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Volume: I, Issue: I, July - December 2010


MATERNAL AND CHILD HEALTH CARE IN THE STATES OF CHHATTISGARH, JHARKHAND AND UTTARAKHAND







Abstract

The maternal and child health, (MCH) programme aims at promoting the health of women in the reproductive age-group and at improving survival and health status of pregnant women, mothers, infants and children. In the scenario of demographic as well as social development the very assurance of safe motherhood has got primary position in terms of Indian Family Welfare Programme strategy. In India, the child survival and safe motherhood programme launched in 1992 was an important step in this direction. Besides this, National Population Policy of India under its socio-demographic goal has also specified achieving 80 percent institutional deliveries by trained birth attendants by 2010.



Keywords Content

Introduction

The concern for health of mothers and children in India dates back to pre-independence period. In fact, as early as in the forties, The Bhore committee and later the Mudaliar committee in the seventies had pinpointed out the need to give high priority to provision of adequate health services for mothers and children in order to reduce maternal and infant mortality Kanitkar [1979 : 301-328]. The importance of safe motherhood practices and child survival can be understood from the fact that country is continuously experiencing high infant and child mortality and maternal mortality. The situation is further complicated because of low education among women, early age at marriage and high frequency of child marriage. Low status of women with strong kinship system in north India is one of the factors influencing high infant and child mortality Dyson and Moore [1983 : 35-39].


MCH programmes emphasized the need to ensure that pregnant women receive adequate prenatal care, safe delivery, post natal care and sought to address high risks that women in many contexts face in relation to child bearing. Maternal health is significantly associated with the health status of children that can be measured in the form of a reduction in either mortality or risks to child survival Caldwell [1979 : 395-413].


In the year 2000, three new states of Chhattisgarh, Jharkhand and Uttarakhand are carved out from the three large states of India, i.e., Madhya Pradesh, Bihar and Uttar Pradesh respectively. The three new states differ from their original states with respect to all the characteristics including demographic and health characteristics. Newly formed states belong to a category of less developed states in the country with considerable district wise variations in demographic, social and economic characteristics. Newly formed states Chhattisgarh, Jharkhand and Uttarakhand are marked by a complex social structure, a predominantly agrarian economy, a difficult and inaccessible terrain and scattered settlements over a vast area. It poses several formidable problems to family planning and reproductive health services. These states are also differs in terms of culture, socio-economic conditions and status of women. The newly formed states are committed for the betterment of the families, communities and health status of women and children by bringing down the level of maternal mortality and infant mortality. In view of the above, the present paper is undertaken to study the maternal and child health care and the factors influencing it in Chhattisgarh, Jharkhand and Uttarakhand.

 

Materials and Methodology

The data have been analysed from District Level Household Survey–Reproductive and Child Health [DLHS-RCH] conducted during 2002-2004 for the present paper. The bi-variate relationship between maternal and child health care and socio-economic characteristics has been analysed.


Maternal and Child Health Care

Ante natal Care

Research evidences have shown that care during pregnancy [ANC] will reduce maternal mortality and leads to safe delivery. The percentage of women who have received any antenatal care in Chhattisgarh, Jharkhand and Uttarakhand are given in Table 1 :

Table 1: Percentage of women who have received any ante natal care check up by background characteristics in Chhattisgarh, Jharkhand and Uttarakhand, 2002-2004:

 

Background characteristics

Chhattisgarh

Jharkhand

Uttarakhand

Any ante natal care

78.9

52.2

62.6

Age-group

15-19

80.1

55.1

63.7

20-34

79.7

53.9

64.6

35-44

70.3

32.2

40.8

Education

 

 

Non-literate

69.1

36.1

45.3

0-9 @ years

88.3

72.4

69.3

10 years & above

96.5

93.4

85.1

Place of residence

 

 

Rural

75.0

42.3

56.9

Urban

90.5

82.8

79.8

Religion

 

 

 

