@minur - Soc-03 - Gender Inequality &amp Reproductive Health

Effect of Gender Inequality on Reproductive Health of Married Women: A Comparative Study on Four Selected Areas of Khulna District
Course No: Soc- 4202
S. M. Aminur Rahman
Sociology Discipline Khulna University March 31, 2008
Course No: Soc- 4202
S. M. Aminur Rahman Student Id-031620 Session-2005-2006
Supervisor
Mosammat Rowshan Ara Assistant Professor Sociology Discipline, Khulna University, Khulna
A Research Monograph Submitted to the Sociology Discipline, Khulna University, Khulna as Partial Fulfillment of the Requirements for the Degree of Bachelor of Social Science (Honours) in Sociology
March 31, 2008
Dedicated To My Beloved Grand-Parents
Acknowledgement
At first, I am paying my gratitude to the almighty Allah, for the completion of the research work. Without His compassion, this research work would not have been possible. I would like to express my heartfelt gratitude to my supervisor Mosammat Rowshan Ara, Assistant Professor of Sociology Discipline, Khulna University. His systematic and sincere supervision and guidance enable to complete this work successfully. It is indeed a great honor and privilege for me to thank my honorable teachers especially Md. Rezaul Karim, Ph.D, Professor of Sociology Discipline, Khulna University. This research work would not have been possible without available supervision, guidance and suggestions of all the teachers of Sociology Discipline of Khulna University. I am also indebted to my parents for the financial support they provided to complete this thesis. I want to express my deep gratitude to my group mates and classmates for their support and encouragement help me to enrich this study. I wish to extend my sincerest thanks to all of them. Particular thanks must be gone to the pocket of Subrata Mallik and Pronoy Kumar Das for their valuable assistance or information about my research topic. Finally, my special appreciation goes to all the respondents of two villages- Sujanshah and Ghona, and two wards of Khulna City Corporation-24 no Gallamari and 25 no Nirala for their cordial help and friendly participation by responding to the queries, discussions and interviews during the time of survey, that enable me to analyze and synthesize all the ideas into a report form. March, 2008 S .M. Aminur Rahman Sociology Discipline
Abstract
Bangladesh is one of the developing nations in South Asia where gender inequality is Very high. Women are grossly discriminated against men in male dominated society. They are discriminated by men in every sphere of public and private life especially in their reproductive health sector. The study reveals that nutritional status of women is marked by sharp differentials with men. Health care for women is restricted to their reproductive health. General health of women at all ages is neglected. Women are married at a much lower age than men. Early marriage, repeated pregnancy, long child bear spans, excessive sexual intercourse, taking several birth control methods and low nutritional food, malnutrition, getting low health care facilities and so on have brought serious implications or problems on reproductive health and lead to high maternal mortality. Besides, due to unrepresented in the decision making process, unemployment and having restricted access to productive resources and social support systems have created heavy mental pressures in women which lead them to many problems in their reproductive health. Gender inequality has also reflected underlying inequalities in the ownership of land or assets, in achieving education, in getting labor wages and so on. So, by analyzing data, it can be said that gender inequality on reproductive health is very high of both in urban and rural area. Eventually, it can be said that this study gets the support about the hypothesis that there is a positive relationship between gender inequality and reproductive health.
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Glossary:
Abortion: The deliberate ending of a pregnancy at an early stage. Access of health care: It refers to the opportunities of health services that a woman gets during illness. Age at marriage: It is the age of female when she is got married. Birth control methods: It refers to the instruments and medicine through which conceive is prevented. Cultural gatekeepers: It refers to the persons who control and prescribe concerning the reproductive health problems of women (e.g., mothers and sisters-in-laws, parents, grandparents, village and community leaders, council chiefs, and religious/opinion leaders). Dhai: It is also called midwife who performs the child delivery activities especially at home. Childbirth: It is the process related to the born of infant. Conceive: When a woman adopt embryo through intercourse for childbirth. Child delivery: When pregnant women delivers infant from her body.
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Extra food: It refers to the more nutritional foods which are necessary during pregnancy to keep the body feet and for the well being of child. Familial decision: The plan that is taken by the elder persons for the running of the activities of family by considering the future. Family planning: The process through which population size is controlled and provides the prescriptions to the couple for taking child. Gender: Social and cultural distinction between men and women. Gender consciousness: The knowledge about him rights of male and female. Gender inequality: Gender inequality refers to the differences in status, power and prestige enjoyed by women and men in various ways. Genital mutilation: Damage of the parts of sexual organ. Immunization: Immunization is the process to be immunized. Intercourse: The sexual activities between male and female.
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Marriage: A socially approved sexual relationship between husband and wife. Malnutrition: A poor condition of health caused by a lack of the right type of food. Menstruation: The process of flowing of blood from her womb, usually once a month. Mortality: The number of death in particular situation or period of time. Maternal deprivation: The absence of stable and affectionate relationship between a child and its mother early in life. Nuclear family: A family group consisting of mother, father and dependent children. Parda: One kind of dress that women wear to cover the whole body to escape the attention of male on her. Pregnancy: The state of being pregnant related to the women having a baby developing inside her body. Reproductive rights: It means the necessities which are required during pregnancy like-safe delivery, sufficient food, medicine, health personnel etc.
Reproductive health: Reproductive health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity, in all matters relating to the reproductive system and to its function and processes. Reproductive knowledge: Reproductive knowledge refers to the knowledge concerning how to conceive, how to maintain the health during pregnancy, when pregnant mother is to go medical to have check up and so on. Sanitation pad: It is one kind of thin paper which is used during menstruation to protest from germ. Sanitation system: Sanitation system includes the saving process for the protecting of health from the outside germ including latrine system, washing process and so on. Spousal violence: Spousal violence includes the domestic violence performing by her husband and other influencing members of the family. Unwanted pregnancy: The pregnancy which occurs unwillingly or unconsciously through intercourse. Violence against women: It is the rampant process which is related to the female. By this process female are physically and mentally tortured by her husband or the other members of the family.
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Womens poverty: It is related with the occupation of women. When a woman belongs to the low occupation or does not posses any occupation, she belongs to the poverty line as her income can not support her to survive.
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ACRONYMS:
WHO UNFPA STDS RTIS HIV AIDS HPSP UNDP BIDS ICDDRB ICPD UNICEF MCWC MOHFW GOB VAW KMC OBS FP World Health Organization United Nations Fund for Population Activities Sexually Transmitted Diseases Reproductive Tract Infection Human Immune Virus Acquired Immune Deficiency Syndrome. Health and Population Sector Programme United Nations Development Programme Bangladesh Institute of Development Studies. International Center for Diarrhoeal Disease Research Bangladesh International Conference on Population and Development United Nations Childrens Emergence Fund. Maternal Child Welfare Center Ministry Of Health and Family Welfare Government of Bangladesh Violence against Women Khulna Medical College. Emergency Obstetric Care. Family Planning
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Table of Contents
Title Acknowledgement Abstract Glossary Acronyms Table of contents List of table Page No. i ii iii viii ix xii
Chapter One
Introduction 1.1 Statement of the problem 1.2 Objectives of the Study 1.2.1 Broad Objectives 1.2.2 Specific Objectives 1.3 Literature Review 1.4 Hypothesis 1.5 Operational Definitions 1.6 Rationale of the Study 1.7 Limitations of the Study 01 01 02 02 02 02 05 05 05 05
Chapter Two
Methodology 2.1 Introduction 2.2 Design 2.3 Unit of Analysis 2.4 Study Area 2.5 Population 2.6 Sampling 2.7 Sources of data 2.7.1 2.7.2 Primary source Secondary sources 07 07 07 07 07 07 08 08 08 08 ix
2.8 Techniques of Data Collection 2.9 Method of data Collection 2.10 2.11 2.12 Data Collection from Field Data Processing and Analysis Presentation of Findings
08 08 08 09 09
Chapter Three
3.1 Historical Background of the Study Area 3.2 Identity of the Respondents 3.3 Age of the Respondents 3.4 Religion of the Respondents 3.5 Educational status of the respondents 3.6 Occupation of the Respondents 3.7 Type of Family 10 10 11 12 12 13 14
Chapter Four
Reproductive Health and Gender 4.1 :Reproductive Health: Household Dynamics and Gender 4.2: Decision of Marriage 4.3: Total Number of Pregnancy after Marriage 4.4: Total Number of Children 4.5: Pattern of Delivery 4.6: Place of Child Delivery 4.7: Delivered by Whom 4.8: Decision of Taking Children 15 15 16 17 17 18 18 19 20
Chapter Five
Use of Birth Control Method and its impact on Reproductive Health 5.1 Use of Birth Control Method 22 22
Chapter Six
Social Relation and its Effects on Reproductive Health 6.1: Unequal Social Relation among the Spouses and Its Effects on Reproductive Health 6.2: Types of Problems for giving female childbirth 6.3: Forced by husband for sexual intercourse during pregnancy 25 26 27 25
Chapter Seven
Reproductive Health Status of the Women during Pregnancy 28
Chapter Eight
Psychological Barriers and Its Effect on Reproductive Health 8.1: Period of Taking Daily Meal 8.2: Health Problems for More Children or Limited Time Space 8.3: Abortion 8.4: Causes of Abortion 33 33 34 34 35
Chapter Nine
Knowledge of the Women about Gender Inequality 9.1: Gender Consciousness Level of Women about Gender Inequality 9.2: Decision Making Power of the Women at Household Activities 9.3: Health Facilities during Illness 37 37 38 39
Chapter Ten
Findings, Recommendations and Conclusion 10.1 10.2 10.3 Findings Recommendations Conclusion 41 41 46 50
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List of Tables
Table 3.1: Percentage distribution of the respondents by their age Table 3.2: Percentage Distribution of the Respondents by Religion Table 3.3: Percentage distribution of the respondents by their education level Table 3.4: Percentage Distribution of the respondents by their occupation Table 3.5: Percentage distribution of the respondents by their family types Table 4.1: Percentage distribution of the respondents by age at marriage Table 4.2: Percentage distribution of the respondents in decision of Marriage Table 4.3: Percentage distribution of the respondents in total number of pregnancy after marriage Table 4.4: Percentage distribution of the respondents having Children Table 4.5: Percentage distribution of respondents by pattern of delivery Table 4.6: Percentage distribution of respondents regarding place of child delivery Table 4.7: Percentage distribution of the respondents considering personnel of delivery Table 4.8: Percentage distribution of the respondents of taking decision about children 21
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11 12 12 13 14 15 16
17 17 18
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Table 5.1: Percentage distribution of the respondents using birth control method 22 Table 5.2: Percentage distribution of respondents using different types of birth control method Table 5.3: Percentage distribution of the respondents taking decision of using birth control method Table 5.4: Percentage distribution of respondents facing problems for using birth control method Table 6.1: Percentage distribution of the respondents facing problems for female childbirth Table 6.2: Percentage distribution of the respondents facing different types of Problems for giving female childbirth Table-6.3: Percentage distribution of the respondents forced by husband for sexual intercourse during pregnancy Table 7.1: Percentage distribution of the respondents using sanitation pad during menstruation period 28 xii 27 26 25 24 23 23
Table 7.2: Percentage distribution of the respondents involving sexual intercourse during menstruation Table 7.3: Percentage distribution of the respondents facing problems at pregnancy Table 7.4: Percentage distribution of the respondents taking immunization at pregnancy Table 7.5: Percentage distribution of the respondents taking of extra food during pregnancy Table 7.6: Percentage distribution of the respondents doing regular household activities during pregnancy Table 7.7: Percentage distribution of the respondents required health services from health personnel during pregnancy Table 8.1: Percentage distribution of respondents taking daily meal Table-8.2: Percentage distribution of respondents facing problems for more children or limited time space Table-8.3: Percentage distribution of respondents doing abortion Table-8.4: Percentage distribution of respondents by causes of abortion Table-9.1: Percentage distribution of respondents having knowledge of gender inequality Table-9.2: Percentage distribution of Respondents having decision making power at household activities Table-9.3: Percentage distribution of respondents getting health facilities during illness 39 38 37 34 35 36 32 33 31 30 30 29 29
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Chapter One
Introduction
1.1 Statement of the problem: Gender inequality in the form of discrimination against women has been identified as one of the prime reproductive health issues in Bangladesh. Gender-based violence (including threats of these acts, such as coercion or arbitrary deprivations of liberty) that results in or is likely to result in physical, sexual, or psychological harm or suffering to women in Bangladesh. This includes battering; sexual abuse of female children; dowry related violence; marital rape; traditional, non-spousal, harmful violence to women; violence related to exploitation; sexual harassment and intimidation at work, in educational institutions, and elsewhere; trafficking of women; forced prostitution; and violence perpetrated or condoned by the state. According to the UNFPA State of the Worlds Women Population Report, 47 percent of the women in Bangladesh testify to having ever been physically assaulted by a male partner. This report, and the fact that Bangladesh would thus rank second in a list of 12 countries with a high rate of violence against Women (VAW) caused a great deal of media attention. A recent study revealed rank ordering of different types of VAW, with verbal abuse being the most prevalent and alarming one; the second most widely occurring violence is battery, while dowry-related violence is third. Inadequate reproductive health care cause high rates of unwanted pregnancy, unsafe abortion, and preventable death and injury as a result of pregnancy and childbirth. Women are treated as the second-class citizen. They are facing widespread discrimination in all spheres of their life. In the study area women are forced to involve in child marriage, unwanted sexual relations, unwanted pregnancies and restricted access to family planning information and contraceptives. Unsafe abortion or injuries sustained during a legal abortion after an unwanted pregnancy. Complications from frequent, high-risk pregnancies and lack of follow-up care; Persistent gynecological problems; Psychological problems, including fear of sex and loss of pleasure are violating the reproductive right of women. They also face difficulties by the family members. Women are treated as unequally and they do not get or exercise human rights due to lack of social consciousness. Due to this social
