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Effect
of Reproductive Knowledge of Mothers on Pregnancy
Wastage in Rural Rajshahi, Bangladesh
.........................................................................................................................
Shamima Akter, Md.
Mizanur Rahman, Md. Atikur Rahman Khan, and
J.A.M. Shoquilur Rahman
1. Shamima Akter, M. Phil fellow
Department of Population Science and Human Resource
Development,
University of Rajshahi,
Rajshahi-6205, Bangladesh.
E-mail: samimarub@yahoo.com
2. Md. Mizanur Rahman
Lecturer
Department of Population Science and Human Resource
Development,
University of Rajshahi,
Rajshahi-6205, Bangladesh.
E-mail: mmr_f@yahoo.com
3. Atikur ahman Khan
Assistant Professor
Department of Population Science and Human Resource
Development,
University of Rajshahi,
Rajshahi-6205, Bangladesh
4. Dr. J.A.M. Shoquilur Rahman
Associate Professor
Department of Population Science and Human Resource
Development,
University of Rajshahi,
Rajshahi-6205, Bangladesh.
Correspondence to:
Shamima Akter, M. Phil fellow
Department of Population Science and Human Resource
Development,
University of Rajshahi,
Rajshahi-6205, Bangladesh.
E-mail: samimarub@yahoo.com
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ABSTRACT
Reproductive
knowledge is a vital factor in bearing
a child. To have reproductive knowledge
and the adverse effect of it over several
birth related factors we have collected
data from some selected rural areas of
Rajshahi District. Some influential factors
those influence the reproductive knowledge
and their adverse effect on child bearing
and pregnancy wastage have been identified.
Analyzing our data by some statistical
tools like linear probability models we
have found that the reproductive knowledge
influences pregnancy wastage of mother.
The pregnancy wastage of women in two
extreme age groups (below 20 and above
35) is tremendously dodgy where as in
other age groups this is relatively benign.
Knowledge on healthy reproductive behavior
as well as lower acceptance of family
planning procedure by contraception substantially
reduces the risk of pregnancy wastage;
however giving more birth increases this
risk.
Keywords
and Phrases: Reproductive Health,
Pregnancy Wastage, Reproductive Knowledge
Rating, and Linear Probability Model.
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Reproductive health is a
crucial part of general health and a central
feature of human development. This is a universal
concern but is of special importance for women,
particularly during the reproductive years.
Reproductive health is becoming an emerging
issue by United Nations. During the past few
decades, there has been a growing recognition
of the reproductive health issue for people,
particularly women, in the third world countries.
Every year at the global level about eight million
women suffer from pregnancy related complications
and over half a million die. About 99% of them
are in developing countries (WHO, 2004). Most
of these deaths can be averted even where resources
are limited. The poor reproductive health of
women in third world countries is an outcome
of the general neglect of health and nutrition
in childhood and adolescence, which affects
their future wellbeing (De Silva 1998).
Improvement of the reproductive health status
of women in the third world is being considered
as one of the most important goals of human
and social development. Reproductive knowledge
of mother is highly related to the education
level. As about 50% of the total population
is woman in Bangladesh, the maternal education
is a key factor that can role over a family,
even over the country. Specifically, mother's
education can change a society which lift-up
a country from lower level to upper level because
the practices of educated mothers with regard
to pregnancy, child birth, immunization, management
of childhood diseases etc. are quite different
from those of their uneducated counterpart (Govindasamy
and Ramesh, 1997). Now to undergo in-depth of
our study we would like to discuss some conceptual
terms in brief like new concept of reproductive
health, knowledge on reproductive health, reproductive
age, pregnancy and pregnancy wastage.
New
concept of reproductive health
Reproductive health does
not start out from a list of diseases or problems-
sexually transmitted diseases (STDs), maternal
mortality or from a list of programs like maternal
and child health, safe motherhood, and family
planning. Reproductive health instead must be
understood in the context of relationships like
fulfillment and risk, the opportunity to have
a desired child or alternatively to avoid unwanted
or unsafe pregnancy. This contributes enormously
to physical and psychological comfort and closeness
and to personal and social maturation or poor
reproductive health is frequently associated
with disease, abuse, exploitation, unwanted
pregnancy and death.
Problems that are specific to women's reproductive
process can be divided into two ways. Firstly,
problems occurring during pregnancy, delivery,
and puerperium are referred to in the medical
literature as obstetric (maternal) morbidity.
Secondly, problems that occur to non-pregnant
women and outside the puerperal period of six
weeks are known as gynecological morbidity.
Knowledge on reproductive health
Reproductive health is an important component
of general health and it is a pre-requisite
for social, economic, and human development.
