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Women’s Perception of Reproductive Illness in Manipur, India

Women’s Perception of Reproductive Illness in Manipur, India Hindawi Publishing Corporation Journal of Anthropology Volume 2014, Article ID 321480, 9 pages http://dx.doi.org/10.1155/2014/321480 Research Article 1 2 1 3 Pebam Krishnakumari, P. C. Joshi, M. C. Arun Kumar, and M. Meghachandra Singh Department of Anthropology, Manipur University, Canchipur 795003, India Department of Anthropology, University of Delhi, Delhi 110007, India Department of Community Medicine, Maulana Azad Medical College, New Delhi 110001, India Correspondence should be addressed to Pebam Krishnakumari; pebam14@yahoo.co.in Received 24 October 2013; Revised 15 January 2014; Accepted 29 January 2014; Published 10 March 2014 Academic Editor: Santos Alonso Copyright © 2014 Pebam Krishnakumari et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Perception of reproductive illness by the women themselves is important in understanding the women’s reproductive health in a particular society. It also indicates the possibility of taking perception as a tool for measuring reproductive illness. o Th ugh women do not have a “germ theory” to explain their reproductive illness they have a sense of illness pathology. Reproductive illness perceived by women is related to physical symptoms and situations in a network of meanings and different meanings are socially generated to articulate their experiences. 1. Introduction consciousness that there is something wrong [2]. u Th s, disease in the Western medical paradigm is malfunctioning Reproductive illnessisnot only biological butalsoisembed- or maladaptation of physiologic processes in the individ- ded in a web of psychological, economic, political, and social ual. Whereas illness represents personal, interpersonal, and factors. Different societies encounter, define, and experience cultural reactions to disease and/or discomfort. Illness is reproductive health problems biologically as well as cultur- shaped by cultural factors governing perception and labelling ally. Different cultures define reproductive illness in different explanation and valuation of the discomforting experience ways;whatisrecognisedasreproductiveillness in onemay and by processes embedded in a complex family, social, and notbesoinothers. Forthispaper,reproductiveillness refers cultural nexus. Because illness experience is an intimate part to the illness which women perceive as related to their sexual of social systems of meaning and rules for behaviour, it is and reproductive organs and function. strongly influenced by culture: it is, as we shall see, culturally As the meaning of health is culturally defined under- constructed [3]. standing of the women’s perception of reproductive health Perception of reproductive illness by the women them- is a sine qua non in order to give a holistic representation of selves is important in understanding the women’s repro- women’s health. Here, understanding the conceptual distinc- ductive health in a particular society. It also indicates the tion between “disease” and “illness” becomes essential. eTh possibilityoftakingperceptionasatool formeasuring conceptofdisease hashistoricallybeenthe most dominant reproductive illness. Though women do not have a “germ” category; it has a biological interpretation and refers to theory to explain their illness, they have a sense of ill- abnormalities in the structure or function of organ and organ ness pathology. Reproductive illness perceived by women is systems, pathological states whether or not they are culturally related to physical symptoms and situations in a network recognised. Health, as a felt experience of the individual, of meaning and different meanings are socially generated to provides another meaning which is embodied in the term articulate their experiences. “illness.” u Th s, illness is the meaning that individual gives Most of the currently known intervention schemes for to health and refers to a “person” disvalued states including improving reproductive illness are based on and guided but not limited to disease [1]. Illness is the individual’s by laboratory test and outsider-based interpretations and 2 Journal of Anthropology perspectives of the key factors that aeff ct reproductive health illnesses, like weakness and backache, and used these terms status. Little attempts have been made to investigate how as euphemisms to report discharge [10, 11]. women themselves perceive and understand the aetiology Pachauri and Gittelsohn [12] constructed an ethnomed- of such illness and how it aeff cts the reproductive health in ical model of women’s illnesses throwing considerable light various societies. on Indian women’s perception of their health. Oomman [13] To design a culturally sensitive health programme there in her study in Rajasthan village emphasised on women’s is a need to incorporate women’s perception of their illness. reproductive morbidity within its socio-economic and cul- eTh meaning of health needs to be recognised for achieving tural context and showed how women attributed their illness an analytical understanding of the process of production of to their biological susceptibility, which is a result of poverty- health as a basis for any realistic and comprehensive eo ff rt induced malnutrition. She also developed an ethnomedical to improve health condition in the community, as it has a model on the basis of women’s perception of severity of direct bearing on the treatment seeking behaviour. It is high “women’s illness” which includes discharge (dhola pani), time to look at the “felt needs” of the reproductive health of menstrual problem (kapdaro bimari), and prolapse (sharer women. This paper is an endeavour to bring into light how bahar aaye). In 1999, Patel explored how in practice women women in Manipur perceive “women’s illness” such as vaginal manipulate fertility decisions in the light of economic struc- discharge and menstrual problem and their perceptions of the turesonone hand andkinship on theother hand and seriousness of different women’s illnesses. concluded that fertility behaviour is constituted in dialectical relationship between people and their settings—objective conditions coupled with subjective perspective thereof. 2. Retrospect of Research on Perception of In 2001 Pimpawun Boonmongkon et al. documented Reproductive Illness from South East aTh iland women’s experiences of gynaeco- logical complaints linked to the “uterus” (mot luuk)through Medical Anthropology has hitherto been conceived of as cultural reasoning. Kaddour et al. [14] elicit the definition a tool for investigating and explicating local perspective of the concept of reproductive health among women in on reproductive health. Medical anthropologist has always three communities around Beirut, Lebanon. In 2008, Abdul tended to describe cultural variation in health belief system, Karim et al. conducted a study to nd fi out community’s emphasizing on people’s own description and experience of knowledge and perceived implications of maternal mortality reproductive health and illnesses within local cultural system. and morbidity in two urban and two rural communities in Borno state, Nigeria. eTh community members’ perception Way back in the1980s medical anthropologist’s ethno- on ways to prevent the scourge was also explored. graphic work primarily focuses on fertility and childbirth. Based on a seminal study in a Muslim village in rural Cormack [4] edited a collection of essays on the cultural Bijnor district (north-western Uttar Pradesh) by P. Jeeff ry and construction of fertility and birth in countries like Sri Lanka, R. Jeeff ry [ 15] argued that government health care provision New Guinea, Ghana and Britain to demonstrate a wide in rural Uttar Pradesh is embedded in a moral universe range of cultural rules and social practices that exist in characterisedbywidespreadand long-termmistrustofthe all societies and influence fertility and childbirth. In India, state services and stressed that encouraging institutional Jeeff ry et al. [ 5] lament out the women’s voices reflecting on deliveries without addressing the perceptions of potential their experiences of childbearing and provided an accessible service users as serious flaw in the approach to reduce and existing reassessment of women’s role in an agricultural maternal mortality. This paper will focus on Andro women’s society traversing a women’s life from the time they marry perception on illnesses related to their sexual and reproduc- to the moment they enter their husband’s household till they tive organs and function such as vaginal discharge (phingou give birth. Nichter [6] examined the cultural notion of fertility chatpa), menstrual-related illness (mangbaga mari leinaba in Sri Lanka and its impact on family planning practices, as anaba), andprolapse(angangkhao nanthaba). This paper will well as the ethnophysiology and food consumption practices also emphasize the policy and program including women’s during pregnancy in South India. Patel [7] explored how perception of reproductive illness. women in Rajasthan have childbirth and postpartum care as their own domain and how their lives showed a mix of sub- ordination and freedom in different spheres of functioning. 3. Methodology In the 1990s health research began to focus on women’s perception of reproductive health. Younis et al. [8]assessed eTh informationusedinthisstudy wasgatheredduringfield the level of reproductive morbidity in Egypt and examined work conducted between July 2004 and January 2005 updated the social context of women’s health and attempted to under- in 2011. A survey was conducted in September and October, stand women’s report of illness in this context. In India, R. 2004, to furnish data about the socioeconomic condition Bang andA.T.Bang[9] made an exploration of the perceived of Andro. To get a general perception of women regard- causes of white discharge and examined the perceived eeff ct. ing commonly prevalent illnesses among them, free listing Evidence suggests that women perceive white discharge to technique was used. This method was used to determine be part of sexual maturation and consider it normal. Studies the items which make up the domain of “illness which only found that women commonly have multiple terms to refer to women get.” A master list of women’s illness was compiled different types of vaginal discharge and they linked it to other andusedaschecked list of illnessesand symptoms.Women Journal of Anthropology 3 were chosen randomly from the village for this method. eTh place for throwing waste has an important role to Ten key informant interviews were conducted among old play in adumbrating the sanitation and hygiene of an area. In Andro, there are three ways of throwing the garbage—throw women, traditional healer (maiba), and traditional birth it in the open, throw it in drainage, and dig a pit hole to dump attendant (maibi) of the community to collect information the wastage. A majority (58.5 percent) of the households regarding women’s illness, causes, childbirth, menstruation, throw the garbage in the open, 35.5 percent throw in the pit sexual behaviour, food taboo, women’s work, and so forth. hole, and 6 percent throw the wastage in the drainage. Women’s group like Women’s torch bearer (Meira Paibi), Having proper toilet facility is essential for healthy exis- Mahila Mandal (name of the women’s organisation), tradi- tence. In Andro, 0.5 percent do not have toilet facility. 