Monday 1 April 2013

A Generating Awareness on ‘Importance of Institutional Delivery’ to Community Volunteers and Pregnant Women-An Action Project of Gujarat



Anjali Pahad*, Nidita Karkare**, Avani Pathak ***
Abstract
The need for bringing down maternal mortality rate significantly and improving maternal health in general has been strongly stressed in the national population policy 2000. To reduce home deliveries and maternal child mortality rate, the government of India took steps to strengthen maternal and child health services. Many attempts have been made to understand the mechanism of maternal mortality in India and antenatal care; institutional delivery have been identified as important contributors for reducing maternal mortality rate (MMR). Thus, with the promotion of institutional delivery the maternal mortality rate can be decreased Keeping in mind the importance of women’s health for family and nation , an action project was planned with an objective to create awareness on importance of institutional delivery amongst the community volunteers and pregnant women of three selected villages of Sinortaluka. Project conducted in different phases. First preliminary survey was done to find out the general awareness level of the villagers.  Based on survey planning and execution of the project was done. Reaction tool was filled up for knowing their reactions regarding the awareness generation programme for evaluation purpose. After the completion of the extensive awareness generation programme in all three villages selected, it was found that hundred percent institutional deliveries were conducted in two villages however in Barkal village after many attempts hospital deliveries were conducted. Awareness was generated on different topics like importance of institutional delivery, importance of medical treatment, etc. Villagers were convinced for the promotion of institutional delivery practices. The pregnant women had the three antenatal visits needed during pregnancy period. They were more conscious about the nutritious food. Majority of the pregnant women started availing facilities provided by the government in the villages.
Introduction
The maternal and child health plays a very significant role on the quality of life of each generation. Mother’s health also influences the health of the next generation. So one may say that the health of the nation is dependent on the health of women and children. Mukhopadhyayand Sarkar (2009), in an article titled “Pregnancy-related food habits among women of rural Sikkim, India”: expressed that, for each person food is a vital component of life, as it contains the nutrients. He/she needs for daily living and also plays an important role in social life. However, food in appropriate quantities is not always accessible to all people, due to various political, economic and geographic reasons. Mothers in developing countries, especially pregnant and lactating ones, are considered to be nutritionally vulnerable as they are often subjected to different degrees of nutritional stress. It has been established that women from less privileged communities in India tend to suffer from malnutrition of different grades and their dietary energy intake is not always adequate to compensate for the heavy physical workload which they often have to undertake. The success of lactation and the health status of the infant depend entirely on the type of diet consumed by women during pregnancy and lactation .It is widely accepted that cultural beliefs and practices play a role in the successful dissemination of nutrition messages to the community.
What is Maternal Mortality?
According to Dutta, (2004), “maternal deaths means death of woman while pregnancy and within 42 days of the termination of pregnancy irrespective of duration and site of the pregnancy from any cause related to or aggravated by the pregnancy or its management but not from accidental or incidental causes”.
Maternal Mortality Ratio
According to Dutta, (2004), “the Maternal mortality rate is expressed in terms of maternal deaths per 1, 00,000 live births.” It means the women who die in a year due to causes related to pregnancy and child birth for every 1, 00,000 live births.The need for bringing down maternal mortality rate significantly and improving maternal health in general has been strongly stressed in the national population policy 2000. This policy recommends a holistic strategy for bringing about total intersectoral co-ordination at the grass root level and involving the non government organizations, civil societies, panchayati raj institutions and women’s group in bringing down maternal mortality rate.
The Need and Importance of Institutional Delivery
According to Mathu  and Pandya ,(2006), “Comprehensive minimal care during pregnancy, child birth and there after steps to ameliorate malnutrition as well as decrease the work load of women and improve access to health services should be the silent instruments for improving the health of women.The guiding principle for the first time and a half decade of planned development in health in India included measures to:make health services more accessible to the women , developing the needed human resources , provision of services for health including maternal and child health” So many attempts have always been made to understand the mechanism of maternal mortality in India and antenatal care; institutional delivery have been identified as important contributors for reducing maternal mortality rate (MMR). Therefore, national rural health mission has an important goal and carries many efforts in this direction. The efforts and steps taken towards the institutional delivery have played a very effective role in reducing maternal mortality rate (MMR).National family healthy survey was conducted in the year 2005-06, in various states of India. The finding of the survey highlighted the maternal mortality rate (MMR) and institutional delivery of the selected states. It revealed that the rate of maternal mortality decreased with increasing rate of institutional delivery. Table shows that the maternal mortality rate was high in Uttar Pradesh state where as institutional delivery rate was only 19 percent. Where as compared to Gujarat the institutional delivery rate was high i.e.55 percent and the maternal mortality rate was 172 which was relatively less.Thus, with the promotion of institutional delivery the maternal mortality rate can be decreased.  Keeping in mind the importance of women’s health for family and nation an action project was planned with an objective to create awareness on importance of institutional delivery amongst the community volunteers and pregnant women of three selected villages of Sinortaluka.
