How prepared are young, rural women in India to address their sexual and reproductive health needs? a cross-sectional assessment of youth in Jharkhand

Reproductive Health

Bimla Upadhyay³  Amit Rawat³  Paramita Aich¹  Janardan Warvadekar³  Kathryn L. Andersen²  Sushanta K. Banerjee³ 

[1] Ipas Development Foundation, C-218 Ashok Path Road #2, Ashok Nagar, Ranchi 834 002, Jharkhand, India;Ipas, 300 Market St., Suite 200, Chapel Hill 27516, NC, USA;Ipas Development Foundation, E-63 Vasant Marg, Vasant Vihar 110 057, New Delhi, India

关键词: Agency;    Health services;    India;    Abortion;    Reproductive health;    Sexual health;    Young women;   

Others  :  1231213
DOI  :  10.1186/s12978-015-0086-8

 received in 2015-02-09, accepted in 2015-10-08,  发布年份 2015

【 摘 要 】

Background

Young, rural Indian women lack sexual and reproductive health (SRH) information and agency and are at risk of negative sexual and reproductive health outcomes. Youth-focused interventions have been shown to improve agency and self-efficacy of young women to make decisions regarding their sexual and reproductive health. The objectives of this study were to assess young women’s sexual and reproductive health knowledge; describe their health-seeking behaviors; describe young women’s experiences with sexual and reproductive health issues, including unwanted pregnancy and abortion; and identify sources of information, including media sources.

Method

A cross-sectional survey with a representative sample of 1381 married and unmarried women young women (15–24 years) from three rural community development blocks in Jharkhand, India was conducted in 2012. Participants were asked a series of questions related to their SRH knowledge and behavior, as well as questions related to their agency in several domains related to self-efficacy and decision-making. Linear regression was used to assess factors associated with greater or less individual agency and to determine differences in SRH knowledge and behavior between married and unmarried women.

Results

Despite national policies, participants married young (mean 15.7 years) and bore children early (53 % with first birth by 17 years). Women achieved low composite scores on knowledge around sex and pregnancy, contraception, and abortion knowledge. Around 3 % of married young women reported experiencing induced abortion; 92 % of these women used private or illegal providers. Married and unmarried women also had limited agency in decision-making, freedom of mobility, self-efficacy, and financial resources. Most of the women in the sample received SRH information by word of mouth.

Conclusions

Lack of knowledge about sexual and reproductive health in this context indicates that young rural Indian women would benefit from a youth-friendly SRH intervention to improve the women’s self-efficacy and decision-making capacity regarding their own health. A communication intervention using outreach workers may be a successful method for delivering this intervention.

