INCIDENCE OF EARLY PREGNANCY AND SELF REPORTED GYNECOLOGICAL SYMPTOMS AMONG TRIBAL COMMUNITY IN INDIA
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INCIDENCE OF EARLY PREGNANCY AND SELF
REPORTED GYNECOLOGICAL SYMPTOMS
AMONG TRIBAL COMMUNITY IN INDIA
A. K. RAVISHANKAR
Introduction 8.21 percent of the country’s total
population.2
In general, most tribal populations
inhabit under-developed areas of the
Tribal women in India experience sexual
country, which are remote, having low
debut as married adolescents. Moreover,
density of population and lacking in
large surveys have found that almost half
adequate access to basic amenities,
of all tribal women aged 20–24 are married
education, employment opportunities and
by age 16 in India.3 High level of poverty,
affordable health care services.
inadequate health resources, ignorance and
Indian tribals are known for their high-risk beliefs and practices among the
unique ways of living, distinct culture, tribal communities has contributed to the
traditions, beliefs and practices which vulnerability of this population. There is
provide them a distinct identity on the a general consensus that the health status
national scene. They are spread across the of the tribal population is very poor and
country mainly concentrated in the states worst among the tribes because of their
of Madhya Pradesh, Orissa, Chhatisgarh, isolation, remoteness and being largely
Maharashtra, Jharkhand and Gujarat. unaffected by the developmental processes
However, they have their presence going on in the country.4 Ignorance and
in all States and UTs except Punjab, high-risk beliefs and practices, high
Pondicherry and Chandigarh.1 According poverty level, inadequate and in accessible
to 2001 census, tribal population in the health resources, in the tribal communities
country, was 84.32 million, representing has contributed to the early marriage/
A.K. Ravishankar, Senior Lecturer, Department of Population Studies, Annamalai University,
Annamalai University, Annamalainagar – 608 002
34 The Journal of Family Welfarepregnancy of this population. Therefore, higher education (1.3%). Their husband’s
there is a felt need to study the influencing educational attainment was much higher.
factors and risks to young tribal women’s More than half of the tribal families (58.0%)
reproductive health. were living in joint families.
Methodology The occupational analysis discloses that
half of the young tribal women were
This study was undertaken to:
not working (49.2%) and 40 percent are
n explore the pattern of early pregnancies engaged in agricultural activities. A
in the young tribal community and its negligible proportion of the tribal women
determinants were working in the technical and
professional category (0.7%). Almost all
n study incidence of self-reported
the husbands were workers, 44 percent
gynecological symptoms among
the young tribal mothers and its were engaged in agricultural activities, 39
association with early pregnancies percent in manual work and 4 percent in
clerical jobs. One-third of tribal families
n study the influence of socio-economic fall in the poorest wealth index category
and demographic characteristics on (33.5%) and a little above one-fifth of
early pregnancy and self-reported them were in the poor category (22.9%).
gynecological symptoms among the Both the richer and richest categories
young tribal community in India constitute 24 percent.
Data About two-third of young women
tribes (64.8%) got married before they
The data were collected from National
Family Health Survey-III5 - nationally reached the legal age at marriage (18
represented large-scale sample survey years), 85 percent of these teenagers get
conducted in India during 2005–065. This into marital life before they attain the
study was focused only on young married legal age at marriage. The mean age at
tribal women in India. A total of 2,527 marriage of young women was 16.48
currently married tribal women aged 15- years. Therefore, it is very clear that child
24, were selected from various States and and early marriages were quite common
Union Territories of India to examine the in the tribal communities.
association between early pregnancies and
self-reported gynecological symptoms. Three-fourth of the young tribal women
(74.4%) gave births to their first child before
attaining 20 years of age. More particularly
Findings two-third of the late-adolescent tribal
Of the 2527 tribal women interviewed, mothers (15-19 year old) gave birth for the
more than one-fourth of the sample first time before they reached the age of 18
population fall in the late-adolescents 15- which has adverse health consequences,
19 and the remaining 73 percent of the both for the mother and their children.
tribal women were young (20 to 24 age The mean age at first birth for young tribal
group). More than half of them were Hindu women was 17.95 years.
(58.1%) and a considerable proportion were
Christian (29.5%). A significant proportion Knowledge of tribes about ovulatory
of the tribal women were living in rural cycle was very poor since, forty-two percent
area (80.6%) and more than two-fifth of the of the teenagers and 37 percent of those
young tribal women were illiterate (43.1%) between 20-24 years of age did not know
and negligible proportion completed about the ovulatory cycle.
