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Indian Journal of Community Medicine

Safe Motherhood Status in the Urban Slums of Davangere City

Author(s): R. R. Venkatesh, A. G. Umakantha, J. Yuvaraj

Vol. 30, No. 1 (2005-03 - 2005-03)

Abstract

Research question : What is the extent of utilisation of health services by the mothers in the antenatal, intranatal and post natal period and what factors influence the same?

Objective : To study the factors influencing the utilisation of health services in te antenatal, intranatal and postnatal period. Study design : Cross sectional study.

Setting : 27 urban slums of Davangere city

Participants : All the mothers (n+510) who had delivery prior to 3 months from the initiation of the study.

Statistical analysis : Simple proportions, Z test, Chi-square test.

Results : Only 35.9% of the women had utilised all the three services i.e., antenatal, intranatal and postnatal completely. The percentage of deliveries conducted by the trained attendants was 70.4% and 64.7% of the women had received at least one postnatal visit. The socio-demographic factors like literacy status, occupation, type of family, parity and an unwanted pregnancy were found to influence the pattern of utilisation.

Key Words : Utilization, Antenatal period, Social determinants

Introduction

The current scenario depicts increased availability and easy accessibility of helth care services both in the rural and urban areas. By further strengthening their services to cater the needs of the vulnerable sections of the society, it is expected the there will be an increase in the utilization of the same, thereby achieving the national goal of providing HFA by 2000 AD. However, many studies have revealed low utilization of the health care services by different segments of the society for varying reasons. This is especially true in case of MCH services for mothers and children. This study was formulated against this background, with an objective of studying the factors influencing the utilization of health services in the spectrum of antenatal, intranatal and postnatal periods of a mother.

Material and Methods

This cross sectional study was conducted in al the 27 slums of Davangere town, Davangere District, Karnataka State. The population of each slum in the town ranged between 600 and 5500. Urban Family Welfare Centres cater to the service needs of these people. The study population comprised of all the mothers who had delivered prior to 3 months form the start of the study in these slums. They were recruited by a door-todoor enumeration, ANM registers and Anganwadi records were used to identify those mothers who were missed during enumeration.Thus, a total of 510 mothers in the study area were surveyed. The study was restricted only to mothers who had delivered within the last three months (which is the last birth), this was stipulated so as to minimise recall bias and to aoid the mix up of the responses with the earlier delivery, if any. The utilization of services was determined at one point of time. A pretested and predesigned tool was used for data capture covering socio-demographic information like age, occupation, religion, literacy, socio-economic status, type of family, martital staus and information regarding utilization of health services during the index pregnancy.

Results and Discussion

A total of 510 mothers were included in the study. Majority (57.2%) of the mothers in ths study population were in the 18- 23 years age group followed by 34.9% in the 24-29 years age group class. The percentage of mothers who were illiterate was 51.6% and only 4.5% of the mothers had college level education. Majority (88%) of the women were housewives and only 12% of the women were working the unorganised sector as daily wage labouers, maidservants or beedi rolling at home. The distribution of the 73.5%, 26% and 0.5% respectively and majority (56%) were from a nuclear family.

Only 35.9% of the women had utilised the health care services completely during antenatal, intranatal and postnatal period. A woman who had received a minimum of three antenatal visits, had her delivery conducted by a trained personnel and had received atleast one postnatal visit is said to have utilized antenatal, intranatal and postnatal services. The percentage of deliveries conducted by the trained attendants was 70.4% and majority of the women had received at least one postnatal visit (Table I).

Table I : Utilization of Maternal Services by the Study Population

Period Utilized Not Utilized Total
Anternatal >3 visits 258 (50.6%) 252 (49.4%) 510
Intranatal 359 (70.4%) 151 (29.6%) 510
Postnatal 330 (64.7%) 180 (35.3%) 510

There was a better awareness of health promotion, availability of existing health services leading to better utilisation of the same by the educated mothers whereas it was other wise amongst illiterate women who were bound by cultural and superstitious beliefs. These results strengthens the findings of studies reported elsewhere1,2,3,4.

Table II : Occupation and Utilization of Maternal Services

Occupation N U NU U NU U NU
Housewife 449 243 206 317 132 297 152
  (54.1) (45.9) (70.6) (29.4) (66.1) (33.9)
Working 61 15 46 42 19 33 28
  (24.6) (75.4) (68.9) (31.1) (54.1) (45.9)
Total 510 258 252 359 151 330 180
  (50.6) (49.4) (70.4) (29.6) (64.7) (35.3)
Z Value Z=4.9 Z=0.27 Z=1.78
P Value (p<0.001)     NS NS

There was a significant difference in the level of utilisation of antenatal services by the housewives compared to workingwomen (p<0.001) (Table II). The level of utilization regarding intranatal and postnatal services by the housewives (54.1%) though was slightly more than the working-women, it was not significant. This reflects the ground realities of prevailing conditions where long waiting time in the antenatal clinics, coupled poor quality of services of the health care institutions inthe government sector, prevents the working women of the socio-economic strata of the society from utilizing the available services because of fear of deprivement of their meagre daily earnings in the process of seeking health care. These reasons compels the pregnant mothers to choose either to ignore their health or choose the private sector which pushes the poorest among them further into the poverty trap to meet the cost of health care.

