BackgroundIndia has made large strides in reducing maternal mortality ratio and neonatal mortality rate, yet care-seeking behavior for appropriate care is still a challenge. We conducted a qualitative study to understand the process of recognition and care-seeking for maternal and newborn illnesses in rural India where a health intervention through women’s self-help groups (SHG) to improve maternal and newborn health behaviors is implemented by a non-governmental organization, the Rajiv Gandhi Mahila Vikas Pariyojana. The study aimed to understand the process of recognition and care-seeking for maternal and newborn illnesses from SHG and non-SHG households in the intervention area.MethodsThirty-two illness narratives, 16 of maternal deaths and illness and 16 of newborn illnesses and deaths, were conducted. Women, their family members, and other caretakers who were present during the event of illness or death were included in the interviews. About 14 key informants, mainly frontline health workers (FLWs), were also interviewed. The interviews were conducted by two Population Council staff using a pre-tested guideline in Hindi.ResultsOur findings suggest that perceptions of causes of illness as “supernatural” or “medical” and the timing of onset of illness influence the pathway of care-seeking. Deep-rooted cultural beliefs and rituals guided care-seeking behavior and restricted new mothers and newborns’ mobility for care-seeking. Though families described experience of postpartum hemorrhage as severe, they often considered it as “normal.” When the onset of illness was during pregnancy, care was sought from health facilities. As the step of care for maternal illness, SHG households went to government facilities, and non-SHG households took home-based care. Home-based care was the first step of care for newborn illnesses for both SHG and non-SHG households; however, SHG households were prompt in seeking care outside of home, and non-SHG households delayed seeking care until symptoms were perceived to be severe.ConclusionOur findings indicate that care-seeking behavior for maternal and newborn morbidities could be improved by interventions through social platforms such as SHGs.

This systematic review synthesizes evidence on the impact of conditional and unconditional cash transfers (CCT and UCT) on contraception in low‐ and middle‐income countries. Scientific and gray literature databases were searched from 1994 to 2016 and 11 papers from ten studies were included. Most of the studies had low risk of bias. Cash transfers were used for increasing school attendance or improving health and nutrition, but not directly for contraception. Three studies showed positive impact on contraceptive use and four showed a decrease in fertility outcomes. An increase in childbearing was observed in two studies, and three studies demonstrated no impact on fertility indicators. All studies treated contraceptive use or fertility only as unintended and indirect outcomes. The available evidence on impact of CCT and UCT on contraception is inconclusive due to the limited number of studies, varying outcome measures, and lack of intervention specifically for contraception.

No abstract

Background: Early childhood growth failure including stunting is associated with suboptimal health and cognitive development outcomes. Despite progress, the prevalence of childhood stunting in India remains amongst the highest globally. Objective: We aimed to evaluate the impact of a systems strengthening interventional package, including body-mass-index measurement at pregnancy registration, monthly weight monitoring, on-the-spot supplementary nutrition, iron-folic acid supplementation, and targeted dietary counselling provided to women during their antenatal care on childhood stunting. Methods: This is a prospective follow-up comparison study. Women from three districts in West Bengal, India in their first trimester of pregnancy between May 2018 and May 2019 were enrolled into the study. Pregnancy, birth and infant characteristics were collected, and anthropometric indices measured. The relative risk of stunting in children in intervention and comparison groups were compared using generalized linear model to adjust for clustering effect. Results: A total of 809 mother-child dyads (406 intervention; 403 comparison) were followed between May 2018 and May 2021. The median age of women in the intervention and comparison group was 23 (IQR 20-25) and 25 (IQR 24-27) years respectively. Median gestational weight gain was higher amongst women in the intervention group (9 vs. 8 kilograms, p=0.04). Low-birth-weight prevalence was 29.3% (119/406) and 32.0% (129/403) in the intervention and comparison group respectively. At 12-35 months of age, children born to women in the intervention group had significantly reduced risk of stunting (RR=0.58, 95% CI 0.45-0.75, p<0.001). The odds of stunting amongst children born with low birthweight to women in the comparison group were statistically significant [OR 2.44 (1.44-4.14)], unlike those amongst children born to women in the intervention group [1.19 (0.58-2.46)]. Conclusions: These results indicate that strengthening of routine antenatal care including targeted nutritional counselling to expectant mothers can have distal beneficial effects on childhood stunting beyond the immediate post-natal period.

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.