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STUDY AIMS AND OBJECTIVES
STUDY APPROACH AND METHODS
STUDY SUGGESTIONS & CONCLUSION
- Mitanin: Mitanins are the community health volunteers ( otherwise known as ASHA in other states ) Over 72,000 such volunteers are working in Chhattisgarh hamlet wise called as ‘Mitanin’ with literal meaning as ‘female friend’. These women voluntarily increase the community demand for modern medical care and help the government in ensuring percolation of health programmes at grass-root level.
- ANM: ANM stands for ‘Auxiliary Nurse Midwife’ . ANM is considered as lowest line agency of health department at Panchayat level and the first point of contact between needs and services, between people and organization. They are the person who are in charge of Sub health centre.
- AWW: AWW stands for ‘ Anganwadi worker’. The integrated child development services comprises of Anganwadi workers. Their responsibility is to manage the Anganwadi centres and promote its services for the children from the age group of 4 to 6 years and also make registration of pregnant women at the community level.
- BCC: Behaviour change and communications strategies.
- IEC: Information, education and communication strategies.
Male involvement has shown to yield positive results in the health of the women and their children, according to many studies conducted earlier in India and Abroad. This study thus subscribes to the hypothesis that interventions that include men during pregnancy and childbirth has greater and positive impact on maternal and child health. Taking references from similar studies which assessed male involvement in either qualitative or quantitative fashion, this utilizes mixed methods wherein the quantitative data and qualitative data were collected concurrently to understand Male involvement in terms of Awareness levels, reproductive health patterns, preferences and perception regarding the health care services available, factors influencing health services seeking behaviour, male partner’s support during all the significant events during pregnancy, delivery and childcare, financial and emotional support from the male partner, assistance obtained from Mitanins, Auxillary nurse midwives, Anganwadi workers, Doctors, and assistance derived from the social network, i.e Neighbours and family members.
The location selected for the study is Bilaspur district of Chhattisgarh India. It hosts a population size of 2,663,629 according to the 2011 census. It is the second largest city after the capital city if Raipur in the entire state and governs around 1635 villages. Bilaspur served as an ideal location as it serves a huge diversity of population within the district. The study took an exploratory approach and adapted mixed methods comprising of questionnaire interviews with 50 couples belonging to 4 different locations in Bilaspur.
The locations were selected according to convenience and the sampling method used was random stratified sampling wherein the sample was broken into small strata and at the same time capturing maximum variation. The selection criteria was to interview only those couples who were expecting a baby at the time of the interviews and couples who are parents of at least one child of 2 years or less.
The tools used for undertaking the study includes personal interaction questionnaire, Focus group discussion and key informant interviews along with reference secondary information collected for the purpose.
The significant observations made from the study suggests that there is maximum involvement of husband in most of the cases and the outcome has been encouraging.
In cases which had lack of male involvement resulted in some complications and C-section deliveries. The observation of the findings reveals there has been increased awareness levels on maternal health part among couples which could be linked to continous efforts of sensitization by the government.
Nuclear families had better indicators of male involvement in most of the cases, as compared to the couples belonging to joint families suggesting the husband is more likely to participate in maternal health services if he belongs to a nuclear family. The study identifies gaps which needs to be addressed , in the view of extraordinary performance of the concept of Mitanins in Chhattisgarh , it was observed that they were not properly prepared to counsel the males, hence the Mitanins are very useful but they need to be properly trained to handle the queries of the males. Similarly the BCC strategies must start focussing on the couples and mens counselling instead of focussing only on women. Interventions related with men’s involvement needs to be performed with respect to education, livelihood, poverty. Incentivising male involvement might also help to motivate the working class on larger involvement in maternal and child health programs.
The precursor of the concept of Male involvement in the reproductive health programs was seen in the International conference of population development in Cairo 1994, but in India very few measures have been taken to encourage male involvement in the their partner’s reproductive health, Maternal and child mortality in the country is yet to come down and the reasons of the mortality can be seen on various counts. Be it on account of standard delays, or referral, or quality treatment or health consciousness behavior or service delivery pattern. All those aspects are hovering around reproductive health focusing mostly on the women’s health and the interventions are planned with women.
The social structure of India subscribes to the norm of keeping men distant from the maternal and child health issues, even though the society is rapidly evolving in its ideologies a large percentage of the rural population find it difficult to understand the importance of the concept of Male involvement in pregnancy and childbirth, they rely on the traditional Dais/Midwives for checkups and delivery, who are often untrained exposing themselves to a range of complications.
