Abstract

*Dr. Tridibesh Tripathy and Dr. Umakant Prusty

ABSTRACT

The current study explores some of the messages given by ASHAs to RDWs while including the planning and activities done by both the ASHAs & RDWs regarding the antenatal care of the RDWs. The study also describes the details on the components of Ante Natal Care (ANC) status and the role of ASHAs in availing these ANC components provided to the Recently Delivered Women (RDW) or mothers in four selected districts of UP. From the catchment area of each ASHA, two RDWs were selected who had a child in the age group of 3 to 6 months. Through this profile, the ANC components of RDWs such as measurement of weight, blood pressure, testing of blood and urine, examination of abdomen, knowledge on expected date of delivery and advice on place of delivery including nutrition during pregnancy. Receiving and consumption of Iron and Folic Acid tablets or bottles of syrup, deworming medicines by the RDWs are the other aspects mentioned in the study. Frequency of Tetanus Toxoid injections taken by the RDWs is the other area dealt in the study. All these aspects by the RDWs are reflected upon to give a picture that represents the entire state of UP. The relevance of the study assumes significance as data on the activities and planning of RDWs on their pregnancy is not at all reflected in many surveys. Usually, health workers are interviewed on their knowledge and messages or services they provide for ANCs of recently delivered mothers but data as actually told by RDWs are not available even in large scale surveys like National Family Health Survey 4 done in 2015-16. The coverage for the four ANCs along with other services related to ANC are given for the state and district level in many surveys but there is a significant difference between the services or indicators mentioned in the current study and large-scale surveys like NFHS 4. The current study also gives the data regarding actual activity done by the RDWs (like buying of IFA tablets/bottles of iron syrup) on ANC. All these reasons are attributed to increased MMR in UP. It is noteworthy to mention here that the Maternal Mortality Ratio (MMR) of UP was 201 as per the MMR bulletin of Sample Registration System of May 2018 but currently it is 216 in UP as per the MMR bulletin of SRS in November, 2019 (SRS, 2018 & 2019). A total of four districts of Uttar Pradesh were selected purposively for the study and the data collection was conducted in the villages of the respective districts with the help of a pre-tested structured interview schedule with both close-ended and open-ended questions. In addition, in-depth interviews were also conducted amongst the RDWs and a total 500 respondents had participated in the study. The results showed that the performance of ASHAs in Barabanki and Gonda districts regarding disseminating ANC messages was poor among the four districts. Less importance was given to the message on nutrition during pregnancy. The ASHAs were not distributing the iron tablets to all the pregnant women in the four districts. Regarding iron tablets, the study elicited that 3% of RDWs in Banda and 1% each in the other 3 districts said that they cannot recall how many tablets or syrups they received. None of the districts also showed that all pregnant women consumed IFA tablets. The study also reflected that the ASHAs were not following up the pregnant women properly for the TT shots as part of ANC. The study also showed that the ASHAs had not ensured availability of mother child cards with all the RDWs in all the 4 districts. It also emergeds that in Gonda district, only 51% of RDWs and in Barabanki district, 67% of RDWs received deworming medicines but 96% in Banda district and 93% in Saharanpur district received deworming medicines.