Knowledge on reproductive health such as early
and unwanted pregnancy, HIV, and other sexually
transmitted infects and pregnancy related illness
and death account for a significant part of
the burden of diseases among adolescent and
adults. To improve knowledge on reproductive
health, efforts have so far focused on the approaches
such as antenatal care, tetanus toxic immunization,
iron supplementation, training of traditional
birth attendants for clean and safe delivery
practices and family planning.
Women in reproductive age
Women can conceive and produce child safely
within certain age limits. Usually, it indicates
childbearing period or reproductive span of
women. Generally, the age from 15 to 49 years
is considered as reproductive span for women.
Pregnancy and pregnancy wastage
Pregnancy is the state of female which is produced
due to the implantation of the fertilized ovum
in the uterine endometrium and ultimately giving
rise to a foetus (Jeffcoate, 1975). In an average,
duration of pregnancy accepted 280 days from
the first day of last menstruation. Pregnancy
wastage may be defined as the loss of product
of conception normally or therapeutically and
can be classified as intra-uterine foetal death,
abortion, and menstrual regulation (Jeffcoate,
1975; and Shaw, Soutter and Stanton, 2003).
In our study, we have dealt with the normal
pregnancy wastages only that are not therapeutically
wasted.
Review of Literature
Many researchers have evaluated factors affecting
maternal education and reproductive health of
women that vary from one geographical area to
another. Ardebili, Kamali, Pouranssari, and
Komarizadeh (1987) studied the reproductive
behavior of 1525 pregnant women at the time
of pregnancy termination in relation to maternal
age, education, prenatal care, and number of
previous pregnancies. The results showed that
the frequency of maternal attendance at prenatal
care centers was significantly related to maternal
education and that total pregnancies or woman
is inversely correlated with maternal education.
The type of pregnancy termination which resulted
in live birth or abortion has significant relation
to the age of mother. Again, the highest percentage
of abortion was observed in (15-19) age group
and the highest number of natural deliveries
was observed in the age group (20-29).
Govindasamy and Ramesh (1997) used Indian's
National Family Health Survey (1992-93) data
and showed that there is a consistently strong
association between maternal health care utilization
and mother's education. In the country as a
whole, only half of births to illiterate women
received antenatal care compared to 79% of births
to literate women with less than middle school
education and more than 90% of births to women
with at least middle school education. Only
12% of births to illiterate women are delivered
in institutions compared with 67% of births
to women with at least a middle school education.
Similarly, only one-fifth of births to illiterate
women are attended by a health professional
where as three-fourth of births to women with
at least a middle school education.
Mothers in third world countries with their
limited resources and cultural background, rarely
give priority to their health problems except
where there is a life threatening danger (Bhatia
and Cleland, 1995). Hence it is not surprising
that such women are also reluctant to admit
having health problems or hesitate to seek medical
help, especially if ailment is related to reproductive
health (Bang et al, 1989). Shidhu and Shidhu
(1988) studied the case of pregnancy wastage
in scheduled caste women of Punjab and identified
some causes of more pregnancy wastage. Besides
these, Banerjee and Hazra (2004) investigated
some socio-economic determinants of pregnancy
wastage. But no such elaborate works have been
conducted in Bangladesh.
Although reproductive health and knowledge
on it is a vital issue by United Nations and
in every country world wide, there have been
some efforts to do the same in Bangladesh. Ashraf
et al (2001) showed that 90% of the rural and
urban women had the knowledge about menstrual
hygiene, need of antenatal care visits, and
immunization during pregnancy. But 55% of women
were not aware of complications associated with
pregnancy and post-delivery with a notable difference
between rural and urban areas. Surprisingly,
68% of the women in both rural and urban areas
had knowledge about delivery related complications.
Khanum et al. (2000) explained the complications
of pregnancy and childbirth regarding the knowledge
and practices of women in Rural Bangladesh.
Women's knowledge on symptoms of complications
relating to pregnancy, delivery, and after-delivery
was found to be high in Abhoynagar Thana in
Mirsarai. More than 60% of them had knowledge
of severe vomiting as a complication during
pregnancy in both the areas. Nearly half of
the Abhoynagar women and one-third in Mirsarai
were aware of severe bleeding as a post-delivery
complication. More than two-fifth (42.5%) of
the women of Abhoynagar and 30.7% women of Mirsarai
mentioned oedema as a danger sign of pregnancy.
