International Journal of Community Medicine and Public Health

Bhimani NR et al. Int J Community Med Public Health. 2017 Apr;4(4):1289-1294

http://www.ijcmph.com pISSN 2394-6032 | eISSN 2394-6040

DOI: http://dx.doi.org/10.18203/2394-6040.ijcmph20171364
Original Research Article

Intranatal and postnatal care practices among married women of

reproductive age group: a community based cross- sectional study in
the rural area of Surendranagar district
Nishant R. Bhimani*, Pushti V. Vachhani, Girija P. Kartha

Department of Community Medicine, C. U. Shah Medical College, Surendranagar, Gujarat, India

Received: 16 February 2017

Accepted: 06 March 2017

*Correspondence:
Dr. Nishant R. Bhimani,
E-mail: bhimaninishant123@gmail.com

Copyright: © the author(s), publisher and licensee Medip Academy. This is an open-access article distributed under
the terms of the Creative Commons Attribution Non-Commercial License, which permits unrestricted non-commercial
use, distribution, and reproduction in any medium, provided the original work is properly cited.

ABSTRACT

Background: Intra natal care means care taken during delivery. This consists of taking care of not only the mother
but also the newborn at the time of child-birth. Appropriate delivery care is crucial for both maternal and perinatal
health. Increasing skilled attendance at birth is a central goal of the safe motherhood and child survival mission.
Postpartum care aimed at complication-free puerperium and a healthy baby. There is a high risk of mortality for both
the mother and her baby in the immediate period around birth. High quality intranatal and postnatal care is the
important way to reduce the maternal morbidity and mortality. Utilization of intranatal and postnatal services is poor
in the rural areas, which ultimately lead to increased maternal & child morbidity and mortality.
Methods: The study was carried out among married women of reproductive age group. Pre-designed and pretested
Performa was used to obtain the information from participants. It was community based cross - sectional study. All
the collected data were analysed by applying appropriate statistical tests. The data were analysed by statistical
package for social sciences (SPSS).
Results: A total of 353 women were included in the study. Majority (86.97%) of women utilized health facility either
government or private for their deliveries. Significant difference was observed between literacy status as well as socio
economic class and utilization of institutional facility for the place of delivery. More than half women i.e. nearly 56%
had not availed postnatal care services.
Conclusions: Percentage of institutional deliveries as well as deliveries attended by skilled birth attendant was quite
better. The most common reason for not availing the intra natal and postnatal services was found to be lack of
knowledge regarding importance of these services on the outcome of delivery.

Keywords: Intranatal, Postnatal, Health care services, Cross- sectional, Reproductive age group

INTRODUCTION Supervision and care from skilled professionals during

delivery is important to achieve Millennium
One of the important thrusts of the RCH programme is to Development Goal-5 which aims to reduce the maternal
encourage deliveries in proper hygienic conditions under mortality ratio by three-quarters between 1990 and 2015.2
the supervision of trained health professionals.1 The
provision of delivery care in the public health institutions The place of delivery is a crucial factor which affects the
is one of the components of the RCH programme. health and well-being of mother and newborn. The

International Journal of Community Medicine and Public Health | April 2017 | Vol 4 | Issue 4 Page 1289
 Bhimani NR et al. Int J Community Med Public Health. 2017 Apr;4(4):1289-1294

