Factors Responsible For Low Access and Utilization of Janani Sureksh Yaojan (Scheme for Institutional Delivery) Among Rural Women: A Case of South Karnataka - India (original) (raw)
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The findings of the study indicate that Janani Suraksha Yojana (JSY) has made considerable progress in encouraging institutional delivery among mothers and providing ante-natal care, post-natal care, and cash assistance. Majority of mothers utilize JSY services; 85% give birth in a health care facility, 65% receive ante-natal care, and 76% receive post- natal care. However the program benefits are not shared equally among eligible beneficiaries, especially disadvantaged are mothers from the Scheduled Caste (SC) group. In comparison to higher caste mothers, mothers from the SC group lack necessary information regarding JSY services, under-utilize available services and its benefits, and face caste-based discrimination when utilizing the services.
Background: Janani Suraksha Yojana (JSY) –a new maternity benefit scheme-was launched by Govt. of India in April 2005 with the objective of reducing maternal and neonatal mortality by promoting institutional deliveries by providing cash incentive to beneficiaries as well as promoter. Ante –natal services are one of the most important component of JSY. Study was designed to assess the antenatal characteristic of JSY beneficiaries. Materials and Methods: A cross-sectional study was conducted under rural health training centre and urban health training centre of the field practice area of department of Community Medicine, HIMS, Dehradun. Results: A total of 2221 married women (15-49 years) were interviewed out of which 1290(58.08%) women were from urban slums and 931(41.92%) women belonged to rural areas. Out of the total number of married women who delivered at govt. hospital i.e. 227 (75.17%), majority (78.42%) of the women were registered with the some health personals. Out of these, 74.15% women were registered with ASHA .Only 29.21% women went for three or more ANC visits. Only 48.31% women consumed hundred IFA tablets and the proportion was high (79.41%) in rural women. All the women received complete TT immunization. Conclusion: It was found that registration of the women with some health personnel was influenced by women's religion and socioeconomic status the level of education and socioeconomic status was found to have a positive effect on the number of ANC visits. The consumption of IFA tablets was also found to be influenced by the educational status of the women.
Journal of Health, Population and Nutrition, 2015
Background: India leads all nations in numbers of maternal deaths, with poor, rural women contributing disproportionately to the high maternal mortality ratio. In 2005, India launched the world's largest conditional cash transfer scheme, Janani Suraksha Yojana (JSY), to increase poor women's access to institutional delivery, anticipating that facility-based birthing would decrease deaths. Indian states have taken different approaches to implementing JSY. Tamil Nadu adopted JSY with a reorganization of its public health system, and Gujarat augmented JSY with the state-funded Chiranjeevi Yojana (CY) scheme, contracting with private physicians for delivery services. Given scarce evidence of the outcomes of these approaches, especially in states with more optimal health indicators, this cross-sectional study examined the role of JSY/CY and other healthcare system and social factors in predicting poor, rural women's use of maternal health services in Gujarat and Tamil Nadu. Methods: Using the District Level Household Survey (DLHS)-3, the sample included 1584 Gujarati and 601 Tamil rural women in the lowest two wealth quintiles. Multivariate logistic regression analyses examined associations between JSY/CY and other salient health system, socio-demographic, and obstetric factors with three outcomes: adequate antenatal care, institutional delivery, and Cesarean-section. Results: Tamil women reported greater use of maternal healthcare services than Gujarati women. JSY/CY participation predicted institutional delivery in Gujarat (AOR = 3.9), but JSY assistance failed to predict institutional delivery in Tamil Nadu, where mothers received some cash for home births under another scheme. JSY/CY assistance failed to predict adequate antenatal care, which was not incentivized. All-weather road access predicted institutional delivery in both Tamil Nadu (AOR = 3.4) and Gujarat (AOR = 1.4). Women's education predicted institutional delivery and Cesarean-section in Tamil Nadu, while husbands' education predicted institutional delivery in Gujarat. Conclusions: Overall, assistance from health financing schemes, good road access to health facilities, and socio-demographic and obstetric factors were associated with differential use of maternity health services by poor, rural women in the two states. Policymakers and practitioners should promote financing schemes to increase access, including consideration of incentives for antenatal care, and address health system and social factors in designing state-level interventions to promote safe motherhood.
BMC public health, 2012
Background: While India has made significant progress in reducing maternal mortality, attaining further declines will require increased skilled birth attendance and institutional delivery among marginalized and difficult to reach populations. Methods: A population-based survey was carried out among 16 randomly selected rural villages in rural Mysore District in Karnataka, India between August and September 2008. All households in selected villages were enumerated and women with children 6 years of age or younger underwent an interviewer-administered questionnaire on antenatal care and institutional delivery. Results: Institutional deliveries in rural areas of Mysore District increased from 51% to 70% between 2002 and 2008. While increasing numbers of women were accessing antenatal care and delivering in hospitals, large disparities were found in uptake of these services among different castes. Mothers belonging to general castes were almost twice as likely to have an institutional birth as compared to scheduled castes and tribes. Mothers belonging to other backward caste or general castes had 1.8 times higher odds (95% CI: 1.21, 2.89) of having an institutional delivery as compared to scheduled castes and tribes. In multivariable analysis, which adjusted for interand intra-village variance, Below Poverty Line status, caste, and receiving antenatal care were all associated with institutional delivery. Conclusion: The results of the study suggest that while the Indian Government has made significant progress in increasing antenatal care and institutional deliveries among rural populations, further success in lowering maternal mortality will likely hinge on the success of NRHM programs focused on serving marginalized groups. Health interventions which target SC/ST may also have to address both perceived and actual stigma and discrimination, in addition to providing needed services. Strategies for overcoming these barriers may include sensitization of healthcare workers, targeted health education and outreach, and culturally appropriate community-level interventions. Addressing the needs of these communities will be critical to achieving Millennium Development Goal Five by 2015.