There are enough evidences existing in India which suggests that male involvement has a greater net impact on the maternal and child health and can increase the health service utilization as well as outreach of various maternal and child health services being provided. As rightly concluded by (Dudgeon and Inhorn 2004) that men have the capability to influence the health outcomes of Their partners and children “positively” or “Negatively”, “Directly” or “ Indirectly”. This statement fits the Indian scenario due to the high status of a decision maker which is given to an average Indian Male which when directed in an efficient way can actually contribute in reducing the maternal and infant mortality rate in the country which is very much the need of the hour. To fulfil this objective of the study primary data was collected from the eligible couples who fall under the selection criteria of the study i.e expecting couples and couples who have atleast one child of 2 years or less.
Most of the studies have examined the positive effects of men’s involvement in maternal and child health, these studies include: ( Bhalerao et al. 1984; Carter 2002; Mullany, Becker and Hindin 2007; Singh, Lahiri and Srivastava 2004). The study conducted by Bhalerao et al.(1984) in Mumbai was one of the earliest conducted studies which found that “involving husbands in antenatal care counseling significantly increases the frequency of antenatal care visits, significantly lowers peri-natal mortality, and pays dividends even among uneducated and low socio-economic groups.”
A study by Mullany, Becker and Hindin (2007) provided evidence that women tend to understand and utilize the health services and exercise their rights in a better way when they are educated along with their partners. A report by Raju .S and A .Leonard (2000) suggests that “men are interested in becoming more supportive and involved in all reproductive health domains, and that they have reproductive needs of their own which are rarely addressed” and also how “the timing ,location and structure of intervention can encourage or discourage the partner involvement” . Further, in contrast to men who do not participate in antenatal care counselling, men participating in antenatal care counselling tend to know more about family planning, nutrition and health of their wives during pregnancy, and the ways and means of preventing complications during pregnancy, at delivery, or during an abortion. An intervention during prenatal consultations to increase men’s involvement in their partners’ maternal care increased couples’ discussion and use of contraception and improved knowledge about pregnancy and family planning (Varkey et al. 2004).
According to study conducted by M.Carter (2002) among Guatemalan women who had some complications during the pregnancy, considered “type of prenatal care sought and the quality of the familial and marital relationships are important factors .” further he also pointed out the complex nature of male participation as it is not a “singular behaviour” and is subject to influence by various socio-economic, cultural, and gendered norms. Among the studies conducted in India, a study conducted by Abhishek Singh and Faujdar Ram(2009) in Rural Ahmednagar provided a good understanding of the factors which govern the male involvement in their partner’s pregnancy and childbirth. This study was an innovative approach to look at male involvement through the lens of ‘Gender attitudes’ and ‘Social Networking.’ Further they were also able to substantiate the correlation between male involvement and its positive effects on the overall well being in the health of both mother and child.
According to the NFHS 2005-2006 report of Chhattisgarh state out of 79% of men who claimed that their wives received Antenatal care, Fifty-two percent of men with a child under three said they were present during at least one antenatal check-up received by the child’s mother; only one-third were told what to do if the mother had a pregnancy complication, and 10-15 percent were told by a health or family planning worker about specific signs of pregnancy complications. Not all fathers with a child less than three years of age were provided information related to maternal care. Only half (53%) were told about the importance of proper nutrition for the mother during pregnancy and 38 percent were told about the importance of delivering the baby in a health facility. Among fathers whose child was not delivered in a health facility, 58 percent were told about the importance of using a new or unused blade to cut the umbilical cord, 43-44 percent were told about the importance of cleanliness at the time of delivery, and the importance of breastfeeding the baby immediately after birth, and one-fourth were told about keeping the baby warm immediately after birth. The patriarchal nature of society and male domination are the peripheral factors though significant were rarely touched in these reports. If anything can be done that will help yield good results on expected lines by intervening with the male counterparts, it would be an interesting section to delve and also help in designing better strategies. At least 10% of mortality , if curtailed through the greater and effective involvement of Men, it would be a great contribution for the overall efforts. For this to happen a study is necessitated which will basically assess the dimensions of male involvement and the scope for improvement. This will help to redesign the BCC [behavioural change and communication] strategies and also contribute in reducing the maternal and child mortality. The present study is one such attempt to assess the level of male involvement in the partners pregnancy as well as to identify the scope for improving the male involvement thereby reducing the mortality and increasing the coverage of ANC and institutional delivery.