decision about place of delivery is mainly influenced by METHODS

social and economic factors.3 Important thrust of the
RCH programme is to encourage deliveries in proper Field practice area of Rural Health Training Centre
hygienic conditions under the supervision of trained (RHTC) of C. U. Shah Medical College, Surendranagar
health professionals. Major factor contributing to high was selected for recruitment of study participants. A
maternal morbidity & mortality during delivery was cross-sectional survey including 353 married women of
found to be unclean or unhygienic delivery practices. reproductive age group was carried out using Pre
Clean delivery (clean hands, clean ligature, clean surface, designed & pre-tested questionnaire. Married women of
clean cord-stump, clean razor blade) means conducting reproductive age group were interviewed on literacy
delivery under aseptic precautions and safe delivery status, socio-demographic profile, educational status of
means causing minimal damage to the mother.4 To their partners, details regarding place of delivery, birth
observe five cleans at home deliveries, the mother during attendant, reasons for non-utilization of services, history
the last antenatal check-up, is given a ‘disposable regarding Intranatal & Postnatal complication, Postnatal
delivery kit’ (DDK) by the Female Health Worker. care givers, etc. Questionnaire was read out to the
Observing five cleans helps to conduct delivery under mothers and relevant information also collected from
aseptic precautions, which will prevent infections like their antenatal card. To reach the adequate size two or
neonatal tetanus, ophthalmia neonatorum and puerperal three visits were made to those who could not be
sepsis, thereby reducing IMR and MMR. contacted in the first visit. Eligible women who had not
given consent, showed non co-operation as well as post-
However in India, about 60% of the deliveries in rural menopausal women were excluded from the study.
areas still occur at home. Births in health facilities are Ethical clearance for conducting the study was taken
about equally divided between those that take place in a from Institutional Ethics Committee and Scientific
private health facility and those that take place in public Review Committee. Informed consent was obtained from
institutions (such as government-operated district, all the mothers interviewed. Data was collected by
tehsil/taluk, town, or municipal hospitals, and Primary trained investigators. Data collected as such was
Health Centers). Two-thirds of deliveries in urban areas compiled, coded and analyzed using SPSS and expressed
and 29 percent of deliveries in rural areas take place in in percentage. Chi-square test was used to find out
health facilities as per NFHS 3.5 There are association between variables. ‘P’ value less than 0.05
medical/obstetric conditions during a pregnancy when the was considered statistically significant.
chances of a complication are increased, and a home
delivery may be risky and potentially life-threatening. RESULTS
Under such conditions, we need to explain the woman
why the delivery needs to be at a facility level only and A total of 353 women were surveyed during the study
strongly advise her to deliver only in an institutional period. Majority of them i.e. 146 (41.36%) were between
setting.6 20-24 years followed by 112 (31.73%) between 25-29
years, 47 (13.31%) between 30-34 years, 29 (8.22%)
One half to two third of all maternal deaths occur in the were in the age group of 35 years or more. Only 19
postpartum period, especially in the first 24 hours. The (5.38%) women were in the age group of 15-19 years as
postpartum period, despite its heavy toll of deaths, is shown in Table 1.
often neglected. Within this period, the first week is most
prone to risk. About 45% of postpartum maternal deaths Table 1: Age group of study participants (n=353).
occur during the first four, and more than two thirds
during the first week.7 The post natal period offers a Age group (years) Numbers Percentage (%)
window of opportunity to ensure reduction in maternal 15-19 19 5.38 %
and infant mortality so as to achieve the millennium 20-24 146 41.36 %
development goals 4 and 5.8 In developing countries, over
25-29 112 31.73 %
70% of all babies born outside the hospital do not receive
any postnatal care.9 30-34 47 13.31 %
≥ 35 29 8.22 %
Understanding of the factors affecting the utilization of Total 353 100.0 %
Intranatal and postnatal care services is very essential.
Correct identification of responsible factors is necessary On analyzing the educational status, it was seen that most
to increase the acceptance/utilization rates of services of the women i.e. 156 (44.19%) were illiterate, 27
provided by the government. Therefore, the present study (7.65%) were just literate (who can read & write but not
was carried out in the rural area of Surendranagar district completed primary education), 86 (24.36%) had
with the following objectives: To find out the utilization education up to primary, 39 (11.05%) had education up to
pattern of intranatal & postnatal healthcare services, to secondary (SC), 26 (7.37%) had education up to higher
identify social factors associated with utilization and to secondary (HSC) and only 19 (5.38%) were graduated &
assess the reasons for non-utilization of services. had education above that. Data regarding their husband’s
education revealed that 22.10% (78) were educated up to

International Journal of Community Medicine and Public Health | April 2017 | Vol 4 | Issue 4 Page 1290
 Bhimani NR et al. Int J Community Med Public Health. 2017 Apr;4(4):1289-1294

primary, 20.96% (74) were illiterate, 26.63% (94) were services, only about 13% had an intra natal complication
educated up to secondary (SC), 5.95% (21) had education as compared to nearly 26% of women who had not
up to higher secondary and 7.93% (28) were graduated or utilized the services as shown in Table 4 and 5.
had education above that as shown in Table 2.

