality and
morbidity operate through these set of proximate determinants. This framework has been
utilized extensively to study the child mortality in various populations. Studies using this
3
framework to examine the child morbidity are undertaken very rarely. In general, quality of
childcare is one of the major factors likely to influence the incidence of child morbidity.
Social and economic conditions prevailing within the household and in the community are
directly or indirectly linked to the quality of childcare. Similarly education of both mother
and father facilitates the acquisition of information about better childcare and feeding
practices. Appropriate variables are identified in the analysis keeping the framework into
consideration and depending on their availability in the RHS. A study conducted among
poor community in Coimbatore district showed that majority of the social, economic and
demographic factors have no significant effect on the morbidity among children under age
five (Sivakami, 2000).
Data and Methodology
The data used for the present study is taken from the Rapid Household Surveys
(RHS– Round I) of Reproductive and Child Health (RCH) project conducted in
Karnataka State. The survey was conducted in a phased manner- half of the districts were
covered in the year 1998 and the remaining districts were covered in the year 1999. As
mentioned earlier, Government of India commissioned this project and the survey was
co-ordinated by the International Institute for Population Sciences (IIPS), Mumbai. Out
of the 20 districts, the data collection for 10 districts such as Bangalore, Belgaum, Bidar,
Chikmagalore, Dakshin Kannada, Gulbarga, Kodagu, Mandya, Raichur and Tumkur was
completed during September-November, 1998 and the data collection in the remaining 10
districts namely Dharwad, Bellary, Bijapur, Uttar Kannada, Chitradurga, Hassan, Kolar,
Shimoga, Mysore and Bangalore (Rural) was carried out during July- September 1999. In
each district, 50 primary sampling units (PSUs) representing both rural and urban areas of
the district were selected using Probability Proportion to Size (PPS) method. In all,
17,318 currently married women in the age group 15-44 were interviewed from 21,257
households covering all the districts of the state.
The survey collected information on major health problems during pregnancy,
delivery and first week after delivery to all eligible mothers who had a live or still birth
during the three years preceding the survey (since January, 1995 for Phase I districts and
4
since January, 1996 for Phase II districts) in relevance to the last pregnancy termination.
Similarly, all the eligible women in the age group 15-44 were asked three questions to
assess reproductive health problems during the three months preceding the survey. These
questions include: during the past three months did the woman experience burning
sensation, pain or difficulty while urinating; during the past three months did the woman
experience pain in the lower abdomen or vagina during intercourse; and during the past
three months did the woman have any problem of vaginal discharge. The survey also
collected information on two childhood diseases, namely acute respiratory infection and
diarrhoea, to all mothers having surviving children born during three years preceding the
survey (born after January, 1995 for Phase I districts and after January, 1996 for Phase II
districts) in relevance to the youngest living child. These aspects of reproductive and
child health are examined in this paper.
In order to examine the regional differentials in the reproductive and child health
indicators, the districts of Karnataka are grouped into three regions viz. Southern Maidan,
Malenad and Northern Maidan. Southern Maidan region include Bangalore (Urban),
Bangalore (Rural), Kolar, Mandya, Mysore, Hassan, Tumkur and Chitradurga districts;
Malenad region include Uttar Kannada, Kodagu, Chikmagalur, Dakshin Kannada; and
Norther Maidan region include Belgaum, Bellary, Bidar, Bijapur, Raichur, Dharwad and
Gulbarga districts.
The dependant variable for the analysis takes two outcomes such as experienced
or not experienced a health problem, even though some of the mothers might have
suffered more than one health problem. First, we examined the differentials in the
selected reproductive and child heath indicators according to selected demographic and
socio-economic variables. Regional disparities in these indicators are also examined.