Hindu

78.4

52.7

64.1

Muslim

95.3

46.7

50.9

Christian

84.5

64.1

91.7

Sikh

100.0

89.3

96.9

Buddhist

100.0

100.0

100.0

Jain

100.0

0.0

100.0

Other

50.0

39.8

 

Caste/tribe

Scheduled caste

83.1

45.0

49.6

Scheduled tribe

67.3

41.3

55.5

Other backward class

83.3

53.9

59.9

Other Castes

93.0

77.1

69.3

Standard of living index

Low

71.6

40.3

48.0

Medium

89.8

75.7

64.2

High

98.3

93.1

83.5

Total number of cases

4307

3799

2439

 

The highest percentage of any antenatal care is found to be 79 percent in Chhattisgarh followed by 63 percent in Uttarakhand and lowest 52 percent in Jharkhand. Any antenatal check-ups are more common among younger women age below 34 years than among older women. It is important to note from table that, the percentage of any antenatal care increases with increase in education of the women, place of residence and standard of the living of the family in all the states. Any antenatal care is found to be highest in urban area as compared to rural areas. Any antenatal care by religion is found to be higher among Sikh, Buddhist and Jain religions and lower among Hindu, Muslim and Christian religions and varies from religion to religion and by states. Any antenatal care by caste/tribe is found to be highest in case of other category followed by other backward class and lower among scheduled castes and scheduled tribes in all the three states.


Table 2 explains the reasons for not receiving any antenatal care in Chhattisgarh, Jharkhand and Uttarakhand. About 56 percent, 48 percent and 42 percent of women in Uttarakhand, Jharkhand and Chhattisgarh reported not necessary as the main reason for not seeking antenatal care followed by lack of knowledge, cost too much and not customary respectively.


Table 2: Percentage of women who did not received antenatal care by reasons in Chhattisgarh, Jharkhand and Uttarakhand, 2002-2004:

 

Reasons for no antenatal care

Chhattisgarh

Jharkhand

Uttarakhand

Not necessary

41.9

47.6

56.2

Not customary

6.1

6.8

6.6

Cost too much

10.9

21.5

5.9

Too far/no transport

8.0

9.3

15.3

Poor quality service

1.3

1.4

1.7

No time to go

8.1

4.0

4.0

Family did not allow

8.0

4.2

4.0

Lack of knowledge

26.7

11.4

7.2

Other reason

3.4

1.9

4.0

No. of cases

1149

3479

1455

 

The low status of women or dependence of women on their family is also a matter of concern as some of them reported family did not allow, no time to go, too far/no transport as the reasons for not seeking antenatal care. Another important point to be noted here is that considerable number of women i.e. 19 percent in Chhattisgarh, 17 percent in Uttarakhand and 11 percent in Jharkhand reported health facility is too far/no transport/ poor quality of services as the reasons for not seeking antenatal care.

Delivery and Complications

One of the important thrusts of the reproductive and child health programme is to encourage deliveries under proper hygienic conditions under the supervision of trained health professionals. Table 3 shows the percentage distribution of women’s place of delivery, delivery conducted by and complications during pregnancy, delivery and post delivery in Chhattisgarh, Jharkhand and Uttarakhand. A very small percentage of births took place in government and health institutions i.e. 10 and 11 percent in Chhattisgarh, 5 and 17 percent in Jharkhand and 11 and 13 percent in Uttarakhand respectively. A large proportion of the births [80 percent, 77 percent and 76 percent] took place at home in Chhattisgarh, Jharkhand and Uttarakhand respectively. The highest 80 percent of safe deliveries took place in Chhattisgarh followed by 76 percent in Uttarakhand and 77 percent in Jharkhand. Generally, assistance during delivery can be provided by medical staff [doctors, ANM or nurse/LHV, TBA, untrained dai] and relatives and friends. If more than one type of attendant assisted during delivery, then only the most qualified person is considered. Only 5 percent, 4 percent and 2 percent of deliveries were attended by doctors and 8 percent, 4 percent and 11 percent of deliveries were assisted by ANM/Nurse/LHV in Chhattisgarh, Jharkhand and Uttarakhand respectively. Whereas 20 percent, 3 percent and 10 percent of deliveries were attended by trained dai and 45 percent, 85 percent and 62 percent of deliveries were assisted by untrained dai in Chhattisgarh, Jharkhand and Uttarakhand respectively.


