Perception of reproductive illness by the women themselves is important in understanding the women's reproductive health in a particular society. It also indicates the possibility of taking perception as a tool for measuring reproductive illness. Though women do not have a “germ theory” to explain their reproductive illness they have a sense of illness pathology. Reproductive illness perceived by women is related to physical symptoms and situations in a network of meanings and different meanings are socially generated to articulate their experiences.
Reproductive illness is not only biological but also is embedded in a web of psychological, economic, political, and social factors. Different societies encounter, define, and experience reproductive health problems biologically as well as culturally. Different cultures define reproductive illness in different ways; what is recognised as reproductive illness in one may not be so in others. For this paper, reproductive illness refers to the illness which women perceive as related to their sexual and reproductive organs and function.
As the meaning of health is culturally defined understanding of the women’s perception of reproductive health is a
Perception of reproductive illness by the women themselves is important in understanding the women’s reproductive health in a particular society. It also indicates the possibility of taking perception as a tool for measuring reproductive illness. Though women do not have a “germ” theory to explain their illness, they have a sense of illness pathology. Reproductive illness perceived by women is related to physical symptoms and situations in a network of meaning and different meanings are socially generated to articulate their experiences.
Most of the currently known intervention schemes for improving reproductive illness are based on and guided by laboratory test and outsider-based interpretations and perspectives of the key factors that affect reproductive health status. Little attempts have been made to investigate how women themselves perceive and understand the aetiology of such illness and how it affects the reproductive health in various societies.
To design a culturally sensitive health programme there is a need to incorporate women’s perception of their illness. The meaning of health needs to be recognised for achieving an analytical understanding of the process of production of health as a basis for any realistic and comprehensive effort to improve health condition in the community, as it has a direct bearing on the treatment seeking behaviour. It is high time to look at the “felt needs” of the reproductive health of women. This paper is an endeavour to bring into light how women in Manipur perceive “women’s illness” such as vaginal discharge and menstrual problem and their perceptions of the seriousness of different women’s illnesses.
Medical Anthropology has hitherto been conceived of as a tool for investigating and explicating local perspective on reproductive health. Medical anthropologist has always tended to describe cultural variation in health belief system, emphasizing on people’s own description and experience of reproductive health and illnesses within local cultural system.
Way back in the1980s medical anthropologist’s ethnographic work primarily focuses on fertility and childbirth. Cormack [
In the 1990s health research began to focus on women’s perception of reproductive health. Younis et al. [
Pachauri and Gittelsohn [
In 2001 Pimpawun Boonmongkon et al. documented from South East Thailand women’s experiences of gynaecological complaints linked to the “uterus” (
Based on a seminal study in a Muslim village in rural Bijnor district (north-western Uttar Pradesh) by P. Jeffery and R. Jeffery [
The information used in this study was gathered during field work conducted between July 2004 and January 2005 updated in 2011. A survey was conducted in September and October, 2004, to furnish data about the socioeconomic condition of Andro. To get a general perception of women regarding commonly prevalent illnesses among them, free listing technique was used. This method was used to determine the items which make up the domain of “illness which only women get.” A master list of women’s illness was compiled and used as checked list of illnesses and symptoms. Women were chosen randomly from the village for this method. Ten key informant interviews were conducted among old women, traditional healer (
Andro is a village inhabited by the
Agriculture is the mainstay in Andro. It is a family enterprise. However, rice cultivation relies heavily on women’s labour. Besides agriculture, brewing liquor, weaving, and potteries are some of the economic pursuit done by women in Andro. Based on the socioeconomic data collected during survey phase in Andro which was conducted in September and October, 2004, 46.9 percent of the females are literate. The mean family income per month in Andro is Rs. 3972.50 (approx. US$ 65).
The source of water is one of the indicators of sanitation and hygiene. If there is scarcity of water then women will have to bear the brunt of fetching the water and in maintaining a clean surrounding in their vicinity and in maintaining personal hygiene. In Andro, the main sources of water for cleaning and washing are pond and stream water. However, for drinking and cooking purposes, the main sources of water are spring water, hand pump, and tap water. 25 percent use tap water, 27.5 percent use hand pump, and 49 percent use spring water in Andro as potable water.
The place for throwing waste has an important role to play in adumbrating the sanitation and hygiene of an area. In Andro, there are three ways of throwing the garbage—throw it in the open, throw it in drainage, and dig a pit hole to dump the wastage. A majority (58.5 percent) of the households throw the garbage in the open, 35.5 percent throw in the pit hole, and 6 percent throw the wastage in the drainage.
