http://doi.org/10.33698/NRF0030-   Kaushalya, Avinash Kaur Rana,Sushma Kumari Saini

Abstract: A descriptive study was conducted in a rural community (Chandigarh) to ascertain fertility pattern, prevalence of pregnancy wastage and their relationship with the health of women. Systematic random sampling technique was used to select 100 subjects. A Survey Proforma, Interview Proforma, Health Assessment Proforma and Mental Well Being Measure were used to collect the information. The data revealed that out of total 302 pregnancies which were recorded in 100 subjects, 233 (77.2%) resulted in live births, whereas 69 (22.8%) ended up in pregnancy wastage. Thirty-five subjects had 2 live births each, where as 4 subjects had 7 live births each, and the mean number of live born children per women was 2.4, whereas the mean pregnancy wastage per women was 0.69. Relationship between the fertility pattern and the pregnancy wastage in regard to women’s health shows that anemic and under weight subjects had higher fertility pattern and pregnancy wastage. Mental well being level of the women decreased with the increase in pregnancy wastage.

Key Words :

Fertility, Pregnancy wastage, Abortion, Stillbirth, Women’s Health, Obesity, Anemia.

 

Correspondence at : Kaushalya

National Institute of Nursing Education, PGIMER, Chandigarh, India.

Introduction

Human fertility is one of the most com- plex processes. Men and women are biologi- cal partners in the reproductive process. The reproductive life of a female starts with the onset of menarche or marriage, and ends with menopause. Fertility is directly influenced by a set of social and biological factors. These factors are often called intermediate fertility variables because they are influenced in turn by several socio-economic, cultural and bio- logical variables.1,2

Women’s health is inversely propor- tional to fertility. Fertility of women is further affected by the factors like: universality of mar- riage, lower age at marriage, low level of lit- eracy, poor standard of living, limited use of contraceptives, traditional way of life, caste, religion and preference for a male child, so- cial and cultural factors etc. Information on fer tility in India indicates that an average woman gives birth to an average of six or seven children if her married life is uninter- rupted.3

Pregnancy wastage means all preg- nancy outcomes other than a live birth which includes abortions and still-births. Still-birth is the major contributor towards perinatal wastage. Still-birth rate still continues to be high in India, reported rates ranging from to 9 per thousand births. Several fac- tors such as socioeconomic status, biologi- cal characteristics of the mother and medical care are associated with still-birth and have a complex interrelationship.4,5

Unregulated fertility is directly asso- ciated with anemia, high incidence of sponta- neous abortions, ante partum haemorrhage and high perinatal mortality. These health haz- ards have shown a sharp rise in the preva- lence after the fourth pregnancy. It is esti- mated that anemia affects nearly two thirds of pregnant women in the developing coun- tries. Though anemia is more prevalent among women belonging to the lower socio-eco- nomic strata of the society, but it is not un- common among the well-to-do sections of the society as well.6

Since fertility and pregnancy wastage has a great impact on women’s health so a need was felt to conduct the study on the fertility pat- tern, prevalence of pregnancy wastage and their relationship with the health of women. The health planners, care givers and women could be greatly benefited from it. Hence a study was conducted with following objectives:

  • To ascertain fertility pattern among
  • To determine prevalence of “preg- nancy wastage” among

To describe the relationship of fertility pattern and pregnancy wastage with health of women in a    rural community, U.T. Chandigarh

Material and Methods

The study was conducted in rural community at village Dhanas, (Chandigarh) during the month of May and June 2004.There are approximately 322 houses with a population of 3154. Sampling size comprised of 100 subjects (married and menstruating women of 15-45 years age). Systematic random sampling technique was used to select subjects. Research tools used were Survey Proforma, Interview Schedule and Health Assessment Proforma. A Survey Proforma consisted of questions to ascertain identification of the study subjects. An Interview Schedule included identification, socio-demographic data , menstrual history, fertility pattern , pregnancy wastage, long term illness and short term illness (during the last 15 days).Health Assessment Proforma, consisted of 4 items i.e. hemoglobin, height, weight, and blood pressure. The standardized tool used in the study was PGI General Well Being Measure Mental well being questionnaire, consisting of 20 items, each with score one was administered to subjects. The score ranged from 0-20 with three classes of 0 to 4 (below average), 5 to 12 (good), 13 to 20 (very good). The data thus collected were tabulated and analyzed manually by using chi-square test. The study subjects were explained about the purpose and need of the study. Their verbal consent was obtained and confidentiality of the information sought was ensured.