Table 3: Percentage distribution of women’s place of delivery, delivery conducted by and complications during pregnancy, delivery and post delivery in Chhattisgarh, Jharkhand and Uttarakhand, 2002-2004:

 

Indicators

Chhattisgarh

Jharkhand

Uttarakhand

Place of delivery

 

 

 

Government

9.6

5.3

10.7

Private/NGO/Trust

10.6

17.1

13.0

Home delivery

79.6

77.3

76.2

Safe Delivery [Either institutional delivery or home delivery attendant by Doctor/Nurse]

29.1

27.8

32.5

Delivery conducted by

 

 

 

Doctor

5.1

3.6

1.7

ANM/Nurse/LHV

8.2

3.6

10.7

Trained Dai

20.0

3.4

9.7

Untrained Dai

44.9

84.6

62.2

Relatives/Friends

21.3

4.3

14.6

Non

0.6

0.4

1.0

Complications

 

 

 

Women who had pregnancy complications

20.1

39.0

24.0

Women who had delivery complications

16.3

75.5

20.1

Women who had post delivery complications

16.0

44.0

26.0

Sought treatment

 

 

 

Sought treatment for pregnancy complications

43.5

37.4

35.7

Sought treatment for post delivery complications

40.6

39.3

43.9

Source: DLHS-RCH, II.

The deliveries assisted by relatives/friends are 21 percent in Chhattisgarh, 4 percent in Jharkhand and 15 percent in Uttarakhand. Less than 1 percent of deliveries are not assisted in Chhattisgarh and Jharkhand whereas it is 1 percent in Uttarakhand.


Complications during pregnancy may affect both women’s health and the outcome of the pregnancy adversely. Early detections of problems during pregnancy and their management are important components of safe motherhood programme. The highest 39 percentage of women experienced pregnancy related problem in Jharkhand followed by 24 percent in Uttarakhand and lowest 20 percent in Chhattisgarh. Complications during delivery include premature labour, obstructed labour, prolonged labour [more than 12 hours], breech presentations, excessive bleeding and other problems during delivery reported by women during the three years preceding the survey. The proportion of delivery complications is highest 76 percent in Jharkhand and lowest 16 percent in Chhattisgarh whereas 20 percent of women experienced delivery related problem in Uttarakhand. The incidence of post delivery complications was judged by high fever, lower abdominal pain, foul smelling vaginal discharge, excessive bleeding, convulsion, severe headache and other problems during the first six weeks of delivery. About 44 percent of women in Jharkhand, 26 percent in Uttarakhand and 16 percent in Chhattisgarh reported that they faced any of these problems during the first six weeks after their delivery. Women who reported at least one complication during the pregnancy and the postpartum period were asked whether they had consulted or sought treatment for the problems. About 44 percent and 41 percent in Chhattisgarh, 37 percent and 39 percent in Jharkhand and 36 percent and 44 percent of women reported that they had sought treatment for pregnancy and post delivery complications respectively.

Safe Delivery

The government and NGOs have done various efforts to increase the extent of safe delivery in all the states, even though the extent of safe delivery is low and varied substantially by background characteristics of women in all the three states. The percentage of women who have safe delivery by background characteristics is given in Table 4. It is found from table that, only three out of ten pregnant mothers had safe delivery in Chhattisgarh, Uttarakhand and Jharkhand.

