Care-seeking behaviors for maternal and newborn illnesses among self-help group households in Uttar Pradesh, India

Abstract

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.

The Knowledge of Danger Signs of Obstetric Complications Among Women in Rural India: Evaluating an Integrated Microfinance and Health Literacy Program

“…Past studies show that early detection of maternal danger signs can help reduce maternal deaths in rural India that are otherwise precipitated due to delayed care-seeking by households (16,24,61). Moreover, evidence from verbal autopsy studies in rural and tribal India found that while delays occur in all stages of care-seeking, a disproportionate number of women and households lack awareness of danger signs, the reason why serious complications are ignored and not treated in pregnancy, leading to deaths (16,24,61).…”

“…Past studies show that early detection of maternal danger signs can help reduce maternal deaths in rural India that are otherwise precipitated due to delayed care-seeking by households (16,24,61). Moreover, evidence from verbal autopsy studies in rural and tribal India found that while delays occur in all stages of care-seeking, a disproportionate number of women and households lack awareness of danger signs, the reason why serious complications are ignored and not treated in pregnancy, leading to deaths (16,24,61). The lack of awareness in a rural setting, such as in this study, is exacerbated by high poverty and low education in general, and speci cally for women who are further marginalised due to restrictive cultural norms that in uence women's independent decision-making and healthcare-seeking (24,29,61).…”

“…Studies from rural Uttar Pradesh showed that delays in care-seeking were exacerbated by health system gaps in the provision of adequate pre-and post-natal care, gaps that disproportionately impact poor families with low literacy (24)(25)(26)(27). Additionally, among the 22 per cent of pregnant women in rural UP who reported receiving the minimum required three Antenatal care (ANC) visits (now the minimum required ANC visits are revised to four), only 10 per cent consumed the recommended iron-folic acid (IFA) for 100 days or more when they were pregnant (23).…”

“…Women having knowledge of danger sign are likely to support earlier identi cation of maternal complications when they occur and prompt families to seek early health care. Studies in many settings found that low knowledge levels predispose women and households to either miss out potential maternal complications or seek delayed care to the detriment of the mother (16,24,27,28,29).…”

Health information needs assessment among self-help groups and willingness for involvement in health promotion in a rural setting in Puducherry: A mixed-method study

“…Various other studies published in the Asian context have emphasized the greater picture of involving SHGs in providing health services. [2324] They were willing to take up jobs such as provision of IFA tablets, serving as proxy for bed-ridden noncommunicable disease (NCD) patients, and mobilization for NCD screening. Some showed interest in taking up cancer screening and measurement of blood pressure.…”