|Year : 2022 | Volume
| Issue : 3 | Page : 142-146
Coverage of maternal & child health services by the beneficiaries residing in an Urban Poor Locality, Bengaluru
Ashwath N Doddabele Hanumanthaiah1, Hulugappa Lakshmi2, Manchegowda Ramya3, Huluvadi Shivalingaiah Anwith1
1 Department of Community Medicine, Kempegowda Institute of Medical Sciences, Bengaluru, Karnataka, India
2 Department of Community Medicine, AIMS&RC, Bengaluru, Karnataka, India
3 Primary Health Centre, Mysore, Karnataka, India
|Date of Submission||17-May-2022|
|Date of Decision||17-Jun-2022|
|Date of Acceptance||21-Jun-2022|
|Date of Web Publication||20-Jul-2022|
Huluvadi Shivalingaiah Anwith
Department of Community Medicine, Kempegowda Institute of Medical Sciences, Banashankari 2nd Stage, Bengaluru - 560 070, Karnataka
Source of Support: None, Conflict of Interest: None
Introduction: Under the National Population Policy-2000, National Health Policy-2002, 10th Five-Year Plan, and Reproductive and Child Health-2 Programme, the maternal and child health (MCH) services of the urban poor have been recognized as an important thrust area for the country's development. Objective: The objective is to assess the MCH services coverage and utilization provided by the government. Methods: A cross-sectional study was conducted during October 2015–November 2016 in the eight urban poor localities falling under the urban field practice area of the medical college in Bengaluru. Using the probability proportional to population size, a total of 2540 beneficiaries meeting the inclusion and exclusion criteria were included in the study. Data were collected using pretested semistructured pro forma by interview method and analyzed using appropriate inferential and descriptive statistics. Results: Around 83.3% of subjects had registered their pregnancy within 12 weeks. Majority (83.1%) of women delivered in the government hospital and 7.2% had complications following delivery. Around 56.8% of women had practiced one of the family planning methods (couple protection rate of 56.8%). Most of the women 67% had utilized MCH services in the past 6 months and 74.5% utilized services from the government health facility. The utilization of MCH services was mainly by subjects of the Muslim religion, nuclear families, literates, and unemployed and on applying Z-test this difference was statistically significant. Conclusion: Coverage of MCH services was not satisfactory. There is a statistically significant difference in the utilization based on religion, type of family, literacy, and employment.
Keywords: Child health, maternal health, reproductive and child health, urban poor, utilization
|How to cite this article:|
Doddabele Hanumanthaiah AN, Lakshmi H, Ramya M, Anwith HS. Coverage of maternal & child health services by the beneficiaries residing in an Urban Poor Locality, Bengaluru. Apollo Med 2022;19:142-6
|How to cite this URL:|
Doddabele Hanumanthaiah AN, Lakshmi H, Ramya M, Anwith HS. Coverage of maternal & child health services by the beneficiaries residing in an Urban Poor Locality, Bengaluru. Apollo Med [serial online] 2022 [cited 2022 Nov 30];19:142-6. Available from: https://apollomedicine.org/text.asp?2022/19/3/142/351547
| Introduction|| |
The health of women during pregnancy, childbirth, and the postnatal period is referred to as maternal health. It is important that each stage must be a positive experience, ensuring women and their babies reach their full potential for health and well-being. Although significant progress has been made in the past two decades, about 295,000 women have died during or following pregnancy and childbirth in 2017.
Maternal mortality is unacceptably high, especially in low-income countries which account for 94% of preventable global maternal deaths.
One-third of urban population in India is constituted by urban poor which is growing at a rate that is thrice the national population growth rate. The slum dwellers in cities suffer from adverse health conditions due to insufficient health services, low awareness, and poor environmental conditions. Public health services have failed to reach the urban slums and other urban poor populations who are actually in need of these services. Maternal and child health (MCH) services to the urban poor have been recognized as an important thrust area by the government under the National Population Policy-2000, National Health Policy-2002, Tenth Five-Year Plan, and Reproductive and Child Health-2 (RCH-2) programme.,
RCH-2 was started from April 1, 2005, with an aim to strengthen/improve the quality of services and to achieve the Millennium Development Goal (MDG) by overcoming the lacunas of RCH-1.
The second phase of RCH program, i.e., RCH-2 commenced from April 1, 2005, under the Five-Year Plan. The main objective of the program was to bring about change in mainly three critical health indicators, i.e., reducing total fertility rate, infant mortality rate, and maternal mortality rate. These objectives are aimed at realizing the outcomes envisioned in the MDGs, the National Population Policy-2000, the Tenth Plan document, the National Health Policy-2002, and Vision 2020 India.
