Women’s Health in Rural Tamil Nadu

Sample Size

The total sample size is 384 which were collected through power scale analyze methods. Based on the below formula sample size has been fixed. ( ) ( ) 2 Z * p * 1-p SS= 2 c Z = Z value (e.g. 1.96 for 95% confidence level) p= percentage picking a choice expressed as a decimal (.5 used for sample size needed) c = confidence interval, expressed as decimal(e.g., .04 = ±4)

Demographic Profile of the Respondents

Demographic variables are essential to understand the socio-economic status of respondents. Demographic variables include age group, community, religion, marital status, type of house, type of family, and monthly income.

Above Table 1 shows that 24 percent of the respondents are in the age group of 47 -53 years followed by 20 percent of the respondents are in the age group of 26-32, 20 percent of the respondents are in the age group of 40-46, 16 percent of the respondents are in the age group of 33-39, 8 percent of the respondents are in the age group of 54-60, another 8 percent of the respondents are in the age group of 18-25, and 4 percent of the respondents are in the age group of above 61. It is observed that the sample populations are among the rural women population. Thus, the majority (80%) of the respondents agreed to participate in this study and they belong to the age group of 26-53.

Caste in TN can be created based on their traditional occupation (Table 2). Tamil Nadu Government has notified five categories of communities namely; open category, Backward Class, Most Backward Class, Scheduled Cates, and Scheduled Tribes (ST), those who are not included in these categories come under the open categories (OC). Divisions of the community have greater control over the health and well-being of human being and the caste system affects the educational development and career progress of an individual and there is a close relationship between educational development and individual. Higher education leads to a higher level of awareness related to health and well-being. The poor health of people from the lower castes, Dalits/Adivasi and they have restricted access to clean water, sanitation, nutrition, and health care. The structural determinants of everyday life are thus perceived to contribute to the social determinants of health. Viewing health in general as an individual or medical issue, reducing population health to a biomedical perspective and suggesting individual medical interventions reflect a poor understanding of issues. Social interventions should form the core of all health and prevention programs as individual medical interventions have little impact on population indices, which require population interventions. The present study observed that caste is a major contribution to poor health among rural women which affects the health care system.

India has secular States and the Government of India has classified into Hindu, Muslim, Christian, Sikh, Buddhist, Jain, and other religions and persuasions (Table 3). The majority (80%) of the respondents belongs to the Hindu religion, 12 percent of the respondents belong to the Christian religion, and the remaining 4percent of the respondents belong to Muslim and other religions are also the same 4 percent. It is observed that the majority (80.2%) of the respondent belong to the Hindu religions. The present study raises the question is that how religion has affected health among rural women? Religions are an important aspect of mental health and create the mental health of every human to make perfection in everyday life. Mental health has two dimensions such as the absence of mental illness and the presence of a well-adjusted personality that contributes effectively to the life of the individual. Hence rural women are enthusiastically involving all religious functions which indirectly promote the mental health of rural women and they can take decision with peace of mind. Most of the rural women can take fasting for their religious function, but it can indirectly help to promote blood sugar control by reducing insulin resistance, and enhances heart by improving blood pressure and so on.

The community and religions are closely associated with physical health as well as mental health. The divisions of Community behavior tell upon health, SCs/STs populations had worse health as compared to other sections of the population. The poor health of these disadvantaged groups is evident in the higher levels of morbidity and under nutrition, higher rates of mortality and early onset of death. They also have relatively lower utilization of both preventive and curative services, and receiving poor quality of services when they do access to services.

The above Table 4 reveals that the distribution of the respondents based on their marital status and majority (88%) of the respondents are married, 8 percent of the respondents are unmarried, and 4 percent of the respondents live separately. It is observed that the majority (88%) of the respondents are married in this survey. Marriage and health are closely related. It gives commitment and responsibility to the individual to plan for a family. It gives confidence in the minds of the spouse; and also ensures that caregiving is an added dimension to social life. When there is a perfect understanding between the couples there is less chance of becoming depressive and other related diseases.

Need-based Hierarchy theory rightly points out that shelter is one of the primary physiological needs. The above Table 5 shows the distribution of the respondents based on their type of house. The majority (64%) of the respondents are having own house and 36 percent of the respondents are living in a rented house. How does the house influence rural women’s health? Types of houses are directly associated with health and residence of house renters have to pay money to house owners in a month which is an additional burden of household income. The quality of housing has major implications for people’s health. Raising housing standards is a key pathway for providing healthy housing conditions and improving health and well-being. It is clear that housing conditions can influence physical health, mental health, and well-being of humanity. It is observed that the house owner gets money, house renters get poor health.

