PREGNANCY WASTAGE AMONG MERRIED WOMEN IN RURAL RAJSHAHI, BANGLADESH

1. Md. Mahfuzar Rahman Research Fellow E-mail: rahmanru_pops@yahoo.com 2. Md. Atikur Rahman Khan Assistant Professor 3. Md. Nazrul Islam Mondal Assistant Professor E-mail: nazrul_ru@yahoo.com Department of Population Science & Human Resource Development University of Rajshahi-6205, Bangladesh. Correspondence to: Md. Mahfuzar Rahman Research Fellow Department of Population Science & Human Resource Development University of Rajshahi-6205, Bangladesh. E-mail: rahmanru_pops@yahoo.com

Key words: Pregnancy wastage, Reproductive knowledge, Logistic regression analysis.

INTRODUCTION

Pregnancy wastage can be classified as intra-uterine foetal death, abortion, and menstrual regulation (Jeffcoate, 1975; and Shaw, Soutter and Stanton 2003). According to Sir Norman Jeffcoate (1975), "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; and pregnancy wastage is the loss of product of conception normally or therapeutically". In an average, duration of pregnancy accepted 280 days from the first day of last menstruation.

Every year about eight million women suffer from pregnancy related complications and over half a million die. About 99% of these 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 well being (De Silva, 1998). Using the information from 2967 mothers from Rajshahi District within the reproductive span (15-49 years), Khan et al. (2007), found that the proportion of pregnancy wastage to live births in two ages of reproductive years is tremendously 'dodgy' whereas in other age groups, between 20 and 35, these are comparatively benign. Further, 6717 births were studied to investigate the flow of caesarian deliveries over the ages. They also found that 359 caesarian deliveries against 6,358 natural (vaginal) deliveries.

Ardebili, et al., (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 per woman is inversely correlated with maternal education. 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). In 2002, Meharunnisa studied on 2104 gynaecological patients, and out of them 240 cases were of abortion i.e. 11.4% was the prevalence of abortion. Most cases of abortion occurred in women between the age groups of 26-35 years. The commonest type of abortion was incomplete i.e. 30.4%. Prevalence of repeated abortions was 29.1%. Most of these abortions occurred at 8-12 weeks of gestation i.e. 50.8%. Apparent causes for the abortion were most commonly the metabolic diseases i.e. 29.5% and the least common causes were the uterine malformations i.e. 8.2%.

Abortion is the commonest complication of the pregnancy, and is responsible for the maximum number of pregnancy wastages (Rana et al., 1990). In Bangladesh, the law prohibits induced abortion except when a woman's life is endangered by her pregnancy. Nearly half of admissions to gynecology units of major hospitals in Bangladesh involve abortion-related complications (Measham, 1981). Risk factors for pregnancy wastage in Bangladesh have not been studied very extensively. This is in part because of the lack of reliable data. It is difficult to obtain information on abortion from clients, and service statistics are highly inaccurate.

Nonetheless, in this article, the main aim and objective is to identify the impact of some selected variables on the extent of pregnancy wastage in rural Rajshahi by logistic regression analysis.

DATA AND METHODS

In the present research, the data were collected from 750 women of reproductive ages (15-49 years) who lived in rural areas of Rajshahi district, Bangladesh. We select Baksimoil Union of Mohonpur thana as a representative part of rural Rajshahi. The respondents were directly contracted and the desired information was collected successfully using a pre-designed questionnaire through a purposive sampling technique.

Various alternative statistical tools exist for analyzing the effect of various background characteristics on pregnancy wastage over time. In this study, the logistic regression model is used to analysis the data because this model is being used in many different areas and has become the standard method of analyzing model in which the dependency of a binary response variable is being tested on a number of explanatory variables. The logistic regression model is a curvilinear response function and this function assures that the probability of occurrence of an event is always between 0 and 1. Hence the dependent variable used in the logistic regression model is as follows.

Y=1, if the women had at least one pregnancy wastage during their life and
=0, otherwise.

RESULTS AND DISCUSSION

To know the age specific flow of pregnancy wastage, the proportions of pregnancy wastage to mothers and to live births have been computed. The computed values have been incorporated in Table 1 and to divulge the age specific flow of pregnancy wastage, age specific line graph has been constructed (Figure 1).

The study showed that the number of pregnancy wastages in the age group 25-29 is 10 which is highest among the women. The second highest is the women who are of the age group 40-44. This usually happens in most rural areas of Bangladesh because women of age group 25-29 are desired for more children than the women of age below 29 and due to the lack of proper awareness about the adverse effect of pregnancy among the older ages women, pregnancy wastage occurs in age group 40-44. But the proportion of pregnancy wastage to mothers is very higher in the age group 40-44 than any other previous age groups (Figure 1). At the same time, the proportion of pregnancy wastage to live births is high in the age group15-19. Thereafter, this proportion is slowly decreasing (considering the smoothed pattern) over the ages but it again very rapidly increases after the age group 35-39 (Figure 1).

