Chapter 3

 

REPRODUCTIVE HEALTH OF WOMEN

 

 

Through this survey, a pioneering effort has been made to collect information on all indicators of reproductive health at national level. Though, earlier the subject has been explored partially and in limited geographic areas by Agha Khan University, Karachi and NIPS (Hakim et al; 1999), the need to collect information at national and provincial level was convincingly expressed in all circles having interest in this field. This chapter covers basic information collected on almost all aspects of reproductive health including infant, child and maternal mortality.

3.1              Prenatal Care

For the health of mother and child, prenatal care is important. It is noted that over 50 percent women received any antenatal care in their last pregnancy and over one-third women (35 percent) reported having been to a doctor for antenatal check-ups (Table 3.1). Prenatal care is positively correlated with education and urban residence. Data show that more women with higher level of education tend to visit health professionals (doctors, nurses, FWWs, LHVs) for prenatal care (94 percent) compared to women with lower level of education or with no schooling (33 percent). Similarly, more urban (73 percent) than rural women (32 percent) receive prenatal care from health professionals.

Table 3.1

 

Percent Distribution of Last Birth in the Three Year Preceding the Survey According to Sources

of Antenatal Care (ANC) During Pregnancy by Background Characteristics

 

Background characteristics		Sources of antenatal care							Number
		Doctor	Nurse/ FWW/LHV	TBA/Dai	VBFPW/ LHW	Hakim/ Homoeopath	Other	No one
Mother's age at Birth	< 20	29.8	8.0	5.8	0.9	--	0.7	54.7	187
	20 – 24	36.4	10.2	6.7	0.5	0.3	0.3	45.6	745
	25 – 34	36.4	8.8	6.4	0.7	0.2	1.0	46.5	1702
	35 +	29.5	6.9	5.2	0.3	0.6	0.4	57.1	669
Birth Order	1	45.2	9.8	4.9	0.6	--	1.1	38.3	554
	2-3	38.2	10.3	7.0	0.9	--	0.5	43.2	1022
	4-5	33.2	8.0	5.8	0.9	0.9	1.0	50.2	801
	6 +	25.7	6.6	6.1	0.1	0.2	0.5	60.8	898
Residence	Total Urban	63.0	10.1	4.7	0.3	--	0.4	21.4	916
	Major Urban	72.5	8.3	3.8	0.4	--	0.1	14.9	538
	Other Urban	49.6	12.6	6.0	0.2	--	1.0	30.6	379
	Rural	23.7	8.2	6.7	0.7	0.4	0.8	59.5	2386
Province	Punjab	28.2	12.2	8.4	0.8	0.5	0.5	49.4	1795
	Sindh	54.7	5.1	3.7	0.2	--	--	36.3	835
	NWFP	29.2	4.4	2.8	0.3	--	2.8	60.4	522
	Balochistan	18.2	1.8	5.3	0.6	--	0.3	73.8	150
Education Levels	No Education	24.5	8.2	6.4	0.4	0.4	0.9	59.3	2423
	Upto Primary	45.0	12.1	8.6	2.4	--	0.2	31.6	404
	Upto Middle	63.3	11.3	7.8	0.1	--	--	17.5	116
	Upto Secondary	78.3	8.8	2.0	--	--	--	11.0	223
	Above Secondary	87.7	5.8	1.4	--	--	0.7	4.5	136
All		34.6	8.7	6.2	0.6	0.3	0.7	48.9	3303

 

Table 3.2 shows that women who did not get prenatal care during their last pregnancy reported to have been constrained by non-affordability (21 percent) followed by health facility being too far (7 percent) and the poor quality of service (2 percent). A significant number of women (47 percent) also abstained from visiting a health professional for prenatal check-ups on the ground that they did not encounter any health problem during pregnancy. This may be partly due to economic pressure and non-availability of services, which need attention.

Table 3.2

 

Percentage of Women who did not Receive Antenatal Care During Last Pregnancy

by Reasons and Background Characteristics

 

 

 

As seen earlier, only 50 percent women had a prenatal checkup during their last pregnancy. Table 3.3 shows that nearly one-third of the women were diagnosed as anaemic and only 39 percent of them had a blood test. Those who were diagnosed for anaemia, nearly half of them received treatment from a doctor and over one-third did not receive any treatment at all. The stated incidence of anaemia is higher among educated and urban women who presumably are more health conscious and seek treatment for anaemia during pregnancy.

 

Table 3.3

 

Percentage of Women Diagnosed as Anaemic During Recent Pregnancy in Three Years Period Prior to Survey with Blood Test and Treatment Received from Health Professional by Background Characteristics

 

 

3.2       Place of Delivery

For the safe health of mother and child, it is imperative that all deliveries are catered at hospitals/clinics under the supervision of qualified doctors. However, it is noted that 77 percent women had delivered their last babies at home and only 23 percent deliveries occurred in government and private hospitals (Table 3.4). Even in urban areas more than half of the deliveries are occurring in home and only one fifth deliveries are occurring in public hospitals compared to over one fourth in private hospitals. There are not much differentials among provinces except that in Sindh where nearly 36 percent deliveries occurred in hospitals. Again education is positively correlated with deliveries in hospitals, that is, women with higher education, are more likely to be delivering their babies in hospitals.

 

Table 3.4

 

Percent Distribution of Mothers by Place of Their Last Delivery in Three Years Preceding

the Survey by Selected Background Characteristics

 

 

Women in the PRHFP survey were asked about the outcome of the last pregnancy – whether it ended in a live birth or in a still birth. It was found that 98 percent were live births while 2 percent pregnancies ended in still births (Table 3.5). It is noted that over one-quarter pregnancies were either mistimed or unwanted. Nearly 13 percent women wanted no more pregnancies, while about 16 percent wanted to delay or postpone their last pregnancies. This is a very large magnitude and need attention of policy makers as women’s reproductive health and family planning needs are not fully met. By providing services to these women, it is not only improving their reproductive health, but also enhancing contraceptive prevalence affecting fertility negatively.

Table 3.5

 

Percent Distribution of Most Recent Births by Survival Status at the time of Delivery and

Desire of Women for the Last Pregnancy