Table 4: Percentage of women who had safe delivery by background characteristics in Chhattisgarh, Jharkhand and Uttarakhand, 2002-2004:

 

Background characteristics

Chhattisgarh

Jharkhand

Uttarakhand

Safe Delivery

29.1

27.9

32.6

Age-group

 

 

 

15-19

28.9

27.7

37.6

20-34

29.6

29.2

33.6

35-44

24.3

17.0

19.3

Education

 

 

 

Non-literate

15.4

13.6

16.9

0-9 @years

32.0

39.1

29.8

10 years & above

80.5

76.5

63.1

Place of residence

 

 

 

Rural

19.4

15.7

25.4

Urban

57.7

66.1

54.0

Religion

 

 

 

Hindu

27.6

29.1

33.3

Muslim

77.8

20.6

25.0

Christian

30.5

28.6

83.3

Sikh

100.0

100.0

65.6

Buddhist

87.5

100.0

0.0

Jain

100.0

0.0

100.0

Other

33.3

12.2

0.0

Caste/tribe

 

 

 

Scheduled caste

25.4

20.3

21.5

Scheduled tribe

16.8

12.9

26.1

Other backward class

29.5

29.8

31.8

Other

71.0

61.4

36.9

Do not know

35.6

35.0

19.8

Standard of living index

 

 

 

Low

17.0

14.3

15.4

Medium

34.2

48.2

28.4

High

82.7

83.3

65.5

Total no. Cases

1588

2034

1269

 

The percentage of safe delivery is higher in Uttarakhand as compared to Chhattisgarh and Jharkhand. About 27-38 percent of deliveries were safe for younger women aged below 35 years than 17-24 percent for elderly women in Chhattisgarh, Jharkhand and Uttarakhand. Education undoubtedly influences the health status in general and maternal health in particular. The women who had schooling more than 10 years found to have highest safe delivery as compared to non literate and up to nine years schooling in all the three states. More than half of the deliveries were safe in urban areas as compared to little more than quarter in rural areas. In urban areas about 58 percent, 66 percent and 54 percent of deliveries were safe as against 19 percent, 16 percent and 25 percent in Chhattisgarh, Jharkhand and Uttarakhand respectively. Complete or more than 60 percent deliveries is safe in Sikh, Jain and Muslim religions in Chhattisgarh, Sikh and Buddhist religions in Jharkhand and Jain, Christian and Sikh religions in Uttarakhand. Whereas the percentage of safe deliveries is lower in case of Hindu, Christian and other religions in Chhattisgarh, Hindu, Muslim, Christian and other religions in Jharkhand and Hindu and Muslim religions in Uttarakhand. Further, the percentage of safe delivery by caste/tribe is more in case of other castes followed by other backward classes and is lower among scheduled castes and scheduled tribes in all the three states. The percentage of safe delivery is highest among the families of high standard of living and lowest among the low standard of living in all the three states.

 

Reasons for Not Going to Health Institutions for Delivery

Place of delivery and delivery conducted either by trained person or untrained person are two important factors in maternal and child health practices. Majority of deliveries takes place at home in Chhattisgarh, Jharkhand and Uttarakhand. Therefore, home delivery by reasons have been analyzed and presented in Table 5. It is interesting to find that more than three fourth of the babies delivered by the women at home who had given last live/still birth during three years preceding the survey. The majority of women in Chhattisgarh, Jharkhand and Uttarakhand reported not necessary as the reason for not going to any health institution for delivery. Poor status of women is reflected from the findings as a sizable proportion of women [34 percent in Chhattisgarh, 13 percent in Uttarakhand and 2 percent in Jharkhand] reported family did not allow as the reason for delivering at home.  

  

Table 5: Percent of women having home delivery by reasons in Chhattisgarh, Jharkhand and Uttarakhand, 2002-2004:

 

Reason

Chhattisgarh

Jharkhand

Uttarakhand

 

N

%

N

%

N

%

Home

4349

79.6

5632

77.3

2974

76.2

Not necessary

1863

42.7

2834

50.2

1687

56.7

Not customary

134

3.1

182

3.2

157

5.3

Cost too much

244

5.6

1034

18.3

328

11.0

Too far/no transport

67

1.5

414

7.3

172

5.8

Poor quality service

168

3.8

46

0.8

31

1.0

No time to go

196

4.5

206

3.6

93

3.1

Family did not allow

1478

33.9

100

1.8

377

12.7

Better care at home

126

2.9

631

11.2

61

2.1

Lack of knowledge

41

0.9

171

3.0

50

1.7

Other reason

3

0.1

22

0.4

2

0.1

Missing

45

1.0

6

0.1

19

0.6

Number of women

4365

100

5648

100

2976

100

 

