Improving reproductive health services: Is integration with primary healthcare better than vertical programmes?

Maternal and child health reflects the level of development of both community as well as the performance of the health care delivery system. Maternal mortality in India, estimated at 437 maternal deaths per 100,000 live births. The existing health system does not sufficiently meet the needs of pregnant women, particularly for complications of pregnancy and obstetrical emergencies. For the present study, Malegaon city has chosen in Maharashtra state where the Muslims form numerical majority (66 percent). The vital statistical indicators for the city, indicates that CBR (28.6) and CDR (8.9) is very high as compared to state average i.e. 9.1 CDR and 18.1 CBR in Maharashtra. Infant mortality (49 per 1,000 live births) is also higher in the city than state average for Muslim (28/1,000 live births). The health systems fail to provide quality of health care services to the people. Both primary as well secondary data will be used for this study. The main objective of the study is to see the availability, pattern of utilization of MCH services among Muslim communities in the study area. Data will be analyzed through SPSS and GIS software and will be presented in graphical and tabular form.

The main aim of this paper is to assess the impact of at least one maternal healthcare service from three core components (antenatal care, institutional delivery, postnatal care) on contraceptive use. Data from the third wave of cross-sectional District Level Household Survey (2007-08) that covered 87,564 ever-married women aged 15-44 years in Uttar Pradesh have been analyzed. Results from the propensity score matching show that effects of utilizing at least one MH service (treatment) on contraceptive use (outcome) is statistically significant. The correlation coefficient among unobservable factors is also found to be significant. It indicates that variable for treatment variable created a selection bias while it was taken as one of the independent variables to predict likelihood of using a contraceptive method. Biprobit analysis shows that effects of using at least one MH service are positive and significant on likelihood of using a FP method. Likelihood of using a FP method also significantly varies by intensity of MCH services utilization and available community level factors. Reproductive health managers may use such dividends of utilization of MCH services in making family planning program strategies in rural Uttar Pradesh.

Access to benefits from inclusive development programmes, maternal-child health (MCH) care and family planning (FP) services can aid development of country’s health. Early efforts to combine these services are still untested and approved. Structural equation models utilize to examine the effect of inclusive development programme at village level on the relationship between MCH and FP service utilization. A cross-sectional District Level Household Survey (2007-08) covered 76,147 currently married women age 15-44 years through multi-stage stratified probability proportion to size sampling. It was found there were no specific pattern of common exogenous predictors except children ever born (p<0.05), mothers education (p<0.05) and wealth index of households (p<0.05) for the service utilization. Finding suggests that FP, MCH care services and inclusive development programs are introduce and available, the likelihood of adoption of services is higher, compared only one service is available in state. The rationale for integration of family planning and MCH care services with inclusive development programme at village level have been based on three grounds: improving the efficiency and effectiveness of programmes and services; meeting clients need from “one-stop” service; and accelerating the pace of health and demographic outcomes.

The Government of India launched several programmes to improve rate of institutional delivery in the country, but the performance of empowered action group (EAG) states on institutional delivery remains a major concern dominated by social customs and vulnerabilities that create barriers to access health care by different social groups. Despite such profound distributional concerns, studies on maternal health in India have exclusively focused on inter-personal inequalities whereas estimates regarding the magnitude of inter-group inequalities are unavailable. An explicit concern for horizontal inequalities not only substantiates the intrinsic concern for equity but also offers vital policy insights that are evidently lost while engaging with a thorough going individualistic approach. The paper calls for explicit targeting of backward castes across the country and improved inter-sectoral collaboration to ensure equitable access to education, healthcare, water and sanitation, particularly across underdeveloped regions. For analytical purposes, the study utilizes the District Level Household and Facility Survey (DLHS-3), conducted during 2007–08. Preliminary analysis reveals that distribution of institutional delivery varies starkly among social groups of which Schedule caste are the most deprived compared to Upper caste Hindus.

This paper examines inequality in utilization of reproductive health care services among economic stratum using data from DLHS-3. It is also attempts to identify the variation in barriers of service utilization by economic status and its effect. Gini concentration index has been used to capture the inequality and multivariate analysis has been carried out to find out the effect of economic status on main reason for non-utilization. Rich-poor disparity is more pronounced among rural, illiterate and Muslim women. Rural-urban disparity reduces with improved economic status, especially for delivery care utilization. Disparity between non-literate and highly literate becomes less in the richer group for utilizing safe delivery, while similar picture is found for Hindu-Muslim disparity in full ANC utilization. ‘Not necessary’ is the main reason for non-utilization of ANC and delivery care. Women from poorest stratum are 2 times more likely to state ‘not necessary’ for non-utilization compared to richest counterpart.