10.5 tional birth attendant (maibi), and women of the reproductive percent use semipucca, 5.05 percent use pucca, and 81 percent ageweretargetedfor thefocus groupdiscussions.Three use pit hole, where a hole is dug up and covered on all the four focus group sessions were conducted, each group consisting directions with rags. of 6–8 women. eTh principal aim during the focus group discussion with women mentioned above was to develop One of the main factors in health issue is transport an understanding of women’s perception of normal against and communication. Within Andro people commute in two abnormal vaginal discharge, menstruation, and prolapse and wheelers like scooter but bicycle is the most common way to their explanation of the ways in which women acquire, glide along. Covering distance by foot is also a common sight prevent, or deal with such a condition. Special attention in Andro. If one has to go beyond Andro then buses and jeep was also paid to the association of these perception with a are the main means of commuting. view to obtain a more comprehensive understanding of the In Andro, there is one primary health centre. The main causality and sociocultural context in which reproductive activities carried out in the primary health centre are curative illnesses are acquired, the stages, how and why such illnesses care, tuberculosis detection, maternal, and child health ser- occurred, and how they were perceived and managed by vices such as diarrhoea disease control, immunization, and the women and their families. Past illness narratives were family planning. used on women who have been identified by traditional birth attendant (maibi), traditional healer (maiba), or the 3.2. Women’s Illness in Andro. Women in Andro perceive ill- womenwho hadparticularsymptomslikevaginal discharge, ness associated with reproduction as women’s illness (nupigi menstrual problem, prolapse, and so forth to furnish infor- anaba) not as reproductive illness. While conducting inter- mation regarding illness episode including symptom onset, view with the traditional birth attendants (Maibi’s), local management, and its perceived consequences on their lives. healers (Maiba), and women in the community, certain Seven such narratives were collected for this study. illnesses were unraveled as experienced only by women. It explicitly shows that there are bouts of illnesses which 3.1. Area and People. Andro is a village inhabited by the only women experienced locally termed as women’s illnesses Lois in Manipur, a state in the north eastern region of India. (nupigi anaba)inAndro. Etymologically, the word Loi means subdued, dependent, During ethnographic study, women spoke about several outcaste, and backward. eTh village is 26 kilometres away women’s illnesses (nupigi anaba). Checks listing of illnesses from Imphal covering an area of 1211.64 Hectares. eTh total was compiled using the ndin fi gs from free listing method as number ofmalesis4307andfemalesis4437(Census ofIndia, well as result from key focus group discussion. This list was 2011). er Th e are thirteen localities in Andro. used to elicit information about each illness on symptom, Agriculture is the mainstay in Andro. It is a family enter- term descriptions, possible causes, and seriousness of the prise. However, rice cultivation relies heavily on women’s problem. labour. Besides agriculture, brewing liquor, weaving, and Table 1 explicates the main women’s illnesses (nupigi potteries are some of the economic pursuit done by women anaba) in Andro and was used to elicit information about in Andro. Basedonthe socioeconomicdatacollected during each illness on symptom, term description, possible causes, survey phase in Andro which was conducted in September and seriousness of the problem. and October, 2004, 46.9 percent of the females are literate. The free listing method showed that women perceived The mean family income per month in Andro is Rs. 3972.50 white discharge (Phingou chatpa)tobethe most common (approx. US$ 65). problem. Weakness (Sonthaba) and menstrual-related prob- The source of water is one of the indicators of sanitation lem (mangbaga mari leinaba anaba)are also frequently men- and hygiene. If there is scarcity of water then women tioned as illnesses indicating that these problems are among will have to bear the brunt of fetching the water and in the most salient. However, the pile sorting method, focus maintaining a clean surrounding in their vicinity and in group session, and in-depth interview with women revealed maintaining personal hygiene. In Andro, the main sources that uterine prolapse (angangkhao nanthaba), although not of water for cleaning and washing are pond and stream reported with high frequency in the free listing results, was a water. However, for drinking and cooking purposes, the problem which women faced in silence until it disturbs their main sources of water are spring water, hand pump, and daily chores. tap water. 25 percent use tap water, 27.5 percent use hand The local connotation for vaginal discharge is phin- pump, and 49 percent use spring water in Andro as potable gou chatpa. In Andro, vagina is used euphemistically as water. “underneath the cloth.” us, Th the word vaginal discharge 4 Journal of Anthropology Table 1: Women’s illnesses. Illness term English translation Description Phingou Chatpa White going underneath the cloth Vaginal discharge Angangkhao nanthaba Uterus coming out/body falling down Prolapse Mangbaga mari leinaba anaba—ee yamna Menstrual-related illness—blood going out Menstrual problem, heavy period, irregular chatpa, mangba, changnaidaba, puk naba, profusely, irregular menstruation, stomach period, menstrual cramp, and scanty period ee likna chatpa pain, and blood going out scantily Khwang naba Back pain Pain at the back Chaning naba Abdominal pain Pain in the pelvic region Chakmangba/nupamangba Rice polluted/man polluted Postpartum illness Puk chakring Stomach left over Postdelivery problem Kok ngaoba/Mit tandan paiba Head spinning/seeing stars Dizziness Sonthaba Weakness Weakness is Phingou chatpa which means discharge coming out of Another interpretation is that pain aeft r childbirth ( puk chakring) is due to incomplete cleansing of the blood which vagina or discharge coming out from “underneath the cloth.” remains aeft r giving birth to the baby. They believe that if Angangkhao nanthaba refers to uterine prolapse which liter- the remnant blood remains inside the body for long then the ally means “baby sac slipping out” and Mangbaga mari lein- concerned women will have unbearable pain in the abdomen. aba anaba refers to problems/illness related to menstruation. So if women have such kind of problem during postpartum The reported menstruation-related illnesses are blood going period then they seek treatment from the traditional birth out profusely (ee yamna chatpa), irregular menstruation attendant (Maibi). The traditional birth attendant ( maibi)will (mangba changnaidaba), puk naba (stomach pain), and blood massagetheabdomenchantingmantras.Itisbelievedthatthe going out scantily (ee likna chatpa). Back pain (Khwang naba) pain will wane aer ft this enactment. refers to pain at the back along the spinal cord. Most of the women face this problem of back pain several times in their lives. 3.5. Postpartum Illness (Chak Mangba/Nupa Mangba). Dur- ing postpartum period if proper care is not taken then such illness oeft n happens. Care should be taken properly 3.3. Pain in the Lower Abdomen (Chaning Naba). Pain in the regarding intake of her food and drinks during this stage and lower abdomen (Chaning naba)isone of theproblemswhich sexshouldbetotally abstained. Rice polluted locallytermed women face at different times of their lives. Some women say as Chak mangba is the condition where the women will lose that they have this pain almost all the time. Some say that this her tendency to eat. If these conditions prevail then she will pain is experienced when they work for long in the field or puke even at thesight of food.Peoplebelieve that it will when they lift things which are heavy while others encounter get cured aer ft some months. Care should be taken during it in their postchildbirth or aeft r sterilization operation stage. postpartum; a woman should drink only boiled water and Most womensay that thepainsurfacesuponcloudydaysor use warm water. eTh water which becomes cold aer ft boiling on rainy days. Relief from this illness is achieved by massaging should also notbegiven becauseitisbelievedthatthiscauses the abdominal and pelvic area with mustard oil and salt. If the diarrhea. pain persists for long and becomes intolerable then they will In Andro, a woman is not allowed to have sex aeft r call a traditional birth attendant (Maibi)/traditional healer childbirth for three months. If a woman transgresses such (Maiba) or preferably a traditional birth attendant (Maibi)for restriction then an illness known as “men polluted” locally massaging the abdomen (puk suba). If this does not produce termed as Nupa mangba occurs to the woman concerned. It any effect then the woman will see a doctor in the nearest is perceived that in the first stage her face will get swollen town. up,while herhands,feet, andbodywillshrink. If shedoes not get any treatment then she will die aer ft some months. People believe that even doctors cannot cure such ailments. 3.4. Pain aer ft Childbirth (Puk Chakring). Pain aer ft child- It is only the traditional birth attendant (Maiba’s)/traditional birth (Puk chakring) is described as the pain which women healer (Maiba) who can cure these types of illnesses. experience aeft r childbirth. Some of the key informants reported womensueff ringfromseverepainfor severaldays Weakness (Sonthaba) is an illness as well as the cause aer ft their last delivery. They were gave different opinion of other illnesses like vaginal discharge (Phingou chatpa). about the perceived cause of such pain. Some said that the Womenoeft nreportedweaknessinassociation with other pain was basically due to air (nungsit)insidebecause of illnesses as well as the cause of other illnesses. Women believe the space created in the women’s belly aer ft delivery. eTh y that the primary cause for these conditions is work overload believed that pain wanes once the woman starts taking proper and lack of nutritious food. Dizziness (Kok ngaoba)isalso food. another problem reported by women oeft n in association Journal of Anthropology 5 with other illnesses. Back pain (Khwang naba)isone major women reported the presence of discharge without a smell probleminwhich most of thewomen arefacing. Some have as odorless (manam namdaba). severe back pain in which they have problem in standing up Women spoke of having large amount or little discharge andsitting down.This illnessisalsoassociatedwithother and were also able to describe the frequency which they had illnesses. Women perceive that back pain (khwang naba)is it every day or sometimes. Women also reported a range duetoheavy burden of circadianactivities. of duration for which they experience discharge problem. Some women said they have it before their menstruation for a few days. Illness narratives conducted on women who 3.6. Criteria for Selection of Illnesses for Further Investigation. had reported vaginal discharge (Phingou chatpa)asanillness By the term “reproductive illness,” we mean indigenously revealed the typical ways in which it is characterized. named complaints and conditions that are localized in repro- ductive organs or are associated with reproductive functions. “It is just like having menses. It soiled my wrap As this paperaimstolookatreproductivehealthproblems, around (phanek). I have to wear two wrap around a subset of women’s nonpregnancy-related reproductive ill- (phanek) at a time” (Mema, 33-year-old woman). nesses was chosen for further investigation based on the Here, the woman talks about the frequency of vaginal following criteria of seriousness and the most common: discharge they experience comparing it with the flow of (1) most frequently mentioned in the free listing results, menstruation when the discharge is frequent and quantity is (2) perceived that many women experience the illness, more. In such a situation one had to wear two wraps around (phanek) one on top of the other. The wrap around worn (3) an illness which women are hesitant to report because outside conceals the soiled wrap around which is worn inside. of the stigma associated with it and has been unat- tended to by health providers. “It is white and has foul smell. It itches a lot too. Whenever I go out I feel so conscious of the Based on these criteria, vaginal white discharge (Phingou smell that I couldn’t talk with my friends properly” chatpa), menstrual-related illness (mangbaga mari leinaba (aTh balei, 32- year-old woman). anaba), and prolapse (angangkhao nanthaba)werelooked into for further investigation for symptom, description, This identifies the women’s uncomfortability experienced etiology, and seriousness of these illnesses as perceived