No time to go and better care at home is reported by 15 percent women in Jharkhand, 7 percent women in Chhattisgarh and 5 percent in Uttarakhand. Many women in Jharkhand [18 percent], Uttarakhand [11 percent] and Chhattisgarh [6 percent] reported cost too much as one of the reason for not visiting health facility. Above all, a majority of women in Uttarakhand [17 percent], Jharkhand [11 percent] and Chhattisgarh [9 percent] could not avail the services due to either location is too far/no transport facilities available or poor quality of services at the institutions.

Immunization of Children

The immunization of children against six serious but preventable diseases namely, tuberculosis, diphtheria, pertusis, poliomyelitis and measles is the main component of child survival programme. As a part of the National Health Policy, the government of India initiated the Expanded Programme on Immunization in 1978 and the Universal Immunization Programme in 1986-86 with the objective of reducing morbidity, mortality and disabilities among children for six diseases and covering 85 percent of all infants against the six vaccine preventable diseases by 1990. Table 6 presents vaccination coverage rates for children of age 12-35 months according to some selected background characteristics in Chhattisgarh, Jharkhand and Uttarakhand. The highest 68 percent of children are fully vaccinated in Chhattisgarh as compared to 44 percent of children in Uttarakhand and 27 percent of children in Jharkhand. On contrary, 73 percent of children in Jharkhand, 56 percent of children in Uttarakhand and 32 percent of children in Chhattisgarh are not fully vaccinated. These data indicate that coverage levels are still low and a large proportion of children are not fully vaccinated. The data indicates that the coverage of fully vaccination is more in urban areas than in rural areas in all the three states. It varies lowest 19 percent in Jharkhand to highest 53 percent in Chhattisgarh and the lowest 50 percent in Jharkhand to highest 73 percent in Chhattisgarh in rural and urban areas respectively. Male children [58 percent, 28 percent and 48 percent] are more likely than female children [59 percent, 25 percent and 41 percent] to be vaccinated in Chhattisgarh, Jharkhand and Uttarakhand respectively. The relationship between vaccination coverage and birth order is consistently negative for full vaccination in all the three states. A large majority of first order births occur to younger women who are more likely than older women to utilize child health care services. There is a positive relationship between mother’s education and children’s vaccination coverage in all the three states. The 49 percent of children, 15 percent of children and 26 percent of children of non literate mothers are fully vaccinated as compared to 62 percent of children, 36 percent of children and 59 percent of children whose mothers were educated to a level below high school and 87 percent of children, 65 percent of children and 63 percent of children whose mothers were at least completed high school in Chhattisgarh, Jharkhand and Uttarakhand respectively. In Chhattisgarh, children from Muslim religion [74 percent] are much more likely than Hindu religion [58 percent] to have received full vaccination.  


Table 6: Percentage of children age 12-35 months who have received vaccination according to some selected background characteristics in Chhattisgarh, Jharkhand and Uttarakhand, 2002-04:

 

Background Characteristics

Chhattisgarh

Jharkhand

Uttarakhand

Full vaccination 1

67.8

26.6

44.3

Place of residence

 

 

 

Rural

52.9

18.9

41.3

Urban

73

49.7

53.7

Sex of the child

 

 

 

Male

57.5

28.2

47.6

Female

58.8

24.9

41

Birth order

 

 

 

1

62.2

33.8

62

2

62.8

29.7

47.3

3

57.1

26.3

39.8

4

49.7

17

22.7

Education

 

 

 

Non-literate

49

14.7

25.6

0-9@years

62.4

35.5

58.7

10 years & above

86.7

64.7

62.8

Religion

 

 

Hindu

57.7

27.4

49.1

Muslim

[74.2]

18.4

16.1

Christian

 

36.4

 

Others

[65.7]

[25.9]

 

Caste /tribe#

 

 

