Rural women’s health is an infinitely broad topic. Many Indian women have come from circumstances in which women have limited access to healthcare. Traditionally, there has been discrimination towards women in decision-making; access to resources such as food, education and health care; job opportunities; and in child-rearing and parenting. However, women’s health in rural areas affects everything in their environment from their families to their economies and vice versa. A woman’s health, especially among the poor and illiterate, is often neglected not just by her family but by the woman herself. She is taught not to complain and if she does then she is directed either to use condiments in the kitchen or try faith healing.
Man is unique in that he has a distinct cultural environment of his own. This includes all the conditions in which men are born, brought up, live, work, procreate and perish. Culture as an environment is deeply related to the health of humans. It includes patterns of social organizations designed to regulate a particular society; one can understand the behaviour of people belonging to various sections and predict how an individual of a particular section will react in a given situation. With our knowledge of health, the treatment of diseases among ignorant peoples appears to be strange since they frequently follow practices of praying, wearing of amulets or consulting an exorcist who recites certain verbal formula. Hence, we can say that beliefs and cultural practices are predominately playing significant roles in the human health more peculiarly in the health of women.
Many rural people did not know about the services set up for them at sub-centres and PHC by the government because they did not see any evidence of these services being provided for them. As a part of the awareness programmes, the health workers (ANM) have been organizing to several exposure trips at the villages. It was there that the women were informed about the specifics of various services supposed to be made available to them. This encouraged some of them to ask questions and report on the situation in their PHC. They explained that though a nurse did visit their village it was not a daily visit, nor did she go beyond a certain point in the village, and certainly did not take a round of the village. They made a show of doing their duty by providing nominal services.
A variety of factors, including an older population, a limited supply of health care providers, and further distances from health care resources may contribute to special health concerns for people in non-metropolitan areas. Access to health care and social services are critical issues for rural women.
Belief is the psychological state in which an individual is convinced of the truth of a proposition. Like the related concepts truth, knowledge, and wisdom, there is no precise definition of belief on which scholars agree, but rather numerous theories and continued debate about the nature of belief 1.
The cultural phenomenon of social organization, according to Giger and Davidhizar (2004), includes groups in the social environment that influence cultural development and identification. The family, an important aspect of the social organization phenomenon, strongly influences cultural behavior through a process of socialization or enculturation of children and group members (Giger & Davidhizar; Niska, 1999). These learned cultural behaviors guide individuals through life situations, events and health practices. Understanding family from a cultural perspective is a significant element in providing nursing care to Mexican-Americans since Giger and Davidhizar identify the family as being most values in this culture.
Environmental control is defined by Giger and Davidhizar (2004) as the ability of persons within a particular cultural heritage to plan activities that control their environment as well as their perception of one’s ability to direct factors in the environment. Kuipers’ (1999) discussion of this model, in relation to Mexican-American culture, emphasized the construct of environmental control with a focus on locus-of-control, health beliefs, and folk medicine. Locus-of-control explains the way in which individuals, within their cultural environment, perceive their ability to control what happens to them and to their health. Health may be viewed as being dependent on outside forces or their own actions (Bundek et al., 1993). Beliefs about health and illness, which are components of environmental control, affect health practices, use of health resources, and a person’s response to experiences of both health and illness (Giger & Davidhizer, 2004; Northam, 1996). A third component of environmental control, folk medicine, includes alternative therapies such as using herbs and teas or visiting a cultural folk healer.
Objectives:
1. Exploration of women beliefs on health, risk and their relationship to lifestyles;
2. Elicitation of their views across a range of health-related behaviours and practices, especially puberty, menstruation, pregnancy and child rearing, and assessment of the potential for the positive promotion of women health in these and other areas of her sexual health.
3. Identification of the sources of information and influences on the development of health beliefs amongst women, particularly with respect to common elements in attitudes to risk-taking across a number of health beliefs and practices.
