|Year : 2007 | Volume
| Issue : 3 | Page : 210-211
Socio-economic factors and delivery practices in an urban slum of district Nainital, Uttaranchal
Sanjay Pandey1, Ravi Shankar1, CMS Rawat1, VM Gupta2
1 Department of Community Medicine, UFHT Medical College, Haldwani, India
2 Dr. STM Hospital, UFHT Medical College, Haldwani, India
|Date of Submission||23-Jun-2007|
|Date of Acceptance||04-May-2007|
Department of Community Medicine, UFHT Medical College, Rampur Road, Haldwani, Distt Nainital, Uttranchal
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Pandey S, Shankar R, Rawat C, Gupta V. Socio-economic factors and delivery practices in an urban slum of district Nainital, Uttaranchal. Indian J Community Med 2007;32:210-1
|How to cite this URL:|
Pandey S, Shankar R, Rawat C, Gupta V. Socio-economic factors and delivery practices in an urban slum of district Nainital, Uttaranchal. Indian J Community Med [serial online] 2007 [cited 2017 Mar 28];32:210-1. Available from: http://www.ijcm.org.in/text.asp?2007/32/3/210/36832
Maternal and child mortality is the outcome of a complex web of causal factors that include social, economic, educational, cultural, geographic, state of physical infrastructure, and health system. India has made substantial gains in improving the overall health of women and children in the last 58 years of post-Independence, which is evidenced by decline in infant mortality rate from 146 to 70 (SRS,1999) and maternal mortality rate from 10 to 4.08 (per 1000 live births) through the years 1951 to 2000. Despite these gains, maternal and child deaths constitute a significant burden. According to WHO estimates (2000), India contributes about 24,00,000 out of 108,00,000 global child deaths and accounts for 25% of 529,000 global maternal deaths.  Since the implementation of India's family welfare programme in 1950s, many strategic modifications were made, but safe motherhood services have remained neglected even in the RCH-II programme launched earlier. The success in reducing maternal mortality has also been demonstrated in many states under the RCH-I programme, where the health departments creatively utilized the packages.  Thus, MCH services have been recognized as important thrust area not only to rural population but also to urban slum dwellers by the Government under National Population Policy 2000, National Health Policy 2002 and the Tenth Five Year Plan. Many complications occur during the delivery of a child, which may relate to the place of delivery or person conducting the delivery. The decision about place of delivery is also mainly influenced by social and economic factors. With this perspective, the present study has been aimed with an objective to ascertain the delivery practices with importance of socio-economic factors of the family.
| Materials and Methods|| |
A community-based, cross-sectional study was carried out during September to November 2005 in the catchment area of Urban Health Training Center of the Medical College at Haldwani of Nainital district, Uttaranchal.
The study subjects comprised mothers aged 15-49 years who delivered a child in the previous year and residing in the study area. After conducting door-to-door survey, a total of 103 mothers were selected and interviewed for data collection. The mothers selected for the study were either normal or having any risk related to their pregnancy state. A pre-designed, pre-tested, semi-structured schedule was used for data collection. Microsoft Excel software was used for data entry.
| Results and Discussion|| |
The reach and effectiveness of maternal and child health services in urban slums are strained by several challenges. Those with greatest need for health care often have the least access.
A population of 4561 individuals constituting 872 families residing in the study area of the Urban Health Training Center of the Medical College was surveyed by door-to-door visits. The crude birth rate of the surveyed area was 22.58 per 1000 population. The birth rate of the area was higher than the birth rate of the state of Uttaranchal (20.2 per 1000 population as per Census, 2001). According to the results of our study [Table - 1], about half the deliveries were conducted at home (51.45%) and the rest in different hospitals (48.55%) in the town. Deliveries conducted at home were assisted almost equally by both trained and untrained personnel.
The proportion of institutional deliveries (48.54%) in this area was much higher than our national figure (33.6%) and that of the neighboring state of Uttar Pradesh (15.5%).  This was also greater than the proportion of institutional deliveries in the eastern part of the country, i.e. the state of West Bengal. According to a study done in some blocks of West Bengal, the proportion of home deliveries (89.36%)was found to be higher than institutional deliveries (10.64%).  However, this is lower than the values from the southern part of the country. Results of a study conducted at Aurangabad city of Maharashatra stated that 67.62% of deliveries were conducted in government and private hospitals. 
According to the data in [Table - 2], hospital deliveries increase sharply with socio-economic status of the family ( p0 < 0.001). Results of the study also indicated that mothers belonging to upper socio-economic background (82.36%) preferred hospitals for delivery and those from lower (66.6%) and middle (57.83%) socio-economic group preferred home.
Poor access to health services even in urban area despite proximity to hospitals is a result of many factors including weak demand, minimal outreach services, weak community provider linkages, and timings that often do not suit the daily-wage-earning urban poor.
The type of family had no significant effect in deciding about the place of birth of child ( p > 0.05). The education of mother played a crucial role in making the decision about place of delivery ( p < 0.001). Mothers educated up to graduation and above (54%) opted for delivering their child at a hospital. Deliveries were conducted at home for mothers who were either illiterate (19%) or educated up to fifth standard (30%). These figures were in conformity with the report by National Family Health Survey-II of the neighboring state of Uttar Pradesh.  Therefore, the role of female literacy is also an important factor for achieving the target of institutional deliveries in our country.
The women of schedule caste and tribe (28%) had significantly lower proportions of institutional deliveries than women who belonged to other groups ( p < 0.001). This proportion is also in accordance with the reports from Uttar Pradesh. 
| References|| |
|1.||WHO/UNICEF/UNFPA. Maternal mortality in 2000: Estimates developed by WHO, UNICEF and UNFPA. World Health Organization: Geneva; 2004. |
|2.||Ved R Rajani, Dua AS. Review of women and children's health in India: Focus on safe mother hood. National commission on Macro economics and Health Back ground papers. Burden of disease in India. 2005. p. 85-103. |
|3.||International Institute for Population Sciences, Mumbai. National Family Health Survey (NFHS-2)-1998-99. p. 295-7. |
|4.||Sengupta B, Das BK, Sinha RN, Chaudhari RN. A study on the delivery practices irreverence and non Reverine blocks of the district of South 24- Parganas, West- Bangal. Indian J Public Health 2006;49:243-4. |
|5.||Doke PP, Sathe PV. Social classification and maternity Practices in Aurangabad, India. Indian J Public Health 1991;35:75-9. [PUBMED] |
[Table - 1], [Table - 2]
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