Vol. 58, No.1, June - 2012 35TABLE 1 Characteristic Number Percent
Background characteristics of young tribal women
Marital duration
in India
0-4 1542 61.0
Characteristic Number Percent
5-9 914 36.2
Age of the women
10-14 69 2.7
15-19 669 26.5
20-24 1858 73.5 15-19 2 0.1
Place of Residence Age at 1st birth
Urban 490 19.4 12-14 116 6.2
Rural 2037 80.6 15-17 703 37.4
Religion 18-19 579 30.8
Hindu 1466 58.1 20-22 444 23.6
Muslim 59 2.3 23-24 37 2.0
Christian 746 29.5 Mean age at 1st birth 17.95
Other 254 10.1
Total children ever born
Education
0 648 25.6
No education 1089 43.1
1 894 35.4
Primary 486 19.2
Secondary 919 36.4 2 600 23.7
Higher secondary 33 1.3 3 282 11.2
Occupation 4+ 103 4.0
Not working 1241 49.2 Mean CEB 1.33
Professional / Knowledge of ovulatory cycle
Technical Manager 28 0.7
During her period 121 4.8
Sales & service 87 3.5
After period ended 467 18.5
Agricultural labourer 990 39.2
Other 178 7.1 Middle of the cycle 278 11.0
Before period begins 29 1.1
Household structure
Nuclear 890 35.2 At any time 656 26.0
Joint 1465 58.0 Other 4 0.2
Not dejure resident 172 6.8 Don't know 969 38.4
Wealth index The mean number of children ever
Poorest 847 33.5 born (CEB) was 1.33 and mean number
Poorer 578 22.9 of living children including the current
Middle 493 19.5 pregnancy was only 1.41. The number of
Richer 413 16.3 children indicated for a family was 2.66
Richest 196 7.8 and seventy percent of the young tribal
women preferred to have another child in
Age at marriage
future. It indicates that their fertility level
Less than 14 576 22.8
will further increase in future. About
15-17 1062 42.0
sixty percent of the tribal women had less
18-19 556 22.0
than five years of marital duration and
20-24 333 13.2
another thirty-six percent had spent 5-9
Mean age at marriage 16.48 years of marital life.
36 The Journal of Family WelfareIncidence of early pregnancies TABLE 3
A significant proportion of tribal Background characteristics and Incidence of early
girls in India are still expected to marry pregnancy
and begin childbearing in their early or Age at first birth
middle teenage years. However, many lack Characteristic Before 18 Above 18
information and support and are incapable 12-14 15-17 Under 18 18-19
to obtain the health services that the mother
Age
and their children need.
15-19 9.7 63.7 73.4 26.6
TABLE 2 20-24 5.4 31.8 37.2 62.8
Incidence of early pregnancy
Residence
Number Percent
Urban 5.1 29.3 34.4 65.6
Age at 1st birth
Rural 6.4 39.4 45.8 54.2
12-14 116 6.2
Household structure
15-17 703 37.4
Nuclear 8.6 41.8 50.4 49.6
Early pregnancy 819 43.6
Non-nuclear 4.7 35.1 39.8 60.2
18-19 579 30.8
Education
20-22 444 23.6
No education 9.2 47.2 56.4 43.6
23-24 37 2.0
Primary 6.6 41.8 48.4 51.6
Pregnancy after 18 years 1060 56.4
Secondary 2.4 24.2 26.6 73.4
Of the 1879 total tribal young women Higher – – – 100.0
who reported their age at first birth, 116
Occupation
women (6.2%) had given their first birth
between 12 to 14 age and 703 women Not working 4.2 33.1 37.3 62.7
(37.4%) had given their first children at Agricultural
the age of 15-17. In total about forty- labourer 7.6 44.0 51.6 48.4
four percent of the tribal women had Service 22.2 27.8 50.0 50.0
given their first birth under the age of 18. Sale 10.0 38.0 48.0 52.0
Further, three-fourth of the young tribes Clerical – 44.4 44.4 55.6
had given their first birth when they were Skilled &
teenagers. It is evident from the analysis unskilled 10.0 32.5 42.5 57.5
that the incidence of early and teenage Professional /
pregnancy was quite common in the tribal Technical – 30.0 30.0 70.0
community.
