Informed motherhood: Women’s knowledge of danger signs of obstetric complications and birth preparedness in low income communities in India
Introduction
Worldwide, maternal mortality has considerably decreased in the last ten years. However, this decline has not been uniform across countries and regions. Developing countries contribute to 99% of maternal deaths around the world [WHO, 2007]. India has followed global trends in declining maternal mortality, achieving a reduction from 290 maternal deaths per 100,000 live births in 1990 to 130 in 2016 [Sample Registration System, GOI, 2019]. However, maternal deaths remain high to achieve the Sustainable Developmental Goals (SDGs) target of 70 per 100,000 live births.
There is a need to focus on preventative aspects which was not considered important in the past. Most causes of maternal mortality are preventable and attributed to three delays: delay in the decision to seek care, delay in reaching the place of care, and delay in receiving appropriate care (Bhutta et al., 2014, Jungari and Chauhan, 2015, Rathod et al., 2016). Care-seeking is delayed because of the delay in (a) identifying the complication, (b) deciding to seek care, (c) identifying transportation and reaching a health facility, and (d) receiving adequate and appropriate treatment at the health facility (Thaddeus and Maine, 1994). The main direct causes of maternal deaths are haemorrhage, hypertensive disorders, infections, prolonged labour and unsafe abortion (Say et al., 2014, Montgomery et al., 2014, Liu et al., 2015).
Birth preparedness and complication readiness (BPACR) is the process of planning for normal birth and anticipating the actions needed in case of an obstetric emergency. Birth Preparedness and Complication Readiness (BPACR) is a program approach to improve the use and effectiveness of key maternal and new-born health services, including skilled delivery service utilization. This approach is based on the argument that preparing for birth and being ready for complications reduces all three phases of delays in receiving the necessary health care services. BPACR interventions have been successful in reducing maternal and neonatal health risks in many developing countries (Soubeiga, Gauvin, Hatem, & Johri, 2014). BPACR is a crucial strategy in safe motherhood efforts and contributed to reduction in maternal mortality and morbidity.
Women equipped with appropriate knowledge about the danger signs of obstetric complications contribute profoundly to enhance utilization of skilled maternal health care during pregnancy, childbirth and postpartum period (Doctor et al., 2013, Jungari and Paswan, 2019). Awareness of the danger signs of obstetric complications is the essential first step in accessing appropriate and timely referral to obstetric care. Most studies undertaken in this area are exclusively focused on knowledge of obstetric complications (Chandrakar, Verma, Gupta, & Dhurandhar, 2019), birth preparedness and complications readiness (Acharya et al., 2015, Ghosh et al., 2017) and male participation in maternal health (Chattopadhyay, 2012, Jungari and Paswan, 2017). They have not examined the associations among them. Therefore, the current study is an attempt to close the knowledge gap. It examined the women’s knowledge of the danger signs of obstetric complications during pregnancy, childbirth and postpartum and its association with the birth preparedness and complication readiness in the low income slum communities of Pune, Maharashtra.
Section snippets
Study design and setting
A community-based cross-sectional study was conducted during January 2018 to February 2018 in the recognized 10 urban slum settlements in Pune (Maharashtra, India). Pune is the second largest urban agglomerate in Maharashtra after Mumbai and is the seventh most populous city in the country. The Pune Metropolitan Region consists of Pune city and the suburbs of Pimpri-Chinchwad. Pune Municipal Corporation (PMC) has 48 municipal and 76 electoral wards.
Sample size and sampling
The sample for the present study was drawn
Sample characteristics
Table 1 presents the socio-demographic characteristics of the sample (n = 500). The table shows that 46.6% respondents were less than 24 years’ old; and 44.4% respondents were aged between 25 and 30 years. The mean age of the respondents was 25.17 ± 4.10. Illiterates comprised 5.8% of the sample; and 3.4% had a primary education. Most of the respondents (85%) had studied up to secondary or higher level. The majority of the respondents (84.6%) were not working. Most respondents (67.6%) came from
Discussion
The results of the study show poor overall knowledge of obstetric complications during pregnancy, childbirth and postpartum among women living in urban slums. However, it is seen that a few complications are well known to the women. The study also highlights the importance of complete knowledge of obstetric complications during pregnancy, childbirth and postpartum period. The index of birth preparedness and complication readiness (BPACR) is found to be less among the slum communities. Earlier
Limitations of the study
Despite the study following the accepted methodology, it is necessary to mention the limitations. Study used a cross-sectional design approach with cause and effect relations cannot be accurately ascertained. Since the study was conducted in the slums of one city, Pune, the results and findings cannot generalised to other slums in India. The study tried to examine women’s knowledge of obstetric complications during pregnancy, childbirth, and the postpartum period and its association with birth
Conclusion
The results of the study demonstrate that women’s education level, their knowledge of obstetric complications during pregnancy, childbirth and after delivery are important predictors of birth preparedness among women from low income slum communities. Study results are useful for informing policy makers and programme mangers on the importance of educating pregnant women about obstetric complications during pregnancy, delivery and postpartum periods.
Ethics approval and consent to participate
Ethical clearance to conduct the study was obtained from the Savitribai Phule Pune University, Pune, India. Individual informal written consent was obtained from participants for conducting the survey.
Consent for publication
Not applicable
Funding
Funding for this research is received from the Savitribai Phule Pune University under the scheme of University with Potential of Excellence (UPE) phase -II granted by the University Grants Commission, New Delhi.
Declaration of Competing Interest
The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.
Acknowledgement
The author would like to thanks field work team. I also thank the participants for their active participation.
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