Results

Total 100 subjects were interviewed with pre tested interview schedule, out of which 79 subjects were literates, and 62 had their income ranging (per month per capita) between Rs.501-1000. Maximum subjects (70) were married between the age group of 18-24 years, 80 subjects had their first pregnancy during 18-24 years of age, while the marital duration of 34 subjects was between 6-10 years. Except one all (99) subjects had regular menstrual cycles.

Total 302 pregnancies were recorded, out of which 233 (77.2%) resulted in live births, whereas 69 (22.8%) ended up in pregnancy wastage.(Table-1) Thirty-five subjects had 2 pregnancies each, where as 4 subjects had 7 pregnancies each, It was observed that pregnancy wastage increased with the increase in number of pregnancies Among 35 subjects, who had two preganancies each, and thereby having a total of 70 preganancies, 62 (88.6%) resulted in live births and the remaining 8 (11.4%) ended in pregnancy wastage. Four subjects who had 7 pregnancies each, 14 (50%) resulted in live births and 15 (53.6%) ended in pregnancy wastage. As such, mean fertility was 2.4+0.2 and mean pregnancy wastage was 0.69+ 0.5.

Relationship between fertility pattern, pregnancy wastage and mental well being, Body Mass Index (BMI) and anemia was observed. The result shows that below average mental well being was associated with pregnancy wastage. Higher percentage of subjects (5.4%) with 1-2 pregnancy wastage had below average mental well being as compared to subjects (5.0%) having no pregnancy wastage and more than 3 pregnancy wastage.(Table No. 2). It is further observed that as the fer tility pattern and pregnancy wastage increased the BMI decreased. More percentage (73.7%) of subjects with higher fertility pattern were non- obese. In case of pregnancy wastage higher percentage (81.7%) of subjects with1-2 pregnancy wastage were non obese than more than 3 pregnancy wastage and no pregnancy wastage. But the subjects with no pregnancy wastage were non obese in higher percentage than subjects with more than 3 pregnancy wastage.(Table No.3).

Table 1 : Fertility pattern and pregnancy wastage

  N=100
No. of   Total Live   Pregnancy
Pregnancies f Pregnancies births (%) wastage (%)
1 10 10 10 (100 )
2 35 70 62 (88.6) 08 (11.4)
3 25 75 *57 (76.0) 19 (25.3)
4 13 52 41 (78.8) 11 (21.2)
5 11 55 42 (76.4) 13 (23.6)
6 02 12 09 (75.0) 03 (25.0)
7 04 28 *14 (50.0) 15 (53.6)

302                      235                                                                     69 (22.8%)

* Two twins live births

Data further revealed that the subjects (57.9%) with higher fertility pattern (3 and above) were anemic in higher percentage as compared to subjects (41.9%) with lower fertility pattern (1-2). Higher pregnancy wastage was also associated with anemia. Higher percentage of subjects (75%) with higher pregnancy wastage were anemic as compared to subjects with less pregnancy wastage (1-2) and with no pregnancy wastage.(Table No.4)
Mean fertility = 2.4 + 0.2, Mean pregnancy wastage = 0.69 + 0.5

Table 2 : Mental well being of subjects in relation to fertility pattern and pregnancy wastage

Fertility pattern and                                   Mental well being
N=100

pregnancy wastage                Very Good                          Good                     Below                       c2

average

 

  n f (%) f (%) f (%)  
Fertility Pattern

1-2

 

62

 

38

 

(61.3)

 

20

 

(32.3)

 

4

 

(6.4)

 

c2 =0.443

3 & above 38 24 (63.2) 13 (34.2) 1 (2.6) d.f.= 2
                p = N.S.
Pregnancy wastage

Nil

 

59

 

41

 

(69.5)

 

15

 

(25.5)

 

3

 

(5.0)

 

c2 =3.009

1-2 37 20 (54.1) 15 (40.5) 2 (5.4) *d.f.= 2
3 & above 04 01 (25.0) 03 (75.0)   p =N.S.

*Pregnancy wastage 1-2 and > 3 merge together for calculating chi square

Table No. 3 : Body mass index of subjects in relation to fertility pattern and pregnancy wastage

Body Mass Index
N=100

Fertility pattern and           Non-Obese                                  Obese

pregnancy wastage                <25                                           > 25                                       c2

 

  n f (%) f (%)  
1-2 62 41 (66.1) 21 (33.9) c2 =0.072
3 & above 38 28 (73.7) 10 (26.3) d.f = 1
            p = N.S.
Pregnancy wastage

Nil

 

59

 

37

 

(62.7)

 

22

 

(37.3)

 

c2 =2.856

1-2 37 30 (81.1) 07 (18.9) *d.f.= 1
3 & above 04 02 (50.0) 02 (50.0) p =N.S.