Wealth Index
The teenage tribal mothers who had Poorest 9.9 45.6 55.5 44.5
given their first birth before 18 years of Poorer 5.3 42.2 47.5 52.5
age constituted 73 percent as against 37.2
Middle 4.9 33.6 38.5 61.5
percent in young tribal mothers between
Richer 2.9 28.0 30.9 69.1
20-24 years of age. It is obvious that early
pregnancy was common among late – Richest 3.4 19.6 23.0 77.0
adolescents. Getting pregnant before legal More than half of the illiterate tribal
age at marriage within wedlock was higher young women (56.4%) had given their
among the rural-based tribes (45.8%) than first births in their early part of marital
the urban-based tribes (34.4%). The nuclear life (under 18 year) and this percentage
family structure had comparatively higher decreases to 48.4 percent among young
early pregnancies than the joint family girls who had completed primary school
structure (50.4%, 39.8% respectively).
Vol. 58, No.1, June - 2012 37education and to 26.6 percent among status has little influence on early births.
women who completed secondary school Giving birth before the legal age at
education. It can be concluded from the marriage was higher among women who
analysis that mother’s age at first birth were in the poorest wealth index category
decreases with increasing educational (55.5%) than the middle and richest
attainment. At the same time, working categories (38.5% and 23.0%, respectively).
TABLE 4
Odds ratios from logistic regression examining the effect of selected background variables on the
Incidence of early pregnancy
95.0 C.I.for EXP(B)
Variable B S.E. Sig. Exp(B)
Lower Upper
Age
15-19 (Ref) 1.000
20-24 1.467 .142 .000 4.336 3.282 5.730
Residence
Urban (Ref) 1.000
Rural .140 .156 .370 1.150 .847 1.562
Religion
Hindu (Ref) .002 1.000
Muslim .066 .345 .849 1.068 .543 2.101
Christian .486 .129 .000 1.626 1.263 2.093
Others .107 .171 .533 1.113 .795 1.557
Education
No Education (Ref) .000 1.000
Primary .158 .143 .270 1.171 .884 1.552
Secondary .983 .139 .000 2.672 2.035 3.508
Higher 6.217 5.069 .220 501.120 .024 10334615.97
Occupation
Not working (Ref) .018 1.000
Agriculture -.253 .119 .033 .776 .124 .977
Sale & Service -.557 .275 .043 .573 .334 .983
Professional -1.054 .526 .045 .349 .615 .980
Manual Labour .063 .216 .770 1.065 .698 1.625
Wealth Index
Poorest (Ref) .795 1.000
Poorer .045 .142 .752 1.046 .791 1.382
Middle .133 .156 .394 1.142 .841 1.550
Richer .183 .192 .342 1.200 .823 1.750
Richest .300 .269 .265 1.349 .796 2.286
Constant -1.571 .218 .000 .208
Log likelihood 2247.179 Cox & Snell R Square.158 Nagelkerke R Square .212
38 The Journal of Family WelfareLogistic regression technique has been The most frequently stated symptom
employed to assess the effect of the each was excessive fatigue (45%). The next
background variable on the probability highest reported symptom was swelling
of early child birth, controlling for other of leg, body or face (29%). Another 12
variables. For this analysis, the dependent percent of them reported convulsions.
variable considered is ‘Early Pregnancy’, Vaginal bleeding was reported by negligible
which has been coded as 0 (birth given proportion (4%) of young tribal women.
under the age 18 years). TABLE 5
Table 4 shows the effect of socio- Gynecological symptoms reported by young tribal
economic factors on early pregnancy. women
For example, the effect of age - 15-19 age Gynecological Symptoms Percent
group relative to 20-24 age group, holding Excessive fatigue 45.1
other predictor variables constant, the Swelling of leg, body or face 29.3
odds ratio (the probability of not having
Convulsions 11.8
early pregnancy) is 4.336 times. The
Difficulty with night vision 11.0
effect of place of residence, religion and
wealth index factors on early pregnancy Difficulty with daylight vision 9.7
does not show any significance. At the Vaginal bleeding 3.9
same time education attainment of the
Number of Symptoms reported
respondents and their occupational status
show significance at 5% level. The logistic None 41.4
regression analysis indicates that early One symptom 26.2
pregnancy is not consistently improving 2 symptoms 18.6
with the improving socio-economic 3 symptoms 7.4
condition of women. 4 symptoms 4.1
5 symptoms 1.6
Incidence of Self-reported Gynecological
symptoms All 6 symptoms 0.1
Any one symptom 58.6
Age is an important demographic
variable that determines biological and More than half of the tribal women
mental maturity. Therefore teenage/young experienced any one of gynecological
mothers are usually expected to experience symptom (58.6%). Around 60 percent
the reproductive health disadvantages (59.4%) among young girls between 15-19
or serious reproductive problems that years of age and 58.4 percent among young
sometimes lead to mortality. Therefore, this women between 20-24 years of age had
study attempts to observe the association reported any one gynecological symptom
between self-reported gynecological (not shown in table). Almost an equal
symptoms and age-specific pregnancy. proportion in late-adolescent (24.5%) and
The young tribal women were asked young tribal women (26.5%) had reported
if at any time during the pregnancy only one symptom during the most recent
they experienced any of the following birth in the five years preceding the survey.