Logistic regression with corrections for sample design is utilised to understand the factors
influencing the outcomes of selected reproductive and health indicators in Karnataka. The
following is the basic model used in the analysis:
Yij= a + bXij+ cPj + mj+ eij
5
Yij: outcome variable, Xij: individual level control variables, Pj: variables at community
(PSU) level, mj : error of unobserved community variables, ejj : error of unobserved
individual variables. The basic assumption is that mj’s are uncorrelated with the
regressors. Specifically, the model predicting the probability of experiencing the
morbidity condition takes the form:
eY
p( z  1) =
1  eY
Results
Health problems experienced during pregnancy, delivery and first week after
delivery
In this survey information on the experience of nine specific health problems such
as swelling of hands and feet, paleness, weakness or tiredness, visual disturbances,
bleeding, convulsions, weak or no movement of foetus, abnormal presentation and other
complications, during pregnancy was colleted. Similarly, detailed information on the
incidence of premature labour, obstructed labour, prolonged labour, breech presentation
and other complications during the delivery was also collected. In addition, information
on the experience of health problems such as high fever, lower abdominal pain, vaginal
discharge with foul smelling, excessive bleeding, dizziness or severe headache and other
conditions was also collected. On the whole, most frequently reported health problem
during the pregnancy is weakness (30 per cent) followed by dizziness (23 per cent),
swelling of hands and feet (13 per cent), paleness (9 per cent), visual disturbance and
convulsions (7 per cent each)1. Similarly, about an equal number of mothers are reported
to have experienced prolonged labour and obstructed labour (10 per cent each) followed
by premature labour (5 per cent). However, maximum number of mothers experienced
lower abdominal pain (15 per cent), 12 per cent have experienced excessive bleeding,
about 10 per cent each have experienced high fever and dizziness or sever headache
during first week after delivery.
1
No table is generated to show each health problems separately.
6
Table 1 presents the regional and district level variations in the health problems
during pregnancy, delivery and first week after delivery. The analysis considered only the
experience of at least one health problem during pregnancy, delivery and first week after
delivery. In other words, we did not consider the specific health problems during
pregnancy, delivery and first week after delivery separately. Over all, about 45 per cent
of the mothers in Karnataka experienced at least one health problem during pregnancy,
one-fifth of mothers reported to have experienced health problem during delivery and
about 29 per cent of mothers experienced a health problem during first week after the
delivery.
There are considerable regional and interdistrict variations in the health problems
experienced by mothers during pregnancy, delivery and first week after delivery. For
example, more mothers in the Malenad region experienced health problems during
pregnancy, delivery and first week after delivery as compared to mothers in the Southern
and Northern Maidan regions. Among the districts, the percentage of mothers who have
experienced health problem during pregnancy ranges from 26 per cent in Tumkur district
to 70 per cent in Shimoga district. However, health problems experienced during delivery
is greater among mothers in Bangalore (Urban) district (42 per cent) and is lowest among
mothers in Gulbarage district (10 per cent). Likelihood of mothers experiencing health
problems in the first week after delivery is more in Bidar district (50 per cent) and is less
in Uttar Kannada district (15 per cent).
Differentials in the health problems during the pregnancy, delivery and the first
week after pregnancy by demographic and socio-economic characteristics are shown in
Table 2. The background characteristics included are: place of residence, education of
woman, education of husband, religion and caste/tribe of household head, type of house,
children ever born, age of woman and duration of marriage. Health problems during
pregnancy, delivery and first week is greater among women belongs to other than Hindu
and Muslim religion. Hindu mothers are reported to have experienced less health
problems during pregnancy and first week after delivery compared to Muslim mothers
and mothers belonging to other than Hindu and Muslim religion. The likelihood of
7
experiencing health problems during pregnancy as well as delivery is less among
Scheduled Tribe mothers, mothers living in Kachcha house, illiterate mothers, women
whose husband is illiterate and mothers living in rural areas. However, the incidence of
health problem in the first week after delivery is less among mothers belonging to Other
Backward Caste, mothers living in Pucca house, mother who have ten or more years of
schooling, women whose husband is also studied ten or more years of schooling and
mothers living in urban areas.
