Maternal and Child Health Commons^™

Cultural Factors Associated With Utilization Of Antenatal Care Services In Rural India, Anjali Om

Undergraduate Research Posters

Despite vast economic growth in developing countries in the past few years, infant mortality continues to plague underdeveloped regions, particularly rural regions of India. Many of these deaths are caused by a lack of education and motivation in regard to utilization of antenatal and neonatal care services to prevent and treat consequences of unhygienic umbilical cord care.

For years, high incidences of neonatal tetanus have plagued rural areas of India as a result of cultural practices that encourage topical applications of cow dung to cut umbilical stumps either directly or by using ghee heated with cow dung to warm umbilical …

Shaping Demand And Practices To Improve Family Health Outcomes: Findings From A Quantitative Survey, Volume 3: Bihar, M.E. Khan, France Donnay, Usha Kiran Tarigopula, Kumudha Aruldas

Reproductive Health

This report provides findings of a study undertaken to generate comprehensive information on eight target behaviors that have direct bearing on family health in rural Bihar. Behaviors include: 1) Increasing the proportion of deliveries that occur in a facility and mothers who have access to basic emergency obstetric care; 2) Increasing the proportion of safe deliveries at home; 3) Increasing the uptake of preventive postnatal-care services for newborns and mothers; 4) Increasing the practice of skin-to-skin care/Kangaroo Mother Care for newborns; 5) Increasing the practice of early and exclusive breastfeeding of infants during the first six months of life; 6) …

The Antecedents, Process, And Consequences Of Female Sterilization For Low-Income Women In Mumbai, Marie A. Brault

Master's Theses

Surgical sterilization is the primary method of family planning among low-income women in India; the result of limited knowledge and poor access to family planning alternatives. To understand the dynamics of sterilization, 37 in-depth interviews were conducted with sterilized women from the study community, as well as key informant interviews with community men, providers and government officials. The results indicate that sterilization decisions are made after exceeding ideal family size, that the procedures for sterilization frequently do not follow official protocol, but that for the most part women are highly positive about being free of the risk of unwanted conception.

Providing Maternal And Newborn Health Services: Experiences Of Auxiliary Nurse Midwives In Rajasthan, K.G. Santhya, Shireen J. Jejeebhoy

Poverty, Gender, and Youth

To better understand the experiences of auxiliary nurse-midwives (ANMs) in providing maternal and newborn health services and to obtain their perspectives on Janani Suraksha Yojana (JSY), the Population Council undertook an exploratory study of ANMs in two districts of the north-western state of Rajasthan, India. Findings show that the vast majority of the ANMs were aware of best practices related to the immediate care of the newborn. Nevertheless, the findings also suggested a number of priority areas for action, including increased investment in training, encouraging provision of services on a more regular basis, making special efforts to enable ANMs to …

Increasing Access To Family Planning And Reproductive Health Services Through Community Work: A Case Study Of A Dual Cadre Model In India, Jaleel Ahmad, Isha Bhatnagar, M.E. Khan

Reproductive Health

Before the introduction of Accredited Social Health Activists (ASHAs) in India, mid-level auxiliary nurse midwives (ANMs) were responsible for community health education and services such as antenatal care, delivery, IUCD insertion, and sterilization referrals. The Population Council studied how community extension work and some primary care responsibilities have been shifted to ASHAs, who are tasked with identifying pregnant women; facilitating ANC check-ups; motivating women for institutional deliveries during ANC checkups; and organizing child immunization. Establishing dual worker cadres in India by shifting community extension tasks from ANMs to local ASHAs has been well conceived. Task shifting has allowed ANMs, as …

Implementing The Janani Suraksha Yojana: Perspectives And Experiences Of Accredited Social Health Activists In Rajasthan, K.G. Santhya, Shireen J. Jejeebhoy, A.J. Francis Zavier

Poverty, Gender, and Youth

This report is the result of an explanatory study of Accredited Social Health Activists (ASHAs) conducted as part of a large-scale evaluation of the Janani Suraksha Yojana in rural and urban settings in Rajasthan. The findings of the study suggest training ASHAs more comprehensively about their rights and responsibilities, raising awareness of lesser known best practices regarding maternal and newborn care, emphasizing ASHA’s engagement in promoting postpartum care, and making special efforts to increase the credibility of ASHAs in the community.

