Shashirekha - CHLP Final Kannada Report.pdf

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WHY I JOINED FOR THIS FELLOWSHIP
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Orientation:
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JA§ÄzÀ£ÀÄß w½AiÀįÁ¬ÄvÀÄ.

Page 1 of 26

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¸ÁPÀëöå avÀæUÀ¼ÄÀ :
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w½AiÀįÁ¬ÄvÀÄ.
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ID: EzÀÄ §tÚ, ªÀAiÀĸÀÄì, °AUÀ EªÀÅUÀ¼°
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À ¹gÀÄvÀÛzÉ.
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Page 13 of 26

SOCHARA
Community Health Learning Fellowship Programme
2012-2013
Research Report
“A study on the knowledge, awareness and experience of women on maternal health in
urban underprivileged (slum) area of Bangalore city”
Ms. Shashirekha.P
Fellow, Community Health Learning Programme,
SOCHARA, Bangalore, India
Acknowledgement

I would like to thank SOCHARA team for giving me the opportunity to conduct this research
project as a part of my fellowship.

In particular, I would like to specially thank APSA (Association for Promoting Social
Action), team, Bangalore for guiding me through this project as well.

Without the constant guidance of my mentors, Mr. Karthikeyan and Mr. Chander my mentors
from the SOCHARA team for this project would not have been possible. I thank them for the
same.
Table of Contents

SL.No

Topic

1

Background

2

Objectives

3

Methodology

3.1

Study Design

3.2

Study Setting

3.3

Sampling design and Study Area

4

Results and Discussion

5

Conclusion

6

Limitations of the Study

7

Suggestion and Recommendations

8

References

Page no.

Page 14 of 26

LIST OF TABLES

Table No

Table Details

Page No.

1

Socio Demographic profile of respondents

9-10

2

Details of income of respondents

10

3

Marriage related characteristics of respondents

11

4

Reproductive history of respondents

12

5

Problems in conceiving among the respondents

12

6

Visit to the Doctor during pregnancy

13

7

Nutrition, medications and immunization

13

8

Problems faced by respondents during pregnancy

14

9

Place of delivery and type of delivery of respondents

14

10

Details of child birth

15

11

Post natal history

15

12

Problem in breast feeding

16

INTRODUCTION:
WHO defines maternal health as “the health of women during the pregnancy, child
birth and the post-partum period”. Worldwide, the Maternal Mortality Ratio (MMR) has
decreased, with South-East Asia seeing the most dramatic decrease of 59% and Africa seeing
a decline of 27%. The MMR of India is 212 per one lakh live births, whereas the country’s
target is to reduce it to 109 per one lakh live births by 2015(Sources-health.india.comNews). Karnataka sees a maternal mortality rate of 178 deaths per 100,000 live births, the
highest found in any southern Indian state, according to data from the National Family Health
Survey and the government's Sample Registration System (www.figo.org/.../Karnataka)
The major direct causes of maternal morbidity and mortality include hemorrhage,
infections, high blood pressure, unsafe abortion, and obstructed labor. Maternal health not
only depends on biological factors but also the socio economic factors/social determinants
which play a vital role in determining maternal health. The socio economic /social
determinants are; nutrition, income-status, literacy, access to healthcare, place of residence,
and age at marriage.

Page 15 of 26

Socio-economic factors like poor housing, inadequate water and sanitation facility,
food habits, unhealthy working conditions and low income are some of the factors linked
directly and indirectly to maternal mortality. Poor women are more susceptible to maternal
death and morbidity than those economically well off. The affordability of reproductive
health services for women is also a major concern.
In India the traditional habit is that women eat food after men. Secondly frequent
delivery without spacing and lack of knowledge of balanced diet, and inappropriate
management of monthly cycle among women leads to anemia. According to UNICEF the
prevalence of anemia in females in India because of gender-based discrimination in access to
food, nutrition and health care throughout the life cycle. Anemia during childhood can also
cause stunted growth which further increases risk of maternal mortality as a result of
obstructed labor
Gender plays a vital role in determining education in India with literacy among
women in India being low compared to men. Lack of education amongst women especially
rural women result in inadequate knowledge on health and hygiene and leads to unhealthy
practices. Harmful local practices during pregnancy result in complications and even death of
pregnant women and mothers.
Worldwide maternal death and morbidity is linked, both directly and indirectly, to
child marriage. In India marriage is considered as one of the important aspects of social life.
A significant percentage of marriages in India are conducted below the legal age of marriage
and states with high rates of child marriage also have high rates of maternal mortality. (NFHS
3) The reasons for child marriage in India are diverse, significant reasons being cultural
influence, ignorance, and feeling of insecurity and of fulfilling the responsibility on the part
of parents.
According to a recent UN report though maternal deaths have declined by nearly half
in the past two decades mainly due to improvements in health systems and increase in female
education, there are no regions that are on track to meet the Millennium Development Goal
of decreasing maternal mortality by 75% by the year 2015. In this context the study was
conducted to understand maternal health and its related knowledge awareness and
experiences in Gulbarga slum located in urban Bangalore City in order to identify areas
requiring improvements for achieving better maternal health outcomes improve.

