Accessibility And Utilisation of Maternal and Child Health Services Among Bpl Households: A Case Study of Guntur District

: Mothers and children make up over 2/3 of the whole population. Women in reproductive age (15-49) constitute 21%, pregnant women, 4.5%, children under15, 47%, children under 5, 18%, under 3: 12% and infants: 4%. Maternal mortality is an adverse outcome of many pregnancies. About 80 percent of maternal deaths in are directed obstetric deaths. They result from obstetric complications of the pregnant state (pregnancy, labour, and puerperium), from intervention, omissions, incorrect treatment, or from a chain of events resulting from any of the above.


IJFMR23057104
Volume 5, Issue 5, September-October 2023 2 households having an expectant mother and/or a lactating mother.While the expectant mother can better focus on the maternal health care services, the lactating mothers can respond queries to both maternal and child health care services.Thereafter the questionnaire will be canvassed to the sample units for recording their responses.Where the questionnaires will not be possible to be filled in by the respondent, interview schedule will be used.Focused Group Discussion (FGD) will also be conducted with the respondents to probe deep into the matter.

Sample of the Study:
The study includes 200 households to which these mothers belong (64 from Pregnant Women and 136 from Lactating Women) as the final sample units.

Data Collection:
Data from published sources and field survey will be used to reach the objectives of the research.Secondary data will be collected from the sources like Annual Health Survey (AHS), District Level Household Survey (DLHS), Sample Registration System (SRS), National Family Level Household Survey (NFHS), World Bank, National Sample Survey Office (NSSO), Coverage Evaluation Survey (CES), Health Management and Information Systems (HMIS), ICDS reports and other relevant reports and publications.Secondary data will not only be used to put the things in their historical perspective but also to be used for validation purposes wherever appropriate.

Data Analysis:
Simple analytics and empirics have been used in the study.Use of only analytics will not be enough to derive the conclusion in a world where empirics conduct the way of research almost in all branches of knowledge.In the present study, depending upon the situation, necessary empirical facts have been used to reach the inference.Most frequently used variables in the study are institutional delivery, breast feeding within half an hour of delivery, exclusive breast feeding, number of PNC visits, 48 hours stay after delivery, SBA attended delivery, LBW, children under severe and mild malnutrition, number of SAM child, the level of maternal education and household income.In a social science research, all variables may not be listed for inclusion at a single spell.This may increase as the research proceeds to its final conclusion.Accordingly, the list is not exhaustive.This may include some few more variables depending upon the requirement.The occupational distribution of the husbands of the respondents is presented in this table.It is observed that majority of the respondents husbands in the study district 46% were agricultural wage labourer, 19% were did not work but was seeking and/or available for work, 16% were non-agricultural wage labourer, 10% were self employed (excluding cultivators), 5.5% were regular salaried/wage employee, 3% were attending routine domestic chores, etc. and only 0.5% was employer.The data presented in this table shows that the majority of the respondents monthly income is 9,001 to 12,000 and they were 41%, followed by 7,001 to 9,000 and they were 23%, 12,001 to 17,000 and they were 16%, Less than 5,000 and they were 11% and last monthly income group is 5,001 to 7,000 and they were only 9%.Availed maternity financial assistance 91 The data in the above table depicts the utilisation pattern of MCH services particularly delivery care services in the sample district.The information reveals that 87% of the respondents choose the Institutional delivery against reported delivery, 66% of them choose the Home delivery by Non-SBA, 76% of them go to Minimum 48 hrs stay in case of institutional delivery, 91% of them availed maternity financial assistance and only 13% of the respondents choose the Home delivery against reported delivery.Choice of institutional delivery has been on increase.Stated differently, consequent upon the percentage increase in institutional delivery, this has acted as a motivating force to the service providers.Throwing of colostrum to River with an anticipation that the flow of milk will be more 154 (77)

Prevailing of major superstitions and distribution of respondents
When the baby is looking in good condition, why should a mother will visit the AWC or ANM center without any medical requirement.It is just waste of money and loss of wages.