gynecological symptoms/problems for Another eighteen percent of both the age
the most recent births in the five years experienced any two problems (Table 5).
preceding the survey (2005-06): Convulsions Background characteristics and
(not from fever), Swelling of leg, body or gynecological symptoms
face, excessive fatigue, vaginal bleeding,
difficulty with daylight vision, and The percentage distributions of Indian
difficulty with night vision. young tribes by any one of self-reported
Vol. 58, No.1, June - 2012 39gynecological symptoms with their Any one gynecological
Characteristic
background characteristics are presented symptom (Percent)
in Table 6. Almost an equal proportion in Education
late-adolescent (59.4%) and young tribal No education 56.0
women (58.4%) had reported any one Primary 61.3
pregnancy-related health problem during Secondary 60.6
the most recent birth in the five years Higher 47.1
preceding the survey. A small difference Occupation
was noted between rural (59.1%) and urban Not working 56.6
population (56.5%). Agri. Employ 59.9
The analysis of educational attainment Sales & Service 69.8
of young tribal women and any one self Skilled & Unskilled 57.8
Prof., Tech., 73.7
reported gynecological symptom shows a
difference between illiterate women (56.0%) Wealth Index
and higher educated women (47.1%). No Poorest 62.3
difference was found among primary Poorer 54.6
and secondary level educated women Middle 53.8
(60%). While analyzing the respondents’ Richer 58.3
Richest 67.1
occupation with any one gynecological
symptom, a similar pattern was noticed. Age at first marriage
The wealth index analysis discloses that Less than 14 53.5
67 percent of the richest young tribal 15-17 60.1
women reported any one self reported 18-19 59.7
gynecological symptom, while it was 20-24 62.0
reported by 62.3 percent poorest, 55 percent Age at 1st birth
by poorer and 54 percent by middle wealth 12-14 56.4
quintile tribal women. 15-17 56.6
18-19 59.4
The proportion of any one self reported 20-22 61.2
gynecological symptom was 54 percent for 23-24 56.8
women who got married before the age of
Logistic regression was used to assess
14. This increased with increase in age at
the effect of each background variable on
marriage.
the probability of decreasing the incidence
TABLE 6
of self-reported gynecological symptom,
Tribal women reporting any one gynecological controlling for other variables. For this
symptom by background characteristics
analysis, the dependent variable considered
Any one gynecological is ‘affected with any one gynecological
Characteristic
symptom (Percent)
symptom’, which has been coded as 0 and
Age of women `not affected’ coded as 1.
15-19 59.4
It is noted from the logistic regression
20-24 58.4
analysis that the chance of getting any
Residence one self-reported gynecological symptom
Rural 59.1 does not consistently improve with
Urban 56.5
the improving socio-economic and
Religion demographic conditions of women. The
Hindu 57.5 result indicates that the background
Muslim 56.1 characteristics of tribal women does not
Christian 57.8
affect the reported incidence of any one
Other 66.5
gynecological symptom (Table 7).
40 The Journal of Family WelfareTABLE 7
Odds ratios examining the effect of selected background variables on the reported incidence of any one
gynecological symptom
95.0 C.I.for EXP(B)
Background variable B S.E. Sig. Exp(B)
Lower Upper
Age
15-19 (Ref) 1.000
20-24 .052 .127 .682 1.053 .821 1.351
Residence
Urban (Ref) 1.000
Rural -.229 .144 .112 .796 .600 1.054
Religion
Hindu (Ref) .113 1.000
Muslim -.118 .328 .720 .889 .467 1.692
Christian -.011 .121 .929 .989 .781 1.253
Others -.401 .170 .018 .670 .480 .934
Education
No Education (Ref) .009 1.000
Primary -.361 .143 .012 .697 .527 .923
Secondary -.321 .133 .016 .725 .559 .941
Higher .636 .545 .243 1.889 .649 5.498
Occupation
Not Working (Ref) .104 1.000
Prof -.842 .541 .120 .431 .149 1.244
Sale & Service -.616 .287 .032 .540 .308 .948
Agriculture -.143 .114 .209 .866 .693 1.084
Manual labour -.088 .206 .668 .915 .611 1.371
Wealth
Poorest (Ref) .000 1.000
Poorer .418 .138 .003 1.519 1.158 1.993
Middle .487 .153 .001 1.628 1.207 2.195
Richer .242 .182 .185 1.273 .891 1.820
Richest -.253 .255 .321 .776 .471 1.281
Constant -.110 .196 .574 .896
Step 1-2 Log likelihood 2412.033; Cox & Snell R Square.023 Nagelkerke R Square.031
Early Pregnancies and Self-reported above 18 (45%) (Table 8).