*Pregnancy wastage 1-2 and > 3 merge together for calculating chi square.

Table 4 : Haemoglobin level of subjects in relation to fertility pattern and pregnancy wastage

N=100

pregnancy wastage                                            < 10                               > 10                     c2Fertility pattern and                                                Haemoglobin (Hb) level

 

  n f (%) f   (%)  
Fertility Pattern             c2 =2.721
1-2 62 26 (41.9) 36   (58.1) d.f. = 1
3 & above 38 22 (57.9) 16   (42.1) p = N.S
Pregnancy wastage

Nil

 

59

 

31

 

(52.5)

 

28

   

(47.5)

 

c2 =1.489

1-2 37 14 (37.8) 23 (62.2) *d.f. =1
3 & above 04 03 (75.0) 01 (25.0) p = N.S

*Pregnancy wastage 1-2 and > 3 merge together for calculating chi square

 

Discussion

The fer tility pattern of developing countries is characterized by high fertility levels associated with inadequate spacing of births, subsequent malnutrition, and still higher morbidity and infant mortality levels. One of the important problems faced by countries with a high rate of population growth is constraint to socio-economic development. 7

The family planning programme was initiated in India in 1952 in order to control the growth of population, or to be more specific, to reduce the fertility level. India has also liberalized the legal restriction on induced abor tion by adopting of the Medical Termination of Pregnancy Act 1971, which became effective from April 1972. One of the objectives of the Government of India’s Integrated Child Development Services (I.C.D.S.) scheme is to reduce childhood mortality by providing a package of Maternal and Child Care Services. In spite of all these programmes maternal mortality and morbidity rate still continues to be high in India.

The present study revealed that the mean number of live born children per women was 2.4. Almost similar pattern was reported in another study conducted in rural Delhi2 i.e. mean number of live born children per women was 2.3, and this figure is lower than India i.e., 2.67 reported in the National Family Health Survey (1992-1993). 8 A number of live born children per women (2.98) were reported in a study conducted in Thane (Maharashtra).6

Pregnancy wastage of 22.8% was observed in present study, where as a study in Chandigarh reported 16% of pregnancy wastage (aged 18-30 years).9 Reasons for the higher percentage observed could be variations in age of subjects (In present study subjects were between age group of 15-45 years). In present study 19.2% of pregnancy wastage was due to abortions. This figure is comparable to the findings reported in a study conducted in Chandigarh that out of total 641 pregnancies 134 wasted in abortions.9 Total 3.6% still births were reported in the present study. This figure is almost similar to the study conducted at Trivandrum which has reported 3.8% still births4 and slightly higher than National Family Health Survey which reported 3% stillbirths.8 Where as this is higher than the study conducted at Vellore which has reported 1.3% still births. 10

It was observed that subjects with higher fertility pattern (57.9%) were anemic as compared to subjects with lower fertility (41.9%). Almost similar results were also observed in a study conducted in Thane (Maharashtra) which repor ted that 98 (60.12%) out of 163 multigravidous subjects were anemic.6 It was also found that more percentage of subjects with higher fertility pattern were non obese (73.7%) as compared to subjects with lower fertility (66.1%). Total 69% subjects were non obese and 31% were obese. Similarly another study from Banaras also reported that out of 625 subjects above 15 years of age, 69.76% were non-obese and 30.24% subjects were obese. But in this study the relationship of obesity with fertility pattern and pregnancy wastage was not discussed. 11

Pregnancy wastage was associated with below average mental well being. i.e. more percentage of subjects (5.4%) with (1- 2) pregnancy wastage had below average mental well being as compared to subjects (5%) with no pregnancy wastage(Table No. 2). But none of the subjects with higher pregnancy wastage (3 and above) had below average mental well being. Total 5% subjects had below average mental well being. A meta- analysis (1998) of 13 psychiatric epidemiological studies (88) carried out in different parts of the country reported an overall prevalence rate of mental health problems (minor and major combined) was 64.8 per 1000 population of women.12 But in this study the relationship of mental well being with fertility pattern and pregnancy wastage was not discussed.

Hence the study findings indicate that the fertility pattern and the pregnancy wastage have relationship with the health of women. As fertility pattern and pregnancy wastage increased, the haemoglobin Level and BMI decreased. The mental well being level decreased with the 1-2 pregnancy wastage. Though these differences are statistically not significant, but the trend has shown an inverse relationship.

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