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Women, reproductive health and the private sector in India

What are the biggest health problems for women? Is the current emphasis on reproductive health correct? Where do women go for healthcare? Researchers from the Indian Institute of Management and the London School of Hygiene and Tropical Medicine investigated women’s health in Karnataka State, India.

Women are very concerned with reproductive health problems, which account for a quarter of all illnesses. For all health problems, both rural and urban women prefer to visit a private practitioner, rather than government clinics. The researchers argue for a re-think of the way reproductive healthcare is provided.

Women's reproductive health has been a high priority for national and international policy-makers since the 1980s. As HIV continues to spread throughout the developing world, the need for good quality reproductive healthcare has never been greater.

But many developing country governments face the dual challenges of increased demand and reduced resources for healthcare. Accurate information about the health needs of the population is crucial to guide policy decisions about the best use of scarce resources. This research provides information on the health needs of 421 young married women in Karnataka State, India, over the course of a year.

Women’s responses to questions about their health showed that:

Reproductive illnesses account for 26 percent of all episodes of ill-health.
Women tend to self medicate for symptoms such as vaginal discharge or menstrual disorders. They either regard these as part of daily life or are too embarrassed to see a doctor.
Women are much more likely to visit a doctor about pregnancy or family-planning issues.
A large majority of consultations (80 percent) are with private practitioners. Women have greater faith in private services.
All doctors give a lot of injections - patients expect them and believe they will work. Since the placebo effect of injections is very high, doctors would rather give them than lose a patient.
Government health services cost almost as much as private care. Public healthcare is officially free, but in practice patients have to pay for care and medicine.

These findings suggest that policy-makers attempting to improve the quality of healthcare for women in Karnataka should:

focus mainly on the private medical sector
conduct a detailed assessment of the clinical and drug-dispensing procedures of private practitioners, to identify priorities for improvement
use a multi-faceted approach, including accreditation schemes and self-regulating bodies as well as further education for private practitioners
abandon the myth that government services are provided free of charge and base policy decisions on the actual amount people spend on public healthcare.

Source(s):
‘The contribution of reproductive ill-health to the overall burden of perceived illness in South Indian women’ by J. Bhatia and J. Cleland, Bulletin of the World Health Organization 79 (2001)
‘Health-care seeking and expenditure by young Indian mothers in the public and private sectors’ by J. Bhatia and J. Cleland, Health Policy and Planning 16 (2001)

Funded by: The Ford Foundation

id21 Research Highlight: 03 October 2001

Further Information:
John Cleland
London School of Hygiene and Tropical Medicine
49-51 Bedford Square
London WC1B 3DP
UK

Tel: +44 (0)20 7299 4614
Fax: +44 (0)20 7299 4637
Contact the contributor: john.cleland@lshtm.ac.uk

London School of Hygiene and Tropical Medicine, UK

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