8
The level of experiencing health problem during pregnancy also varies with
parity2, increasing from 40 per cent for mothers having five or more children to 50 per
cent for mothers having one child. Similarly, the incidence of health problems during
delivery is also increasing from 14 per cent for mothers having five or more children to
28 for mothers having one child. But in case of health problem in the first week after
delivery no such trend is observed. Incidence of health problems during pregnancy,
delivery and the first week after delivery is found to be varies according to age of women
and duration of marriage. As the age of the women and duration of marriage increases the
health problem during pregnancy and delivery is also increases. No consistent
relationship is found between health problems in the first week after delivery and age of
the women and duration of marriage.
The discussion above is based on analysis that does not have any statistical
controls. In order to assess the independent effects of the various background
characteristics on the probability of a woman experiencing health problem during
pregnancy, delivery and first week after delivery, logistic regression with sample design
correction is applied. The predicted percentage of mothers experiencing health problems
during pregnancy, delivery and first week after delivery is measured from the logistic
regression and these values are presented instead of regression coefficients. Also,
whether the effects are statistically significant at the minimum threshold level of 0.05 is
indicated.
The results of logistic regression of mothers experiencing health problem during
pregnancy is given in Table 3. Most of the variables considered in the analysis are found
to be insignificant in explaining the experience of health problem during pregnancy.
Somewhat statistically significant relationship is found between the experience of health
problem during pregnancy and caste/tribe, education of women, duration of marriage,
place of residence and region. The likelihood of experiencing heath problem is high
among scheduled caste mothers compared to other mothers. A strong positive
2
Mothers who have experienced only still births and no live birth is included in parity 1.
9
relationship between education of mother and the level of health problems experienced
during pregnancy.
10
Similarly, more urban mothers experience health problem during pregnancy.
Significantly, higher percentage of mothers in the Malenad Region experienced health
problem during pregnancy, even after controlling for other factors.
Table 4 presents the predicted percentage of mothers experiencing health problem
during delivery. Significantly higher proportion of mothers belonging to non-Hindu and
non-Muslims reported to have experienced health problem during delivery. The incidence
of health problem during delivery is more among mothers living in Pucca houses,
mothers who have educated 10 or more years of schooling and mothers who are
delivering their first child. A higher proportion of urban mothers are reported to have
experienced problem during pregnancy. The results also suggest that more mothers in
Malenad Region experience health problem during delivery.
Predicted percentage of mothers experiencing health problem during first week
after delivery is shown in Table 5. Majority of the factors considered in the analysis are
not significant in explaining the experience of health problem during first week after
delivery. Significant differentials are found only according to caste/tribe, with more
Scheduled Caste mothers experiencing health problem during first week after delivery.
Although, a higher proportion of mothers in Malenad Region found to have experiencing
health problems during first week after delivery, the effect is not statistically significant,
when other factors are controlled for.
Self reported symptoms of reproductive tract infections
As mentioned earlier, all the eligible women in the age group 15-44 were asked
three questions to assess reproductive health problems during the three months preceding
the survey. The information collected include: during the past three months whether the
woman experience burning sensation, pain or difficulty while urinating; during the past
three months whether the woman experience pain in the lower abdomen or vagina during
intercourse; and during the past three months whether the woman have any problem of
vaginal discharge.
11
12
Regional disparities in the incidence of reproductive health problems are provided
in Table 6. Overall, 6 per cent of women reported to have burning sensation, pain or
difficulty while urinating, 5 per cent reported to have pain in lower abdomen or vagina
during intercourse and 12 per cent reported to have problem of vaginal discharge. About
17 per cent of women reported to have experienced at least one reproductive health
problem during three months prior to the survey. The incidence of burning sensation,
pain or difficulty while urinating and pain in lower abdomen or vagina during intercourse
is reported to have high among women in Malenad region than Southern and Northern
Maidan Regions. However, the occurrence of vaginal discharge among women is almost
same in Southern Maidan and Malenad regions. Further, the percentage of women
experiencing at least one reproductive health problem is also more in Malenad Region
(21 per cent) followed by Southern (18 per cent) and Northern (13 per cent) Maidan
Regions.
