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Silent suffering: the burden of reproductive health problems in the Gambia

Reproduction plays a central role in the lives and health of women in many parts of the world. What is the real burden of reproductive health disorders in developing countries? Researchers from the Medical Research Council Laboratories in The Gambia assessed the scale of the problem in the rural Farafenni area.

Women received a questionnaire from a fieldworker, then were examined by a gynaecologist and tested for several medical conditions. Around 70 percent have at least one reproductive organ disorder, the study showed. How can reproductive health services with limited resources tackle this huge, but largely silent, problem?

Of the 1348 women who took part in the study:

Only 3.1 percent have any formal education and 95 percent list farming and working in the household as their main occupation. Over half are in polygamous marriages.
Anaemia affects more than half and 16 percent are malnourished.
The most common symptoms are menstrual problems and vaginal discharge and itching. Less than half seek healthcare for these symptoms due to cost, fear or embarrassment, mistrust of the health system or acceptance of the condition.
34 percent have menstrual problems, 10 percent are infertile, nearly half have reproductive tract infections, one in ten have pelvic tenderness, 6.7 percent have cervical irregularities, 16 percent have abnormal lumps in the abdomen and nearly half have pelvic damage resulting from childbirth.
Over half have visible signs of genital cutting and only 6 percent use modern contraceptive methods.

HIV prevalence is low (1.7 percent), but nearly a third of women have herpes simplex virus 2 infection. This suggests that sexual behaviour patterns here are conducive to the spread of HIV and sexually transmitted infections. However, it is difficult for women to negotiate safe sex in a polygamous setting where childbearing is highly valued.

For many women, their security depends on continuing fertility and motherhood and they are seldom in a position to attain and maintain health and wellbeing. To improve the reproductive health of women here and in other communities, policy-makers should:

increase the use of health services through community education about symptoms, prevention and treatment of disease
improve the efficacy of food promotion and iron and folic acid supplementation programmes through counselling and guaranteed supply
ensure the continued local availability of effective and inexpensive treatments for menstrual disorders
encourage sexual behaviour change by focusing on the risk of infertility, which is greatly feared by many women
promote improved menstrual hygiene as a strategy for preventing endogenous reproductive tract infections
reduce the risk of childbirth-related damage by improving delivery care services, especially at home, and increasing general awareness of reproductive health and fertility
encourage communities to assume some responsibility for women's health.

However, the researchers stress that serious reforms and improvements are unlikely without increased public-sector spending on reproductive health services.

Source(s):
'The burden of reproductive-organ disease in rural women in The Gambia, West Africa' by G. Walraven et al., The Lancet 357 (2001)

Funded by: UK Medical Research Council

id21 Research Highlight: 15 August 2001

Further Information:
Gijs Walraven
Medical Research Council Laboratories
Farafenni Field Station
PO Box 273
Banjul
The Gambia

Contact the contributor: gwalraven@mrc.gm

Robin Bailey
London School of Hygiene and Tropical Medicine
Keppel Street
London
WC1E 7HT
UK

Contact the contributor: robin.bailey@lshtm.ac.uk

London School of Hygiene and Tropical Medicine, UK

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