Table 2: Educational level of women and their 100% 35.13%

husband (n=353). PRIV…
80% GOVE…
Educational Women Husband 60%

PERCENTAGE
Status Number (%) Number (%)
40%
Illiterate 156 (44.19%) 74 (20.96%) 13.03%
51.84%
Just literate 27 (7.65%) 58 (16.43%) 20%
Primary 86 (24.36%) 78 (22.10%) 0%
Secondary 39 (11.05%) 94 (26.63%) UTILIZED NOT UTILIZED
Higher secondary 26 (7.37%) 21 (5.95%) UTILIZATION OF HEALTH
Graduate & above 19 (5.38%) 28 (7.93%) FACILITY
Total 353 (100.0%) 353 (100.0%)
Figure 1: Utilization of health facility for delivery
Uday Pareek classification was used to categorize study (N=353).
participants according to their socio-economic class. It
was seen that 4.82% (17) women were in the upper (I)
socioeconomic class, 17.28% (61) women were in the 68.56%
upper middle (II) socioeconomic class, 10.48% (37) were 70%
60%
in the lower middle (III) socioeconomic class, 36.54% 50%
(129) were in the upper lower (IV) socioeconomic class 40% 18.41%
30% 13.03%
and 30.88% (109) were in the lower (V) socioeconomic
PERCENTAGE

class as shown in Table 3. 20%

10%
0%
Table 3: Socio- economic class of study participants
(n=353).

Socio-economic class Numbers Percentage(%)

Upper i 17 4.82%
Upper middle ii 61 17.28% BIRTH ATTENDANT
Lower middle iii 37 10.48%
Upper lower iv 129 36.54%
Lower v 109 30.88% Figure 2: Distribution of women according to birth
attendant (n=353).
Total 353 100.0%
The most common reason (35.85%) for not availing the
Out of 353 women, 51.84% & 35.13% women utilized intra natal services was found to be lack of knowledge
government & private health facility respectively for their regarding importance of these services on the outcome of
deliveries, whereas it was unfortunate to note that 13.03% delivery or financial problems followed by tradition
deliveries were conducted at home. Study showed that (26.42%), refusal by the family members (16.98%), poor
68.56% deliveries were attended by doctors, 18.41% quality of services at the health facility (11.32%) and
were attended by ANM/Nurse/Trained Birth Attendant transport problem in case of around 6% of women as
(TBA), whereas 13.03% deliveries were attended by shown in Table 6.
Untrained Birth Attendant (UTBA) or relatives as shown
in Figure 1 and 2. Among 353 total women, more than half i.e. nearly 56%
had not availed postnatal care services. About 46.47%
Significant difference was found so far as the literacy literate women had utilized PNC services as compared to
status of both the partners & socio-economic class of 42.08% of illiterate women but the difference was not
family were concerned. There is a positive association significant statistically. The present study showed that
between education of both the partners & the place of 24.93% women availed PNC from doctors, 11.61% from
delivery. Out of 46 women who delivered at home, ANM/Nurse/TBA, whereas 7.65% women availed
around 73% were illiterate. Similarly husband’s postnatal care from UTBA/others as shown in Table 7
education also had a significant impact on the place of and 8.
delivery. Out of total women who utilized intra natal

International Journal of Community Medicine and Public Health | April 2017 | Vol 4 | Issue 4 Page 1291
 Bhimani NR et al. Int J Community Med Public Health. 2017 Apr;4(4):1289-1294

Table 4: Place of delivery and its association with literacy status of both partners & socio-economic class of family
(n=353).

Place of delivery
Statistical
Socio-demographic variable Home Institution
Values
Number (%) Number (%)
Literacy status of women
Illiterate 34 (18.58%) 149 (81.42%) = 10.321
Literate 12 (7.06%) 158 (92.94%) P < 0.05
Literacy status of husband
Illiterate 27 (20.45%) 105 (79.54%) = 10.252
Literate 19 (8.60%) 202 (91.40%) P < 0.05
Socio-economic class
Upper (i&ii) 04 (5.41%) 74 (94.59%) = 5.518
Lower (iii,iv&v) 42 (18.03%) 233 (81.97%) P < 0.05
Total 46 (13.03) 307 (86.97%) 353 (100%)

Table 5: Utilization of intranatal services and intranatal complication (n=353).

Intranatal complication Statistical

Intranatal srvices Absent Present Values
Number (%) Number (%) = 4.752
Utilized 265 (86.31%) 42 (13.68%) P < 0.05
Not utilized 34 (73.91%) 12 (26.09%) Or = 2.23
Total 299 (84.70%) 54 (15.30%) (1.07 – 4.64)#

Table 6: Reasons for non-utilization of intranatal services (n=46).

