oxytoComparison of Domiciliary and Institutional Delivery-care Practices in Rural Rajasthan, India

Abstract

A retrospective cross-sectional survey was conducted to assess key practices and costs relating to home-and institutional delivery care in rural Rajasthan, India. One block from each of two sample districts was covered (estimated population-279,132). Field investigators listed women who had delivered in the past three months and contacted them for structured case interview. In total, 1,947 (96%) of 2,031 listed women were successfully interviewed. An average of 2.4 and 1.7 care providers attended each home-and institutional delivery respectively. While 34% of the women delivered in health facilities, modern care providers attended half of all the deliveries. Intramuscular injections, intravenous drips, and abdominal fundal pressure were widely used for hastening delivery in both homes and facilities while post-delivery injections for active management of the third stage were administered to a minority of women in both the venues. Most women were discharged prematurely after institutional delivery, especially by smaller health facilities. The cost of accessing home-delivery care was Rs 379 (US$ 8) while the mean costs in facilities for elective, difficult vaginal deliveries and for caesarean sections were Rs 1,336 (US$ 30), Rs 2,419 (US$ 54), and Rs 11,146 (US$ 248) respectively. Most families took loans at high interest rates to meet these costs. It is concluded that widespread irrational practices by a range of care providers in both homes and facilities can adversely affect women and newborns while inadequate observance of beneficial practices and high costs are likely to reduce the benefits of institutional delivery, especially for the poor. Government health agencies need to strengthen regulation of delivery care and, especially, monitor perinatal outcomes. Family preference for hastening delivery and early discharge also require educational efforts.

Maternal Health: A Case Study of Rajasthan

“…Evidence from a qualitative study revealed that several women were discharged very early from facilities after delivery, often within 2-3 hours, without any advice about postnatal care or initiation of breastfeeding (17). This has been corroborated by a survey in two districts of Rajasthan (reported separately in this issue of the Journal), which showed that 14% of 632 women who had an institutional vaginal delivery were discharged within six hours of delivery, and 70% before 24 hours had elapsed (18). Results of a verbal autopsy study of all 57 deaths in two rural blocks showed that five deaths had occurred among women who were discharged within 1-2 hour(s) of delivery, one from postpartum haemorrhage and four from sepsis (19).…”

“…For example, in 10 districts of Rajasthan, only 39% of the CHCs and 0.5% of the PHCs provided MTP services in 2007-2008 (data collected by ARTH from offices of health authorities in 2007-2008). A few doctors managed to receive MTP training in the state—1,056 doctors were trained during 1971-2002, with an average of 35 doctors per year (22). The availability of abortion services in the private sector also is poor—a review of services has revealed that 428 certified private facilities provided abortion services in 2002 (23), or an average of 0.67 certified private facilities per 100,000 population.…”

Place of delivery and newborn care practices in Kaski district: a cross sectional study from Nepal

“…The study done in Baitadi district shows that 28% of mother had not any ANC visit [5]. The study done in Rajasthan, India shows that majority 88% of respondent have ANC visit two or more than 2 times [6]. Similarly study conducted on Darjeeling districts shows 66.5% mother had two or more than 2 times ANC visit [7].…”

A study of factors affecting the knowledge of Janani Shishu Suraksha Karyakram among health workers in rural block Shirur of Pune district, Maharashtra

“…Direct cost incurred by the end user was considered as out-ofpocket (OOP) expenditure and both the terms were used interchangeably. 7 …”

“…6,7 Poor households often resort to borrow cash or sell assets to meet the health expenditure. 8,9 The household costs are broadly categorized as direct cost and indirect cost.…”