CHAPTER-I

Introduction:

"The health of the people is really the foundation upon which all their happiness and all
their powers as a state depend"

Benjamin Disraeli

Reproductive health has been defined by world health Organization (WHO) as the state of
complete physical, mental and social wellbeing and not merely the absence of disease or
infirmity in all matters relating to the reproductive system and to its functions and processes.
(1)

According to world health organization (WHO) estimates 2011, reproductive ill health
accounts for 33% of the total burden of disease in women. As a result, every year an
estimated 50 million women are affected by reproductive tract related morbidities and for
approximately 18 million of them, these morbidities become long-term and are often
debilitating. The third millennium development programme emphasized on maternal health
which can be assessed by maternal mortality ratio. However, for every woman who dies,
approximately twenty others face serious or long-lasting morbidities. (2)

Reproductive morbidities can be broadly categorized into three subgroups: obstetric

morbidity, gynecological morbidity and contraceptive morbidity. Gynecologic morbidities
include reproductive tract infections, menstrual disorders, reproductive endocrinal disorders
and primary infertility. Obstetric morbidities are related to pregnancy, delivery or treatment of
conditions that arise during pregnancy or delivery. These can be acute or chronic. The short
term or acute morbidities occur during pregnancy, delivery or within six months of delivery
or abortion and include Eclampsia, ante partum and postpartum hemorrhage, obstructed
labour, sepsis and post abortion bleeding or sepsis. The long term or chronic obstetric
morbidities (COM) include obstetric fistula (Vesico-vaginal or recto-vaginal), genital
prolapse, chronic pelvic inflammatory disease and secondary infertility. Contraceptive
morbidities include conditions, which result from efforts to limit fertility, whether they are
traditional or modern methods. In India, almost 39% of currently married womens
reproductive morbidities are in terms of gynecological disease. (3)

1
Reproductive morbidities have vast impact on the health and quality of life of women. Beside
that many women who suffered from reproductive organ disorders had not sought appropriate
(2)
care. The health seeking behaviour among women is influenced by many factors.
Reproductive morbidity in general, is an outcome of not just biological factors but of women
poverty, powerlessness and lack of control over resources as well. Malnutrition, infection,
early and repeated childbearing and high fertility also play an important role in poor maternal
health conditions in India. (4)

RTI cover three types of infections. Sexually transmitted infections (STI's) infections that
result from overgrowth of organisms normally present in the reproductive tract and infections
associated with medical procedures including abortion and insertion of intra uterine devices.
Female RTI's usually originate in the lower genital tract as vaginitis or cervicitis and may
produce symptoms such as abnormal vaginal discharge, genital pain, itching and burning
feeling with urination.