Maternal and Newborn Care Practices Among the Urban Poor in Indore, India

Maternal and Newborn Care Practices Among the Urban Poor in Indore, India

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Author Siddharth Agarwal
Category Medicine
Rating Not Available
Language en
Copyrights Not Available
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One out of every 14 newborn dies in poor slum dwellings of Madhya Pradesh (M.P.) in India . Neonatal survival is influenced much by care provided by the family before, during and after delivery, which in turn is influenced not only by mothers beliefs, but also perceptions of her immediate family, which are context specific. Antenatal, intra-partum and postnatal practices associated with better newborn survival are well-known through evidence-based research . For promoting these practices in wider programme settings, an understanding of current practices and factors influencing them is crucial. This would help identify barriers and possible context responsive program options for improving these evidence-based practices. Findings: Antenatal care: Establishing contact with a health provider: Practices and reasons ƒ 95.5% mothers mentioned that they established one or more contact with a health provider during their pregnancy either for seeking antenatal advice or antenatal care (routine check up or sickness care). ƒ Amongst those who established a contact, 84.0% approached a health provider in their first trimester, 6.7% in the second trimester and 4.8% in the third trimester. ƒ Health providers approached for seeking antenatal care/advice included14: a) ANMs during health camps in slums (45.4%), b) doctors in government institutions like Maharaja Yashwantrao (MY) and Zila Hospital (39.7%), c) doctors in private charitable institutions like Pushpkunj and Kasturba Gram (28.2%) and d) private doctors residing nearby (16%). ƒ Mothers mentioned that the choice of the health provider approached depended upon various interrelated factors like low cost, proximity, knowledgeable and hospitable behaviour of the health provider towards them. Receiving 2 tetanus toxoid shots during pregnancy: ƒ 82.0% of mothers had received 2 TT shots during their pregnancy. This was possible perhaps due to the efforts of the NGO partners of the Indore program in ensuring that the ANM comes for immunization in these slums on monthly basis. ƒ Barriers to complete TT immunization included- i) pregnant women not being present in the slum at the time of an immunization camp either because they were working as maids in nearby colonies/labourers or because they had gone to their native village for delivery in the seventh month of pregnancy; ii) Infrequent visits by the ANM in a few slums and iii) reluctance of some pregnant women to take their TT shots, as they were scared of injections. Consuming 100+ Iron Folic Acid (IFA) tablets during pregnancy: ƒ IFA tablets were being provided through the NGO working in the slums in the UHRC program so supply side problem was not there. ƒ 86.2% mothers received IFA tablets. Out of the mothers who received IFA tablets only 11.5% of them consumed IFA tablets for 3+ months during their pregnancy. ƒ Reasons cited by others mothers who did consume some IFA tablets but not appropriate number of IFA tablets during their pregnancy were i) belief that the tablet is hot and hence may lead to a miscarriage; ii) diarrhoea/nausea/vomitish feeling after eating the tablet as they did not like the taste; iii) IFA tablet was found foul smelling by them and iv) forgetting to consume the tablet due to household workload. Preparedness for delivery and obstetric complications: Practices and Reasons: (a) Identifying a trained birth attendant for delivery and obstetric complications: ƒ Nearly 70% mothers mentioned that while pregnant they had identified a birth attendant from whom they would seek help for delivery and related obstetric complications. ƒ Birth attendants identified included - trained sTBA of the slum and doctors in government/charitable hospitals. Possibly, health education through trained slum or cluster level health volunteers (LCBOs/BCBOs) contributed to the above mentioned preparedness practices. ƒ Lack of perceived need, economic constraints or traditional practices emerged as barriers to this practice. Identifying a health facility for delivery and obstetric complications: ƒ While pregnant, 64% mothers identified a health facility they would contact in event of an obstetric complication. Barriers to following this practice that emerged were: not facing any complication in pregnancy and due to poverty related constraints taking it for granted that their delivery would be conducted at home. Savings: ƒ More than 3/4th (76.9%) of families saved some money to incur delivery related costs and to prepare for any complications that could arise. ƒ In slums where SHGs were active, only 41% of mothers were aware of an SHG being present in their slum and only 15.8% mothers were members of such a group. Reasons for a large proportion of mothers not being members of SHGs included: a) Economic constraint related fear of not being able to pay money each month, b) disapproval by family members either due to meager and irregular income or lack of faith in the SHG after hearing past negative experiences from other members of the SHG. Making arrangements for transportation: ƒ Arrangements for transportation to prepare for an obstetric emergency were made only in 29.5% of families, as in the slums visited, tricycle Rickshaws were available close by and private doctors resided in the vicinity. Identifying danger signs indicating a complication and seeking prompt referral: ƒ Out of 312 mothers 2-4 months of age interviewed, 65 mothers were not aware of any maternal complications during pregnancy. Most others mentioned excessive bleeding prior to experiencing labour pains, breathlessness with blurring of vision and severe abdominal pain suggestive of referral. ƒ Economic constraints, apathy on part of the family members to escort the pregnant lady to a referral facility at night, advice of the sTBA that pain is natural emerged as barriers for seeking timely emergency obstetric care.
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