‘Early intervention can help mitigate risk of women’s sexual health problems’

Even routine gynaecological problems among women are indicative of negative life situations and can be associated with emotional and sexual health risk, the findings of a project implemented in a slum community in Mumbai over the past six years have suggested. An early and holistic intervention in married lives can help mitigate the risk of women’s sexual health problems, it said.

The Research and Intervention for Sexual Health: Theory to Action (RISHTA) project focussed attention on the symptom of vaginal discharge and established a Women’s Health Clinic in June 2009 in the Urban Health Clinic serving a low income community inhabited largely by Muslims. Every woman recruited into the project — 1125 of them — was asked to provide a medical history, to undergo an internal examination, and test for sexually transmitted infections (STI) before being given treatment.

RISHTA used a multi-level approach with a view that bringing about changes in women’s attitudes must be accompanied by positive change in the marital relationship and community norms that perpetuate gender inequitable attitudes. The approach incorporated counselling on marital relations with women and group meetings of couples. It also included a community education component to target gender inequitable norms.

Vaginal discharge is the leading symptom for which women in India and South Asia seek care. There is evidence to prove that women seeking treatment for this is particularly high among the poor, representing a physical, emotional and financial burden for low-income families.

From a biomedical perspective, vaginal discharge is most likely to be a normal, non-pathological, biochemical process influenced by diet and hormone levels and the menstrual cycle. In the medical literature, this condition has been attributed to frequent or early onset of sexual activity, sexual intercourse during menstruation, use of hormones and oral contraceptives, antibiotic medication, insertion of vaginal agents for birth control, complications with sterilisation, lack of personal hygiene and reproductive tract infection.

The National Aids Control Organisation (NACO) has provided guidelines for syndromic treatment based on reported gynaecological symptoms including white discharge.

Initially, 230 women were tested for STIs that include gonorrhea, Chlamydia, and other conditions. Of these, 84 per cent presented white discharge as the symptom that brought them to Women’s Health Clinic. Following the NACO guidelines for management of STIs, almost 70 per cent of these women were treated with an antibiotic (in most cases antifungal). However, repeat tests showed that only one case of gonorrhea was identified among them. Of the 161 women treated with antibiotic, 160 were uninfected, creating undue costs for the municipal corporation, potential side effects for treated women, including, in some cases, increasing discharge, as well as heightened antibiotic resistance in the population.

RISHTA — implemented by the International Centre for Research on Women and its collaborating partners — subsequently asked every woman who came to the clinic complaining of white discharge about any related events or life situations that she faced, including financial problems, difficult communication or conflict with husband, problem with extended family, experience of coercive or forced sex or other physical or psychological abuse, poor self image, restrictions on the woman’s behaviour and husband’s extramarital sex or alcohol or other substance use.

“As women were put into discussion with our counsellors, they would tell us the story of their lives, and this would tell us about how they understand their own risks and vulnerabilities,” Ravi Verma, Asia Regional Director, ICRW, told reporters here while releasing the findings of the project.

Trained counsellors led group counselling sessions, which helped the couple understand each other better.

To change community beliefs about the roles and relationships of men and women, the RISHTA consortium worked with local community-based organisations to conduct campaigns on gender and gender-based equity and spread awareness about the importance of improved marital communication. In a unique move to target men in the community, the research team brought the Imams on board to deliver messages concerning women’s health, violence and sexual health.