Scheduled caste

52.2

25.4

31

Scheduled tribe

48.4

18.6

[42.3]

Other backward class

62.7

25.5

30.5

Other

82.3

46.9

55.1

Do not know

 

0

 

Standard of living index

 

 

Low

50.5

16.9

38.1

Medium

65.4

39.9

44.5

High

82.1

67

54.4

Number of children

1547

2143

1227

 

Note: Table includes only last and last but one living children born since 1.1.1999/1.1.2001. @ Literate mother with no year of schooling are included. # Total figure may not add to N value due to not and missing cases. One BCG, three injection of DPT, Three dose of Polio [excluding Polio 0] and Measles. [] Based on less than 50 weight cases.

Children from Christian religion [36 percent] are more likely than Hindu [27 percent] and Muslim children [18 percent] to have received full vaccination in Jharkhand and children from Hindu religion [49 percent] are much more likely than Muslim children [16 percent] to have received full vaccination in Uttarakhand. The full vaccination coverage among the children of other caste groups and other backward classes is higher than the children of scheduled castes and scheduled tribes in all the three states except among the children of scheduled tribes in Uttarakhand as compared to other backward classes. The standard of living index of the household has a strong positive relationship with vaccination coverage. In case of high standard of living index of the household 82 percent of children, 67 percent of children and 54 percent of children as compared to 51 percent of children, 17 percent of children and 38 percent of children are fully vaccinated in Chhattisgarh, Jharkhand and Uttarakhand respectively.

 

Reasons for Not Immunizing Children

The percent distribution of children under the age of three years who did not receive any vaccination by reason as reported by the mother in Chhattisgarh, Jharkhand and Uttarakhand is presented in Table 7. About 3 out of 10 children in Chhattisgarh and Jharkhand and 5 out of 10 children in Jharkhand did not receive any vaccination because the mothers of children were unaware of the need for immunization. One fourth of children in Chhattisgarh, 9 percent of children in Jharkhand and 14 percent of children in Uttarakhand were not vaccinated, as the mothers felt that they were too young. Family problems for not immunizing the children were reported by 16 percent of mothers in Chhattisgarh and 6 percent of mothers in Uttarakhand and Jharkhand.

 

Table 7: Percent distribution of children under age 3 who did not received any vaccination by reason reported by mother for not giving vaccination in Chhattisgarh, Jharkhand and Uttarakhand, 2002-2004:

 

Reason for not giving vaccination

Chhattisgarh

Jharkhand

Uttarakhand

Unaware of need for immunization

26.9

45.6

30.3

Place/time unknown

10.0

19.6

10.1

Place/time inconvenient

6.4

10.0

13.2

Fear of side effect

2.1

2.6

5.2

No faith in Immunization

2.7

1.0

4.4

ANM absent/ Vaccination not available

8.5

4.5

10.6

Long waiting time

1.1

0.2

0.1

Child too young

24.8

9.0

14.0

Family problems

16

6

6

Other

1.9

1.8

2.6

Total percent

100

100

100.0

Number of children

667

3027

106

 

The place or time of vaccination was not known for not immunizing the children was reported by 10 percent of mothers in Chhattisgarh and Uttarakhand and 20 percent of mothers in Jharkhand. The place or time of vaccination was inconvenient was reported by 6 percent of mothers in Chhattisgarh, 10 percent of mothers in Jharkhand and 13 percent of mothers in Uttarakhand. The fear of side effects was reported by 2 percent, 3 percent and 5 percent of mothers in Chhattisgarh, Jharkhand and Uttarakhand respectively. No faith in immunization was reported by 3 percent, 1 percent and 4 percent of mothers in Chhattisgarh, Jharkhand and Uttarakhand respectively. ANM absent/ vaccination not available was reported by 9 percent, 5 percent and 11 percent of mothers in Chhattisgarh, Jharkhand and Uttarakhand respectively. Very few mothers reported long waiting time as a reason for not immunizing the children in all the three states.