Reasons* Numbers Percentage

Cost too much/lack of knowledge 19 35.85%
Health facility far/transport problem 03 5.66%
Poor quality of services 06 11.32%
Family did not allow 09 16.98%
Tradition 14 26.42%
Any other 02 3.77%
*Multiple reasons

Table 7: Literacy status of women and utilization of postnatal care services (n=353).

Postnatal care services Statistical

Literacy status of women Availed Not availed Values
Number (%) Number (%)
Literate 79 (46.47%) 91 (53.53%) = 0.69
Illiterate 77 (42.08%) 106 (57.92%) P > 0.05
Total 156 (44.19%) 197 (55.81%)

Table 8: Distribution of women according to postnatal care givers (n=353).

Postnatal care Numbers Percentage(%)

Not received 197 55.81%
Doctor 88 24.93%
Anm/nurse/tba 41 11.61%
Utba/others* 27 7.65%
Total 353 100.0%
*Others include relatives, neighbours etc.

International Journal of Community Medicine and Public Health | April 2017 | Vol 4 | Issue 4 Page 1292
 Bhimani NR et al. Int J Community Med Public Health. 2017 Apr;4(4):1289-1294

Out of 37 women who had complication during postnatal other reasons were, cost too much (12.5%), transport
period, nearly 27% women had availed health services problem (9.61%) and poor services in govt. hospitals
from government health facility and 16.21% from private (5.76%) which were nearly similar to present study. 14
set up. Majority i.e. 56.76% women did not seek any
medical health services for their postnatal problems as The days and weeks following childbirth – the postnatal
shown in Figure 3. period – is a critical phase in the lives of mothers and
newborn babies. Yet, this is the most neglected time for
the provision of quality services.
60%
PRIVATE
PNC components like abdominal examination,
50% 16.21% breastfeeding advice, family planning advice, baby care
HEALTH
FACILITY advice etc. were considered in the present study. The
PERCENTAGE

40%
study showed that nearly 56% of mothers did not avail
56.76% postnatal care. 24.93% women availed PNC from
30%
doctors, 11.61% from ANM/Nurse/TBA whereas 7.65%
GOVERN
20% from UTBA. As per DLHS 3 & NFHS 3, 49.7% & 36.8%
27.03% MENT
HEALTH women had availed postnatal care within 2 days to 2
10% FACILITY weeks.12 A study conducted in Gandhinagar district of
Gujarat by Puwar et al revealed that nearly 67% of
0%
AVAILED NOT AVAILED women had not availed PNC and among women who
availed PNC, majority availed from ANM/AWW.15
UTILIZATION OF HEALTH SERVICES
Percentage of institutional deliveries was better when
compared with DLHS 3. Deliveries attended by skilled
Figure 3: Postnatal complication and availing the
birth attendant were quite better as more than three forth
health services (n=37).
of deliveries were attendant by trained birth attendant.
Literacy status of women & husband and socio-economic
DISCUSSION
class were found to be positively related to utilization of
services.
The present study informs major findings based on
analysis of data relating to utilization pattern of intranatal
CONCLUSION
and postnatal health care services and other aspects
germane to the objectives of the study.
The main reason for non-utilization of services was found
to be unawareness. Utilization of intranatal services had
Present study indicated positive association of literacy
also an impact on the development of complication.
status of women, literacy status of husband & socio-
Women who did not avail institutional intranatal services
economic class with the place of delivery. Chauhan et al
had faced more complications as compared to women
also observed positive association between women’s
who had utilized full package of services. The grass root
education & place of delivery.10 Pandey et al also found
level link workers like ASHA/ANM and others were
significant association between place of delivery & socio-
responsible for imparting knowledge in majority of the
demographic factors like education of women, socio-
participants and they were responsible for the selection of
economic class. Similar to present study, Gupta et al in
place of delivery also. Hence it clearly emphasizes the
their study also found that husband’s education had also
need to mobilize and motivate these link workers for
an impact on the place of delivery.3,11
better delivery of services and information. IEC activities
with emphasis on government health services focusing on
Skilled attendance during childbirth is among the most
maternal and child health should be strengthened.
crucial factor for maternal and neonatal survival. The
present study showed that 68.56% deliveries were Funding: No funding sources
attended by doctors, 18.41% of the deliveries were Conflict of interest: None declared
attended by ANM/nurse/trained birth attendant whereas Ethical approval: The study was approved by the
nearly 13% deliveries were attended by untrained birth Institutional Ethics Committee
attendant or relatives. As per NFHS 3, 48.8% births were
assisted by doctor / nurse / LHV / ANM / other health REFERENCES
personnel.12 According to DLHS 3, 47% deliveries were
institutional.13 Around 74% of the deliveries were 1. International Institute of Population Sciences (IIPS)
attended by TBA as per study of Pandey S et al. 3 A high and Macro. National Family Health Survey (NFHS-
level of institutional deliveries in present study may be 3) 2005-06: India, Mumbai.
due to availability of health facility nearby within 2 kms. 2. United Nations. Millennium Development Goals.
United Nations Millennium Declaration, 2000.
In a study conducted by Punia et al, 35.58% mothers
believed that institutional delivery was not necessary, the