construction, they do not get proper nutrition which is basically hamper their reproductive health. 1.2 Objectives of the Study: 1.2.1 Broad ObjectivesThe broad objective of this study is to identify the relationship between gender inequalities and reproductive health. 1.2.2 Specific Objectivesa. To know how gender inequality plays the role against reproductive health. b. To explore the idea of the major obstacles of satisfactory reproductive health. c. To know whether the rural women or urban women are facing the problems bitterly as the effect of gender inequality. d. To explore the idea plays the dominant role against reproductive health. e. To find out the effect of birth control technique on the married women and its relations to gender inequality. f. To know the initiatives and strategies to solve reproductive health problem created due to gender inequality. 1.3 Literature Review: The affect of gender inequality on different issues have been published at several times. However, affect on the reproductive health has a few writings. Among them, some vital issues are indicated bellow. Reproductive health (RH) is defined as all health events related to reproduction in the life cycle. Its components include family planning, post abortion care, safe pregnancy and safe motherhood, reproductive tract infections, sexually transmitted diseases, HIV/AIDS, RH services for adolescents, maternal and infant nutrition, and cancer of the reproductive tract, infertility, female genital mutilation, and gender-based violence. This paper presents a review of the prevailing RH situation in Bangladesh. Despite improvements in some aspects of health, the RH situation in Bangladesh remains unsatisfactory. This situation is reflected in the unacceptably high rates of maternal and child mortality and morbidity in the country. Although significant success has been achieved in the decline of fertility and
increase in contraceptive prevalence rate, the population growth rate is still high. Adolescent RH is also becoming an important issue. Added to the high rates of premarital and extramarital sex among male and female adolescents are concerns related to early marriage and teenage pregnancy. While the HIV/AIDS situation remains under control, there exists a potential threat of spreading the fatal disease rapidly. The government of Bangladesh has officially adopted the International Conference on Population and Development definition of RH and developed a comprehensive plan of action in light of the recommendations of the conference. Source: Jopsom. Journal of preventive and social medicine, 1999 June; 18(1):66-73. Barkat, Howlader.S.R. 1997: Barkat identified some basic elements of reproductive health coverage a range of reproductive problems, including family planning, safe motherhood, safe abortion facilities, adolescent reproductive health, infertility, Reproductive Tract Infections(RTI), and Sexually Transmitted Diseases (STD), HIV/SIDS, concern of reproductive tract, and reproductive health needs of disables.(, Howlader.S.R 1997 Population and Development issues in Bangladesh) It may appear from the list of elements that the medicalization of diseases and supply of service deliveries could be enough to take care of womens reproductive health. Medical science and technology play a very important role in protecting human health. However, we also know that human health is the outcome of social factors that is the main concern of this conducted study including gender inequality, which is socially constructed, and acts as a social factor affecting on reproductive health. But the above study does not explicitly include the social factor for being responsible to reproductive health. Siddiquee, A. R.: Siddiquee has emphasized on women poverty and reproductive health. For womens poverty, he blamed on social restrictions and religious codes of conduct, which ultimately resist them in participating in broader economic activities beyond their courtyards. In addition, he showed womens poverty is one kind of inequality that has horrible affect on reproductive health for not to meeting their health need. In most cases, the rural women
work as farm hands and mostly they are under paid in return of longer working hour than their male counterparts are. Thus, the rural women remain in a whirlpool of hunger, exploitation and ultimate health hazards. He mainly emphasized on one criterion that is poverty, which has a great affect on reproductive health. However, he does not clearly mention gender inequality is responsible for womens poverty. Therefore, this study does not quietly match with the proposed study. Hence, we are going to conduct a study based on gender inequality, which has direct impact on reproductive health. Bangladesh Institute of Development Studies: In rural areas, many girls marry at the age of 12 years. It may be noted here that 23 per cent of the population below 19 years of age. Of this adolescent population, 48 percent are young girls aged between 10-19 years. The general condition of health of these girls is very poor, right from their birth. Obviously, they are more vulnerable than their male counterparts are (Bangladesh Institute of Development Studies/UNDP 1997). Here mainly emphasized on adolescent girls but our study is not only based on adolescent but also married women. In addition, studies show the impact of early marriage under gender inequality. In spite of having early marriage, not every married couple has children. Someone takes children at their matured age and early marriage itself is not responsible for the risk of reproductive health as here another intervening factor like education, unconsciousness etc might play pivotal role for creating the problems. In addition, here both husband and wife might be illiterate or unconscious. In this sense, gender inequality might not play the role for the risk of reproductive health Ministry of Health and family Welfare 1999:48: It has mainly emphasized on food that has an affect on reproductive health, which is especially seen among women in rural area for little taking of food. The aftermath of this little taking is malnutrition that breeds early oldness and sickness. This study indicates upon malnutrition. This phenomenon might be apt for both male and female in rural area. Some special diseases are seen into female body that is related to their biological order so they might be sick. However, it indicates on one criteria but our
study will be done on several criteria or inequalities that have respective effect on reproductive health. 1.4 Hypothesis: There is a positive relationship between gender inequality and reproductive health. 1.5 Operational Definitions: Reproductive health: Reproductive health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity, in all matters relating to the reproductive system and to its function and processes. Gender inequality: Gender inequality refers to the differences in status, power and prestige enjoyed by women and men in various ways. Married Women: The respondents of this study are married women who are in age between 15-49 years. 1.6 Rationale of the Study: The term gender inequality is a pervasive phenomenon especially in the context of developing countries. Gender inequality affects not only a particular group of society but also the overall socio-economic development of that society. On the other hand, the concept of reproductive health is appeared as the most discussing issue at the present situation, because the overall health condition of particular country is determined on the condition of reproductive health. A healthy mother can give a healthy child. Unequal power relations between men and women often limit womens control over sexual activity and their ability to protect themselves against unwanted pregnancy and sexually transmitted diseases including HIV/AIDS. In Bangladesh whether almost fifty percent people are women, so without the proper step to eradicate this great problems the national development is not possible at all. It is also mentionable that the effect of gender inequality in rural area is more pervasive than the urban area and for this reason we are
inclined to conduct a study under the headings of effect of gender inequality on reproductive health. 1.7 Limitations of the Study: This study may have some limitations. The limitations of this study are following: a. Financial limitations: Money is essential to conduct a comprehensive study, but as a student I had not the ability. b. Limitations of time: I had got limited time to conduct the study c. Limitations of personnel: d. Limitations of experience: This was my first comprehensive study as a result I had not much experience about social research. e. Limitations of study area: The study was conducted on only two villages and two wards as a result it was difficult to generalize the findings in whole Bangladesh.
Chapter Two
Methodology 2.1 Introduction: Methodology means the way or manner by which the study is accomplished, which refers to the full outcome of the process at a glance. It includes some chronological steps that are necessary to complete the study successfully. Mode of operation differs with the nature of the study. Methodology is very important in the sense that it gives one an idea about how the study has been conducted. In other words, methodology helps to organize, represent, and analyze data and their logical expression in a systematical chronology to achieve the ultimate goal of the study. The methodology is adopted for the current research work is presented in a sequential manner. 2.2 Design: The study was conducted through the use of survey design. Data were collected from the married women who are affected by gender inequality in their reproductive life to test the hypothesis. To realize the other objectives of the study data about respective concepts were collected through incorporating relevant items (variables) in the questionnaire and analyzed and interpreted by using descriptive techniques and compared between rural and urban area. For in-depth study few case studies are incorporate. 2.3 Unit of Analysis: Married Women (age 15-49) 2.4 Study Area: Ward no 24 and 25 of Khulna City and two villages of Tala thana- Satkhira district named Sujansaha and Ghona. 2.5 Population: All Married Women of two villages and two wards (above-mentioned places in study area).
2.6 Sampling: Data were collect from the field through the use of purposive sampling. The whole data were collected on the basis of the objectives and the sample size is 200 (one hundred from rural and one hundred from urban area). 2.7 Sources of data: There are two sources of data collection, these sources are following2.7.1 Primary sourcePrimary source includes the field where the incidence occurs. Data were collected through face-to-face interaction by using a questionnaire. 2.7.2 Secondary sources Secondary data are supplied by some institutions, organization, NGOs and other governmental agencies. Then data were collected from booklets, pamphlets and brochures from the department such asBBS ER-2006-2007 Books, Journals and daily newspaper etc. 2.8 Techniques of Data Collection: A questionnaire was developed and finalized through pre-test and used for data collection. 2.9 Methods of data Collection: In this study survey, simple observation method was followed. 2.10 Data Collection from Field:
Two teams of four interviewers (2 in each team) and one supervisor collected data from field.
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Data Processing and Analysis:
Data are computerized, analyzed and interpreted by using softwares like SPSS, Excel, etc. 2.12 Presentation of Findings:
Findings are presented through written research report. A draft report is prepared and given to the proper authority for comments and suggestions. According to the suggestions the draft report was revised and finalized and submitted to the authority.
Chapter Three
3.1 Historical Background of the Study Area Selection of study area is considered as one of the significant phase of a research development and for the implementation of this study two villages and two wards were selected from two different geographical areas. These areas are selected purposively. The name of the selected village is Sujanshah and Ghona. It is located at Tala Thana of Satkhira District. These two villages represent the ultimate beauty of traditional rural Bengal. Nature has natured it in her own hands. Neither Jibananda nor Ibne Batuta could portray the ultimate beauty of it. The fields of these villages are full with green trees and crops. Different types of crops like paddy, jute, sugarcane, potato, wheat, bin, etc are cultivated by the farmers and the main sources of income of the inhabitants are agricultural products. Besides this, other occupational groups are found like pottery, blacksmith, fishermen, carpenter, etc. These two villages also represent a wonderful accomplishment of communal harmony. People of different religion like Hindu, Muslim and a small portion of Christian community live peacefully. On the other hand, two wards of Khulna city named Nirala and Gallamari and ward no is 24 and 25 were selected. Gallamari is located beside the Mayur River and it has its historical importance from the perspectives of Liberation War of 1971. In the period of Liberation War a large number of people were killed by the Pakistani army and for the reminiscence of the Great Martyrs a monument popularly called Gallamari Baddhabhumi has designed by the side of Gallamari Bridge. The other Ward Nirala is located near the Gallamari and is renowned for Vegetable market popularly known Nirala Kacha Bazar. People of different
occupations live in these two wards included professionals, businessmen, workers, Rickshaw and Van drivers, etc. These two wards are mainly famous for business activities and succinctly these are the chronological depiction of my study area. 3.2 Identity of the Respondents Identity of respondents is an essential part of any research report. By the observation of the identity of Respondents, a reader can easily grasp the nature and extent of the respondents, their age distribution, religious status, level of education, type of occupation, type of family, etc and the overall identity of the respondents are portrayed in the below with several steps.
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3.3 Age of the Respondents Table 3.1: Percentage distribution of the respondents by their age
Age ( in year) Urban No. 15-20 21-26 27-32 33-38 39-44 45-49 Total 7 31 34 10 16 2 100 % 7.0 31.0 34.0 10.0 16.0 2.0 100.0 Rural No. 8 24 31 29 8 0.0 100.0 % 8.0 24.0 31.0 29.0 8.0 0.0 100.0 Total of Urban and Rural people Total No. 15 55 65 39 24 2 200 % 7.5 27.5 32.5 19.5 12 1 100.0
Source: Household Sample Survey, 2007-08 This table shows that 7.5% of total respondents belong to the age of 15-20; 27.5% of total respondents belong to the age of 21-26; 32.5% of total respondents belong to the age of 27-32; 19.5% of total respondents belong to the age of33-38; 12% of total respondents belong to the age of 39-44; 1% of total respondents belong to the age of 45-49; This table also reveals that highest 32.5% of total respondents belong to the age group of 27-32. In the urban-rural perspective, the table shows that in urban area highest 34% of total respondents belong to the age group of 27-32 and lowest 2% of total respondents belong to the age group of 45-49. On the other hand in rural Area 31% of total respondents belong to the age group of 27-32 and there were no respondents in the age group of 45-49. From the Table-1, it is seen that there is less variation in the age distribution of the respondents of urban and rural areas comparatively.
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3.4 Religion of the Respondents Table 3.2: Percentage Distribution of the Respondents by Religion.
Types of Religion No. Islam Hindu Christian Total 75 21 4 100 Urban % 75.0 21.0 4.0 100.0 No. 50 50 0 100 Rural % 50.0 50.0 0.0 100.0 Total of Urban-Rural people Total No. Total (%) 125 71 4 200 62.5 35.5 2 100
Source: Household Sample Survey, 2007-08