Page 16 of 26

SITUATIONAL ANALYSIS OF GULBARGA SLUM, BANGALORE
The area has a total of 280 households with approximately a population of 2500.Most of the
women in this colony are uneducated and are involved in construction and domestic work.
Their income is based on unorganised labour. Their living conditions are poor as they lack
basic sanitation and hygiene facilities. Patriarchy, alcoholism and seasonal work have further
added to their burden. Their poor socio-economic condition places them in a vulnerable
position during their antenatal, prenatal and post natal periods. Special attention that is
needed during these periods remains ignored.
Map of Gulbarga Slum

OBJECTIVES
 To study the social demographic profile of women from Gulbarga colony urban slum,
Bangalore
 To study the knowledge, awareness and experience about antenatal care, prenatal
care, postnatal care and maternal health care facility.
METHODOLOGY
Study design:
Cross sectional study- household survey method was used.
Page 17 of 26

Study population:
Pregnant women and lactating mothers residing in Gulbarga Colony Urban slum Bangalore.
Study period: August – September 2013

Sampling:
The nature of sampling is purposive and is based on the list obtained from the Anganwadi
centre that is located within the colony. Among the list of 80 households the researcher has
selected 55 households based on the inclusion and exclusion criteria that are listed below.

Inclusion criteria:
 Pregnant and lactating women belonging to Gulbarga colony in urban slum area
Bangalore.
 Women who gave their consent for the study.

Exclusion criteria:
 Women who were out of slum (Gulbarga Colony) during the study period
 Women who did not give their consent to the interview

Tools used for data collection:
Semi structured interview schedule was prepared by the researcher to collect the details of the
socio-demographic profile and that of antenatal, prenatal and postnatal health of the women
included in the study.

Pilot study
A pilot study was conducted to get a better understanding of the maternal health situation in
the slum (Gulbarga colony) and few changes were made in the interview schedule
RESULTS
The study was conducted to understand the experiences of underprivileged women
from Gulbarga colony during pregnancy, at the time of delivery and following delivery.
Table 1. Socio Demographic Profile of respondents
Variable

Frequency

Percent

Age (in years) (Mean=22.6, S.D.=3.1)
Page 18 of 26

<= 20
21- 24
25- 28
29- 30

18
19
15
3

33
35
27
5

Religion
Hindu
Muslim
Christian

51
3
1

93
5
2

Education
Non-literate
Primary education
Secondary education
12 or more year education

22
12
16
5

40
30
29
9

Occupation
Housewife
Contract worker

34
21

70
38

Table 1 provides details of socio demographic profile of the respondents. A total of 55
women were interviewed, whose age range was between 18-30 years. The mean age is 22.6
years with Standard deviation of 3.1. The sample consisted of 93% Hindus, 40% of the
respondents are non-literate and 30% of the respondents were educated up to primary level.
70% of the respondents were housewives and the rest were contract workers. (Table-1)
Table 2. Details of income of respondent
Details of income
Family income of the respondent
<= 8000
8001- 10000
10001 – 15000
15001- 19000
19000 above
Personal income of the respondent
Nil
1500
2000
3000
4000
6000

Frequency

Percent

15
8
15
6
11

27
15
27
11
20

41
1
5
6
1
1

74
2
9
11
2
2

About one-fourth of the respondents had monthly family income of less than Rs 8000, and
between Rs 10000-15000 Majority of the participants did not have any personal income of
their own. (Table-2)
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Table 3. Marriage related characteristics of respondents
Variable
Age at the time of marriage
< = 13
14 – 16
17 – 18
19 - 20
21 +
Number of year of marriage
<=3
4-6
6-8
8-10
11+
Type of marriage
Marriage by choice
Arranged marriage
Consanguinity
Consanguineous marriage
Outside marriage

Frequency

Percent

16
12
11
13
3

29
22
20
24
5

17
12
9
5
12

31
22
16
9
22

13
42

24
76

34
21

62
38

Almost 29% of the respondents were married at the age of 13 years or less with 22% being
married between age of 14 and 16 years, 20% between 17 and 18 years, 24% between 19 and
20 years, and 5% above age of 21 years. About 31% of participants at married less than 3
years, 22% were married for between 4-6 years and for more than 11 years respectively.
Majority of the participants reported that they had arranged marriage .Higher proportion of
participants reported that they had consanguineous marriage. (Table-3)
Table 4. Reproductive history of respondents
Variable
Number of children
0
1
2
3
4 & above
Interval between the each children
1-2 years
2-3 years
3-4 years
4 years and above
Not applicable