International Journal of Community Medicine and Public Health | April 2017 | Vol 4 | Issue 4 Page 1293
 Bhimani NR et al. Int J Community Med Public Health. 2017 Apr;4(4):1289-1294

3. Pandey S, Shankar R, Rawat CMS, Gupta VM. 11. Gupta A, Chhabra P, Kannan AT, Sharma G.
Socio-Economic Factors and Delivery Practices in Determinants of Utilization Pattern of Antenatal and
an Urban Slum of District Nainital, Uttaranchal. Delivery Services in an Urbanized Village of East
Indian J of Community Med. 2007;32(3):210-1. Delhi. Indian J Prev Social Med.
4. Suryakantha AH. Community Medicine with Recent 2010;41(3&4):240-5.
Advances. Chapter 22. Maternal and Child Health 12. India National Family Health Survey (NFHS III)
Services (Preventive Obstetrics and Pediatrics). 2005-06 key findings. International Institute of
New Delhi: Jaypee Brothers Medical publishers (P) Population Sciences Deonar, Mumbai. Ministry of
LTD; 2014: 568. Health and Family Welfare; Government of India.
5. National Family Health Survey (NFHS-3); 2005- 13. District Level Household and Facility Survey
2006, Government of India, Volume-1, 2007. (DLHS III) 2007-08 fact sheet Gujarat. Institute of
6. Guidelines for Pregnancy Care and Management of Population Sciences Deonar, Mumbai Ministry of
Common Obstetric Complications by Medical Health and Family Welfare, Government of India.
Officers, Maternal Health Division Department of 14. Punia A, Punia MS, Kalhan M, Dayal P, Nagar M,
Family Welfare Ministry of Health & Family Rana V. Socio-economic and Cultural Constraints
Welfare Government of India; 2005. for having Institutional Deliveries in Peri-urban
7. Gupta RK, Bhalwar R. Textbook of Community colonies of Rohtak City. Indian J Maternal Child
Medicine. Chapter 34. Health Care of the Mothers. Health. 2010;12(3):1-8.
New Delhi: United India Periodicals Pvt Ltd; 2013: 15. Puwar BT, Patel VD, Sheth JK. Utilization of
251-262. services by postnatal women I n the rural area of
8. Paul J. Millenium Development Goals: World Gandhinagar district, Gujarat. Indian J Maternal
Health and Population. World Health Popul. Child Health. 2013;15(3):1-8.
2008;10(2):3-4.
9. World Health Organization (WHO), Maternal,
newborn, child and adolescent health 2014. Cite this article as: Bhimani NR, Vachhani PV,
Available from: http://www.who.int/maternal_ Kartha GP. Intranatal and postnatal care practices
child_adolescent/topics/newborn/postnatal_care/en/. among married women of reproductive age group: a
Accessed on 4 February 2017. community based cross- sectional study in the rural
10. Chauhan A, Yadav KV. Determinants of area of Surendranagar district. Int J Community Med
Institutional and Safe Delivery in Hanumangarh Public Health 2017;4:1289-94.
District (Rajasthan): A Multivariate Analysis. Indian
J Maternal Child Health. 2012;14(1):1-8.

International Journal of Community Medicine and Public Health | April 2017 | Vol 4 | Issue 4 Page 1294