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Year : 2007  |  Volume : 32  |  Issue : 3  |  Page : 203-205
 

Maternal health-care utilization among women in an urban slum in Delhi


Department of Community Medicine, Maulana Azad Medical College, New Delhi, India

Date of Submission23-May-2006
Date of Acceptance08-Jun-2007

Correspondence Address:
Suneela Garg
Department of Community Medicine, Maulana Azad Medical College, New Delhi - 110 002
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0970-0218.36829

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How to cite this article:
Agarwal P, Singh M M, Garg S. Maternal health-care utilization among women in an urban slum in Delhi. Indian J Community Med 2007;32:203-5

How to cite this URL:
Agarwal P, Singh M M, Garg S. Maternal health-care utilization among women in an urban slum in Delhi. Indian J Community Med [serial online] 2007 [cited 2017 Mar 29];32:203-5. Available from: http://www.ijcm.org.in/text.asp?2007/32/3/203/36829



   Introduction Top


Maternal mortality is on an average 18 times higher in developed countries compared to developing countries. [1] In addition to the number of deaths each year, over 50 million women suffer from maternal morbidity due to acute complications from pregnancy. [2]

Maternal mortality and morbidity continue to be high despite the existence of national programs for improving maternal and child health in India. This could be related to several factors, an important one being non-utilization or under-utilization of maternal health-care services, especially amongst the rural poor and urban slum population due to either lack of awareness or access to health-care services. Understanding of the knowledge and practices of the community regarding maternity care during pregnancy, delivery and postnatal period is required for program implementation. Therefore, the present study was carried out to evaluate the socio-demographic correlates and barriers of maternal health-care utilization amongst married women aged 15-45 years living in a slum in Delhi.


   Materials and Methods Top


The present study was conducted in a slum - Balmiki Basti, a field practice area of Department of Community Medicine, Maulana Azad Medical College, New Delhi - during June-July 2004 after approval of the institutional ethical committee. The slum has been in existence for the past two decades, with an approximate population of 1,900. The peripheral health post (PHP) in collaboration with Basti Vikas Kendra (Slum Development Center) and a non-Governmental Organization - Sur Nirman Educational and Cultural Society - provide the health facilities at this slum.

All married women in the age group of 15-45 years who were either pregnant at the time of interview or had delivered within the last 1 year were included. A total of 100 such women identified by door-to-door survey participated in the study after getting informed written consent. These women were interviewed using a pre-structured interview schedule including identification data, socio-demographic profile, details of antenatal care, delivery, postnatal care and perceived barriers for non-utilization of maternal health-care services. At least three visits were made to include all the women who could not be contacted in the first visit.

Data was coded, entered and analyzed using SPSS (version 10.0) package. Data was expressed in percentage. Chi-square test was used for evaluating association between antenatal care (ANC) and categorical variables. ' P ' value less than 0.05 was considered statistically significant.


   Results Top


Out of 100 women, 82 women delivered during the last one year, and 18 were pregnant at the time of interview. As many as 76% respondents received antenatal care either from government hospitals (59%) or from the peripheral health post (17%), and 24% did not seek antenatal care.

The socioeconomic and demographic characteristics of the participant women in relation to antenatal care are shown in [Table - 1]. Majority of them were Hindus (61%), aged 24-29 years (44%), with a literacy rate of 38%; and 54% were unskilled laborers. Antenatal care received was significantly lower among illiterate women and among those whose husbands were illiterate and unskilled laborers. No significant association was found with either their religion or the mean per capita income of family.

As shown in [Table - 2], the prevalence of medical problems like anemia and tuberculosis was found to be significantly higher among women without antenatal care (95.8%) than those seeking antenatal care (53.9%). Obstetric problems like pregnancy-induced hypertension, antepartum hemorrhage, previous cesarean section were observed to be more frequent among antenatal clinic attendees (17.1%) than non-attendees (4.1%).

Of the women who delivered during the past one year, 78 (95.1%) had vaginal delivery and only 4 had cesarean section [Table - 2]. Majority of women had hospital delivery conducted by doctor or nurse (68.2%), and by a trained dai in cases of home delivery (66.6%). Most women (95.1%) breast-fed their infants, but initiation within 24 hours of delivery was better in women who had ANC (64.4%) than in women who had not had ANC (33.3%). Postnatal care was not sought by 84% mothers, and only 16% receiving ANC visited either hospital or PHP for postnatal care. Only 83% women had received two doses of tetanus toxoid injections.