by the by the women who had vaginal discharge with foul smell women. along with itchiness. us, Th women in Andro identified vagi- naldischarge in termsofcolor,smell,consistency,frequency, 3.7. Vaginal Discharge (Phingou Chatpa). In Andro, vagina is and duration. used euphemistically as underneath the cloth. u Th s, vaginal (ii) Etiology of Vaginal Discharge (Phingou Chatpa).Women discharge is Phingou chatpa literally translated as “white attributed vaginal discharge (Phingou chatpa)toseveral going underneath the cloth.” Vaginal discharge is categorized different causes. Causes listed in Table 1 were most frequently into two types—nonbloody and bloody discharge (phingouda mentioned by women in depth interview and in pile sorting ee yaoba). Women in Andro believe that when their body of illnesses. Weakness (sonthaba), worry (wakhal waba), becomes weak they often have discharge. Bloody discharge anger (asaoba), overload of work (thabak henba), conditions describes the presence of blood in vaginal discharge. eTh y produced by economic hardship were felt to cause vaginal believe that such a condition is serious and feel the need to discharge (Phingou chatpa). Women also perceived that attend to it properly. eating fruits and avoidable food during menstruation and Women have different perceptions about whom this post-artum period transforms blood to water leading to illness aeff cts and the extent to which Phingou chatpa was vaginal discharge (Phingou chatpa). Other factors believed prevalent in their village. In one focus group session women to causevaginal discharge(Phingou chatpa)wererelated to unanimously agreed that this illness was prevalent among events like sterilization operation, wearing an intrauterine sexually active women. device, abortion, and childbirth. Though women reported high prevalence of vaginal dis- During illness narrative interviews, women reported that charge (Phingou chatpa) they consider it as normal until and the onset of vaginal discharge (phingou chapta)occurred unless it disturbs their circadian activities. Women perceive oen ft because of one or more of these events. Some women that everybody has vaginal discharge (Phingou chatpa). who had vaginal discharge (phingou chapta)atthe time of (i) Characteristic of Vaginal Discharge (Phingou Chatpa). interviewing said that they have no idea why they had this Women described vaginal discharge in terms of color, smell, illness. Interview conducted with woman provides examples consistency, frequency, and duration. Besides white discharge of woman’s perception regarding the causes of such illness. some women also complained of discharge with blood. Chingabham Tombinou, traditional birth attendant (Mai- They identified it as discharge with banana flower colour bi), retorts “Young women start wearing inners (Panties) (laphutharo machu). Smells are also recognized by women which obstruct the circulation of the blood and causes many particularly if the discharge is associated with strong and illness like vaginal discharge which is actually blood turned foul smellwhich made womenfeeluncomfortable that to water. Moreover, they do not restrict on tabooed foods other people may be able to detect it. Discharge with smell which are supposed to be kept at bay during menses and post- is described by women as foul smell (manam namthiba); partum period.” 6 Journal of Anthropology Women perceived that wearing panties obstructs the Economic burden of a family is borne by the women and it is flow of menstrual blood turning blood into water thereby women who suffer. causing vaginal discharge. In Andro, there are certain food (iii) Seriousness of Vaginal Discharge (Phingou Chatpa). items which are restricted to be taken during menstruation Womenbelieve that an illnessisserious forparticularrea- and postpartum period. The verbose of the traditional birth sons. Vaginal discharge (Phingou chatpa)isperceived as a attendant implies that women have vaginal discharge as they problem when the discharge is an excess. In an in-depth did not put any restriction on eating the tabooed food during interview menstruation and postpartum period. However, women in Andro unanimously agreed that a Th ba (a woman from Andro) said “If the dis- dailyhardtoiltomakebothendsmeetisthe root cause charge wets the wrap around (phanek) then the of discharge. There is a saying in Andro “If you don’t work condition is serious.” then you starve.” Economic crunch in a household aeff cts women. Engaged in a daily struggle to meet the basic needs, “When the discharge is like the menstrual ofl w they cannot spare time to improve and safeguard their own then it is a serious case”.(Tampha, 34-year-old health. Economic hardship compels women to work hard to woman). make both ends meet. This leads to physiological weakness, which in turn deteriorates the health condition and causes all In Andro women wear wrap around known as phanek.If illnesses. The price of poverty has to be paid by women as thedischarge is heavylikethe menstrualflow,and when it poverty makes them compromise on their health. soils the wrap around then, such a condition is considered to be a serious case of discharge. Women use onomatopoeic “Whenawomanispregnantorduringpost- terms like o-ro-rochatpa (going) and jo-ro-rochatpa (going) to partum period a woman is supposed to be fed explain the severity of vaginal discharge. Women compare the with nutritious and strengthening food but when severity of vaginal discharge allegorically with the menstrual you don’t have the money to buy then you blood flow. have to survive on whatever is available. iTh s Women in Andro also perceive discharge to be serious deteriorates the health condition of woman and when there is blood in it. Driving home this point is Moyonsakhi’s assertion that “If there is blood in discharge invites all ailments including vaginal discharge (Phingou chatpa)”. (Daya, 34-year-old woman then it is a problem that needs to be looked into.” from Andro) The above ndin fi g explicates that women perceive vaginal discharge (Phingou chatpa) as serious when the discharge is in excess which they describe in onomatopoeic terms “Woman eats whatever is growing in their kitchen like oo-ro-rochatpa (going) or jo-ro-rochatpa (going). The garden. eTh y cannot afford to have nutritious food seriousness of vaginal discharge (Phingou chatpa)was also like milk,nuts, meat,and so forth, to supplement described allegorically with the menstrual blood flow. They their diet. Rice and curry are their staple food. also perceived that vaginal discharge (Phingou chatpa)is This weakens a woman’s body moreover, a child serious when there is blood in discharge. bearing mother. Thus most women in Andro suffer from vaginal discharge.” (Memcha, 37-year-old woman from Andro) 3.8. Menstrual-Related Illness (Mangbaga Mari Leinaba An- aba). Menstrual-related illness (Mangbaga mari leinaba anaba), a common complaint among women, is a collec- The above verbose explicates the brunt women have to tive term for different illnesses/problems associated with bear due to their impoverished condition. It reveals the menstruation. Women describe heavy menstruation as a inability of women in Andro to have the luxury of having debilitating illness which sucks out all their strength. Men- nutritious food when it is considered to be a requirement strual cramp was not considered as a serious illness. Women during pregnancy and postpartum period due to economic generally endure or bear the pain by lying down or using crunchandhowitbecametherootcauseofvaginaldischarge. hot water bottle/water bag. Other menstrual problems like Women also relate their symptoms to different proce- irregular menstruation and scanty period were also reported. dures or conditions that they had undergone. Some blamed it on abortion, insertion of IUD, and unhygienic way of (i) Causes of Menstrual-Related Illness (Mangbaga Mari Le- living as a probable cause of vaginal discharge. Women in inaba Anaba).Thecausesofmenstrual problemwhich Andro associate vaginal discharge (Phingou chatpa)with women perceive include wearing panties, using pads, eating poor perineal hygiene and by working in dirty water in avoidable food during menstruation, abortion, insertion of the rice efi ld. Some of the women perceive that vaginal IUD, sterilization operation, pregnancy, delivery problems, discharge (Phingou chatpa) can be transmitted from hus- and improper cleaning during childbirth. Interviews with band and can happen due to lack of nutritious food. u Th s, women provide examples of women’s beliefs about the causes womenhavediversiefi dopinion regardingthe etiology of of menstrual problem. vaginal discharge but they unanimously agreed that their Hemsori, a 50-year-old traditional birth attendant (mai- impoverished condition is the root cause of vaginal discharge. bi) from Andro, Cites the reasons for menstrual problem: “If Journal of Anthropology 7 the remnant blood aer ft delivering the baby is not cleaned due to long and difficult labour problem, carrying heavy items properly then it happens.” during postpartum period, sterilization, frequent abortion, As cited by the traditional birth attendant one of the and frequent childbirth. Interviews with women provide perceived cause of menstrual problem is improper cleaning example of beliefs about causes of prolapse. of blood aer ft childbirth. Others reason out on utilization of “Frequent childbirth and abortion spoils the body. contraceptive device like Cu-T and sterilization operation as Playing with your body is not good. eTh pulling the root cause of menstrual problem. This is supported by the and pushing, inserting instruments and hand following citation. inside thedelicatewomen’s body will destroy Another 45-year-old woman from Andro describes the everything” (Monsori, 43-year-old woman from reasons for menstrual problem: “Women started putting for- Andro). eign particle inside their body (copper-T) and had operation. All these block their tubes which lead to menstrual problem.” During childbirth, if the fetus did not come out as soon u Th s, women in Andro perceived that the causes of as the amniotic sac bursts then the traditional birth attendant menstrual problem are improper cleansing of blood after (maibi) has to pummel the stomach and insert the n fi ger delivery, insertion of IUD, and sterilization. However, these inside the vagina to pull the fetus out. Simultaneously, the are the proximate factors responsible for menstrual-related woman in labour was encouraged to push harder to accelerate illness. the birth of the child. Some women remarked how this kind of pulling and pushing leads to prolapse. (ii) Seriousness of Menstrual-Related Illness (Mangbaga Mari Women also believe that lifting heavy weights also causes Leinaba Anaba). Menstrual disorders are perceived as a prolapse. In their day-to-day activities, a woman routinely problemwithwhichwomanhavetoliveandsueff r.Oneofthe lifts heavy weights. This includes lifting and carrying heavy menstrualproblemswhich is perceivedtobethe most serious pots of water from the ponds, hand pumps, and tap to the is heavymenstruation. eTh ybelieve that heavymenstruation house. Lifting heavyweightespeciallyjustaeft rchildbirthis drains away all the strength and is considered to be weakening considered to be dangerous because woman’s body during and cause dizziness and exhaustion. this stage is still tender and lifting heavy weight could push Though heavy period is considered a serious case, women the body out. do not seek any treatment. Menstrual disorders are perceived It is believed that performing heavy activities can lead to to be a problem which women have to sueff r in silence. prolapse (Angangkhao nanthaba)asawomanrelates:“If you Engagedintheir dailystruggletomeetthe basicneeds, they lift heavy things during the post delivery period when the cannot spare time to improve and safeguard their own health. body is tender aer ft giving birth then you will have prolapse Above all they cannot aoff rd to spend money on illness which (Angangkhao nanthaba). It is like the womb collapses and did not disturb their daily activities. u Th s, the price of poverty comesout.Itisnot painfulbut it is very uncomfortable.” hastobepaidbywomen by compromising on theirhealth. Women also perceived that