2012
Poor, rural women in India contribute disproportionately to the nation's high maternal mortality ratio. In response to this problem, the Indian government launched a conditional cash transfer scheme, "Janani Suraksha Yojana (JSY)," in 2005 to increase poor women's access to maternal health care. The state of Tamil Nadu reorganized public health system resources and the state of Gujarat contracted with private providers to implement the scheme in rural areas. This study investigated the role of JSY/government assistance, and other health care sector and household factors in predicting poor, rural women's utilization of maternal health services in the two states. Health care sector factors included receipt of JSY payment, availability of a primary health center with round-the-clock services, and connection to a health facility by an allweather road. Household factors included maternal education, paternal education, age at first birth and parity. Use of four maternal health care services was examined: adequate antenatal care, institutional delivery, private facility delivery and Cesarean section. State
Indian journal of community medicine : official publication of Indian Association of Preventive & Social Medicine
In India, Janani Shishu Suraksha Karyakaram (JSSK) was launched in the year 2011 to assure cashless institutional delivery to pregnant women, including free transport and diet. To assess the impact of JSSK on institutional delivery. A record review was done at the primary health care facility in Faridabad district of Haryana from August 2010 to March 2013. Focus group discussion/ informal interviews were carried out to get an insight about various factors determining use / non-use of health facilities for delivery. Institutional delivery increased by almost 2.7 times (197 Vs 537) after launch of JSSK (p < 0.001). For institutional deliveries, the most important facilitator as well as barrier was identified as ambulance service under JSSK and pressure by elders in the family respectively. JSSK scheme had a positive impact on institutional deliveries. It should be supported with targeted intervention designed to facilitate appropriate decision-making at family level in order to add...
International Journal of Medicine and Public Health, 2015
Introduction: Maternal health issues continue to be a forefront of national and global health policies. Janani Suraksha Yojana (JSY) was launched under the umbrella of National Rural Health Mission to increase the number of institutional deliveries and decrease the maternal and neonatal mortality. Objective: The aim was to assess the utilization of maternal health care services including JSY among the mothers of underfi ve children in a slum at Baghbazar, Kolkata. Materials and Methods: A descriptive, cross-sectional study was conducted at Baghbazar slum, which is under the Urban Training Centre of R.G. Kar Medical College, Kolkata from 1 st to 28 th February, 2014. A total of 72 mothers of under-fi ve children were interviewed using a predesigned, pretested and semi-structured schedule. Results: About 74% mothers were in the age group of 20-30 years and 56.8% mothers were from class IV socioeconomic status (Modifi ed Prasad scale, 2013). Illiterate mothers were 4.2%. Three-fourth of the mothers heard about JSY. Around 47% mothers got cash benefi t. Lack of eligibility document (42.1%) and ignorance (34.2%) were main causes of nonreceiving of the benefi t. About 76% mothers had antenatal registration within the fi rst trimester. About 99% were institutional deliveries. At least one postnatal checkup was received by 77% mothers. Only 33.3% mothers initiated breast feeding within 1 hr of delivery. Natural method (30.6%) and condom (30.6%) were main contraceptive methods accepted by them at the time of conducting study. Conclusion: Information, Education and Communication activities should be carried out to increase awareness regarding JSY utilization.
This paper examines utilization of maternal health care services within and across social groups among married women in India using data from third round of District Level Household and Facility Survey conducted during 2007-08. Maternal health care utilization is measured through full antenatal care, safe delivery and postnatal care. Besides, selected socioeconomic and demographic factors have been included as predictor variables. Bi-variate, logistic regression and concentration curve have been employed to understand the inter-caste differences, net effect of the predictor variables on selected outcomes and intra-caste differentials respectively. Our findings show significant difference in the utilization of maternal health care services by caste, women’ age at first birth, educational attainment, place of residence, economic status and region. Besides, high inequality is found among poor and non-poor in ‘Other’ Caste followed by Other Backward Classes. This paper concludes that Scheduled Tribe and Scheduled Caste married women bear the multiple burdens of social exclusion, poverty and womanhood in patriarchal Indian society. As a result, their conditions are worse on utilizing maternal health care services which could lead to higher maternal and child mortality rate.
Improving maternal health was one of the eight Millennium Development Goals (MDGs) and now it is one of the targets of 17-point Sustainable Development Goals (SDGs). The utilisation of Maternal Health Care Services (MHCSs) is a complex phenomenon and it is influenced by several factors, like-health care seeking behaviour of the cohorts belonging to different socio-economic and cultural background, distance of the facility centres, type and conditions of the roads including undulating surface, transportation cost, type and availability of transportation mode along with the factors related to the accountability and surveillances of the health care services. Therefore, clear understanding and discussion is needed to draw an association between MHCSs and its influential factors. The objectives of the study are to estimate the impact of accessibility on the underserved status of MHCSs and on the utilisation of MHCSs through paucity index. In addition, the study aims to evaluate the causal relationships between underserved situation and obstacle score with the paucity index of MHCS utilisation. The empirical observation unfolds that the provision and utilisation of MHCSs are strongly dependent on accessibility and distance. The situation is aggravating for proper delivery of services, which is responsible for the increasing obstacle score and paucity index, especially in remote sub- centres of Murarai-II C.D. Block of Birbhum District. Key words: Maternal Health Care Services (MHCSs), Accessibility Index, Underserved Scenario, Paucity Index, Postnatal Cases, West Bengal, India