Knowledge and current use of any modern and traditional family planning

Lack of knowledge of various contraceptive choices can be a major barrier to promotion and use of contraceptives among couples. The extent of knowledge and use of any modern and traditional family planning methods in Chhattisgarh, Jharkhand and Uttarakhand is depicted in Table 8. It is well known fact that knowledge of family planning is universal in India. Knowledge of any method including any modern contraceptive method is almost universal in the states of Chhattisgarh, Jharkhand and Uttarakhand.

Table 8: Percentage of women who had knowledge and current use of family planning methods in Chhattisgarh, Jharkhand and Uttarakhand, 2002-2004:

 

Methods

Chhattisgarh

Jharkhand

Uttarakhand

Knowledge of any modern family planning method

97.2

99.5

97.6

Knowledge of all modern family planning methods

31.2

36.7

56.3

Knowledge of any traditional methods

32.4

44.3

36.4

Current use of any family planning methods

46.6

37.9

48.7

Current use of any modern family planning methods

41.7

33.3

44.2

Current use of any traditional family planning methods

4.8

4.6

4.3

Current use-female sterilization

34.8

25.3

25.1

Current use-condom

2.6

2.9

11.1

Women who had side effects due to use of female sterilization

10.0

21.1

12.1

 

The knowledge of all modern family planning methods is highest 56 percent in Uttarakhand followed by 37 percent in Jharkhand and lowest 31 percent in Chhattisgarh. Women who have knowledge of any traditional methods of family planning are highest 44 percent in Jharkhand as compared to 36 percent in Uttarakhand and 32 percent in Chhattisgarh.

 

Current use of any family planning methods is highest 49 percent in Uttarakhand followed by 47 percent in Chhattisgarh and lowest 38 percent in Jharkhand. The current use of any modern family planning methods is highest 44 percent in Uttarakhand followed by 42 percent in Chhattisgarh and lowest 33 percent in Jharkhand. The current use of any traditional family planning method is found to be 5 percent in Chhattisgarh and Jharkhand and 4 percent in Uttarakhand. Female sterilization is found to be highest 35 percent in Chhattisgarh as compared to lowest 25 percent in Jharkhand and Uttarakhand whereas the use of condom is found to be highest 11 percent in Uttarakhand as compared to 3 percent in Jharkhand and Chhattisgarh. The side effects due to the female sterilization are reported by 21 percent, 12 percent and 10 percent women in Jharkhand, Uttarakhand and Chhattisgarh respectively.

Current use of family planning methods by background characteristics

The information on current use of family planning methods by background characteristics of currently women in Chhattisgarh, Jharkhand and Uttarakhand is provided in Table 9. About 49 percent, 47 percent and 38 percent currently married women in Jharkhand, Chhattisgarh and Uttarakhand were using some method of contraception. Current use of family planning is highest at older age group 35-44 years and lowest at younger age group 15-19 years in all the three states. The current use of family planning methods increases with increase in the education. The current use of family planning methods is high among the women who have 10 or more years of schooling [57 percent in Uttarakhand and 54 percent Chhattisgarh and Jharkhand] than the women who have less than 10 years of schooling i.e. 50 percent, 47 percent and 41 percent in Jharkhand, Chhattisgarh and Uttarakhand respectively.


Table 9: Percentage of women currently using family planning methods by background characteristics in Chhattisgarh, Jharkhand and Uttarakhand, 2002-2004:

 

Background characteristics

Chhattisgarh

Jharkhand

Uttarakhand

Current use of any family planning method

46.6

48.7

37.9

Age-group

 

 

 

15-19

5.3

7.8

4.3

20-34

39.8

41.5

35.7

35-44

71.9

68.6

58.9

Education

 

 

 

Non-literate

44.5

45.1

31.4

0-9 years

46.9

49.6

41.2

10 years & above

54.3

53.7

57.3

Place of residence

 

 

 

Rural

42.3

45.8

29.2

Urban

56.5

56.4

57.1

Religion

 

 

 