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A newborn baby should not be weighed because this process will result in loss of weight of baby in future 90 (45) Mentally some of the respondents do not feel urgency in visiting health facilities for post-natal checkups.Women also find it difficult to visit the health care institutions due to their social and household's cores.During this study, attempt has been made to find the prevailing cultural practices or superstitions among the respondents in the study area.

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(11) However, in case of Guntur district, it is found that while 92.5% of the respondents know and believe that colostrums should be given to the newborns but only 84% have fed colostrums to their newborns.Similarly, 92% of the respondents in study area feel that birth weight of the baby should be recorded at birth but only 89% of the respondents have recorded the birth weight of their babies.The reasons behind such gaps have been revealed during FGDs with the respondents.The respondents agreed that they know the right things but more often they don't practice it.This may be attributed to the age-old misconceptions regarding child care, low level of education, lack of exposure to the mass media, lack of strong determination of practicing the best practices (or a casual outlook towards such matters), etc. Immunisation session held 99 The data in the above table shows that 46% of the respondents were 48hrs stay after delivery, 76% of them were in PNC within 48hrs after delivery, 88% of Women getting PNC within 48hrs and 14 days, 93% of them give Newborn breastfed within 1 hour, 77% were Home delivery newborn visit rate within 24hrs, 85% were Newborn weighed at birth and 99% of the respondents were availed Immunisation session held.

Conclusion:
Accessibility of maternal and child health services and its utilisation by BPL women is greatly influenced by various socio-economic factors.Looking at the importance of the reproductive health of the mother and for better outcome of pregnancy, various interventions have been undertaken by both state and central government.Efforts have been made to find out the determinants of accessibility of MCH services in the study area.It is found that access to health care services increase with increase in the level of education.
the causes of child deaths in the study area.It is observed that birth asphyxia and premature births are the main reason for neonatal death.Similarly, pneumonia, diarrhoea, congenital anomalies are the major causes for post neonatal (1 to 59 months) deaths.If we compare the neonatal and post-neonatal period, the major reason for death of the infants is premature.Causes responsible for neonatal deaths can easily avoided by ensuring professional attendant during pre and postnatal periods.

of respondents on the basis of family types S. No Family Type
The details mentioned in the above table reveals that the majority of the respondents belong to ST category 39.5%, followed by SC category 30%, BC category 22% and only 8.5% of them taken as a sample from OC category.The data mentioned in this table indicating that an overwhelming majority of the respondents 86% were belonging into joint whereas only 14% of them belong to nuclear family taken as a sample for this study.The information projected in this table shows that the majority of the respondents 40% taken from Hindus by religion followed by Christians 31%, 15.5% of them taken from Muslims category and 13.5% of the respondents belongs to other religions.education is one of the important determining factors in utilisation of MCH services.This table presents the distribution of respondents by their level of education in the study area.The majority of the respondents 17.5% were illiterates, 16.5% of them literate without formal education, 15.5% of them secondary (Class-VIII -X), 13.5% of them were Intermediate, 11.5% of them were Upper Primary (Class VI-VIII), 9.5% of them were Primary (Class I-V), 9% of them were Graduation and only 7% of the respondents were post graduation.

of respondents according to the sources of ANC S. No.
Details in this table present the distribution of respondents availing antenatal care services.The table reveals that 66% of total respondents are availing Anganwadi as a source of ANC, 15.5% of them opted the hospitals, 12% of them went to Sub centres, 5% of them approach to PHCs and only 1.5% of the respondents availing CHC services.

related to child health care
The information in this table shows the child health status of the respondents in the study area.It is revealed that 83.3 percent of them Newborn vaccinated at Birth, 89% Newborn weighed at Birth, 44% Children fully immunised, 86% Infant breastfed exclusively and 84% Newborn fed with colostrums just after birth.