Correspondence Address:
Samiksha Singh
Senior Resident, Community Medicine, University College of Medical Sciences, Delhi
India

Full Text

With the increasing need of addressing reproductive health problems of women like RTI/STI, HIV/AIDS, family planning, maternal health etc, it becomes important to assess the status of reproductive health of women at each stage of their life cycle. World Health Organisation also recommends a life cycle approach to deal with whole spectrum of reproductive health issues of women. But during the period immediately after marriage, women are neither assessed for their reproductive health nor given any intervention for the same. In our society, most women begin their sexual and family life after marriage and thus they are susceptible to various gynaecological and reproductive health problems immediately after marriage [1],[2],[3] . The status is believed to be worse for the poorer women. If any form of intervention is available for them there might be a long term impact on health status of the women and family both. For this, it is important to assess the status and patterns of reproductive health of the newly married women.

The present study was carried out from November 2005 - January 2007 in Nand Nagari, a resettlement colony in East Delhi, with population of approximately 75,000. This is the urban field practice area of the Department of Community Medicine, UCMS & GTB Hospital, Delhi. In a study 53% of 16-20 year women had reported some of the gynaecological symptoms [4]. Using this, maximum sample size calculated by Epi-info 2000, for α=0.05 and d=12%, was 66. Considering 10% attrition the required sample size was 73. There is socio-cultural practice of the bride moving in to the groom's house after marriage. Thus to identify the cohort of newly married women, all marriages of the male residents that took place within the time period from 1 st November 2005 through 30 th April 2006 were identified. The above time period was chosen as most marriages occur in this part of the year which is considered auspicious in their culture. In total, 79 marriages of males were identified and 75 brides were registered to be included in the study with their written consent in the local language. In the remaining 4 marriages the wife had to come to the husband's house after few months of marriage ('Gauna' system) so could not be included. The 4 women, lost to follow up before 2 nd assessment visit, were excluded from analysis thus finally leaving 71 newly married women in the study cohort. All the newly married women were visited within one month of marriage for the first assessment and then they were followed at 3, 6 and 9 months or till they conceived, whichever was earlier. Various reproductive health parameters of the newly married women from marriage till early ANC registration were studied. The information regarding these was recorded on a pre-tested, pre-coded and semi-structured proforma by the investigator. We also measured haemoglobin levels, body weight and blood pressure as per the recommended standard procedures. Haemoglobin level was measured using Sahli's method done at the spot by the investigator herself. All the instruments were standardized before use. Pregnancy status was confirmed by urine pregnancy test done for qualitative assessment of HCG in early morning sample of urine by using dip-stick test. The data was analyzed in STATA 9.0 and survival analysis [5] .

Only 3 females and 2 males were married before their legal age for marriage of 18 years and 21 years, respectively. The mean age at marriage of the study women (20.2 ± 0.5 years) is equal to that in North East Delhi and the proportion of men and women married before legal age of marriage is less in our study as compared to that reported for Delhi and North-east Delhi by NFHS-III [6] . Most (94.93%) newly married women had started cohabiting with their husbands soon after marriage. Most, 56 (78.87%) were educated upto at least 8 th standard and only 6 (8.45%) were illiterate.

The pre and peri-conception nutrition status of young adolescents is reported to be poor. The mean haemoglobin of the study subjects was 10.92 mg/dl (± 0.24 mg/dl) and 76.06% of the women were found to be anemic. The proportion of anaemia in the group was less than 90.10% documented by ICMR, 2001 study for adolescent girls [7] . Of the total, 7 were consuming Iron-folic acid tablets at the beginning of the study. Mean weight was observed to be 44.01 kg (+ 0.926 kg). Saibaba et al. [8] found that the height and weight for given age for the adolescent, married and unmarried was far below the standards. In our study about 78% of the total subjects' weight was less than the expected weight for their age. Several other studies have documented the similar status of health among the adolescent married females. [9],[10]

Balachander et al. [11] reported that of the gynecological problems menstrual disorders were the commonest (54.25%); and commonest among them being oligomenorrhoea and dysmenorrhoea. In our study also, amongst the menstrual complaints the most common complaint at base line was dysmenorrhoea. At baseline 35.21% complained regarding dysmenorrhoea. The proportion of women reporting any of the menstrual complaints over time significantly increased from 0-month to 3-month (p=0.032). There was no significant change between 3-month and 6-month follow up [Table 1]. Only 24 (33.80%), participants reported healthy menstrual hygiene habits at baseline. There was no significant change in menstrual hygiene over time. Sexual hygiene was assessed by the practice of washing genitals before and after sexual act and it was found to be poor throughout the study period [Table 2]. It seems that the women do not acknowledge the importance and need of sexual hygiene to prevent RTIs.{Table 1}{Table 2}

After marriage, 22(30.99%) women reported to have symptoms of RTI/STI during some part of the study which is comparable to NFHS-3 data for North East Delhi i.e. 34.8% of sexually active women reported to ever had any symptoms of RTIs/STIs in last one year. [6] On repeated measure analysis in present study it was seen that with time, there is significant increase in RTI cases at 3-month (P=0.010) and 6-month (P=0.014) as compared to base line. There was no significant change from 3-month to 6-month in the proportion of women reporting any symptoms of RTI/STI (P=0.532). In the present study all the RTI cases reported to have abnormal vaginal discharge. The study done in Agra by Deoki Nandan et al. [12] found the most common symptom reported was vaginal discharge (94%) followed by lower abdominal pain (55%), similar pattern was seen in our study too. In South India, Prasad et al. [4] have found 53% of women in 16-20 age group reporting gynecologic symptoms, 38% women had laboratory findings of RTIs and 14% had clinically diagnosed pelvic inflammatory disease and only one thirds of women aged 16-20 years sought any health care. Despite of having health facilities available with female health care functionaries in our study area there was high rate of non-consultation. Few (23%) of the newly married women reporting RTI/STI symptoms and 33.3% of women with menstrual problems at 6 months after marriage consulted the doctor. Most common reason for not accessing health care was told to be feeling shy or embarrassed to talk about it. As the time passed there was slight increase in health care seeking behavior because in our study towards the end only those were left who had not yet conceived and they had attributed their gynaecological complaints to not conceiving and thus sought medical care for it.

Only 3 women reported using OCPs at the baseline. Only 14 (16.18%) were using any of the contraceptive methods at any time during our study. Of the total, 6 ever used OCPs and 8 ever used condoms. This is very high than those reported by the previous studies conducted in this age group. Only 2.9% women married for 3 years had ever used contraception before the first child in a study by Khokhar A and Mehra M done in a resettlement colony of Delhi. [13] As per NFHS-III only 2% of women with no children used any contraceptive method. [6] The higher rates of contraceptive use in our study could be attributed to the changing trends, higher education level of the women in our study compared to the women in above stated studies. About 79% of the total women conceived within 9 months of marriage. Median pre-conception gap (days between date of marriage and last menstrual period) was 101 days as calculated by survival analysis using Kaplan Meier method. Nearly half, 43% of the pregnant females were below 20 years of age. Amongst the women who had conceived, only 25% got themselves registered for ante natal care in the first trimester.

It is evident from the literature and the current study that the young married women have higher burden of the gynaecological problems and have poor nutritional status. If these women continue to live their gynaecological and obstetric life with the current status they may land up in poorer state of both general and gynaecological health. This necessitates intervening and promoting the health of the women right at the beginning of their sexual and family life.

References