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Reproductive Health Status in AP


       Age at marriage                         Fertility                             Birth Intervals 
     
       Maternal Mortality                     Reproductive Morbidity  

Reproductive health refers to mortality, morbidity and quality of life attributable to the reproductive system, process and events experienced by men and women at all ages. Conceptually, the term should include reproduction related mortality, morbidity and quality of life issues of both men and women. But discussion about women’s health problems usually gets larger attention in the context of pregnancy and child birth related morbidity and mortality. For example; Zurayk (1988) defined reproductive health as "The ability of women to live through the reproductive years and beyond with reproductive choice, dignity, and successful childbearing, and to be free of gynecological disease and risk". The International Conference on Population and Development (ICPD, 1994) defined reproductive health in generic terms but stressed the importance of women’s reproductive health. The consensus view, in ICPD (1994), of reproductive health was that; (a) people have the ability to reproduce, (b) women are able to go through pregnancy and child birth safely, (c) the outcome of pregnancy is successful in terms of maternal and infant survival and well being, and (d) couples are able to have sexual relations free of the fear of pregnancy and of contracting disease (Fathalla, 1988). The World Health Organisation (WHO, 1998) defines reproductive health as "a state of physical, mental and social well-being in all matters relating to the reproductive system at all stages of life." The term reproductive age group refers to the active reproductive years in women starting with menarche around 12-14 years and ending with menopause around 45-49 years. For demographic purposes, reproductive age group is usually defined as 15-49 years or 12-49 years. Reproductive health may at times be, confusedly, restricted to problems of women in the reproductive age group. The "... at all ages of life" part in the WHO definition is to remind us about the reproductive tract related mortality and morbidity experienced beyond the reproductive age group. For example, carcinoma of cervix, prolapse uterus, etc.

                
Indicators of Reproductive Health

The World Health Organisation indicators for monitoring progress towards Health for All (WHO, 1981) included a few broad indicators of reproductive health, such as; (a) Fertility rates, (b) maternal mortality rate, (c) ages at which mothers have children, and (d) birth intervals. In 1996 the working group on Reproductive Health of the Administrative Committee on Coordination (ACC)* task force on Basic social services for all (BSSA) held a meeting to facilitate interagency dialogue and cooperation on the issue of reproductive health indicators.

The following table shows the list of outcome and process indicators recommended by the ACC task force on basic social services for all. Process indicators are subject of a separate paper dealing with RCH program performance. In this paper we will concern ourselves with the outcome indicators of reproductive and child health. This list does not include age at marriage, which affects biological, social, and personal health status of the married. Marriage is an important marker of the beginning of reproductive phase of life in India. Although, reproduction is feasible and does take place to some extent, outside of marriage, marital fertility is the major contributor to the fertility. Pre-puberty marriage is dysfunctional not only for the individual but also for the family and the society. It affects the health of the mother, for at an early age a woman is not fully prepared for the great physical and mental strains of maternity. The comparative immaturity of mother in turn affects the health of her children too. Since by marrying at an early age, the period available for begetting children is large, size of the family also becomes large which makes it difficult to maintain minimum living standards. In some cases child marriage creates maladjustment's in the family, ultimately leading to family disorganization. Hence average age of marriage, particularly of women gives useful insights about reproductive health status of a population. Late marriage has also certain complications and increases reproductive risks. However, early marriage is the contemporary problem. Hence rise in average age at marriage from the very low levels as of now, will be an indicator or progress towards better and hence Similarly, the average age of mothers at the time of first birth is another important indicator of reproductive health. It reflects the average age at marriage, and the average time from marriage to first birth. From the reproductive health point of view, mothers average age at first child birth is a more valid indicator.

Reproductive Health Indicators

Outcome indicators of reproductive health

 

Total fertility rate (TFR)

 

Maternal mortality ratio (MMR)

 

Perinatal mortality rate

 

Low birth weight prevalence

 

Syphilis prevalence in pregnancy

 

Anemia prevalence in pregnancy

 

Infertility prevalence in women

 

Urethritis incidence in men

 

Prevalence of female genital mutilation

 

HIV prevalence in pregnant women aged 15-24

Process indicators of reproductive health

 

Contraceptive prevalence rate

 

Ante natal care coverage

 

Births attended by skilled health personnel

 

Availability of basic essential obstetric care

 

Availability of comprehensive essential obstetric care

 

% of obstetric and gynecological admissions owing to abortion

Fertility rates, such as the age specific and total fertility rate, average birth intervals are an indicator of the extent to which couples in the society are planning their families and the intensity of reproductive load on an average woman. Birth intervals, give an indication of birth spacing and the pace of reproductive activity. Maternal mortality and mortality differentials by sex, indicate the mortality directly associated with reproduction, and differential mortality in women, which may be attributable to their role, and status in society. Reproductive morbidity, indicate the quality of life affected on account of reproductive activity or reproductive tract diseases.


* The Administrative Committee on Coordination (ACC) was established in 1946 as a standing committee that supervises the implementation of the agreements between the United Nations system organizations, the specialized agencies, WTO and Bretton Woods institutions. Its mandate is to promote cooperation within the system in the pursuit of the common goals of member states. The committee meets twice a year and is chaired by the Secretary General of the United Nations. It has an extensive machinery consisting of subcommittees and subsidiary bodies.

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Updated by Samatha Reddy Dated: 18/08/2003

    

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