sterilization operation and inserting Copper-T (IUD) cause this problem because it weakens the body and makes it easier for the body to come 3.9. Prolapse (Angangkhao Nanthaba). Prolapse (Angang- out. u Th s, women believe that problem during childbirth, khao nanthaba nanthaba)isliterally translated as baby sac lifting heavy weight, or undergoing a sterilization operation slipping out. Women do not make any distinction between are susceptible to prolapse (Angangkhao nanthaba). vaginal and uterine prolapse. They simply refer to a feeling of heaviness “down below” or that “something coming out” of (iii) Seriousness of Prolapse (Angangkhao Nanthaba).Pro- vagina.Women believethatprolapseisanillness whichneeds lapses (Angangkhao nanthaba) were unanimously perceived attention from allopathic health care provider because there by the people and traditional birth attendant (Maibi)which is no local treatment for it. needs to be addressed by a doctor. Women consider pro- lapse (angangkhao nanthaba) a serious illness which needs (i) Characteristics of Prolapse (Angangkhao Nanthaba).Dieff r- medication from allopathic provider. eTh y consider prolapse ent types of prolapse that women experience are described. (angangkhao nanthaba) serious when they see/feel the body eTh y have constant feeling of heaviness below or as if parts coming out. something is falling out from below making them dicffi ult The traditional birth attendant ( maibi)alsoputstheir to sit, stand, or walk. This makes them so inconvenient hands up in such case. Monsori, a maibi in Andro com- and disturbs their daily activities. This is associated with mented: severe back pain. eTh y cannot stand up abruptly after sitting also. Prolapse interferes with women’s work activities and “is Th is a serious problem because there is no with their lives. eTh degree to which they feel inconvenient treatment for this illness. One has to operate to by a prolapse depends on “how much the body is coming lift up the Angangkhao (baby sac) at a big hospital out.” Women say that they have difficulty lifting weight and whichmostofthe womencannotaoff rd.So, until difficulty in urinating when they have prolapse. and unless it disturbs the daily domestic chores one will not get treatment.” (ii) Causes of Prolapse (Angangkhao Nanthaba).Women in Andro gave different version for causes of prolapse Women in Andro believe that many women suffer from (Angangkhao nanthaba). Women believe that prolapse occurs prolapse (angangkhao nanthaba)but they sueff rinsilence 8 Journal of Anthropology as financial problem refrains woman from seeking timely symptoms such as weakness. Additionally, the finding expli- care.Thus,itisasetbackthatwomen in Androhaveto cates that women describe the feeling of impoverishment in sueff r because of their reproductive caliber due to na fi ncial connection with vaginal discharge (Phingou chatpa). In other constraint. words, women can report vaginal discharge (Phingou chatpa) if she is impoverished and feels weak although she might not have physical symptomofvaginal dischargeorifshe hasnor- 4. Discussion and Conclusion mal physiological discharge. u Th s, an illness is the meaning that womengivetohealthand refers to aperson’sperception Women in Andro refer to health problem relating to repro- and experiences of certain socially disvalued status. eTh ductive organ and function not as “reproductive illness” meaning of health needs to be recognized for achieving an but as women’s illness (nupigi anaba). Though women do analytical understanding of the process of production of not have a “germ theory” of illness, they have a sense of health as a basis for any realistic and comprehensive eo ff rt to illness pathology. Women attributed their illnesses to several improve health condition in a community, as it has a direct different causes such as heavy workload, sterilization, aer ft bearing on the treatment-seeking behavior. insertion of IUD, wearing panty, eating avoidable food, We would like to highlight the need to incorporate and improper cleansing after childbirth. However, women women’s perception of reproductive illness while designing in Andro unanimously perceived that poverty is the root reproductive health programs which are culturally sensitive cause of women’s illness. Economic crunch in a household to bridge the gap between what is considered as the need and affects women. Engaged in a daily struggle to meet basic the actual need at the grassroots level. Reproductive health needs, they cannot spare time to improve and safeguard their programs should includemen andwomen andbeintroduced own health. Economic hardship compels a woman to work within a larger development project that addresses poverty hard to make both ends meet. This leads to physiological and livelihood issues. eTh project can focus on developing weakness, which in turn deteriorates the health condition human capacity to generate income for households and andcausesall theillness.Theprice of povertyhas to be thereby addressing the primary needs of the local community. paid by women as poverty makes them compromise on their In the process of addressing the “root cause” (poverty) of health. Conditions directly resulting from poverty include women’s illnesses an approach towards women’s reproductive anger, worry, lack of nutritious food,and hard toil.These health can also be considered simultaneously. If women conditions will produce physiological weakness (sonthaba). feel that they have time and money to attend to their This physiological weakness is brought about by economic ownhealththeywillbemorewilling to participateina hardship. eTh y fundamentally believed that the treatment of reproductive health program. If poverty alleviation program such illnessispossibleonlywhentheir livesare economically can be developed then local men will be more willing to improved.Women believethatwhentheyare physically weak understand the reproductive health needs of their wives and they are susceptible to other factors causing vaginal discharge encouragethemtoparticipate in theprogram. (Phingou chatpa), menstruation-related illnesses (mangbaga Innovative health program which will provide women mari leinaba anaba), and prolapse (angangkhao nanthaba). (including men) with the knowledge to understand the eTh se factors are referred to as “susceptibility” factors [ 16]. “pathology” of disease within the context of their lives can be The proximate factors may be categorized in the following created. Gradually, as biomedical model of disease interacts manner: problem aer ft sterilization operation or aer ft inser- with the women’s perception of illness, they may begin to dis- tion of Copper-T, problem aer ft a spontaneous or induced tinguishphysicalsymptomofsicknessfromother“meanings” abortion, childbirth and delivery problem, lack of nutritious of sickness and report these as symptom to a health provider. and strength giving food, problem of violation of food taboo On the other hand, health provider should understand the during menstruation and postpartum period, problem with complexity of the reported symptom and not assume that a transmission of illness through sexual intercourse from man reported symptom correlates with disease. u Th s, reproductive to women, and problem of lifting heavy weights. health program can be more innovative and touch the life of The finding explicates that women’s perception of repro- the women concerned thereby approaching towards the “felt ductive illness succinctly differs from the biomedical defini- needs.” tion of reproductive disease. Meanings are embodied in the term “women’s illness” and symptoms are filtered through the Conflict of Interests world view of the people. Reproduction is perceived to be the sole responsibility of women; thereby the term women’s eTh authors declare that there is no conflict of interests illness (nupigianaba) for illness associated with reproductive regarding the publication of this paper. organ. The aetiology, progression, and seriousness of illness are also filtered through the world view of the women and References this will have a direct bearing on treatment. Illness described by the term Phingou chatpa is related to [1] A. Young, “eTh anthropologies of illness and sickness,” Annual physical symptoms and situation in a network of meanings Review of Anthropology, vol. 11, pp. 257–285, 1982. and different meanings are socially generated by individual [2] R. Frakenberg, “Medical anthropology and development: a to articulate their experiences. eTh ndin fi gs show that vagi- theoretical perspective,” Social Science and Medicine,vol.14, pp. nal discharge (Phingou chatpa)isusedwithother physical 197–207, 1980. Journal of Anthropology 9 [3] A.Kleinman,L.Eisenberg,and B. Good,“Culture, illness,and care. Clinical lessons from anthropologic and cross-cultural research,” Annals of Internal Medicine,vol.88, no.2,pp. 251– 258, 1978. [4] M.C.P.Cormack,Ed., Ethnography of Fertility and Birth, Aca- demic Press, London, UK, 1982. [5] P. Jeffery, R. Jeeff ry, and A. Lyon, Labour Pains and Labour Power: Women and Childbearing in India,Zed Publishers, London, UK, 1989. [6] M. Nichter, “Idioms of distress: alternatives in the expression of psychosocial distress: a case study from South India,” Culture, Medicine and Psychiatry,vol.5,no. 4, pp.379–408,1981. [7] T. Patel, “Women’s work and their status: dialectics of subordi- nation and assertion,” Social Action,vol.37, no.2,pp. 126–149, [8] N. Younis, H. Khattab, H. Zurayk, M. El-Mouelhy, M. F. Amin, and A. M. Farag, “A community study of gynecological and related morbidities in rural Egypt,” Studies in Family Planning, vol. 24,no. 3, pp.175–186,1993. [9] R. Bang and A. T. Bang, “Women’s perceptions of white vag- inal discharge: ethnographic data from rural maharashtra,” in Listening To Women Talk About ei Th r Health: Issues and Evidence From India,J.Gittelsohnand M. E. Bentley, Eds.,Ford Foundation, Har-Anand Publications, New Delhi, India, 1994. [10] S. Kanani,K.Latha,and M. Shah,“Applicationofqualitaive methodologies to investigate perceptions of women and health practitioners regarding women’s health disorders in baroda slums,” in Listening To Women Talk About ei Th r Health: Issues and Evidence From India, Ford Foundation,J.Gittelsohnand M. E. Bentley, Eds., Har-Anand Publications, New Delhi, India, [11] T. Patel, Fertility BehAviour: PopulAtion And Society in A RAjAsthAn VillAge, Oxford University Press, New Delhi, India, [12] S. Pachauri and J. Gittelsohn, “Summary of research studies and implications for health policy and programmes,” in Listening To Women Talk About Their Health: Issues and Evidence From India , J. Gittelsohn andM.E.Bentley,Eds., Har-AnandPublications, NewDelhi,India,1994. [13] N. M. Oomman, Poverty and Pathology: Comparing Rural Rajasthani Women’s Ethno-medical Models with Biomedical Model of Reproductive Behaviour [Ph.D. thesis],JohnHopkins University,Baltimore,Md, USA, 1996. [14] A. Kaddour, R. Hafez, and H. Zurayk, “Women’s perceptions of reproductive health in three communities around Beirut, Lebanon,” Reproductive Health Matters, vol. 13, no. 25, pp. 34– 42, 2005. [15] P. Jeffery and R. Jeeff ry, “Only when the boat has started sinking: a maternal death in rural north India,” Social Science and Medicine,vol.71, no.10, pp.1711–1718,2010. [16] H. Zurayak, H. Khattab, N. Younis, and M. El-Mouelhy, “Con- cepts and measures of reproductive morbidities in rural Egypt,” Studies in Family Planning,vol.3,no. 1, pp.17–40,1993. 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Women’s Perception of Reproductive Illness in Manipur, India

