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ORIGINAL ARTICLE
Year : 2021 | Volume
: 10
| Issue : 3 | Page : 211-215
Factors driving the “preferred place for delivery” among tribal women in Southern India
Kavita Yadav1, MR Narayana Murthy2, Manohar Prasad3, Praveen Kulkarni2
1 Public Health Researcher, Centre of Social Medicine and Community Health, Jawaharlal Nehru University, New Delhi, India
2 Department of Community Medicine, JSS Medical College and Hospital, Mysore, Karnataka, India
3 Community Health Activities, Swami Vivekananda Youth Movement, Mysore, Karnataka, India
Correspondence Address:
Dr. M R Narayana Murthy
Department of Community Medicine, JSS Medical College and Hospital, Mysore - 570 015, Karnataka
India
Source of Support: None, Conflict of Interest: None
CheckDOI: 10.4103/ijhas.IJHAS_255_20
BACKGROUND: Mother and child health is an important issue for the tribal community and a lot of it depends on the prenatal, natal and postnatal care of the mother and child. Institutional deliveries are known to have a positive impact on their health and it is important to understand the factors that lead to the choice of place of delivery.
MATERIALS AND METHODS: A community-based study was conducted in the tribal area of H D Kote taluk Mysore. Of 16 Primary Health Centers, five centers which cover nearly 50% of the population were chosen for the study. All the mothers who resided in those areas and delivered from January 2013 to December 2013 were chosen for study, which came to 215. Those who had migrated to areas outside our study area and those who were not found in home during data collection home visit were left out. Hence, the final sample size came to be 165. Chi-square test and Fisher's exact test and logistic regression analysis were applied to test the significance of association of factors with place of delivery.
RESULTS: In the present study, 20.6% mothers had delivered at home, 12.7% in government hospital, and 66.7% in private hospital. Past delivery experience, early registration of pregnancies, and higher number of pregnancies were the factor found to be significantly associated with institutional deliveries.
CONCLUSION: Mothers who utilize the antenatal care services and who have had experience of delivery in a hospital/higher number of deliveries are more likely to choose hospital for their delivery.
Keywords: Institutional deliveries, MCH care, tribal health
Mother and child are considered as one unit and they constitute a vulnerable group in community and the mortality and morbidity is always high among them. Hence, protection and promotion of health of the mother and child is of prime importance for building a healthy and sound nation.
Every year, over 500,000 women die of pregnancy- and childbirth-related complications globally. Of these 99% occur in developing countries.[1],[2] Thus, maternal mortality is the indicator with the widest disparity between developed and developing countries. In realization of this unacceptable level of maternal mortality around the globe, in 2000 world leaders committed themselves and set goals commonly known as Millennium Development Goals (MDGs).[3] “Improving maternal health” is MDG 5 with set target of maternal mortality ratio reduction by three-quarters of 1990 level by the year 2015.[3]
Critical in attainment of the above goal is to ensure availability, utilization, and quality of maternal care services antenatal care, delivery, and postpartum care. Intra-partum and peri-partum death accounted for over 70% of global maternal death. Thus, making skilled attendance during pregnancy is critical and an essential intervention in reducing maternal mortality and morbidity.[3]
In developed world, where <1% of maternal death occurs, it is estimated that 97%, 99%, and 90% of women receive antenatal care, deliver in health institution and receive postpartum care, respectively.
In developing countries, 65% receive antenatal care services, 53% deliver in health institutions, and 30% receive some form of postpartum care1. This discrepancy in maternity care coverage between developed and developing countries offer some explanation to the maternal mortality situation around the world.
In India, the proportion of institutional deliveries is low (<41%).[4] Every 7 min a maternal death occurs, leading to more than 77,000 Indian women dying each year. Most maternal deaths can be prevented if deliveries are attended by skilled birth attendant and proper antenatal care and postnatal care is received. Furthermore, institutional deliveries are encouraged for women with potential complications since home deliveries lack the type of emergency obstetric care that trained health professionals in an institution can provide. The high maternal mortality ratio in India is associated with factors such as insufficient public hospital facilities, shortage of doctors, and culture and traditions. Below poverty line women in tribal areas are particularly vulnerable to such deficiencies because they lack the economic resources to overcome these problems. The situation worsens even more for the tribal communities. However, despite the existence of these national programs for improving maternal and child health, maternal mortality, and morbidity continues to be at higher side, at an unacceptable level. There are multiple reasons for this situation. Early marriage, malnutrition, illiteracy, ignorance, lack of health services, and unavailability of transport facilities are the major contributors. One of the most important reasons for the same is nonacceptance or nonutilization/underutilization of maternal health-care services, especially among the tribal population. For effective implementation of the programs, understanding of the factors affecting the utilization of maternity care during pregnancy and delivery is required. If these factors are correctly identified, then the program efforts can be concentrated to increase the acceptance/utilization rates. Therefore, the present study is carried out to find out the factors associated with choice of place of delivery and utilization of maternal care services in remote tribal areas of HD Kote.
Type of study
This was a community-based study.