The reason for more utilizaiton of services by the women in joint families could be attributed to increased awareness created, the concern and support shown by other members in the family and also their affordability to avail the services because there is no economic pressure on them. Most women from the nuclear families tended to utilize the intranatal and post natal services more than antenatal services. This could be probably attributed to the absence of concern and support, which are available for the women from the joint family and also the need for help if delivery occurred at home. Utilization of antenatal, intranatal and postnatal services was higher among women with lower parity and in women in the 18-29 years age group with more than three visits this proportion gradually declined with rise of parity and age. Similar findings were observed by others2,3. This could be due to the fact that the younger primiparous were more aware of the need for natenatal care hence the utilisation is more compared to the awareness amongst the elderly multiparous.

Regarding the decision to take antenatal care, 375 (87%) of the women did so on their own acord, of which only 25 (5.8%) were driven by symptoms to go for antenatal check up. This shows the high level of awareness among women themselves regarding the need to utilize antenatal services. Only 44 (10.3%) had to be motivated by the health personnel to utilize antenatal services and one woman was advised by her mother to avail antenatal services.

Table III: Utilization of Antenatal Services by 'High risk' women

Risk Factors N Not Utilized ANC (%age)
Time since last delivery <2 year 155 55 (35.5)
Past H/o. Foetal loss 123 32 (26.0)
Maternal age < 18 years 9 5 (55.6)
Maternal age >35 years 2 2 (100.0)
Pregnancy with systemic diseases 3 -  
Grand multipara 75 64 (85.3)
Preclampsia/eclampsia/APH 31 -  
Malpresentation/Multiple Presentation 9 3 (33.3)
Previous Caesarean/Instrumental 42 -  

With respect to the pattern of utilisation in high risk women as seen in Table III, women, at extremes of ages < 18 years and > 35 years did not avail antenatal services. The younger women probably due to ignorance, the older women did not feel the need for it due to past experience. A review of the association of 'risk factor' with maternal mortality revealed than 50% of maternal deaths had one or more risk factors associated (CSSM) Programme, 1991) in the said age classes. However, with the introduction of risk approach to maternal care it is expected to ensure the level of care provided is appropriate to the level of need.

Sixy five percent of the 79 women who did not pay even a single visit to avail antenatal care felt that it was necessary as they had planned their delivery at home. Twenty two percent women said that they were not permitted to avail the same because they were not the decision makers in the family.

Pregnancy is said to be 'unwanted' if the women indicated that either she or her husband was unhappy, resenful or upset about the pregnancy, or did not want the pregnancy or that the pregnancy was mistimed. In this study, 92.5% pregnancies were wanted and only 7.5% were unwanted. There was a poor (15.8%) utilization of health services in case of unwanted pregnancies however, amongh the same group 60.5% and 47.5% had availed intra and post-natal services respectively for which reasons could not be attributed.

Conclusion

The Maternal and Child Health services in India have been initiated, strengthened and expanded over the year and are still under utilized particularly in urban areas. The present study has observed that there are socio-cultural and behavioural barriers like famale literacy, occupation, poverty, low status of women, parity, age of the women, type of family, which has influenced the utilization of the same by the expectant mothers. It was also observed that the awareness and the benefit of these services are yet to be understood by the maternal community. Therefore vigorous attempts should be made in this direction to usher the establishment of a safe mother in a safe society.

References

  1. Tara Kanitkar and R.K. Sinha Antenatal care services in five states of India. In Singh S.M., Premi M.K., Bhatia P.S. Bose A, eds. International Institute for Population Sciences. Delhi Population Transition in India, 1989: 201-211.
  2. Dutta P.K., Urmil A.C., Gund S.S., Dutta M. Utilization of health services by "High risk" pregnant women in a semiurban community of Pune-An analytical study. Indian J Maternal Child Health, 1990; 1 (1): 15-19.
  3. Rajeswari N.V. and Kulkarni A.S. Utilization of maternal and child health services in rural Karnataka. J of Institute of Economics Res. 1992;17(1) : 13;24.
  4. Mondal S.K. Utilization of Antental care services in Rajastant. Observations from the NFHS. J of Family Welfare 1997; 43(3): 28-33.
  5. Rao A.B., Purandave M, Mehta A. Awareness of family planning methods amongh pregnant women. J Obstet Gynecol India, 1988; 38(4): 451-455.

Deptt. of Community Medicine, M.S. Ramaiah Medical College, Bangalore

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