|Year : 2013 | Volume
| Issue : 1 | Page : 7-13
Status of institutional delivery in a block of Western India
AK Singh1, Niraj Pandit2, Diwakar Sharma3
1 Resident, Department of Community Medicine, SBKS Medical Institute & Research Center, Sumandeep Vidyapeeth, Piparia, Vadodara-391760, Gujarat, India
2 Professor, Department of Community Medicine, SBKS Medical Institute & Research Center, Sumandeep Vidyapeeth, Piparia, Vadodara-391760, Gujarat, India
3 Assistant Professor, Biostatistics, Department of Community Medicine, GMERS Medical College, Patan, India
|Date of Web Publication||13-Aug-2018|
Professor, Department of Community Medicine, SBKS Medical Institute & Research Center, Sumandeep Vidyapeeth, Piparia, Vadodara-391760, Gujarat, India
Source of Support: None, Conflict of Interest: None
Introduction: Health of mother and children is an asset to the family, society and community. The contribution of institutional delivery in achieving the optimal health of a mother and a child is beyond doubt. The present study was conducted with the objective to know the status of institutional delivery in a block of Vadodara district of western India.
Methods: A cross sectional study was conducted during December 2011 to October 2012. The study participants were mother, who had delivered their live baby during 1st April 2010 to 31st March 2011 and living in Vadodara Block. One per cent of the total live births during that duration were selected as the study participants. Samples represent both urban and rural areas of Vadodara Block. The systemic stratified random sampling method was used for selection of participants.
Results: Majority 327 (90.6%) of the delivery was institutional. Among institutional delivery, 173 (47.9%) participants went to public health institution and 154 (42.7%) went to private health institution. The reasons for home delivery (9.4%) were dissatisfaction from the institution (hospital) 19 (56%), economic constrain 11(32%) and distance factor 4(12%).
Conclusion: Almost 90% of study participants delivered baby at institution. It is a positive trend observed in the achievement of government target to 100% institution deliveries. The home deliveries are still prevalent in illiterate and schedule caste and schedule tribe population.
Keywords: Institutional delivery, Home delivery, Vadodara block
|How to cite this article:|
Singh A K, Pandit N, Sharma D. Status of institutional delivery in a block of Western India. J Integr Health Sci 2013;1:7-13
|How to cite this URL:|
Singh A K, Pandit N, Sharma D. Status of institutional delivery in a block of Western India. J Integr Health Sci [serial online] 2013 [cited 2021 Dec 3];1:7-13. Available from: https://www.jihs.in/text.asp?2013/1/1/7/238987
| Introduction|| |
The contribution of institutional delivery in achieving the optimal health of a mother and a child is beyond explanation. The place of delivery is an important determinant which affects the health of the mother and the newborn. Institutional deliveries provide access to skilled person, assistance, drugs, equipment, and transport. As per the National Population Policy 2000 of India, one of the goals is to achieve 80% institutional deliveries and 100% deliveries to be assisted by skilled health personnel by year 2015. These are the two interventions, which are identified as important initiatives to reduce the maternal mortality ratio, an important goal of the fifth Millennium Development Goal.
Most of the maternal and childhood morbidity and mortality are prevented with skilled obstetric care,. The World Health Organization (WHO) has outlined the importance of skilled obstetric care in critical strategy for reducing maternal morbidity and mortality in developing countries. WHO defines Skilled Birth Attendant (SBA) as “accredited health professional(s) who may be a midwife, doctor or nurse; who is competent in managing normal pregnancy and childbirth, as well as identifying, managing and referring mother and her baby when it get complicated .
Skilled birth attendant at delivery is a one of the indicator in monitoring of progress towards Millennium Development Goals 4 and 5 which are to reduce the infant mortality rate and maternal mortality ratio by three quarters between 1990 and 2015. It is important that mother deliver their babies in a suitable environment, where life saving support exists and hygienic conditions can help to reduce the risk of complications which attribute the illness or death to mother and child.
India accounts for more than twenty percent of global burden of maternal mortality and the largest number of maternal deaths. A quarter of the world’s neonatal deaths occur in India. Most of maternal morbidity and mortality are caused by Haemorrhage (29%), anaemia (19%), sepsis (16%), obstructed labour (10%), unsafe abortion (9%), and hypertensive disorders of pregnancy (8%). The perinatal mortality has great contribution in reducing infant and childhood mortality rate. The main causes of perinatal mortality are intrauterine and birth asphyxia, low birth weight, birth trauma, and intrauterine or neonatal infections.