About 62.5 % are the follower of Islam, 35.5% of total respondents follow the religion of
Hinduism, and only 2% follow the religion of Christianity. In the urban-rural perspective, the table shows that in urban areas 75% of total respondents are the followers of Islam; 21% are the follower of Hinduism and only 4% are the follower of Christianity. On the other hand, in rural area the followers of Hindu and Islam Religion are same that is 50% and the follower of Christianity is absent. The data were collected from different religious groups from different perspectives. 3.5 Educational status of the respondents Table 3.3: Percentage distribution of the respondents by their education level
Urban Level of Education Illiterate Primary Secondary SSC HSC Graduation Post Graduation Technical Madrasa Total No 27 20 9 8 20 7 2 1 6 100 Rural Total of Urban-Rural people Total No 65 45 38 14 22 7 2 Total Percentage (%) 32.5 22.5 19.0 7.0 11.0 3.5 1.0 0.5 3.0 100.0
Percentage No Percentage (%) (%) 27.0 38 38.0 20.0 25 25.0 9.0 29 29.0 8.0 6 6.0 20.0 2 2.0 7.0 0 0.0 2.0 0 0.0 1.0 6.0 100.0 0 0 100
O.0 1 0.0 6 100.0 200
Source: Household Sample Survey, 2007-08 The Table-3.3 indicates the level of education among the respondents, and from which it is seen that 22.5% have finished their primary education; 19% have achieved the
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secondary education; only 7% have passed the SSC examination; 11% have passed the HSC level, only 3.5% have completed the graduation level; only 1% of total respondents have completed Post Graduation degree; only 1 respondent completed the technical education and 3% of total respondents completed their education from Madrasa. In the urban-rural perspective, the table shows that illiteracy is higher in rural area than the urban area. In rural areas 38% of total respondents are illiterate and in urban area the illiteracy rate is 27%.From this comparison it is evident that the rate of literacy and higher education is higher in urban area than the rural area. 3.6 Occupation of the Respondents Table 3.4: Percentage Distribution of the respondents by their occupation
Categories of Occupation No Urban Percentage (%) 48.0 2.0 18.0 3.0 2.0 14.0 13.0 0.0 100.0 No Rural Percentage (%) 56.0 5.0 0.0 5.0 0.0 0.0 0.0 34.0 100.0 Total of UrbanRural Total Total No Percentage (%) 104 52.0 7 3.5 18 9.0 8 4.0 2 1.0 14 7.0 13 5.5 34 17.0 200 100
Household Activities Agriculture Service Business Maid Servant Multifarious Works Day Laborer Pottery Total
48 2 18 3 2 14 13 0 100
56 5 0 5 0 0 0 34 100
Source: Household Sample Survey, 2007-08 This Table shows the comparison of occupation of the respondents between urban and rural. From this Table, it is seen that 48% respondents engage themselves in household activities, 2% in agriculture, 18% in service, 3% in business, 2% in maid servant, and 17% in other sectors. On the other hand, in rural areas, highest 56% in are household activities, and 34% in pottery. Other percentage is very few. And highest total 52% occupation is household activities. From the Table 3.6 it is observed that, the occupation of household activities of the respondents is higher in rural area than urban area. So, it can be said that existence of inequality also found both of the region.
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3.7 Type of Family Table 3.5: Percentage distribution of the respondents by their family types Family types
Urban Frequency Nuclear Family Joint Family Total 81 19 100 Percent 81.0 19.0 100.0 Rural Frequency 61 39 100 Percent 61.0 39.0 100.0 Combination of Urban Rural Total Frequency 142 58 200 Percentage 71.0 29.0 100.0
Source: Household Sample Survey, 2007-08 The Table- 3.7 represents various types of family of the respondents of both in urban and rural area. From this table, it is seen that in urban area 81% respondents live in nuclear family and 19% respondents live in joint family. On the other hand, in rural areas 61% respondents live in nuclear family and 39% respondents live in joint family. In urbanrural perspective, from total 200 respondents 71% live in nuclear family and 29% live in joint family. Eventually it can be said that the percentage of the respondents of the nuclear family is higher in urban area than in rural area that is, 81% in urban and 61% in rural area.
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Chapter Four
Reproductive Health and Gender 4.1 Reproductive Health: Household Dynamics and Gender
The concept 'Women Health' comes from the branded MCH (Maternal & Child health) program. Reproductive health is a state of complete physical, mental and social well-
being and not merely the absence of disease or infirmity, in all matters relating to the reproductive system and to its function and processes. The reproductive period of women begin at menarche and end in menopause. It usually extends from 15-49 years. Womens household and family roles include those of spouse/partner, household head, parent/guardian, and nuclear and/or extended family member (including being one wife of a polygamous husband). In many cultures, the status of women is derived from their performance in these roles, along with cultural expectations of how women "should" behave relative to others in the household unit. A woman's interaction with her spouse and other family members concerning decisions about family size may improve communication and strengthen relationships. On the other hand, it may result in negative sanctions, including domestic violence. Although the nature of women's domestic roles varies across cultures, common denominators may be found in partner relations (including issues of sexuality and sexual relations), family communication and dynamics, household decision-making, role strain and violence against women Table 4.1: Percentage distribution of the respondents by age at marriage
Age at marriage No 63 34 2 1 100 Urban Percentage (%) 63.0 34.0 2.0 1.0 100.0 No 75 25 0 0 100 Rural Percentage (%) 75.0 25.0 0.0 0.0 100.0 Combination of Urban-Rural Total Total Percentage No (%) 138 69 59 29.5 2 1 1 0.5 200 100
18-25 26-33 34-41 Total
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The Table 4.1 represents the picture of age at marriage of respondents under study area. Most of the respondents (63%) in urban area have married between 10 and 17 years; 34% in 18-25 yrs, 2% in 26-33 years in urban area; whereas most of the respondents (75%) in rural area have married between 10 and 17 years. and 25% in 18-25 years. It can also be said that lowest 1% respondents in urban area have married between 34 and 41yrs; whereas we do not find out any respondent in rural area who have married between 34 and 41yrs. 4.2 Decision at marriage In our country, elder members of the family or parents especially father play influential role in decision of marriage. Here females or girls get less freedom to take decision for their marriage. The real picture in decision of marriage is showed through the following table. Table 4.2: Percentage distribution of the respondents in decision of Marriage
Urban Decision Makers Parents Both Husband and Wife Other Members of the Family Total Frequenc y Rural Combination of Urban-Rural Total Percentage Total Percentage (%) No (%) 90.0 152 76.0 3.0 7.0 100.0 23 25 200 11.5 12.5 100.0
Percentag Frequenc e y (%) 62 62.0 90 20 18 20.0 18.0 100.0 3 7 100
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Source: Household Sample Survey 2007-08 The Bangladeshi women are excluded from financial and social decision making process; even they have no freedom of choice about their own marriage. The table 4.2 exemplifies that truth, among the total 100 urban respondents only 20 that means 20% respondents marriage conducted as their own will, whereas only 3% rural respondents experienced affair marriage. The survey data also express that the urban women received more freedom in taking decision to select their life partner than the rural women.
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4.3 Total Number of Pregnancy after Marriage Table 4.3: Percentage distribution of the respondents in total number of pregnancy after marriage
Urban Number of Pregnancy 1 2 3 4 5 or more 0 Total No 41 34 11 9 5 0 100 Percentage (%) 41.0 34.0 11.0 9.0 5.0 0.0 100.0 No 26 38 11 12 7 6 100 Rural Percentage (%) 26.0 38.0 11.0 12.0 7.0 6.0 100.0 Combination of Urban-Rural Total No 67 72 22 21 12 6 200 Total Percentage (%) 33.5 36.0 11.0 10.5 6.0 3.0 100.0
Source: Household Sample Survey 2007-08 Table reveals the percentage of total number of pregnancy of the respondents after their marriage. It is observed from field survey of urban area that 41% respondents have become pregnant one times, 34% two times, 11% three times, 9% four times, 5% five times; whereas in rural area 26% respondents have become pregnant one time, 38% two times, 11% three times, 12% four times, 7% five or more. In urban-rural perspective, highest 36% respondents have become pregnant two times from 200 respondents. 4.4 Total Number of Children Table 4.4: Percentage distribution of the respondents having Children
Number of Children Combination of UrbanRural Total Total Percentage No (%) 13 6.5 76 38.0 75 37.5 21 10.5 10 5.0 5 2.5 200 100.0
Urban Frequency Percentag e (%) 7.0 43.0 34.0 11.0 2.0 3.0 100.0
Rural Freque ncy 6 33 41 10 8 2 100 Percentag e (%) 6.0 33.0 41.0 10.0 8.0 2.0 100.0
0 1 2 3 4 5 or more Total
7 43 34 11 2 3 100
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The Table 4.4 indicates the number of children of the respondents under study area. From this table, it is seen that in urban area 43% respondents have one children, 34% have two, 11% have three, 2% have four, 3% have 5 or more, whereas in rural area 33% have one children, 41% have two, 10% have three, 8% have four, 5% have five or more. In urbanrural perspective, from total 200 respondents highest 38% respondents have one child and second highest 37.5% respondents have two children. 4.5 Pattern of Delivery Table 4.5: Percentage distribution of respondents by pattern of delivery
Urban Delivery Pattern Normal Caesar Not Applicable Total No Percentage (%) 65 65.0 30 30.0 5 100 5.0 100.0 Combination of UrbanRural Percentage Total Total No (%) No Percentage (%) 86 86.0 151 75.5 8 8.0 38 19.0 Rural 6 100 6.0 100.0 11 200 5.5 100.0
Source: Household Sample Survey 2007-08 The Table- 4.5 represents the percentage distribution of the pattern of delivery of the respondents of both in urban and rural area. From this table, it is seen that in urban area 65% delivery is done by normal way and 30% by caeser. On the other hand, in rural area 86% delivery is done by normal way and 8% by caeser. In urban-rural perspective, from total 200 respondents 75.5% delivery is done by normal way and 19% by caeser. Eventually, it can be said that the percentage of normal delivery is more done than of caeser both in urban and rural area. 4.6 Place of Child Delivery Bangladesh's maternal mortality rate is among the highest in the world - 440 per 100,000 live births, according to UNICEF. A new report released in January by the Obstetrical and Gynecological Society of Bangladesh, states that more than 20,000 women in Bangladesh die annually from complications related to pregnancy and childbirth. The deaths are largely connected to lack of access to health care, which local obstetricians say is exacerbated by religious and cultural barriers. Dr. Rowshanara Khanam, a leading gynecologist, said women experiencing complications in their pregnancies often do not
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get to hospitals in time because of social taboos regarding women going outside the community and being treated by 'strangers.' The Obstetrical and Gynecological Society also says that even routine pregnancies are often put at risk because 90 percent of all deliveries in Bangladesh take place without trained medical attendants."(2002 Women's International Network). Table 4.6: Percentage distribution of respondents regarding place of child delivery
Urban Place of Child Delivery Home Hospital Clinic Non Applicable Total No 57 23 15 5 100 Percentage (%) 57.0 23.0 15.0 5.0 100.0 No 79 4 11 6 100 Rural Percentage (%) 79.0 4.0 11.0 6.0 100.0 Combination of Urban-Rural Total No 136 27 26 11 200 Total Percentage (%) 68.0 13.5 13.0 5.5 100.0
Source: Household Sample Survey 2007-08 Data of the Table-4.6 explicates that almost 68% births are delivered at home, 27% at hospital and 26% at clinic. The percentage of home delivery is high in Rural Area of 79% and in the case of Urban Area the rate is 57%. On the other hand Urban Area had made a considerable progress in the case of safe delivery. In the case, the percentage of hospital delivery is high in urban area of 23%; whereas in rural area the percentage is only 4%. 4.7 Delivered by Whom It is widely agreed that one of the most important health interventions useful in reducing maternal mortality is to have mothers deliver with a skilled birth attendant1 (Safe Motherhood, 2001). However, in Bangladesh, skilled attendants assist only 12% of births (doctors 7% and nurses, midwives, or family welfare visitors2 5%). Furthermore, almost 92% births are delivered at home, often in unsafe and unhygienic conditions. Traditional birth attendants (TBAs, locally called dais) assist 64% births. Again there are significant Rural-Urban differences, as professionally trained personnel attend 33% of births in urban areas, compared to only 8% in rural areas (NIPORT, 2001) .
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Table 4.7: Percentage distribution of the respondents considering personnel of

