Safer pregnancies for all in rural India

Pallikadavath, S., Foss, M. and Stones, R.W (2005) Safer pregnancies for all in rural India. Id21 Health.

Abstract

A mother's access to antenatal care, between conception and birth, is crucial to a healthy birth. In parts of India, many women are not using antenatal services despite government and NGO efforts to improve services. Extending the role of nurses and midwives, and providing more care within communities are key to increasing access to care and limiting pressure on local services.
Researchers from ‘Opportunities and Choices’ programme at the University of Southampton, UK, drew on data on 11,369 women of reproductive age from the Indian states of Bihar, Madhya Pradesh, Rajasthan and Uttar Pradesh in the 1998-99 Indian National Family Health Survey. The researchers examined the factors associated with the use of antenatal care facilities in rural areas, and with access to specific components of antenatal care. They also looked for differences in the pattern of use between health clinics and home visits.
The study uses data on antenatal check-ups for women during their last pregnancy. The variables included were: education level, socio-economic status, demographic characteristics, including age and parity, and level of exposure to the media, such as regular television viewing. The researchers considered the following components of antenatal care: urine testing, taking of blood pressure, blood testing, abdomen examination, internal examination, tetanus vaccination and being given iron and folic acid supplements.
Research findings include:
Overall, 3 out of every 5 women (62.8 percent) did not receive any antenatal check-up during their last pregnancy. Among those women who did attend a clinic, the average number of visits was two. In Uttar Pradesh and Bihar more women were seen by a doctor than by a nurse or midwife. Overall 55 percent of women attending antenatal check-ups were seen by a doctor. The most commonly received services were tetanus vaccination and iron and folic acid supplements. Women visited at home by health workers received fewer services. Women who married at an older age and watched television each week were more likely to use antenatal services, whereas the association between a woman’s religion or caste and access to services varied between states. In all states, women and their husbands who had a higher standard of living and education levels were more likely to visit a health clinic and receive a more specific type of care Women from poor and uneducated backgrounds with at least one child were least likely to receive antenatal care. To overcome the socio-economic and cultural barriers that prevent women in rural India accessing antenatal services, policy-makers should:
take into account the diverse social conditions between states and between communities within each state consider whether the uptake of services for second and subsequent pregnancies may be due to a reduced perception of need, or practical difficulties associated with caring for young children plan health policies that take into account that decisions to access antenatal care are based on an individual's or a community's perception of need, and the cost and quality of different health care providers provide further training and supervision for health workers to ensure all the components of antenatal care are provided increase the role of nurses and midwives so that specialised clinical staff can treat those with complications expand the provision of iron or folic acid supplements in communities to reduce dependence on the health service for these simple interventions.
Contributor(s): Saseendran Pallikadavath, Mary Foss, R. William Stones
Source(s): ‘Antenatal care: provision and inequality in rural north India’, Social Science and Medicine 59: 1147-1158, by S. Pallikadavath, M. Foss and R.W. Stones, 2004 More information.'Obstetric care in central India', Southampton: University of Southampton Press, A. Ranjan and R.W. Stones (eds.), 2004 'A framework for the evaluation of quality of care in maternity services', Southampton: University of Southampton Press, L.A. Hulton, Z. Matthews and R.W. Stones (eds.), 2004
Funded by: UK Department for International Development
id21 Research Highlight: 16 February 2005
Further Information:R William Stones Level F (815) Princess Anne Hospital SouthamptonSO16 5YAUK
Tel: +44 (0) 23 8079 6033Fax: +44 (0) 23 8078 6933Email: r.w.stones@soton.ac.uk

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