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Indian Journal of Community Medicine

Maternal Care Rendered at an Urban Health Centre of a Metropolitan City

Author(s): B. Banerjee

Vol. 31, No. 3 (2006-07 - 2006-09)

Introduction

Worldwide, every day at least 1600 women die from complications of pregnancy and childbirth, the majority of which occur in the developing world1. Between 25 and 33 percent of all deaths of women in the reproductive age group in developing countries are the result of complications of pregnancy and childbirth2. Apart from mortality, maternal morbidities are also of serious concern.

To combat these problems and to ensure maternal health, MCH services evolved from simple midwifery skills to a most integrated approach in the form of Child Survival and Safe Motherhood Programme (CSSM) and later Reproductive and Child Health Programme (RCH). The life cycle approach in RCH stresses the need of attaining good health status from the period of pre-birth, so as to have healthy future generations. This requires a good level of maternal care, which is a major component of the RCH programme. The present study envisages assessing the coverage of maternal care delivered at an urban health centre (UHC) of Kolkata.

Material and Methods

A community based, cross sectional, observational study was undertaken in an UHC of Kolkata, where the study subjects comprised of antenatal (AN) and postnatal (PN) mothers. The estimated number of AN and PN mothers at one point of time were calculated from the birth rate and population of the area during the previous year, which came to 200. For selecting the sample the households were used as the sampling units. Multi stage sampling was done, one of the four units of the UHC serving the population being selected by simple random technique using lottery method in the first stage and the requisite number of households of the selected units being identified by systematic random sampling method in the second stage. Data was collected by house visits and interview method using a pre tested, semi structured schedule which included services, received by the mothers, in the AN and PN period.

Results and Discussion

Under the CSSM programme early registration, i.e., within 16 weeks of pregnancy, has been given much stress as it is important for early identification of problems and prevention of morbidity and mortality. However, Kumar et al observed a very low rate of registration of 21.1 percent of expected and only 3.5 percent were registered in the first trimester3 though other authors have reported higher rates4,5. The present study showed 100 percent registration, of which 58 percent had registered within 16 weeks. AN cards were given to 96 percent of the mothers.

In this study any service, if received once, was considered to have been “received”. It was seen that 72 percent of the antenatal mothers had received all services. Maximum coverage was observed in case of routine investigations, as 96 percent of all the women had had their routine investigations done, 84% had received IFA, and 80% got inj T.T.

Table I : Care Received by Post Natal Mothers

Care Number
(N=100)
Registration 100
AN card 97
Three ante natal check ups 93
Examination of weight, B.P., P/A 100
IFA large100 tablets 92
Inj. T.T. 2nd dose/booster 100
All investigations 100
Delivery by trained personnel 100
PP visits 76
All services 86

Another important factor in maternal care is continuance of care throughout pregnancy, confinement and post partum period. A study conducted in five Delhi slums revealed a very high proportion of women (70-90 percent) had availed of care during pregnancy. But this high rate was not very effective as only one sixth of the women had taken care throughout pregnancy6. Table shows the total antenatal care received by the mothers. As the antenatal women were in different stages of their pregnancy and had not completed their total antenatal period, only the post partum mothers were considered in this table. It was seen that most of the services had been delivered to all the women. But some of them had not had three antenatal check ups or had not received 100 tablets of iron and folic acid. Many mothers had not had post partum check ups by home visits. Full pregnancy care had been received by 86 percent of the mothers, which included receiving an AN card, 3 AN check ups, examination of weight, B.P. and per abdominal examination, 100 large IFA tablets, Inj. Tetanus toxoid 2nd or booster dose and routine investigations. Singh observed that only 52.5 percent of the pregnant women in India had received full package of ANC7. This coverage was 61.6 percent for West Bengal8. In another study, 95.8 percent ante natal women were registered, full immunization received by 90.4 percent and 80.8 percent had taken IFA tablets4.

Agarwal et al, in a study in a peri urban area in New Delhi, found that pregnant women were registered antenatally, with 42 percent paying 3 or more visits. Home deliveries were 70 percent, of which 81.9 percent were conducted by untrained dais. Three fourth of mothers received IFA tablets but only 15 percent received 75 or more5. Kumar observed weight recording in 5.3 percent and haemoglobin estimation in 7.7 percent3. In the present study, both these services were received by 100 percent of the women. All the deliveries were conducted by trained personnel, of which 93 percent were institutional. In a survey by UNICEF, 32.5 percent of deliveries were conducted at health facilities and 53.9 percent were assisted by health personnel9. According to NFHS-2 institutional deliveries were 33.6 percent8. In another survey in Varanasi, home deliveries were found to be very high10. No all India figure is available for post natal care, which is a relatively neglected aspect of maternity care in developing countries. However, according to NFHS-2 data, only 16.5 percent of births were followed by a post partum check up within two months of birth8. In the study area post partum home visits were received by 76 percent of the total mothers. Though the situation in the present study does not appear to be very dismal, there is a lot of scope for improvement of services, which would lead to improvement of the status of maternal health ultimately ensuring a healthy mother and child.

References

  1. Revised 1990 estimates of maternal mortality. A new approach by WHO and UNICEF, WHO, Geneva 1996.
  2. World Health Day 1998, Safe Motherhood, 7 April 1998. Information kit, WHO: WHD 98.
  3. Kumar S, Gupta VK, Tiwari IC. Experience of some operational inputs on work performance of health workers (Female). IJPSM 1981; 12 (1): 55-57.
  4. Swami HM et al. Existing MCH services in rural areas of Chandigarh. IJCM 1997; 22 (3): 110-113.
  5. Agarwal OP, Kumar R, Gupta A, Tiwari RS. Utilization of antenatal care services in peri-urban area of East Delhi. IJCM 1997; 22 (1): 29-32.
  6. Bajaj J. Knowledge and utilization of maternal and child health services in Delhi slums. JFW 1999; 45 (1): 44-52.
  7. Singh P, Yadav RJ. Antenatal care of pregnant women in India. IJCM 2000; 25 (3): 112-117.
  8. National Family Health Survey – 2, 1998-99. India. International Institute of Population Sciences. Mumbai, 2000.
  9. MICS India 1995-96. Draft summary report. UNICEF, New Delhi, August 1996.
  10. Singh DR, Mishra CP, Mehrotra A, Tandon J. Coverage evaluation survey of Universal Immunization Programme in Chiraigaon block of Varanasi district. IJPSM 1993; 24 (2): 62-64.

Deptt. of Public Health Administration
All India Institute of Hygiene and Public Health, Kolkata-700 073
Email: [email protected]

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