geo-analyst , issn 2249-2909 december,...

Geo-Analyst , ISSN 2249-2909 December, 2015

46

DISPARITY IN MATERNAL HEALTHCARE SERVICE UTILIZATION IN

MALDA DISTRICT, WEST BENGAL

Pritam Ghosh* Sanjoy Ahir** SanjibMondal***

Abstract

Good health status of mother is an indicator of progressive society. Among the other districts of

our state Malda is remarkably poor form the aspect of utilization of maternal healthcare service.

Moreover there are some disparity among the mothers of different community development blocks

of this study area in utilization of maternal health care service. The main aim of this study is to

find out year wise and inter block disparity of different healthcare services utilization among the

mothers in the study area. The analysis has been made in this paper mostly based on secondary

data. Collected secondary data has been converted into tertiary data set and then various statistical

calculations, cartographic techniques and also mapping has been made in different software like

Excel 2013, SPSS, Q-GIS etc. There are some inter block disparity among the mothers in ante

natal healthcare, delivery care and post-natal healthcare service utilization. Though, from the

aspect of utilizing ante natal care, institutional delivery care and post-natal care the district is

developing during last few years. Government should take action to spread health care facilities in

each village of the study area, so that the service can be reached to each individuals, families or

communities and also have to develop the accessibility, availability, adequacy and quality of the

healthcare infrastructure. Also, mothers should more conscious about their health for their safe

motherhood.

Keywords:Health, Healthcare, Healthcare Service, Ante natal Healthcare, Post-natal Healthcare

Introduction

Good health status of mother is an indicator of progressive society. Live birth, stillbirth, antenatal

mortality, infant mortality and malnutrition, physical and mental health condition, disease,

disability of child directly or indirectly influenced by maternal mental and physical health status.

Therefore,the mothers need adequate and quality health service to keep our new generation safe

and healthy. Nowadays to protect good health of mother, on behalf of both state and central

government different health service schemes, projects and healthcare serviceshave been

started.But some apathies to take healthcare service among the mothers of different area of the

study area have been observed.Especially in rural area this tendency among the mother is higher.

*& ** Research Scholar, Department of Geography, University of Calcutta

***Junior Research Fellow, Department of Geography, University of Calcutta


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Among the other districts of our state Malda is remarkably poor form the aspect of utilization of

maternal healthcare service. Moreover there are some disparity among the mothers of different

community development blocks of this study area in utilization of maternal health care service.

Objectives

o To find out year wise disparity in different healthcare services utilization of

mother in the study area

o To analyze ante natal healthcare service utilization of mother during pregnancy

in the study area.

o To analyze healthcare service utilization of mother at the time of delivery and

after delivery in different blocks of Malda district.

o To assess the disparity in healthcare service utilization of mother during

antenatal, delivery and post delivery period among different CD blocks of the

study area.

Study Area

Location of the study area

Malda District Lies 347 KM north of the State Capital, Kolkata. It is located between

latitudes 24040' 20" N to 25

032' 8" N, and longitudes 87

045' 50" East to 88

028' 10" East.

Administrative setup of the study area

Malda district is bounded by Bangladesh to its east and Dakshin Dinajpur, Uttar

Dinajpur district to its north, Bihar to the west, south-west part is bounded to Jharkhand.

The Ganga River is flowing along the southern boundary of Malda. It is situating over an

area of 3733, Sq. KM which is 4.10 percent of the total area of West Bengal. The district

has fifteen community development block under two sub-division. Under these

community development blocks there are 146 Gram Panchayats and 1,771 villages.

(Figure No. 1)

Database and Methodology

The analysis has been made in this paper mostly based on secondary data base collected from

Ministry of Health and Family Welfare Department, Government of India, District Level

Household Survey 2 (2002-04), and District Level Household Survey 3 (2007-08), District

Statistical Handbook, Malda district (2010-11, 2013, 2014) etc.

Collected secondary data has been converted into tertiary data set and then various statistical

calculations, cartographic techniques and also mapping has been made in different software like

Excel 2013, SPSS, Q-GIS etc.


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To find out inter block disparity of ante natal maternal healthcare service utilization, Values of

some selected indicators have been standardized with the help of Z - Score method. After that

composite Z score of each block of the study area has been calculated on the basis of z value of

some selected indicators of each blocks.