Family is one of the major social institutions and family is a social unit created by blood, marriage, adoption and can be described as nuclear or extended and data shows that 52 percent of the respondents are living in a nuclear family and 48 percent of the respondents are living in a joint family (Table 6). It is observed that from the data rural communities are partially living in nuclear and joint family structures. In the technological world, many of the families are interested to live in a nuclear family system and they are unable to live with their parents. The impact of the technological world on the joint family system does not affect the rural areas. The study is found that the majority (52%) of the respondents are living in a nuclear family system. Family structure promotes mental health among the family members and mostly elder people give guidance to family members with high-level moral principles. The moral principles are the best way to mold humans which can control crime. At the same time, most of the nuclear family does not have elder people and nuclear family children do not get any moral guidance from grandmother or grandfather. We observed that a joint family promotes ethical principles that create good psychological health and those who live in the joint family are psychologically well, at the same time those who live in the nuclear family are not psychologically well which may lead the wrong way.

Rural women’s income is a key factor for the development of household expenditure; rural women are working as daily wage labor. Above Table 7 reveals that 40 percent of the respondents are earning monthly income between 2001 to 6000, 28 percent of the respondents are earning monthly income below 2000, 24 percent of the respondents are earning monthly income above 8001, and only 8 percent of the respondent are earning monthly income between 6001 – 8000. It is observed that nearly half of the respondents (40%) are earning monthly income between 2001 - 6000 per month. Income is related to health and it is strongly associated with morbidity and mortality across the income distribution, and income-related health disparities appear to be growing over time. Income influences health and longevity through various clinical, behavioral, social, and environmental mechanisms. Low income also contributes to reduced poor health and income inequality has grown substantially in recent decades, which may perpetuate or exacerbate health disparities.

Health Problem of Rural Women

More recently, many rural women are facing a variety of healthcare issues, but often ignore it, on account of poverty, poor access to quality health care, and lack of awareness about health issues.

The present study categories twenty types of health problems among the rural women namely, Fever, Cold/ Cough, Headache, Toothache, Diarrhea, Skin disease, Body pain, Fracture, Typhoid, Cholera, Chest pain, Asthma, Bronchitis, Gynecology Problems, Heart diseases, BP problems, Diabetes, Knee/Joint Pain, Back/Neck Pain, and Chronic diseases (Table 8). Thirteen health problems have been found among the rural women such as Fever, Cold/ Cough, Headache, Toothache, Body Pain, Fracture, Typhoid, BP Problem, Diabetes, Knee/ Joint Pain, Back/Neck Pain, and Chronic Diseases. The above data illustrates that 21 percent of the respondents suffer from knee/joint pain and followed by 12 percent of the respondents suffer from high and low blood pressure, 12 percent of the respondents are suffering from toothache, 8 percent of the respondents suffer from Headache, Typhoid, Back/Neck Pain, Chronic Diseases, 4 percent of the respondents suffer from fever, cold/cough, 4 percent of the respondents suffer from body pain, fracture, diabetes, and 4percent respondents suffer from Asthma. This study found that sample respondents are being suffered from any illness either long term or short term.

The health problems of rural women are divided into two as short term health problems and long term health problems. As per the above data, nearly 50 percent of the respondents are having short term health problems such as fever, cold/cough, headache, toothache, body pain, and typhoid. More than 50 percent (231) of the respondents are above 40 years. Hence, they may be physically weak. That physical weakness results in different types of health issues. Moreover, when they are working in the field for the long term without proper food, exposing them to rain, hot sun, working in the wet soil for long hours will results in all types of temporary pain to the respondents. Further, when they come back from work, they have to do all households work at home such as cooking, cleaning, taking care of milk animals and other activities.

There are 13 health problems have been identified which is classified into two way such as short term and long term health problem. The long term health problems consist of Fracture, BP Problems, Diabetes, Knee/Joint Pain, Back/ Neck Pain, Chronic Diseases (TB, Cancer, etc.), and Asthma. The majority (60%) of the respondents is suffering long term health problems and 40 percent of the respondents are suffering short term health problems which consist of Fever, Cold/Cough, Headache, Toothache, Body Pain, and Typhoid.

Above Table 9 shows fertility-related problems among rural women and 32 percent of the respondents have faced abortion, 28 percent of the respondents (28%) had miscarriage, 24 percent of the respondents are affected due to premature delivery, 8 percent of the respondents are faced infant mortality and another 8 percent of the respondents do not have any child-related problems. It is worth noting that most of the rural women still face abortion problems.

The above Table 10 shows that 44 percent of the respondents are having a menstrual health problem, 32 percent of the respondents are facing menopause, 20 percent of the respondents have faced pregnancy and delivery related problems, 4 percent of the respondents have aging and geriatrics problems.

