Saira Mehnaz

Poor perinatal care practices in urban slums: possible role of social mobilization networks.

Background: Making perinatal care accessible to women in marginalized periurban areas poses a public health problem. Many women do not utilize institutional care in spite of physical accessibility. Home-based care by traditional birth attendants (TBA) is hazardous. Inappropriate early neonatal feeding practices are common. Many barriers to perinatal care can be overcome by social mobilization and capacity building at the community level. Objectives: To determine the existing perinatal practices in an urban slum and to identify barriers to utilization of health services by mothers. Study Design: This is a cross-sectional descriptive study. Setting and Participants: The high-risk periurban areas of Nabi Nagar, Aligarh has a population of 40,000 living in 5,480 households. Mothers delivering babies in September 2007 were identified from records of social mobilization workers (Community Mobilization Coordinators or CMCs) already working in an NGO in the area. A total of 92 mothers were interviewed at home. Current perinatal practices and reasons for utilizing or not utilizing health services were the topics of inquiry. Statistical Analysis: Data was tabulated and analyzed using SPSS 12. Results: Analyses revealed that 80.4% of mothers had received antenatal care. However, this did not translate into safe delivery practices as more than 60% of the women had home deliveries conducted by traditional untrained or trained birth attendants. Reasons for preferring home deliveries were mostly tradition (41.9%) or related to economics (30.7%). A total of 56% of the deliveries were conducted in the squatting position and in 25% of the cases, the umbilical cord was cut using the edge of a broken cup. Although breast-feeding was universal, inappropriate early neonatal feeding practices were common. Prelacteal feeds were given to nearly 50% of the babies and feeding was delayed beyond 24 hours in 8% of the cases. Several mothers had breastfeeding problems. Conclusion: Barriers to utilization of available services leads to hazardous perinatal practices in urban slums.

All slums are not equal: Maternal health conditions among two urban slum dwellers.

Background: Pregnant women inhabiting urban slums are a “high risk” group with limited access to health facilities. Hazardous maternal health practices are rampant in slum areas. Barriers to utilization of health services are well documented. Slums in the same city may differ from one another in their health indicators and service utilization rates. The study examines whether hazardous maternal care practices exist in and whether there are differences in the utilization rates of health services in two different slums. Materials and Methods: A cross-sectional study was carried out in two urban slums of Aligarh city (Uttar Pradesh, India). House-to-house survey was conducted and 200 mothers having live births in the study period were interviewed. The outcome measures were utilization of antenatal care, natal care, postnatal care, and early infant feeding practices. Rates of hazardous health practices and reasons for these practices were elicited. Results: Hazardous maternal health practices were common. At least one antenatal visit was accepted by a little more than half the mothers, but delivery was predominantly home based carried out under unsafe conditions. Important barriers to utilization included family tradition, financial constraints, and rude behavior of health personnel in hospitals. Significant differences existed between the two slums. Conclusion: The fact that barriers to utilization at a local level may differ significantly between slums must be recognized, identified, and addressed in the district level planning for health. Empowerment of slum communities as one of the stakeholders can lend them a stronger voice and help improve access to services.

Utilization of antenatal care services in periurban area of Aligarh

Background: Utilization of antenatal care (ANC) services is poor in the peri-urban areas, causing increased maternal morbidity and mortality. Objective: (i) To determine the current status of utilization of ANC services and (ii) to asses factors affecting utilization of ANC services. Materials and Methods: A community-based cross-sectional study was conducted in peri-urban field practice area of urban health training center, J N Medical College, Aligarh, India. The data were collected by home visit using a pretested, structured, semi-open questionnaire from 200 recently delivered women, who utilized ANC services. Data were tabulated and analyzed by using SPSS-20. Proportion, frequencies, and χ2-tests were used to interpret the data. Result: Full utilization of ANC services was found to be 59%. Home deliveries were 23% and all were conducted by untrained persons. Utilization of ANC services was significantly associated with education, socioeconomic status, parity, and age at marriage. Main reasons for inadequate (partial/no) utilization of ANC services were financial constrains (34.14%) and lack of awareness (30.48%), whereas for home deliveries it was tradition (23.91%) and financial constrains (21.74%). Conclusion: Utilization of ANC services was not satisfactory and home deliveries by untrained person were still present. Prevailing barriers to utilization of ANC services and institutional deliveries must be identified and taken into consideration in planning and policy making.

Quality of care: predictor for utilization of ANC services in slums of Aligarh

Background: Antenatal care (ANC) is the first necessary requisite for a healthy mother and a healthy child. But access to care is poor for women living in slums, particularly newly formed slums. Why women either do not access these services, or access them late, or suffer an avoidable adverse outcome despite timely presentation is related to the concept of quality of care. Respectful maternity care also is an integral aspect of good quality ANC. Objectives: (1) To assess the quality of ANC received by women living in the newly formed urban slums of Aligarh (