Reproductive and sexual health is fundamental to individuals, couples and families, and the social and economic development of communities and nations. The slogan “Healthy women, Healthy World” implies that women play a critical role in maintaining the health and well being of their family as well as their community [1].

Women suffer silently from a large number of reproductive illnesses called as silent epidemic [2]. Reproductive and sexual ill-health such as maternal and perinatal mortality and morbidity, cancers, sexually transmitted infections and HIV/AIDS account for nearly 20% of the global burden of ill-health for women [3].

The World Health Organization (WHO) estimates that about 30-60 million women suffer severe illness as a result of serious maternal complications and about one third of women in developing countries suffer from such morbidity [4].

In 2004, the World Health Assembly renewed the commitment of the international community to sexual and reproductive health by adopting “a global reproductive health strategy” (world health resolution).

Reproductive morbidity is defined as ―any morbidity or dysfunction of the reproductive tract or any morbidity which is a consequence of reproductive behaviours including pregnancy, contraceptive use, abortion, child birth, or sexual behaviour. The morbidity can broadly be divided into 3 categories, as Obstetric morbidity, Contraceptive morbidity and Gynaecological morbidity [5].

It has been observed that there are marked differences in the prevalence and pattern of reproductive morbidity among the women throughout the country. The percentage of currently married women with any reproductive health problem varies from 19 % in Karnataka to 67% in Meghalaya [6]. The prevalence of reproductive morbidity among married females in Kerala was 42.4% (NFHS2) [6] .

The District Level House hold Facility survey 3 conducted by Ministry of Health and Family Welfare reported that 12.1% married women had symptoms suggestive of reproductive tract infections in Kerala and around 77.6% of rural women are aware of the symptoms of reproductive infections [7].

Prevalence of gynaecological morbidity was 36% in a study by Bhatia JC et al (8) in South India in 1997 As the cluster sampling method was used the design effect (D) was taken into account. With an allowable error of 15% and design effect of 2 the sample size calculated was 632.

Cluster sampling method was used for the study. Sub centers areas in Mavoor Panchayat were used as clusters. There were 5 sub center areas in Mavoor Panchayat. Each sub center area was considered as one cluster. For better representation all clusters were included for the study. House hold in the cluster was considered as the primary sampling unit. Hence women from all the clusters were studied.

To obtain the required sample size from the clusters, 126 subjects were included in each cluster. It was decided to take one married female from one household. Allowing a dropout rate of 10% for non availability, non cooperation to a total of 140 houses was included from each sub center area.

From the main bus stop in each ward the different roads originating were enumerated and one of the roads was selected randomly. By simple random method one of the houses situated on that road was selected as the first house.

The next house to be selected for the study was that closest to the first house on the same side of the road and so on till 140 consecutive houses were selected in each sub center area. In case the road was terminated, houses on the opposite road or street were continued. There were 640 eligible subjects in the 750 households.

Eligible subjects in the selected house hold were identified and informed regarding the purpose of the study. If more than one eligible subject was there, then one person was selected using Kish table method. Kish table is a type of random table used to select one individual from eligible persons in the house hold.

After the selection of woman, informed consent was obtained and the data was collected by Interview method using pretested semi structured schedule and general & systemic examination. Houses were pre informed and the interview was conducted in the day time for better compliance.

Self reported reproductive morbidity was assessed by interview method using pre tested semi structured oral questionnaire.

Majority of the women, 535 (89.2%) in the study group were house wives. Socio economic status of the study population was assessed using Modified Udai Parikh scale. In 65(10.8%) houses there was overcrowding. Among the study women 591(98.5%) were currently married, 7 (1.2%) were widows, 1(0.2%) divorcee and 1(0.2%) separated women.

The present study showed that 473 (78.8%) women were co habitating with their husbands currently. Mean age at marriage in the study group is 19.3 + 2.9 (Range- 13 to 35 years), lower than that of Kerala. Socio-demographic details are given detail in the table no 1.

Table No.-1: Distribution according to socio-demography

Table No-2: Prevalence of reproductive morbidity among the population

Reproductive Events

Menstrual cycles: Mean age at menarche was 13.79 +0.935 years which was in the normal age group of 12-14 years [11]. Among the women, 255(42.5%) reported history of at least one menstrual abnormality. Among the menstrual abnormalities the most commonly reported one was dysmenorrhoea i.e. 174 (68.2%), followed by hypomenorrhoea 27(10.5%), menorrhagia 18 (7%), oligomenorrhoea 14 (5.4%). In the study group 10.2% i.e. 61 women were having amenorrhoea.