Secondly, to understand inter block variation of each indicator, coefficient of variation of each

indicator has been calculated here.

Figure 1 Location map of the study area

Result and Discussion

Healthcare service utilization during antenatal period

Main aim to give ante natal service to a mother is to achieve healthy mother and healthy child at

the end of her pregnancy. The mother who has not received good quality ante natal care are found

to be more at risk of having low birth weight babies. (Nair et al., 2000). Also there is a strong


49

correlation between infant mortality rate and poor quality ante natal care service. (Chandrashekar

et al., 1998).

Healthcare service during antenatal period of a mother or Ante natal care (ANC) refers to

pregnancy related healthcare which are usually provided by a doctor, nurse, health personnel, and

other health professional.Good and adequate healthcare service during ante natal period is very

essential for the safe motherhood. But influenced by many socio-economic, religious and spatial

factors many mothers do not take health care service during their pregnancy. Mother’s level of

awareness and education, perception, attitude and accessibility, availability of healthcare services

etc. are associated with the mother decision of utilizing healthcare service during ante natal period.

These factors are being changed after independence in our state as well as Malda district. Also

there are some regional variations of these factors in the study area. So there are some intra district

disparity in utilization of healthcare service among the mothers along with temporal variation.

Temporal variation of ANC service utilization in Malda

A mother during her pregnancy must take different types of healthcare services. Ante natal

checkups are important during that period. These checkups include weight and blood pressure

checkup, Urine and blood test and abdominal examination Internal examined, Breast examined, X-

ray, Sonography /ultrasound, Amniocentesis etc. According to Ministry and family welfare,

Government of India, at least three ante natal checkups during pregnancy are desirable for the

health of mother. But there exist lack of ante natal checkups among the mother of Malda district in

west Bengal. According to DLHS 2, 47.50 percent of mother in Malda district received an ante

natal check up in the 1st trimester of their pregnancy.This percentage was 41.0 in the year of 2007-

08 (DLHS 3). And from the year of 2002-04 to 2007-08,More or less 14 percent of mother

received full ante natal checkup during their pregnancy in the study area.

Percentage of mothers who have taken at least three ante natal healthcare checkups in the study

area is lower than our whole state. Although this percentage has increase in the study area in last

few years. a) Percentage of pregnant women who registered within first trimester (12 weeks) of

their pregnancy for ANC and b) Percentage of pregnant women who received 3 ANC checkups

during their pregnancy of the study area and West Bengal in last few year has been shown in a

diagram. (Figure No. 2).

It is clear from the diagram that percentage of pregnant women who registered within first

trimester in Malda district and West Bengal remain more or less same. But this percentage in west

Bengal as well as in the study area has increased during last few years.Along with this percentage

of pregnant women who received three ANC checkups has increased during last few years in the

study area. Though this percentage is lower than whole West Bengal. This percentage has

decreased in the year of 2014-15 than previous year.


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Figure No.2 Yearwise ante natal healthcare service utilization in Malda and West Bengal

Intra district disparity in ante natal healthcare service utilization in Malda

Side by side other health care services have been provided from different health and family

welfare centers the study area. Like pregnant women given TT1, TT 2 and 100 IFA tablet during

their pregnancy etc. But there are some differences among the mothers in utilize these health care

services. To find out intra district disparity in ante natal healthcare service utilization composite Z-

score value has been calculated for each C.D. Blocks on the basis of some selected indicators.

(Table No.1) These are percentage of pregnant women who a) received 3 ANC checkups b) TT1 c)

TT2 d) 100 IFA tablets etc. to total ANC registered pregnant women. During their pregnancy.

On the other hand coefficient of variation (CV) has been calculated to find out the disparity within

different blocks of each variable.The coefficient of variation is highest, in case of the percentage of

mother who received 100 IFA tablets, as compared to the other factor of ante natal healthcare

service. So there is a huge variation among 100IFA tablet recipient mother in different blocks of

the study area. Also there is a inter block variation among the mother who received at least 3 ante

natal checkups in the study area.