Gynecological symptoms
Convulsion (not from fever) self reported
The proportion of women who reported gynecological symptom was reported more
the difficulty with night blindness at the by women who had given their first birth
time pregnancy was comparatively high under the age of 18 years (51%) than the
among women who given their first birth women who had given their first birth after
under the age of 18 (55%) than at the age of the age of 18 years (49.1%).
Vol. 58, No.1, June - 2012 41TABLE 8 young women and reproductive health
Age at first birth by gynecological symptoms among consequences. The background characteristics
young Indian tribal women of women has little effect on the incidence
Pregnancy-related Early Late of gynecological symptoms, including
health problem Pregnancy Pregnancy Total educational status. It can be concluded that
Under Above the ignorance and high-risk beliefs and
18 age 18 age practices, and inadequate health resources,
among the tribal communities has contributed
Convulsions (not from fever)
to the vulnerability of this population.
Yes 50.9 49.1 100.0
Swelling of Leg, face/body Hence, appropriate/alternate strategies
Yes 38.0 62.0 100.0 should be taken to reduce the early
Excessive Fatigue
pregnancies in the tribal population
Yes 42.4 57.6 100.0
and to strengthen the existing maternal
care service packages. It will definitely
Vaginal Bleeding reduce the incidence rate of gynecological
Yes 41.4 58.6 100.0 s y m p t o m s a n d t h u s i m p r o ve t h e
Difficulty with reproductive health of women. Policy
Day Light vision makers, planners and care providers need
Yes 46.0 54.0 100.0 to think not only the resources of the
Difficulty with health care system, but also keep in their
Night Blindness mind about the tribe’s unique customs,
Yes 54.8 45.2 100.0 values, beliefs and traditions pursuing in
Any one problem 41.1 58.9 100.0 the health practices and also their isolation,
remoteness. So a “differential approach”
The remaining self-reported is to be launched for tribal areas, with
gynecological symptoms had been differential norms for establishing facilities
experienced more by the women who had to gear up the existing programmes to suit
given their first birth after attaining the their specific requirements.
age of 18. Swelling of leg, body /face was
reported by 62.0 percent women above 18 References
years of age and 38 percent of those who 1. Government of India. 2009. Ministry of Tribal
had given birth before they attained 18 Affairs: Annual Report 2008-09. New Delhi.
years of age. Similarly more than half of 2. Ravishankar, A.K. 2008. Prevalence of early
the women who had given their first birth pregnancy and its impact on maternal problems
above the age of 18 years reported that they of Indian young Tribal women. Presented at XXX
had difficulty with day light vision (54.0%) Annual Conference of Indian Association for the
and vaginal bleeding (58.6%). Study of Population, ISEC, Bangalore, Oct 17-19.
2008.
Conclusion 3. Ravishankar A.K. S., Ramachandran and Subbiah,
A. 2008. Trends and Issues in Tribal Studies. In:
The study result indicates that early Safe Motherhood Practices among Indian Tribal
marriages and early births are common in Communities: Facts from NFSH-II. Soubhagya
the tribal community. The study outcome Ranjan Padhi and Biswajita Padhy (Eds). Abhijeet
established an inverse association between Publications, New Delhi, Pp 1-26.
background characteristics of women and 4. Indian Council of Medical Research. 1998.
their early pregnancy behaviour among the Health of Tribal Population in India: Results of
tribal population. Some ICMR Studies. ICMR, New Delhi, p.1.
A significant proportion of young tribal 5. International Institute for Population Sciences
women had experienced any one of the self- (IIPS) and Macro International. 2007. National
reported gynecological symptom and the data Family Health Survey (NFHS-3), 2005-06: India:
have established a base link pregnancy among Volume I. Mumbai: IIPS. n
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