Frequency

Percent

4
14
18
13
6

7
25
33
24
11

8
26
3
2
16

15
47
5
4
29

About one-third of the participants had 2 children with one-fourth having one child and 7%
had no children. The time gap between the each child was between 2 and 3 years for 47% of
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the respondents, 32% had only one child or no children hence the time gap between each
child was not applicable. (Table-4)
Table 5. Problems in conceiving among the respondents
Variable
Problem of conceiving
Yes
No

Frequency

Percent

3
52

5
95

1
2

33
67

If yes what problem(n=3)
Miscarriages
Unwanted pregnancy and abortions

5% (3 women) of women had problem in conceiving out of which 33% (one woman) had
miscarriages and 67% (2 women) of women had unwanted pregnancy and abortions. (Table5)
Table 6.Visit to the Doctor during pregnancy
Variable
Visited the doctor regularly during pregnancy
Yes
No

Frequency

Percent

53
2

96
4

If yes, where (n=53)
Private hospital
Government hospital

4
49

8
92

Number and timing
Every month
3 times
5 times
Never

48
3
2
2

88
6
3
3

Higher proportion ( 96%) of participants reported that they visited doctor regularly out of
which participants 92.% had visited government hospital also 88% of the participants every
month cheek up during pregnancy . (Table-6)
Table 7. Nutrition, Medications and immunization
Variable
women who claimed that they took nutritious food
during pregnancy
Yes
No

Frequency

Percent

38
17

69
31
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IFA tablet and TT injection during pregnancy
Yes
No

51
4

93
7

Majority of the participants reported that they have taken nutritious food during pregnancy.
Higher number of participants reported that they had taken IFA and immunizations. (Table-7)
Table 8. Problems faced by respondents during pregnancy
Variable
Did you have problem during pregnancy
Yes
No
If yes what problem(n=23)
Pain in abdomen
Weight loss
Excessive body pain
Complete bed rest advised by doctor
Excessive vomiting
Bleeding during the pregnancy

Frequency

Percent

23
32

42
58

6
6
6
2
2
1

26
26
26
9
9
4

42% of the respondents had prenatal problem during pregnancy out of which had26% had
weight loss, 26% had pain in abdomen, 26% had excessive body pain, 9% were advised
complete bed rest by the doctor, 9% had Excessive Vomiting, 4% had bleeding during the
pregnancy.(Table-8)
Table 9.Place of delivery and type of delivery of respondents
Variable
Place of the delivery
Hospital
Home

Frequency

Percent

38
10

79
21

Type of delivery
Normal

40

83

Caesarean section

8

17

A higher proportion (79%) of respondents reported that they delivered in a hospital and 21%
respondent’s delivered at home. 83% of participants reported that they had a normal delivery
and 17% of respondents delivered by caesarean section. (Table-)
Table 10. Details of child birth
Variable
Excess of bleeding during delivery
Yes
No

Frequency

Percent

7
41

15
85
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Preterm delivery
Yes
No

17
31

36
64

The proportion of respondents who experienced excess bleeding during delivery is 15% and
36% respondents had a preterm delivery. (Table-10)
Table 11.Post natal history (After delivery)
Variable
Heavy bleeding after delivery
Heavy abdomen pain
Fever after delivery
Felt depressed and sad after delivery which requires doctors
attention
Suicidal thought after delivery
Abnormal thought
Any attachment problem with the baby after delivery

Frequency Percent
9
22
10
24
6
14
1
2

Nutrition and immunization
Gave all the immunization to the baby
Adequate nutritious food

2
11
3

5
26
7

43
8

84
16

With regards to post natal history 26% of the respondents had abnormal thought, 24% had
heavy abdomen pain, 22% had heavy bleeding following delivery, 14% had fever after
delivery, 7% had attachment problem with the baby after delivery. 84% of participants
reported that their baby was fully immunized and 16%claimed that they had taken nutritious
food after the delivery. (Table-11)
Table 12.Problem in breast feeding
Variable
Any problem in breast feeding the baby
Yes
No
If yes, problem
Lack of adequate milk required for baby
Pain in the breast
Milk cysts in the breast
Infection in the breast
Excess of milk generation

Frequency Percent
18
30

38
62

1
7
3
6
1

5
39
17
34
5

Out of the mothers (38%) who reported having a problem in breast feeding,39% pain in the
breast while feeding baby, 34% had infection in the breast, 17% milk cysts in the breast, 5%
inadequate milk required for baby and 5% excess of milk generation.(Table-12)
Page 23 of 26