The health goal of sustainable development goals emphasizes the importance of maternal health hence the targets for maternal health includes 3.1, aiming for an average global ratio of <70 deaths per 100,000 births by 2030, and 3.8 calling for the achievement of universal health coverage. These targets cannot be achieved without reproductive, maternal, newborn, and child health coverage for all.
Maternal complications and poor perinatal outcomes are mainly due to nonutilization of antenatal, delivery care services, and poor socioeconomic conditions of the women. The Government of India launched the National Urban Health Mission (NUHM) in 2013 and the Government of Karnataka has implemented NUHM from January 2014 with the aim of providing comprehensive medical care to vulnerable population in slums and urban poor localities. NUHM was implemented by Bruhat Bengaluru Mahanagara Palike in Bengaluru city from April 2014 and one such area selected was Yarabnagar Health Center, which is within the urban field practice area of the medical college where this study was conducted.,
Thus, this study was undertaken with an objective to assess the coverage of MCH services provided under RCH-2 which may be useful for the urban local body in better implementation of NUHM in Bengaluru city.
| Materials and Methods|| |
Ethical clearance was obtained from the Institutional Ethics Committee before the study initiation. Informed consent was obtained from all the study participants and confidentiality was maintained.
This study was a cross-sectional study.
The study was conducted in the urban field practice area of the medical college which is an urban poor locality. The study was conducted between October 2015 and November 2016. The data collection was done using a pretested semistructured questionnaire.
An approximate center of the given cluster was identified. The number of roads leading from that center was counted and numbered. One of the roads was selected randomly using the lottery method using a currency note. On the selected road, a walk-through survey was done. By tossing a coin, one of the sides was selected randomly. On the selected side of the road, the number of houses was counted. A house was selected randomly using a currency note. The data collection was done in the selected house subsequently by tossing a coin the direction of a survey of the subsequent house was decided. Then onward, every household was visited till the required sample size was achieved in each cluster. A similar method was followed for each cluster until the required study size was surveyed.
The study participants included women in the households residing in the same area for more than six months and aged between 15-49 years which happens to be the reproductive age group. Participants were included only after obtaining the informed consent. Seriously ill women were excluded from the study.
The study participants included consenting pregnant women, lactating women, and married and unmarried women in the reproductive age group.
The following information was obtained from the study subjects regarding:
- Pregnant women: Registration of pregnancy, place of antenatal care (ANC), number of antenatal checkup, number of iron-folic acid (IFA) tablets provided and consumed, and number of injection tetanus toxoid received, whether it was a high-risk pregnancy, comorbid conditions and complications (if any) were collected
- Lactating women: Place of delivery, the person who conducted the delivery, details of postnatal care (PNC), number of IFA tablets provided and consumed, number of PNC visits, family planning methods, comorbid conditions, and complications (if any) were obtained. Information was also obtained regarding benefits obtained under Janani Suraksha Yojana (JSY) scheme and any other government programs/schemes
- Married women: Number of times conceived, abortions/medical termination of pregnancy, use of temporary/permanent family planning methods used, reproductive tract infections (RTI)/sexually transmitted diseases (STDs)
- Unmarried women: Details about health problems including RTI/STD and other services obtained under RCH-2 were collected.
- If the preventive/curative services were utilized by the beneficiaries, it was considered as utilization of MCH services else it was considered not utilized.
The total study size was 2540 which was derived as follows.
The total population of the study area was 43,059 with 8 slums/urban poor localities.
Based on the pilot study conducted before the study, the coverage of full ANC was 25%; considering an allowable error of 10%, the calculated sample size was 1153. Applying the design effect of 2 and 10% additional size, the sample size was increased to 2537 and was rounded off to 2540.
Using probability proportional to population size, it was ensured that there is equal representation of all age groups under the reproductive age.
Data were analyzed using descriptive statistics such as frequencies, percentages, mean, and standard deviation. Inferential statistics such as Z-test and logistic regression were used. Data were entered into Excel and analyzed using the SPSS version 16.0 (SPSS Inc. Released 2007. SPSS for Windows, Version 16.0. Chicago, SPSS Inc.).
| Results|| |
At the end of the study, a total of 2540 women in the reproductive age (15–49 years) were surveyed and this constituted the study population. Majority (60%) of the study subjects were Muslims, 66% of the study subjects resided in a nuclear family, 42% belonged to the upper-lower socioeconomic status, 33% of women were illiterates, and 32% of study subjects had studied up to high school.