4. To focus on what women themselves know and want to know, including the salience of health, and the relevance of health-related knowledge in their lives
Hypothesis:
1. There is a positive relationship between social beliefs and cultural practices of a given society
2. Positive relationship may be observed among the social beliefs and cultural practices and various other factors such as caste, religion, social and traditional customs in society
3. The explanation for the persistence of belief systems is that people remain committed to them, but for this commitment to last long, the belief system must be validated
Research Design:
A quantitative and qualitative study, building on our previous work in this area, concerning the knowledge, attitudes, beliefs and practices of female children and young women to health, risk and lifestyles. A guiding methodological principle underpinning the study was the development of a sensitive research design for rather than on women: a study grounded not simply in what women know or need to know, but also in what they want to know and feel to be important in the context of their everyday lives. The methods enabling these principles to be taken forward are described below.
a) Area of the Study:
The Telangana region of Andhra Pradesh consists of ten districts namely Hyderabad, Ranagareddy, Mahabubnagar, Medak, Adilabad, Nizamabad, Karimnagar, Warangal, Nalgonda, and Khammam. From this region, the village Ramchandrapur in Koheda Mandal of Karimnagar district has been randomly selected as an area of the study.
b) Universe & Sampling:
According to 2001 census, the village Ramchandrapur has an approximate population of 1840 who from nearly 550 families. This village has a primary health centre (PHC), but lacks a major hospital within a range of 35 kms. And this village has been selected as universe for this study.
So for this study, the researcher adopted stratified-proportionate random method of sampling based on caste composition of the villagers and selected the respondents from the families mentioned in the habitation list of Ramchandrapur. This village population data was collected from Supraja Seva Samithi, a voluntary organization, which is working in the region for the last 10 years in the fields of health, education and environmental protection. The list consists of various caste grouping and from which proportionate stratified samples were selected. Then a list of about 181 respondents was prepared for data collection. Therefore, it is obvious that an attempt has been made to present a general picture of community data and on the basis of which, views and attitudes of the respondents were taken into consideration.
C) Tools of Data Collection:
As the research is qualitative and quantitative, non-participant observation and interview schedule was adopted for the collection of primary data. The aspects that will cover in the interview schedule were defined under two parts, one is for socio-economic and cultural status of respondents such as name, sex, age, social status, education, religion, income, nature and type of the house, etc. and the other for socio-cultural beliefs and practice patterns in health and the related treatment of the villagers.
D) Analysis and interpretation of data:
After arranging the collected data through tabulation and classification, they were analyzed and interpreted in the socio-cultural context so as to give a scientific basis to the study. Although statistical methods like frequencies, percentages, means, standard deviations, t-test, chi-squire and ANOVA have been used in the study, they were applied in a relevant way.
Findings:
Socio-Economic Profile:
During the field work, observed that 22 castes were appeared and most of the respondent belongs to the BC castes like Yadava, Gouda, Munnuru Kapu, Vishwa Brahmin, Mudiraj and a insignificant number of people belongs to services caste like Mangali, Chakali, Mera and so on. A considerable amount of people belongs to SC community i.e. Mala and Madigas. Only a few respondents belong to ST (Erukala) community. Out of the 181 respondents, 55 percent are male and 45 percent female,. This research is carried out with almost all the equal four fold age groups of respondents. Thus, it is noted that age group is scattered in this study. More number of respondents i.e. 91% belongs to Hindu religion and 5% are Muslim. Nearly 4% of the respondents belong to Christianity. It is also proved that common phenomena of religion composition in India.
In this village, a majority of the respondents i.e. 82 (45%) are illiterates. The next more number of respondents have studied up to primary and secondary level i.e. 24 (13%). There are 21 (12%) of the respondents can read and write. A significant number of respondents i.e. 18 (10%) claimed to have studied up to college level while the small number of people who have studied up to professional level, technical level and others stands at 7 (4%), 3 (2%) and 2 (1%) respectively. The findings reveal that more number of the respondents i.e. 55 (30.4%) are labourers and one-fourths of the respondents i.e. 45 (24.9%) are engaging in the farming. On the whole 38(21%) are continuing their caste occupation while 20 (11%) and 17 (9.4%) respondents are doing other occupation and brought up into the service sector respectively. Only a few of the respondents i.e. 6 (3.3%) are carrying out business.
It is also noted that a majority of the respondents i.e. 84.21% are living under the tiled houses and a significant number of the respondents i.e. 15.79% posses R.C.C houses. A substantial number of the BC community respondents i.e. 75% owned the tiled house and rest of them i.e. 14.29% have R.C.C. houses and 8.04% own asbestos roofed houses. Most of the SC respondents i.e. 91.49% are residing under the tiled houses while only 8.51% consist R.C.C. houses. Among the ST respondents, 33.33% have R.C.C., tiled house and thatched house equally. Regarding the income, less than 24% of the respondents earn Rs. 1501 – 2000 per month. Almost equal number i.e. 22.7 and 21.5 % of the respondents earn below Rs. 500 and between Rs. 1001 and 1500 respectively. A significant number of respondents i.e. 20 % obtaining monthly income is in the range of Rs. 501 – 1000 while only 12.7% claimed their income was over Rs. 2000.