Perceived barriers to maternal health-care utilization in hospitals/ health centers among the participants were (multiple responses) as follows: thinking that health checkup is not required (27%), lack of knowledge about available services (17%), long waiting time (22%), none to accompany (15%), financial constraints (12%), working (7%), fear of hospital care (6%) and objection from family (2%).

Those seeking health care in the hospital/ health center knew more about iron and calcium distribution (71/76, 93.4%), tetanus toxoid injection (74/76, 97.4%) and blood test for anemia (20/76, 26.3%) than women not seeking health care - viz., (2/24, 8.3%), (6/24, 25%) and (1/24, 4.1%) respectively.


   Discussion Top


Most maternal deaths can be prevented if women have access to basic medical care during pregnancy, childbirth and postpartum period. [3] In India, these services are provided through a network of health centers in outpatient clinics, as well as through home visits by health workers. [4] However, utilization of these services by the target population continues to be poor. [5] This could be due to lack of awareness, availability or accessibility to these services.

In our study population, various socioeconomic factors such as literacy of women and their husbands, husbands' occupations showed a significant association with respect to utilization of antenatal care services, indicating the impact of education on awareness and health status of, and utilization by, the population. Most women (76%) received antenatal care. Reports of the coverage evaluation survey carried out throughout the sampled districts of India showed a similar level of antenatal care - averaging 75% across the country. [6]

Mothers availing ANC preferred dais to a lesser extent (13.1%) than those having no ANC (66%). A study by Ray et al. [7] showed that practices of delivery at home in slums were found to be 34.7%, which corroborated with the findings of the present study (31.7%). However, Misra et al. [8] reported that three-fourths of the deliveries were conducted by untrained dais / family members in some parts of Varanasi district, U.P. The reasons for the differences might be due to differences in the literacy levels or presence of better primary health-care facilities in the surrounding areas.

Despite the target of universal immunization of pregnant women against tetanus, 17% in the present study were unprotected against tetanus. Similar to an evaluation survey report, the present study shows that there is lack of awareness or interest among few slum dwellers of Delhi for maternal health care in spite of the availability of the health facility in the vicinity. In a study of utilization of maternal health-care services over time, a significant improvement was observed in subsequent pregnancy due to better awareness. Another study of urban slums identified prolonged waiting time, heavy workload at home and long distance as reasons for non-utilization.

The present study findings suggest that awareness and accessibility of health care equipped with modern maternity facilities has a significant influence upon the health-seeking behavior of women. Since it may not be possible to establish a health facility staffed with a doctor or a nurse in every slum area of Delhi, there is a need to increase awareness of the community about benefits of using modern maternity care at nearby health centers for better pregnancy outcome.

 
   References Top

1.Revised 1990 Estimates of Maternal Mortality: A New Approach by WHO and UNICEF. World Health Organization: Geneva; 1996.  Back to cited text no. 1    
2.The Progress of Nations. UNICEF: New York; 1996.  Back to cited text no. 2    
3.Mother-baby package: Implementing safe motherhood in countries. World Health Organization: Geneva; 1994.  Back to cited text no. 3    
4.Government of India. National Child Survival and Safe Motherhood Programme: Plan to implement MCH Services. Ministry of Health and Family Welfare, Government of India: New Delhi; 1992.  Back to cited text no. 4    
5.Kumar R, Singh MM, Kaur A, Kaur M. Reproductive health behaviour of rural women. J Indian Med Assoc 1995;93:129-31.  Back to cited text no. 5  [PUBMED]  
6.Gupta JP, Murali I. National review of immunization programmes. Indian J Community Med 1990;15:217-21.  Back to cited text no. 6    
7.Ray SK, Mukherjee B, Dobe M, Sengupta D, Ghosh M, Chaudhuri N. Utilization of maternal services in West Bengal. Indian Pediatr 1993;30:351-4.  Back to cited text no. 7  [PUBMED]  
8.Ministry of Health and Family Welfare, Government of India - Evaluation of Service Coverage, Child Survival and Safe Motherhood Programme. Ministry of Health and Family Welfare: New Delhi; 1992. p. 1-33.  Back to cited text no. 8    



 
 
    Tables

  [Table - 1], [Table - 2]


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