In India reproductive women health was viewed as a women’s matter without considering the role of male as a supportive partner. But in terms of sexual health male role can never be ruled out even in terms of biology. The family planning decision and reproductive performance is not only the product of the method of contraception but also the features like gender equity, girl child education, empowerment of women’s are also the outcomes of these performances. Here, the role of the male partner is a serious matter to provide successfulness of such interventions. The reproductive women health is promoted by a man with responsibility, respect and care brings the secured human resources for future. The safe motherhood and safe pregnancy are the major evaluation period for the male to make the stable future women health. The maternal and child health (MCH) care before, and during pregnancy and care before, after delivery are the most trivial steps for the male to make safe motherhood. It also helps the family planning by the adoption of proper information’s, proper timing, the number of pregnancies, the gap between pregnancies, antenatal care (ANC), complicated pregnancy interventions, delivery by trained women health etc. In the post-birth period, the male counterpart also have knowledge about after delivery complications, breastfeeding and immunisation (Ondimu, 1998). In the International Conference on Population and Development (ICPD, 1994) at Cairo emphasised the necessity of men involvement as a supportive partner in the women’s reproductive women health. Male dominance in the physical and social arena of sexual relationships situates the women at jeopardy of unwanted sexual hazards like unwanted pregnancies and infections. The service delivery system in our country is entirely women oriented and provide negligible information to male counterpart regarding the reproductive women health behaviour. The technical reports of UNFPA (1995) identifies that doctors and women health staffs also show negative attitudes towards contraceptive measures and proper counselling regarding safer sexual practices. Thus, the efficiency of the reproductive women health providing system is also liable to take the responsibility. The process of childbearing is a stressful one, hence, an all-inclusive enclose is compulsory to address the requirements of women during pregnancy. India performs leisurely in this issue since from the inception of Family Welfare Programme (FWP) in 1951. After sixty-five years of independence the maternal and child health (MCH) care developmental indicators still remain low or middle performer.
The global position changes rapidly during the same time frame. India observed the situation and during 1997 regarding family welfare introduced some directional changes. The new direction is on user choice, service quality, gender issues and underserved groups such as adolescents, post-menopausal women and men were included under the RCH care (Jejeebhoy et al, 1999). Beyond subjective evidence, there are modestly organised evaluations of what supply factors are critical for utilisation of RCH services. Some studies identified that within the favourable gender inequalities men have some special responsibilities to realise the need regarding reproduce women health hence some special attempt should be made to support men to take liability as a husband, father and also as a sexual (Pachauri, 1997). But studies in India find that men’s knowledge in this respect was limited (Moore, 1999). It added 80 percent men were incapable to recognize the fertile phase during menstrual period, 45 percent were unable to identify a symptom of critical pregnancy or birth-related problems, 70 percent have no idea regarding the symptom of sexually transmitted disease (STD), and 45 percent were ignorant whether such STD diseases were transmitted to the future generations. Those who completed high school education with high socio-economic status, only 30 percent among them have knowledge about correct fertile period and symptom of pregnancy complications. Certainly such outcomes are the products of cultural and social effects. The events like son preferences, large size of families, women as a property, child marriage turn the system more critical. Even in some states studies revealed that when women are not prepared to take sexual intercourse but it becomes a regular incidence because the idea behind such act is that women’s are always prepared for the sexual desires of their partner.
Background of the study of Reproductive Women Health
To examine the role of men in reproductive women health in India several programmes were undertaken. In 1992, action plan for revamping the family welfare programme was adopted. It was a strategy based restoration for the family welfare programme but did not care about male role or gender disparities. A draft national population policy adopted in 1994 and it was a momentous departure from past demographic goal-oriented policies. It suggested for the abolition of gender disparities and promote for men participation in a gender agenda. identifies the margins of a top-down approach and suggest the need-based approach. In 1996, a target free approach for family welfare programme was initiated but the issues like male involvement or gender discrepancies are not given importance. In the community need assessment approach of 1998 some forms were designed to consider the male involvement and gender issues and also the importance of data collected by sex was initiated here for the first time. During 1997 reproductive and child health (RCH) programmes implemented within the philosophical outlines of RCH. The scheme was formulated on the basis of need-based approach and which are client oriented and demand driven also. The significant variables were the quality of services, client satisfaction, and follow-up process. It considers that MCH care, STD disease treatment, and family planning services are the agglomerated issues and cannot be separated by any means. The event like the personal contact of health personal with women as per need given priority but the factor like male involvement and gender disparities are not received their prior importance. During ninth plan period programmes like population control, family welfare and health for the first time added male participation in the process of Planned Parenthood and the increasing level of acceptance of vasectomy was set as a major demographic target. During 2000 national population policy adopted, where the role of men in family formation was recognised and family planning educational campaigns on men was emphasised. Hence, the system was found with the nonexistence of clear policy advice and monitoring system to accomplish male involvement in reproductive health programme of women. So the family welfare programme faces the difficulties to address such old problem. This is the basic need of such studies from the policy implication viewpoint.