Having proper toilet facility is essential for healthy existence. In Andro, 0.5 percent do not have toilet facility. 10.5 percent use semipucca, 5.05 percent use pucca, and 81 percent use pit hole, where a hole is dug up and covered on all the four directions with rags.
One of the main factors in health issue is transport and communication. Within Andro people commute in two wheelers like scooter but bicycle is the most common way to glide along. Covering distance by foot is also a common sight in Andro. If one has to go beyond Andro then buses and jeep are the main means of commuting.
In Andro, there is one primary health centre. The main activities carried out in the primary health centre are curative care, tuberculosis detection, maternal, and child health services such as diarrhoea disease control, immunization, and family planning.
Women in Andro perceive illness associated with reproduction as women’s illness (
During ethnographic study, women spoke about several women’s illnesses (
Table
Women’s illnesses.
Illness term | English translation | Description |
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White going underneath the cloth | Vaginal discharge |
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Uterus coming out/body falling down | Prolapse |
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Menstrual-related illness—blood going out profusely, irregular menstruation, stomach pain, and blood going out scantily | Menstrual problem, heavy period, irregular period, menstrual cramp, and scanty period |
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Back pain | Pain at the back |
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Abdominal pain | Pain in the pelvic region |
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Rice polluted/man polluted | Postpartum illness |
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Stomach left over | Postdelivery problem |
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Head spinning/seeing stars | Dizziness |
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Weakness | Weakness |
The free listing method showed that women perceived white discharge (
The local connotation for vaginal discharge is
Pain in the lower abdomen (
Pain after childbirth (
Another interpretation is that pain after childbirth (
During postpartum period if proper care is not taken then such illness often happens. Care should be taken properly regarding intake of her food and drinks during this stage and sex should be totally abstained. Rice polluted locally termed as
In Andro, a woman is not allowed to have sex after childbirth for three months. If a woman transgresses such restriction then an illness known as “men polluted” locally termed as
Weakness (
By the term “reproductive illness,” we mean indigenously named complaints and conditions that are localized in reproductive organs or are associated with reproductive functions. As this paper aims to look at reproductive health problems, a subset of women’s nonpregnancy-related reproductive illnesses was chosen for further investigation based on the following criteria of seriousness and the most common: most frequently mentioned in the free listing results, perceived that many women experience the illness, an illness which women are hesitant to report because of the stigma associated with it and has been unattended to by health providers.
Based on these criteria, vaginal white discharge (
In Andro, vagina is used euphemistically as underneath the cloth. Thus, vaginal discharge is
Women have different perceptions about whom this illness affects and the extent to which
Though women reported high prevalence of vaginal discharge (
Women spoke of having large amount or little discharge and were also able to describe the frequency which they had it every day or sometimes. Women also reported a range of duration for which they experience discharge problem. Some women said they have it before their menstruation for a few days. Illness narratives conducted on women who had reported vaginal discharge (
Here, the woman talks about the frequency of vaginal discharge they experience comparing it with the flow of menstruation when the discharge is frequent and quantity is more. In such a situation one had to wear two wraps around (
This identifies the women’s uncomfortability experienced by the women who had vaginal discharge with foul smell along with itchiness. Thus, women in Andro identified vaginal discharge in terms of color, smell, consistency, frequency, and duration.
During illness narrative interviews, women reported that the onset of vaginal discharge (
Chingabham Tombinou, traditional birth attendant (
Women perceived that wearing panties obstructs the flow of menstrual blood turning blood into water thereby causing vaginal discharge. In Andro, there are certain food items which are restricted to be taken during menstruation and postpartum period. The verbose of the traditional birth attendant implies that women have vaginal discharge as they did not put any restriction on eating the tabooed food during menstruation and postpartum period.
However, women in Andro unanimously agreed that daily hard toil to make both ends meet is the root cause of discharge. There is a saying in Andro “If you don’t work then you starve.” Economic crunch in a household affects women. Engaged in a daily struggle to meet the basic needs, they cannot spare time to improve and safeguard their own health. Economic hardship compels women to work hard to make both ends meet. This leads to physiological weakness, which in turn deteriorates the health condition and causes all illnesses. The price of poverty has to be paid by women as poverty makes them compromise on their health.
