Care seeking for postpartum morbidities in Murshidabad, rural India

Abstract

Worldwide, an estimated 536 000 maternal deaths occur each year [1]. Of these, approximately 25% occur in India alone [2]. Postpartum maternal morbidity, defined by the WHO as morbidity occurring in the first 6 weeks after delivery, is a serious problem in resource-poor settings that contributes to maternal death [3]. Despite the high prevalence of postpartum morbidity and the danger of maternal mortality, women in low-resource settings such as rural India frequently fail to seek care from formal health providers [4]. Understanding the factors that influence care-seeking behavior for postpartum health problems in India is vital to setting program priorities and designing appropriate interventions. Our study sought to elucidate these factors in the rural district of Murshidabad, India.We conducted secondary data analysis using multinomial logistic regression methods, using data collected through a household survey involving interviews with 2114 mothers carried out in February 2008 in the Murshidabad district of India. IRB approval was obtained from Johns Hopkins University Bloomberg School of Public Health.A total of 929 (43.9%) mothers were reported to have had postpartum morbidities in the 6 weeks after delivery and were included in our analysis. Of these women, 54 (5.8%) did not seek care, 457 (49.2%) sought care from informal providers, and 418 (45.0%) sought care from formal providers. Most mothers lived in rural areas, were of lower socioeconomic status, were unemployed, and did not deliver at health facilities. The majority of mothers (62.5%) were Muslim, and most women and household heads had low educational levels. The mean distance to the nearest healthcare facility from a household was 3.9 kilometers (Table 1).Women who sought care for their morbidities from formal providers were compared with those who sought care from informal providers. In households in which the household head had a high school or higher level of education, the women were more likely to have sought care from a formal rather than an informal provider (relative risk ratio [RRR] 1.79; P b 0.05). Women who had delivered at a health facility were nearly 4 times more likely to seek care from a formal provider (RRR 3.85; P b 0.001). Women who were reported to have had a severe postpartum morbidity were more likely to have sought care from a formal provider (RRR 1.48; P b 0.05). Hindu women

Inequity in India: the case of maternal and reproductive health

“…A study looking at factors influencing the use of maternal health care service in Madhya Pradesh found that Muslim women, and women belonging to non-ST, were more likely to receive ANC than other groups of women (53). Muslim women were found to be more likely to seek care for postpartum morbidities from formal providers as compared to Hindu women in a study conducted in rural West Bengal (82). An ethnographic study conducted in a rural Muslim village in Uttar Pradesh on perceptions and experiences in regards to institutional deliveries, showed how widespread mistrust toward the public health system, traditional practices in regards to the use of contraceptives and home deliveries, and poverty, interact in causing barriers for women to access skilled assistant at birth for Muslim women in this community (83).…”

Determinants of Maternity Care Services Utilization among Married Adolescents in Rural India

“…Delivery conducted either in a medical institution or home deliveries assisted by doctor/nurse/Lady Health Visitor (LHV)/Auxiliary Nurse Midwife (ANM)/other health professionals are termed as safe delivery [37]. The study considered postnatal care check-up within 42 days after child birth as a potential maternal healthcare service indicator [41], [42].…”

Informal rural healthcare providers in North and South India

“…People consult IPs for a variety of common conditions, which include fevers, diarrhoea and respiratory problems (Rohde and Vishwanathan 1995; Kanjilal et al 2007; Gautham et al 2011; George and Iyer 2013) postpartum morbidity, anaemia and white discharge in women (Rao 2005; Tuddenham et al 2010) and newborn illnesses (Kaushal et al 2005). These providers tend to be viewed as a homogenous group, but studies in different settings suggest that they differ, in terms of education and training, the contents of their practice and their business model (Gautham et al 2011; George and Iyer 2013).…”