delivery. Personnel of Delivery Combination of UrbanRural Percentage Percentage Total Total Percentage No No (%) (%) No (%) 49 49.0 81 81.0 130 65.0 34 34.0 10 10.0 44 22.0 12 12.0 5 5.0 17 8.5 Urban Rural 5 100 5.0 100.0 6 100 6.0 100.0 11 200 5.5 100.0
Midwife Doctor Nurse Not Applicable Total
Source: Household Sample Survey 2007-08 The Table- 4.7 represents that in urban area 49% delivery of the respondents is done by midwife; 34% by doctor; 12% nurse. On the other hand, in rural area 81% delivery is done by midwife; 10% by doctor; 5% by nurse. From this Table, it is seen that the percentage of delivery by midwife is higher in rural than of urban area, that is, 81% in rural and 49% in urban area. Eventually, in urban-rural perspective, from total 200 respondents highest 65% delivery of the respondents is done by midwife. 4.8 Decision of Taking Children Bangladesh is a male dominated country. In the all spheres of life, male plays a vital role as a dominator. In the case of decision of taking children, males decision is considered as a pivot decision. Women are deprived of decision of taking children. Nevertheless, at present, this situation is being improved. Both husband and wife take decision in the taking in children. From this study, it is seen that 39% decision makers are both husband and wife.
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Table 4.8: Percentage distribution of the respondents of taking decision about children
Decision Makers No Husband Own Both Husband and Wife Mother in law Unwanted Pregnancy Infertile Total 35 8 39 2 11 5 100 Urban Percentage (%) 35.0 8.0 39.0 2.0 11.0 5.0 100.0 No 42 5 40 3 8 2 100 Rural Percentage (%) 42.0 5.0 40.0 3.0 8.0 2.0 100.0 Combination of UrbanRural Total Total No Percentage (%) 77 13 79 5 19 7 200 38.5 6.5 39.5 2.5 9.5 3.5 100.0
Source: Household Sample Survey 2007-08 The Table represents the percentage of decision makers in taking children under study area. From this table, it is seen in urban area that in the decision of taking children 35% respondents are husband, 8% are own (women or respondents), 39% both in husband and wife, 2% mother in law, 11% unwanted pregnancy; whereas in rural area in the decision of taking children, 42% are husband, 5% own, 40% both husband and wife, 3% mother in law, and 8% unwanted pregnancy. And in urban-rural perspective, from total 2oo respondents 39.5% are both husband and wife in decision of taking children.
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Chapter Five
Use of Birth Control Method and its effect on Reproductive Health: There are many types of birth control methods. These are condom, oral pill, injection and so on. These methods bring a lot of impacts on reproductive health of women which sometimes act as good or harmful on their health. 5.1 Use of Birth Control Method Table 5.1: Percentage distribution of the respondents using birth control method
Urban Category of Response yes No Total No Percentage (%) 65 65.0 35 35.0 100 100.0 No Rural Percentage (%) 60 60.0 40 40 100 100.0 Combination of Urban-Rural Total Total Percentage No (%) 125 62.5 75 37.5 200 100.0
Source: Household Sample Survey 2007-08 The Table- 5.1 represents the methods which are used by the respondents in birth control. From the data of the table, it is seen that in urban area 65% respondents use the birth control methods and 35% respondents abstain or do not use any kinds of birth control methods. On the other hand, in rural area 60% respondents use the birth control methods and 40% respondents abstain or do not use any kinds of birth control methods. In urbanrural perspective, from total 200 respondents, 62.5% respondents use the birth control methods and 37.5% respondents abstain or do not use any kinds of birth control methods. Eventually, it can also be said that the percentage of the respondents those who use birth control methods is higher in urban area than in rural area.
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Table 5.2: Percentage distribution of respondents using different types of birth control method
Category of Birth Control Method No Condom Oral Pill Injection Others No use Total 18 37 7 3 35 100 Urban Percentage (%) 18.0 27.0 7.0 3.0 35.0 100.0 No 5 40 13 2 40 100 Rural Percentage (%) 5.0 40.0 13.0 2.0 40.0 100.0 Combination of UrbanRural Total Total Percentage No (%) 23 11.5 77 38.5 20 10.0 5 2.5 75 37.5 200 100.0
Source: Household Sample Survey, 2007-08 The table-5.2 shows the various types of birth control methods. From this Table, it is seen that in urban area 18% use condom, 27% use oral pill, 7% use injection, 3% use others, 35% abstain from using any types of methods. On the other hand, that in rural area 5% use condom, 40% use oral pill, 13% use injection, 2% use others, 40% abstain from using any types of methods. In urban rural perspective, highest 38.5% use oral pill and lowest 2.5% use other methods. Eventually, it can also be said that the percentage of the respondents those who use various types of birth control methods is higher in urban area than in rural area. Table 5.3: Percentage distribution of the respondents taking decision of using birth control method
Decision Makers No Husband Own Family Planner Other(Dispensary) Both husband and wife No Use Total 27 5 6 4 23 35 100 Urban Percentag e (%) 27.0 5.0 6.0 4.0 23.0 35.0 100.0 No 25 3 6 0 26 40 100 Rural Percentage (%) 25.0 3.0 6.0 0.0 26.0 40.0 100.0 Combination of UrbanRural Total Total No Percentage (%) 52 26.0 8 4.0 12 6.0 4 2.0 49 75 200 24.5 37.5 100.0
Source: Household Sample Survey 2007-08 The Table -5.3 represents the decision makers who decide the using of the methods in birth control. from the Table, it is seen that in urban areas 27% decision makers of using
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birth control method is husband, 5% is own, 6% family planner, 4% other, 23% both husband and wife, 35% abstain from using birth control methods. On the other hand, in rural areas 25% decision makers of using birth control method are husband, 3% is own, 6% family planner, 0% other, 26% both husband and wife, 40% abstain from using birth control methods. Eventually, it can also be said that the percentage of the decision makers those who decide to accept various types of birth control methods is higher in urban area than in rural area. Table 5.4: Percentage distribution of respondents facing problems for using birth control method:
Category of Response Urban Percentage (%) 42.0 21.0 37.0 100.0 Rural Percentage (%) 25.0 30.0 45.0 100.0 Combination of Urban-Rural Total Total Percentage No (%) 67 33.5 51 25.5 82 41.0 200 100.0
No Yes No No Response Total 42 21 37 100
No 25 30 45 100
Source: Household Sample Survey 2007-08 The Table-5.4 represents the problems of the respondents which are created by using various types of birth control method. From this Table, it is seen that in urban area 42% respondents that they have faced many problems by the using of birth control method; said 21% do not face any problems; 37% have no response. On the other hand, in rural area, 25% respondents say that they have faced many problems by the using of birth control method; 30% do not face any problems; 45% have no response. In urban rural perspective, from total 200 respondents highest 33.5% say that they have faced many problems by the using of birth control method; 25% do not face any problems.
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Chapter Six
Social Relation and its Effects on Reproductive Health: 6.1 Unequal Social Relation among the Spouses and Its Effects on Reproductive Health: Unequal power relations between females and males lead to widespread violations of health and human rights (UNFPA). Women should get equal rights in their family arena but due to unequal power relations between husband and wife and the traditional patriarchal manners creates enormous problems in womens daily lives. Yet gender inequality remains pervasive. It is a public concern, but it also relates to private behavior, and therefore has not yet been fully discussed, especially where male dominance is the basis of family life. Elsewhere, though unequal restrictions on women may be outlawed or condemned, they persist in forms that have been rendered more socially acceptable. (The State of World Population, 2000) Table 6.1: Percentage distribution of the respondents facing problems for female childbirth
Urban Category of Response Yes No No Response Total No 42 31 27 100 Percentage (%) 42.0 31.0 27.0 100.0 Rural No 32 33 35 100 Percentage (%) 32.0 33.0 35.0 100.0 Combination of Urban-Rural Total No 74 64 62 200 Total Percentage (%) 37.0 32.0 31.0 100.0
Source: Household Sample Survey 2007-08 The Table-6.1 represents the problems of the respondents which are created due to female childbirth. From this table, it is seen that in urban area 42% respondents said that they have faced many problems for giving female childbirth; 31% do not face any problems; 27% have no response. On the other hand, in rural area, 32% respondents say that they have faced many problems for giving female childbirth; 30% do not face any problems; 45% have no response. And in urban- rural perspective, from total 200 respondents, highest 37% respondents say that they have faced many problems for giving female
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childbirth. Eventually, it can be said that the percentage of urban respondents those who facing problems for female childbirth is more high than rural respondents. 6.2 Types of Problems for giving female childbirth It is beyond belief that in our society women have to face problems due to female child birth. Conceive is not an easy thing; it is a sacred thing and in their pregnancy period mothers tolerate relentless pain and other things. But when after the birth of a female child, this mothers are tortured by their counterpart the things violate not only the human right but also the level of humanity. Table 6.2: Percentage distribution of the respondents facing different types of Problems for giving female childbirth
Type of Problems No Physical Torture Mental Torture Other No Response Total 8 30 2 60 100 Urban Percentage (%) 8.0 30.0 2.0 60.0 100.0 No 5 27 0 68 100 Rural Percentage (%) 5.0 27.0 0.0 68.0 100.0 Combination of UrbanRural Total Total Percentage No (%) 13 57 2 128 200 6.5 28.5 1.0 64.0 100.0
Source: Household Sample Survey, 2007-08 Table-6.2: represents the types of problems of the respondents for giving female childbirth. From this Table, it is seen that in urban area 8% respondents said that they have faced the problems of physical torture for giving female childbirth; 30% in mental torture; 2% in other types; and 60% have no response. On the other hand, in rural area, 5% respondents said that they have faced the problems of physical torture for giving female childbirth; 27% in mental torture; and 68% have no response. Eventually, in urban- rural perspective, from total 200 respondents highest 28.5% have faced the problem of mental torture, which is high in urban area than in rural area, that is, 30% in urban area and 27% in rural area.
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6.3 Forced by husband for sexual intercourse during pregnancy Women are always exploited by men in our male dominated society. They play the secondary role in household decision making process. Even during their pregnancy they are also compelled to sexual intercourse. Consequently, their health falls in danger. Table-6.3: Percentage distribution of the respondents forced by husband for sexual intercourse during pregnancy
Category of Response No yes No No Comments Total Urban Percentage (%) 51 51.0 46 46.0 3 100 3.0 100.0 No Rural Percentage (%) 46 46.0 53 53.0 1 100 1.0 100.0 Combination of Urban-Rural Total No 97 99 4 200 Total Percentage (%) 48.5 49.5 2.0 100.0
Source: Household Sample Survey, 2007-08 The Table-6.3 represents the percentage distribution of the respondents those who are forced by their husbands for sexual intercourse during their pregnant period. From this table, it is seen that in urban area 51% respondents said that they have been forced by their husband for sexual intercourse during pregnant period, 46% respondents have never been forced by their husband, and 3% respondents have no comments about this matter. On the other hand, in rural area 46% respondents say that they have been forced by their husband for sexual intercourse during pregnant period, 53% respondents have never been forced by their husband, and 1% respondents have no comments about this matter. In urban rural perspective, approximately same percentage of the respondents have commented on the category of response Yes and No thats are 48.5% and 49.5%. Eventually, it can be said that the percentage of the respondents forcing their husband is higher in urban area than in rural area.
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Chapter Seven
Reproductive Health Status of the Women during Pregnancy The reproductive period of women begin at menarche and end in menopause. It usually extends from 15-49 years. During their pregnancy, the following symptoms may occurCyclic bleeding may occur up to 12 weeks of pregnancy. Vomiting is started at any time during pregnancy. Morning sickness may appear during 8-12th weeks of pregnancy. The breasts are enlarged and contain milk during 6-8th weeks. Frequency of micturition is quite troublesome symptom during 80 days of pregnancy. Fatigue is a frequent symptom which may occur in pregnancy. Uterus straightens up after 12th weeks. Table 7.1: Percentage distribution of the respondents using sanitation pad during menstruation period
Category of Response Yes No No Response Total No 43 55 2 100 Urban Percentage (%) 43.0 55.0 2.0 100.0 No 27 70 3 100 Rural Percentage (%) 27.0 70.0 3.0 100.0 Combination of Urban-Rural Total Total Percentage No (%) 70 125 5 200 35.0 62.5 2.5 100.0
Source: Household Sample Survey 2007-08 The Table-7.1 represents the sanitation pad which is used by the respondents during their menstruation. From this Table, it is seen that in urban area 43% respondents have used sanitation pad during their menstruation period; 55% do not use sanitation pad; and 2% have no comments about this matter. On the other hand, in rural area 27% use sanitation pad; 70% do not use sanitation pad and 3% have no comments. In urban-rural perspective, from total 200 respondents 35% use sanitation pad and 62.5% do not use sanitation pad. Eventually, it can be said that the percentage of users of the respondents is higher in urban area than rural area.
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Table 7.2: Percentage distribution of the respondents involving sexual intercourse during menstruation
Category of Response Yes No Irregular No response Total No 17 74 7 2 100 Urban Rural Combination of Urban-Rural Percentage No Percentage Total Percentage Total No (%) (%) (%) 17.0 7 7.0 24 12.0 74.0 87 87.0 161 80.5 7.0 6 6.0 13 6.5 2.0 0 0.0 2 1.0 100.00 100 100.00 200 100.00
Source: Household Sample Survey, 2007-08 The table-7.2 represents the picture of sexual intercourse of the respondents during their menstruation. From this Table, it is seen that in urban area 17% respondents said that the category of Yes because they have regularly sexed with their partner, 74% respondents said that the category of No, 7% say the category of irregular and 2% have no response. On the other hand, in rural area 7% respondents say the category of Yes because they have regularly sexed with their partner during their menstruation, 87% respondents say the category of No, 6% say the category of irregular because they have to sex sometimes. In urban-rural perspective, total 24% respondents do sexual intercourse during menstruation and it can also be said that the percentage of the respondents those sex during menstruation is higher in urban area than in rural area. Table 7.3: Percentage distribution of the respondents facing problems at pregnancy
Types of Problem No Bleeding Headache Vomit Fever Others Various Problems Total 6 25 29 5 9 26 100 Urban Percentage (%) 6.0 25.0 29.0 5.0 9.0 26.0 100.0 No 3 15 50 3 3 26 100 Rural Percentage (%) 3.0 15.0 50.0 3.0 3.0 26.0 100.0 Combination of Urban-Rural Total No 9 40 79 8 12 52 200 Total Percentage (%) 4.5 20.0 39.5 4.0 6.0 26.0 200.0
Source: Household Sample Survey 2007-08 The Table-7.3 represents the percentage of the problems of the respondents during their pregnancy period. From this table, it is seen that in urban area, during pregnancy period
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6%have faced bleeding, 25% in headache, 29% in vomit, 55 in fever, and 26% in various problems ;whereas in rural area, during pregnant period 3%have faced bleeding, 15% in headache, 50% in vomit, 3% in fever, and 26% in various problems. In urban-rural perspective, from 200 respondents we have found that highest 39% respondents have faced vomit. Eventually, it can also be said that the percentage of the respondent in the problem of vomit is high in rural area than in urban area. Table 7.4: Percentage distribution of the respondents taking immunization at pregnancy
Category of Response No Yes No Total 97 3 100 Urban Percentage (%) 97.0 3.0 100.0 No 96 4 100 Rural Percentage (%) 96.0 4.0 100.0 Combination of Urban-Rural Total No 193 7 200 Total Percentage (%) 96.5 3.5 100.0
Source: Household Sample Survey 2007-08 The Table 7.4 represents the percentage of the respondents those who have taken immunization vaccine during their pregnant time, and those who do not take immunization vaccine during their pregnant time. From this table it seen that in urban area 97% respondents have taken immunization vaccine, and 3% do not take this
vaccine; where as in rural area, 96% respondents have taken immunization vaccine, and 4% do not take this vaccine. In urban rural perspective, from total 200 respondents highest 96.5% respondents have taken immunization vaccine during their pregnancy. Table 7.5: Percentage distribution of the respondents taking of extra food during pregnancy
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The Table 7.5 represents the percentage of the respondents under study area those who taking extra food during their pregnancy. From this Table it is seen that in urban area 52% respondents have taken extra food during their pregnancy period and 48% do not take of extra food during their pregnancy period; whereas in rural area 46%% respondents have taken extra food during their pregnancy period and 54% do not take of extra food during their pregnancy period. The percentage of the respondents taking of extra food, are high in urban area than in rural area. In urban-rural perspective, from total 200 respondents highest 51% respondents do not take extra food during their pregnancy. Table 7.6: Percentage distribution of the respondents doing regular household activities during pregnancy
Source: Household Sample Survey, 2007-08 The Table 7.6 indicates the percentage of the respondents those who regularly accomplish household activities during their pregnancy. From this Table, it is seen that in urban area 60% respondents have to accomplish household activities and 40% do not accomplish household activities regularly during their pregnancy; whereas in rural area 92% respondents have to accomplish household activities and 8% do not accomplish household activities regularly during their pregnancy. So it can be said that the participation of respondents in household activities in rural area is greater than in urban area. In urban-rural perspective, from total 200 respondents highest 76% respondents accomplish household activities regularly.
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Table 7.7: Percentage distribution of the respondents required health services from health personnel during pregnancy
Source: Household Sample Survey 2007-08 The Table 7.7 shows the picture of health service which is required during pregnancy. It is clear from field survey that 65% respondents get proper health service during pregnancy in urban area and 35% respondents do not get any proper health service in this area whereas 52% respondents enjoy proper health service facilities during their pregnancy and 48% respondents do not get proper health service facilities during their pregnancy in rural area. Eventually in urban-rural perspective, from total 200 respondents, highest 58.5% respondents get proper health care facilities and 41.5% respondents do not get proper health care facilities during their pregnancy period. So there is a difference in getting health care services both in urban and rural area during their pregnancy period.
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Chapter Eight
Psychological Barriers and Its Effect on Reproductive Health In pregnancy, there is hyperinsulinism and is marked particularly at third trimester which coincides with the peak concentration of placental hormones. However, despite the increase in postprandial insulin level, the fasting insulin concentration is reduced. Several anti-insulin factors operate during pregnancy. These include: Increased glucagons from cells of the langerhans of pancress. Increased glucocorticoid secreted by hyperactive adrenal cortex. Increased growth hormone elaborated by anterior pituitary and placenta (HPL) Degradation of circulating insulin by placental enzymes.
These changes or barriers affect on women reproductive health in their of taking daily meal, abortion, and other health problems. 8.1 Period of Taking Daily Meal Wives should take meal after the taking meal of their husbands, its a popular concept in Rural Area among the Aged Women. And in many cases especially in joint family the women become bound to take their meal after their husband. Data presented in the Table1 indicate that 21% women took their daily meal before their husband; 71% at later and 54% took their meal together with their husbands. Table 8.1: Percentage distribution of respondents taking daily meal
Urban Period of Taking Daily Meal Earlier Later Together Total No Percentage (%) 18 35 47 100 18.0 35.0 47.0 100.0 Rural No Percentage (%) 3 36 61 100 3.0 36.0 61.0 100.0 Combination of Urban-Rural Total Total No Percentage (%) 21 10.5 71 35.5 108 54 200 100.0
Source: Household Sample Survey 2007-08 In urban areas the percentage of taking daily meal before their husband was higher 18% than the rural area of 3%. Percentage of taking daily meal after the husband was almost
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same in rural and urban area. In urban area the percentage was 35% and in rural area the percentage was 36%. On the other hand taking meal at together was higher in rural area was higher 61% than the urban area of 47%. 8.2 Health Problems for More Children or Limited Time Space Millions of women in developing countries experience life threatening and other serious health problems related to pregnancy or childbirth. Complications of pregnancy and childbirth cause more deaths and disability than any other reproductive health problems (EC/UNFPA, 2000 ). The situation is worse in developing countries like Bangladesh due to inadequate access to modern health services and poor utilization. (Nitai Chakraborty, M. Ataharul Islam, Rafiqul Islam Chowdhury, Wasimul Bari and Halida Hanum Akhter.) Table-8.2: Percentage distribution of respondents facing problems for more children or limited time space
Period of Taking Daily Meal Urban No Percentage (%) 18 51 31 100 18.0 51.0 31.0 100.0 Rural No Combination of Urban-Rural Percentage Total Total (%) No Percentage (%) 27 27.0 45 22.5 43 43.0 94 47.0 30 100 30.0 100.0 200 61 100.0 30.5
Yes No Not Applicable Total
Source: Household Sample Survey 2007-08 Data of Table-8.2 clarify that 22.5% of women had to face physical problems for conceive more children or get limited time space for conceive; 47% respondents didnt face this type of problems and this question was not applicable for 30.5% of total Respondents. In urban-rural perspectives rural women were greater in number. In rural area 27% respondents had to face the problem and in urban area the figure was only 18%. That means the rate of single children was higher in urban area than the rural area. 8.3 Abortion Abortion is the termination of pregnancy before the period of viability which is considered to occur at 28th weeks. 75% abortions occur before the 16th weeks and 75% abortions occur before the 8th weeks.
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In South Asia, three women die every hour from unsafe, often illegal abortions - some 29,000 every year. Unsafe abortion is the leading cause of maternal mortality in Sri Lanka. In Bangladesh, where most abortions are illegal, 200 women a day are hospitalized for abortion-related complications. (Common Reproductive Health Problems in South Asia, 2004). In 1995-96, there were 3.8 legal abortions per thousand women aged 15-44 in Bangladesh. About 3.1% of the pregnancies were legally resolved by abortion. On the other hand there were 28 illegal abortions per thousand women aged 1544 and 18% pregnancies were aborted illegally (Henshaw, et. al., 1999). There were also some extramarital abortions in Bangladesh. According to some adhoc survey/hospital records in 1991 3.3% of the abortions in Bangladesh were extramarital (Bankole, et. al., 1999) Table-8.3: Percentage distribution of respondents doing abortion
Source: Household Sample Survey, 2007-08 Data presented in the Table-8.3 explicates that 22% of total respondents were aborted after marriage and abortion has not happened in the case of 78% of total Respondents. Now if we look at the urban-rural perspectives then the data reveals that the rate of abortion was higher in urban area than the rural area. In urban area the rate of abortion was 25% but in rural area the rate was only 19%. 8.4 Causes of Abortion There are many causes or factors which are responsible for abortion. These are maternal illness, maternal hypoxia and shock, chronic illness like hypertension, toxic agents like lead, arsenic, tobacco, alcohol, and incompatible ABO blood group, deficiency of folic acid or Vitamin E and so on. Studies suggest in most of the cases financing the pregnancy termination, particularly the complications, was also a male role (Hossain et al., 1997; Rob and Piet-Pelon, 2001).
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Table-8.4: Percentage distribution of respondents by causes of abortion