Effects Of The Janani Suraksha Yojana On Maternal And Newborn Care Practices: Women's Experiences In Rajasthan, K.G. Santhya, Shireen J. Jejeebhoy, Rajib Acharya, A.J. Francis Zavier

Poverty, Gender, and Youth

Report on an evaluation of Janani Suraksha Yojana, a program to encourage institutional delivery and provide access to care during pregnancy and in the postpartum period.

Shaping Demand And Practices To Improve Family Health Outcomes In Northern India: A Framework For Behavior Change Communication, Population Council

Reproductive Health

An initiative from the Population Council could help in developing a comprehensive communication strategy to improve reproductive, maternal, newborn, and child health, and nutrition outcomes in Uttar Pradesh and other northern states of India. The identification of key barriers to and facilitating factors for selected target behaviors that have a direct bearing on maternal and child health could go a long way in packaging specific messages for different stakeholders, such as women, husbands, elder family members, opinion makers in the community, and frontline health workers. One of the key deliverables of this publication is to fill an important knowledge gap …

Expanding Access To Safe Abortion And Post-Abortion Care: Recommendations Of A South Asia Regional Consultation, Population Council

Reproductive Health

A South Asia Regional Consultation, organized by the Population Council with representation from governments and key stakeholders of Bangladesh, India, Nepal, and Pakistan, was held in New Delhi, to discuss ways of expanding women’s access to safe abortion services. The Consultation deliberated on ways of expanding the provider base for safe induced abortion so as to overcome inadequate and inequitable access to safe abortion. They also looked to expand access to services for the management of incomplete abortion and complications of unsafe abortion that persist in the region and, thereby, to reduce morbidity and mortality resulting from unsafe abortion. In …

Increasing Access To Family Planning (Fp) And Reproductive Health (Rh) Services Through Task-Sharing Between Community Health Workers (Chws) And Community Mid-Level Professionals In Large-Scale Public-Sector Programs: A Literature Review To Help Guide Case Studies, James R. Foreit, Sarah Raifman

Reproductive Health

This literature review covers case studies related to community-based distribution of family planning programs, and community health worker (CHW) programs that included family planning and other reproductive health services. It offers essential processes and implications for additional operations research which look at constraints and factors critical to introducing new program procedures or strengthening existing ones.

Comparing Modelled Predictions Of Neonatal Mortality Impacts Using List With Observed Results Of Community-Based Intervention Trials In South Asia, Ingrid K. Friberg, Zulfiqar Ahmed Bhutta, Gary L. Darmstadt, Abhay Bang, Simon Cousens, Abdullah H. Baqui, Vishwajeet Kumar, Neff Walker, Joy E. Lawn

Woman and Child Health

Background:There is an increasing body of evidence from trials suggesting that major reductions in neonatal mortality are possible through community-based interventions. Since these trials involve packages of varying content, determining how much of the observed mortality reduction is due to specific interventions is problematic. The Lives Saved Tool (LiST) is designed to facilitate programmatic prioritization by modelling mortality reductions related to increasing coverage of specific interventions which may be combined into packages.
Methods: To assess the validity of LiST outputs, we compared predictions generated by LiST with observed neonatal mortality reductions in trials of packages which met inclusion criteria …

Increasing Complete Immunization In Rural Uttar Pradesh: Implications For Behavior Change Communication, Population Council

Reproductive Health

The Population Council conducted a formative study in rural Uttar Pradesh, India to determine the current rate of compliance for recommended schedules of child immunization, identify the barriers and factors facilitating the uptake of full immunization, and identify behavior change communication (BCC) initiatives that could accelerate adoption of this practice. This policy brief identifies a number of barriers to immunization: low risk perception, lack of faith in vaccines, lack of knowledge about vaccines, fear of side effects, lack of family support, and lack of knowledge about location and type of services available. The brief also identifies several facilitating factors and …

