• Users Online: 479
  • Home
  • Print this page
  • Email this page
Home About us Editorial board Ahead of print Current issue Search Archives Submit article Instructions Subscribe Contacts Login 


 
 Table of Contents  
ORIGINAL ARTICLE
Year : 2020  |  Volume : 10  |  Issue : 3  |  Page : 103-109

A study to assess the utilisation of health services by pregnant women in rural area of Vadodara district


Department of Management, Sumandeep Vidyapeeth (Deemed to be University), Vadodara, Gujarat, India

Date of Submission08-May-2020
Date of Acceptance10-Aug-2020
Date of Web Publication22-Sep-2020

Correspondence Address:
Medha Wadhwa
Department of Management, Sumandeep Vidyapeeth Deemed to be University, Piparia, Vadodara, Gujarat
India
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/AIHB.AIHB_38_20

Rights and Permissions
  Abstract 


Introduction: A healthy society is indicated by not merely the absence of disease or low mortality/morbidity status but rather the different dimensions of health of the population of a society. The sound maternal health status is always the intention of any nation as it reflects many dimensions of the society. However, in India, there is a huge gap in the services offered and utilised at rural and urban areas. The considerable efforts by government by which the foundation of healthcare sector of the nation be made strong cannot deliver the fruitful results. The present study aims to assess the utilisation of maternal health services and the factors associated with it.Methodology: The present study was undertaken in Waghodia taluka of Vadodara district. The Waghodia taluka has four primary health centres (PHCs). The duration of the study was 9 months. The proportionate stratified sampling was used to assess the utilisation of maternal health services in four PHCs. The sample of the study was 1333. The study design was a prospective cohort study as the sample were followed up to determine their category of utilisation of antenatal care services. The data were analysed using SPSS version 21. Results: Nearly 65.3% of the pregnant women have utilised the antenatal services in an ideal manner, 28.5% in the moderate utilisation category and 6.2% in the undesirable category. There is an association between the predisposing factors such as age of respondent, education of respondent and her husband, occupation of respondent and her husband and level of autonomy of the respondent. The need factors are also statistically significantly associated with the category of utilisation of antenatal services. The majority of the pregnant women with hypertension and diabetes are utilising the services in an ideal manner. Conclusion: The majority of the pregnant women in rural area of Vadodara are utilising the antenatal services in an ideal manner, but the focus should be on the pregnant women who are unable to utilise these services properly. The proper utilisation of antenatal services by the pregnant women would help in the sustainable development of our country.

Keywords: Antenatal services, factors, pregnant women, utilisation


How to cite this article:
Wadhwa M, Chatterjee S. A study to assess the utilisation of health services by pregnant women in rural area of Vadodara district. Adv Hum Biol 2020;10:103-9

How to cite this URL:
Wadhwa M, Chatterjee S. A study to assess the utilisation of health services by pregnant women in rural area of Vadodara district. Adv Hum Biol [serial online] 2020 [cited 2021 Feb 27];10:103-9. Available from: https://www.aihbonline.com/text.asp?2020/10/3/103/295830




  Introduction Top


The sustainable development goals by the United Nation aim to reduce the maternal and infant mortality rate.[1] These sustainable development goals were formulated with an aim to A healthy society is indicated by not merely the absence of disease or low mortality/morbidity status but rather the different dimensions of health of the population of a society. The sound maternal health status is always the intention of any nation as it reflects many dimensions of the society. However, in India, there is a huge gap in the services offered and utilised at rural and urban areas. The considerable efforts by government by which the foundation of healthcare sector of the nation be made strong cannot deliver fruitful results. The universal health coverage by introducing various national health programmes such as Ayushman Bharat and National Rural Health Mission leads to the development of accessible, affordable and appropriate healthcare services.[2] There are ample evidences that show that the despite all the efforts, the utilisation of health services in rural areas is an issue.[3]

In India, the National Family Health Survey -3 data shows that the utilization of ANC and medical assistance was higher in urban areas than in rural areas. The WHO recommends that every pregnant woman should undergo at least four ANC visits and the visit should start as early as in the first trimester.[4]