The above verbose explicates the brunt women have to bear due to their impoverished condition. It reveals the inability of women in Andro to have the luxury of having nutritious food when it is considered to be a requirement during pregnancy and postpartum period due to economic crunch and how it became the root cause of vaginal discharge.
Women also relate their symptoms to different procedures or conditions that they had undergone. Some blamed it on abortion, insertion of IUD, and unhygienic way of living as a probable cause of vaginal discharge. Women in Andro associate vaginal discharge (
In Andro women wear wrap around known as
Women in Andro also perceive discharge to be serious when there is blood in it. Driving home this point is Moyonsakhi’s assertion that “If there is blood in discharge then it is a problem that needs to be looked into.”
The above finding explicates that women perceive vaginal discharge (
Menstrual-related illness (
Hemsori, a 50-year-old traditional birth attendant (
As cited by the traditional birth attendant one of the perceived cause of menstrual problem is improper cleaning of blood after childbirth. Others reason out on utilization of contraceptive device like Cu-T and sterilization operation as the root cause of menstrual problem. This is supported by the following citation.
Another 45-year-old woman from Andro describes the reasons for menstrual problem: “Women started putting foreign particle inside their body (copper-T) and had operation. All these block their tubes which lead to menstrual problem.”
Thus, women in Andro perceived that the causes of menstrual problem are improper cleansing of blood after delivery, insertion of IUD, and sterilization. However, these are the proximate factors responsible for menstrual-related illness.
Though heavy period is considered a serious case, women do not seek any treatment. Menstrual disorders are perceived to be a problem which women have to suffer in silence. Engaged in their daily struggle to meet the basic needs, they cannot spare time to improve and safeguard their own health. Above all they cannot afford to spend money on illness which did not disturb their daily activities. Thus, the price of poverty has to be paid by women by compromising on their health.
Prolapse (
During childbirth, if the fetus did not come out as soon as the amniotic sac bursts then the traditional birth attendant (
Women also believe that lifting heavy weights also causes prolapse. In their day-to-day activities, a woman routinely lifts heavy weights. This includes lifting and carrying heavy pots of water from the ponds, hand pumps, and tap to the house. Lifting heavy weight especially just after childbirth is considered to be dangerous because woman’s body during this stage is still tender and lifting heavy weight could push the body out.
It is believed that performing heavy activities can lead to prolapse (
Women also perceived that sterilization operation and inserting Copper-T (IUD) cause this problem because it weakens the body and makes it easier for the body to come out. Thus, women believe that problem during childbirth, lifting heavy weight, or undergoing a sterilization operation are susceptible to prolapse (
The traditional birth attendant (
Women in Andro believe that many women suffer from prolapse (
Women in Andro refer to health problem relating to reproductive organ and function not as “reproductive illness” but as women’s illness (
The finding explicates that women’s perception of reproductive illness succinctly differs from the biomedical definition of reproductive disease. Meanings are embodied in the term “women’s illness” and symptoms are filtered through the world view of the people. Reproduction is perceived to be the sole responsibility of women; thereby the term women’s illness (nupigianaba) for illness associated with reproductive organ. The aetiology, progression, and seriousness of illness are also filtered through the world view of the women and this will have a direct bearing on treatment.
Illness described by the term
We would like to highlight the need to incorporate women’s perception of reproductive illness while designing reproductive health programs which are culturally sensitive to bridge the gap between what is considered as the need and the actual need at the grassroots level. Reproductive health programs should include men and women and be introduced within a larger development project that addresses poverty and livelihood issues. The project can focus on developing human capacity to generate income for households and thereby addressing the primary needs of the local community. In the process of addressing the “root cause” (poverty) of women’s illnesses an approach towards women’s reproductive health can also be considered simultaneously. If women feel that they have time and money to attend to their own health they will be more willing to participate in a reproductive health program. If poverty alleviation program can be developed then local men will be more willing to understand the reproductive health needs of their wives and encourage them to participate in the program.
Innovative health program which will provide women (including men) with the knowledge to understand the “pathology” of disease within the context of their lives can be created. Gradually, as biomedical model of disease interacts with the women’s perception of illness, they may begin to distinguish physical symptom of sickness from other “meanings” of sickness and report these as symptom to a health provider. On the other hand, health provider should understand the complexity of the reported symptom and not assume that a reported symptom correlates with disease. Thus, reproductive health program can be more innovative and touch the life of the women concerned thereby approaching towards the “felt needs.”
The authors declare that there is no conflict of interests regarding the publication of this paper.