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Hindawi Publishing Corporation Journal of Anthropology Volume 2014, Article ID 321480, 9 pages http://dx.doi.org/10.1155/2014/321480 Research Article 1 2 1 3 Pebam Krishnakumari, P. C. Joshi, M. C. Arun Kumar, and M. Meghachandra Singh Department of Anthropology, Manipur University, Canchipur 795003, India Department of Anthropology, University of Delhi, Delhi 110007, India Department of Community Medicine, Maulana Azad Medical College, New Delhi 110001, India Correspondence should be addressed to Pebam Krishnakumari; pebam14@yahoo.co.in Received 24 October 2013; Revised 15 January 2014; Accepted 29 January 2014; Published 10 March 2014 Academic Editor: Santos Alonso Copyright © 2014 Pebam Krishnakumari et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Perception of reproductive illness by the women themselves is important in understanding the women’s reproductive health in a particular society. It also indicates the possibility of taking perception as a tool for measuring reproductive illness. o Th ugh women do not have a “germ theory” to explain their reproductive illness they have a sense of illness pathology. Reproductive illness perceived by women is related to physical symptoms and situations in a network of meanings and different meanings are socially generated to articulate their experiences. 1. Introduction consciousness that there is something wrong [2]. u Th s, disease in the Western medical paradigm is malfunctioning Reproductive illnessisnot only biological butalsoisembed- or maladaptation of physiologic processes in the individ- ded in a web of psychological, economic, political, and social ual. Whereas illness represents personal, interpersonal, and factors. Different societies encounter, define, and experience cultural reactions to disease and/or discomfort. Illness is reproductive health problems biologically as well as cultur- shaped by cultural factors governing perception and labelling ally. Different cultures define reproductive illness in different explanation and valuation of the discomforting experience ways;whatisrecognisedasreproductiveillness in onemay and by processes embedded in a complex family, social, and notbesoinothers. Forthispaper,reproductiveillness refers cultural nexus. Because illness experience is an intimate part to the illness which women perceive as related to their sexual of social systems of meaning and rules for behaviour, it is and reproductive organs and function. strongly influenced by culture: it is, as we shall see, culturally As the meaning of health is culturally defined under- constructed [3]. standing of the women’s perception of reproductive health Perception of reproductive illness by the women them- is a sine qua non in order to give a holistic representation of selves is important in understanding the women’s repro- women’s health. Here, understanding the conceptual distinc- ductive health in a particular society. It also indicates the tion between “disease” and “illness” becomes essential. eTh possibilityoftakingperceptionasatool formeasuring conceptofdisease hashistoricallybeenthe most dominant reproductive illness. Though women do not have a “germ” category; it has a biological interpretation and refers to theory to explain their illness, they have a sense of ill- abnormalities in the structure or function of organ and organ ness pathology. Reproductive illness perceived by women is systems, pathological states whether or not they are culturally related to physical symptoms and situations in a network recognised. Health, as a felt experience of the individual, of meaning and different meanings are socially generated to provides another meaning which is embodied in the term articulate their experiences. “illness.” u Th s, illness is the meaning that individual gives Most of the currently known intervention schemes for to health and refers to a “person” disvalued states including improving reproductive illness are based on and guided but not limited to disease [1]. Illness is the individual’s by laboratory test and outsider-based interpretations and 2 Journal of Anthropology perspectives of the key factors that aeff ct reproductive health illnesses, like weakness and backache, and used these terms status. Little attempts have been made to investigate how as euphemisms to report discharge [10, 11]. women themselves perceive and understand the aetiology Pachauri and Gittelsohn [12] constructed an ethnomed- of such illness and how it aeff cts the reproductive health in ical model of women’s illnesses throwing considerable light various societies. on Indian women’s perception of their health. Oomman [13] To design a culturally sensitive health programme there in her study in Rajasthan village emphasised on women’s is a need to incorporate women’s perception of their illness. reproductive morbidity within its socio-economic and cul- eTh meaning of health needs to be recognised for achieving tural context and showed how women attributed their illness an analytical understanding of the process of production of to their biological susceptibility, which is a result of poverty- health as a basis for any realistic and comprehensive eo ff rt induced malnutrition. She also developed an ethnomedical to improve health condition in the community, as it has a model on the basis of women’s perception of severity of direct bearing on the treatment seeking behaviour. It is high “women’s illness” which includes discharge (dhola pani), time to look at the “felt needs” of the reproductive health of menstrual problem (kapdaro bimari), and prolapse (sharer women. This paper is an endeavour to bring into light how bahar aaye). In 1999, Patel explored how in practice women women in Manipur perceive “women’s illness” such as vaginal manipulate fertility decisions in the light of economic struc- discharge and menstrual problem and their perceptions of the turesonone hand andkinship on theother hand and seriousness of different women’s illnesses. concluded that fertility behaviour is constituted in dialectical relationship between people and their settings—objective conditions coupled with subjective perspective thereof. 2. Retrospect of Research on Perception of In 2001 Pimpawun Boonmongkon et al. documented Reproductive Illness from South East aTh iland women’s experiences of gynaeco- logical complaints linked to the “uterus” (mot luuk)through Medical Anthropology has hitherto been conceived of as cultural reasoning. Kaddour et al. [14] elicit the definition a tool for investigating and explicating local perspective of the concept of reproductive health among women in on reproductive health. Medical anthropologist has always three communities around Beirut, Lebanon. In 2008, Abdul tended to describe cultural variation in health belief system, Karim et al. conducted a study to nd fi out community’s emphasizing on people’s own description and experience of knowledge and perceived implications of maternal mortality reproductive health and illnesses within local cultural system. and morbidity in two urban and two rural communities in Borno state, Nigeria. eTh community members’ perception Way back in the1980s medical anthropologist’s ethno- on ways to prevent the scourge was also explored. graphic work primarily focuses on fertility and childbirth. Based on a seminal study in a Muslim village in rural Cormack [4] edited a collection of essays on the cultural Bijnor district (north-western Uttar Pradesh) by P. Jeeff ry and construction of fertility and birth in countries like Sri Lanka, R. Jeeff ry [ 15] argued that government health care provision New Guinea, Ghana and Britain to demonstrate a wide in rural Uttar Pradesh is embedded in a moral universe range of cultural rules and social practices that exist in characterisedbywidespreadand long-termmistrustofthe all societies and influence fertility and childbirth. In India, state services and stressed that encouraging institutional Jeeff ry et al. [ 5] lament out the women’s voices reflecting on deliveries without addressing the perceptions of potential their experiences of childbearing and provided an accessible service users as serious flaw in the approach to reduce and existing reassessment of women’s role in an agricultural maternal mortality. This paper will focus on Andro women’s society traversing a women’s life from the time they marry perception on illnesses related to their sexual and reproduc- to the moment they enter their husband’s household till they tive organs and function such as vaginal discharge (phingou give birth. Nichter [6] examined the cultural notion of fertility chatpa), menstrual-related illness (mangbaga mari leinaba in Sri Lanka and its impact on family planning practices, as anaba), andprolapse(angangkhao nanthaba). This paper will well as the ethnophysiology and food consumption practices also emphasize the policy and program including women’s during pregnancy in South India. Patel [7] explored how perception of reproductive illness. women in Rajasthan have childbirth and postpartum care as their own domain and how their lives showed a mix of sub- ordination and freedom in different spheres of functioning. 3. Methodology In the 1990s health research began to focus on women’s perception of reproductive health. Younis et al. [8]assessed eTh informationusedinthisstudy wasgatheredduringfield the level of reproductive morbidity in Egypt and examined work conducted between July 2004 and January 2005 updated the social context of women’s health and attempted to under- in 2011. A survey was conducted in September and October, stand women’s report of illness in this context. In India, R. 2004, to furnish data about the socioeconomic condition Bang andA.T.Bang[9] made an exploration of the perceived of Andro. To get a general perception of women regard- causes of white discharge and examined the perceived eeff ct. ing commonly prevalent illnesses among them, free listing Evidence suggests that women perceive white discharge to technique was used. This method was used to determine be part of sexual maturation and consider it normal. Studies the items which make up the domain of “illness which only found that women commonly have multiple terms to refer to women get.” A master list of women’s illness was compiled different types of vaginal discharge and they linked it to other andusedaschecked list of illnessesand symptoms.Women Journal of Anthropology 3 were chosen randomly from the village for this method. eTh place for throwing waste has an important role to Ten key informant interviews were conducted among old play in adumbrating the sanitation and hygiene of an area. In Andro, there are three ways of throwing the garbage—throw women, traditional healer (maiba), and traditional birth it in the open, throw it in drainage, and dig a pit hole to dump attendant (maibi) of the community to collect information the wastage. A majority (58.5 percent) of the households regarding women’s illness, causes, childbirth, menstruation, throw the garbage in the open, 35.5 percent throw in the pit sexual behaviour, food taboo, women’s work, and so forth. hole, and 6 percent throw the wastage in the drainage. Women’s group like Women’s torch bearer (Meira Paibi), Having proper toilet facility is essential for healthy exis- Mahila Mandal (name of the women’s organisation), tradi- tence. In Andro, 0.5 percent do not have toilet facility. 