The timely and routinely visit for ANC check-ups ensure healthy pregnancy and encourage women to have skilled attendant during childbirth. The ANC providers and quality of services play an important role in the utilisation of these services.[5] A study in Nepal revealed that distance of >1 h to the maternity hospital, low education, multiple parity and ANC were associated with an increased risk of home delivery.[6],[7]

In the past, there have been several studies that highlight the determinants of maternal health status, but fewer literature is available that highlights the factors affecting the utilisation of maternal health services. Andersen's behavior model of healthcare services utilization focuses on various factors that affect and determine the Utilization behavior in a population.[8],[9],[10] The present study aims to assess the utilisation of maternal health services and the factors associated with it.


  Methodology Top


The present study was undertaken in Waghodia taluka of Vadodara district. The Waghodia taluka has four primary health centres (PHCs). The duration of the study was 9 months. The proportionate stratified sampling was used to assess the utilisation of maternal health services in the four PHCs. The sample of the study was 1333. The study design was a prospective cohort study as the sample were followed up to determine their category of utilisation of ANC services. which is classified as follows:

(1) Ideal/desirable category: women attended at least four ANC visits; they were assisted by skilled personnel; (2) moderate category: women received <4 ANC visits and (3) undesirable category: women made no ANC visits.

The data from the pregnant women were collected by a structured close-ended schedule. The schedule comprised of variables from Andersen's behavioural model and the items listed in the schedule were as follows: predisposing factors, enabling factors, health service factors and need factors.

The data collection tool was content validated by the experts.

The data collected were entered into MS excel, and analysis was carried out using SPSS Version 23 (SPSS Inc., IBM SPSS Statistics for Windows, Armonk, NY:IBM corp. USA) software.


  Results Top


The data from the sample of pregnant women visiting the four PHCs were analysed and the findings are as follows:

[Graph 1] shows the frequency of pregnant women in rural area according to their utilisation of maternal health services. Majority of the pregnant women have utilised antenatal services in an ideal way and only 6.2% of the total pregnant women are in the undesirable utilisation category.

[Table 1] shows that there is an association between the predisposing factors such as age of respondent, education of respondent and her husband, occupation of respondent and her husband and level of autonomy of the respondent. The women who are able to utilise the antenatal services in an ideal manner were seen to be associated with these factors. The P value of the Chi-square test of association showed that there is an association between these factors and utilisation of antenatal services.
Table 1: The association between the predisposing factors and the utilisation category of antenatal services

Click here to view



[Table 2] shows that the enabling factors have a key role to play in the utilisation of antenatal services. The enabling factors such as cost involved availing healthcare facility, mass media availability, support by national programme and family income are statistically significantly associated with the category of utilisation of antenatal services. Nearly 65.3% of the pregnant women have utilised the antenatal services in an ideal manner, 28.5% fell in the moderate utilisation category and 6.2% fell in the undesirable category. The pregnant women with a family monthly income of > Rs. 25,000 are in the undesirable category of utilisation. The majority of the pregnant women utilising the antenatal services fell in the ideal and moderate category, wherein the cost involved in availing healthcare services is low, which is not the case with moderate cost involved.
Table 2: The association between the enabling factors and utilisation category

Click here to view


[Table 3] shows that there is a statistically significant association between the category of utilisation of antenatal services and health service factor as P < 0.05. The table shows that factors such as availability of doctors, nurses and skilled attendants is statistically significant with the utilisation of services. The table also shows that the majority of the pregnant women (53.3%) prefer public healthcare services, while 46.7% prefer private healthcare services, out of which majority of the pregnant women fell in ideal utilisation category who preferred public healthcare services. Amongst the 46.7% of the pregnant women who preferred private healthcare services, majority had utilised the services in the moderate category.
Table 3: The association between the health services factor and utilisation category

Click here to view


[Table 4] shows that the need factors are also statistically significantly associated with the category of utilisation of antenatal services. The majority of the pregnant women with hypertension and diabetes are utilising the services in an ideal manner.
Table 4: The association between the need factors and utilisation category