0

10

20

30

40

50

60

70

80

90

2008-09 2009-10 2010-11 2011-12 2012-13 2013-14 2014-15

Ante natal Healthcare service utilization in West

Bengal and Malda

1st Trimester ANC (WB) 1st Trimester ANC (M)

3 ANC (WB) 3 ANC(M)


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Table No. 1 Composite Z score of ante natal healthcare service utilization in Malda district,

2014-15

CD Blocks Mother

received 3

ANC

Checkups

Mother

received

TT1

Mother

received

TT2

Mother

received 100

IFA Tablets

Composite

Z Score

Harischandrapur I 73.019 81.873 88.728 67.079 -3.6906

Harischandrapur II 71.241 88.762 88.189 81.048 -0.6749

Chanchol I 72.079 81.492 86.743 71.470 -4.3214

Chanchol II 82.317 83.498 93.451 75.716 3.1755

Ratua I 80.691 93.256 91.682 77.709 4.4135

Ratua II 74.982 87.752 88.833 70.407 -1.1431

Gazole 74.395 81.543 87.931 84.996 -0.8815

Bamongola 77.441 82.194 89.469 75.795 -0.5198

Habibpur 72.820 87.057 89.623 80.676 0.0415

Old Malda 74.214 91.442 88.478 86.583 1.8779

Englishbazar 74.336 88.028 85.724 78.011 -1.5588

Manikchak 77.388 88.598 90.804 76.593 1.7191

Kaliachak I 79.777 90.112 85.035 82.237 0.9356

Kaliachak II 76.638 89.400 88.246 80.198 1.0218

Kaliachak III 72.133 77.832 89.722 92.464 -0.3946

CV 4.312334 4.990885 2.348727 7.997514

On the other hand, to represent block wise disparity of ante natal maternal healthcare service

utilization a thematic map on the basis of Composite z- Score of the study area has been prepared.

(Figure No. 3) The map reveals that Harischnandapur I and Chanchol I are in very bad condition

from the ante natal maternal healthcare service utilization aspect, as compared to the other blocks

of the study area. Whereas Chanchol II and Ratua I are best in ranking from the same aspect. Old

Malda (Excluding Municipality) is better in position than Englishbazar (Excluding Municipality)

from this aspect.


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Figure No.3 Utilization of maternal healthcare services during ante natal period in Malda

(2014-15)

Healthcare service utilization at the time of delivery

The place or the institution where delivery is conducted is an important indicator of maternal

health status. Generally it is conducted at home or any public or private institution. Delivery at

home is conducted with presence of doctor or nurse or without presence of any doctor or nurse or

any health personnel. But the delivery which conducted any institution or at home with the

presence of any doctor, nurse and or health personnel is safe for mothers health.

Temporal variation of delivery care in the study area

Since independence along with the increase of literacy, level of education and health awareness

among the mother, percentage of delivery at home is decreasing in our state as well as in the study

area.According to DLHS 2 (2002-03) only 27.40 percent of women had institutional delivery in


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the study area. In 2007-08 this percentage was 28.50 (DLHS 3). Alternatively in 2002-03, the

percentage of delivery at home was 72.60, which came down at 71.20 in 2007-08. Though the

percentage of delivery at home is always higher than the percentage of delivery at home in West

Bengal as a whole during few previous year. On the other hand percentage of delivery at public

institution has increased in last few year in the study area. Though year wise this percentage is

lower than the percentage of public institutional delivery of West Bengal. Percentage of delivery at

private institutionis very poor in the study area and it remains more or less same during the last

fewyears. Whereas delivery at private institution is increasing in our state since last few years.

This scenario of delivery has been represented here through a diagram. (Figure No.4).

Figure No.4 Delivery characteristics of West Bengal and Malda district in different years.

Intra district disparity in delivery care

Traditional culture, Religious belief, level of education, health consciousness, status of life and

income level of a family and availability of medical institution have created the intra district

disparity in delivery characteristics of mother. Institutional delivery is the sign of safe delivery.

These has been shown here in Figure No.5

0

10

20

30

40

50

60

70

Per

centa

ge

of

Del

iver

y

Years

Home Delivery (M)

Public Inst. Delivery

(M)

Private Inst.

