Findings of Maternal Health Research Study Conducted in AssamKeyur SorathiaDepartment of Design, Indian Institute of Technology Guwahati

Tuesday 3 July 2012

Location of the study:This study was conducted in 3 villages and 4 tea gardens of Assam, India.These areas were selected on the basis of National Rural Health Mission (NRHM) authorityʼs recommendation having higher maternal deaths in Assam, especially the areas of tea gardens in Dibrugardh district. It is considered to have maximum maternal deaths in Assam.

User group:The users (mothers) were selected on the criteria of illiterate/low literacy and low income group. However the team was forced to abandon this selection criterion because mothers were found very shy to talk to researchers (male and female both). In few cases, we had interviewed family member, especially husbands as mothers had died during pregnancy. The users from tea gardens were mostly from Bangladesh and isolated from local community. However they were allowed to avail services provided by NRHM.

Occupation:Mostly into agriculture, local shops such as grocery shops, restaurants, pan and tea shops. In tea gardens, they were workers (male & female) of those tea gardens

Education & Income level:Villages: mostly primary education & income of 30 Rs. to 150 Rs. per dayTea gardens: No education & income level 60-80 Rs per day

Tuesday 3 July 2012

Rural Areas: Belkona, Katin Pahar, AmingaonGeneral characteristics: In proximity of 50 kms from Guwahati, population of less than 50 thousand

Tea Garden: Tea gardens from Dibrugardh district (Beheating, Borborooah, Boughpara and Mancotta)General characteristics: 450km from Guwahati, tea gardens

Tuesday 3 July 2012

ShynessWomen feel shy to talk about pregnancy. During interaction with female researcher, mothers did not talk and gave smile on every question. One mother was found shy to call ambulance. She said “agar bula liya aur kuch nahi nikla to, sab bolenge ki abhi tak kuch nahi hai phir bhi bula liya” (If i call and nothing happens, everyone will blame that she does not need ambulance but still called it). In one case, child dies during first pregnancy and mother is pregnant second time. Till that date, she was unaware of the reason of her childʼs death. She felt shy asking doctors or ASHA members.

Due to their shyness, they do not share their problems with doctors and ASHA members. Sometimes they feel shy talking to their husbands. Typically they are guided by mother-in-law. But in some cases, mother-in-law does not allow her to go to hospital and prefer traditional home based health care methods.

Tuesday 3 July 2012

Lack of family supportHusbands do not earn money, so mothers have to work. Husbandʼs work timings does not match with hospital timings, so husband does not accompany mothers to hospital, which results in low utilization of health services. Husbands unaware of whether child is delivered in hospital or home.

In one case, husband says, “jo ho gaya wo ho gaya ab kya kar sakte hain” (Whatever happened, it has happened, what to do now), but never attempted to bring his wife to hospitals. In tea gardens, hospital timings and tea garden timings does not match that leads to low utilization of maternal health services.

Tuesday 3 July 2012

Lack of information and family supportIn this particular case (tea garden worker), mother has died during her second pregnancy. Husband is unaware of the cause of his wifeʼs death and his childʼs death. At midnight, mother got labour pain, husband did not have any information related to emergency ambulance number and nearby PHC. Being unaware and unplanned, he carried his wife in a lori to hospital and she died in between. After two years of his wifeʼs death, he does not know the reason behind her death.

Tuesday 3 July 2012

MigrationLess stable jobs and unemployment causes families to migrate from one place to another for job hunting. This causes less utilization of health services at hospitals, as every new hospitals requires mother to register again.

One mother did not receive NRHM money because her registration place and delivery place were different.

Tuesday 3 July 2012

Road conditionLow quality of infrastructure, especially road conditions restricts ambulance/emergency vehicles to reach at required places. In most of the cases, mothers are brought to hospitals either on a cycle/lori or through a auto rickshaw chasing a longer route.