There are considerable variations in the occurrence of different reproductive
health problems examined according to district. Maximum incidence of burning
sensation, pain or difficulty while urinating is reported among women in Chikmagalur
(13 per cent) district and is minimum in Chitradurga and Kolar districts (about 2 per cent
each). On the other hand, more women in Tumkur (9 per cent) district reported to have
experienced pain in lower abdomen or vagina during intercourse and this problem is
minimum among women in Bijapur, Chitradurga and Kolar districts (about 2 per cent
each). The problem of vaginal discharge is reported to have highest among women in
Mandya (30 per cent) district and it is low among women in Gulbarga (2 per cent)
district. Consequently, more women in Mandya (33 per cent) district reported to have
experienced at least one reproductive health problem. Reporting of at least one
reproductive health problem is low among women in Gulbarga and Bijapur (6 per cent
each) districts.
13
Differentials in the incidence of individual reproductive health problems
according to selected socio-economic and demographic characteristics are presented in
Table 7. Variables included are: place of residence, education of woman, education of
husband, type of house, religion and caste/tribe of household head, age of woman,
duration of marriage, children ever born, current status of contraceptive use and
experience of abortion.
14
All the reproductive health problems studied are more among women who are
currently using IUD, women who have experienced abortion, Muslim women, women
who have studied 4 or less years of schooling, women with marriage duration between 10
and 14 years and women living in rural areas. Accordingly, reporting of at least one
reproductive health problem is more among women who have experienced abortion,
women who are currently using IUD, women who have studied 4 or less years of
schooling and women living in rural areas.
For identifying the risk factors of reproductive health problem logistic regression
with sample design correction is applied. The experience of at least one reproductive
health problem is taken as the dependent variable. Two separate models are considered:
first model is not included the experience of abortion and however the second model
included this variable. The predicted percentage of women reported to have experienced
at least one reproductive health problem and whether the effect is statistically significant
is provided in Table 8.
Statistically significant variations in the incidence of at least one reproductive
health problem are found according to region. More women in the Malenad region are
found to have reporting at least one reproductive health problem as compared to Southern
and Northern Maidan regions. Likelihood of experiencing at least one reproductive health
problem is also more among women who are currently using IUD, even after controlling
for other factors. The experience of at least one reproductive health problem is high
among women living in rural areas. Surprisingly, significantly more women living in
Pucca households are found to be reporting at least one symptom of reproductive health
problem. Current age of women found to have a statistically significant effect on the
reproductive health problem with more women in the age group 20-24 reported to have
experienced at least one reproductive health problem. Considerably higher proportion of
women who have experienced abortion is likely to report at least one reproductive health
problem.
15
Childhood Morbidity
Information on childhood morbidity was collected from women who have a
youngest living child born during three years preceding the survey. Information of only
two childhood morbidities such as diarrhoea and cold and cough with difficulty in
breathing in the two months prior to survey was gathered. These two morbidity
conditions are used to study the child health indicator in Karnataka. Table 9 show the
district and regional level variations in the prevalence of diarrhoea and cough and cold
with difficulty in breathing among youngest living child born during three years prior to
the survey. In Karnataka as a whole, about 19 per cent and 17 per cent of youngest
children born three years prior to the RHS suffered from diarrhoea and cough and cold
with difficulty in breathing, respectively.