Increasing Institutional Delivery And Access To Emergency Obstetric Care Services In Rural Uttar Pradesh: Implications For Behavior Change Communication, Population Council

Reproductive Health

The Population Council conducted a formative in rural Uttar Pradesh (UP), India to determine the impact of the Janani Suraksha Yojana (JSY) scheme on the current status of institutional delivery in the region, to understand the facilitating factors and barriers in delivering in a health facility, and to identify programmatic and behavior change communication (BCC) initiatives that could accelerate the adoption of institutional delivery. JSY was launched as an intervention to address the barriers to institutional delivery, through the introduction of community-based women volunteers. The study shows that with the introduction of the JSY the rate of institutional delivery jumped …

Transition To Marriage And Parenthood Among Youth In India, International Institute For Population Sciences (Iips), Population Council

Poverty, Gender, and Youth

This Population Council policy brief documents the magnitude of early marriage and early childbearing in India and sheds light on young people’s marriage-related planning and preparedness for married life, and the nature of married life. While child marriage is particularly evident among young women, it is notable that significant proportions of young men too have married below the legal minimum age at marriage for males. Findings call for multi-pronged efforts to eliminate the practice of early marriage among young men and women, and to support newlywed young women. Ensuring that these programs reach young people and the influential adults in …

Youth In India: Situation And Needs 2006-2007—Executive Summary, Andhra Pradesh, International Institute For Population Sciences (Iips), Population Council

Poverty, Gender, and Youth

This study, implemented by the International Institute for Population Sciences, Mumbai and the Population Council, New Delhi is the first-ever subnationally representative study conducted to identify key transitions experienced by married and unmarried youth in India. In recognition of the importance of investing in young people, several national policies and programs formulated since 2000 have underscored a commitment to addressing the multiple needs of this group in India. Effective implementation of policies and programs, however, has been handicapped by lack of evidence on young people’s situation and needs. This study focused on married and unmarried young women and unmarried young …

Youth In India: Situation And Needs 2006–2007, International Institute For Population Sciences (Iips), Population Council

Poverty, Gender, and Youth

This report is the result of a subnational study undertaken by the International Institute for Population Sciences, Mumbai and the Population Council, New Delhi as part of a project to collect information on key transitions experienced by youth in India. The project was implemented in six states of India, namely, Andhra Pradesh, Bihar, Jharkhand, Maharashtra, Rajasthan, and Tamil Nadu. The report offers a roadmap for programs and priorities that aim to address young people’s needs. More than 50,000 young people were interviewed in the study, providing a robust picture of youth in India and a wealth of evidence on almost …

Youth In India: Situation And Needs 2006-2007—Executive Summary, International Institute For Population Sciences (Iips), Population Council

Poverty, Gender, and Youth

This executive summary presents, in brief, findings from the Youth in India: Situation and Needs study, a subnational study undertaken by the International Institute for Population Sciences, Mumbai and the Population Council, New Delhi to collect information on key transitions experienced by youth in India, including those related to education, workforce participation, sexual activity, marriage, health, and civic participation. The magnitude and patterns of young people’s sexual and reproductive practices before, within, and outside of marriage, as well as related knowledge, decisionmaking, and attitudes, is also assessed. The project was implemented in six states of India, namely, Andhra Pradesh, Bihar, …

Public Expenditure On Health Care In Orissa: Focus On Reproductive And Child Health Services, Sarit Kumar Rout

Reproductive Health

In view of the importance of public financing in influencing health outcomes and the paucity of studies that have explored patterns of resource allocation on reproductive and child health services, a study was undertaken in Orissa, India to examine the pattern of and trends in public expenditure on health care with a special focus on expenditure on reproductive and child health services. The study was part of the Population Council, India’s Health and Population Innovation Fellowship program. Findings indicate that major policy issues such as the transfer of power to panchayati raj institutions and those involving health administration and management, …