Bangladesh has among the lowest indicators
of use of maternal health care services in the
world. Recently around 67% of all pregnant women
had no antenatal check-up throughout their whole
pregnancy, around 92% of deliveries occur at
home and approximately 87% of deliveries occur
without the presence of a skilled attendant
(ICDDR, B, 2003). Less than one-half of pregnant
women obtain antenatal care and almost all births
(91%) occur at home, generally with an unskilled
attendant (BMSS, 2002 and BDHS, 2000). Limited
access to essential obstetric contributes to
high maternal mortality and has been estimated
to be 320 to 400 per 100,000 live births (BMMS,
2002). Thus no clear policies have been formulated
towards ensuring basic obstetric care at the
community level. But the regional study of these
factors is really shaky. A study on Tangail
and Noakhali district confirmed only on some
indicators like total population, crude birth
rate, expected number of deliveries, life saving
obstetric surgery and unmet need only. But no
such study has been conducted in the district
of Rajshahi in Bangladesh. From the above review,
it is obvious that there are many scopes of
conducting research. To our knowledge, no work
has been done yet in Rajshahi district regarding
different factors like reproductive knowledge,
pregnancy wastage, delivery status, acceptance
of family planning and their impacts on each
other.
In this paper an attempt has been made to investigate
the impact of reproductive knowledge, acceptance
of family planning, birth spacing, number of
live birth, age, education, and occupation of
mother on pregnancy wastage.
| DATA
AND ANALYTICAL METHODS |
Data
The data were collected from a field survey
conducted in the rural area of the district
of Rajshahi in Bangladesh. We selected Baksimoil
Union of Mohanpur Thana as a representative
part of Rural Rajshahi. We have collected information
from 1500 mothers by preparing a questionnaire.
Analytical Methods
In our study we have used mainly the tabular
system of data, and rating the knowledge on
reproductive behavior. We have also used the
linear probability models to predict the pregnancy
wastage and to identify the impact of some most
influential variables.
Linear probability model
Let us consider a simple model
where X is the reproductive knowledge rate,
Y = 1 when pregnancy wastage occurs,
and Y = 0 when there depicts no pregnancy
wastage.
This model expresses the dichotomous Yi
as a linear function of the explanatory variables
Xi and is called linear probability
model. Now the conditional expectation ofYi
given Xi can be interpreted
as the conditional probability that the event
will occur given Xi, that
is,  .
Thus  gives
the probability of pregnancy wastage whose reproductive
knowledge is rated as Xi (Gujarati,
1995).
Assuming to find an unbiased estimator we obtain
 .
Now letting Pi probability
that Yi = 1 (the event occurs)
and 1-Pi probability that
Yi = 0 (the event does not
occur), the variable has the following distribution:
Now by the definition of mathematical expectation
we obtain  .
Thus we can write the conditional expectation
as probability, that is, .
Since the probabilityPi must
lie between 0 and 1, we have the restriction
 ,
that is, the conditional expectation or conditional
probability must lie between 0 and 1.
The general expression of the linear probability
model (LPM) is
where, Y equal to 1 or 0 according as pregnancy
wastage occurs or not, Xi
and 's are explanatory variables like reproductive
knowledge rating, acceptance of family planning,
birth spacing, total number of live birth, age
of respondent, and other relevant factors.
Reproductive knowledge rating
We have collected some reproductive knowledge
(opinion) related information like risk of pregnancy
before 18 years, taking iron tablets during
pregnancy, vitamins before and after birth,
T.T. injection during pregnancy, medical check-up,
understand pregnancy complications, need of
safe birth attendant, and birth spacing. Assuming
these eight factors have uniform weight we have
scored on knowledge for every factor. We rated
for each factor such that if one had knowledge
about a factor and she did according her knowledge
then we had rated her knowledge as 1/8=0.15
for that factor and 0 otherwise. For example,
if a respondent replies that she has taken T.T.
injection during pregnancy (obviously she knows
it) then we have rated her knowledge 0.15 for
this factor. Finally we have summed the scores
of all eight factors to obtain the rate of knowledge
that is then termed as reproductive knowledge
rate. If a respondent bears knowledge on each
of these eight factors in mind then she is termed
to have perfect knowledge of reproductive behavior.
Thus this knowledge rating ranges between 0
and 1.
Some basic characteristics of the study population
have been incorporated in Table 1. We observe
that the highest number of respondents is aged
between 25-29 years and the lowest number of
respondents is aged between 45 to 49 years.
By the constitutional law of Bangladesh the
minimum age at first marriage for women is 18
years and in an average first age at marriage
is found 20.44 years and 21.4 years in urban
and rural areas, respectively (SVRS, 2002).
But in our study area early marriage is most
frequent and more than 90% respondents get married
before their early eighteens. This clearly depicts
that the female populations in that study area
and their guardians are not aware of the extent
of various physical and mental complications
for early marriage. The most vulnerable sight
of this early marriage is that the mean age
at marriage of the study population is only
16.8 years.