Hindu

46.2

50.5

40.5

Muslim

54.6

31.7

21.9

Christian

59.5

70.0

25.5

Sikh

45.6

61.9

59.5

Buddhist

10.3

0.0

25.0

Jain

75.0

75.0

37.5

No religion

0.0

0.0

0.0

Other

60.0

100.0

22.7

Caste/tribe

 

 

 

Scheduled caste

41.7

43.3

33.5

Scheduled tribe

34.2

48.8

22.6

Other backward class

53.7

44.7

40.5

Other

57.0

51.5

55.4

Do not know

41.4

44.1

36.1

Standard of living

 

 

 

Low

39.9

41.1

27.0

Medium

51.5

45.0

51.8

High

63.8

61.3

63.0

Total number of cases

5916

4692

5839

 

Similarly, the current use of family planning varies positively with respect to the standard of living of the household, increasing the prevalence rate 40 percent to 64 percent women in Chhattisgarh, 41 percent to 61 percent women in Jharkhand and 27 percent to 63 percent women in Uttarakhand from the lowest to highest standard of living of the households. The current use of family planning methods is higher in urban areas as compared to rural areas in all the three states. The current use of family planning methods by religion is highest 75 percent in case of Jain followed by 59.5 percent in case of Christian and lowest 46 percent in case of Sikh and Hindu in Chhattisgarh. The higher 75 percent women in case of Buddhists and 70 percent women in case of Christian are currently using family planning methods as compared to lower 32 percent in case of Muslims and 51 percent in case of Hindus in Jharkhand. The highest 60 percent of women in case of Christian followed by 41 percent of women in case of Hindus and lower 22 percent of women in case of Muslims and 25 percent of women in case of Christians and Buddhists currently using family planning methods in Uttarakhand. The current use of family planning methods is higher among the women of other castes [57 percent, 52 percent and 55 percent] than other backward classes [54 percent, 45 percent and 41 percent], scheduled caste women [42 percent, 43 percent and 34 percent] and women from scheduled tribe [34 percent, 49 percent and 23 percent] in Chhattisgarh, Jharkhand and Uttarakhand respectively.

 

Conclusions

It is concluded from analysis that the utilization of maternal and child health care services is not uniform in Chhattisgarh, Jharkhand and Uttarakhand. The coverage of antenatal care is a matter of concern in all the three states but special attention should be focussed on Jharkhand as half of the women are not seeking any antenatal care. The coverage of safe delivery is also not satisfactory in all the three states. The coverage levels of vaccination are still low and a large proportion of children are not fully vaccinated due to the various reasons. Knowledge of any method including any modern contraceptive method is almost universal but the current use of family planning methods varies by religion and state. The current use of family planning methods is higher among the women of other castes and other backward class as compared to scheduled caste and scheduled tribes. Therefore, special attention should be focussed on scheduled castes and scheduled tribes in Chhattisgarh, Jharkhand and Uttarakhand. The analysis indicates that, antenatal care, safe delivery, coverage of full vaccination, current use of family planning methods increases with increase in education of the women, place of residence and standard of the living of the family in all the three states.

 

Policy Implications

  1. As education is positively associated with the maternal and child health care utilization, education of the girls needs to be encouraged.

  2. The provision of adequate health services, infrastructure, equipment and trained personnel should be provided in rural areas to remove rural-urban disparity.

  3. Majority of women are unaware of the importance of maternal and child health care therefore efforts should be made to create awareness.

 

REFERENCES

 

Caldwell, J. 1979. ‘Education as a factor in Mortality Decline: An Examination of Nigeria Data’, Population Studies 33 [1] : 395-413.

 

Dyson, T. and Moore M. 1983. ‘On Kinship Structure, Female Autonomy and Demographic Behaviour in India’, Population and Development Review 9 [1] : 35-39

 

International Institute for Population Sciences. 2004. District Level Household Survey – Reproductive and Child Health [DLHS-RCH], Mumbai.

 

Kanitkar, T. 1979. Development of Maternal and Child Health Services in India. In K. Srinivasan, P C. Saxena and Tara Kanitkar [eds.], Demographic and Socio-economic Aspects of the Child in India. Bombay: Himalaya Publishing House : 301-328.