Tuesday 3 July 2012

Medical cardMothers and family members rarely read the medical card and information provided inside medical card. They are typically taken out only during the PHC visits

Tuesday 3 July 2012

Lack of information and ASHAMothers blindly follow what ASHA proposes. One mother received all the tests and checkups, but did not receive any money. When asked she says, “ab ASHA se ladai to nahi kar sakte” (We cannot fight with ASHA). Mother walked to hospital for delivery. Mothers do not have any clue about which tests are performed during pregnancy and why they are performed? Mother do not know how much money they are suppose the receive.

Information regarding maternal health is not shared frequently. Mother of one house did not know about ANC, NRHM services etc. while mother in neighbor house received complete ANC checkup and NRHM services.

Tuesday 3 July 2012

Culture and ritualsEvening gossip and get together is a culture is every village. Male community of village perform various activities such as gossip at pan shop, playing carrom, chess and cards. Most talks are regarding the news and updates about the same village or nearby villages.

Local uncertified doctors (dai/vaidh) play an important role and has more significance than PHC doctors. A mother, despite of her 11 day child being infected, checkup was done by local vaidh instead of a doctor. According to her and her family members, every house in that village have shown the local vaidh for health related problems.

Culturally, every mother in her last trimester of pregnancy is invited to every house of the village for lunch. This lunch is found to be flooded with fish and chicken based food.

Tuesday 3 July 2012

Financial constraintsUltrasound test is not provided in NRHM services. Most mothers did not go for ultrasound test due to lack of money. One mother stated that she got pregnant because she did not have money to buy “Saheli” (Birth control pill).

Tuesday 3 July 2012

Anemia, salt based tea and unawarenessPeople in tea gardens have habit of drinking salt based tea instead of using sugar. This was considered major cause of anemia. However, when asked, none was aware of salt based tea being major cause of anemia. Even most mothers were unaware of the term “anemia”. Another cause of anemia was availability of hook warm in tea gardens.

Tuesday 3 July 2012

Food consumptionMost mothers were unaware of proper diet, food and fruits to be taken. There was no food instruction provided by doctors or ASHA members. Suggestions given by doctors were to eat good food, no specific food was mentioned during instruction. It was food that few local available food is very nutritious but consumption was very low. e.g. banana flower is found cheap and frequent in Assam which is a good cure for anemic condition, but never suggested by doctors or ASHA members.

Tuesday 3 July 2012

Technology usageAll interviewed houses had a mobile phone, However they were used by husbands or elderly of the house. Mother who had mobile phone took proper care of their mobile phone. One mother (husband died and earns 25-30 Rs. a day) used her phone in such a way that battery remains for almost a week as there were frequent electricity failures. A mother who worked as a maid, she charged her phone at her workplace due to electricity failures in her village.

Most of the houses in villages and tea gardens had tata sky or dish tv and a radio or tap recorder.

Tuesday 3 July 2012

Emergency numbersFew mothers were found aware of 108 emergency numbers. No mothers had ASHA or PHC doctorʼs number. In few cases, mothers did not have their husbandʼs contact number. No mother was aware of 104 telephone service provided by NRHM

Tuesday 3 July 2012

Unawareness of ASHA membersASHA members (especially from tea gardens) were found unaware of the term “ultrasound test”. When asked, they were not aware of the reason of provided tests and check ups. According to them, their work is to find out a pregnant women and request her to go to hospital for further checkup.

Tuesday 3 July 2012

Other findings Social status:mothers from lower caste (ST/SC) were less likely to go for ANC checkups. Issues such as husband work timings, social status, female not allowed to talk to male etc. were found to be barrier for mothers to go to health centers

Sometimes doctors:Few mothers mentioned the attitude of doctors, where doctors never explained anything, are not on time, and most of time check up done by available nurses

Hospital conditions:Hospital conditions are found to be inappropriate and not updated. One hospital discharged mothers within 2 hours of delivery. When asked, doctors mentioned that they have only 3 beds and can not allow to stay mothers for longer time period

Tea garden managers:Tea garden workers are unaware of ultrasound test funded by tea garden owners.

Lack of family planning, HIV test and postnatal test are also found negligible among mothers

Tuesday 3 July 2012

Thank you

Tuesday 3 July 2012