Study Title : “Male involvement in their partner’s pregnancy and childbirth; An Exploratory study in the Bilaspur district of Chhattisgarh state”
This study intends to look at the status of Male involvement in the district of Bilaspur, Chhattisgarh .Male involvement in this study is defined as Men getting involved in decision making, planning of their partners pregnancy, presence in all the ante-natal check-ups, active participation in the counselling process, and support during the pregnancy and Delivery, support which is financial, emotional and in the form of childcare. This study aims to provide an insight into the patterns of men’s participation in the pregnancy, childbirth, and its effects on the reproductive health of the women. This will eventually lead to a better understanding of the preferences and perception of men, women and the society they live in about communication between the couple, utilization of health services, and norms dictating the participation of the male partner, which could be addressed in an efficient way further to frame appropriate and relevant policies to encourage male involvement in their partner’s pregnancy and childbirth.
The basic study questions attempted to answer in the study are:
- What is the level and affect of involvement of males in their partner’s pregnancy?
- How can the males be involved for ensuring safe deliveries and reducing mortality?
- What are the possible methods of involving males in their partner`s pregnancy period ?
The study started on a hypothesis mode wherein it was assumed that ‘male involvement has positive effects in maternal and child health’ later it took an exploratory orientation while taking references from similar kind of studies to assess the effects of male involvement in the maternal and child health. The purpose of the study has been to gain more familiarity/ insight into the phenomenon of male involvement in the maternal and child health programs and to gain experience that will be helpful in formulating definitive hypothesis for more definite investigation.
Thus the study demanded to adopt a flexible approach like an ‘Exploratory research’.
This particular study was performed during the span of one month from 14February till 30 March 2015. A convergent design was framed for the study wherein the intent was to merge concurrent quantitative and qualitative data to address the study aims and objectives, by using a mixed methods research methodology. The interview schedule was designed such that it captured essential information in a quantitative manner while also giving an opportunity to engage the respondents in an ‘in-depth conversation’ for certain sections of the questionnaires. Thus a semi-structured questionnaire was designed for this purpose. The same study tool was used for Men and women. They were interviewed face-to-face and for each respondent the study collected information on age, years of marriage, number of living children, status of pregnancy, occupation, educational status, type of family. The questionnaire also collected information from the men and women on their awareness on reproductive health behavior, knowledge of immunization schedule, institutional delivery, birth planning, planning of pregnancy, men’s willingness to participate in the ANC ,delivery and PNC checkups, decision making , support to the partner in terms of financial, emotional and in childcare, which provide various indicators of men’s involvement in their partner’s pregnancy and childbirth. The questionnaire comprises of primarily closed ended questions, and also certain open ended questions regarding problems and inconvenience faced by the couple specially the male partner to get involved in the ANC, delivery and PNC checkups. Male involvement during the delivery in this study is defined as male partner being present in the institution at the time of delivery.
The study sample was restricted to couples who were expecting and parents of children less than 2 years. ‘Random stratified sampling’ was opted for the study, with 18 couples interviewed were couples who have had delivery and were admitted in the ‘District hospital of Bilaspur’. The rest of the respondents belonged to Three different Anganwadi centres located in the distant areas of Bilaspur covering three different localities of ‘village Sarkanda’, ‘Yadav Muhalla’(Talapara), ‘Badhwapara’. These Anganwadi centres were chosen according to convenience. Data collection was also performed by conducting ‘household couples interviews’, after obtaining their address from the Anganwadi centres, since getting the couples to interview together was pivotal for the study. This also opened gates for counselling the couples in terms of Birth planning, Ante-natal check-ups, Post-natal check-ups, Exclusive breast feeding, Immunization of the child, and other important issues related to maternal and child health. The sample size was 50 eligible couples of the aforementioned selection criteria, and the sample divide was in between couples those who are expecting and parents of children less than or of 2 years of age. During data collection preference was being given to such couples who have had a delivery, because such couples will help to capture all the nuances of pregnancy and childbirth, till the immunization of the child. Thus the sample had 12 expecting couples who belonged to Anganwadi centres, while the rest 38 couples had delivery, or were parents of atleast one child of or less than 2 years of age. Out of these 38 couples 18 were from the District hospital while the rest were those couples who utilized the services of Anganwadi centres. The inclusion criteria of the study involves any pregnant women or parents of a child less than or of 2 years, who have been utilizing the Maternal and child health Facilities of the District hospital as well as the Anganwadi centres. The exclusion criteria involves women who has been admitted to the hospital suffering a miscarriage or have a stillbirth situation, and parents of children of age more than 2 years .
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Fig:1 Pie chart showing the percentages of sample taken from 4 different locations.
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Fig: 2= Pie chart showing the sample break up.
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Fig.3: Bar graph showing Years of marriage range from 11 months to 7 years.
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Fig: 4= Bar graph showing sample considered for the study are in the age group of 19 to 34 in females (Average age-23.52).
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