This village consist very good fertile lands, There is just below half of the respondents i.e. 84 (46.4%) have not possess any land on their own. There are 35 (19.3%) of the respondents possess land between 1- 2.19 acres. A significant number of respondents i.e. 28 (15.5%) and 20 (11.04%) are having land between 2.20 – 4.39 acres and 5 – 9.39 acres respectively. A considerable number of respondents i.e. 14 (7.7%) are owned land 10 and above acres.
Social Dogmatism on Menstruation
Patriarchal societies have tended to control women by first announcing menarche (the onset of menstrual cycle in a young girl) to the world in an apparently celebratory fashion while thereafter attempting to control the implied fertility and sexual power by monthly rites of pollution, restriction and isolation of the menstruating woman.
The various names for menstruation or ‘periods’ point to its polluting quality. For instance in Telugu, it is called samurta or peddamanshi meaning attaining maturity. Menstrual blood is believed to be polluting. There are varying restrictions put on a girl due to this belief such as not touching people or hanging washed clothes out to dry; not touching certain flowering plants lest they die or not fruit; sleeping on a jute bag or woollen blanket away from others. A woman cannot touch her child during menstruation. If she has to, the child must first be unclothed completely or made to wear silken clothes. Visiting or touching images of gods, temples, religious scriptures is also prohibited. A fear is inculcated in the adolescent that she will sin if she breaks these taboos. Restrictions are also placed on diet. These pollution taboos result in many women getting an enforced rest for at least these three days of the month since they are barred from carrying out their normal activities.
Not only is menstrual blood supposed to be dirty, but evil too. A menstruating girl should not let her shadow fall on a child with measles lest the child turn blind. The used menstrual cloth also possesses an evil quality. If men see the cloth, dry or otherwise, they could go blind. If a cow were to swallow the cloth she would curse the girl with infertility. In villages in A.P., women do not throw their menstrual cloth-they either burn it or bury it.
There seem to be some similarities between Hindus and Muslims regarding the practice of some of these rituals. Among Muslims, the menstruating woman should not touch holy books lest they become impure. Converted Christians follow, although to a lesser degree, the rituals of their original castes. The taboos and rituals clearly devalue. Women’s reproductive powers. The notion of women being polluted and unclean can be ascribed to patriarchal control of women’s reproductive powers. While the woman fulfils a vital social role of giving birth to progeny through her biological reproductive capacity, she is, at the same time, isolated during menstruation.
Cultural Practices of Puberty
Most women do not know about the physiology of menstruation and therefore the first experience of menstruation is filled with fear, shame and disgust. In some areas such as in rural areas of A.P. the girl is sometimes told to dub three or four dots of menstrual blood or mustard oil on the wall and draw a line between the second and third or third and fourth; it is believed that she will finish her menstruation within two and a half or three and a half days in all subsequent periods.
Elaborate rituals are performed in south Indian states-as well as in many parts of north India-at the onset of menstruation. The onset of puberty is traditionally viewed in terms of the girl’s emergent sexuality and prospective motherhood. The pubescent girl is given an elaborate ritual bath, after a massage with turmeric and vermillion. The Mudiraj communities in A.P. isolate the pubescent girl for 21 days within the house, away from the male gaze. The room in which she is secluded is separated with an iron rod and a fire is kept constantly burning during this period. Fire signifies purity and also keeps away daiyyam or witches and evil spirits. The girl is polluted and hence prohibited from touching people and other people are not allowed to touch her. In case of default, a bath is essential for ritual purification.
The Impact of the Food Habits on Women Health:
Although women are more or less marginalized and neglected in relation to the quality and quantity of food, certain occasions in a woman’s life are celebrated with the offering of a variety of nutritious foods specially prepared for her. Almost every community has the practice of feeding a girl on her first menstruation with delicious and nutritive foods, with the time of seclusion for the period ranging between nine to 21 days. In parts of A.P., sweets made of jaggery, groundnuts, sesame, fenugreek, wheat flour and sorgum are given to the girl. Menstruation for the first time in the house of one’s in-laws is also considered very auspicious in all regions of A.P. and is celebrated with gaiety.. The idea seems to be to give the girl ‘rich’, that is, strength-giving foods as well as both ‘hot’ and ‘cold’ foods.
