Institutional Deliveries

Category: Education

Presentation Description

No description available.


Presentation Transcript

Institutional Deliveries : 

Institutional Deliveries A socio – Economic and cultural view By Dr.V.Sudhakaram

Objectives…. : 

Objectives…. Why this is a public health problem? What are the socio economic factors affecting? What are the role of belief and norms? What are the non medical causes associated? What are the psychological and cultural aspects?

A Public Health Problem : 

A Public Health Problem MDG goal 5 :- India has the largest number of births per year (27 million) in the world.1 With its high maternal mortality of about 300–500 per 100 000 births This is about 20% of the global burden hence India’s prog­ress in reducing maternal deaths is cru­cial to the global achievement of Millen­nium Development Goal 5 (MDG 5)

A Conceptual Framework for Analyzing Socio-Economic inequalities in Health service utilization Source: De Brouwere and Lerberghe (2001) : 

A Conceptual Framework for Analyzing Socio-Economic inequalities in Health service utilization Source: De Brouwere and Lerberghe (2001)

Obstacle for low utilization of delivery services : 

Obstacle for low utilization of delivery services Distance from health services; Costs, including user fees The cost of transport, Quality of care, Drugs availability & Supplies Attitudes of health personnel, Multiple demands on women’s time; Women’s lack of autonomy indecision-making. (The WHO (1998) and Magadi et al (2002)

Poverty as a factor… : 

Poverty as a factor… 44 countries surveyed, 26 countries have a disparity between the richest and the poorest quintile in delivery attendance of above 50% and 3 countries with disparities above 90%. Disparities in utilisation of delivery care exists between rich and poor individuals as well as rich and poor countries. (A World Bank report by Gwatkin et al (2000)

Maternity services utilisationSource:DHS 2006 : 

Maternity services utilisationSource:DHS 2006

Norms and Beliefs : 

Norms and Beliefs A few Examples Prolonged labour is a punishment for past infidelity An unassisted delivery a sign of courage (Thaddeus and Maine, 1990) Traditional beliefs about childbirth, coupled with misconceptions and fears of medical institutions, have led many women to maintain reliance on home births in India (American Journal of Public Health 2006) Shame in the first birth, and newly pregnant girls are expected to exhibit modest behaviour by remaining quiet in their vital condition and not talk at all about their pregnancy, the social pressure may create a major barrier to seeking antenatal care or delivering in hospital. Wall (1998 )

Contd…. : 

Contd…. Traditionally in rural India pregnancy is considered a natural state of being for a woman rather than a condition requiring medical attention and care. Such perceptions and beliefs constitute a “lay-health culture” that is an intervening factor between the presence of a morbidity condition and its corresponding treatment.(2NFHS) some African, Latin American and South Asian cultures, pain and illness are considered to be a normal part of women’s life, therefore it is deemed unnecessary to seek medical care, including delivery care. (Ascadi and Johnson-Ascadi (1993)

Quality of care : 

Quality of care a woman with a complication is likely to delay or avoid accessing care from a health facility where she has experienced a good but disrespectful treatment in a previous normal birth. Hulton et al (2000) receiving one or more antenatal check-ups is the strongest predictor of institutional delivery.(NFHS2)

Transport : 

Transport Transport cost and the opportunity cost of patients and caregiver(s), where necessary, had a significant negative impact on utilisation of delivery care services. (A study in Cameroon by Litvack and Bodart (1992) cited by Kutzin (1993)

Literacy : 

Literacy mother’s education has a strong positive effect institutional deliveries(NFHS2) woman’s education is a major factor affecting utilization of maternal health services in both north and south India (Govindasamy and Ramesh 1997) high levels of husbands’ education increase the likelihood of health service(American Journal of Public Health 2006)

caste and religion : 

caste and religion Muslim mothers are more likely than Hindu mothers to give birth in a medical institution in Andhra Pradesh and Gujarat, but Muslim mothers are much less likely than Hindu mothers to do so in Bihar and Rajasthan.(NFHS2) Rural mothers belonging to scheduled castes or scheduled tribes are much less likely to give birth in a medical institution than mothers not belonging to a scheduled caste or scheduled tribe.(NFHS2)

Institutional Deliveries Residence wise – Trends India : 

Institutional Deliveries Residence wise – Trends India

woman’s Autonomy : 

woman’s Autonomy woman’s autonomy, as measured by decision making about her own health care, shows little association with institutional delivery. (NFHS2) According to Kutzin (1993) the inability of women in some developing countries to make decisions in relation to choice of medical care severely affects their choice of delivery care. A conflict between biomedical and traditionally perceived causes of health conditions also limits women’s access to delivery care

Economic Status of the community : 

Economic Status of the community The level of community economic development may influence health directly, through an association between deprivation and poor health, and indirectly through access to health services and social support systems.(NFHS2)

Some Demographic Factors : 

Some Demographic Factors Age:- Increase in the Maternal age has a strong positive effect in utilizing delivery services Birth order :- Increase in the birth order has a negative in the maternal service utilization , NFHS-2 in Andhra Pradesh, 53 percent of first-order births but only 24 percent of fourth or higher-order births took place in medical institutions. Marital Status:- Unmarried pregnant girls are less likely to utilize the maternity health services .

Contd…. : 

Contd…. High fertility:- High fertility may also reflect a lack of reproductive health services and a lack of awareness of such services, both of which have obvious implications for maternal health service use. (American Journal of Public Health 2006) Occupation:- Working urban mothers are less likely to deliver in a medical institution than nonworking mothers.NFHS2

Mass media :- : 

Mass media :- Instructional delivery are higher for mothers who are regularly exposed to the electronic mass media than mothers who are not regularly exposed(NFHS2)

Political will:- : 

Political will:- For politicians, Health is a low priority No political party has maternal health on its priority agenda. Hardly any questions are asked about maternal deaths in the parlia­ment or state legislatures. Achieving Millennium Development Goal 5: is India serious? Dileep Mavalankar,a Kranti Voraa & M Prakasamma

Slide 21: 

Thank you

authorStream Live Help