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“A Cross Sectional Study to Assess Antenatal Coverage and Antenatal Health Seeking Behavior in Rural Etawah”

Authors:Kumar Sandip, Dev DA,

Srivastava Dhiraj, Jaiswal Kirti, Singh CM, Shukla SK

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Introduction

One of the most important component of antenatal care is to offer information and advice to women about risk factors & complications related to pregnancy and their possible curative measures.

Promotion of Maternal and child health have been one of the most important component of the Family welfare programme of Government of India and National Population Policy.

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However, Maternal Mortality Ratio (MMR) in India is still around 254 per 1,00,000 women (2004-06) and 440 per 1,00,000 women (2004-06) in Uttar Pradesh indicating a lag to access essential obstetric care even after significant efforts by Governmental and Non Governmental Organizations. The antenatal coverage is also significantly low as per the NFHS-3 data.

Uptake of ANC services is far from universal, even in settings where they are widely available. While the antenatal care is considered essential for the health of both mother and child, it is also important to analyze the possible factors contributing to its utilization.

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Objectives:

To assess the antenatal coverage among the pregnant women.

To analyze the possible factors contributing in Antenatal Services seeking behavior and utilization of Public Health Services by pregnant women.

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Material & Methods

Study Design: Cross sectional study.

Study area: Villages covered under field practice area of RHTC, Department of Community Medicine, UPRIMS & R, Saifai, Etawah. A total of 14 villages, having a population of 15674 were covered from August 2008 to January 2009.

Study Participants: All Pregnant women.

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Methodology:

A House to house visit was carried out in these villages to find out the pregnant women in the village. These pregnant women were interviewed by the investigating teams consisting of at least one female member using a pre–designed, pre-tested questionnaire. A prior informed consent was also taken from these women. The result was analyzed using the chi square test & proportion. P value calculated accordingly.

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Results

A total of 519 pregnant women were listed in the study. However, only 502 gave the informed consent for participation in the study. Thus the study sample was limited to 502.

Out of 502, 234 (46.61%) were those who received ANC checkup & 268 (53.39%) were those who did not received any ANC checkup.

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S.No. Variables ANC Received (n=234)

ANC not Received

(n=268)

Total (n=502)

P value

No. % No. %

1. Age group < 20 years 20-24 years 25-29 years 30-34 years > 34 years

4156684722

17.5223.9329.0620.0809.41

5261724934

19.4222.7826.8818.3112.61

931171409656

X2=5.26df= 4p= 0.261

2. Literacy Status Illiterate Primary Up to 12th

Graduate and above

36567864

15.3823.9333.3427.35

68746462

25.3727.6123.8823.14

104130142126

X2=11.5df= 3p= 0.009

3. Parity 0 >=1 78

15633.3366.67

91177

33.9666.04

169333

X2=00.0df= 1p= 0.958

4. Outcome of last pregnancy

Live birth Still

birth/abortion

13521

86.5413.46

14235

80.2319.77

27756

X2=2.36df= 1p= 0.124

5. Distance from nearest health facility

< 2Km > 2Km 131

10355.9844.02

128140

47.7652.24

259243

X2=3.38df= 1p= 0.066

Table-1: Socio-demographic profile

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Table-2: ANC Services providedS.No. ANC Services Number (n=234) Percentage

1. Place of registration Sub-Center CHC/PHC Private Practitioner

7114221

30.8660.6808.98

2. Physical Examination (Any two or more: Weight recording, PA examination, BP measurement & FHS auscultation)

212 90.60

3. IFA tablets 209 89.32

4. TT given 207 88.46

5. Blood Examination 152 64.96

6. Urine Examination 141 60.26

7. Counseling Rest Diet Family Planning Baby Care

81926856

34.6239.3229.0623.93

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Table-3: Views of Study Participants

S.No.

Views ANC Received (n=234)

ANC not Received (n=268)

Total(n=502)

No. % No. %

1. Facilities for safe delivery in the village should be available for 24 hours.

227 97.00 244 91.04 471

2. Transport facility for pregnant women should be available in the village.

224 95.73 241 89.92 465

3. Availability of trained persons for safe delivery in each village.

219 93.59 217 80.97 436

4. Facilities for investigation should be available nearest to the village as much as possible.

207 88.46 212 79.10 419

5. Awareness programme on pregnancy & its complications should be conducted regularly.

194 82.90 178 66.42 372

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Discussion

The present study has found ANC coverage of 46.61%. This is lower than the coverage reported by Chandhiok N. et. al. in their study involving 28 districts of India.

It was noted in the present study that the women, who have received antenatal services were maximum in the age group of 25-29 years (29%). This group is higher than reported by Chandhiok N. et. al.

Similarly a higher coverage was noted among more educated women and this difference is statistically significant. Similar findings were also noted by Singh P. et. al.

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It was also noted in the present study that there is no statistically significant difference in the two groups on variables like parity, outcome of last pregnancy and distance of health facility from home.

40% of the study subjects self report for ANC care, giving an idea of health seeking behavior of pregnant women residing in rural Etawah. Similar findings were also reported by other researchers.

ANC services which were provided to registered pregnant women, physical examination (Any two or more: Weight recording, PA examination, BP measurement & FHS auscultation) was maximum followed by distribution of IFA tablets and TT immunization.

In the present study, it was also observed that the counseling was the most neglected aspect of ANC services.

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A unanimous consensus was found among majority of the study participants that facility for safe delivery should be available in the villages for 24 hours or availability of trained manpower for safe delivery in each village should be there.

Similarly, there was a unanimous view that the facility for transport & investigations should be available in the village or as near as possible to the village.

Majority of the study participants expressed the view that there should be a regular awareness programme on pregnancy related issues like dangerous signs, its complications & managements, counseling, newborn care etc.

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Conclusion: The present study hereby concludes that there is a need for further strengthening of ANC services so as to increase the ANC coverage.

The present study also concludes that there is a need for the programme managers to direct their strategies to motivate families to utilize these services, even when, they are well aware that it is necessary for them.

The present study also makes a conclusion that there should be more awareness programme directed towards pregnancy related issues.

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References:1. http://mohfw.nic.in/NHRM/State%20Files/up.htm assessed on

14/10/2010.2. Park K. Textbook of Preventive and Social medicine.20th Edition

Banasridas Bhanot publishers, Jabalpur, 2009:p450-55.3. Taneja DK. Health Policies and Programs in India. 8th ed.

Doctors Publication (Regd.), Delhi; 2010:p 120-22.4. Chandhiok N, Dhillon BS , Kambo I, Sxena NC. Determinants of

antenatal care utilization in rural areas of India : A cross-sectional study from 28 districts (An ICMR task force study) J Obstet Gynecol India,2006; 56( 1) p47-52.

5. Singh P, Yadav RJ. Antenatal Care of Pregnant Women in India. IJCM, 2009; 25(3).

6. Das R, Amir A ,Nath P. Utilization and coverage of services by women of Jawan Block in Aligarh. IJCM,2001;26(2):p94-99.

7. Singh A, Arora AK. The changing profile of pregnant women and quality of antenatal care in rural North India. IJCM,2007;32:p135-6.

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