Objectives of the project
·         To create awareness on importance of institutional delivery to selected      community volunteers of MotaFofaliya,Zanzad and Barkal, villages of Sinortaluka, Vadodara.
·         To evaluate the community volunteers on their skills for creating the awareness on importance of institutional delivery to selected pregnant women of MotaFofaliya, Zanzad and Barakal, villages of Sinortaluka, Vadodara.
·         To study the reactions and suggestions of the selected community volunteers regarding the awareness generation programme on importance of institutional delivery conducted by the project worker.
·         To study the reactions and suggestions of the selected pregnant women regarding the awareness generation programme on importance of institutional delivery conducted by community volunteers.
Justification of the Project
According to Das,(2007) “in India’60-70 percent of the population thrives in rural area, rural women acquires an important role in rural development. They are capable of improving the quality of life in rural communities by remaining fit and healthy.Women can play a significant role in contributing social, economic, cultural, educational and political development in a country. In a family, women are the only one who takes care of everyone .She deals with home related things as well as stays in touch with other members of the family and children .She is like a pivot in the family through which development can be attained. It is because when women get all the development it is spontaneously passed on to the other members in the family. But, for the attainment of development she should be aware about various information around her, to satisfy her needs. So, this project is mainly for creating and strengthening awareness about “institutional delivery” amongst community volunteers and pregnant women.”Home deliveries are very commonly prevalent practices in many villages of Gujarat. This leads to many problems like,
·         Pregnant women get scared of taking injections.
·         Sometimes they are unaware about their delivery date.
·         Many women think that hospital delivery is an expensive affair and so they prefer home delivery.
·         Sometimes they are not aware about the government’s schemes, which can finally help them for delivery in hospitals.
In the villages selected for this project, majority of women are laborers. They have to work hard during pregnancy period also and they can not take rest which is needed during pregnancy period. This is very harmful for the mother and her baby also. Hence the need was felt by the project worker to create awareness amongst them on importance of institutional delivery.
The success of the project may motivate pregnant women of these villages for promoting institutional delivery that will yield tangible results.
Thus institutional delivery project was planned in MotaFofaliya, Zanzad and Barkal villages. If this project sustain for longer period of time then it may provide multidimensional benefits like increase in institutional delivery, good care of pregnant women, deliveries of healthy baby, etc.
METHODOLOGY
The project was divided into four phases

No
Phase-1 (Preliminary survey)
Phase-2 (Planning of the project)
Phase-3 (implementation of the project)
Phase-4 (Evaluation of the awareness geneartionprogramme on institutional delivery)
1
Visits to the selected villages for project
Selection of the content on creating awareeness on importnce of instituional deliveries
(Part-A)-Implementation of the project for the commuinity volunteers by the project worker.
The reactions of the community volunteers regarding awareness generation programme on institutional delivery
2
Interview with anganwadi workers, asha workers and dais 
Preparation of the teaching learning material
Rapport building with the community volunteers
The reactions of the pregnant women regarding awareness generation programme on institutional delivery
3
Home visits of pregnant women.
Preparation of reaction tool for evaluation
Execution of the project by the project worker for the community volunteeers

4
Findings of the survey

(Part-B) Implementation of the project for the pregnant women by the commuinty volunteers.

PHASE-1-Preliminery Survey
Project worker conducted a preliminary survey in three selected villages i.e. MotaFofaliya, Zanzad and Barkal to know the awareness level of the community volunteers regarding the importance of institutional delivery.
To conduct the preliminary survey following steps were carried out by the project worker Finding of the Survey
The project worker received the data regarding the institutional and home deliveries from the community volunteers which reveled that is the in Barkal village seventy percent 70 percent of the women, in Zanzad village 40 percent of the women and in the MotaFofaliya village 20 percent of the women had delivered their babies at home.  Majority of the deliveries of the pregnant women were done at home with the help of untrained dais.