Figure 1: Age specific flow of pregnancy wastage to mothers and to live births.

Reproductive knowledge rating is a system in which the respondents are scored (this rating ranges between 0 and 1) uniformly on the basis of some variables related to reproductive health. More than 50% (50.4%) of all females (750) have reproductive knowledge scored in the group (0.4-0.6) whereas the reproductive knowledge average is 0.45 (Table 2). So, from the study, it is clear that the reproductive knowledge of the respondents, living in the study areas, is not so good. However, fairly saying, about half of the respondents bearing medium reproductive knowledge.

Table 3 showed the logistic regression estimate of odds ratios for the effects of selected background characteristics of ever-married women of reproductive ages on pregnancy wastage. Odds ratios are shown in place of regression co-efficient for the easy interpretation of results. A statistically significant odds ratio below 1.00 means a negative effect while a statistically significant odds ratio above 1.00 means a positive effect on the independent variable.

Table 3. Logistic Regression Estimates of the Odds Ratio Predicting that Rural Women had Pregnancy Wastages by Some Background Characteristics

Background characteristics	Coefficient ()	S. E. of estimates	Odds ratio
Age at marriage:
<18 years	0.929	0.215	2.532
18+ years (Ref.)	-	-	1.000
Family planning:
No (Ref.)	-	-	1.000
Yes	-2.158	0.526	0.116***
Respondent’s education:
Illiterate	0.637	0.623	1.891*
Literate (Ref.)	-	-	1.000
Reproductive knowledge rating:
< Average (Ref.)	-	-	1.000
Average	-2.627	0.299	0.072***
Number of live children:
> 2 (Ref.)	-	-	1.000
2	- 2.380	0.348	0.093***

Note: (Ref.)= Reference category
***, **, and * indicate p<0.001 (highly significant), p<0.01 (significant) and p<0.05(less significant) respectively.

The regression coefficient of women corresponding to their mean age at marriage is calculated. Since the legal age at marriage in Bangladesh is 18 years for women, therefore, the age at marriage above 18 years is considered as reference category. The odds ratio for women whose age at marriage is <18 years is 2.532. This indicates that the women of age at marriage <18 years have 2.532 times more likely to have higher pregnancy wastage than that of the reference category.

Considering the women who did not practice family planning, as a reference category, the regression coefficient corresponding to women who practiced family planning has been computed and the results are statistically significant. The result indicates that the women, who currently used family planning, have 0.116 times less pregnancy wastage than those women who did not use (reference category).

In case of educational qualifications of the respondents, the regression coefficient has been computed by considering the literate women as a reference category and the result is negative in sign and also showed the significant effect on pregnancy wastage. The odds ratio corresponding to the illiterate women is 1.891. It indicates that the illiterate women have 1.891 times higher pregnancy wastage than the literate women. This happens as because the illiterate women of the study area are less aware about the adverse effect of pregnancy wastage on their reproductive health.

As about half of the women of the study area have medium reproductive knowledge, so, the women who had average reproductive knowledge were considered in this study as a reference category. The result showed that the women, whose reproductive knowledge is average, have 0.072 times less pregnancy wastage than the women whose reproductive knowledge below the average (reference category).

The couples are encouraged for 2 live children in Bangladesh during their life, therefore, considering the women having >2 children as a reference category, the regression coefficient is computed and the result showed statistically significant effect on pregnancy wastage. The odds ratio corresponding to women having children 2 is 0.093. This result clearly indicates that the women who had less than or equal to two children, have 0.093 times less pregnancy wastage than those women of the reference category (who had more than two children).

CONCLUSION AND RECOMMENDATIONS

Risk of pregnancy wastage changes with age. Increased age decreases the risk of pregnancy wastage. However, in the extreme age groups pregnancy wastages are observed substantially larger. The logistic regression analysis shows the statistically significant effect of the selected variables except age at marriage on pregnancy wastage.
Therefore, the effective policies and recommendations are needed to create the awareness among mothers living not only in the study areas but also other areas of Bangladesh.

i. Early marriage (before 18 years) and teenage motherhood is a bleak reality behind the scrape of female health hazards in Bangladesh. The women should be aware of safe motherhood (no birth before 25 years) that may be helpful to overcome the pregnancy related deficiencies as well as to control the population growth to a large extent.

ii. The knowledge of women relating to reproductive health should be increased through education, information and communication campaigns among rural areas so that the pregnancy wastage situation cannot be evaded easily.

REFERENCES

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De Silva W.I. 1998. Symptoms of Ill Health and Health Seeking Behavior of Sri Lankan Mothers during the Puerperium: Asia Research Institute, National University of Singapore.

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