Of the 2540 women surveyed, 194 (07.6%) were unmarried and 2346 (92.4%) were married. Among married women, 186 (07.9%) were pregnant, 391 (16.7%) were lactating, and the remaining 1769 (75.4%) were nonpregnant and nonlactating married women in the reproductive age group.
Among 186 pregnant women, 180 (96.8%) had registered their pregnancy [Table 1].
|Table 1: Distribution of pregnant women according to the utilization of maternal and child health services (n=180)|
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Among 186 pregnant women, 160 (86%) pregnant women were provided with IFA tablets. A total of 66 (41.1%) pregnant women suffering from anemia were provided with a therapeutic dose (two tablets of IFA per day) and the remaining 94 (58.8%) were provided prophylactic dose (one tablet of IFA per day). About 163 (87.6%) pregnant women had taken tetanus toxoid injection, among them 96 (58.9%) had taken two doses and 67 (41.1%) had taken one dose of tetanus toxoid injection.
Out of the 1769 nonpregnant and nonlactating married women in the reproductive age group, 352 (19.9%) had abortion and of the 352 women who had abortions, 286 (81.3%) had a spontaneous abortion and 66 (18.7%) had induced abortion.
Majority of the study subjects, 208 (59.1%) were managed in a government health facility, 65 (18.5%) in a private hospital, and the rest 79 (22.4%) at home.
Out of 2160 eligible study subjects, (380 study subjects were excluded while calculating contraceptive use since 186 subjects were pregnant and 194 subjects were not married at the time of the survey) for using contraceptive methods; 1227 (56.8%) adopted one of the of family planning methods hence the couple protection rate among the study population was 56%. About 166 (13.7%) of married nonpregnant, lactating/nonlactating women were using temporary contraceptives and 1046 (86.3%) had undergone permanent sterilization. A total of 722 (40.8%) women had a birth order of 3 and above.
Out of 166 users of temporary contraceptives, 96 (7.9%) were using copper (CU)-T, 60 (4.9%) were using oral contraceptive pills (OCP), and 10 (0.8%) had taken injection depot medroxyprogesterone acetate (DMPA). Among the 1046 women who had undergone permanent sterilization, 593 (49%) had undergone open tubectomy and 453 (37.4%) had undergone laparoscopic tubectomy.
Among 610 nonpregnant, nonlactating women who had different morbidities, 245 (40.2%) had anemia; only 125 (51%) had taken treatment. Among them, 63 (25.7%) had taken treatment in a government hospital, 77 (31.4%) in a private hospital, and 105 (42.9%) had not taken any treatment.
Menstrual disorders were seen in a certain section of the study population accordingly 207 (33.9%) of women suffered from menstrual disorders, 46 (22.2%) had taken treatment in a government hospital, 50 (24.2%) had taken treatment in a private health facility, and 111 (53.6%) had not taken any treatment.
RTI/STI was seen in 158 (25.9%) study subjects of the majority 67 (42.4%) had taken treatment in a private facility, 42 (26.6%) in a government health facility, and 49 (31.0%) had not taken any treatment.
In the present study, 1701 (67%) of women (respondents) informed that they have utilized some MCH services in the past 6 months and 839 (33%) had not utilized MCH services in the past 6 months [Table 2] & [Table 3].
|Table 2: Distribution of lactating women according to maternal and child health service utilization (n=391)|
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|Table 3: Distribution of lactating women according to the place of treatment for complications following delivery|
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There was a statistically significant association between religion, type of family, literacy, and employment with the utilization of MCH services [Table 4].
|Table 4: Comparison of the utilization of maternal and child health services by different groups (n=2540)|
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| Discussion|| |
Urban India has a relatively strong health and nutrition infrastructure, but there is a marked inequitable distribution of service availability and utilization between the rich and poor, between the settled urban population, and the marginalized slum dwellers. Hence, the present study intended to assess the utilization of MCH services by women residing in urban slum.
In the present study, the majority of 60% of the study subjects belonged to the Muslim religion, 66% were residing in nuclear families, 42% belonged to upper-lower socioeconomic status, and 33% of women were illiterates. However, in a study conducted by Parikapahwa, 66% of women were illiterates.
In the present study, majority (96.8%) of women had registered their pregnancy, while as per the National Family Health Survey-4 (NFHS-4) data, it is 89.3% and 97.3% as per the NFHS-5 for Karnataka.,
Thus, the registration proportion is in par with government data.