Obstetric events: In obstetric history, 438 (73%) of the women had only normal deliveries, 60(10%) had only caesarian section and 8 (1.3%) women had both. Among the women 162(27%) had history of at least one complication due to pregnancy and delivery. Pregnancy induced hypertension and anemia were the most common complications in the ante natal period.

Post-partum hemorrhage and infection were the major complications in the post-partum period.

Contraceptive details: Among the study participant, 322(53.6%) adopted a method of family planning currently. The most commonly adopted method was tubectomy 234(72.7%), followed by condom 61(18.9%). 8 (1.3%) women had complications due to family planning methods. The complications were bleeding and low back ache.

Prevalence of reproductive morbidity

Among the women 183 had at least one type of reproductive morbidity. Prevalence of reproductive morbidity was 30.5% (95% CI 26% - 34.99%). Among the morbidity, 167 (27.8%) women had gynaecological morbidity, and 8 women had obstertic morbidity i.e. 1.3% and prevalence of contraceptive morbidity was 8 (1.3%). Reproductive tract infections (10.5%), Urirary tract infection (8.2%), Stress incontinence (4%), PID(1.3%) were the major Gynaecological morbidities (Table 3). 4.3% had chronic type of Gynaecological morbidity (>3months). In women with Gynaecological morbidity, 24(14.4%) had more than one episode of the illness. Prevalence is given in detail in the table number 2. Pregnancy induced hypertension, Gestational diabetes, Caesarian section, intrauterine death were the reported obstetric morbidity in this study. Low back ache (5 persons), bleeding (2 in no) and had post operative infection followed by tubectomy were the reported contraceptive morbidity.

Treatment seeking behavior: Among the diseased, 145 women (79.2%) took some mode of treatment. All women with obstetric morbidity and contraceptive morbidity took treatment. 38 women (20.8%) with gynaecological morbidity didn‘t take any treatment. Among the women who did not avail treatment, majority 20 (52.63%) were shy to reveal the problem and 9 (23.8%) had not perceived the symptoms as a problem. Some of women 7 (18.42%) feel that the treatment is not necessary for this problem.

Among the women 42.5% reported a history of menstrual abnormality within one year of the survey. Most frequently reported problem was dysmenorrhoea. Similar results were observed in other Indian studies Sowmini C V and Sankara sarma P et al in the year 1999 in a study conducted at Thiruvananthapuram. There was a higher prevalence of the specific menstrual symptoms in this study when compared with Sowmini C V and Sankara sarma P et al [12].

S K Singh, Sourabh singh et al [13] reported that most frequently reported menstrual symptoms were painful periods and scanty bleeding in the study conducted in the rural women of Maharashtra. Monika Rathore, Leela Vyas et al found out that 35% of the ever married women reported menstrual problems in the study conducted in Jaipur in 2002 [14]. Mulgaonkar, Veena Bet al reprted in 1996 that the prevalence of menstrual disorders was 39% in a study conducted in urban slum of Bombay [15].

In the study women, 30.5% reported at least one type of reproductive morbidity within the 3 months of survey. 167(27.8%) women had gynaecological morbidity, 8(1.3%) had obstetric morbidity and 8 (1.3%) had contraceptive morbidity. Prevalence of the reproductive morbidity was found to be lower than that reported by Sourabh singh et al in Rural Maharashtra in 2006 [12] where the prevalence was 60% (Varies from 40.2% to 80.3% in different districts). The prevalence of gynecological morbidity was similar to that in other studies. The ICMR task force study (1996-97) in 23 districts by Indra P. Kambo et al [16] reported a prevalence of 29.1% in Kerala. The result is also similar to the prevalence of 24.4% noted by Bhatia JC et al [8] in South India. In a study done in Salem District Tamil nadu ( kannan C Athmaraman et al [17] the prevalence of any one self reported reproductive morbidity was 24%.

Other risk factors included early age at menarche, early age at marriage, bad obstetric history, increased parity, history of menstrual abnormality and poor nutritional status etc. Even though there is a higher prevalence, the proportion of women seeking the healthcare is comparatively less. In a state like Kerala where the accessibility to the health care facilities are high and people are concerned with health, even then 20% (not taken any treatment) is not acceptable.

Shyness to reveal the problem still exists in the community. The female literacy of Kerala is high when compared to the other states, but most of the women are unaware regarding the symptoms, signs and complications of reproductive health problems. There is a need for improving awareness and motivation of early treatment seeking behaviour for reproductive morbidities to reduce complication due to such morbidity.

Acknowledge all the participants of in this study