Delivery(M)

Home Delivery (WB)

Public Inst. Delivery

(WB)

Private Inst Delivery

(WB)


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Figure No.5 Disparity inpublic institutional delivery in Malda District (2012-13 & 2014-15)

Percentage of public institutional delivery to total delivery is very low in Old Malda (Excluding

Municipality), Harischandrapur II and Chanchol II block from the year of 2012-13 to 2014-15. But

this public institutional delivery has increase in Kaliachak II &III, Bamongola, Englishbazar

(Excluding Municipality) and Kaliachak I block in 2014-15.

Disparity in utilization of JSY

There are some disparity among the mothers of the study area in utilizing theincentives of Janani

Suraksha Yojana (JSY).It is a scheme run by the government of India’s National Rural Health

Mission (NRHM) to reduce the mortality of mothers and new born babies. The main aim of the

JSY scheme is to encourage poor pregnant women to give birth in a registered health institution

where medical staff are present for emergency situation. To fulfill this aim, poor mothers are

given incentives at the time of their delivery. Though the percentage of mother paid incentive for

deliveries conducted at home or any public institution has increased in the last few years in the

study area.Percentage of mothers paid JSY incentive for home and public institutional deliveries to

total reported deliveries during last few year in the study area has been shown in a diagram.

(Figure No.6) It is clear from this diagram that percentage of mother paid JSY incentive for

delivery at home to total delivery has increased during last few years. Along with this percentage

of mother paid JSY incentive for public institutional delivery to total public institutional delivery

has also increased from the year of 2013-14 in the study area.

Figure No.6 Janani Suraksha Yojana incentive to the mother for deliver

institution in Malda district

In Figure No. 7 block wise a) percentage of mother who received JSY incentive for delivery at

home to total no of delivery at home and b) percentage of mother who received JSY incentive for

delivery at any public institution to total public institutional delivery has been shown. In Chanchal

II, Ratua I, Manikchak percentage of institutional delivery was very poor in 2014

maximum percentage of mother has been paid JSY incentive for public institut

these blocks. On the other hand, in Englishbazar block (excluding Municipality) percentage of

institutional delivery was good in 2014

JSY incentive for public institutional delivery h

Healthcare service utilization during post

After delivery women need a health checkup for heal

level of literacy, financial crises poor mother does not take any health or medical checkup after

delivery. It is mostly observed in the rural zones of the study area. The health checkup during post

natal period can be classified into temporal division. One is health check within 48 hours after

delivery and other is health checkup from 48 hours to 14 days after delivery.

0

10

20

30

40

50

60

70

2012-13

JSY Incentive for Delivery at Home

JSY Incentive for Public Institutional Delivery

Geo-Analyst , ISSN 2249-2909 December,

55

Janani Suraksha Yojana incentive to the mother for delivery at home or any public



any public institution to total public institutional delivery has been shown. In Chanchal

II, Ratua I, Manikchak percentage of institutional delivery was very poor in 2014

maximum percentage of mother has been paid JSY incentive for public institutional delivery in


institutional delivery was good in 2014-15. And a good percentage of mother has also been paid

JSY incentive for public institutional delivery here.

Healthcare service utilization during post-natal period:

After delivery women need a health checkup for healthy life. But due to lack of awareness, low


delivery. It is mostly observed in the rural zones of the study area. The health checkup during post

can be classified into temporal division. One is health check within 48 hours after

delivery and other is health checkup from 48 hours to 14 days after delivery.

2013-14 2014-15 2015-16

JSY Incentive for Delivery at Home

JSY Incentive for Public Institutional Delivery

December, 2015

y at home or any public



any public institution to total public institutional delivery has been shown. In Chanchal

II, Ratua I, Manikchak percentage of institutional delivery was very poor in 2014-15. But

ional delivery in


15. And a good percentage of mother has also been paid

thy life. But due to lack of awareness, low


delivery. It is mostly observed in the rural zones of the study area. The health checkup during post-

can be classified into temporal division. One is health check within 48 hours after


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Figure No.7Block wise JSY incentive to the mother for delivery at home or any public institution

in Malda (2014-15)

Temporal variation of post-natal health care service utilization in Malda

These two temporal types of health checkups have increased during last few years in the study

area. It has been shown in a diagram. (Figure No.8) Post-natal checkups from 48 hours after

delivery to 14 days has increase during last few years along with post-natal checkups within 48

hours after delivery in the study area.