Tables 9 & 10 shows that the child-related gynecology problems among rural women. due to following reasons, reproductive health is affected; male and female sexual dysfunction, endometriosis, cervical cancer, HIV, polycystic ovary syndrome (PCOS), primary ovarian insufficiency (POI), uterine fibroids, interstitial cystitis, (IC), excess body weight, not enough body weight, gonorrhea and chlamydia, environmental harms, lifestyle choices which include smoking, excess alcohol use, stress, and poor diet which evidence that recently fertility centers have been increasing all over the nation to addressing fertility problems.

Above Table 11 shows majority (68%) of the respondents manage their own expenditure from their pocket money or saving money, and 32 percent of the respondents are depending on their family member’s expenditure (family member includes husband, son, daughter, son – in law, daughter – in – law and family relatives). It is observed that the majority of rural women are spending their own money when they are ill. Medical expenses can be related to medicines bought from  medical  shops or pharmacies or treatment of an ailment done at any clinic, medications, private hospital or public hospital.

Table12: Distribution of respondents based on their Medication in health institutions.

The above Table 12 shows the distribution of the respondents based on their treatment in health institutions which includes primary health centers, private and government hospitals. The majority (52%) of the respondents visits private hospitals and the remaining 48 percent of the respondents attend government institutions that cover primary health centers and government hospitals. Out of 183 respondents, 152 respondents sought treatment from primary health centers and it is located in the village, and only 8 percent of the respondents are seeking health treatment in government hospitals.. The study identified three kinds of health institutions namely primary health centre, private hospital, and government hospital which have been admitted by rural women to take regular treatment. Rural women look at a private hospital for better quality treatment.

Above Table 13 shows 56 percent of the respondents are not postponing their medication and they can take the medication with the proper time, and 44 percent of the respondents are postponing their medication due to financial problems. It is found that majority of the respondents are taking medication on time when they are ill. It is evidenced that rural women are more aware of their health status and their impacts also.

The above Table 14 reveals that the majority (68%) of the respondents does not have any burden of their health expenditure and 32 percent of the respondents are facing the burden of health expenditure. Rural women have admitted that health expenditure has not affected their regular income. It is because most of them have only temporary physical problems.

The majority (56%) of the respondents does not have any health insurance scheme and they are not benefited from any government or private health insurance, rural women are not willing to take any health insurance, 44 percent of the respondents have taken health insurance scheme (Table 15). It is observed that the majority (56%) of rural women are not willing to take health insurance policies. Even

Pradhan Mantri Jeevan Jyoti Bima Yojana (PMJJBY), Pradhan Mantri Suraksha Bima Yojana (PMSBY), Atal Pension Yojana (APY) has not reached to rural areas. It is highly noted that government health insurance schemes have not properly executed among rural women. Ultimately, what is inferred from the above table is 56 percent of rural women are not aware of the importance of health insurance schemes.

Above the Table 17 shows the majority of the respondents (84%) are eating fruits regularly, and 16 percent of the respondents are not eating fruits regularly. The rural women know the importance of taking fruits. When the researchers enquired them personally they revealed that they take fruits that are available at the backyard of their houses like banana, mango, guava, papaya and tender coconut.

Health drinks are classified into two namely homemade branded and company branded. The above Table 18 shows 64 percent of the respondents are taking company-branded health drinks. 36 percent of the respondents are taking homemade health drink. It is observed that the majority (64%) of the rural women are willing to buy health drinks from markets and drink branded products.

Tables 17 & 18 demonstrate the eating habits of fruits and healthy drinks. Food has a very significant place in our lives because it is our primary requirement and which promotes good nutrition. Food is a tool for good health and implying an instrumental relationship between food and health.

The above Table 19 shows that the majority of the respondents (76%) agreed that there is sufficient staff is available in primary health care centers and 24 percent of the respondents said that there is insufficient staff in the primary health care centers. The reason behind this is the area where it in situated.

The above Table 20 shows that majority of the respondents (84%) told that adequate medicines are available at the primary health centers and 16 percent of the respondents told that no adequate medicines are available at the primary health center.

Tables 19 & 20 revivals that the availability of staff and medicines at PHCs, in rural health centers should be adequately available. So that every individual in the villages can access the basic health care benefit at possible cost. Health infrastructures are an important indicator to understand the health care delivery provisions and mechanisms in a region. PHC is the first contact point between the village community and the medical officer. The PHCs were envisaged to provide an integrated curative and preventive health care to the rural population with emphasis on preventive and promote aspects of health care.

The correlation coefficient for Food habit and Physical problem is .223. The direction of the relationship is positive. Hence, Food habits and Physical problems are positively correlated (Table 21). The P-value for this correlation

The correlation coefficient for Food habit and Child- related problems is -.296. The direction of the relationship is negative. Hence, Food habits and Child-related problems are negatively correlated (Table 22). The P-value for this correlation coefficient is .000. Hence the Null hypothesis is rejected and the alternative hypothesis is accepted. It is observed that there is a negative correlation between food habits and Child-related problems.