DISCUSSION:
The study examines the maternal health problems of women belonging to Gulbarga colony, a
slum located in Bangalore. The study assessed the socio demography profile of women,
health of women during pregnancy, child birth and also during postpartum period. The
sample size consisted of 55 pregnant and lactating women. The study used a descriptive
survey design involving the administration of semi structure interview schedule which
assessed the health status of women during ante natal, post natal and natal periods.
70% of the women interviewed were housewives followed by daily wage workers with 70%
of them not having any personal income of their own. About 1/3rd of the respondents were
married at the age of 13 years or less and majority of the respondents had arranged and
consanguineous marriages. 96% of the respondents reported that they were visiting doctors
regularly at the time of pregnancy which is higherin comparison to 48.8% respondents across
India and 89.4% respondents in urban Karnataka who were visiting doctors regularly during
pregnancy (NFHS-3). They were undergoing monthly check-ups and had adequate intake of
nutritious food during pregnancy. 93% of the respondent reported that they had medications
and immunizations when compared to 79.7% of respondents across the country and 85.2% of
respondents in urban Karnataka (NFHS-3). 42% of the respondents had prenatal problem
during pregnancy. 79% of the respondents reported that they delivered in a hospital which is
higher compared to 40.8% of respondents across the country but lower than that of
respondents in urban Karnataka (81.8%) (NFHS-3). 83% of respondents reported that they
had a normal delivery and 17% of respondents had Caesarean section while as per NFHS-3
99.2% and 84.5% of pregnant women had a normal delivery in India and in urban Karnataka
respectively and 15.2% and 22% of respondents had delivered by caesarean -caesarean across
the country, urban Karnataka respectively (NFHS-3). 15% of the respondents experienced
excessive bleeding during delivery and 36% respondents had a preterm delivery. 22% of the
respondents experienced excessive bleeding after delivery when compared to 12.4% of
respondents according to NFHS-3. 84% of respondents reported that their baby was fully
immunized. 16% had adequate nutrition after delivery. 38% of the mothers reported having a
problem in breast feeding.

LIMITATION OF THE STUDY
 As the time spent by the researcher was limited (two months) only 55 households were
surveyed
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 Though, there were 80 respondents who are lactating and pregnant, it was difficult for the
researcher to focus on the 80 respondents due to lack of their availability thus was able to
focus only on 55 as a sample size
CONCLUSION:
Gulbarga colony is an underprivileged area with overall population of 2500. Early marriage
and consanguineous marriage is common in the slum area since the people are illiterate and
they have less knowledge about early marriage. Most of the women in slum reported that they
go for ANC check up every month, eat nutritious food, take IFA regularly and are immunized
against tetanus. Many of them preferred to have a hospital delivery, thus it reduces the
delivery related complications. Majority delivered in government hospital and had a normal
delivery, very few women delivered by caesarean section. Respondents reported that they
immunize their babies. The women were given awareness about nutritious diet.

SUGGESTIONS AND RECOMMENDATIONS:
Based on the conclusions of the study the researchers would like to offer following
suggestion and recommendations:
 A future study can be conducted for awareness program in maternal health.
 More variable like joint family personality stress and coping can be incorporated for
detailed in depth understanding their interaction.
 Government should provide more financial assistance to pregnant women’s.
 To avoid the consanguinity more awareness on the consequences.
 To give awareness on nutrition’s food during pregnancy and after delivery.
 To give awareness on immunizations and follow up prescribed by the doctor during
pregnancy and after delivery.
 Awareness on immunization and vaccines for the new born baby.
 To educate the Anganwadi teacher to build up self-confidence and periodical visit to the
women.
REFERENCES:
1. Bhatt,P.Nmari, K.Navaneethamand S,irudaya rajan-1995.maternal mortality in
India
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2. Teena Thacker :New Delhi, The April 13 2010( Lancet: India records decline
in maternal mortality rate
3. K.Navaneetham (Center for development studies) National Family Health
Survey (NFHS)1992-93
4. IndrajitHazarika, Women’s Reproductive Health in slum populations in India:
Evidence from NFHS-3
5. DNA daily news paper ,2012 (published Wednesday, may 16,2012,1st place :
united Nations / Agency : PTI
6. Guest Blogger on 8.31.2010 maternal Health Task Force and the Public health
Institute of India, in New Delhi
7. Kranti S vora, Dileep V mavalankar, KV Ramani, muditaupadhyapa, bharati
Sharma, sharadlyengar, VikramGupta, Kirthilyengar “The beginning of the
safe motherhood programme.”
8. S,scott,C,RonsmansArticale Tropical medicine and international health
volume 14,issue 12,pages 1523-1533,December 2009
9. Estimates from a regression modal studies in family planning 26(4):217-232

Web site
1. www.ask .com
2. Maternal health task force’s website

Other source
1. News paper (Times of India, Deccan herald)

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