Figure No.8 Post-natal maternal health checkups in Malda

Intra district disparity in post-

Also there are inter block disparity in post

These disparity in the year of 2014

area. (Figure no. 9) Percentage of mother who received post

Chanchol I and Kaliachak I. Only Englishbazar (excluding Municipality) is good in condition from

the aspect of utilizing post-natal checkup after delivery.

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54

56

58

60

62

64

66

68

70

72

2012-13

Within 48 Hours

Geo-Analyst , ISSN 2249-2909 December,

57

natal maternal health checkups in Maldadistrict from thr yrar of 2012

2014-15

-natal healthcare service utilization in Malda

Also there are inter block disparity in post-natal checkups among the mothers of the study area.

These disparity in the year of 2014-15 has been shown here through thematic map of the study

area. (Figure no. 9) Percentage of mother who received post-natal checkups is very poor in


natal checkup after delivery.

2013-14 2014-15

Within 48 Hours 48 Hours - 14 Days

December, 2015

district from thr yrar of 2012-13 to

natal checkups among the mothers of the study area.

15 has been shown here through thematic map of the study

checkups is very poor in



58

Figure No.9 Disparity in post-natal maternal health checkups in Malda (2014-15)

Major Findings

• From the aspect of utilizing ante natal care the district is developing during last few years.

• There are some inter block disparity among the mothers in ante natal healthcare service

utilization.

• Being totally rural block, mothers of Chanchol II and Ratua I, from the aspect of ante

natal care utilization are in best position as compared to the other blocks of the study

area.

• Though there are inter block disparity in institutional delivery, delivery at public or

private institution have increased in each and every block of the study area during last

few years.

• Block wise JSY incentive to the mother for delivery at home or any Public institution

have increased in each block of the study area.

• Englishbazar is one of the block where percentage of mother who received post-natal

checkup both within 48 hours and 48 hours to 14 days after delivery is most. It may be

due to accessibility of health instruction, level of education among the mother and status

of their family life are good.


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Conclusion

Though there are inter block disparity in maternal healthcare service utilization, it can clearly say

that it has increase during last few year in the study area. Government should take action to spread

health care facilities in each village of the district. So that the service can be reached to each

individuals, families or communities and also have to develop the accessibility, availability,

adequacy and quality of the healthcare infrastructure. Government should more active to increase

the health awareness among the people, and should make them aware about different healthcare

service scheme, so that they can utilize properly different health service. On the other hand

mothers should more conscious about their health, health care, Medical infrastructure, and

different government scheme for their safe motherhood.

References

Chandrasekhar, S., Rao, R.S., Nair, N.S., Kutty, P.R., (1998). “Socio- Demographic Determinants

of Antenatal care” Tropical Doctors, Vol-28, pp 206-209

Nair, N.S., Rao, R.S., Chandrasekhar, S., Acharya, D., Bhat, H.V. (2000) “Socio-Demographic

and Maternal Determinants of Low Birth Weights: A Multivariate Approach.” Indian Journal of

Pediatrics, Vol- 67, pp.9-14.

Mishra, R. P. (2007): Geography of Health: A Treatise on geography of life and Death of India.

New Delhi, Concept Publishing Company.

Sinha, H. (2014): People and health in North East India, Mittal Publications, New Delhi, India.

Government of West Bengal (2015, 2014, 2010-2011): District Statistical Hand Book, Malda

District, Bureau of Applied Economics and Statistics, Department of Statistics & Programme

Implementation.

Government of India (2006), Reproductive and Child Health, District Level Household Survey

(DLHS - 2), West Bengal, 2002-04, International Institute for Population Sciences, TNS India Pvt.

Ltd., Ministry of Health & Family Welfare, Government of India,

Government of India (2010), District Level Household and Facility Survey (DLHS-3), West

Bengal, 2007-08, West Bengal, International Institute for Population Sciences, Ministry of Health

& Family Welfare, Government of India.

Government of India (2017), Ministry of Health & Family Welfare, Government of India, Health

Management and Information System.

Government of West Bengal (2015): Health on March (2014-15), State of Health Intelligence,

Directorate of Health Service.







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