The knowledge of danger signs of obstetric complications among women in rural India: evaluating an integrated microfinance and health literacy program

Roy

et al. 2021

J Family Med Prim Care

Background: Caesarean section (C-section) delivery is a serious maternal health concern in the long run. Notedly, there is a lack of studies dealing with understanding the ways and reasons of C-section deliveries becoming a public health issue in today’s time in India and the measures to reduce the unnecessary caesarean sections. We have conducted this study to study the changes in the state-wise prevalence of C-section deliveries in India and understand C-section delivery’s socioeconomic and biomedical predictors. Materials and Methods: The study uses data from the fourth and fifth rounds of the National Family Health Surveys (NFHS). The per cent differences in the C-section deliveries from NFHS-4 to NFHS-5 across the states were measured through relative changes. The association between the C-section delivery and socioeconomic and biomedical factors were assessed using multiple logistic regression. Results: This study revealed that the C-section deliveries are higher in the southern states than in the other parts of India. Literacy plays a vital role in C-section deliveries. The probabilities of C-section deliveries are more in 30–40 and 40 + years. The women belonging to the median wealth index category were more likely (OR–CI, 1.62 [1.55–1.66]) to undergo the C-section followed by the women from wealthy households (OR–CI, 1.46 [1.41–1.52]). Conclusion: The Government’s health policymakers should take the initiative to reduce the C-section section delivery by means of building maternal health literacy and awareness among women and the community so that its future implications can be minimised. It is crucial to formulate a mandate and implement it in the states where C-sections are too high through community health workers and primary care providers.

Section: Discussionmentioning

confidence: 99%

Changing scenario of C-section delivery in India: Understanding the maternal health concern and its associated predictors

Roy

et al. 2021

J Family Med Prim Care

“…The study used cross-sectional data from a quasi-experimental survey design, collected as part of the IMFHL programme in two rounds (pre–post programme implementation), capturing the programme’s characteristics and other factors in the first round in 2015, followed by a second round of data collection 2 years into the programme in 2017. 32 33 …”

Section: Methodsmentioning

confidence: 99%

“…This research builds on limited evidence on the effectiveness of membership in microfinance programmes integrated with a health literacy component on BPCR practice among women in rural areas. [32][33][34][35][36] It is hypothesised that women in low-income rural households receiving financial access and additional health information through SHGs would reduce healthcare-seeking delays during maternal complications.…”

Section: Study Strengths and Limitations Of This Studymentioning

confidence: 99%

“…32 33 A woman was classified as an SHG member if she was a member herself or someone else in the household, usually a mother-in-law or sister-in-law, was a member. 32 These SHG members represented the first tier of beneficiaries who directly received health information, encouraging them to adopt desired health behaviours to promote maternal and neonatal health. As members and nonmembers lived in the same villages, it was expected that members receiving health information would communicate knowledge to neighbouring non-member households through informal communication networks that would gradually lead to the adoption of desired behaviours, as observed elsewhere in previous social network analysis studies.…”

Section: Description Of the Imfhl Programme Interventionmentioning

confidence: 99%

“…Microfinance-based self-help group(SHG) platforms in UP and other low-development regions of India have previously shown that integrated health literacy and SHG interventions can improve routine maternal health practices such as ANC utilisation, increase institutional deliveries and also improve newborn health practises at home, such as cord care and timely breastfeeding. 32 33 However, the impact of membership in a SHG-based health programme on the practice of BPCR among SHG members to reduce maternal mortality has not been evaluated. Also, the potential of the programme to diffuse health information from members to non-members in villages where SHGs are established is untested.…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Improving birth preparedness and complication readiness in rural India through an integrated microfinance and health literacy programme: evidence from a quasi-experimental study

2022

Self Cite

ObjectiveRecently, a novel community health programme—the integrated microfinance and health literacy (IMFHL) programme was implemented through microfinance-based women’s only self-help groups (SHGs) in India to promote birth preparedness and complication readiness (BPCR) to improve maternal health. The study evaluated the impact of the IMFHL programme on BPCR practice by women in one of India’s poorest states—Uttar Pradesh—adjusting for the community, household and individual variables. The paper also examined for any diffusion of knowledge of BPCR from SHG members receiving the health literacy intervention to non-members in programme villages.DesignQuasi-experimental study using cross-sectional survey data.SettingsSecondary survey data from the IMFHL programme were used.ParticipantsSurvey data were collected from 17 244 women in households with SHG member and non-member households in rural India.Primary outcomesMultivariable logistic regression was used to estimate main and adjusted IMFHL programme effects on maternal BPCR practice in their last pregnancy.ResultsMembership in SHGs alone is positively associated with BPCR practice, with 17% higher odds (OR=1.17, 95% CI 1.07 to 1.29, p<0.01) of these women practising BPCR compared with women in villages without the programmes. Furthermore, the odds of practising complete BPCR increase to almost 50% (OR=1.48, 95% CI 1.35 to 1.63, p<0.01) when a maternal health literacy component is added to the SHGs. A diffusion effect was found for BPCR practice from SHG members to non-members when the health literacy component was integrated into the SHG model.ConclusionsThe results suggest that SHG membership exerts a positive impact on planned health behaviour and a diffusion effect of BPCR practice from members to non-members when SHGs are enriched with a health literacy component. The study provides evidence to guide the implementation of community health programmes seeking to promote BPCR practise in low resource settings.

Glob Implement Res Appl

Tracking Care-Seeking Pathways: A Qualitative Study of Maternal Complications in Uttar Pradesh, India

Aruldas

Kant

2022

To understand the referral pathways followed by families, the highest level of health facility reached for care, the time taken to receive that level of maternal healthcare, and families' experiences of care received, we conducted a qualitative study of six maternal deaths, 10 perceived postpartum hemorrhage, and 14 frontline health workers. Thematic analysis of the data showed that of the six maternal death cases, one went directly to a secondary care public hospital, four women visited four to five hospitals before they died. One of them died after visiting four hospitals in over 30 h. Of the 10 women who experienced postpartum hemorrhage, six never went to a hospital, three went to two hospitals, and one was in the hospital when the event occurred. Time taken from the first step of care-seeking outside the home to initiation of care at the highest level ranged from 11 h to 8 days. The providers of the public health system followed a hierarchical 'referral pyramid' irrespective of whether the next level hospital could provide appropriate care or not. This research provides evidence to the 'outer setting' domain of the Consolidated Framework for Implementation Science from families' perspectives about their needs and the referral network. Providing information about emergency obstetric care services to all the hospitals within a district and developing a communication system through the Federation of Obstetric and Gynaecological Societies of India for care continuum through referral would help reduce mortality and improve family's experience with the health system.