Increasing Appropriate Complementary Feeding In Rural Uttar Pradesh: Implications For Behavior Change Communication, Population Council

Reproductive Health

The Population Council conducted a formative study in rural Uttar Pradesh, India to determine current complementary feeding practices among children aged 6–23 months; understand the facilitating factors and barriers in adopting appropriate complementary feeding practices; and identify programmatic and behavior change communication (BCC) initiatives that could promote the adoption of appropriate complementary feeding practices. The qualitative study shows that women and family members did not feed a measured quantity of food to their children. A lack of knowledge and lack of communication created barriers to initiating complementary feeding. The policy brief recognized education and antenatal care as facilitating factors and …

Increasing Early And Exclusive Breastfeeding In Rural Uttar Pradesh: Implications For Behavior Change Communication, Population Council

Reproductive Health

The Population Council conducted a formative study in rural Uttar Pradesh, India to determine the current status of early and exclusive breastfeeding, understand the facilitating factors and barriers in adopting the desired breastfeeding practices, and identify programmatic and behavior change communication (BCC) initiatives to promote the practice. Findings indicate that efforts by Primary Health Centre staff to counsel and encourage women to breastfeed early could significantly increase adoption of this practice. The policy brief identifies barriers that reflect a lack of knowledge and misperceptions about breastfeeding, but finds that education, supportive family members, and knowledgeable health workers can facilitate breastfeeding. …

Increasing Postpartum Contraception In Rural Uttar Pradesh: Implications For Behavior Change Communication, Population Council

Reproductive Health

The Population Council conducted a formative study in rural Uttar Pradesh, India to assess the level of adoption of postpartum contraception for spacing among low parity women, identify the facilitating factors and barriers to the adoption of this target behavior, and identify programmatic and behavior change communications (BCC) initiatives that could accelerate the adoption of postpartum contraception for spacing and improve the service delivery system, if required, to facilitate the process. Barriers included low awareness of consequences of closely spaced births, misconceptions about contraceptive methods, lack of counseling by health workers, reluctance to include husbands, and programmatic emphasis on limiting …

Future Demands For Services From Public Health Facilities In Uttar Pradesh, Population Council

Reproductive Health

A Population Council-led consortium in India conducted a study to assess (a) the expected workload of public health facilities, and (b) the extent to which the demand for contraception could be met by the existing health facilities in Uttar Pradesh, following the implementation of behavior change communication (BCC) activities. This policy brief recommends that BCC efforts create demand for services and address perceptions that it is “not necessary” to access health care services. BCC must play a greater role in motivating women to move to facilities not just for institutional delivery but for other services as well. BCC can also …

Increasing The Practice Of Thermal Care To Prevent Newborn Hypothermia: Implications For Behavior Change Communication In Rural Uttar Pradesh, Population Council

Reproductive Health

The Population Council conducted a formative study in rural Uttar Pradesh, India to assess current newborn bathing practices and the methods adopted to keep the baby warm immediately after birth; explore the beliefs that guide these customs and practices; identify the barriers and facilitating factors in adopting healthy newborn care practices, such as skin-to-skin contact (STSC); and identify programmatic and behavior change communication (BCC) initiatives that could accelerate the adoption of newborn care practices. Barriers included misconceptions about the consequences of bathing a newborn and a lack of awareness among mothers and health workers about STSC. Facilitating factors included contact …

Community Needs Assessment Of Mayasandra Village, Karnataka, India, Alexander Hernandez Holl

MPA/MPP/MPFM Capstone Projects

No executive summary.