Majority of the community volunteers had not taken the training related to the awareness generation of institutional delivery programme. They did not have any teaching learning material for convincing the people for institutional delivery, too. So the anganawadi workers, asha workers and dais had confidence on project worker that she would be able to promote the awareness of institutional delivery of their village.  This awareness programme would definitely solve their problems of unsafe home deliveries, which are harmful for baby and mother both. So after the survey the project worker had finally concluded that there is a great need to create awareness on importance of institutional delivery, the importance of mother’s health, food, nutrition etc to minimize the number of home delivery and to motivate the people, institutional for institutional delivery.
                                  PHASE-2 Planning of the Project
Selection of the Content on Creating Awareness on Importance of Institutional Delivery
Project worker prepared content on creating awareness on importance of institutional delivery. For these she had visited different non government organizations and resource persons working in the area of the health, particularly for women. The content was adapted from different sources like books, non government organization’s material, web sites and non government organization’s manual. Once the content was finalized, it was validated by the experts.
Preparation of Reaction Tool for Evaluation
There were two reaction tools prepared by the project worker, one was for the community volunteers and the other on was for the pregnant women.
PHASE 3: Implementation of the Project
This third phase of the action project was the actual implementation of the activities for imparting awareness on importance of institutional delivery. The third phase was divided in two parts. The first part of this phase was implementation of the activities for the community volunteers by the project worker and the second part was implementation of the activities for the pregnant women by the community volunteers. 
PART-A, Implementation of the Activities for the Community Volunteer by the Project Worker
1) Rapport building with community volunteers
Project worker met all the anganawai workers, asha workers and dais. All of them were very helpful and enthusiastic. First, the project worker had discussed about the subject on which she is going to take action with the help of anganwadi workers, asha workers and dais. As the topic was familiar with them, so they were taking interest in the project. They were very eagerly waiting of the project’s initiation. There were eighteen community volunteers of which seven were asha workers, seven anganawadi workers and four were dais of MotaFofaliya, Zanzad and Barkal villages.
2) Execution of the projectby the project worker for community volunteers
Project worker had selected three different villages MotaFofaliya, Zanzad and Barkal. All the community volunteers could not get together at the same place so project worker had arranged awareness programmes at their own villages at different times. Thus the project worker executed the awareness generation programme on importance of institutional delivery separately in all three villages through different materials and methods for implementation of the project like charts, posters, calendar, documentary movie, flip books etc.
Details of the activities conducted under the project are mentioned below:
1) Illustrated talk: The project worker had given illustrated talk on different topics like internal organs of the women, development period of baby during pregnancy period, importance of institutional delivery. For this project worker had used discussion and lectures as a method. She had used teaching learning materials like charts, posters, flip books, calendar.
2) Expert talk: The project worker had invited Dr.Salim Shekh from Shree C.A.Patel Hospital, MotaFofaliya as a expert. He had given talk on the importance of institutional delivery and various government schemes for the pregnant women. He had explained the importance of institutional delivery and harmful effects of the home delivery.
3) Bhavai on institutional delivery: Thebhvai on institutional delivery was performed by the project worker and other supporters .The main aim of the bhavai was imparting awareness to stop home delivery and get the benefit of the institutional delivery along with the entertainment.
4) Documentary movie on importance of institutional delivery: The documentary movie on the importance of institutional delivery was show by the project worker. The name of the documentary movie was “kali kemmari?” project worker had collected the CD of “kali kemmari?’ by Shroff foundation a non governmentorganization.This movie was mainly on the harmful effects of home deliveries. It focused on the babies delivered by the dais at home which have harmful effect on the health of the mother and baby.
PART-B, Implementation of the Activities for the Pregnant Women by the Community Volunteers
1)   Rapport building with the pregnant women
Project worker had another target group which was of pregnant women. So she had build rapport with the pregnant women through home visits. She had discussed with them about the project and activities. Initially they got scared and felt shy with the project worker but after rapport building they were much closer to the project worker. There were 20 pregnant women from three selected villages.
2)   Execution of the project by the community volunteers for the pregnant women
The second part of the project was awareness programme for pregnant women by community volunteers. So in this part the awareness on importance of institutional delivery was generated by the community volunteers amongst the pregnant women through different materials and methods for implementation of the project like charts, posters, calendar, documentary movie, flip books etc.