causes of abortion No Female child birth Forced by Husband Physical Problem Non applicable Total 13 7 5 75 100 Urban Percentage (%) 13.0 7.0 5.0 75.0 100.0 No 2 3 14 81 100 Rural Percentage (%) 2.0 3.0 14.0 81.0 100.0 Combination of UrbanRural Total Total Percentage No (%) 15 10 19 156 200 7.5 5.0 9.5 78.0 100.0
Source: Household Sample Survey 2007-08 The Table-8.4 elucidates that 7.5% pregnancies were aborted due to Female Childbirth; 5% pregnancies were aborted due to the pressure of respondents husband and 9.5% for physical problems of the respondents. From Table-4 it is also evident that in urban area 13% pregnancies were aborted due to female childbirth and the reason behind this was the desire of son among the respondents family members. The percentage of abortion for female childbirth was lower in rural area and that was only2%. The reason behind this was the less medical access and low level of economic solvency. Data of Table-8.4 also indicates that pressure of husband for abortion was 7% in urban area and that was higher than the Rural Area of 3%. The percentage of abortion for physical problem was 14% in rural area and that was higher than the urban area of 5%. In most cases the women had no choice over abortion. They were forced by their husband for abortion and the main reason was conceive of female childbirth. As they had no control over decision making process in household dynamics, the women were forced to obey the order of their husbands. This indicates the clear gender discrimination over the reproductive health of women.
36
Chapter Nine
Knowledge of the Women about Gender Inequality 9.1 Gender Consciousness Level of Women about Gender Inequality Gender refers to a set of qualities and behaviors expected from a female or male by society. Gender roles are learned and can be affected by factors such as education or economics. They vary widely within and among cultures. While an individual's sex does not change, gender roles are socially determined and can evolve over time. Gender roles and expectations are often identified as factors hindering the equal rights and status of women with adverse consequences that affect life, family, socioeconomic status, and health. (Department of Education, Training and the Arts, 2002). Table-9.1: Percentage distribution of respondents having knowledge of gender i inequality Category of Response Urban No Rural Percentage No (%) Combination of Urban-Rural Percentag Total Total e No Percentage (%) (%) 30 30.0 72 36.0 61 61.0 114 57.0 14 9 9.0 7.0 100.0 200 100.0
Yes 42 42.0 No 53 53.0 No 5 5.0 Response Total 100 100.0 100 Source: Household Sample Survey, 2007-08
The Table-9.1 Explicates that among 200 Respondents only 36% had the knowledge about gender inequality.57% had no knowledge about gender inequality and 7% of total respondents didnt give any response. On the other hand in urban-rural perspective, the knowledge about gender inequality was higher among the Respondents of urban area. In urban area among the 100 respondents, 42% had the knowledge of gender inequality and in rural area only 30% respondents had the awareness of gender inequality. In urban area 53% respondents had no knowledge about gender inequality and in rural area 61% respondents had no knowledge on the particular issue. Respondents of urban area were more aware about gender inequality because in urban area the literacy rate was higher than the rural area. It is also mentionable that in urban area the access of electronic media
37
was higher than the rural area but as a whole the level of knowledge about gender inequality was still lower among the women of study area. The discriminatory attitude against women, rooted in the family and extends to the state level, should be ended. Because of the constraints from the family, society and thesState in general, Bangladeshi women are not aware of their rights. And even if some of them become aware of their rights, they still would not assert them due to the "ingrained unexpected continuity" (i.e., the traditional belief of keeping women under the shadow of somebody such as their fathers or husbands). 9.2 Decision Making Power of the Women at Household Activities Gender inequality holds back the growth of individuals, the development of countries and the evolution of societies, to the disadvantage of both women and men. The facts of gender inequalitythe restrictions placed on women's choices, opportunities and participationhave direct and often malign consequences for women's health and education, and for their social and economic participation. Yet until recent years, these restrictions have been considered either unimportant or non-existent, either accepted or ignored. The reality of women's lives has been invisible to men. This invisibility persists at all levels, from the family to the nation. Though they share the same space, women and men live in different worlds. (The State of World Population, 2000) Table-9.2: Percentage distribution of Respondents having decision making power at household activities.
Category of Response Urban No Percentage (%) 51 45 4 100 51.0 45.0 4.0 100.0 Rural No Percentage (%) 32 56 12 100 32.0 56.0 12.0 100.0 Combination of Urban-Rural Total Total No Percentage (%) 83 41.5 101 50.5 16 8.0 200 100.0
Yes No No Response Total
Source: Household Sample Survey 2007-08 The Table-9.2 clarifies that the respondents of study area shared a low level of decision making power at the household dynamics. Among 200 respondents only 41.5% had the decision making power in their family actions and almost 50.5% Respondents had no decision making power over household dynamics. On the other hand in urban-rural
38
perspectives the rural women were in vulnerable position. Most of them were illiterate and out of income as a result their husbands ignored their view about family actions. In rural area only 32% respondents shared the decision making power and 56% were deprived from this authority. In urban area women shared the better privileges than the rural women. The percentage of sharing decision making power was 51% and the nonshared percentage was 45%in urban area. 9.3 Health Facilities during Illness Maternal health status for many Bangladeshi women remains poor. Around 50% of Bangladeshi women suffer from chronic energy deficiency. Over 43% of the pregnant women are iodine deficient and more than 2.7% develop night blindness during pregnancy (Bangladesh Demographic Health Survey (BDHS) 2001). Despite very low level of the use of antenatal and skilled care at birth, the situation in respect of Tetanus Toxoid vaccination among women is much better. About 81% of mothers who gave birth during 1995-1999 received Tetanus Toxoid vaccination (BDHS 2001). Bangladesh has a high maternal mortality ratio (MMR). The high MMR directly relates to the high prenatal (newborn) mortality rate in the country. The estimated lifetime risk of dying from pregnancy and childbirth-related causes in Bangladesh is around 100 times higher than that in developed countries. Table-9.3: Percentage distribution of respondents getting health facilities during illness
Category of Response No Yes No Total 46 54 100 Urban Percentage (%) 46.0 54.0 100.0 No 38 62 100 Rural Percentage (%) Combination of Urban-Rural Total No Total Percentage (%) 42.0 58.0 100.0
38.0 84 62.0 116 100.0 s200
Source: Household Sample Survey 2007-08 The Table-9.3 explicate that the women have less access on health related phenomena. During their illness they didnt get the proper health facility in time. Data of the Table-9.3 make clear that only 42% of total respondents had got medical facilities during their illness and 58% had not got the medical facility during their illness. On the other hand in urban-rural perspective data of Table-9.3 elucidates that urban women were shared little
39
bit of more facilities during their illness period than the rural women. In urban area 46% respondents had got the medical facilities during their illness period and in rural area the rate was only 38%. That means in rural area almost 62% Women didnt get the medical facility and in urban area the figure of deprived women were 54%. This reminds that more than half of the total women of study area had no access of getting health facilities during their illness and this creates a huge impact on their reproductive health.
40
Chapter Ten
Findings, Recommendations and conclusion: 10.1 Findings:
The findings of this study explicate that the majority of the women of study area, based on sample investigated, were not aware of the concept of gender inequality because of traditional beliefs kept them in the shadow of their fathers and husbands. From the analysis of data it comes clear that the term gender inequality has a clear effect on the reproductive health of the women of study area. Data reveals that almost half of the total respondents were illiterate or contain low level of education. 69 percent respondents were married before the age of 18 and they had no preference over the decision of marriage. 58 percent of the total respondents are engaged in household activities and mainly they depend on the income of their husband, respondents who earn money has a little control over the income. As a result they have less access on decision making process of household activities and even they have no control over their own body. A larger portion of respondents do not get medical facility during illness, they didnt get proper rest at their pregnancy period.47.5 percent respondents didnt get extra food during pregnancy. Almost 76 percent respondents had to perform regular household activities during their pregnancy, and 41.5 percent respondents didnt get proper medical facility from the health personnel. On the other hand 58 percent respondents viewed that they didnt get medical facility during illness. 62 percent respondents use contraceptive techniques and 41.5% decision was taken by their husband. 33.5 percent respondents argued that they faced problems due to use birth control method. 80 percent of total delivery was placed at home and 68.35 percent delivery was assisted by traditional birth attendants (Dai) but in rural area it happened for 85.1 percent cases. Abortion was happened for 22 percent of total respondents and it is astounding that due to conceive of girl child 13 percent respondents were forced by their husband to make abortion. Data also reveals that 48.5 percent respondents were forced to engage in sexual intercourse and this created health hazard for them. It is also astounding that 37percent respondents were faced problems due to first childbirth of girl. These are the ultimate scenery of the reproductive health situation of the respondents of study area and the effect of gender inequality on
41
reproductive health. Now the overall findings are portrayed in the below under the heading of particular chapter.
Findings of the study have started from the chapter three. In this chapter, historical background of the study area, the overall identity of the respondents such as age, religion, education, occupation, family types are illustrated briefly. The study area includes two villages from Satkhira district and two wards from Khulna city. Respondents from different age group were selected for the study purpose and highest 32.5 percent respondents belonged to the age group of 27-32. In urban area highest 34 percent of total respondents belong to the age group of 27-32 and lowest 2 percent of total respondents belong to the age group of 45-49. On the other hand in rural area 31 percent of total respondents are in the age group of 27-32 and there is no respondent in the age group of 45-49. From religious point of view 62.5 percent are the follower of Islam and 35.5 percent are the follower of Hindu religion. Among 200 respondents 32.5 percent are illiterate, and 19 percent have finished their secondary education, the percentage of higher education is very low. Data also reveals that illiteracy rate is higher in rural area than the rural area and there is no higher educated respondent in rural area. From occupational point of view highest 52 percent respondents were engaged in household activities and only 9 percent were service holder. Data also reveals that there is no service holder in rural area and 34 percent respondents were involved in pottery. Among the total respondents 71 percent belonged to the nuclear family and 29 percent respondents belonged to the joint family. In rural area joint family is seen more than the urban area. In chapter four under the heading of Reproductive Health and Gender respondents age at marriage, decision makers at marriage, total number of pregnancy after marriage, total number of children, decision of taking children, pattern of delivery, place of child delivery, delivery personnel are briefly described. From the analysis of data it comes clear that most of the respondents were engaged in marriage before the age of 18 and only a limited portion was married in matured age. In the decision of marriage most of respondents had no choice and in the decision of marriage parents played a dominant role. It is also evident that in rural area parents were decided 90 percent marriages whereas in rural area parents were decided 62 percent marriages. From this we can easily assume the nature of gender inequality practiced in patriarchal society. Data also reveals that in decision of taking children respondents had a limited role. In most cases
42
respondents husband took the decision and even unwanted pregnancy was happened for few cases. Normal delivery was happened in most cases than the caesarian delivery. Data also reveals that Percentage of caesarian delivery was higher in urban area than the rural area. The delivery of a baby is an important phase of the reproductive cycle of the pregnant women. Data reveals that that almost 72 percent births were delivered at home, 14.3 percent at hospital and 13.7 percent at clinic. It is widely agreed that one of the most important health interventions useful in reducing maternal mortality is to have mothers deliver with a skilled birth attendant but it is astounding that 68.35 percent births were assisted by the traditional birth attendants (locally called Dais). In urban-rural comparison, data indicates that in rural area 85.1 percent births were assisted by the traditional birth attendants and in urban area 51.6 percent births were assisted by the traditional birth attendants. From this we can clearly assume that respondents have a limited control over their reproductive health and even in the case of child delivery.
In chapter five under the heading of Use of Birth Control Method and Its Impact on Reproductive Health different variables such as use of birth control method, type of birth control method, decision of using birth control method, problems due to use birth control method are illustrated. From the analysis it is evident that birth control method has an adverse effect on the reproductive health. In my study area 62.5 percent respondent use birth control method and most of the technique are applied to the women as a result this created health hazard for them. Data also reveals that in the use of birth control method women didnt take the decision, most of the decision came from their husband.
In chapter six under the heading of Social Relation and Its Effects on Reproductive Health problems due to birth of first child girl, types of problem, forced by husband for sexual intercourse during pregnancy, and its effects are illustrated briefly. From the analysis it is evident that 37 percent of total respondents were faced problems by their husbands and other members of the family due to female child birth. Data also reveals that urban women were faced problems greater than the rural area and the women had nothing to do. And this indicates the chronic effect of gender inequality. Due to give birth of female child 6.5 percent respondents were faced physical torture by their male counterpart due to first female childbirth. Mental torture was more than the physical torture. 28.5 percent of total respondents were faced mental torture by their male counterparts as well as the other members of the family. Data indicates that 48.5 percent
43
respondents were forced by husband to engage in sexual intercourse during pregnancy and due to this forced sexual intercourse respondents had to face different kinds of physical and mental problems.