Age at first birth is also a measure of proper
reproductive behavior. In Bangladesh average
age at first birth is 19 (BDHS, 2001). But,
early pregnancy and early motherhood is commonly
observed in our study area. More than 70% of
married women gave their first birth before
reaching 20 years of age. The tendency of early
motherhood is so high that the mean age at first
birth is only 18.7 years, that is, most of the
mothers are in high risk with respect to their
proper physical growth of being pregnant.
Gender equity is acceptable worldwide. Many
government and non-government organizations
are working for establishing gender equality
over the country and are encouraging women to
work with their male counterpart. However, around
98% of married women in this area are house
keeper. Although the Government of Bangladesh
launched two-child program several years (nearly
25 years) ago in 1980, around one-fourth respondents
have more than two children, that is, the effect
of family planning services is very slow here.
Two consecutive births within 24 months (2
years) are very risky for mother's health. However,
15% mothers gave their last birth before two
years from their previous birth. Only 44% of
mothers in this area maintained proper child
spacing. Surprisingly enough that very limited
number of respondent bear knowledge on healthy
reproductive behavior. Most of the females in
this study area are not aware of their reproductive
health. The most perilous deed is that mean
reproductive knowledge rating is only 0.45 that
covers the 45% of most influential knowledge
of reproductive behavior.
Education is the single most factors that accumulate
knowledge on social as well as reproductive
behavior. Illiteracy is common here and around
one-third respondent and their husbands are
illiterate. Only one-third of our study population
with their husband studied at primary level
only. Lack of much formal education may cause
such fall in reproductive knowledge rating.
Further, the proportions of pregnancy wastage
to mother have been computed just dividing the
number of pregnancy wastage in a certain age
group by the number of women in that age group.
The proportion of pregnancy wastage to mother
depicts that pregnancy wastage is higher for
below 20 age groups and above 35 age groups
(Fig.1). Pregnancy wastage may be a result of
many causes. But we have counted only unintentional
pregnancy wastages.
Fig 1. Age-specific
propotion of pregnancy wasteage to mother |
Click
here for Table 1: Characteristics of study population
Now we fit linear probability model using
occurrence and non-occurrence of pregnancy wastage
as the dependant variable. We have dealt with
several explanatory variables like reproductive
knowledge rating, acceptance of family planning,
total number of live birth, age, working status
and education level of respondent. We found
that only reproductive knowledge rating, acceptance
of family planning, and numbers of live children
were significantly affecting the pregnancy wastage.
However age, working status and education level
showed no significant effect on pregnancy wastage.
Thus our fitted linear probability model includes
only those significant factors and can be expressed
as
where X1 represents reproductive
knowledge rating (continuous variable), X2
= 0 when number of children is less than or
equal to two and X2 = 1when
the number of children is more than two, and
X3 = 0 when the respondent
accepts family planning and X3
= 1when she does not accept it. The dichotomous
dependent variableYi is such
that when there depicts no pregnancy wastage
then Yi = 0 and when there
occurs any pregnancy wastage then Yi
= 1.
We observe that increase in reproductive knowledge
and acceptance of family planning (contraception)
substantially decreases the risk of pregnancy
wastage. But the increased number of living
child as well as increased number of birth increases
the risk of pregnancy wastage. We can also explain
theses feature that with the 10%, 20%, and 30%
increase in reproductive knowledge rates the
risk of pregnancy wastage is decreased by 4.57%,
9.14%, and 13.71%, respectively subject to the
condition that all other factors in the model
are fixed at certain level.
Now we fit linear probability
model using occurrence and non-occurrence of
pregnancy wastage as the dependant variable.
We have dealt with several explanatory variables
like reproductive knowledge rating, acceptance
of family planning, total number of live birth,
age, working status and education level of respondent.
We found that only reproductive knowledge rating,
acceptance of family planning, and numbers of
live children were significantly affecting the
pregnancy wastage. However age, working status
and education level showed no significant effect
on pregnancy wastage. Thus our fitted linear
probability model includes only those significant
factors and can be expressed as
where represents reproductive knowledge rating
(continuous variable), when number of children
is less than or equal to two and when the number
of children is more than two, and when the respondent
accepts family planning and when she does not
accept it. The dichotomous dependent variable
is such that when there depicts no pregnancy
wastage then and when there occurs any pregnancy
wastage then
We observe that increase in reproductive knowledge
and acceptance of family planning (contraception)
substantially decreases the risk of pregnancy
wastage. But the increased number of living
child as well as increased number of birth increases
the risk of pregnancy wastage. We can also explain
theses feature that with the 10%, 20%, and 30%
increase in reproductive knowledge rates the
risk of pregnancy wastage is decreased by 4.57%,
9.14%, and 13.71%, respectively subject to the
condition that all other factors in the model
are fixed at certain level.
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