10.5 tional birth attendant (maibi), and women of the reproductive percent use semipucca, 5.05 percent use pucca, and 81 percent ageweretargetedfor thefocus groupdiscussions.Three use pit hole, where a hole is dug up and covered on all the four focus group sessions were conducted, each group consisting directions with rags. of 6–8 women. eTh principal aim during the focus group discussion with women mentioned above was to develop One of the main factors in health issue is transport an understanding of women’s perception of normal against and communication. Within Andro people commute in two abnormal vaginal discharge, menstruation, and prolapse and wheelers like scooter but bicycle is the most common way to their explanation of the ways in which women acquire, glide along. Covering distance by foot is also a common sight prevent, or deal with such a condition. Special attention in Andro. If one has to go beyond Andro then buses and jeep was also paid to the association of these perception with a are the main means of commuting. view to obtain a more comprehensive understanding of the In Andro, there is one primary health centre. The main causality and sociocultural context in which reproductive activities carried out in the primary health centre are curative illnesses are acquired, the stages, how and why such illnesses care, tuberculosis detection, maternal, and child health ser- occurred, and how they were perceived and managed by vices such as diarrhoea disease control, immunization, and the women and their families. Past illness narratives were family planning. used on women who have been identified by traditional birth attendant (maibi), traditional healer (maiba), or the 3.2. Women’s Illness in Andro. Women in Andro perceive ill- womenwho hadparticularsymptomslikevaginal discharge, ness associated with reproduction as women’s illness (nupigi menstrual problem, prolapse, and so forth to furnish infor- anaba) not as reproductive illness. While conducting inter- mation regarding illness episode including symptom onset, view with the traditional birth attendants (Maibi’s), local management, and its perceived consequences on their lives. healers (Maiba), and women in the community, certain Seven such narratives were collected for this study. illnesses were unraveled as experienced only by women. It explicitly shows that there are bouts of illnesses which 3.1. Area and People. Andro is a village inhabited by the only women experienced locally termed as women’s illnesses Lois in Manipur, a state in the north eastern region of India. (nupigi anaba)inAndro. Etymologically, the word Loi means subdued, dependent, During ethnographic study, women spoke about several outcaste, and backward. eTh village is 26 kilometres away women’s illnesses (nupigi anaba). Checks listing of illnesses from Imphal covering an area of 1211.64 Hectares. eTh total was compiled using the ndin fi gs from free listing method as number ofmalesis4307andfemalesis4437(Census ofIndia, well as result from key focus group discussion. This list was 2011). er Th e are thirteen localities in Andro. used to elicit information about each illness on symptom, Agriculture is the mainstay in Andro. It is a family enter- term descriptions, possible causes, and seriousness of the prise. However, rice cultivation relies heavily on women’s problem. labour. Besides agriculture, brewing liquor, weaving, and Table 1 explicates the main women’s illnesses (nupigi potteries are some of the economic pursuit done by women anaba) in Andro and was used to elicit information about in Andro. Basedonthe socioeconomicdatacollected during each illness on symptom, term description, possible causes, survey phase in Andro which was conducted in September and seriousness of the problem. and October, 2004, 46.9 percent of the females are literate. The free listing method showed that women perceived The mean family income per month in Andro is Rs. 3972.50 white discharge (Phingou chatpa)tobethe most common (approx. US$ 65). problem. Weakness (Sonthaba) and menstrual-related prob- The source of water is one of the indicators of sanitation lem (mangbaga mari leinaba anaba)are also frequently men- and hygiene. If there is scarcity of water then women tioned as illnesses indicating that these problems are among will have to bear the brunt of fetching the water and in the most salient. However, the pile sorting method, focus maintaining a clean surrounding in their vicinity and in group session, and in-depth interview with women revealed maintaining personal hygiene. In Andro, the main sources that uterine prolapse (angangkhao nanthaba), although not of water for cleaning and washing are pond and stream reported with high frequency in the free listing results, was a water. However, for drinking and cooking purposes, the problem which women faced in silence until it disturbs their main sources of water are spring water, hand pump, and daily chores. tap water. 25 percent use tap water, 27.5 percent use hand The local connotation for vaginal discharge is phin- pump, and 49 percent use spring water in Andro as potable gou chatpa. In Andro, vagina is used euphemistically as water. “underneath the cloth.” us, Th the word vaginal discharge 4 Journal of Anthropology Table 1: Women’s illnesses. Illness term English translation Description Phingou Chatpa White going underneath the cloth Vaginal discharge Angangkhao nanthaba Uterus coming out/body falling down Prolapse Mangbaga mari leinaba anaba—ee yamna Menstrual-related illness—blood going out Menstrual problem, heavy period, irregular chatpa, mangba, changnaidaba, puk naba, profusely, irregular menstruation, stomach period, menstrual cramp, and scanty period ee likna chatpa pain, and blood going out scantily Khwang naba Back pain Pain at the back Chaning naba Abdominal pain Pain in the pelvic region Chakmangba/nupamangba Rice polluted/man polluted Postpartum illness Puk chakring Stomach left over Postdelivery problem Kok ngaoba/Mit tandan paiba Head spinning/seeing stars Dizziness Sonthaba Weakness Weakness is Phingou chatpa which means discharge coming out of Another interpretation is that pain aeft r childbirth ( puk chakring) is due to incomplete cleansing of the blood which vagina or discharge coming out from “underneath the cloth.” remains aeft r giving birth to the baby. They believe that if Angangkhao nanthaba refers to uterine prolapse which liter- the remnant blood remains inside the body for long then the ally means “baby sac slipping out” and Mangbaga mari lein- concerned women will have unbearable pain in the abdomen. aba anaba refers to problems/illness related to menstruation. So if women have such kind of problem during postpartum The reported menstruation-related illnesses are blood going period then they seek treatment from the traditional birth out profusely (ee yamna chatpa), irregular menstruation attendant (Maibi). The traditional birth attendant ( maibi)will (mangba changnaidaba), puk naba (stomach pain), and blood massagetheabdomenchantingmantras.Itisbelievedthatthe going out scantily (ee likna chatpa). Back pain (Khwang naba) pain will wane aer ft this enactment. refers to pain at the back along the spinal cord. Most of the women face this problem of back pain several times in their lives. 3.5. Postpartum Illness (Chak Mangba/Nupa Mangba). Dur- ing postpartum period if proper care is not taken then such illness oeft n happens. Care should be taken properly 3.3. Pain in the Lower Abdomen (Chaning Naba). Pain in the regarding intake of her food and drinks during this stage and lower abdomen (Chaning naba)isone of theproblemswhich sexshouldbetotally abstained. Rice polluted locallytermed women face at different times of their lives. Some women say as Chak mangba is the condition where the women will lose that they have this pain almost all the time. Some say that this her tendency to eat. If these conditions prevail then she will pain is experienced when they work for long in the field or puke even at thesight of food.Peoplebelieve that it will when they lift things which are heavy while others encounter get cured aer ft some months. Care should be taken during it in their postchildbirth or aeft r sterilization operation stage. postpartum; a woman should drink only boiled water and Most womensay that thepainsurfacesuponcloudydaysor use warm water. eTh water which becomes cold aer ft boiling on rainy days. Relief from this illness is achieved by massaging should also notbegiven becauseitisbelievedthatthiscauses the abdominal and pelvic area with mustard oil and salt. If the diarrhea. pain persists for long and becomes intolerable then they will In Andro, a woman is not allowed to have sex aeft r call a traditional birth attendant (Maibi)/traditional healer childbirth for three months. If a woman transgresses such (Maiba) or preferably a traditional birth attendant (Maibi)for restriction then an illness known as “men polluted” locally massaging the abdomen (puk suba). If this does not produce termed as Nupa mangba occurs to the woman concerned. It any effect then the woman will see a doctor in the nearest is perceived that in the first stage her face will get swollen town. up,while herhands,feet, andbodywillshrink. If shedoes not get any treatment then she will die aer ft some months. People believe that even doctors cannot cure such ailments. 3.4. Pain aer ft Childbirth (Puk Chakring). Pain aer ft child- It is only the traditional birth attendant (Maiba’s)/traditional birth (Puk chakring) is described as the pain which women healer (Maiba) who can cure these types of illnesses. experience aeft r childbirth. Some of the key informants reported womensueff ringfromseverepainfor severaldays Weakness (Sonthaba) is an illness as well as the cause aer ft their last delivery. They were gave different opinion of other illnesses like vaginal discharge (Phingou chatpa). about the perceived cause of such pain. Some said that the Womenoeft nreportedweaknessinassociation with other pain was basically due to air (nungsit)insidebecause of illnesses as well as the cause of other illnesses. Women believe the space created in the women’s belly aer ft delivery. eTh y that the primary cause for these conditions is work overload believed that pain wanes once the woman starts taking proper and lack of nutritious food. Dizziness (Kok ngaoba)isalso food. another problem reported by women oeft n in association Journal of Anthropology 5 with other illnesses. Back pain (Khwang naba)isone major women reported the presence of discharge without a smell probleminwhich most of thewomen arefacing. Some have as odorless (manam namdaba). severe back pain in which they have problem in standing up Women spoke of having large amount or little discharge andsitting down.This illnessisalsoassociatedwithother and were also able to describe the frequency which they had illnesses. Women perceive that back pain (khwang naba)is it every day or sometimes. Women also reported a range duetoheavy burden of circadianactivities. of duration for which they experience discharge problem. Some women said they have it before their menstruation for a few days. Illness narratives conducted on women who 3.6. Criteria for Selection of Illnesses for Further Investigation. had reported vaginal discharge (Phingou chatpa)asanillness By the term “reproductive illness,” we mean indigenously revealed the typical ways in which it is characterized. named complaints and conditions that are localized in repro- ductive organs or are associated with reproductive functions. “It is just like having menses. It soiled my wrap As this paperaimstolookatreproductivehealthproblems, around (phanek). I have to wear two wrap around a subset of women’s nonpregnancy-related reproductive ill- (phanek) at a time” (Mema, 33-year-old woman). nesses was chosen for further investigation based on the Here, the woman talks about the frequency of vaginal following criteria of seriousness and the most common: discharge they experience comparing it with the flow of (1) most frequently mentioned in the free listing results, menstruation when the discharge is frequent and quantity is (2) perceived that many women experience the illness, more. In such a situation one had to wear two wraps around (phanek) one on top of the other. The wrap around worn (3) an illness which women are hesitant to report because outside conceals the soiled wrap around which is worn inside. of the stigma associated with it and has been unat- tended to by health providers. “It is white and has foul smell. It itches a lot too. Whenever I go out I feel so conscious of the Based on these criteria, vaginal white discharge (Phingou smell that I couldn’t talk with my friends properly” chatpa), menstrual-related illness (mangbaga mari leinaba (aTh balei, 32- year-old woman). anaba), and prolapse (angangkhao nanthaba)werelooked into for further investigation for symptom, description, This identifies the women’s uncomfortability experienced etiology, and seriousness of these illnesses as perceived by the by the women who had vaginal discharge with foul smell women. along with itchiness. us, Th women in Andro identified vagi- naldischarge in termsofcolor,smell,consistency,frequency, 3.7. Vaginal Discharge (Phingou Chatpa). In Andro, vagina is and duration. used euphemistically as underneath the cloth. u Th s, vaginal (ii) Etiology of Vaginal Discharge (Phingou Chatpa).Women discharge is Phingou chatpa literally translated as “white attributed vaginal discharge (Phingou chatpa)toseveral going underneath the cloth.” Vaginal discharge is categorized different causes. Causes listed in Table 1 were most frequently into two types—nonbloody and bloody discharge (phingouda mentioned by women in depth interview and in pile sorting ee yaoba). Women in Andro believe that when their body of illnesses. Weakness (sonthaba), worry (wakhal waba), becomes weak they often have discharge. Bloody discharge anger (asaoba), overload of work (thabak henba), conditions describes the presence of blood in vaginal discharge. eTh y produced by economic hardship were felt to cause vaginal believe that such a condition is serious and feel the need to discharge (Phingou chatpa). Women also perceived that attend to it properly. eating fruits and avoidable food during menstruation and Women have different perceptions about whom this post-artum period transforms blood to water leading to illness aeff cts and the extent to which Phingou chatpa was vaginal discharge (Phingou chatpa). Other factors believed prevalent in their village. In one focus group session women to causevaginal discharge(Phingou chatpa)wererelated to unanimously agreed that this illness was prevalent among events like sterilization operation, wearing an intrauterine sexually active women. device, abortion, and childbirth. Though women reported high prevalence of vaginal dis- During illness narrative interviews, women reported that charge (Phingou chatpa) they consider it as normal until and the onset of vaginal discharge (phingou chapta)occurred unless it disturbs their circadian activities. Women perceive oen ft because of one or more of these events. Some women that everybody has vaginal discharge (Phingou chatpa). who had vaginal discharge (phingou chapta)atthe time of (i) Characteristic of Vaginal Discharge (Phingou Chatpa). interviewing said that they have no idea why they had this Women described vaginal discharge in terms of color, smell, illness. Interview conducted with woman provides examples consistency, frequency, and duration. Besides white discharge of woman’s perception regarding the causes of such illness. some women also complained of discharge with blood. Chingabham Tombinou, traditional birth attendant (Mai- They identified it as discharge with banana flower colour bi), retorts “Young women start wearing inners (Panties) (laphutharo machu). Smells are also recognized by women which obstruct the circulation of the blood and causes many particularly if the discharge is associated with strong and illness like vaginal discharge which is actually blood turned foul smellwhich made womenfeeluncomfortable that to water. Moreover, they do not restrict on tabooed foods other people may be able to detect it. Discharge with smell which are supposed to be kept at bay during menses and post- is described by women as foul smell (manam namthiba); partum period.” 6 Journal of Anthropology Women perceived that wearing panties obstructs the Economic burden of a family is borne by the women and it is flow of menstrual blood turning blood into water thereby women who suffer. causing vaginal discharge. In Andro, there are certain food (iii) Seriousness of Vaginal Discharge (Phingou Chatpa). items which are restricted to be taken during menstruation Womenbelieve that an illnessisserious forparticularrea- and postpartum period. The verbose of the traditional birth sons. Vaginal discharge (Phingou chatpa)isperceived as a attendant implies that women have vaginal discharge as they problem when the discharge is an excess. In an in-depth did not put any restriction on eating the tabooed food during interview menstruation and postpartum period. However, women in Andro unanimously agreed that a Th ba (a woman from Andro) said “If the dis- dailyhardtoiltomakebothendsmeetisthe root cause charge wets the wrap around (phanek) then the of discharge. There is a saying in Andro “If you don’t work condition is serious.” then you starve.” Economic crunch in a household aeff cts women. Engaged in a daily struggle to meet the basic needs, “When the discharge is like the menstrual ofl w they cannot spare time to improve and safeguard their own then it is a serious case”.(Tampha, 34-year-old health. Economic hardship compels women to work hard to woman). make both ends meet. This leads to physiological weakness, which in turn deteriorates the health condition and causes all In Andro women wear wrap around known as phanek.If illnesses. The price of poverty has to be paid by women as thedischarge is heavylikethe menstrualflow,and when it poverty makes them compromise on their health. soils the wrap around then, such a condition is considered to be a serious case of discharge. Women use onomatopoeic “Whenawomanispregnantorduringpost- terms like o-ro-rochatpa (going) and jo-ro-rochatpa (going) to partum period a woman is supposed to be fed explain the severity of vaginal discharge. Women compare the with nutritious and strengthening food but when severity of vaginal discharge allegorically with the menstrual you don’t have the money to buy then you blood flow. have to survive on whatever is available. iTh s Women in Andro also perceive discharge to be serious deteriorates the health condition of woman and when there is blood in it. Driving home this point is Moyonsakhi’s assertion that “If there is blood in discharge invites all ailments including vaginal discharge (Phingou chatpa)”. (Daya, 34-year-old woman then it is a problem that needs to be looked into.” from Andro) The above ndin fi g explicates that women perceive vaginal discharge (Phingou chatpa) as serious when the discharge is in excess which they describe in onomatopoeic terms “Woman eats whatever is growing in their kitchen like oo-ro-rochatpa (going) or jo-ro-rochatpa (going). The garden. eTh y cannot afford to have nutritious food seriousness of vaginal discharge (Phingou chatpa)was also like milk,nuts, meat,and so forth, to supplement described allegorically with the menstrual blood flow. They their diet. Rice and curry are their staple food. also perceived that vaginal discharge (Phingou chatpa)is This weakens a woman’s body moreover, a child serious when there is blood in discharge. bearing mother. Thus most women in Andro suffer from vaginal discharge.” (Memcha, 37-year-old woman from Andro) 3.8. Menstrual-Related Illness (Mangbaga Mari Leinaba An- aba). Menstrual-related illness (Mangbaga mari leinaba anaba), a common complaint among women, is a collec- The above verbose explicates the brunt women have to tive term for different illnesses/problems associated with bear due to their impoverished condition. It reveals the menstruation. Women describe heavy menstruation as a inability of women in Andro to have the luxury of having debilitating illness which sucks out all their strength. Men- nutritious food when it is considered to be a requirement strual cramp was not considered as a serious illness. Women during pregnancy and postpartum period due to economic generally endure or bear the pain by lying down or using crunchandhowitbecametherootcauseofvaginaldischarge. hot water bottle/water bag. Other menstrual problems like Women also relate their symptoms to different proce- irregular menstruation and scanty period were also reported. dures or conditions that they had undergone. Some blamed it on abortion, insertion of IUD, and unhygienic way of (i) Causes of Menstrual-Related Illness (Mangbaga Mari Le- living as a probable cause of vaginal discharge. Women in inaba Anaba).Thecausesofmenstrual problemwhich Andro associate vaginal discharge (Phingou chatpa)with women perceive include wearing panties, using pads, eating poor perineal hygiene and by working in dirty water in avoidable food during menstruation, abortion, insertion of the rice efi ld. Some of the women perceive that vaginal IUD, sterilization operation, pregnancy, delivery problems, discharge (Phingou chatpa) can be transmitted from hus- and improper cleaning during childbirth. Interviews with band and can happen due to lack of nutritious food. u Th s, women provide examples of women’s beliefs about the causes womenhavediversiefi dopinion regardingthe etiology of of menstrual problem. vaginal discharge but they unanimously agreed that their Hemsori, a 50-year-old traditional birth attendant (mai- impoverished condition is the root cause of vaginal discharge. bi) from Andro, Cites the reasons for menstrual problem: “If Journal of Anthropology 7 the remnant blood aer ft delivering the baby is not cleaned due to long and difficult labour problem, carrying heavy items properly then it happens.” during postpartum period, sterilization, frequent abortion, As cited by the traditional birth attendant one of the and frequent childbirth. Interviews with women provide perceived cause of menstrual problem is improper cleaning example of beliefs about causes of prolapse. of blood aer ft childbirth. Others reason out on utilization of “Frequent childbirth and abortion spoils the body. contraceptive device like Cu-T and sterilization operation as Playing with your body is not good. eTh pulling the root cause of menstrual problem. This is supported by the and pushing, inserting instruments and hand following citation. inside thedelicatewomen’s body will destroy Another 45-year-old woman from Andro describes the everything” (Monsori, 43-year-old woman from reasons for menstrual problem: “Women started putting for- Andro). eign particle inside their body (copper-T) and had operation. All these block their tubes which lead to menstrual problem.” During childbirth, if the fetus did not come out as soon u Th s, women in Andro perceived that the causes of as the amniotic sac bursts then the traditional birth attendant menstrual problem are improper cleansing of blood after (maibi) has to pummel the stomach and insert the n fi ger delivery, insertion of IUD, and sterilization. However, these inside the vagina to pull the fetus out. Simultaneously, the are the proximate factors responsible for menstrual-related woman in labour was encouraged to push harder to accelerate illness. the birth of the child. Some women remarked how this kind of pulling and pushing leads to prolapse. (ii) Seriousness of Menstrual-Related Illness (Mangbaga Mari Women also believe that lifting heavy weights also causes Leinaba Anaba). Menstrual disorders are perceived as a prolapse. In their day-to-day activities, a woman routinely problemwithwhichwomanhavetoliveandsueff r.Oneofthe lifts heavy weights. This includes lifting and carrying heavy menstrualproblemswhich is perceivedtobethe most serious pots of water from the ponds, hand pumps, and tap to the is heavymenstruation. eTh ybelieve that heavymenstruation house. Lifting heavyweightespeciallyjustaeft rchildbirthis drains away all the strength and is considered to be weakening considered to be dangerous because woman’s body during and cause dizziness and exhaustion. this stage is still tender and lifting heavy weight could push Though heavy period is considered a serious case, women the body out. do not seek any treatment. Menstrual disorders are perceived It is believed that performing heavy activities can lead to to be a problem which women have to sueff r in silence. prolapse (Angangkhao nanthaba)asawomanrelates:“If you Engagedintheir dailystruggletomeetthe basicneeds, they lift heavy things during the post delivery period when the cannot spare time to improve and safeguard their own health. body is tender aer ft giving birth then you will have prolapse Above all they cannot aoff rd to spend money on illness which (Angangkhao nanthaba). It is like the womb collapses and did not disturb their daily activities. u Th s, the price of poverty comesout.Itisnot painfulbut it is very uncomfortable.” hastobepaidbywomen by compromising on theirhealth. Women also perceived that sterilization operation and inserting Copper-T (IUD) cause this problem because it weakens the body and makes it easier for the body to come 3.9. Prolapse (Angangkhao Nanthaba). Prolapse (Angang- out. u Th s, women believe that problem during childbirth, khao nanthaba nanthaba)isliterally translated as baby sac lifting heavy weight, or undergoing a sterilization operation slipping out. Women do not make any distinction between are susceptible to prolapse (Angangkhao nanthaba). vaginal and uterine prolapse. They simply refer to a feeling of heaviness “down below” or that “something coming out” of (iii) Seriousness of Prolapse (Angangkhao Nanthaba).Pro- vagina.Women believethatprolapseisanillness whichneeds lapses (Angangkhao nanthaba) were unanimously perceived attention from allopathic health care provider