With the purpose to examine the progress in maternal care with decentralized NRHM program (2005) implemented in rural India. This study from the District Level Household Survey data shows that little use is made of antenatal and delivery-care services in EAG states. After adjusting for individual-level factors, availability of all weather road, information given on ANC significantly increases the likelihood of timely receipt of antenatal care and of at least antenatal care visits, while the availability of a health center within 5 kilometers providing natal care significantly increases the odds of each outcome. The odds of having institutional delivery are significantly reduced by distance from the nearest hospital, and are increased if a health worker is present in the neighborhood; and providing antenatal care; furthermore increases with essential adequate equipment/drugs and doctors availability at Primary health center (PHC). Neighborhood higher education increases the likelihood of delivery care. The findings suggest that improving the use made of maternal healthcare services would require, among other things, improvement of the availability of adequate services especially at PHC and road connectivity, information on service delivery in addition to remuneration beneficiary given to women for institutional births (JSY).

Although the majority of postpartum women indicate a desire to use contraceptives, family planning methods are often not offered to, or taken up by, women after delivery or in the first year postpartum. This study examines exposure to family planning services at the time of delivery and at an immunization appointment to determine if these points of integration are associated with greater use of postpartum family planning. A representative sample of women ages 15-49 was surveyed from six cities in Senegal in 2011. This study focuses on the women who were within two years postpartum (weighted n=1879). We show that women who received family planning information at the time of delivery are more likely to be using modern family planning postpartum than their counterparts who also delivered in a facility but did not receive such information. Exposure to family planning at an immunization visit was not significantly related to postpartum family planning use. Another key finding is that women with greater self-efficacy are more likely to use modern family planning. Programmatic recommendations are made for improving integration of family planning into maternal and child health services with the goal of increasing postpartum women’s use of family planning in urban Senegal.

Efforts to reduce maternal and neonatal mortality are essential if the Millennium Development Goal is to be met. Maternal and neonatal mortality could be reduced if women delivered in settings where skilled attendants could provide emergency obstetric care. The objective of this study was to identify factors which are influencing women to receive delivery care at home in rural Bangladesh. A total of 3300 women were interviewed from 22 sub-districts in Bangladesh who had delivered a birth within one year preceding the survey. Findings reveal that more than 80 percent deliveries were placed at home where about 60 percent women perceive that there was no necessity to go to a facility for delivery. Although there are some factual reasons like economic (19percent), religious and cultural (7percent) still their perception on delivery care in not up to the mark. Other socio- economic and demographic factors also influencing home deliveries include women’s education, occupation, income, number of children and number of parity, economic status, knowledge and practice of safe delivery. Considering this situation, providing financial support through a program like Demand Side Financing may encourage women to use institution or skilled provider for delivery rather than home.

In India, iron deficiency anaemia remained an intractable problem despite national policies recommending routine iron-folate (IFA) and food supplementation. Poor effectiveness of IFA supplementation has been attributed to various factors including: Insufficient dose, Time of supplementation and Poor adherence. Understanding dose-response relationships between IFA and food supplementations during pregnancy with: severe/moderate and overall anameia in post-partum women and low birth weight (LBW) and neonatal mortality among infants - could help optimize implementation of anaemia control policies. We undertook an analysis of three large cross-sectional surveys in India during 2005-09, to test the hypothesis whether, ‘higher doses of IFA consumption during pregnancy improve post-partum haemoglobin (Hb), decrease severe/moderate and overall anaemia, decrease LBW, and decrease neonatal mortality or not. Our analysis showed, increase in IFA-dose during pregnancy resulted in corresponding increase in mean Hb level, significant drop in severe/moderate and overall anaemia, and significant drop in incidence of neonatal deaths, even after adjusting for socio-demographic factors. IFA supplementation increased the risk of LBW, although association was insignificant. Associations between exclusive food supplementation and outcomes were in expe

Maternal mortality has become a grave concern worldwide. Ghana is one of the sub-Saharan African countries with a maternal mortality ratio (MMR) of 350/100,000 live births. This ratio is high when compared with other countries such as Namibia (MMR of 180/100,000 live births). Improved coverage and quality of skilled attendance at birth is one of the strategies recommended by The WHO and UNFPA to address maternal mortality. In 2000 the Ghana Health Service (GHS) began training a subset of middle level health care providers known as Community Health Officers (CHOs) to provide skilled delivery care to women in rural areas through the Community-Based Health Planning and Services (CHPS) program. This study examines factors which influence women’s decision to have skilled attendants at birth in rural areas of northern Ghana. Generally, results show that 40% of women sought skilled delivery care from the CHO-midwives in the CHPS zones. Ethnicity and husband’s education play a role in women’s choice of place of delivery. We interpret these results in light of the need for the GHS to target men especially the illiterate and the Nankam ethnic group to enable them understand the importance of women receiving skilled care at birth.