In India, only 46.6% of births are attended by a Skilled Birth Attendant (SBA) reported by United Nation in 2008. Whereas in Gujarat, the institutional delivery had increased from 46.1% in District Level Household Survey  – 1 (DLHS-1) to 52.2% in DLHS-2 and 56.4% in DLHS-3. But there is wide variation as per DLHS reports  in district-wise data of Gujarat. The Gujarat Government targeted to achieve 100% institutional delivery, reduction of MMR to 100 per live births and reduction of IMR to 30 by 2015.
The Government of India has implemented large intersecting programmes to improve women’s and child’s health. Reproductive and Child Health –II, National Rural Heath Mission (NRHM) programme (2005-2012) including the Janani Suraksha Yojana (JSY), a maternity incentive scheme under which all pregnant women living below poverty line (BPL) receive cash money to attend antenatal care, deliver baby in a health facility and receive postnatal checkup and recently, Ministry of Health has launched Janani Shishu Suraksha Karyakram (JSSK) under NRHM, on 1st June 2011. In addition to above mentioned programmes of Govt. of India, Gujarat Govt. has also taken several other steps like Chiranjeevi Yojana, 108 emergency ambulance services to promote institutional delivery.
Looking to all above initiatives by state and central government to promote the Institutional delivery to reduce the maternal mortality as well as the perinatal mortality, the present study aimed to know the status of institutional delivery in Vadodara Taluka of Vadodara district.
| Materials and Methods|| |
Study location: Vadodara block in Vadodara district of western Indian state Gujarat.
Study type: Cross sectional study
Study Period: December 2011 to October 2012
Study population: Mother, who had delivered her live baby during 1st April 2010 to 31st March 2011 and living in Vadodara block.
Sample selection: The data of registered live birth for year 2010-2011 was collected. During the time the registered live birth in municipal area (urban area) were 27753 as per report from the Chief Municipal Health Officer, Vadodara Municipal Corporation, Vadodara and the registered live birth in Vadodara rural area were 8335 as per report from the Chief District Health Officer, District Panchayat, Vadodara. The systemic stratified random sampling method was use for selection of participants.
Looking to feasibility of study, it was decided to take one per cent of the total live births of both areas as the study participants, thus 278 participants were from municipal area (urban) and 83 participants were from rural area, make the study population. The total sample size was 361 women. The Vadodara city has 13 wards. The 278 participants were selected from all wards of city. Thus there were 21 study participants from each ward. These 21 – 22 participants were selected purposely (first found first selected) equally from each of four corners of every ward. Similarly, there are 9 PHC areas in Vadodara taluka. The 83 study participants were selected form these 9 PHC area. There were 9 – 10 participants selected purposely (first found first selected) equally from each of four corners of every PHC areas.
Procedure: The list of the participants was taken from Anganwari centre with the help of Anganwadi worker the selected mother was approached. The participant was informed regarding the study viz. purpose of the study, method of the study to the head of family in the vernacular language. Written informed consent was obtained from the each participant. The pilot pre-tested questionnaire was used for data collection. Questionnaire had two parts. First parts contained socio-demographic details of study participants regarding age, sex, religion, marital status, education, occupation, income, addiction (tobacco and alcohol), drug using for any chronic illness etc. Second part of questionnaire consisted of specific question related to institutional delivery.
Statistical method: Collected data were cleaned and analyzed by Epi Info 7 software and SPSS version 20 software.
| Results|| |
There were 278 (77.00%) participants from urban and 83 (23.00%) from rural areas. Among 361 participants one had delivered her baby en-route while going to institution for delivery. En-route delivery was considered as home delivery in study.
The socio-demographic characteristics of the respondent mothers (participants) are shown in table I. It was observed that 244 (67.6%) participants belong to age group 19 to 25 and 102 (28.3%) participants in age group 26 to 35. Almost 57% participants belonged to joint family while 42.9% participants belonged to nuclear family.
For the socio-economic classification, modified Prasad’s socio-economic classification was used. Majority of participants 178 (49.3%) and 135 (37.4%) belonged to upper and middle socio-economic class respectively, while only 88 (13.3%) belonged to lower socio-economic class [Table 1].