In the present study, 87.6% of women received tetanus injection; which was similar to NFHS-4 data for Karnataka 87.8%, whereas it is 94.9% in NFHS-5.
In the present study, 86% of pregnant women received IFA tablets which were satisfactory, in comparison to only 46% of pregnant women consumed IFA tablets as per the NFHS-4 for Karnataka and 50.7% as per the NFHS-5 survey.,
In the present study, 83.1% of women had delivered in a government hospital, 16.1% in a private hospital, and 0.8% at home. However, NFHS-5 data for Karnataka showed 98.3% institutional delivery and 1.1% home delivery which was similar to the NFHS data.,
In the present study, 70% of subjects had a normal delivery and 29.9% cesarean delivery which is comparable to the data of NFHS-4, i.e., 29.3% cesarean sections. In the present study, 72.9% of deliveries were conducted by the doctor, and 26.3% by the nurse. However, NFHS-4 data shows births assisted by a doctor/nurse/LHV/ANM/other health personnel was 92.8%.
In the present study, 12.5% of women were suffering from anemia and 51% of anemic women were taking IFA tablets. However, NFHS-4 data for Karnataka showed the prevalence of anemia was 60.7%. The present study revealed less proportion of women suffered anemia which may be because anemia was diagnosed based on signs/symptoms in the present study and not by blood investigation unlike in NFHS-4.
In the present study, women suffering from menstrual disorders were 10.54% which is similar to the District Level Household and Facility Survey-4 (DLHS-4) (12.2%). Women suffering from white discharge were 8% in the present study and it was 10.7% in DLHS-4.
In the present study, 56.8% of women had adopted one of the approved methods of family planning method (couple protection rate of 56%). Eighty-four percent undergone tubectomy, 7% undergone CU-T insertion, 5% using OCP, 1.2% condom, and 0.8% injection DMPA. However, DLHS-4 result shows 52% female sterilization, 0.1% male sterilization, 1.2% OCP, 2.1% CU-T, and condom usage of 2.7%.
To conclude, the coverage of MCH services was not satisfactory. Utilization of MCH services was more by Muslims, individuals residing in nuclear families, literates, and unemployed and this association was statistically significant. Majority of the beneficiaries had utilized government health facilities for availing MCH services.
Based on the study results, we recommend there is a need for further studies involving a larger population and wider geographic areas assessing the utilization of the latest RMNCH + A programme to generalize the results and improve the coverage of these services. There is a need for social mobilization and promotion of female literacy among the urban poor since it is evident that there is a better utilization of MCH services among educated women.
| Conclusion|| |
Maternal and child health services provided by the government are largely under utilized.
We sincerely thank all the study participants for their cooperation.
Conflicts of interest
There are no conflicts of interest.
Informed consent/Institutional Ethical Committee approval
Informed consent was obtained from all study subjects and ethical clearance was obtained from the Institutional Ethics Committee.
Name Contribution, Ashwath Narayana DH - Conception of the idea Lakshmi HulugappA - Statistical analysis, Ramya Manchegowda - Data collection & initial article draft, Huluvadi Shivalingaiah Anwith - Critical revision of the article and Final approval of the version to be published.
| References|| |
Agarwal S, Sangar K. Need for dedicated focus on urban health within National Rural Health Mission. Indian J Public Health 2005;49:141-51.
] [Full text]
Kishore J. National Health Programmes of India. 9th
ed. New Delhi: Century Publications; 2011. p. 144-50.
Suryakantha AH. Community Medicine with Recent Advances. 3rd
ed. New Delhi: Jaypee Brothers Medical Publishers; 2014. p. 864.
National Urban Health Mission- Project implementation plan for Bangalore city 2013-14. Bangalore: Bruhat Bengaluru Mahanagara Palike; 2014.
Ministry of Health and Family welfare. District Level Household and Facility Survey-4. State Fact Sheet, Karnataka. Mumbai: International Institute for Population Sciences; 2013.
Pahwa P, Sood A. Existing practices and barriers to access of MCH services – A case study of residential urban slums of districts Mohali, Punjab, India. Glob J Med Public Health 2013;2:1-8.
Ministry of Health and Family Welfare. National Family Health Survey, State Fact Sheet, Karnataka. Mumbai: International Institute for Population Sciences; 2015-16.
Ministry of Health and Family Welfare. National Family Health Survey, State Fact Sheet, Karnataka. Mumbai: International Institute for Population Sciences; 2019-20.
[Table 1], [Table 2], [Table 3], [Table 4]