Objectives and Methods of the study of Reproductive Women Health
To determine the determinants of male involvement in reproductive women health behaviour, the study has twofold objectives. It has some query about the knowledge, perception and behaviour of a husband towards reproductive and sexual women health behaviour of their wives. It also studies about the factors which determine male involvement in reproductive healthcare of women.
The present study based on a primary survey on Jalpaiguri district located at the northern part of West Bengal. The need for a special focus on Jalpaiguri is longstanding due to its extreme geographical barriers and huge poverty among most of the blocks which faces inadequate and ineffective public women health services. The primary survey based on household interviews and the choices of the households done by two-stage random sampling procedure. As per the perspective of this study the blocks are arranged m terms of high, medium and low population density and three blocks are chosen, one from each category. Now from every block three PSU / Villages are chosen in terms of their location (distance) from block headquarter through purposive sampling. The selection of PSU is based on their distance from the block headquarters. One PSU is selected from the very remote area of the block (more than 10 Km), the second one from the relatively less remote area (5-10 Km) and the third one from the nearest (located within 0-5 Km) to the block headquarter. Here, we assume that the highest level MCH care facilities are mainly located near block head quarter. The selected blocks for this study of Jalpaiguri districts are Alipurduar-II, Falakata and Madarihat and from these three blocks, total 9 villages / PSUs are selected on the basis of the distance from the block headquarters. In the second stage, 50 percent of the total households were selected from each of the selected PSU / villages. A 10 percent over-sampling (i.e. additional 10 percent of total households in each PSU) of the households would be considered in order to adjust for non-responses. The survey has covered a total of 778 households from nine villages. The household selection criteria were that it must have at least one eligible couple whose wives were in the reproductive age group 15-49. In the case of data collection both the qualitative and quantitative techniques have been used by the study. In the interrogation process, 891 husbands and 866 wives were interrogated for the purpose of the study. To accomplish qualitative survey 10, focus group discussions (FDGs) have been conducted by the study. One husband involvement index (HII) regarding reproductive women health issues of their wives has been constructed to capture the essence of male involvement in the wives reproductive health.
Findings of the study of Reproductive Women Health
Table 1 represents the background characteristics of the respondents of the sampled individuals of nine villages. It consists of demographic and socio-economic characteristics of the sampled area.
Table 1: Background Characteristics in (%) sampled area
|Variables||Variable Group||Husband (N=891)||Wives (N=866)|
|Age in Years||15-29||32.7||58.3|
|No of Children||0||9.6||9.0|
|Up to Primary||33.8||18.6|
|Up to middle||21.2||7.6|
|9 Yrs +||13.8||4.3|
Source: Sample Survey, 2012
The study found maximum husband (48.4) were in the middle age (30-40) group, whereas 58.3 per cent wives were at the younger age group (15-29). The study added 39 per cent husbands and 40 per cent wives having 1-3 children and the corresponding figure for 4-5 children were 35 per cent and 37 percent respectively. 16 percent of the husbands and 13 percent of the wives have more than five children. The majority of the surveyed respondents were Hindu for both in the case of husbands (44%) and wives (45%’ nd 43 percent belongs to Scheduled Tribes (ST). Jalpaiguri district as a part of Western Dooars has some historical background for the existence of ST people. The most common explanation is during British colonial rule the tribal were uprooted from the Chhotonagpur plateau to this area of Jalpaiguri for the tea plantation works. They commonly belonged to Santhal, Murmu, Oroan, Mech, Rava etc. The study found 31 percent of the husband and 70 per cent of the wives have no formal educational background, and only 14 per cent of the husbands and 4 per cent of the wives have more than nine years educational background. Majority of the husbands (73%) and wives (57%) were engaged in agricultural works. The study found that a few number of wives were economically in active.