District and regional variations are substantial, but they must be interpreted with
caution because the incidence of these disease conditions is somewhat seasonal and the
survey was conducted at different times in different districts. The occurrence of diarrhoea
is higher in Sothern Maidan region (24 per cent), but the occurrence of cough, cold and
difficulty in breathing is more in Malenad region. Prevalence of diarrhoea during two
months before the survey varies from 6 per cent in Dakshina Kannada district to 31 per
cent in Kolar district. However the prevalence of cough, cold and difficulty in breathing
varies from a low of 6 per cent in Kodagu district to a high of 28 per cent in Bangalore
(Urban) district. Higher-level of pollution in Bangalore (Urban) district may be the
reason for such findings.
Table 10 shows prevalence of diarrhoea and cough, cold and difficulty among
youngest living child born during three years before the survey by selected demographic
and socio-economic characteristics. The background characteristics included are: place of
residence, education of mother, education of father, religion and caste/tribe of household
head, age of mother, type of house, sex of the child, child’s age and source of drinking
water to the household. Substantial differentials in the occurrence of diarrhoea and cough,
cold and difficulty in breathing is found according to child’s age, with a peak of 25 per
16
cent prevalence for diarrhoea and 23 per cent prevalence for cough, cold and difficulty in
breathing among children age 6-11 months. Significant differentials in the occurrence of
diarrhoea are also found according to religion and caste/tribe. For many of the other
socio-economic variables, the differentials in the prevalence of diarrhoea found to be
small. However, the percentage of children suffering from cough, cold and difficulty in
breathing at any time during two months prior to survey does not vary much by majority
of the background variables considered.
The results of the predicted percentage of children suffering from diarrhoea are
given in Table 11. The effects of majority of the factors considered in the analysis are
found to be insignificant, when other factors are controlled for. Substantially more
children in the Southern Region are found to be suffering from diarrhoea than Northern
and Malenad Regions.
Child’s age is another factor found statistically significant influence on diarrhoea,
with 25 per cent of children age 6-11 are suffering from diarrhoea. Similarly, statistically
significant effect is found only for one category of the factors caste/tribe status of
household head and age of mother. Children belonging to higher-caste are less likely to
be suffering from diarrhoea. However, children of younger mothers are more likely to
have diarrhoea. The statistically insignificant effect of socio-economic and demographic
factors indicates that diarrhoea tends to strike the young children in Karnataka
irrespective of their socio-economic and demographic status.
None of the socio-economic and demographic factors are found to be significant
in explaining the prevalence of cough, cold and difficulty in breathing among children in
Karnataka. Only one category of child’s age and caste/tribe status of household head is
showing a statistically significant effect on the prevalence of cough, cold and difficulty in
breathing among children. The results thus suggest that both childhood morbid conditions
are not influenced by the socio-economic factors. In other words, young children in
Karnataka suffer from childhood morbidities such as diarrhoea and cough, cold and
difficulty in breathing regardless of their background characteristics.
17
Discussion and Conclusions
The present paper examined the reproductive morbidity among women and
morbidity among young children in Karnataka with special emphasis on regional
variations in these aspects. In particular attention has been made to study the prevalence
and determinants of health problems during pregnancy, delivery and first week after
delivery (obstetric morbidity) and reproductive health problems (gynaecological
morbidity/ reproductive tract infections) from self-reported symptoms. Two morbidity
conditions among young children, such as diarrhoea and cough, cold and difficulty in
breathing, are also examined. Certain limitations are documented in studying the
gynaecological morbidity based on self-reported symptoms (for example see, Oomman,
2000). Most important limitation is that some women may not report the symptoms due
to various reasons and also for certain disease conditions symptoms may not be present at
the time of survey.
The analysis revealed that in Karnataka as a whole about 45 per cent of women
suffered from health problem during pregnancy; 21 per cent experienced a health
problem during delivery and another 29 per cent experienced a problem during the first
week after delivery. However, according to the study of Bhatia and Cleland (1996) onefifth reported at least one problem during ante-natal period; only about 8 per cent
experienced a problem during delivery and another 23 per cent indicated problems during
post-partum period. The bi-variate analysis of health problems during pregnancy,
delivery and first week after delivery, and socio-economic and demographic variables
suggested wide differentials. But multivariate analysis suggested that significance of
most of the socio-economic and demographic factors considered in explaining the health
problems during pregnancy, delivery and first week after delivery comes out to be weak.