because there by the people and traditional birth attendant (Maibi)which is no local treatment for it. needs to be addressed by a doctor. Women consider pro- lapse (angangkhao nanthaba) a serious illness which needs (i) Characteristics of Prolapse (Angangkhao Nanthaba).Dieff r- medication from allopathic provider. eTh y consider prolapse ent types of prolapse that women experience are described. (angangkhao nanthaba) serious when they see/feel the body eTh y have constant feeling of heaviness below or as if parts coming out. something is falling out from below making them dicffi ult The traditional birth attendant ( maibi)alsoputstheir to sit, stand, or walk. This makes them so inconvenient hands up in such case. Monsori, a maibi in Andro com- and disturbs their daily activities. This is associated with mented: severe back pain. eTh y cannot stand up abruptly after sitting also. Prolapse interferes with women’s work activities and “is Th is a serious problem because there is no with their lives. eTh degree to which they feel inconvenient treatment for this illness. One has to operate to by a prolapse depends on “how much the body is coming lift up the Angangkhao (baby sac) at a big hospital out.” Women say that they have difficulty lifting weight and whichmostofthe womencannotaoff rd.So, until difficulty in urinating when they have prolapse. and unless it disturbs the daily domestic chores one will not get treatment.” (ii) Causes of Prolapse (Angangkhao Nanthaba).Women in Andro gave different version for causes of prolapse Women in Andro believe that many women suffer from (Angangkhao nanthaba). Women believe that prolapse occurs prolapse (angangkhao nanthaba)but they sueff rinsilence 8 Journal of Anthropology as financial problem refrains woman from seeking timely symptoms such as weakness. Additionally, the finding expli- care.Thus,itisasetbackthatwomen in Androhaveto cates that women describe the feeling of impoverishment in sueff r because of their reproductive caliber due to na fi ncial connection with vaginal discharge (Phingou chatpa). In other constraint. words, women can report vaginal discharge (Phingou chatpa) if she is impoverished and feels weak although she might not have physical symptomofvaginal dischargeorifshe hasnor- 4. Discussion and Conclusion mal physiological discharge. u Th s, an illness is the meaning that womengivetohealthand refers to aperson’sperception Women in Andro refer to health problem relating to repro- and experiences of certain socially disvalued status. eTh ductive organ and function not as “reproductive illness” meaning of health needs to be recognized for achieving an but as women’s illness (nupigi anaba). Though women do analytical understanding of the process of production of not have a “germ theory” of illness, they have a sense of health as a basis for any realistic and comprehensive eo ff rt to illness pathology. Women attributed their illnesses to several improve health condition in a community, as it has a direct different causes such as heavy workload, sterilization, aer ft bearing on the treatment-seeking behavior. insertion of IUD, wearing panty, eating avoidable food, We would like to highlight the need to incorporate and improper cleansing after childbirth. However, women women’s perception of reproductive illness while designing in Andro unanimously perceived that poverty is the root reproductive health programs which are culturally sensitive cause of women’s illness. Economic crunch in a household to bridge the gap between what is considered as the need and affects women. Engaged in a daily struggle to meet basic the actual need at the grassroots level. Reproductive health needs, they cannot spare time to improve and safeguard their programs should includemen andwomen andbeintroduced own health. Economic hardship compels a woman to work within a larger development project that addresses poverty hard to make both ends meet. This leads to physiological and livelihood issues. eTh project can focus on developing weakness, which in turn deteriorates the health condition human capacity to generate income for households and andcausesall theillness.Theprice of povertyhas to be thereby addressing the primary needs of the local community. paid by women as poverty makes them compromise on their In the process of addressing the “root cause” (poverty) of health. Conditions directly resulting from poverty include women’s illnesses an approach towards women’s reproductive anger, worry, lack of nutritious food,and hard toil.These health can also be considered simultaneously. If women conditions will produce physiological weakness (sonthaba). feel that they have time and money to attend to their This physiological weakness is brought about by economic ownhealththeywillbemorewilling to participateina hardship. eTh y fundamentally believed that the treatment of reproductive health program. If poverty alleviation program such illnessispossibleonlywhentheir livesare economically can be developed then local men will be more willing to improved.Women believethatwhentheyare physically weak understand the reproductive health needs of their wives and they are susceptible to other factors causing vaginal discharge encouragethemtoparticipate in theprogram. (Phingou chatpa), menstruation-related illnesses (mangbaga Innovative health program which will provide women mari leinaba anaba), and prolapse (angangkhao nanthaba). (including men) with the knowledge to understand the eTh se factors are referred to as “susceptibility” factors [ 16]. “pathology” of disease within the context of their lives can be The proximate factors may be categorized in the following created. Gradually, as biomedical model of disease interacts manner: problem aer ft sterilization operation or aer ft inser- with the women’s perception of illness, they may begin to dis- tion of Copper-T, problem aer ft a spontaneous or induced tinguishphysicalsymptomofsicknessfromother“meanings” abortion, childbirth and delivery problem, lack of nutritious of sickness and report these as symptom to a health provider. and strength giving food, problem of violation of food taboo On the other hand, health provider should understand the during menstruation and postpartum period, problem with complexity of the reported symptom and not assume that a transmission of illness through sexual intercourse from man reported symptom correlates with disease. u Th s, reproductive to women, and problem of lifting heavy weights. health program can be more innovative and touch the life of The finding explicates that women’s perception of repro- the women concerned thereby approaching towards the “felt ductive illness succinctly differs from the biomedical defini- needs.” tion of reproductive disease. Meanings are embodied in the term “women’s illness” and symptoms are filtered through the Conflict of Interests world view of the people. Reproduction is perceived to be the sole responsibility of women; thereby the term women’s eTh authors declare that there is no conflict of interests illness (nupigianaba) for illness associated with reproductive regarding the publication of this paper. organ. The aetiology, progression, and seriousness of illness are also filtered through the world view of the women and References this will have a direct bearing on treatment. Illness described by the term Phingou chatpa is related to [1] A. Young, “eTh anthropologies of illness and sickness,” Annual physical symptoms and situation in a network of meanings Review of Anthropology, vol. 11, pp. 257–285, 1982. and different meanings are socially generated by individual [2] R. Frakenberg, “Medical anthropology and development: a to articulate their experiences. eTh ndin fi gs show that vagi- theoretical perspective,” Social Science and Medicine,vol.14, pp. nal discharge (Phingou chatpa)isusedwithother physical 197–207, 1980. Journal of Anthropology 9 [3] A.Kleinman,L.Eisenberg,and B. Good,“Culture, illness,and care. Clinical lessons from anthropologic and cross-cultural research,” Annals of Internal Medicine,vol.88, no.2,pp. 251– 258, 1978. [4] M.C.P.Cormack,Ed., Ethnography of Fertility and Birth, Aca- demic Press, London, UK, 1982. [5] P. Jeffery, R. Jeeff ry, and A. Lyon, Labour Pains and Labour Power: Women and Childbearing in India,Zed Publishers, London, UK, 1989. [6] M. Nichter, “Idioms of distress: alternatives in the expression of psychosocial distress: a case study from South India,” Culture, Medicine and Psychiatry,vol.5,no. 4, pp.379–408,1981. [7] T. Patel, “Women’s work and their status: dialectics of subordi- nation and assertion,” Social Action,vol.37, no.2,pp. 126–149, [8] N. Younis, H. Khattab, H. Zurayk, M. El-Mouelhy, M. F. Amin, and A. M. Farag, “A community study of gynecological and related morbidities in rural Egypt,” Studies in Family Planning, vol. 24,no. 3, pp.175–186,1993. [9] R. Bang and A. T. Bang, “Women’s perceptions of white vag- inal discharge: ethnographic data from rural maharashtra,” in Listening To Women Talk About ei Th r Health: Issues and Evidence From India,J.Gittelsohnand M. E. Bentley, Eds.,Ford Foundation, Har-Anand Publications, New Delhi, India, 1994. [10] S. Kanani,K.Latha,and M. Shah,“Applicationofqualitaive methodologies to investigate perceptions of women and health practitioners regarding women’s health disorders in baroda slums,” in Listening To Women Talk About ei Th r Health: Issues and Evidence From India, Ford Foundation,J.Gittelsohnand M. E. Bentley, Eds., Har-Anand Publications, New Delhi, India, [11] T. Patel, Fertility BehAviour: PopulAtion And Society in A RAjAsthAn VillAge, Oxford University Press, New Delhi, India, [12] S. Pachauri and J. Gittelsohn, “Summary of research studies and implications for health policy and programmes,” in Listening To Women Talk About Their Health: Issues and Evidence From India , J. Gittelsohn andM.E.Bentley,Eds., Har-AnandPublications, NewDelhi,India,1994. [13] N. M. Oomman, Poverty and Pathology: Comparing Rural Rajasthani Women’s Ethno-medical Models with Biomedical Model of Reproductive Behaviour [Ph.D. thesis],JohnHopkins University,Baltimore,Md, USA, 1996. [14] A. Kaddour, R. Hafez, and H. Zurayk, “Women’s perceptions of reproductive health in three communities around Beirut, Lebanon,” Reproductive Health Matters, vol. 13, no. 25, pp. 34– 42, 2005. [15] P. Jeffery and R. Jeeff ry, “Only when the boat has started sinking: a maternal death in rural north India,” Social Science and Medicine,vol.71, no.10, pp.1711–1718,2010. [16] H. Zurayak, H. Khattab, N. Younis, and M. El-Mouelhy, “Con- cepts and measures of reproductive morbidities in rural Egypt,” Studies in Family Planning,vol.3,no. 1, pp.17–40,1993. 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Journal of Anthropology – Hindawi Publishing Corporation

Published: Mar 10, 2014

References

  • The anthropologies of illness and sickness,
    A. Young
  • Medical anthropology and development: a theoretical perspective,
    R. Frakenberg
  • Culture, illness, and care. Clinical lessons from anthropologic and cross-cultural research,
    A. Kleinman, L. Eisenberg, and B. Good
  • Idioms of distress: alternatives in the expression of psychosocial distress: a case study from South India,
    M. Nichter
  • Women's work and their status: dialectics of subordination and assertion,
    T. Patel
  • A community study of gynecological and related morbidities in rural Egypt,
    N. Younis, H. Khattab, H. Zurayk, M. El-Mouelhy, M. F. Amin, and A. M. Farag
  • Women's perceptions of white vaginal discharge: ethnographic data from rural maharashtra,
    R. Bang and A. T. Bang
  • Application of qualitaive methodologies to investigate perceptions of women and health practitioners regarding women’s health disorders in baroda slums,
    S. Kanani, K. Latha, and M. Shah
  • Summary of research studies and implications for health policy and programmes,
    S. Pachauri and J. Gittelsohn
  • Women's perceptions of reproductive health in three communities around Beirut, Lebanon,
    A. Kaddour, R. Hafez, and H. Zurayk
  • Only when the boat has started sinking: a maternal death in rural north India,
    P. Jeffery and R. Jeffery
  • Concepts and measures of reproductive morbidities in rural Egypt,
    H. Zurayak, H. Khattab, N. Younis, and M. El-Mouelhy