Chapter seven has started with the heading Reproductive Health Status of the Women during Pregnancy. Data reveals that menstruation is a natural event, affecting women and girls of reproductive age. For most women it occurs once a month and in the menstruation period using sanitation pad is essential. But in the study area 62.5 percent respondents do not use sanitation pad and in rural area most of the respondents viewed that they use a piece of cloth which is not healthy. In the menstruation period, 12 percent respondents were involved in sexual intercourse. Pregnancy period is a critical phase of married women and in this period if they do not get proper facility then it creates health hazard for them. Data reveals that the respondents of study area were faced a variety of problems including bleeding, headache, vomit, fever etc. Immunization is an important aspect of physical wellbeing of a pregnant woman because it helps to protect her from few diseases and in this sector I have found a tremendous success. Almost 96.5 percent of total respondents had immunized during their pregnancy. Taking of extra food during pregnancy period is an essential part of the reproductive health of women because if the pregnant women are not able to take extra food then it creates enormous problem for their overall health condition. Data reveals that 47.5 respondents didnt take extra food during their pregnancy period and the percentage of not taking extra food was higher in rural area than the urban area. It is astounding that among 200 respondents; 76 percent had to perform their regular household activities in their pregnancy period. In this case rural women suffered more than the urban women and due to gender inequality the affected women were forced to perform regular household activities. Required health services from health personnel during pregnancy is an important aspect of reproductive health and in my study area 41.5 percent respondents didnt get required health services. Data of this chapter reveals that in the pregnancy period the overall reproductive health situation of the respondents was not so good. As they have no control over the economic field and family arena they didnt get the proper facility on their will.
Chapter eight has started with the heading of psychological barriers and its effect on reproductive health. Data reveals that indicate that 21 percent women took their daily meal before their husband; 71 percent at later and 54 percent took their meal together
44
with their husbands. Millions of women in developing countries experience life threatening and other serious health problems related to pregnancy or childbirth. In the study area 22.5 percent of total respondents had to face physical problems for conceive more children or get limited time space for conceives. Safe abortion is an important aspect of reproductive health and in the study area 22 percent of total respondents were aborted after marriage and in most cases the women had no choice over abortion. They were forced by their husband for abortion and the main reason was conceive of female childbirth. As they had no control over decision making process in household dynamics, the women were forced to obey the order of their husbands. This indicates the clear gender discrimination over the reproductive health of women.
In chapter nine it is tried to seek out the gender consciousness level of the respondents and data reveals that 57 respondents had no knowledge about Gender Inequality and 7 percent of total respondents didnt give any response. The level of knowledge about gender inequality is still lower among the women of study area and the discriminatory attitude against women, rooted in the family and extends to the State level, should be ended. The facts of gender inequalitythe restrictions placed on women's choices, opportunities and participationhave direct and often malign consequences for women's health and education, and for their social and economic participation. In the study area among 200 Respondents only 41.5 percent had the decision making power in their family actions and almost 50.5 percent respondents had no decision making power over household dynamics. This indicates the ultimate nature and extent of gender inequality. Women have less access on health related phenomena. During their illness they didnt get the proper health facility in time. In the study area 58% respondents didnt get the medical facility during their illness. The above mentioned circumstances indicate the manifest effect of gender inequality on the reproductive health of married women of the study area.
45
10.2
Recommendations:
By considering the reproductive health situations of the study areas, some recommendations are given bellowRecommendations made by CEDAW: The Convention on the Elimination of all the forms of Discrimination Against Women (CEDAW) have some recommendations. These areWithdrawal of reservation to articles 2 and 16-1(c) from CEDAW as early as possible. Increased awareness raising program among the people about The Convention on the Elimination of all the forms of Discrimination Against Women. Reform child marriage in current country context. To motivate women and female child for greater participation in education. To increase women participation in the public sector decision making both at national and local level. To raise the productivity and income opportunity of female labour force through skill development and training. To reduce population growth at a faster rate through enhancement of socioeconomic status of women. To reduce substantially the male-female literacy gap. To raise female nutrition level and improve provision of health service to women. To enhance the participation of women in nitrition based agriculture and maintenance of ecological balance. To ensure participation of poorer 50 percent women in the development process mere effectively. Recommendation made by the ICPD, Caro94: Safe Motherhood : To reduce the maternal mortality and improve the overall reproductive health status of women, Bangladesh government should take an extensive program, The major activities aimed at maternal health focus on awareness about and access to contraceptive methods; antenatal care (Tetanus immunization, iron folic acid
46
supplementation, nutrition education); promotion of safe delivery practices by skilled birth attendants. Family Planning Services: Family Planning is an important component of reproductive health Family Planning can help to reduce the incidence of high risk birth of the mothers by spacing and limiting the number of children. So government should strengthen this program by the skilled personnel. Prevention and Control of RTIs, STDs and HIV / AIDS: Government has to emphasis on RTI and STD case management and treatment and prevention of HIV and AIDs. The government should take a country wide program with the aim of creating awareness among the people on HIV / AIDs and imparted training to all level of service providers. Adolescent Care: Since the national family Planning program targets eligible couples especially married women between 15 to 49 years, many of these adolescents are not receiving education and services of their reproductive health. So government has to identify the problems of adolescent. Promotion of Maternal Nutrition: The traditional biological demands due to menstruation, pregnancy and lactation have made nutritional deficiency most widespread among the girls and women. The Government should strong emphasis on maternal nutrition. Gender Issues: The important issues, where attention should be needed for ensuring reproductive health, are elimination of discrimination on gender. As women constitute almost half of the Bangladesh population, have little opportunity to enjoy equality. Less participation in the economic activities carry a disproportion burden of poverty, illiteracy, malnutrition and ill
47
health. So, to accelerate the total socio economic development and promote the reproductive health of women Bangladesh should give importance on gender issue aspect. Other recommendations: Considering the high unmet need for Reproductive Health (RH) information and services, the deplorable situation of the married women and the socio-cultural conservatism that prevails in the country, the following recommendations are: 1. The government set up a task force which would propose appropriate legal amendments, within a stipulated time frame, to make laws consistent with the provisions of the constitution. 2. Print media have capacity to promote women rights- issues thats why newspaper editors can allocate a page for women. 3. Gatekeepers, formal and informal community leaders, and religious leaders at all levels need to be motivated and trained on reproductive health and gender issues. 4. Additional support should be provided to catalyze increased knowledge and attitudinal and behavioral change among service providers with regard to reproductive health. 5. Service providers at all levels should be trained on reproductive health. 6. An effective referral system should be developed. 7. Special training should be conducted for male and female at community clinics, satellite clinics, family welfare centers, and Thana health complexes. 8. Female family life education curriculum needs to be developed. 9. Increased networking between all relevant government organizations and NGOs working with women should be encouraged to ensure the proper implementation of projects. 10. Female doctors need to be deployed for the provision RH services to women. 11. Counseling services for the male and female need to be arranged. 12. Behavior change communication and IEC materials need to be developed and distributed in collaboration with multisectoral agencies. 13. The government and NGOs should help to provide vocational training on various trades and provide loans for income-generation activities for women. 14. The Ministry of Health and Youth Directorate could assist in conducting training to peer educators and partner NGOs.
48
15. Innovative strategies should be developed and implemented to deal with culturally sensitive to reproductive health issues that require winning the confidence and desensitization of cultural gatekeepers (e.g., mothers and sistersin-laws, parents, grandparents, village and community leaders, council chiefs, and religious/opinion leaders). 16. The feasibility of linkages with existing activities for an integrated approach to service delivery and adolescents involvement in service planning and evaluation should be examined. 17. 18. Both the governments and NGOs experiences in reproductive health project implementation (e.g., networking and partnership-building, formation of advisory or management committees involving adolescents, and best practices) should be studied and replicated. 18. Needed gender and development training for government official especially police, administration and judiciary cadre. 19. Bangladesh needs to urgently design schemes for compensation, insurance or Safety nets for women workers.
49
10.3
Conclusion:
The problem of gender inequality is a worldwide phenomenon, especially in the developing countries and it is very threatening for the development of these countries like Bangladesh. This paper analyzes the impact of gender inequality on reproductive health in some selected areas such as two wards-24 and 25 from Khulna City name Nirala and Gallamari and two villages from Tala Thana at Satkhira district name Sujanshah and Ghona. In these study areas, gender inequality has brought a lot of problems or threats in women especially on their reproductive health. These are early marriage, repeated pregnancy, and long child bear spans, excessive sexual intercourse, taking several birth control methods and low nutritional food, malnutrition, getting low health care facilities and so on. Besides, unrepresenting in the decision making process, unemployment and having restricted access to productive resources and social support systems have created heavy mental pressures in women which lead them to many problems in the long run in their reproductive health. These inequalities are the impediments of our countrys development. Without removing these inequalities, the development of our country is not possible. So everyone must be tried to reduce these inequalities and should recall that if they are left out of the mainstream of development activities, our nation will not be able to prosper to all, and the words of Kazi Nazrul Islam, What is the wonderful achievement in the world has been half done by women and the rest half by men is considered as a false opinion.
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References
BIBLIOGRAPHY
ADB (2001) Women in Bangladesh: Country Briefing Paper. Manila: Asian Development Bank. Amin, S. & Pebley, R.A. (1994) Gender Inequality within Households: the Impact of a Womens Development Programme in 36 Bangladeshi Villages,The Bangladesh Development Studies, XXII (2 & 3): 121-152. Barkat, A. and N. Ahmed. 2001. Human Poverty and Deprivation in Bangladesh: Lack of Substantive Freedom and Eradication Possibilities. Presented at a Workshop, organized by DLB, Engelskirchen, Germany: September 1, 2001. Dutta, D.C (1983). Text Book of Obstetrics, Kolkata: New central book agency, fourth edition, p-165 Hadi, A. (2001) Effects of the Productive Role of Bangladeshi Women on Their Reproductive Decisions. Asia-Pacific Population Journal, 16 (4): 1-14. Islam, M. (2000) Women Look Forward p. 4, in: M. Ahmad (ed.) Bangladesh in the New Millennium. Dhaka: Community Development Library. Islam, M.M. & Hasan, A.H. (2000) Mass Media Exposure and its Impact on Family Planning in Bangladesh, Journal of Biosocial Science, 32 (4): 513-526. Mahmud, Simeen and Anne M. Johnston. 1994. Women's Status, Empowerment andReproductive Outcomes. In Gita Sen, Adrienne Germain, and Lincoln C. Chen (eds.), Population Mannan, M.A. (2002) Violence against Women: Marital Violence in Rural Bangladesh, CPD-UNFPA Paper Series No. 20, Programme on Population and Sustainable Development, Dhaka. Ministry of Finance (MOF). 2000. Economic Survey, 1999-2000. New Delhi: Economic Division.
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References
Ministry of Health and Family Welfare (MOHFW). 1991. Family Welfare Programme in India:Year Book, 198990. Dhaka: Department of Family Welfare, MOHFW. Monsoor, T. (1999) From Patriarchy to Gender Equality: Family Law and its Impact on Women in Bangladesh. Dhaka: The University Press Limited. Popkin BM. Time allocation of the mother and child nutrition. Ecol Food Nutrition 1980; 9(1): 1-14. Population Council. 1999. Reproductive tract infections: A set of factsheets. Bangkok: Population Council. Sen, Gita and Srilatha Batliwala. 1997. Empowering women for reproductive rights: Moving beyond Cairo. Paper presented at the Seminar on Female Empowerment and Demographic Processes: Moving Beyond Cairo, IUSSP, Lund, Sweden, 21 24 April. Seshadri, Subadra. 1997. Nutritional Anaemia in South Asia. In Stuart Gillespie (ed.), Malnutrition in South Asia: A Regional Profile. Kathmandu: Regional Office for South Asia,UNICEF. Siddique, A.R.(2003) Women Poverty and Reproductive Health: Reflections on the Rural scene of Bangladesh, Women Health and Poverty, Higher education link program, Department of Sociology, University of Rajshahi ( Rajshahi: Uttaran offset printing press) Tabutin, Dominique and Michel Willems. 1995. Excess female child mortality in the developing world in the 1970s and 1980s. Population Bulletin of the United Nations 39:4578. White K, Otero M, Lycette MA, Buvinic M. Integrating women into development programmes: A guide for implementation for Latin America and the Caribbean. Paper prepared for U.S. Agency for International Development, Bureau for Latin America and the Caribbean. Washington, DC: International Centre for Research on Women, 1986.
52
Appendix-A
Ward map of Khulna City no: 24
Ward map of Khulna City no: 25
xiv
Appendix-B
QUESTIONNAIRE Schedule No.
Date 1. Identity of Respondent: Name-----------------------------------------------------------------------------------------Age(in year)---------------------------------------------------------------------------------Union-----------------------------------------------------------------------------------------Mauza----------------------------------------------------------------------------------------House Hold No.(HHN) Religiona Islam b Hinduism c Christianity d b Buddhism e Others
1.7 Family type:
nuclear
joint/ extended
1.8 Educational status: a e Illiterate b H.S.C f primary level(1-5) c Graduate g secondary level( 6-10) d Vocational S.S.C
Postgraduate h
i Others (please specify) 1.9 occupations: a e Service b business c agriculture d multifarious works
Others (please specify)
xv
Appendix-B
1.10 Information of family members: SL. NO. Name Age Relation with Educationalqualification occupation Annual the head of income(intaka) the family
A. Social dimension of the effect of gender inequality on reproductive health:

1. When did you get married? -----------------------------------------------------------------------------------------------------------2. Did you have the consent to get marry?
a.
Yes
b.
No
3. When did you get pregnant at the first time? --------------------------------------------------4. How many times have you become pregnant? ________________________________________________________________________ 5. Do you have any children? a. Yes b. No
6. How many live children do you have? -------------------------------------------------------7. Please tell the delivery condition of your childbirth. a. Caesar b. normal delivery c. other 8. Please, tell the birth interval from one child to another. _____________________________________________________________________
9. Whose decision was important to have children?
xvi
Appendix-B
a. b. c. d. e.
husband mother-in-law Your both you and your husband others
10. Do you use any contraceptive methods to control birth? a. b. Yes b. No
If yes11. Which type of contraceptive methods is used more? a. condom b. oral pills c. injection d. others 12. Who takes the decision to use contraceptive methods?
13. From where you collect the birth control methods? a. clinic b. store of medicine c. Health worker d. others(please specify). 14. Do you face any problems after using contraceptive methods? a. Yes b. No
15. If yes, what types of problems?_______________________________________________ 16. Is there any organization to provide counseling and information education concerning reproductive health? a. Yes b. No
If yes17. What types of organization?
18. Do you think it is necessary? a. Yes b. No
If yes why? xvii
Appendix-B
19. Do you go to the medical centre to solve health problems? a. b. Yes No If yes, 20. Is it sufficient for you? (Please specify) ________________________________________________________________________
21. Do you face any problem for female childbirth? a. Yes b. No
If yes--22. What types of problems, are you facing?
23. Did your husband force you to involve in sexual activities during pregnancy? a. Yes b. No
If yes----24. Please narrate the problems you face due to this exercise. ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________
25. Do you face any religious prohibitions to exercise reproductive rights? (Please specify)
26. Do you have any knowledge about gender inequality and reproductive health? a. Yes b. No
27. Do you face any problem to gather the knowledge? (Please specify) ___________________________________________________________________
B. Economic dimensions of the effect of gender inequality on reproductive health:
xviii
Appendix-B
1. Are you involved with job? a. Yes b. No
a. If yesa.1. What types of job do you perform?
b. If nob.1. What is the source of your income?
b.2 . Is it sufficient to solve your health problems? a. Yes b. No
b.3. If no, please narrate the problem you face due to this insufficiency. ________________________________________________________________________ ________________________________________________________________________
2. Do you get the proper maternal health related facilities from the organization where you serve?
C. Health dimensions of the effect of gender inequality on reproductive health:
1. Do you know what menstruation is? ________________________________________________________________________
xix
Appendix-B
2. How many interval times does menstruation need to start from one to another?
3. How many days menstruation contains?
4. Do you have the access to use sanitation pad during menstruation period? a. Yes b. No
5. Is it possible to perform sexual union during menstruation? a. Yes b. No
If yes6. Do you face physical problem if sexual intercourse is performed during menstruation? a. Yes b. No
If yes----7. What types of problems are observed? a. physical b. mental c. both 8. Did you ever face irregular menstruation problem?
9. Please tell the proper time to have conceived. a. Earlier ten days from the starting of menstruation b. Middle ten days from the starting of menstruation c. Last ten days from the starting of menstruation d. No answer 10. Do you face sexual desire after starting menopause?
a Yes
No
b.No
xx
Appendix-B
11. Please give your opinion about the sexual restrain after conceiving. a. first three months b. last two months c. during pregnant d. above two
12. There are seen five desiring problems at the pregnancy period. If you know, please tell these. a. bleeding b. headache c. fever d. vomit e. convulsion
13. Do you face unwanted sex that has bad effect on reproductive health? a. Yes b. No c. No response
14. Do you get the proper food during the time of pregnancy? ________________________________________________________________________ 15. Did you face any problem related to reproductive health? a. Yes If yes16. What types of problem? b. No
17. Do you get the sufficient food from your family after delivery?
18. Do you think the house is comfortable for your living where you are? a. Yes b. No
If no 19. What types of problems do you face in your living place? 1. broken house 2. not to have ample lighting 3. ragging bed 4. unhygienic sanitation xxi
Appendix-B
5. damp floor 6. lack of security 7. others 20. What types of requirements do you need at the time of pregnancy?
21. Is it sufficient for you? a. Yes b. No
If no22. Please, narrate the problems. a. food b. healthcare c. sanitation d. housing e. others( please specify) 23. Where do you have access to go at the time of delivery? a. government hospital b. private clinic c. own home d. others 23. Please, tell about the prenatal and postnatal cares that have been served to you from your family. ________________________________________________________________________ ________________________________________________________________________ 24. Please, mention your household sanitation facilities. a. open latrine b. flash toilet c. semi-latrine d. others 25. Do you have any habit to use tobacco, alcohol etc? a. Yes b. No
26. Have you ever aborted? a. Yes b. No c. No comments
if yes--27. What is the reason behind this? ________________________________________________________________________ ________________________________________________________________________ xxii
Appendix-B
28. Whose decision is more to have aborted? a. husband b. other members of the family c. self d. others 29. Do you have any following reproductive diseases? a. HIV/AIDS (Human Immune Virus/ Acquired Immune Deficiency Syndrome) b. STD (Sexually Transmitted Diseases) c. RTI (Reproductive Track Infection) d. Infertility e. Breast cancer f. iron-deficiency anemia g. Others.
D. Political dimensions of the effect of gender inequality on reproductive health:
1. Do you have any decision-making power related to sexual and reproductive health?
2. Do you agree that abortion should be legally permitted in our country? 1. 2. 3. 4. agree strongly agree disagree strongly disagree
3. Do you face any problem regarding political instability, landslide, river erosion, and cyclone and so on?
xxiii
Appendix-B
4. Please, give your important opinion to reduce the effect of gender inequality on reproductive health. 1______________________________________________________________________ 2_______________________________________________________________________ 3_______________________________________________________________________ 4_______________________________________________________________________ 5_______________________________________________________________________ 6_______________________________________________________________________ 7_______________________________________________________________________ 8_______________________________________________________________________ 9______________________________________________________________________ 10_____________________________________________________________________
Signature of the respondents
Signature of the interviewer
xxiv