Sampling method and sample size
Total population of H D Kote taluk is 275160. Among these, the tribal population is scattered in haadis (tribal hamlet) which are 119 in number. There are 16 Primary Health Centers covering the tribal population of 19,964. Out of these 16 Primary Health Centers, five centers namely B. Matakari, D. B Kuppe, N Belthur, Dadadahalli, and Badagalapura which cover nearly 50% of tribal population and are also reached by the program Vatsalya Vahini (reproductive and child health initiative of SVYM) were selected. Then from the selected Primary Health Centers catering to tribal hamlets, all the mothers who delivered from January 2013 to December 2013, were chosen for study, which came to 215.
Inclusion criteria
Tribal women permanently residing in HD Kote who delivered from January 2013 to December 2013 and who consented to participate in study.
Exclusion criteria
Those mothers who had migrated to areas outside our study area and those who were not found in home during data collection home visit.
Ethics committee
After obtaining approval from the Institutional Ethical Committee, JSS Medical College, Mysore, and Institutional Review Board, Swami Vivekananda Youth Movement, we conducted study in the above-mentioned area. All the chosen mothers were interviewed personally using a pretested semi-structured pro forma, with the help of health worker in respective areas. Before interview, a written consent was obtained from each of participant in local language Kannada.
Data collection was done from July 2014 to December 2014. Those houses found locked on first visit, were given the second visit after 1 week. Moreover, if still found locked or mother was missing, then they were excluded from the study.
ResultsIn the present study, a total of 165 mothers were interviewed. Majority of the mothers (59.3%) were in the age group of 20–24 years. 26.7% mothers belonged to the group of 25–29 years and rest 14% belonged to 15–19 years of age group. 82.4% of mothers were married before the age of 19 years and rest 15.8% were married during 20–24 years. 80.6% of mothers were working as coolie or daily wager whereas 17.6% were homemakers and rest 1.8% were involved in other activities such as honey collection. All the mothers were Hindu by religion. They were further divided into four castes namely Jenu kuruba (66.1%), Kadu kuruba (15.2%), Yeravas (12.1%), and Soligas (6.7%). Majority of the mothers (80%) were literate, at least having primary school education whereas literacy rate among husbands was comparatively low (64.8%). 66.7% of mothers had delivered in private hospital, 12.7% of mothers had delivered in government hospital, and 20.6% of mothers had delivered in home [Table 1].
Chi-square test and Fisher's exact test were applied to test the significance of association of factors with place of delivery. Age of the mother, past place of delivery, number of deliveries, history of still birth, past delivery experience, ANC registration, TT injections, IFA tablet consumption, months of supplementary nutrition, awareness about place of delivery, and government schemes are the factors that were found to be significantly associated with the choice of place of delivery [Table 2] and [Table 3].
Logistic regression
All the factors which were found to be significant in Chi-square test were put into logistic regression model and after three iterations the below mentioned factors were found to be significant with Nagelkerke R2 = 0.499 [Table 4].
DiscussionIn the present study, 20.6% mothers had delivered at home, 12.7% in government hospital, and 66.7% in private hospital. It is similar to the studies conducted in 2013 by Baiju Dinesh Shahand Laxmi Kant Dwivedi in Gujrat,[5] and Jinu A Jose, Sonali Sarkar, Sitanshu S Kar, and S Ganesh Kumar[6] where 66% and 95.4% tribal mothers had deliveries at hospital.
In our study, mother's and father's education and occupation were not found to be significantly associated with the choice of place of delivery. It is in contrast to the findings of the study conducted by Sachin S Mumbare, Rekha Rege in tribals of Nashik, Maharashtra, where mother's and father's education levels were significantly associated with delivery place choices.[7]
A study conducted in Srinagar[8] demonstrated that age, parity, and number of antenatal visits were significantly related to the place of delivery. This is in line with findings of our study.
Another study conducted in Eritrea showed that women who had more number of deliveries and past delivery in hospital had higher chances of delivering in hospital.[9] This supports out study where these two factors were found to be significantly associated with the choice of place of delivery. A study conducted in Meghalaya also confirmed similar findings.[10]
ConclusionAll these findings confirm to the fact that mothers who utilize the antenatal care services are more likely to delivery in hospital. This holds true even for the tribal areas. However, because they live in isolation in hilly areas, far away from civilization with their ancestral values, rituals, customs, beliefs, and myths intact, they essentially live in an environment that is not conducive to the general wellbeing of an individual as there is often lack of hygiene, shortage of food and water supply, etc. To add to this, their socio-economic vulnerabilities force them to face a lot of issues when it comes to health. Lack of awareness and access to health care, along with the strong belief in their magical/religious practices further add to the issue of health condition of the tribal people. However, his ordeal of the tribal people can be eased to an extent if MCH care utilization increases as demonstrated in our study. Institutional delivery would ensure that they are not predisposed to the bad health conditions since birth and in its essence, may act as a stepping stone for a better health care and a better future for both mother and the child. ANC care utilization and institutional deliveries also help to get mothers to understand their health needs and thus creating a demand for the same among the tribal communities which in turn would lead to better acceptance of the MCH care services.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
References
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