Title : Reproductive health seeking behaviour and its determinants in Indian women- A systematic review and meta-analysis
Abstract:
Introduction: Reproductive health-seeking behaviour is central to improving maternal and child health, family planning, and overall well-being. The scope of women’s reproductive health has expanded beyond pregnancy-related care to include pre-pregnancy interventions, disease management, and treatment of disorders in non-pregnant women. Despite this broader perspective, reproductive health disorders such as endometriosis and preeclampsia remain underdiagnosed and continue to cause significant morbidity and mortality. Evidence from India highlights high prevalence rates of reproductive tract and sexually transmitted infections, with barriers to care including normalization of symptoms, embarrassment, lack of female providers, and limited healthcare access. These challenges underscore the urgent need for targeted interventions that combine medical, societal, and policy-driven approaches to improve women’s reproductive health outcomes, particularly in low- and middle-income countries.
Method: The SRMA protocol was registered in PROSPERO (CRD42024562508) and conducted adhering to the Preferred Reporting Items of Systematic Reviews and Meta-Analysis (PRISMA) 2020 guidelines. We searched PubMed, Scopus, and Google Scholar databases for studies on health-seeking behaviour for women's Reproductive health in India from its inception till June 27, 2024. The included studies focused on reproductive morbidities and women’s reproductive health-seeking behaviours. Conditions considered were menstrual disorders, gynaecological infections, pregnancy complications, menopause-related problems, infertility, reproductive structural abnormalities, and chronic pelvic pain, along with the corresponding health-seeking practices. Data extraction and risk of bias assessment were carried out, and quantitative data were synthesized through a meta-analysis of proportions was performed using the inverse variance method with a logit transformation. A random-effects model employing the DerSimonian–Laird estimator was used to account for between-study variability. Heterogeneity among studies was assessed using Cochran’s Q test (reported as a chi-square statistic with k–1 degrees of freedom) and quantified with the I² statistic.
Results: The pooled proportion of women seeking treatment for at least one reproductive morbidity was 54.2% (95% CI: 45.1%–63.1%, I² = 100%). Among those who sought care, 10.7% (95% CI: 6.2%–18%, I² = 100%) visited government facilities, while 16.1% (95% CI: 10.1%–24.8%; I² = 99.9%) utilized private facilities. In terms of treatment type, 52.1% of women sought allopathic medicine (95% CI: 33%–70.5%; I² = 93%), 14.5% used alternative medicine (95% CI: 6.3%–30.0%; I² = 94.4%), 22.3% relied on home remedies (95% CI: 13%–35.5%; I² = 96.8), and 15.4% obtained over-the-counter (OTC) medications (95% CI: 11.8%–20%; I² = 55.7%). The reported barriers to seeking treatment included financial constraints (12.3%), embarrassment or shyness in disclosing illness (16.3%), and perceiving symptoms as normal rather than an illness (60%). Additional barriers were family restrictions (3.7%), lack of awareness about available treatments (13.5%), poor health condition preventing hospital visits (8.6%), communication difficulties with healthcare providers (27.3%), and distance to healthcare facilities (8.4%). Notably, 47% of women perceived no need for treatment.
Conclusion: This SRMA provides a comprehensive overview of health-seeking behaviour among women with reproductive morbidities in India. Despite the high disease burden, only about half of affected women seek hospital-based treatment, with education and socioeconomic status continuing to influence care-seeking decisions. Gaps in awareness and knowledge of reproductive health services remain major barriers to timely and appropriate treatment.
Key words: Health-Seeking Behaviour of Women; Healthcare Access; Reproductive Morbidities; Gynaecological Morbidities; India; Systematic Review; Meta-Analysis.