Certain ‘hot’ foods (like jaggery) and ‘cold’ foods (like tamarind and lemons) are taboo as it is believed that the girl will suffer from menstrual pain. ‘Hot’ foods may cause heavy bleeding and ‘cold’ foods may cause severe menstrual pain. Special foods are understood to compensate for the loss of blood, regularise the menstrual cycle and flow, strengthen her reproductive organs and generally contribute to her fertility.
Work Prohibition of Pregnant Women:
It is also observed during the fieldwork that almost all the respondents have revealed that prohibition of work is compulsory while a women pregnancy but this notion is varies to one community to another. The higher social status communities are not allowed to perform the works even domestic works also from the early months to after late months of maternity. Whereas weaker section women perform the daily domestic actives some of them perform field activates but it is only in the early months. They should also take rest in the late months of pregnancy and early months of maternity.
Encourage and Disencourage Food Items During the Pregnancy of Women:
During pregnancy and lactation, many traditional communities across the country restrict a woman’s food intake. It is believed that if a pregnant woman eats too much, the foetus will not have room to move. The abdomen is supposed to contain both the food and the foetus and the latter’s space needs should be given greater priority. Another reason for controlling a pregnant woman’s food consumption is perhaps that excess weight would reduce the productivity of her work in the fields and around the house. A widely prevalent practice all over India is shrimanta. In the seventh month of pregnancy special rituals are performed and different types of sweets are prepared and given to the parents-to-be. The purpose is to give moral support and encouragement to the pregnant woman and celebrate her achievement of having reached near full-term. The sweets are generally made of wheat flour, jaggery, ghee, fenugreek and dry fruits. In the final stages of pregnancy, the pregnant woman is supposed to cat these foods custom every day. This is a good custom because it provides the calories and protein needed for the rapidly growing foetus in the last trimester of pregnancy.
Food Items Encourage % Disencourage %
1. Milk 173 95.5 8 4.4
2. Green leafs 148 81.7 33 18.2
3. Toddy 80 44.1 101 55.8
4. Non-Veg 132 72.9 49 27
5. Papaya — — 181 100
6. Potato 49 27 132 72.9
7. Brinjal 50 27.6 131 72.3
The above table explains the villager’s perceptions on encourage and disencourage food items during the pregnancy of women. The data shows that there are 173 (95.5%) of the respondents have stated that they are encouraging milk and its related food items and only insignificant number of respondents i.e.8 (4.4%) are not encouraging the food items of milk. As many as 148 (81.7%) of them revealed that they are encouraging green leafs and rest of the significant number of respondents i.e. 33 (18.2%) are not interested to give the green leafs to the pregnants. Interestingly the data depicts that more than half of the respondents i.e. 101 (55.8%) have said that they are encouraging toddy and 80 (44.1%) of them are not giving taking toddy. A substantial number of the respondents i.e. 132 (72.9%) have expressed that they are encouraging the consummation of non-vegetarian foods like mutton, chicken and egg. The total number of respondents is practicing the prohibition of papaya consummation during the pregnancy. All most all equal number of respondents i.e. 49 (27%) and 50 (27.6%) have revealed that Potato and Brinjal are encouraged food items and as similar 132 (72.9%) and 131 (72.3%) of them are not encouraging the food items of Potato and Brinjal.
The data regarding Caring of Pregnant Women among the Villagers clarifies the pursuance of the opinion of several communities respondents such as Yadava 14 (7.7%), Gouda 3 (1.7%), Munurukapu 11 (6.1%), Oddera 6 (3.3%), Vishwa Brahmin 5 (2.8%), Mala 25 (13.8%), Madiga 21 (11.6%), Padmashali 7 (3.9%), each 3 (1.7%) of Mangali, Dudekula and Erukala, Kumari 2 (1.1%) and each 1 (0.6%) of Pusala, Mera, Chindi and Dakkali have stated that family and their kins are taking care of their pregnant women. In this category the total numbers of SC and ST communities are appeared because of less financial status and peer group pressure. A majority number of working caste like Yadava, Munnurukapu, Oddera, Padmashali, Dudekula and Kummari are appeared. However, these communities’ people are visiting either government or private hospital for check up their health conditions during early pregnant hood as well as before delivery. One more interesting thing that the caste Mangali itself is traditional birth attendant community in this village so we may consider them in response to this query that they are taking care about pregnant as a traditional birth attendant and as a family. On the whole 3 (1.7 %) of Yadava, 2 (1.1 %) Gouda, 1 (0.6 %) of Munnurukapu and Kummari, 8 (4.4 %) of Chakali, 5 (2.7%) of Dudekula and the total number of Mudiraj 7 (4%) community respondent have expressed that traditional birth attendant are taking care about pregnant of their communities. It is important to note that previous these caste people took care about pregnant but at presently they are seeking the help of traditional birth attendant by reason of saving of time. These kind of villagers always busy in their routine work if they involve in the caring process they should be lost more time in order to money also. The data also describes that all most all the respondents of Deshmukh 3 (1.6%), Vysya 4 (2.2%) and Vaisnava 5 (2.7%) communities have revealed that health workers or ANMs are looking after the pregnant women. It may due to the higher awareness regarding health and personal bias or prejudices of health workers or ANMs who are interested to associate with the higher social status communities.
