June 2000, Vol. 6, No. 2

Reproductive Health
Rural Egyptian Women Bear Heavy Disease Burden

In 1988, a multidisciplinary group of researchers set out to investigate and document women’s reproductive health in two rural villages in Giza, Egypt. The researchers expected gynecological and related ailments to affect perhaps 10 percent of the women; they were surprised by the true prevalence of such disorders. The vast majority of the women studied were found to have at least one gynecological or related condition. The team also discovered that two-thirds of women with symptoms had not sought care. “Women perceive pelvic discomfort as part of their nature and lot in life,” explained Huda Zurayk, dean of the faculty of Health Sciences at the American University of Beirut and a primary author of the study. At the time of the research, Zurayk was Senior Associate at the Population Council’s Cairo office.

The study was conducted under the auspices of the Reproductive Health Working Group (RHWG), a research group established at the Council’s Cairo office. Anthropologist Hind Khattab of Delta Consultants, Cairo; obstetrician-gynecologist Nabil Younis of al-Azhar University; and biostatistician Zurayk, primary authors of the study, summarized the findings in their recently published book, Women, Reproduction, and Health in Rural Egypt: The Giza Study.

Array of disorders
The researchers collected data from clinical examinations and laboratory tests, which are considered the gold standards for determining women’s health status, and a questionnaire supplemented with in-depth interviews, which illuminated women’s perceptions of illness and the sociocultural context of the community. The researchers studied a random sample of 509 women who were not pregnant, and who were or had been married. They found that these women suffer from a spectrum of conditions. Beyond reproductive tract infections (RTIs), which affect roughly half of the women, genital prolapse (a painful condition in which the uterus or vagina is displaced downward) afflicts 56 percent and anemia 63 percent. The investigators found suspicious cervical cell changes in 11 percent of the women and cervical erosion in 22 percent. Related conditions were also highly prevalent: women suffered from urinary tract infections (14 percent), obesity (43 percent), and hypertension (18 percent). Only 1 percent of the women had syphilis, however.

Women in these villages frequently use contraceptive methods that are inadvisable because of disorders that they have. For example, some women with RTIs use intrauterine devices, which can lead to pelvic inflammatory disease and infertility. Some women with hypertension use birth control pills, which can aggravate the condition. The researchers argue that providers of family planning should check for contraindicated conditions and provide treatment and advice to patients if necessary.

The questionnaires and interviews showed that factors other than physical accessibility play a role in whether women seek care for symptoms they experience. (Both communities had clinics with female physicians.) Women’s comments indicated that they avoid consulting doctors because the quality and nature of available services are often inadequate. For instance, many cited a lack of communication with, and a fear of being treated poorly by, providers.

Women also place a low priority on their own health and report that they seldom seek care unless symptoms occur during pregnancy or seem related to fertility. Many are unaware of the medical significance of their symptoms, which led the investigators to the conclusion that education could significantly increase the use of health care. If women were aware of the link between RTIs and infertility, for example, they would be more likely to seek treatment for symptoms such as discharge or pelvic pain. If they realized that hypertension can threaten pregnancies, they would have their blood pressure measured more often.

Holistic approach to provision
“One of the most important lessons we have learned from the study is that a multidisciplinary approach is the most effective way to address reproductive health and ill health in communities of the developing world. . . . Health is a multidimensional concept combining the physical, the social, and the psychological,” conclude the authors. The holistic style of medical provision, taking women’s perceptions into account, is more acceptable to women and communities and is more effective at addressing all health needs than is a more fragmented approach.

“Much has indeed changed in reproductive health in Egypt, the Middle East, and internationally over the last ten years, and the Giza study is one of a select group of studies from around the world which has played a critical role in informing this evolution,” writes Jocelyn DeJong, Ford Foundation program officer, Cairo, in the foreword to Khattab, Younis, and Zurayk’s book. RHWG teams are now conducting research similar to the Giza study in Jordan, Lebanon, and Sudan.

Source
Khattab, Hind, Nabil Younis, and Huda Zurayk. 1999. Women, Reproduction, and Health in Rural Egypt: The Giza Study. Cairo, Egypt: The American University in Cairo Press.

Outside funding
The Ford Foundation, the Netherlands Embassy/Egypt, UNICEF/Amman Regional Office, United Nations Population Fund/Egypt, and the World Health Organization (Safe Motherhood Program)

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See Also

• "Approaches to researching women’s reproductive health," Population Briefs, June 2004 (full text)

• Reproductive Health

• Robert H. Ebert Program on Critical Issues in Reproductive Health