Childbirth practices in rural Rajasthan, India: implications for neonatal health and survival

Iyengar, Sharad D; Iyengar, Kirti; Martines, José; Dashora, Kalpana; Deora, K K

doi:10.1038/jp.2008.174

Cited by 63 publications

(75 citation statements)

References 11 publications

(11 reference statements)

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“…22 The belief that breast milk does not become available until 3 days after birth is another common reason for delaying breast-feeding among mothers in rural India and Ghana. 23,24 Mothers may also delay feeding because the newborn has not cried for milk. 24 Several of these determinants, including maternal education, number of pregnancies and surrogates for socio-economic status, were examined but did not confound the association between breast-feeding initiation time and neonatal mortality.…”

Section: Discussionmentioning

confidence: 99%

Breast-feeding initiation time and neonatal mortality risk among newborns in South India

et al. 2010

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Objective: To examine the association between breast-feeding initiation time and neonatal mortality in India, where breast-feeding initiation varies widely from region to region.Study Design: Data were collected as part of a community-based, randomized, placebo-controlled trial of the impact of vitamin A supplementation in rural villages of Tamil Nadu, India. Multivariate binomial regression analysis was used to estimate the association between neonatal mortality and breast-feeding initiation time (<12 h, 12 to 24 h, >24 h) among infants surviving a minimum of 48 h.Result: Among 10 464 newborns, 82.1% were first breast-fed before 12 h, 13.8% were breast-fed between 12 and 24 h, and 4.1% were breast-fed after 24 h. After adjusting for birth weight, gestational age and other covariates, late initiators (>24 h) were at B78% higher risk of death (relative risk ¼ 1.78 (95% confidence interval (CI) ¼ 1.03 to 3.10)). There was no difference in mortality risk when comparing babies fed in the first 12 h compared with the second 12 h after birth.Conclusion: Late (>24 h) initiation of breast-feeding is associated with a higher risk of neonatal mortality in Tamil Nadu. Emphasis on breastfeeding promotion programs in low-resource settings of India where early initiation is low could significantly reduce neonatal mortality.

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Section: Discussionmentioning

confidence: 99%

Breast-feeding initiation time and neonatal mortality risk among newborns in South India

et al. 2010

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“…The focus in this paper is not to describe these gaps nor is it a detailed description of the types of constraints that interventions need to address and, where they exist, facilitators to closing these gaps; these are covered in the accompanying papers. [7][8][9]13,14 Also included in this volume are two papers detailing how specific formative research findings were used to make decisions about the content and delivery of the intervention. These papers cover the two main community-based approaches to reducing neonatal mortality, namely women's groups 11 and home visits by community-based volunteers.…”

Section: Lessons Learnedmentioning

confidence: 99%

“…In most sites, continuing to work hard during pregnancy appears to be more common than eating down to achieve an easy labor, although there are constraints on what should or should not be eaten during pregnancy. 8 An important lesson for interventions that seek to identify and visit women early in pregnancy is that it is common for pregnancy to be kept secret for as long as possible; it is often seen as a time of danger and vulnerability. Even highly resourced and intensive longitudinal research studies that make regular enquiries about the onset of pregnancy have found that generally women do not disclose before the fourth month.…”

Section: Lessons Learnedmentioning

confidence: 99%

“…In Rajasthan, vaginal examinations were carried out using bare, unwashed hands in all home births observed (and in some facility births). 8 In all settings, birth attendants carried out a variety of procedures aimed at helping women to deliver quickly; manual abdominal compression or pushing was common, and in Rajasthan, oxytocin injections were used to intensify contractions. 8 In all settings, the focus remains on the mother until the placenta is delivered, at which point the cord can be cut; the newborn is left unattended, generally on the floor until then, and is not picked up, wiped or dried.…”

Section: Lessons Learnedmentioning

confidence: 99%

“…8 In all settings, birth attendants carried out a variety of procedures aimed at helping women to deliver quickly; manual abdominal compression or pushing was common, and in Rajasthan, oxytocin injections were used to intensify contractions. 8 In all settings, the focus remains on the mother until the placenta is delivered, at which point the cord can be cut; the newborn is left unattended, generally on the floor until then, and is not picked up, wiped or dried. Although local solutions exist for the resuscitation of newborns, such as immersion in cold water, applying hot pepper to the skin and slapping the soles of the feet, 10 they are of unproven effectiveness and delays in resuscitation attempts occur; inspection of the baby, including its breathing, often waits until after the placenta is delivered.…”

Section: Lessons Learnedmentioning

confidence: 99%

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Developing community-based intervention strategies to save newborn lives: lessons learned from formative research in five countries

2008

J Perinatol

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This paper summarizes lessons learned from formative research conducted in Bangladesh, Ghana, India, Mali and Nepal to inform the development of newborn health interventions, mostly in the context of field trials. Current practices, constraints to the adoption of optimal practices and implications for implementing inventions to improve newborn survival are discussed for: optimal care during pregnancy; skilled care at birth; optimal delivery and newborn care practices; special care of low birth weight babies; and timely and appropriate care seeking for newborn illness. General lessons concerning target audiences and intervention strategy are also drawn. In brief, interventions to reduce neonatal mortality need to start during pregnancy not only to promote birth preparedness and institutional delivery, but also to start the process of change concerning early newborn care practices. Their target audience should not only be pregnant or recently delivered women, but also include the main gatekeepers, particularly traditional birth attendants, grandmothers and other family members. Health providers' opinions also matter as care practices are less likely to change if families receive conflicting messages from different sources. Interventions are more likely to succeed if they are not simply message based, but include problem solving approaches, and a behavior change component to address community norms. Although antenatal care (ANC) is theoretically a good channel for newborn interventions, capitalising on its potential is not straightforward, and will require considerable investment and intervention development in its own right in order to improve ANC counselling, which will need to extend beyond training and tackle the many working day constraints encountered by ANC providers. Removing or subsidising the cost of deliveries may be a necessary action to increase institutional deliveries, but it is unlikely to be sufficient; measures will need to be put in place to ensure the basic quality of institutional deliveries and newborn care, and to change staff attitudes and practices. Post-natal visits should include observation of the baby, referral and counselling of the mother concerning danger signs in addition to promoting optimal care practices. The lessons learned should guide the development of interventions in other contexts, and ensure that key essential elements are not overlooked. They do not, however, mean that formative research will not be needed in other contexts, although the list of questions to address should be considerably reduced; successful intervention strategies require adaptation to make them local, context-specific if they are to be effective, and ongoing process monitoring to ensure the quality of intervention delivery, to check that it is having its intended effect, and to respond to any concerns from its implementers, recipients or the community. Finally, major gaps in evidence are highlighted. These include: establishing levels of recognition of asphyxiated babies and effectiveness of local solu...

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Integrating Traditional and Modern Medical Practices: Perspectives from the History of Science and Medicine

Bono

2020

Transforming Global Health

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Childbirth practices in rural Rajasthan, India: implications for neonatal health and survival

Cited by 63 publications

References 11 publications

Breast-feeding initiation time and neonatal mortality risk among newborns in South India

Breast-feeding initiation time and neonatal mortality risk among newborns in South India

Developing community-based intervention strategies to save newborn lives: lessons learned from formative research in five countries

Integrating Traditional and Modern Medical Practices: Perspectives from the History of Science and Medicine

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