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RIJS
Volume 2, Issue 7 (July 2013)
ISSN: 2250 – 3994
A Journal of Radix International Educational and
Research Consortium
RIJS
RADIX INTERNATIONAL JOURNAL OF
RESEARCH IN SOCIAL SCIENCE
TREATMENT SEEKING BEHAVIOUR OF YOUNG MARRIED SCHEDULEDCASTES
WOMEN TOWARDS SEXUALLY TRANSMITTED INFECTIONS IN
THIRUVARUR DISTRICT, TAMILNADU, INDIA
Dr. P.R. Rejoice
Consultant, Kottayam
Kerala
ABSTRACT
Adolescents and young adults (15-24) are the age groups at the greatest risk for acquiring STI’s and 3
million become infected each year. These infections and diseases can have severe consequences, especially
in women, if not treated. The aim of this study was to assess the treatment seeking behavior of young
married scheduled castes women towards sexually transmitted infections in Thiruvarur district, TamilNadu,
India. Multistage stratified random sampling technique was applied to select 605 women in the age group
of 15-24 years in the five blocks of Thiruvarur district. The study was carried out during July 2010 - April
2011. Data was collected through interview method and chi-square and binary logistic regression were
applied for determining the influencing factors. The result reveals that 8.8% of women experienced STIs and
major portion of women sought treatment (77.4%) for their sexual health problems. The result indicates
that women in households in the highest wealth quintile were more likely to receive treatment for sexually
transmitted infections (100%) than women in households in the lowest quintile (72.7%). It concludes that
women with less advantaged demographic backgrounds, such as women with low educational level and
low wealth quintile, could be specifically targeted, as they were more likely to delay in seeking healthcare
and to delay longer than those with more advantaged demographic backgrounds.
Keywords: Young women, scheduled castes, sexually transmitted infections and health care practices.
INTRODUCTION
Sexually transmitted infections (STI’s) are to a large extent infections of the young, mainly because their
sexual relations are often unplanned, sometimes a result of pressure or force, and typically happen before
they have the experience and skills to protect themselves. Although compiled data about sexually
Journal of Radix International Educational and Research Consortium
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ISSN: 2250 – 3994
transmitted infection acquisition by age are sparse, US data show that young adults aged 15–24 years
acquired 48 percent of all such infections, (Weinstock et, al. 2000) even though not all young adults of this
age are sexually active. Perversely, the young have the most to lose from acquiring sexually transmitted
infections, since they will suffer the consequences the longest, and might not reach their full reproductive
potential. An estimated 340 million new cases of four common sexually transmitted bacterial and
protozoal infections are acquired every year, at least a third of which affect people aged under 25 (WHO,
Global prevalence and incidence of STIs 2001). Such infections contribute to the global problem of
infertility, which affects more than 180 million couples in developing countries (excluding China) (Rutstein
& Shah 2004). Adolescents and young adults (15-24) are the age groups at the greatest risk for acquiring
STI’s and 3 million become infected each year. These infections and diseases can have severe
consequences, especially in women, if not treated.
Many sexually transmitted infections affect the outcome of pregnancy and some are passed to unborn and
newborn babies (Mullick et, al. 2005). In sub-Saharan Africa alone, an estimated 1 640 000 pregnant
women have undiagnosed syphilis every year; 17 almost all these women remain undetected (Goyal et, al.
2001). Untreated early syphilis results in a stillbirth rate of 25 percent and a perinatal mortality of about 20
percent. An effective screening and treatment programme for syphilis in pregnancy in that region could
prevent close to half a million fetal deaths a year, a figure rivaling the number of infants infected with HIV
by mother-to-child transmission of the virus, which receives much more attention than does syphilis
(Schmid 2004).
Furthermore, research indicates that knowledge, attitudes and sexual practices (KAP) relating to STIs are
potentially associated with delay in seeking care for STIs. For example, a number of studies in South Africa
found that women who delayed tended to be those who held misconceptions regarding the cause of STIs,
and perceived STIs not to be serious (Meyer et, al. 2000). In the USA and the Netherlands, research
suggested that embarrassment or stigma often resulted in prolonged care‐seeking intervals (Fortenberry
1997 and Leenaars 1993). Studies in Kenya and South Africa have found that women who continued to
have sex while having symptoms were more likely to delay, and delayed longer than other women (Moses
et, al. 1994).
METHODOLOGY
Objectives: To assess the treatment seeking behaviour of young married scheduled castes women towards
sexually transmitted infections in Thiruvarur district, TamilNadu, India.
METHODS
Selection of the District
According to 2001 census, Thiruvarur district was the highest Scheduled Castes populated district and also
backward district in TamilNadu state.