【 授权许可】

   
2015 Banerjee et al.

【 参考文献 】

• [1]Special Bulletin on Maternal Mortality in India 2007–09. Office of Register General, India; 2011.
• [2]Youth in India: Situation and Needs 2006–2007. International Institute for Population Sciences, Mumbai; 2010.
• [3]National Behavioural Surveillance Survey (BSS), 2006; Youth (15–24 Years). NACO, Ministry of Health and Family Welfare, Government of India, New Delhi; 2008.
• [4]National Population Policy 2000. Government of India, New Delhi; 2000.
• [5]National Youth Policy 2003. Government of India, New Delhi; 2003.
• [6]National Policy for the Empowerment of Women. Government of India, New Delhi; 2001.
• [7]Ministry of Law and Justice, 2007. Prohibition of Child Marriage Act, 2006. Issued by: Government of India, No. 6 of 2007. New Delhi: Government of India.
• [8]National family health survey-3 India, 2005–2006. International Institute for Population Sciences, Mumbai; 2007.
• [9]Banerjee SK. Social and demographic attributes of access to safe abortion: A cross section baseline survey in three selected districts of Madhya Pradesh. New Delhi, India; 2013.
• [10]Banerjee SK, Andersen KL. Exploring the pathways of unsafe abortion in Madhya Pradesh, India. Glob Public Health. 2012; 7(8):882-96.
• [11]Finer LB, Frohwirth LF, Dauphinee LA, Singh S, Moore AM. Timing of steps and reasons for delays in obtaining abortions in the United States. Contraception. 2006; 74(4):334-44.
• [12]Aras RY, Pai NP, Jain SG. Termination of pregnancy in adolescents. J Postgrad Med. 1987; 33(3):120-4.
• [13]Orientation Programme on Adolescent Health for Health-care Providers. World Health Organization, Geneva; 2006.
• [14]Banerjee SK, Andersen K, Warvadekar J, Pearson E. Effectiveness of a Behavior Change Communication Intervention to Improve Knowledge and Perceptions About Abortion in Bihar and Jharkhand, India. Int Perspect Sex Reprod Health. 2013; 39(3):142-51.
• [15]Banerjee SK, Andersen KL, Buchanan RM, Warvadekar J. Woman-centered research on access to safe abortion services and implications for behavioral change communication interventions: a cross-sectional study of women in Bihar and Jharkhand, India. BMC Public Health. 2012; 12(1):175. BioMed Central Full Text
• [16]Kabeer N. “Resources, Agency, Achievements: Reflections on the Measurement of Women’s Empowerment” in Discussing Women’s Empowerment – Theory and Practice. Sida Studies. NovumGrafiska AB, Stockholm; 2001.
• [17]Jejeebhoy SJ, Acharya R, Alexander M, Garda L, Kanade S. Measuring Agency among Unmarried Young Women and Men Economic & Political Weekly. 2010.
• [18]Jejeebhoy SJ, Halli S. Marriage Patterns in Rural India: Influence of Sociocultural Context. In: The Changing Transitions to Adulthood in Developing Countries. Lloyd CB, Behrman JR, Stromquist NP, Cohen B, editors. The National Academic Press, Washington DC; 2005: p.172-99.
• [19]Annual report 2012–2013. Ministry of Rural Development, New Delhi; 2013.
• [20]Chromy JR. Probability Proportional to Size (PPS) Sampling. 2008.
• [21]Kish L. A Procedure for Objective Respondent Selection within the Household. J Am Stat Assoc. 1949; 44(247):380-7.
• [22]Alexander M, Garda L, Kanade S. Formation of partnerships among young women and men in Pune District, Maharashtra; Survey Questionnaire. 2003.
• [23]Roy TK, Jayachandran V, Banerjee SK. Economic conditions and fertility: is there a relationship. Econ Polit Wkly. 1999.
• [24]Malhotra A, Schuler S, Boender C. Measuring Women’s Empowerment as a Variable in International Development on Women: Gender and Development Group of the World Bank; World Bank’s Social Development Group. 2002.
• [25]Jejeebhoy SJ, Sebastian MP. Actions that Protect: Promoting Sexual and Reproductive Health and Choice among Young People in India. Population Council Regional Office for South & East Asia, New Delhi; 2003.
• [26]Malleshappal K, Shivaram K, Nandini C. Knowledge and attitude about reproductive health among rural adolescent girls in Kuppam mandal: An intervention Study. Biomed Res. 2011; 22(3):305-10.
• [27]Kothari P. The need of sex education for adolescents in India. National Council of Education Research & Training, New Delhi; 1994.
• [28]"Coming of age" from facts to action for adolescent sexual reproductive health. WHO, Geneva; 1997.
• [29]Daniel EE, Masilamani R, Rahman M. The effect of community-based reproductive health communication interventions on contraceptive use among young married couples in Bihar, India. Int Fam Plan Perspect. 2008; 34(4):189-97.
• [30]Parwej S, Kumar R, Walia I, Aggarwal AK. Reproductive health education intervention trial. Indian J Pediatr. 2005; 72(4):287-91.
• [31]Santhya KG, Haberland N, Das A, Lakhani A, Ram F, Sinha RK et al.. Empowering married young women and improving hteir sexual and reproductive health: effects of the First-Time Parents Project. Population Council, New Delhi; 2008.