@minur - Soc-03 - Gender Inequality &amp Reproductive Health

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Effect of Gender Inequality on Reproductive Health of Married Women: A Comparative Study on Four Selected Areas of Khulna District

Course No: Soc- 4202

Sociology Discipline Khulna University March 31, 2008

Course No: Soc- 4202

S. M. Aminur Rahman Student Id-031620 Session-2005-2006

March 31, 2008

Dedicated To My Beloved Grand-Parents

Data Processing and Analysis:

Source: Household Sample Survey, 2007-08

O.0 1 0.0 6 100.0 200

18-25 26-33 34-41 Total

Source: Household Sample Survey, 2007-08

Percentag Frequenc e y (%) 62 62.0 90 20 18 20.0 18.0 100.0 3 7 100

Source: Household Sample Survey, 2007-08

Table 4.7: Percentage distribution of the respondents considering personnel of

Midwife Doctor Nurse Not Applicable Total

No Yes No No Response Total 42 21 37 100

Source: Household Sample Survey, 2007-08

Yes No Not Applicable Total

Table-8.4: Percentage distribution of respondents by causes of abortion

Yes No No Response Total

38.0 84 62.0 116 100.0 s200

Ward map of Khulna City no: 24

Ward map of Khulna City no: 25

QUESTIONNAIRE Schedule No.

1.7 Family type:

Others (please specify)

A. Social dimension of the effect of gender inequality on reproductive health:

9. Whose decision was important to have children?

husband mother-in-law Your both you and your husband others

10. Do you use any contraceptive methods to control birth? a. b. Yes b. No

If yes17. What types of organization?

18. Do you think it is necessary? a. Yes b. No

If yes why? xvii

21. Do you face any problem for female childbirth? a. Yes b. No

If yes--22. What types of problems, are you facing?

B. Economic dimensions of the effect of gender inequality on reproductive health:

1. Are you involved with job? a. Yes b. No

a. If yesa.1. What types of job do you perform?

b. If nob.1. What is the source of your income?

b.2 . Is it sufficient to solve your health problems? a. Yes b. No

C. Health dimensions of the effect of gender inequality on reproductive health:

1. Do you know what menstruation is? ________________________________________________________________________

3. How many days menstruation contains?

5. Is it possible to perform sexual union during menstruation? a. Yes b. No

21. Is it sufficient for you? a. Yes b. No

26. Have you ever aborted? a. Yes b. No c. No comments

if yes--27. What is the reason behind this? ________________________________________________________________________ ________________________________________________________________________ xxii

D. Political dimensions of the effect of gender inequality on reproductive health:

Signature of the respondents

Signature of the interviewer

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if yes--27. What is the reason behind this? xxii