On account of preferable birthplace; the responses of majority respondents i.e. 112 (62%) is that birth at the traditional birth attendant is more preferable. As many as number of respondent i.e. 36 (20%) have revealed that they prepared birthplace is Government Hospitals and the reaming respondents i.e. 32 (18%) have expressed their perception that Private Hospital are preferable to give the birth. The cluster analysis of data also provides the social status wise explanation that there are 7 (4%) of OC respondents, 19 (10.5%) of BCs and 10 (5.5%) of SCs are interested to go to the government hospitals. There are 10 (5.5%) of OCs and 23 (12.7%) of BCs were interested on Privates hospitals. Among the reaming of categories, the more number of BC respondents i.e. 70 (38.5%), 37 (20.5%) and the total number of ST community respondents i.e. 3 (1.7%) and only few {2(1.1%)} of OC respondent are still interested to give birth under the observation or treatment of traditional birth attendant.
Practices after Delivery:
Women underfed themselves during pregnancy and strove for a small baby to ensure easy delivery. Babies were not to be breast fed on first three days and baby-clothes were not used till a ceremony (purudu/Naming) on 9th day to 21st day. Mothers could not leave the delivery room till that day. To minimize the toilet needs, they severely restricted their intake of fluids and food during first week after delivery. Mothers did not wash hands properly; their clothes and linen were often dirty. Newborn babies, even if sick, were not moved out of home. The usual explanations for the sicknesses in neonates were ‘evil eye’, ‘witch craft’, or ill effects of foods eaten by mother.
The practice of breast-feeding female children for shorter periods of time reflects the strong desire for sons. If women are particularly anxious to have a male child, they may deliberately try to become pregnant again as soon as possible after a female is born. Conversely, women may consciously seek to avoid another pregnancy after the birth of a male child in order to give maximum attention to the new son
Summary and Conclusions:
Due to the orthodoxical and traditional dogma, majority numbers of respondent are not possess proper notion on Women’s health. In addition to supernatural beliefs about what brings on disease, women also have some beliefs about the non-physical causes of ill-health. The most commonly found syndrome was ‘weakness’ which consists of fatigue, body ache, ghabrahat (a generic term used for anxiety, fear, restlessness, trepidation, etc.), pallor, low backache and burning of palms and feet. Thus poverty, illiteracy and social backwardness complete the subordination of women. In reality, therefore, most women carry a tremendous degree of mental anguish and agony due to the improper beliefs and practices.
However, practices existed to over come or to tune with the problems, which may be physical, psychological, cultural and environmental. Subsequently practices are to be strengthen in order to persisting as the beliefs. Once, belief is to be got its own identity; the existence of practice should automatically come by the deeds of the victims or followers. Sometimes belief might be deteriorate due to the business, cost effective and the rationalism should also vanish the irrational beliefs so that we can eventually conclude beliefs exist by the practices which may takes place to over come the problems or to adjust with the nature.
References:
1. http://en.wikipedia.org/wiki/Belief
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3. Spector, R. E. (2004): “Cultural diversity in health & illness” (5th ed.). Upper Saddle River, NJ: Pearson Prentice Hall Health publication..
4. Bundek, N. I., Marks, G., & Richardson, J. I. (1993): “Role of health locus of control beliefs in cancer screening of elderly Hispanic women”. Health Psychology, 12(3), 193-1999.
5. Pachter, L. M. (1994) “Culture and clinical care: Folk illness beliefs and behaviors and their implications for health care delivery”. Journal of the American Medical Association, 271(9), 690-694.
6. Roberson, M. H. (1987): “Folk health beliefs of health professional”. Western Journal of Nursing Research, 9(2), 257-263.
7. Treistman, J. (1988): “Health beliefs in socio-cultural perspective”. In G. Caliandro & B. L. Judkins (Ed.), Primary nursing practice (pp. 119-133). Glenview, IL: Scott, Foresman and Company.
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