They were not engaging in service based jobs but a significant amount of wives were working as a plantation worker in the nearby tea garden.
The study has some other purposive interest about (i) husband knowledge regarding RCH problems (XI); (ii) husband perception about to join in RCH matters (X2); and (iii) husband acquaintance with the reproductive women health related criticalness of their wives (X3). To analyse this table 2 identifies the summarization of descriptive statistics collected during survey.
Table 2: Distribution of knowledge, perception and acquaintance of husbands regarding the reproductive women health of their wives in the study area.
|Variables||Variable Group||Husband (N=891)|
|Knowledge about problems (X1)||Perception to join in (X2)||Acquaintance with criticalness (X3)|
|Age in Years||15-29||61.2||22.6||16.3|
|No of Children||0||75.2||12.3||19.2|
|Up to Primary||42.6||39.7||44.4|
|Up to middle||59.3||52.5||61.1|
|9 Yrs +||68.1||59.4||58.8|
Source: Sample Survey, 2012
The percentage distribution of husband knowledge regarding the reproductive women health episode of their wives (XI) is shown in column four of table 2. To read the figures of table 2 one should remind that the box figures in table 2 are the percentage form of the corresponding box figure of table 1. The study found that 61 per cent of the husbands in the age group 15-29 have some knowledge regarding the reproductive health episode of their wives, and the corresponding figure is higher (76.3%) for 30-44 years age group. The percentage distribution of husband perception regarding their taking part in the reproductive health episode of their wives (X2) or not is shown in column four of table 2. Here, 41 per cent are found positive attitude under the age group 30-44 and only the 14 per cent of the age group above 45 years were in agreement for the same. The distribution of the husbands according to their acquaintance regarding reproductive health criticalness of their wives (X3) is shown in the column five of table 2. Under this arena some specific questions were asked like heavy bleeding during menstruation, painful menstruation, urinal tract infection, pain in lower or upper abdomen etc. The study found that aged husbands (26%) are more concerned about such issue in compared to younger one (16%). In the case of analysing XI for the number of children ever born in the family, the study found that 52 per cent with 1-3 children size were concerned positively about XI, but as the size of children increases the concern level reduces. In the case of analysing X2, the study found that 46 per cent of the husbands with 1-3 children reported affirmative to join in RCH health matters. The situation of X3 the study found 52 per cent husband of 1-3 children size group have some perception regarding the criticalness of reproductive health. In case of religion 62, 56, and 69 per cent respectively showed positive association with XI, X2, and X3 respectively. The degree of all levels of association is slightly lower for Muslims in compare to Hindu religion. In case of caste-wise distribution regarding the behaviour of XI, X2, and X3 indicates that for the ST caste the level of consciousness are minimum in compare to other caste.
One important outcome regarding the ‘other caste’ in the table 2 shows better performance and it includes the case of general caste. In the case of correlation between consciousness regarding the XI, X2, and X3 and education status identified the positive impact of education. Here, the study found that 43 per cent of the husbands with primary education showing some knowledge about RCH problems, and the corresponding figure for a husband with middle school level education is 59 per cent and for the husbands who completed, at least, nine years in education the figure is 68 per cent. In the case of occupation based distribution, the study found the level of correlation is comparatively insignificant for the husbands who are related with agricultural activity in all the cases of XI, X2, and X3. Here, the association level increases if the occupation pattern shifts from agriculture to business. In the case of income factor, the study found the association of it with XI, X2, and X3 is lower for the group whose income level is between Rs 0-1000 (INR) and highest for income group Rs 5000+. Hence, the increase in income makes the men more conscious about the XI, X2, and X3.
The distribution of husbands according to the reason for helping their wives during pregnancy or after childbirth is shown in table 3.