293 (81.2%) participants delivered their live baby at term while 44 (12.2%) and 24 (6.6%) participants delivered at post-term and pre-term period of gestational age respectively. Out of 361, majority 327 (90.6%) mother delivered their baby at institution and only 34 (9.4%) participants delivered at home.
The reasons cited by those who opted for home delivery were primarily dissatisfaction from the institution (hospital) in 19 (56%) followed by economic constraint in 11 (32%) cases and distance factor in 4 (12%) cases [Table 2]. The dissatisfaction means they had bad experience about hospital system in past.
[Table 3] shows that there is relation between education and selection of delivery place, as education of mother increase the institution delivery selection is significantly increase (X 2 =47, P<0.001).
There was highly significant home delivery found in Schedule Tribe (ST) participants followed by Schedule Cast (SC) & Other Backward Class (OBC) and least in general community as shown in table (χ2=23.596, df = 6, P= 0.001) (Table 4).
Distance of institution from participants home does not make any significant difference in selection of place of delivery as shown in [Table 5]. There were 30 (88.24%) participants out of 34 who prefer home delivery in spite of having health institution within the 10 kms from their home. It was observed that place of birth significantly affect their survival as shown in [Table 6].
|Table 6: Distribution of child survival at the time of interview and place of delivery|
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| Discussion|| |
The DLHS – 3 (2007 – 2008) shows that the institutional delivery in Gujarat was 56.4%. In present study, 90.6% deliveries were conducted at institutional level. This observation shows that in Gujarat there is a lot of improvement in promoting institutional delivery since last DLHS. Adamson PC mentioned in his study in Karnataka, that among marginalized population 56.7% were institutional deliveries and 35.9% at home. In marginalized group there are many hurdles which prevent to go for institutional delivery. In present study, the major numbers of home deliveries were observed among schedule cast community who are considered marginalized in state. Geeta SP et al found in their study that 69% of the total number of deliveries (n=2,211) in 2008 – 2009 in rural Nanded, Maharashtra were conducted in institutions. They found a substantial increase in the proportion of institutional deliveries since the implementation of NRHM. Panja TK et al also found in their study that 73.1% deliveries (n = 324) were institutional out of which 11.1% were conducted in private facilities. Geeta SP et al also found that 39% of the total number (n=2,211) of deliveries in 2008-2009 were conducted in the public health institutions and 30% in the private institutions. In present study, 173 (47.9%) participants went to public health institution and 154 (42.7%) went to private health institution for delivery during 2010 - 2011.
Literacy status of the mother, socio-economic class of the family and the type of family are strongly associated factors with place of delivery. In present study it was observed that 79.41% non – institutional deliveries (home deliveries) were in middle and lower social class. Kotnis SD at el did a study with sample size (n = 1441) on home delivery in slum and found that home deliveries were more frequent in illiterate mothers (16.38%), while only 4.91% in literate mothers did home delivery. Around 78% of home deliveries were seen in middle and lower Socioeconomic class. They found that leading cause of home deliveries are customs (26.37%), economic problem (25.27%), spontaneous delivery (24.18%), homely atmosphere (13.19%) and not satisfied with service of hospitals (10.9%). In present study, among home delivery (n=34); 55.88% participants did deliver their babies at home due to their inconvenience in institution, 32.35% due to economic constraint and 11.77% cases due to distance factor. Kesterton at al studied on institutional delivery in rural India and reported that distance to hospital is a major factor in choosing institution for delivery. They found that only 13.4 % (n=3027) institutional delivery occurred where the distance is more than 31kms from the home while 32.0% (6160) delivery occurred in less than 5 kms distant institutions.
| Conclusion|| |
The study conclude that institutional delivery has increased markedly reflecting a positive trend which in due course will help in achieving the Gujarat government target of accomplishing 100% institutional deliveries. The home deliveries are still prevalent in illiterate and schedule cast population. The distance to the health care facilities is still seemingly small yet important hurdle.
Limitation and Recommendation:
The limitation of the present study was that the study was small sample size, but still it carry value to see the positive trend in Gujarat.
The government need to focus on overcoming hurdles in order to achieve the target for 2015. There is a need to focus on the weak links like distance, cast based preference, focus on illiterate population for early motivation for institution delivery, providing adequate staff at village or tribal level for counselling and reassurance. Also there is need to keep an eye on the status revealed through such small or big statewide studies.
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[Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6]