Understanding Pregnancy-Related Morbidity And Mortality Among Young Women In Rajasthan, K.G. Santhya

Poverty, Gender, and Youth

Pregnancy and childbearing continue to occur in adolescence for considerable proportions of women in India. The dangers of childbearing for adolescent girls, whose bodies have not physically matured, are widely acknowledged. Yet, little is known about whether morbidity and mortality experiences vary within the subgroup of adolescent girls, whether such experiences differ between adolescent and adult women of similar parity, and whether treatment-seeking behaviors and the delays experienced in seeking treatment differ between adolescent and adult mothers. To begin to fill this gap, the Population Council undertook an exploratory study of the pregnancy-related morbidity and mortality experiences of women who …

Making Pregnancy Safe For Women In Rajasthan: Targeting The Most Vulnerable, K.G. Santhya

Poverty, Gender, and Youth

As recently as 2005–06, almost two out of three women in Rajasthan, India were married before age 18 years (of those aged 20–24). Moreover, half of currently married girls aged 15–19 years in the state had already begun childbearing. The dangers of childbearing among adolescent girls, whose bodies have not physically matured, are widely acknowledged, as are the links between poverty and unsafe pregnancy. Yet, less is known about whether morbidity and mortality experiences vary within the subgroup of adolescent girls, whether such experiences differ between adolescent and adult women of similar parity, and whether treatment-seeking behaviors and the delays …

Being (Becoming Empowered In Nursing Growth): Training Guide For Nursing Students On Sexuality And Gender, Maryann Washington

Reproductive Health

This training guide was produced as part of a Health and Population Innovation Fellowship administered by the Population Council, India, and aims to help the faculty of nursing students to deliver comprehensive sexuality education effectively and efficiently, to help trainee nurses see the whole picture of sexuality in its matrix of safety, pleasure, reproduction, illness, and health. The package is called ‘BEING’ (acronym for Becoming Empowered in Nursing Growth) as it is assumed that, if delivered well, it could empower nurses’ growth to address these issues.

Promoting Healthy Timing And Spacing Of Births In India Through A Community-Based Approach, M.E. Khan, Mary Philip Sebastian, Usha Sharma, Rukma Idnani, Kaushal Kumari, Bharati Maheshwari, Shahid Ashraf

Reproductive Health

The Indian Family Welfare Program, though successful in increasing contraceptive use among couples who have achieved their desired family size, has failed in educating people about the importance and need of using contraceptive methods for spacing births. With its Indian collaborators, the Population Council’s Frontiers in Reproductive Health (FRONTIERS) program undertook a study to test a model to increase use of postpartum contraception among young pregnant women with a parity of 0 or 1. The study showed that the Behavior Change Communication (BCC) model developed to promote Healthy Timing and Spacing of Pregnancy (HTSP) was effective in promoting the lactational …

Increasing The Accessibility, Acceptability And Use Of The Iud In Gujarat, India, M.E. Khan, Sitanshu Sekhar Kar, Vikas Kishor Desai, Pratibha Patel, B.P. Itare, Sandhya Barge

Reproductive Health

The USAID-funded FRONTIERS Program of the Population Council, in collaboration with the Department of Health & Family Welfare, Government of Gujarat, and the Center for Operations Research and Training, Vadodara, conducted an operations research study in India to test the hypothesis that by improving the demand for the IUD and simultaneously strengthening the technical competencies and counseling skills of the providers, use of the IUD use would increase. The findings show that demand-generation activities and provision of good-quality IUD services, together with a supportive programmatic environment, when carried out simultaneously showed increased acceptance of the IUD. The intervention could be …

Creating The Conditions For Scale-Up Of The Men In Maternity Intervention In India, Leila Caleb-Varkey, Anurag Mishra, M.E. Khan

Reproductive Health

The Frontiers in Reproductive Health (FRONTIERS) program conducted an operations research study, called the Men in Maternity (MiM) study, in collaboration with the Employees' State Insurance Corporation of India (ESIC), aimed at involving men in the antenatal and postpartum care of their partners to raise knowledge and use of postpartum contraception and preventive practices against sexually transmitted infections, as well as improving pregnancy outcomes. This report details the MiM scale-up process, which worked well in terms of ESIC assuming ownership of the training component of the program and being able to build capacity for training. However, to further scale up …