Table 3: The Percentage of husbands for helping their wives during pre and post-birth
|Variables||Variable Group||Husband (N=891)|
|Age in Years||15-29||41.5||45.8||42.7||14.4||47.3||38.6||30.1|
|No of Children||0||42.6||51.8||42.4||12.3||44.1||47.1||45.3|
|Up to Primary||27.3||31.1||37.6||31.1||28.1||24.3||26.4|
|Up to middle||38.4||44.6||37.8||25.4||34.0||35.2||58.4|
|9 Yrs +||52.2||57.6||48.2||16.2||46.2||49.1||44.5|
Source: Sample Survey, 2012
The table is prepared on the basis of several questions asked the husband and the percentage of positive response. The study interested about (1) whether the husband have some feeling about the social position of wife (Ql); (2) whether he permits for the resting time of his wife during pregnancy (Q2); (3) whether he consider that for maintaining the family life he also has some responsibility (Q3); (4) whether he realise that it is completely female matter (Q4); (5) whether he expect that for women healthy and the healthy child he has some duty (Q5); (6) whether he understand that his role is very essential in the process of pre-birth and post-birth periods (Q6); (7) whether he consider that only timely visit to health personal is his main duty (Q7). The study found that in the age group 15-29 have some real positive feeling about the care of their wives during reproductive periods At least 46 per cent of them argued that rest of the wives is very urgent during pregnancy zone. But the sense is decreasing for the seniors. Education may be one of the causes of such behaviour, and if this is true the policy makers may be happy about such outcomes. In the case of a number of children under different variable group, the study found as the number of children increases then the quality status of perception of husbands care about the wives reduces. The major basis of such behaviour may be the fact that majority think that childbirth is a very common phenomenon and nothing serious matter exists within it. In the case of question response like Q4 the data shows that husbands with a higher number of the child have such idea. Husbands with Muslims were found relatively lesser able to give reasons for support their wives during pregnancy and in post-birth than the Hindu and others. In the case of caste-wise distribution, the study found a blended picture and only the other caste (including general caste) perform uniformly better than the other. Education has some significant impact on the projected question to the surveyed husbands. As the educational level increases the carefulness indicator value increases continuously. The picture in terms of occupation distribution shows that husbands with agricultural background show less response to support their wives during childbirth and post delivery season in compare to service and business background. Similarly, the sensibility of husbands varies directly with the income level. For higher income level the study found 78 percent husbands realise that rest time is essential for the wives during pregnancy related periods.
Husband’s involvement index (HII) in their wives reproductive women health problems suggested that around 12 per cent were found having little involvement, while 69 percent had moderate involvement and remaining 19 per cent were found highly involved in their wives reproductive health problems.
The value of HII is high for the senior age group (23%) i.e. 30-44 years and low for the most senior age groups (45 years). Similarly in case of child bearing the high value of HII belongs to the husbands with children size 1-3 (22%) and lowest for those husbands with more than 5 children.
The values of HII in the case of different religion and caste. In the case of religion the HII values identify that it is highest for the Hindus (24%) and in the case of caste, it is highest for the others caste where the presence of general caste may influences the result. Here the HII value for Muslims and OBCs were lowest among the high category. The qualitative technique based on data collected through observation method, case study approach and conducting focus group discussions (FDGs). All 10 FDGs was conducted for husbands and wives separately.
The study found husbands were aware of the reproductive women health problems of their wives. A few of them are aware of cycle problems, RTI/STD diseases. Most of the participants of the FDGs argued that they believe RTI/STD diseases are infectious.
Conclusion of the study of Reproductive Women Health
The research output is blended in nature. The study found that socio-economic obstacles are performing as a major hurdle behind the views of husband to seek RCH care for their partners. The education status of the men has some significant impact on choice of reproductive healthcare facility for delivery. Religion factor is a major obstacle on the way of RCH care and the situation is more prominent for the Muslims. The husband from general caste background shows some favourable response to RCH care. The study revealed that more or less one-fifth of the respondents opined that it is their prime responsibility to take care of their wives and helped them in their reproductive problems. Men have been involved in reproductive process at different levels, and they must express responsibility in doing so. [wp_ad_camp_1] They are not only responsible for their own sexual health and behaviour, they also often play a significant role in the decision regarding family health by fulfilling their wives and children health needs. The study can recommend that to make men more understanding as supportive of their wives reproductive health choices. They can be more aware of the need to safeguard their and their wives reproductive health. They should care about unwanted pregnancies by choosing appropriate contraceptive methods. However, there is much that we do not know yet, and continuing research has a big role to play.