Institutional Deliveries In India - A Socio Economic And Cultural View

Institutional Deliveriesavailability of care givers, distance from health care
A socio Economic and cultural viewfacility and the cost including the user fees. The
wages lost to the accompanying pregnant women
• Distance from health services;will play a major role in care givers and their attitude
• Costs, including user feestowards the pregnant lady delays the utilization of
• The cost of transport,delivery services.
• Quality of care,The quality of health care in India with shortage in
• Drugs availability & Supplieshuman resource in health sector and the attitude of
• Attitudes of health personnel,health personnel towards the patient and their higher
• Multiple demands on women's time;absenteeism to the duties questioning the
• Women's lack of autonomy indecision-making.improvement of utilization of maternity health
Poverty plays an important role in utilization ofservices. A woman with a complication is likely to
maternal health services. There is a disparity indelay or avoid accessing care from a health facility
utilization of delivery services between rich and poorwhere she has experienced a good but disrespectful
countries as well as in individuals as evidenced bytreatment in a previous normal birth. Hulton et al
world bank report by Gwatkin et al. India with high(2000) .This may be one of the cause, parity as it
growth rate and yet a developing country havingincreases women are less likely to come to health
significant number of BPL families , in spite of all thecare facility. The quality of care has proved to have
efforts made by the Govt. and NGO agencies thereimpact on utilization of maternity health services by
are only 3 states having more than 75% ofthose women who receive one or more antenatal
institutional deliveries (NFHS3).Poverty itself acts oncheck-ups is the strongest predictor of institutional
poor utilization of maternal services and also relateddelivery.(NFHS2)
to other causes which in turn influence the maternalRural mothers belonging to scheduled caste and
health services like literacy, availability of healthscheduled tribe are much less likely to give birth in
services .medical institutions than the others (NFHS2). This is
Norms and beliefs in different parts of India affectassociated with many other causes like accessibility
significantly the health seeking behavior of women. In,customs , affordability to health care services
rural India there are some false beliefs like prolonged.interestingly same religion having different levels of
labor is a punishment for the past infidelity, andinstitutional deliveries in different parts of India as
unassisted delivery is a sign of courage. Traditionally inseen below. Muslim mothers are more likely than
rural India pregnancy is considered to be a naturalHindu mothers to give birth in a medical institution in
state of being rather than a condition requiringAndhra Pradesh and Gujarat, but Muslim mothers are
medical attention and care. Such perception constrainsmuch less likely than Hindu mothers to do so in Bihar
a lay - health culture which is an intervening factorand Rajasthan. (NFHS2) . There is a difference in
between the presence of morbidity condition and itsutilization of health services scheduled caste and
corresponding treatment.(NFHS3). These traditionalscheduled tribes between rural and urban areas.
beliefs about child birth coupled with misconceptionsScheduled caste and scheduled tribes mothers living in
fears of medical institutions, have led many womenurban areas are more utilizing the maternal health
to maintain reliance on home births in India. (Americanservices. According to the NFHS data there is a study
Journal of Public Health 2006). Even in this high ITgrowth in utilization of maternal health services in
development and industrialization in some parts ofboth rural and urban areas. Growth is more rapid in
India women rely on traditional birth attendant andurban areas than rural but growth must be more in
some state govt. also supporting the TBA (mithani)order to achieve IMR and MMR goals set by NRHM.
system in Chattisgadh thus indirectly supporting theThe inability of women in some developing countries
home deliveries.to make decisions in relation to choice of medical
Shame in the first birth and newly pregnant girls arecare severely affects their choice of delivery care. A
expected to exihi9bit modest behavior by remainingconflict between biomedical and traditionally perceived
calm in their vital condition and not talk at all aboutcauses of health conditions also limits women's access
the pregnancy, the social pressure may create ato delivery care. Surprisingly woman's autonomy, as
major barrier to seeking antenatal care or delivering inmeasured by decision making about her own health
hospital. Wall (1998 ).This is further strengthened bycare, shows little association with institutional delivery
some religions and illiteracy , some cultures. thesein India. (NFHS2).
type of beliefs and norms are not only confined toInstitutional deliveries were also influenced like some
India and also seen in some African and Latindemographic factors, some of them are, Increase in
American and south Asian cultures pain and illness arethe Maternal age has a strong positive effect in
considered to be natural part of women , therefore itutilizing delivery services, Increase in the birth order
is deemed unnecessary to9 seek medical carehas a negative in the maternal service
including delivery care. (Ascadi and Johnson-Ascadiutilization,(NFHS-2) in Andhra Pradesh, 53 percent of
(1993)first-order births but only 24 percent of fourth or
Literacy has a strong association in utilizing thehigher-order births took place in medical institutions.
maternal health services. woman's education is aUnmarried pregnant girls are less likely to utilize the
major factor affecting utilization of maternal healthmaternity health services. High fertility may also
services in both north and south India (Govindasamyreflect a lack of reproductive health services and a
and Ramesh 1997). Literacy is also related with otherlack of awareness of such services, both of which
factors like poverty and overcoming some old normshave obvious implications for maternal health service
and beliefs and knowing herself about the physiologyuse. (American Journal of Public Health 2006). Working
of pregnancy. when a girl is in studies it prolongs theurban mothers are less likely to deliver in a medical
age at marriage preventing early marriages which isinstitution than nonworking mothers.NFHS2.
associated with major problems like LBW,IMR andThe role of Mass media should not be forget,
also contributing to the low utilization of maternityInstructional delivery are higher for mothers who are
health services .(NFHS1,2,3). High levels of husbands'regularly exposed to the electronic mass media than
education increase the likelihood of health servicemothers who are not regularly exposed(NFHS2)
(American Journal of Public Health 2006)It's a bitter part that no political party is interested in
In India transport cost and the opportunity cost ofmaternal health and has maternal health on its
the patient and care givers where necessary have aagenda. If India wants to reach the NRHM goals it
significant negative impact on utilization of deliveryneeds strong political commitment with more focus
care services. In real, most of the rural women inon health sector which it turn contribute towards
India land in a health care facility with advanced stage"HEALTHY INDIA''
of labour or after developing the complications. This is- Dr.V.Sudhakaram,M.B.B.
also influenced by factors like transport availability,