Differentials in the quality of antenatal care in India

Rani, Manju; Bonu, Sekhar; Harvey, Steven A.

doi:10.1093/intqhc/mzm052

Cited by 134 publications

(108 citation statements)

References 16 publications

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“…71 Another important data gap involves indicators for coverage of stillbirth interventions that should be provided during antenatal or intrapartum care. Many of the interventions to reduce stillbirths, such as appropriate management of hypertensive disease in pregnancy, syphilis screening and treatment, 93,94 or fetal heart rate monitoring, as discussed in the third paper of this Series, 20 are not routinely tracked at the population level. For women who receive care, there are often missed opportunities between the contact point (antenatal or intrapartum) and the provision of high-impact, evidencebased interventions.…”

Section: Comparable Definitionmentioning

confidence: 99%

Stillbirths: Where? When? Why? How to make the data count?

et al. 2011

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for The Lancet's Stillbirths Series steering committee* Despite increasing attention and investment for maternal, neonatal, and child health, stillbirths remain invisible-not counted in the Millennium Development Goals, nor tracked by the UN, nor in the Global Burden of Disease metrics. At least 2·65 million stillbirths (uncertainty range 2·08 million to 3·79 million) were estimated worldwide in 2008 (≥1000 g birthweight or ≥28 weeks of gestation). 98% of stillbirths occur in low-income and middle-income countries, and numbers vary from 2·0 per 1000 total births in Finland to more than 40 per 1000 total births in Nigeria and Pakistan. Worldwide, 67% of stillbirths occur in rural families, 55% in rural sub-Saharan Africa and south Asia, where skilled birth attendance and caesarean sections are much lower than that for urban births. In total, an estimated 1·19 million (range 0·82 million to 1·97 million) intrapartum stillbirths occur yearly. Most intrapartum stillbirths are associated with obstetric emergencies, whereas antepartum stillbirths are associated with maternal infections and fetal growth restriction. National estimates of causes of stillbirths are scarce, and multiple (>35) classifi cation systems impede international comparison. Immediate data improvements are feasible through household surveys and facility audit, and improvements in vital registration, including specifi c perinatal certifi cates and revised International Classifi cation of Disease codes, are needed. A simple, programme-relevant stillbirth classifi cation that can be used with verbal autopsy would provide a basis for comparable national estimates. A new focus on all deaths around the time of birth is crucial to inform programmatic investment. Why don't stillbirths count?Stillbirths are invisible in many societies and on the worldwide policy agenda, but are very real to families who experience a death. Despite 30 years of attention to child survival interventions, 1,2 more than 20 years of attention to safe motherhood, 3,4 and increasing recent attention to survival of newborn babies, 5-7 the focus worldwide has remained on survival after livebirth. Stillbirths remain mostly ignored, not counting on policy, programme, and investment agendas, both internationally and often also at the national level. 8 The importance of neonatal deaths has risen on the worldwide policy agenda, mainly because of the Millennium Development Goals (MDGs) and recognition of the increasing proportion of child deaths that happen in the fi rst month of life-from 37% in 2000 7 to 41% in 2008. 9 A baby who dies just after birth counts in the MDG tracking, but a baby who dies in the third trimester or even during labour does not. Neither the MDGs nor the Global Burden of Disease metrics mention stillbirths, and stillbirth data are not routinely compiled by the UN. Even when stillbirths are recorded in surveys, the data are frequently combined with early neonatal deaths and reported as perinatal mortality, a combination that reduces visibility and might mask reporti...

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Section: Comparable Definitionmentioning

confidence: 99%

Stillbirths: Where? When? Why? How to make the data count?

et al. 2011

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“…(Paramedic PACPs are mostly male, whom women are unlikely to visit for antenatal care in this setting because of the gender barrier.) A more recent study also reported the poor quality of antenatal care in the north Indian states and the negative influence this could have on the uptake of such care (Rani et al 2008). The same is the case with skilled attendance at delivery.…”

Section: Discussionmentioning

confidence: 98%

Private individual ambulatory health care providers in Madhya Pradesh province, India

Costa¹,

Eriksson²,

Diwan³

2009

J Public Health

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Background Ambulatory health care services are a major contributor to the large and inequitable health financing burdens (largely out-of-pocket) faced by households in India. The private sector has a virtual monopoly over ambulatory curative services in rural and urban India. Despite this, there is little knowledge about who these providers are, their numbers, distribution, and activities. Aim This study describes the numbers, gender, distribution, and characteristics of private individual ambulatory care providers in Madhya Pradesh (60.4 million people), one of India's largest provinces. It discusses the suitability of this provider mix to deal with maternal and child health, a major health priority in the province. Method A survey enlisting all health care providers was conducted in the 52,117 villages and 394 towns of the province. Results There were 14,046 private qualified physicians (12.5% women), 57,684 qualified paramedics (3.4% women), and 89,090 unqualified providers (10% women) providing ambulatory services in individual setups. In addition, 55,393 traditional birth attendants provided home-based intranatal care. The macro organization of these providers in this setting is presented. Given the high levels of maternal and child mortality in the province, excessive reliance is placed on less than competent providers as these present lower access barriers. Conclusion Given the public health priorities in this province (maternal and child health), the provider mix is not optimally suited to the populations' needs. There is a lack of competent qualified care required to deal with the major causes of morbidity and mortality, particularly in rural areas. Access to qualified women providers is low. The lack of a cadre of qualified midwives possibly contributes to some of the high maternal mortality observed in this province.

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“…These findings were consistent with findings of other studies. [5][6][7][8][9] This study shows that 30.50% babies of unbooked mothers and 19.50% babies of booked mother had Apgar score <7 at one minute (p<0.002) while 12% babies of unbooked mothers and 5.50% babies of booked mothers had Apgar score of <7 at five minute. It indicates that as compared to booked mothers, babies of unbooked mothers were 1.5 times more likely to have birth asphyxia (p<0.002).…”

Section: Discussionmentioning

confidence: 99%

Analytical study to assess fetal and perinatal outcome in booked and unbooked obstetric cases

Chourasia

Yadav

2016

Int J Reprod Contracept Obstet Gynecol

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Background:The high perinatal mortality rates are indicators of the poor state of health services and it is pertinent to determine the relationship between the booking status of mother and fetal outcomes. Methods: In the present randomized prospective study of 400 unbooked (study group) obstetric cases were evaluated and compared with 400 booked (control group) obstetric cases over a period of one year. Results: Perinatal outcomes of women in study group were significantly poorer than women in control group due to high preterm delivery, LBW, with low Apgar score at five minutes, with more NICU admission due to RDS, with high perinatal mortality in term of IUD, early neonatal deaths in study group. Conclusions: Findings of the study will help the programmers and service providers in identifying areas where emphasis has to be given in the development of strategies that will promote the utilization of antenatal services, to reduce adverse perinatal and fetal outcome.

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Differentials in the quality of antenatal care in India

Cited by 134 publications

References 16 publications

Stillbirths: Where? When? Why? How to make the data count?

Stillbirths: Where? When? Why? How to make the data count?

Private individual ambulatory health care providers in Madhya Pradesh province, India

Analytical study to assess fetal and perinatal outcome in booked and unbooked obstetric cases

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