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Selection of the Taluks
Multistage stratified random sampling technique was applied to select the respondents from the
Thiruvarur district for the research purpose in the period of ten months from July 2010 to April 2011.
Selection of the taluk was the first step in the multistage stratified sampling techniques. Thiruvarur district
had totally seven Taluks, which comprise 573 revenue villages and 430 panchayat villages. In the first
stage, out of seven taluks, it was decided to select five taluks. These five taluks represent the geographical
area of the study district.
Selection of the Sample Blocks
In the second stage, the purposive sampling technique was applied to select the
blocks, for the
convenience of research work. The selected blocks were Nannilam, Thiruvarur, Tiruturaipundi,
Valangaiman, and Mannargudi.
Selection of the Sample Villages
The selected five blocks totally comprise 352 revenue villages. During the third phase, an attempt was
made to find out the villages which had more than 50% of scheduled castes population. The total number
of these villages was 87. Out of the 87 villages, around one-third of the villages were selected from each of
the blocks by lottery method. The total number of selected villages was 28.
Selection of the Sample Respondents
After identifying the villages in each block, house listing operation was carried out in each of the selected
villages prior to the data collection to provide the necessary frame for selecting the households for the
study. Totally 6376 houses were listed in all the five blocks. Identification of eligible married young women
(15-24 years) in each household was the next step in the research. There were 1164 households with the
target population (39 households had two couples). Totally 1203 women in the age group of 15-24 were
identified in all the five blocks. These women were living with their husbands and had given at least one
birth one year prior to the survey.
It was planned to select half of the population in each of the sample villages i.e., 601 was fixed as the
sample size of the study. Thus, in all, 661 respondents were selected following circular systematic random
sampling technique. Of these 661, 605 respondents were completely participated for the research study.
RESULTS
All the respondents were asked whether they had experienced sexually transmitted infections (STIs) last six
months prior to the study and the results are tabulated. Table 1 presents the percentage distribution of
women by incidence of STIs symptoms. The result reveals that 8.8% of women experienced STIs in the
study area. Only 4.6% of women reported that they suffer from ‘Discharge with unpleasant odor’ and
another 4% of women experienced ‘Frequent and uncomfortable urination’. Meager portion of women
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ISSN: 2250 – 3994
stated that they experienced ‘Pain during sexual intercourse’ (3.1%) and very negligible portion
respondents experienced ‘spotting after sexual intercourse’ (1%).
TABLE 1: DISTRIBUTION OF WOMEN WHO EXPERIENCED VARIOUS SYMPTOMS OF STIS
(MULTIPLE RESPONSES)
Experienced various symptoms of STIs
Discharge with unpleasant
odor
Frequent and
uncomfortable urination
Pain during sexual
intercourse
Spotting after sexual
intercourse
Experienced any one type of STIs
Number of
Women
28
Percentage
4.6
22
3.6
19
3.1
6
1.0
53
8.8
The Table 2 shows women who sought treatment for sexually transmitted infections in the study area. A
significant portion of women sought treatment (77.4%) and the remaining 22.6% of women did not receive
any kind of treatment for their sexual health problems among scheduled caste women.
TABLE 2: DISTRIBUTION OF WOMEN WHO SOUGHT TREATMENT FOR VARIOUS SYMPTOMS OF STIS
(MULTIPLE RESPONSES)
Sought treatment for various
symptoms of STIs
Discharge with unpleasant
odor
Frequent and
uncomfortable urination
Pain during sexual
intercourse
Spotting after sexual
intercourse
Women who had sought
treatment
Treatment seeking behaviour
Yes
No
82.1
17.9
Total
28
81.8
18.2
22
73.7
26.3
34
66.7
33.3
6
77.4
22.6
53
Table 2 shows that women who had ‘Discharge with unpleasant odor’ problems, about 82.1% of them had
undergone the treatment. More than eighty percent of the women who had experienced the ‘Frequent
and uncomfortable urination’ had taken treatment (81.8%). Nearly three forth of women had sought
treatment for their ‘Pain during sexual intercourse’ problem (73.7%), and 66.7% of SC women had
undergone treatment for their ‘Spotting after sexual intercourse’ problem.
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Logistic Regression examining the effect of background characteristics on prevalence of STIs symptom
Table 3 shows the result of analysis made by binary logistic regression whether the women experienced
STIs symptoms with background characteristics. In the present analysis, women who did not experience
STIs were coded ‘0’ and those who experienced STIs were coded ‘1’. Independent variables chosen for the
analysis were age of women, education of women, occupation of women, type of family, standard of living
index, age at marriage, duration of marital life, age at first birth, birth order, exposure to mass media
weekly and distance of health care facility.