The findings of the present paper are almost consistent with an earlier paper by Bhatia
and Cleland (1996). One important finding is that the importance of factors varies with
health problems at the different stages of childbearing process. For example, caste/tribe
status is found to be important factor in explaining the health problem during pregnancy
and first week after delivery, but is not significant in case of health problem during
delivery. Similarly, strong relationship is found between type of house and health
problems during delivery only. Fairly significant relationship is identified between
18
education of women and health problems during pregnancy and delivery. Significant
regional variations in the health problem during pregnancy and delivery are found only
for Malenad region. The results suggest that significantly higher proportion of women in
Maleand region is found to have experiencing health problems during pregnancy and
delivery. However, in case of health problem during first week after delivery, no regional
disparity is identified. It is possible that women from Malenad region are more likely to
undergo routine ante-natal check-ups and that some conditions emerge during these
check-ups. Receipt of ante-natal care services is as high in Southern region as in Malenad
region (91 per cent in Southern region, 97 per cent in Malenad region and 65 per cent in
Northern region), but there is a substantial difference in the reporting of health problem
during pregnancy between Southern and Malenad regions. Thus diagnosis by practitioner
cannot be accounted for the observed regional differentials in the reported morbidity
during pregnancy.
The paper also analyzed the self-reported symptoms of certain reproductive health
problems experienced during three months before the survey. Over all, about 17 per cent
of currently married women in the age group 15-44 reported to have at least one
reproductive health problem. Bivariate analysis reveals that only few socio-economic
factors are found to have significant difference in the incidence of at least one
reproductive health problem. Most of the relationships identified in the bivariate analysis
are remain unchanged in the multivariate analysis. The result confirms that women using
IUD and women who experienced a history of abortion are significantly more likely to
report at least a reproductive health problem, even after controlling for other socioeconomic factors. Regional differentials in the incidence of reproductive health problem
is also confirmed, with women in Malenad region reporting more incidence followed by
women in Southern region. Other factors that show significant differentials in the
reporting of reproductive health problems are age of the women and place of residence.
The incidence of reproductive health problem is found to be less among urban women
than rural women. The reporting of reproductive health problem is highest among women
in the age group 20-24.
19
Some of the results identified from the analysis may not be in the expected
direction. It is documented that reproductive morbidity is an outcome of not just
biological factors but of women’s poverty, powerlessness and lack of control over
resources as well (Jejeebhoy, 2000). As such, it is expected that women from socially and
economically weaker sections of the population may have higher incidence of
reproductive morbidity. But the results indicate that women in Northern part of
Karnataka reported to have low incidence of reproductive health problems, although this
part of Karnataka is considered to be socially and economically backward. Similarly, the
incidence of reproductive health problem is found to be significantly higher among
women living in Pucca houses. The possible reason for such unexpected finding is that
women from socially and economically weaker sections may have lack of information on
good health conditions and practices. Thus women from socially and economically
backward sections may tend to report less health problems.
The analysis of childhood morbidity indicates that there are not much difference
in the percentage of children suffering either from diarrhoea or from cough, cold and
difficulty in breathing according to socio-economic characteristics. The multivariate
analysis indicates that young children in Karnataka suffer from childhood morbidities
such as diarrhoea and cough, cold and difficulty in breathing regardless of their
background characteristics. Child’s age is the only factor that found statistically
significant influence on diarrhoea, with 25 per cent of children age 6-11 are suffering
from diarrhoea.
Acknowledgement
The author wishes to thank Dr. P. K. Bhargava, Director, Population Research Centre,
Dharwad, for helpful comments and suggestions.
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