Barriers to Institutional Delivery– A Study on Tribals of Narmada District

 

Vijendra Katre¹, Mridula Pandey², Subodh Jaiswal³

¹Aditional CEO, RSBY, Department of Management, Kalinga University, New Raipur, Chhattisgarh, Research ²Research Scholar, Department of Management, Kalinga University, New Raipur, Chhattisgarh

³Independent Consultant, Department of Management, Kalinga University, New Raipur, Chhattisgarh

 

ABSTRACT:

Background: Every minute of every day, somewhere in the world and most often in a developing country, a woman dies from complications related to pregnancy or childbirth.¹ as the health of newborn is directly linked with the health and wellbeing of mother, so interventions have been planned to address the issues of maternal health. Through National Rural Health Mission extensive focus has been made on institutional delivery services in order to develop millennium development goals no 1, 4 and 5².In the process of utilization of health care particularly with respect to institutional delivery there are many challenges, and that increases to many fold if it is related to addressing the challenges related to tribal areas. The study explores the barriers to institutional delivery at tribal areas.

Methods: Random sampling technique was adopted for the selection of blocks of the district. Qualitative methodology was adopted for the collection of data. The tools used for data collection were   In-depth interview, Observation and Case study. The target population for gathering information were pregnant women, Female health workers, Medical officers and staff Nurses of PHC.

Results: The main barriers in terms of utilization of institutional delivery services were, Lack of awareness about institutional delivery and government health schemes, Social customs as barriers, poor economic condition of the family, Lack of communication network.

Conclusion: The institutional delivery services in tribal areas are affected by various factors which if remain addressed will lead to increase in maternal deaths in the region. The barriers to institutional delivery at tribal areas can be addressed with effective planning.

 

 

INTRODUCTION:

National rural health mission was implemented with the goal of reduction of maternal mortality rate and infant mortality rates .Various interventions are planned in order to address the barriers to utilization of institutional delivery care³.

 

Interventions like cash incentives, nutritional support, free delivery care, free drugs, etc are planned in order to address the challenges. Ensuring provision of skilled birth attendance is a key factor in determining maternal and child outcomes along the continuum of care. These health professionals are expected to manage normal pregnancies, deliveries, and postnatal care, and identify, manage, or refer complications for women who are delivering and infants⁴

 

It has been estimated that almost 40% of pregnancies could require specialized services, and about 15% of all pregnant women develop complications during the intra-partum and immediate post-partum period needing access to emergency obstetric care⁵. A review on Global causes of maternal deaths from 2003-2009 showed that 73% of all deaths from the sample were due to obstetric causes⁶.

 

Delivery at an institution provides not only skilled birth attendance but also equipment and referral mechanisms to handle basic and emergency obstetric complications. Institutional delivery rate was 68% in rural India .The same if compared with that in tribal dominated areas is lower than that.⁷ The challenges to institutional delivery at urban, rural and tribal areas are different.

 

METHODS:

Study Approach:

Aim of the study is to assess barriers of institutional delivery.

·      A situational analysis of the district was done with keeping an eye the barriers associated with institutional delivery.

·      Series of in-depth interviews conducted with the Pregnant Women, FHW’s, SN and MO PHCs.

·      The data collected by in-depth interviews and case studies. 

 

Type of Data:

·      Primary data – Data collected with help of in-depth interviews

·      Secondary data - Monthly records of the District Panchayat.

·      Annual action plan of the district   

 

Instruments or Tools:

·         In-depth interview Questionnaire.

 

Selection of Sample:

·      Stratified sampling - Using purposive sampling the selection of blocks were carried out. , The criteria for selection of blocks were tribal dominance. The blocks with more tribal population were selected for the study.

·      In 22PHC of the district 8 PHC has been selected and out of 134 sub centre 58 had been selected.

·      Total 50 pregnant women, 22 FHW/ANM, 16 MO and 4 SN were interviewed.

 

Table -1

Selection of Sample:

Sample was selected from two blocks of Narmada district (Nandod and Tilakwada) while sample criteria was 5 women taken randomly from 10 Villages of these Two Blocks.

 

Table-2

Target group	No.	Sample criteria
Pregnant women	50	5 women taken randomly from 10 villages of two blocks
FHS	22	One each from the PHCs of the district
Medical officer	16	All covered
Staff nurse	4	All those who were trained in Institutional delivery

 

Study Process:

·      Preparation of questionnaire to gather the basic information from pregnant women, FHW’s, SN and MO PHC’s.

·      The data was compiled with help of Microsoft Excel, codification of findings were done.

 

RESULTS:

The responses of pregnant women, FHW’s, SN and MO’s were analyzed to understand the probable barriers to institutional deliveries. The findings were collected on barriers in terms of delivery of services and also on barriers faced by benefices on availing the services.

 

1. Socioeconomic characteristics of tribal population: The socio-economic and demographic characteristics of the women are presented in Table 3. Level of education as well as per capita monthly income of tribal women was significantly lower.

 

Table -3

Characteristics of women	No of Women (50)
Age 20-24 25-29 >- 30	20 10 20
Education Over secondary (5-7) Upper secondary (8-10) Post secondary (10-12)	30   15 5
Family source of Income Agriculture land own Agriculture land labourer Industrial or other labourer	2 30   18

2. Lack of awareness about Institutional delivery and government health schemes:

 

Graph No-1

 

The women were interviewed on why institutional delivery is important and whether they have received any counseling for promotion of institutional delivery .The graph no-1 shows the responses of females on institutional delivery.

