In 1996, safe motherhood and child health services were incorporated into the Reproductive and Child Health Programme. (Ministry of Health and Family Welfare, 1997, 1998b)
The important components of this programme are
- Provision of antenatal care, including at least three antenatal care visits, iron prophylaxis for pregnant and lactating mothers, two doses of tetanus toxoid vaccine, detection and treatment of anaemia in mothers, and management and referral of high–risk pregnancies.
- Encouragement of institutional deliveries or home deliveries assisted by trained health personnel.
- Provision of postnatal care, including at least three postnatal visits.
- Identification and management of reproductive tract and sexually transmitted infections.
One of the important reasons for this is under–utilisation or non–utilisation of the maternal health care services due to lack of awareness in the rural and slum population in India.
It is a known fact that education has an important influence on awareness. The lack or low rates of literacy are a major obstacle to health awareness in this area. Due to lack of education, the rural population and the poor urban population still prefer the deliveries performed at home by the Dais (nannies who are not medically trained, but are known for their experience in performing deliveries and are preferred to doctors in rural areas). A study by Ray et al. (1993) showed that practices of delivery at home in slums were found to be 34.7%, which corroborated with the findings of another study (31.7%) by Agarwal et al.(2007). Yet another study of urban slums identified prolonged waiting time, heavy workload at home and long distance as reasons for non–utilization. Women from this population tend not to use antenatal care services due to the traditional belief that medical attention is not required during pregnancy (Jejeebhoy 1997).
Health care–seeking attitudes and age and parity of the pregnant women are co–related. According to a study published in the Journal of Obstetrics and Gynaecology of India (Chandhiok et al., 2006), there was a statistically significant reduction in the proportion of women obtaining antenatal care services with increasing age, parity, and number of living children. In short, awareness and accessibility of health care services heavily influence the health care–seeking behaviour of pregnant women from the rural and urban poor population. According to WHO (1994), most maternal deaths are preventable if women have access to basic medical care during pregnancy, delivery and post partum period.
The antenatal care facilities provided by the government can be accessed by visiting a health centre that provides such facilities or from health workers during their visits. To ensure better health care–seeking attitudes of pregnant women, it is important to create awareness of the possible complications during pregnancy and their management and hence the need for care during pregnancy. This can reduce maternal mortality and morbidity.
A survey commissioned by Department of Family Welfare, Ministry of Health and Family Welfare, Govt. of India and conducted by ICMR (Indian Council Of Medical Research), looked at the immunisation of children and pregnant women including antenatal care of pregnant women. The conclusion of this study from the result was that the literacy of women in rural areas is an important key to improve accessibility of antenatal services provided by the government (Singh & Yadav 2007). Improvement in literacy is estimated to have an effect not just on the initial accessibility of the services but also on the over all compliance with the antenatal care programmes.
Antenatal care has an effect on the health care seeking attitude of women during delivery/ child birth. The results from NFHS–2(National Family Health Survey 2) show that women who received three or more antenatal care visits (as recommended) were more than twice as likely to receive professional assistance for home delivery.
The primary aim of antenatal care is to achieve, at the end of pregnancy, a healthy mother and a healthy baby (Park & Park 2002). With government antenatal care services in place, it is important to look at the reasons for under/ non–utilisation of these services. Addressing these issues will ensure increase in utilisation of these services and in turn decrease maternal and child mortality.
From the above discussion it is clear that public health interventions need to concentrate on literacy of the pregnant women in rural areas and slums in cities and on ensuring sufficient staff in Antenatal Care services to reach out to this population.
- Agarwal P, Singh MM, Garg S. Maternal health–care utilization among women in an urban slum in Delhi. Indian J Community Med 2007,32:203–5.
- Chandhiok N, Dhillon B.S, Kambo I, Saxena N C. 2006 Determinants of antenatal care utilization in rural areas of India : A cross–sectional study from 28 districts (An ICMR (Indian Council Of Medical Research) task force study) Journal of Obstetrics and Gynecology of India Vol. 56, No. 1: January/February 2006 Pg 47–52.
- Jejeebhoy SJ. 1997 Maternal mortality and morbidity in India: priorities for social sciences research. J Family Welfare 42(2): 30–51.
- Mother–baby package: Implementing safe motherhood in countries. World Health Organization: Geneva, 1994.
- National Population Policy – 2000. Department of family welfare. Ministry of Health and Family Welfare. Government of India, New Delhi.
- Park JE, Park K. Text Book of Preventive and Social Medicine, 18th edition M/s. Banarsidas Bhanot Publishers: Jabalpur, 2002: 386.
- 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. [PUBMED].
- Singh P, Yadav RJ. 2000 Antenatal care of pregnant women in India. Indian J Com Med, 25(3): 112–17.