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Objective To investigate the relationship between common gynecological symptoms, reproductive tract infections and psychosocial factors such as violence and depression.
Background
Gynecological complaints are common and disabling health problems for women in India. The commonest gynecological complaint is abnormal vaginal discharge. Although some women's complaints may be caused by Reproductive Tract Infections (RTI), studies have shown that the majority of women with this complaint do not have an RTI. There is a large body of information showing that depressive and anxiety disorders are very common in women and that they are an important cause of medically unexplained physical complaints. This primary research objective of this study was to describe the relationship between common gynecological complaints, in particular of abnormal vaginal discharge with psychosocial factors, related to common mental disorders and gender disadvantage. the study also aimed to investigate the risk factors of common mental disorders in women.
Progress:
The main study was implemented between November 2001 and June 2004 and has been described in our previous biennial report. After the completion of field work in June 2004, our focus was on data management, cleaning and analysis, the preparation and submission of scientific publications, and on dissemination in the community. Following initial analysis of the recruitment data, we carried out a comprehensive dissemination program in the local community. The Director of Health Services (Government of Goa), Dr. Arvind Salelkar, inaugurated the first community meeting on 24th April 2005 which was attended by around 150 women. Since then, we have held a total of 15 community meetings in the research area to disseminate the study findings and more than 1500 women have participated in these meetings. In each meeting, a brief presentation on the study findings was made, followed by a play whose script was derived from these findings. Information brochures have been distributed to all the participants of the study. Posters were distributed to anganwadis and health centres in research areas and all over Goa. We have also made concerted efforts to disseminate our findings in the scientific community. We have published over a dozen papers in international journals and presented papers at several international and national conferences (listed later in this report). A policy oriented report which summarised all the findings has been published and disseminated to state, national and international stakeholders. The full report can be downloaded from the Sangath website. As a consequence of this work, Sangath has been awarded a Mother NGO status under the Ministry of Health and Family Welfare, Government of India, Reproductive and Child Health Program on 2nd March 2007 (see description of this program later in the report).
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| Poster presentation at 4th Asia Pacific Conference on reproductive and Sexual Health and Rights in Hyderabad |
Major Findings of the SAS project
- Reproductive Tract Infections (RTIs) and dysmenorrhea are amongst the commonest health problems affecting women aged 18 to 50 years; sexually transmitted infections (STI) affect about 4% of women.
- Depressive Disorder affects about 1 in 20 women.
- Social disadvantage, particularly spousal sexual violence and economic difficulties, are important determinants of both biomedical diagnoses and women's reported complaints.
- There are strong linkages between mental health and common physical health complaints experienced by women. Medical assumptions about causes of symptoms (that the symptom of abnormal vaginal discharge is most commonly caused by RTIs; or that fatigue is most commonly caused by anaemia) are not valid in community settings. Poor mental health is an important determinant of such symptoms.
- Depressive Disorder is a major cause of disability, health service use, and health care costs and, as a consequence, may impoverish women.
- Over a period of 12 months, about I in 100 women will attempt suicide. Attempted suicide is caused by acute economic difficulties; spousal violence; and Depressive Disorder.
Implications for Public Health Policy
- To increase the coverage of effective diagnosis and treatment for Depressive Disorders through integration of mental health care in all health programs targeted to women, especially Primary Health Care, Reproductive &Child Health, and Maternal &Child Health.
- To strengthen the Reproductive & Child Health program to increase the coverage of RTI management through simple lab diagnosis of common RTIs (such as bacterial vaginosis) and the development of central lab facilities for diagnoses of other RTIs (including STIs); and to addressing menstrual health complaints.
- To modify the syndromic management guidelines for the control of RTIs in women with an approach aimed at identifying and treating the causes of abnormal vaginal discharge (in particular, RTI and mental health problems).
- To implement community strategies to reduce the burden of domestic violence, particularly sexual violence, in married women.
- To improve access for reproductive and mental health services for socially disadvantaged groups in the population