 

15 out of the 50 pregnant women were informed that complications related o child birth can be better managed at facility. Only 4 out of 50 respondents were aware of schemes primarily JSY which is available for mothers who deliver at institution. Only 1 female responded that she had been given advice of making arrangements for transportation at the time delivery. One women could recall being given information on danger signs of pregnancy and 3 out of 50 pregnant women could recall on cost associated with facility based delivery.

 

The staff engaged with service delivery was asked on reasons why females do not undergo institutional delivery. Out of the 16 medical officers and 4 SN interviewed all said that due to lack of conveyance facility and lack of birth waiting rooms in majority of cases the females opt to deliver at home .15 out of the 22 FHW’s interviewed informed that the mother in laws who are the decision makers of the household are unaware of the benefits of institutional delivery and they rather believe in home delivery due to cultural barriers.

 

1. Lack of Accessibility:

Out of the 50 pregnant women interviewed 45 informed that the distance between facilities play a major role in deciding what will be the place of delivery. Table no-4 shows the average distance between household and health facility.

 

Table-4

Distance between facilities and households	No of Pregnant Women interviewed (50)
<5 kms	2
5-8 kms	22
>- 8 Kms	16

 

Out of the 22 FHW contacted 20 informed that they do birth preparedness counseling well in advance to make the families understand the importance of institutional delivery, however as the distance between facility and home is almost more than eight kms and there is no referral transportation available in tribal areas of the district hence the lady either has to travel the distance by walking or in cart. Due to all these issues families choose to get the delivery done at home.

 

2. Poor economic Condition of the Family;

The district Narmada is primarily agrarian with majority of population being dependent on agriculture for economy. Out of the 50 pregnant women interviewed 40 belonged to being from agriculture background and rest 10 were from the families who belonged to daily wage workers in industries. The low income due to the occupation also is one reason for females not opting for institutional delivery. As already discussed the families and pregnant women are primarily ignorant of the govt. schemes which facilitate the process of promotion of institutional delivery. Due to lack of awareness and poor economic condition the families opt for home based deliveries.

 

3. Lack of Motivation From Health Functionary;

The responses of pregnant women on schemes related to maternal health and on counseling being done regarding identification of danger signs in pregnancy or benefits of institutional delivery being discussed by health care providers has been analyzed. The results shows that only 15 women were aware of the fact that complications related to pregnancy can be handled at facility level. 4 out of 50 were told about govt. schemes on maternal health, 3 were aware of cost that the family may have to incur for institutional delivery and only one pregnant women had information of danger signs during pregnancy.

 

4. Quality of Facility at Health Care Institution

10 out of 50 pregnant women revealed that they had privacy issues at PHC’s which is also an important factor for them opting out of institutional delivery. Almost 80% of the pregnant women interviewed revealed that they find the place of delivery un clean and hence they opt of delivery at home.

 

DISCUSSION:

The determinants of utilization of maternal care services among tribal women were level of empowerment among them which was dependent to a high extent on levels of literacy, socio cultural and economic condition. Accessibility of health services was second leading cause as a barrier to institutional delivery services. Lack of motivation by health workers emerged as an important factor as a barrier for better utilization.

 

ACKNOWLEDGEMENT:

The authors present there sincere gratitude and thanks to the Department of Health and Family Welfare, Government of Gujarat for allowing to conduct study in health department. Special thanks to Health Commissioner Dr. Amarjit Singh. The study could not had been completed without the immense cooperation of Block Health officers, MO’s and ANM’s of Narmada district.

 

CONFLICT OF INTEREST:

The article entitled Barriers to Institutional Delivery– A study on tribals of Narmada District. is herewith submitted for publication in Asian Journal of management. It has not been published before, and it is not under consideration for publication in any other journals. We certify that we have obtained written permission for the use of text, tables, and/or illustrations from any copyrighted source, and we declare no conflict of interest.

 

REFERENCES:

1.        Maternal Health Situation in India: A Case Study ,Kranti S. Vora, Dileep V. Mavalankar,¹ K.V. Ramani,² Mudita Upadhyaya,¹ Bharati Sharma,¹ Sharad Iyengar,³ Vikram Gupta,⁴ and Kirti Iyengar⁴

2.        Millennium development goals, Country Report 2015

3.        Understanding Barriers to Antenatal Care and Institutional Delivery-Survey, Part 1 –Survey of Women Who Recently Delivered a Child Rajsamand, Rajasthan July 2015, DR. ESHA SHETH Mr. Kshitiz Sisodia Mr. Dinesh Songara.

4.        WHO. (2005). World Health Report 2005: Make Every Mother and Child Count. Geneva. Retrieved From: http://www.who.int/whr/2005/whr2005_en.pdf

5.        Fauveau, V. (2004). UNFPA strategy for increasing access to skilled birth attendants in institutions (with special focus on rural/isolated areas). Regional Workshop on skilled birth attendants in South and West Asia, 19-21 April 2004. Islamabad.

6.        Say, L., Chou, D., Gemmill, A., Tunçalp, Ö., Moller, A.-B., Daniels, J. Alkema, L. Global causes of maternal death: a WHO systematic analysis. The Lancet Global Health, 2(6), e323-e333. doi: 10.1016/S2214-109X(14)70227-X

7.        Coverage Evaluation Survey,2009, National fact seet.

 

 

 

 

 

Accepted on 30.07.2017          © A&V Publications all right reserved