Click here to view



  Discussion Top


The present study found that there is an association between the factors affecting the utilisation of antenatal services amongst the pregnant women in rural area of Vadodara district. The predisposing factors like age, education, occupation of the woman, husband's education and occupation are the determinants that are associated with the utilization of healthcare services by a pregnant women. The age of the pregnant woman, more than 30 years, show an undesirable utilisation of antenatal services. This was also seen with respect to education indicating that the pregnant women having post-graduation and residing in rural areas revealed undesirable utilisation of antenatal services. This may also have to do with their attitude towards the antenatal services available at the rural area. The utilisation of the services is also associated with the health service factors such as availability of doctors, nurses, skilled attendants and the quality of health service provided, as also seen in the study by Kkonde et al.[11]

The enabling factors such as monthly family income, distance to healthcare facility, availability of health services, condition of road and husband involvement were seen to have a significant association between the degree to which a pregnant women utilises the antenatal services. A similar finding was also reported by Elmusharaf et al.[12] and Piet-Pelon et al.,[13] where they discussed the importance of transport costs to distant health facility as a major barrier affecting the utilisation of services.

A similar finding in the study highlights that the support by various national or state programmes affects the utilisation of services amongst the pregnant women. The other studies by Elmusharaf et al.,[12] Geddam et al.[14] and Janani Suraksha Yojana (JSY)[15] report that the financial constraint is one of the major reasons for home deliveries, hence the Government of India launched JSY scheme on 12 April 2015, aimed to reduce neonatal and maternal mortality rates by promoting institutional delivery, indicating the support provided by the government to promote maternal health.

The need factors such as the condition of the pregnant women have also significantly affected the utilisation of the health services. However, it is the aggregate of all the factors affecting the attitude and health-seeking behaviour that lead to utilisation or no utilisation of antenatal services by the pregnant women. The similar finding was also reported by Rutaremwa et al.[5] In case of the Indian scenario, the religious and cultural norms affect the women's decision-making, which in addition is constrained by a lot of other factors such as the autonomy to take decision, husband's involvement, quality of health services and economic resources available, as also discussed in Singh et al.[3]

The government has been doing a great role in this regard. The strategies adopted by the government include home visits to involve provision of basic ANC, newborn care preparedness and home-based perinatal care by lady health worker (LHW).[16] Apart from appointing LHW by the government, the other approaches like group session by LHW, delivery of clean kits, identification of danger signs of pregnancy and promotion of health seeking behavior also helps in increasing the utilization of health services.[17] Previous studies have also reported the successful implementation and utilisation of accredited social health activist (ASHA) and Anganwadi worker (AWW) in promoting the utilisation of antenatal services.[18]

Utilisation of health services can be improved by involving all the family members in the group sessions and explaining the best practices to be followed during pregnancy and motherhood. The training of the frontline workers such as ASHA, AWW and nurses will help in the delivery of the antenatal services which will compensate for the shortage of the doctors and promote the utilisation of the antenatal services. The designing of health information should involve the religious practices also and educate the family for the quality of care to be provided to the pregnant women.


  Conclusion Top


The majority of the pregnant women in rural area of Vadodara are utilising the antenatal services in an ideal manner, but the focus should be on the pregnant women which are unable to utilise these services properly. The proper utilisation of antenatal services by the pregnant women would help in the sustainable development of our country. The study revealed the totality of the factors affecting the utilisation of the healthcare services, indicating that the policies to be framed should be specific to the various demographic factors affecting the utilisation of the services, which is the main underlying factor. The enabling factors, health services and need factors influence the decision of the pregnant women, which should also be taken into consideration.

Tt is the integral approach that decides the utilisation of services by the pregnant women. The Andersen's health behaviour model affects the utilisation of services in totality. The framing of health policies should consider this framework and understand the association of these factors in the utilisation of health services.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
World Health Organization. Health in 2015 from MDGs to SDGs. Geneva: World Health Organization; 2015.  Back to cited text no. 1
    
2.
Planning Commission. High Level Expert Group Report on Universal Health Coverage for India; 2011.  Back to cited text no. 2
    
3.
Singh N, Ponna SN, Upadrasta VP, Dudala SR, Sadasivuni R. Determinants of utilization of antenatal and postnatal care services in Telangana. Int J Reprod Contracept Obstet Gynecol 2017;6:3352-61.  Back to cited text no. 3
    