It is observed in the Table 3 that education of women, occupation of women and standard of living index
were statistically significant with prevalence of STIs symptoms. All other independent variables such as age
of women, type of family, age at marriage, duration of marital life, age at first birth, birth order, exposure
to mass media, and distance of health care facility were not associated with the prevalence of STIs
symptoms. The logistic regression analysis discloses that when compared with illiterate women, women
with higher education (secondary and above level) were less likely to experience any one kind of STIs
symptom (OR=0.183). It is noticed that agricultural laborers were 1.145 times more likely to experience
STIs symptom to the reference category (OR= 0.251) and non-workers the chances of getting STIs was less
among non-agriculture category. It is also observed that the chance of getting STIs symptom was less
among women living in high wealth index (OR=0.168) than among women living in medium wealth index
(OR=0.255) and the reference category (low wealth index).
TABLE 3: LOGISTIC REGRESSION EXAMINING THE EFFECT OF BACKGROUND
CHARACTERISTICS ON STIS
Variables
Age of women
18-20 (ref)
21-23
24 years
Education of women
Illiterates (ref)
Primary education
Secondary education
Higher secondary and above
Occupation of Women
Non-workers (ref)
Agricultural labourers
Non-agricultural labourers
Type of family
Logistic
Coefficient
(β)
Significant value Odds Ratio
(p)
Exp(β)
1.000
.285
.863
.595
.892
-1.356
-3.116
-5.377
1.000
.035
.000
.000
.358
.244
.183
1.034
-1.686
1.000
.009
.001
1.145
.251
-.467
-.114
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RIJS
Nuclear Family (ref)
Joint family
Standard of living index
Low level (ref)
Medium level
High level
Age at marriage
18 or less years (ref)
19-20
21 or more
Duration of marital life
1-2 years (ref)
3-4 years
5-6 years
Age at first birth
19 or less years (ref)
20-22
23 or more
Birth order
First birth (ref)
Second birth
Third birth
Exposure to mass media in weekly
Less frequently (ref)
More frequently
Distance of health care facility
Within 1 KM (ref)
1-3 KM
3 or more KM
Constant
-.184
-1.367
-2.684
-.619
-.595
ISSN: 2250 – 3994
1.000
.500
.000
.000
1.000
.413
.519
.832
1.000
.255
.168
.538
.551
1.000
.758
.639
-.277
-.494
.480
.411
-.071
.557
1.000
.825
.897
.303
-.862
1.000
.417
.200
1.355
.422
-.271
1.000
.325
.763
-.457
-.367
3.302
1.000
.259
.310
.000
.931
.570
.633
.693
27.173
-2 log likelihood =1224.049
Treatment seeking behaviour for STIs
Table 4 presents the percentage distribution of women by treatment seeking behavior by background
characteristics of women in the study area. It is observed from the table that younger women were much
more likely to receive treatment for their STIs than the older women. Results in table depicts that women
in age group 18-20 were more likely to receive treatment for STIs (87.5%) than those in old age (77.1%
among 21-22 and 70% among 24 years). Education of women had a positive association with the treatment
seeking behaviour of women. Overwhelming proportion of women received treatment for STIs who
completed secondary education (93.3%) more than those who completed primary education (71.4%) and
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ISSN: 2250 – 3994
illiterates (70%). The treatment for STIs was more pronounced among employed women than their
counterparts.
TABLE 4: PERCENTAGE DISTRIBUTION OF WOMEN BY TREATMENT SEEKING,
ACCORDING TO BACKGROUND CHARACTERISTICS
Background
Characteristics
Women who sought
treatment for STIs
Yes
No
Age of women
18 - 20
87.5
21 - 23
77.1
24 years
70.0
Education of women
Illiterate
70.0
Primary education
71.4
Secondary education
93.3
Occupation of women
Non- workers
73.7
Agricultural labourers
76.7
Non- agricultural labourers
100.0
Standard of living index
Low
72.7
Medium
78.6
High
100.0
Age at marriage
Less than 18 years
100.0
18 - 19 years
72.8
20 - 21 years
75.0
22 - 23 years
78.1
Birth order
First
90.0
Second
70.0
Third
66.7
Exposure to mass media in weekly
More frequently
78.3
Less frequently
71.4
Health care facility
Within one KM
92.3
2 - 3 KM
75.0
4 or more KM
71.9
Total
77.4
Total
X2
P
12.5
22.9
30.0
10
35
8
8.78
.077
30.0
28.6
6.7
15
10
28
11.06
.017
26.3
23.3
-
4
30
19
1.33
.515
27.3
21.4
-
33
11
9
17.17
.006
27.2
25.0
21.9
1
28
18
6
7.37
.532
10.0
30.0
33.3
30
20
3
8.95
.029
21.7
28.6
7
46
.16
.687
7.7
25.0
28.1
22.6
8
13
32
53
11.23
.027
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The finding indicates from the Table 4 that, women in households in the highest wealth quintile were more
likely to receive treatment for sexually transmitted infections (100%) than women in households in the
lowest quintile (72.7%). Further, the table shows that women’s wealth index was significantly associated
with the treatment seeking behaviour with a Chi-square value of 17.17 at p= .006. Another demographic
variable, relationship between treatment seeking behaviour and age at marriage follows positive
association. Birth order had a negative influence on treatment seeking behaviour for sexually transmitted
infections. The higher birth order pregnancies were less likely to receive treatment for sexually transmitted
infections (66.7%) than lower birth order pregnancies (90%). The data reveal that the proportion of women
who received treatment for STIs was slightly higher for women who were frequently exposed to media
(78.3%) than less frequently exposed to media (71.4%). The distance between health care facilities and
respondent’s residence shows a significant difference in treatment seeking behaviour. The result reveals
that distance between health care facilities and home, about 92% of women who residing within one KM
radius of health care institutions received treatment for STIs than women residing four KM away from
health care institutions (71.9%). It observed from the table that the proportion of receiving pattern of
treatment for sexually transmitted infections decreased, when the distance between the residence and
health care institution increased.
