Awareness Regarding Maternal Health Services And Birth Spacing Among The Post-Natal Mothers At A Tertiary Care Hospital, Bangalore: A Cross-Sectional Study

Introduction

The postnatal period is the time immediately after the birth of the baby up to forty-two days after birth, which is critical period for both mother and the newborn.¹

Birth interval, or the time between two consecutive live births, has been recognized by the World Health Organization (WHO) as a key indicator of a child's mortality risk. In order to reduce health risks for both children and mothers, WHO recommended that women should space giving birth between three and five years apart. This recommendation is based on the findings that intervals less than 36 months and more than 60 months are associated with a higher risk of infant death and other unfavorable outcomes.²

Modern contraceptives are still seldom used just after giving birth. In order to fulfil the unmet demand for family planning and optimal birth spacing, the government has placed considerable emphasis on postpartum family planning.

The Janani Suraksha Yojana (JSY) gives an exceptional opportunity to integrate family planning with MCH services. This initiative offers monetary incentives to women who give birth in a medical institution and has a positive effect on the utilization of maternal healthcare services.

Methodology

A cross-sectional study was carried out from April to May 2022 among post-natal mothers admitted in post-natal wards, inborn wards, Kangaroo mother care (KMC), and post-partum care units at Vanivilas Hospital, BMCRI, Bangalore. Based on the parent article by Pranita Achyut et al., sample size of 131 was calculated. Face-to-face interviews were conducted using a pre-tested, semistructured, validated, questionnaire. Data was entered in Microsoft Excel and SPSS version 21.0 was used to analyze the data collected.

Results

In the study, around 52.9% of women were between the ages of 21 and 25 and belonged to urban (59.4%), were from the middle class (49.6%), and had a high school education (47.3%). There was a significant positive association observed. between the place of living with education (p=0.026) and a weak positive association was found between education MCH services (p=0.024), and family planning and birth spacing (p=0.0001) which were found to be statistically significant. See Table 1.

Table 2 illustrated that rural women had little understanding of MCH services and urban women had good knowledge of these services. The place of living, education, and awareness of MCH services for mother and their children were all positively associated.

Figure 2 illustrates the percentage and frequency of utilization of MCH services. Only half of the study population were aware of the available MCH services for maternal and child care in the tertiary care hospital, Bangalore.

The Janani Suraksha Yojana (JSY) ensured free and cashless services (including free transportation) to all pregnant women and unwell newborns visiting public health facilities, primarily in the Vani Villas Hospital of Bangalore. The programmes benefit the mothers of lower middle and lower socio-economic class. However, fewer families were unaware of the programmes for maternal and child healthcare.

Awareness regarding the free vaginal delivery service has been improved, however awareness for other services like the free drop back facility to houses and the free blood supply is still quite low. In order to increase the utilization of the program's benefits and thereby indirectly contribute to a decrease in the infant mortality rate (IMR) and maternal mortality ratio (MMR), more efforts are required to raise overall awareness and a broad understanding of the various provisions of the JSY among women.

Figure 3 illustrates the percentage distribution of women who interacted with health providers and received family planning information during pregnancy, delivery, and the postpartum period, and use of modern contraceptives within a year of giving birth.

Discussion

Although giving family planning services together with maternal healthcare services appears to be useful, this study's analysis showed that these interactions are frequently missing. Earlier investigations also revealed similar practices.^2,3

Women who interacted with healthcare professionals during the antenatal period and institutional delivery were well aware of postnatal care services, according to a study by Singh R et al. This finding suggests that the role of healthcare professionals in creating awareness regarding maternal and child health and the availability of services are the strong determinants for the utilization of MCH services.³ According to study by Vidya Rajan, 92% of pregnant moms were aware of the advantages of birth spacing for their health. However, only 45 percent of people are willing to adopt contraceptive methods.⁴

Similar findings were found in the study by Bajracharya A. et al., which indicated that most women (90.8%) were aware of contraceptives, approximately 60.5% of women who had previously used contraception and Oral contraceptive pills (OCP) were the most frequently used form of contraception.⁵

Conclusion

Family planning is included in the maternal and child healthcare services, training, and research priorities.

The majority of participants in the study were aware of MCH services generally, although there was a lack of thorough understanding of services. The results of the study revealed that a mother's access to maternal healthcare services was significantly influenced by her age, education, and parity. Lack of awareness about the available maternity services, health care practitioners' methods and attitudes, accessibility and availability of services, and husband's acceptance of MCH services were the factors that impeded the use of maternal healthcare services. The advantages of adequate birth spacing should be emphasized in outreach initiatives.

Maternal and child health typically should cover the advantages of proper birth spacing. This will help people to realize the notion of birth-spacing better. There are still women with misconceptions about birth spacing methods, despite the fact that birth spacing methods are well known among urban residents.

Health education and counselling may improve the acceptance of birth-spacing and contraceptives. However, authorities and health managers should work to strengthen the family planning and birth spacing at the community level, and counselling regarding such matters should be given during prenatal care visits.

Overall, the study highlights gaps in utilizing these interactions and urban health interventions that aim to increase access to those in need while supporting the assertion that integrating maternal healthcare services with postpartum family planning may improve postpartum modern contraceptive use.

Acknowledgement

The authors would like to thank the dean and director of Bengaluru Medical College and Research Institute, Bengaluru. Karnataka.

Source of funding

None

Conflict of interest

None