4.
Kumar A, Mohanty SK. State of child health among poor and non-poor in urban India. Genus 2011;67:1-9.  Back to cited text no. 4
    
5.
Rutaremwa G, Wandera SO, Jhamba T, Akiror E, Kiconco A. Determinants of maternal health services utilization in Uganda. BMC Health Serv Res 2015;15:271.  Back to cited text no. 5
    
6.
Wagle RR, Sabroe S, Nielsen BB. Socioeconomic and physical distance to the maternity hospital as predictors for place of delivery: An observation study from Nepal. BMC Pregnancy Childbirth 2004;4:8.  Back to cited text no. 6
    
7.
Gabrysch S, Campbell OM. Still too far to walk: Literature review of the determinants of delivery service use. BMC Pregnancy Childbirth 2009;9:34.  Back to cited text no. 7
    
8.
Andersen RM. Revisiting the behavioral model and access to medical care: Does it matter? J Health Soc Behav 1995;36:1-0.  Back to cited text no. 8
    
9.
Andersen RM. National health surveys and the behavioral model of health services use. Med Care 2008;46:647-53.  Back to cited text no. 9
    
10.
Irfan FB, Irfan BB, Spiegel DA. Barriers to accessing surgical care in Pakistan: Healthcare barrier model and quantitative systematic review. J Surg Res 2012;176:84-94.  Back to cited text no. 10
    
11.
Kkonde A, Dolamo BL, Monareng LV. Ugandan women's childbirth preferences. Afr J Nurs Midwifery 2011;13:3-13.  Back to cited text no. 11
    
12.
Elmusharaf K, Byrne E, O'Donovan D. Strategies to increase demand for maternal health services in resource-limited settings: Challenges to be addressed. BMC Public Health 2015;15:870.  Back to cited text no. 12
    
13.
Piet-Pelon NJ, Rob U, Khan ME. Men in Bangladesh, India and Pakistan: Reproductive Health Issues. Dhaka: Karshaf Publishers; 1999. p. 184.  Back to cited text no. 13
    
14.
Geddam JB, Ponna SN, Kommu PR, Kokku SB, Mamidi S, Bontha VB. Utilization of maternal health services by the migrant population living in the nonnotified slums of Hyderabad City, India. Indian J Comm Health 2017;29:29-38, 27.  Back to cited text no. 14
    
15.
Janani Suraksha Yojana (JSY). Available from: http://www.nhp.gov.in/ janani-suraksha-yojana-jsy_pg accessed on 03rd February 2020.  Back to cited text no. 15
    
16.
Baqui AH, El-Arifeen S, Darmstadt GL, Ahmed S, Williams EK, Seraji HR, et al. Effect of community based newborn-care intervention package implemented through two service-delivery strategies in Sylhet district, Bangladesh: A cluster-randomised controlled trial. Lancet 2008;371:1936-44.  Back to cited text no. 16
    
17.
Bhutta ZA, Soofi S, Cousens S, Mohammad S, Memon ZA, Ali I, et al. Improvement of perinatal and newborn care in rural Pakistan through community-based strategies: A cluster-randomised effectiveness trial. Lancet 2011;377:403-12.  Back to cited text no. 17
    
18.
Padda P, Devgun S, Gupta V, Chaudhari S, Singh G. Role of ASHA in improvement of maternal health status in Northern India: An urban rural comparison. Indian J Community Health 2013;25:465-71.  Back to cited text no. 18
    



 
 
    Tables

  [Table 1], [Table 2], [Table 3], [Table 4]



 

Top
 
 
  Search
 
Similar in PUBMED
 Related articles
Access Statistics
Email Alert *
Add to My List *
* Registration required (free)

 
  In this article
Abstract
Introduction
Methodology
Results
Discussion
Conclusion
References
Article Tables

 Article Access Statistics
    Viewed494    
    Printed21    
    Emailed0    
    PDF Downloaded84    
    Comments [Add]    

Recommend this journal


[TAG2]
[TAG3]
[TAG4]