ABSTRACT
Background: Health inequity is becoming an emerging issue all over the world. Improving maternal health is one of the UN Millennium Development goals. Pregnant women inhabiting urban slums are a “high risk” group with limited access to health facility. Objective: To study the socio economic profile of the mothers and to study the differentials in utilization of maternal health care by the beneficiaries. Study Design: Descriptive, observational cross-sectional field based study in two purposively selected urban slums of district Dehradun. Results: About 70.9% of mothers belonged to social class II and III and 66% of them belonged to nuclear families. Teenage pregnancy was seen in 8.5%. 93.8% of women received complete antenatal care, majority preferring government hospitals. 93.2% of the women received 100 IFA tablets or more but only 63.7% consumed them for 100 days. Majority of the deliveries were institutional and 79.9% were conducted by trained personnel. About 68.5 % received postnatal care. Conclusion: Although usage of ANC service was high, opportunity to deliver important health services was not fully utilized. Policy and programme to improve the quality and care of antenatal mothers, especially for the poor and under privileged are essential to improve maternal health care. Special interventions should be undertaken on priority basis so as to achieve millennium developmental goals in all population groups.
ABSTRACT
Tamilnadu state of India witnessed an increasing trend of institutional deliveries since the beginning of 1990s, with decline of domiciliary deliveries to nearly zero now. Among the institutional deliveries, a shift has been observed since 2006 wherein primary health centres (PHC) have shown a four-fold increase in the number of deliveries while other public and private health facilities showed a decline, despite equal access by people to all categories of health facilities. A qualitative study was designed to explore the determinants that led to increased preference of PHCs for birthing care. In-depth interviews and FGDs were conducted with recently-delivering women and their spouses. User-friendly ambience, courteous attitude and behaviour of staff, good infrastructure, availability of qualified staff, and relative absence of informal payments have contributed to increased preference for birthing care in PHCs. Barriers to seeking care from secondary and tertiary-level public hospitals and private hospitals have also made women prefer PHCs.
ABSTRACT
Aims: The study was conducted to estimate the proportion of eligible women for Janani Suraksha Yojana and to understand the factors affecting receipt of benefits in Maharashtra State, India. Methodology: It was as comparative observational study conducted in Maharashtra State having a population of 112.37 million. Each district was divided into five strata tribal, rural, Municipal Council, slum and non-slum in Municipal Corporation. In each district about 2400 household were surveyed comprising proportionate quotas from each stratum. Surveying unit from each stratum was randomly selected. The study population consisted women delivered in 2008-2009 year. Firstly Head of household was interviewed for confirming child delivery in the reference period. Then delivered woman was interviewed for checking eligibility to JSY and then details of receipt of benefits were obtained from her. Receivers and non-receivers of benefits were compared with respect to some variables. The study was undertaken with the help of Community Medicine Department from Government Medical Colleges. Results: In the reference period 4,544 women delivered children and 41.15% were found eligible for the scheme. But only 52.57% certainly received cash benefits. About 24% surely did not receive and 23% were not sure about receipt or the scheme and hence included in non-receiver group for further analysis. Non-earning women, not delivered in public health care institutions and un-aware about the scheme were unlikely to receive the benefits. Ante Natal Care visits, immunization, receipt and consumption of Iron and Folic Acid tablets were better among beneficiaries then non-receivers of the benefits. The benefits were not received immediately after delivery. About 10% women had problems in receiving the benefits, particularly requirement of certain certificates. Conclusion: The uptake of the scheme may be slightly higher than 53% and there are many factors responsible for not reaching to entire eligible population. Modifiable risk factors like delivery in government health institution and awareness about the scheme are playing major role in receiving the benefits.
ABSTRACT
The Government of India initiated a cash incentive scheme—Janani Suraksha Yojana (JSY)—to promote institutional deliveries with an aim to reduce maternal mortality ratio (MMR). An observational study was conducted in a tertiary-care hospital of Madhya Pradesh, India, before and after implementation of JSY, with a sample of women presenting for institutional delivery. The objectives of this study were to: (i) determine the total number of institutional deliveries before and after implementation of JSY, (ii) determine the MMR, and (iii) compare factors associated with maternal mortality and morbidity. The data were analyzed for two years before implementation of JSY (2003-2005) and compared with two years following implementation of JSY (2005-2007). Overall, institutional deliveries increased by 42.6% after implementation, including those among rural, illiterate and primary-literate persons of lower socioeconomic strata. The main causes of maternal mortality were eclampsia, pre-eclampsia and severe anaemia both before and after implementation of JSY. Anaemia was the most common morbidity factor observed in this study. Among those who had institutional deliveries, there were significant increases in cases of eclampsia, pre-eclampsia, polyhydramnios, oligohydramnios, antepartum haemorrhage (APH), postpartum haemorrhage (PPH), and malaria after implementation of JSY. The scheme appeared to increase institutional delivery by at-risk mothers, which has the potential to reduce maternal morbidity and mortality, improve child survival, and ensure equity in maternal healthcare in India. The lessons from this study and other available sources should be utilized to improve the performance and implementation of JSY scheme in India.
ABSTRACT
Background :Antenatal care is essential to reduce morbidity and mortality among newborn babies and pregnant women. Aims: To study the pattern of utilization of antenatal services and to find out the potential predictors, their distributions and their association with antenatal care utilization and pregnancy outcomes. Settings and Design :A prospective longitudinal study was conducted in Deoli, a rural teaching area of a medical college of Wardha district, Maharashtra state. Materials and Methods : Medical social workers contacted all the registered 305 pregnant women in 1 month. A total of 274 women were included in the study. The response rate was 89.83%. Statistical Analysis Used : Percentages, rate ratio. Results : Mean age at marriage was 19.8±3.6 years, and the average age at first pregnancy was 21.6± 4.5 years. Of the 274 pregnant women, 156 (56.9%) were pregnant for the first time (gravida 1), and the remaining 118 (43.1%) pregnant women, gravida 2 and above, had an average of 2.1 living sons and 1.9 living daughters. Only 92 (33.6%) women had undergone the minimum recommended antenatal checkup during their current pregnancy, and 188 (68.6%) women had institutional deliveries. A large proportion of women in Deoli do not receive proper health care during pregnancy and childbirth. Conclusion : In Deoli, antenatal services, in spite of being essential to the care of pregnant women, are being poorly delivered.