DISCUSSION
The present study reveals that 8.8% of women had experienced sexually transmitted infections among
scheduled castes population in the study area. The global emergence of sexually transmitted infections has
bought attention to women’s reproductive and sexual health. Women’s reproductive and sexual health
had for decades been a neglected area of international research (Sen & Snow 1994). Now, these issues
feature more prominently in policy and programme development of government and non-governmental
organizations (Muller et, al. 1991). Over one third of all healthy life lost among young women is due to
reproductive health problems (WHO 1995). They often deal with unwanted pregnancy; suffer due to
unsafe abortion, problem arising out of contraception, risk of RTI and STI including HIV infections.
Prevalence of sexually transmitted infections is detrained by number of factors. An association between
pelvic inflammatory diseases (PID) women and husband extramarital sexual relation has been well
documented (Ooman et, al. 2000). The present study reveals that 4.6% of women reported that they suffer
from ‘Discharge with unpleasant odor’ and another 3.6% of women experienced ‘Frequent and
uncomfortable urination’. Use of contraception especially, IUD, female sterilization and abortion
procedures also increases risk of RTI/STI (Gittlesohn et, al. 1994 & Bhatia et, al. 1995).
The role of socioeconomic status in the development of STIs has been highlighted in a number of studies
(Radcliffe et, al. 2001, Monteiro et, al. 2005 and Shahmanesh et, al. 2000). A study from Accra among
women with incomplete abortions also showed higher rates of bacterial colonization of the genital tract in
women of lower socioeconomic status (Lassey et, al. 2004). Low socioeconomic status is associated with
greater high risk sexual behaviour (Parikh et, al. 2003) and this would lead to a higher incidence of STIs.
Wealth index was used as a measure for socioeconomic status in this study.
In an Ethiopian study, it was shown that 51% of women who came to an STI clinic with symptoms had a
confirmed clinical diagnosis (Wolday et, al. 2004). Another study in India reported that 72% of women with
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STI symptoms had a clinically confirmed diagnosis. Despite these results it needs to be stressed that the
presence of STI symptoms is not indicative of an STI diagnosis. Increasing age was found to protect against
having STI symptoms. Sexually transmitted infections are diseases of young sexually active women so it is
expected that older women would have fewer symptoms (Prasad et, al. 2005). Women with a lower
educational background delayed in seeking care at the first STI provider significantly longer than women
with higher education, and urban women sought care significantly earlier than women from rural or
remote areas. (Leenaars et, al. 1993).
There were a number of potential implications for delay behaviour interventions. Primarily, to facilitate
early healthcare‐seeking behaviour for STIs, education campaigns should be developed for the general
public about early recognition of STIs and the benefits of prompt care‐seeking. Women with less
advantaged demographic backgrounds, such as women with low educational level or those from rural area
could be specifically targeted, as they were more likely to delay in seeking healthcare and to delay longer
than those with more advantaged demographic backgrounds.
CONCLUSION
In conclusion, given that research about women's healthcare seeking behaviour for STIs in the study area is
still limited. The findings of this study suggest that designing health education messages, about STI
symptoms and the benefits of treatment, that are targeted at low socioeconomic groups might be an
immediately feasible measure that can be implemented to reduce the effects of STIs in rural area. The
present study recommend that government should take concrete steps through targeted programs and
interventions to improve their care seeking behaviour and also care services at health centers, launching of
counseling centers at village level etc.
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