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Measuring reproductive morbidity. Report of a Technical Working Group, Geneva, 30 August - 1 September 1989.
[Unpublished] 1990. 41 p. (WHO/MCH/90.4; Safe Motherhood; UNFPA Project No. INT/88/P14)Reproduction morbidity is defined as any morbidity or dysfunction of the reproductive tract. Obstetric morbidity is related to pregnancy. Direct obstetric morbidity results from obstetric complications of pregnancy, such as ante- or postpartum hemorrhage, eclampsia, or sepsis. Indirect obstetric morbidity results from preexisting diseases, such as malaria, hepatitis, and tuberculosis. Psychological obstetric morbidity includes puerperal psychoses, or fear of pregnancy and childbirth. Direct gynecological morbidity includes reproductive cancers and bacterial or viral sexually transmitted diseases (STDs). Indirect gynecological morbidity includes traditional practices, such as circumcision. Psychological morbidity is associated with STDs, infertility, and dyspareunia. Contraceptive morbidity involves efforts that limit fertility. Some aspects of reproductive morbidity have been covered extensively (e.g., STDs), while studies of uterine prolapse, fistulas, urinary/fecal incontinence, and secondary infertility are few. In a study in India 92% of women had a gynecological problem upon examination, but only 55% reported it. Language is a major impediment to communication because of euphemisms used to describe an ailment. Morbidities tend to be underreported. In a sample of Egyptian women asked about specific problems, backache (47%), abdominal pain (42%), discharge (41%), prolapse (30%), and urinary tract infections (24%) were most common. Hospital studies are used most often to research maternal morbidity followed by community studies, cross-sectional surveys, and case-control studies with proper sample size. The validity of self-reported data greatly depend on the interviewer, but recall bias also has to be considered. It is recommended that WHO sponsor research into reproductive morbidity, develop standardized questionnaires, study a community-based health project, develop a series of "case histories," and plan a meeting during 1990-91.