Details of the activities conducted under the project are mentioned below:
          Illustrated talk: Community volunteers had created awareness on importance institutional delivery. They had covered different topics which were internal organs of the women, development period of baby during pregnancy period, importance of institutional delivery. Community volunteers had used discussion and lecture methods.
           Expert talk: The community volunteers also approached Dr. Salim Shekh was selected for expert talk who was doctor of the Shree C.A.Patel Hospital, MotaFofaliya. He had emphasized his talk on the importance of institutional delivery and government schemes for the pregnant women. He had explained very carefully and with easy to understand language.
Documentary movie on importance of institutional delivery : A movie was shown by the community volunteers to the pregnant women, too. It was mainly on the harmful effects of home deliveries.
Evaluation of the Awareness Generation Programme
The Reactions of the Pregnant Women Regarding Awareness Generation Programme on Institutional Delivery
As the programme was divided in two parts, thus there was a need of seeking reactions of the programme conducted by the community volunteers for the pregnant women. So another reaction tool was filled up by the pregnant women for knowing their reactions regarding the awareness generation programme, the community volunteers and methods and materials used in awareness generation programme.
Evaluation by the Project Worker of the Selected Community Volunteers.
1) The community volunteers had shown their interest during whole project. They eagerly participated and conducted the programme of the importance of institutional delivery.
2) They enthusiastically conducted programme for the pregnant women
3) Earlier no one had provided any teaching learning material to them for creating awareness. At Initial stage they were having some difficulties in handling teaching learning material during explanation. But later on they were able to use teaching learning materials effectively.
4) Community volunteers were from the same community as of the villagers so they could easily convince the target group (pregnant women) for promoting institutional delivery.
5) Community volunteers were already engaged in the same work. But they had fear at some places as they didn’t have enough knowledge. After getting the right information they confidently took the sessions
Outcomes of the Project
Last year i.e. before the commencement of this present project majority 70 percent of the pregnant women had conducted home delivery where as only thirty percent pregnant women registered with the hospital in the Barkalvillage.In the Zanzad village majority 40 percent of the pregnant women delivered their babies at the home where as only thirty six percent had delivered their baby in the hospital.In the MotaFofaliya village all the community volunteers wanted that all the pregnant women must deliver their babies in the hospital but because of some problems like superstitions, the awareness of their expected delivery date etc, were not able to get hundred percent results.Majority of the pregnant women had checked up their weight, urine test, blood test and blood pressure. Majority of the pregnant women had taken three necessary antenatal visits, vaccinated and received all the iron’s tablets after the awareness generation programme on institutional delivery.After the completion of the extensive awareness generation programme in all three villages, project worker had found out that hundred percent results in MotaFofaliya and Zanzad village however in Barkal village she did not get hundred percent result. She found that fifty percent of the pregnant women had conducted their delivery in the hospital. So it was found that twenty percent result was increased after the awareness generation programme.Villagers of Barkal didn’t want to change their delivery practice as they very highly suppositious. After the awareness generation programme some were convinced and had conducted hospital deliveries.                                                         To conclude the Project worker had created awareness on different topics like female organs, importance of institutional delivery, importance of medical treatment, etc. Project worker was able to convince the villagers for the promotion of institutional delivery practices. They also agreed to deliver their babies in the hospital. The pregnant women had the three antenatal visits needed during pregnancy period. They were more conscious about the nutritious food. Majority of the pregnant women started availing facilities provided by the government in the villages.
REFERENES :
Dutta. D. C (2004), Textbook of Obstetrics, 6th edition, new central book agency Pvt. Ltd. Kolkatta.
Mathu.A and Pandya.R,(2006),Facets of women’s development, Kalpaz publication, Delhi.
Nithianandam.S(February,2009),Social Welfare,Vol No.55 Institutional delivery and relationship with infant mortaloity rate.
Gaur.P(2009),Social welfare,Vol.55.delivery practices in the tribal area.
Vyas.A and CHETNA,(2009), listening to women’s experience of pregnancy and childbirth, publication development organization .
The Healing touch, Deepak Foundation (Annual Reaport-2006-2007)
Prof.  Anjali Pahad*, Ms. Nidita Karkare**, Ms. AvaniPathak ***
*Professor, **Teaching assistant,*** Research Scholar
Department of Extension & Communication
Faculty of Family & Community Sciences,
Maharaja Sayajirao University,
Vadodara, Gujarat, India.