Factors affecting maternal health and child health
According to NFH - 4 survey
1. EDUCATION
15 % of women age 15-49 have never been to school. One fourth of women got married before the minimum age of 18 years.
2. Fertility
In Maharashtra, the median age at first marriage is 19.9 years among women age 25-29 years and 19.3 years among women age 20-49 years. Just over one-fourth of women age 20-24 years got married before the legal minimum age of 18 years
At current fertility rates, women with no schooling have 1 child more than women who had 12 or more years of schooling. Similarly, Muslim women will have an average of 0.5 children more than Hindu women
3. Pregnancy Outcomes
9% women terminated pregnancy either in foetal wastage.
[ Abortion, Miscarriage or Stillbirth ]
5% miscarriages reported and 4% for abortion cases.
4. Teenage Pregnancy
Among young women age 15-19 in Maharashtra, 8 percent have already begun childbearing, that is, they have already had a live birth or are pregnant with their first child, down from 14 percent in NFHS-3.
The proportion of women who have started childbearing rises sharply from 5 percent at age 17 years to 13 percent among women age 18 years and to 21 percent among women age 19 years. The proportion who have started childbearing is much higher among young women who had no schooling (24%) than those with 12 or more years of schooling (3%).
5. Birth intervals :
Almost three-fifths (59%) of births in Maharashtra occur within three years of the previous birth.
Research shows that waiting at least three years between children reduces the risk of infant mortality.
6. Family planning
Only 10 percent of currently married women know about the lactational amenorrhoea method (LAM) and 31 percent know about female condoms.
Among all women, only 41 percent know about emergency contraception. The contraceptive prevalence rate (CPR) among currently married women age 15-49 is 65 percent.
Thirty-nine percent of users of modern spacing methods discontinued use within the first year after they adopted the method.
Gender of child
In Maharashtra, contraceptive use shows little difference in rural and urban areas. Contraceptive prevalence decreases with increasing schooling of women; more than 7 in 10 currently married women with no schooling use female sterilization, compared with only 28 percent of women with 12 or more years of schooling. Muslim women (59%) are less likely to use contraception than either Hindu (65%) or Buddhist or Neo-Buddhist women (69%).
Women in Maharashtra are much more likely to use contraception if they already have a son. For example, among women with two children, 80 percent with at least one son use a method of family planning, compared with 55 percent of women with two daughters and no sons.
7. Infant and child mortality
The infant mortality rate in Maharashtra in NFHS-4 is estimated at 24 deaths before the age of one year per 1,000 live births.
As expected, boys have a higher mortality rate than girls, especially during the neonatal period (in the first month of life) and between ages 1 and 5 years.
Children born to the teenage mothers are more likely to die during infancy than mothers age 20-29. High risk birth has higher mortality rates.
8. Maternal health
Antenatal care
Among mothers who gave birth in the five years preceding the survey, more than 9 in 10 received antenatal care for their last birth from a health professional (78% from a doctor and 14% from an auxiliary nurse midwife (ANM), lady health visitor (LHV), nurse, or midwife). Eight percent did not receive any antenatal care (ANC). Seventy-two percent of mothers in Maharashtra received at least four antenatal care visits for their last birth.
9. Postnatal care
Early postnatal care for a mother helps safeguard her health and can reduce maternal mortality. In Maharashtra, 82 percent of mothers had a postnatal check after their last birth and 80 percent of mothers had a postnatal check within two days of the birth, as is recommended. Postnatal care is most common following births in a health facility; 81 percent of births in public health facilities and 86 percent of births in private health facilities were followed by a postnatal check for the mother within two days of birth, compared with 41 percent of home births.
10. Male involvement in maternal care
Ninety-two percent of men with a child under three years of age said that the youngest child’s mother received antenatal care.
Four-fifths of men with a child under three years said they were present during at least one antenatal check received by the child’s mother (84% in urban areas and 79% in rural areas), but only 59 percent were told by a health provider or health worker what to do if the mother had a pregnancy complication
Only 33-56 percent of men were told about the signs of specific pregnancy complications (convulsions, vaginal bleeding, prolonged labour, high blood pressure, and severe abdominal pain).
11. Child health
Vaccination of children:
More than half (56%) of children age 12-23 months received all basic vaccinations against six major childhood illnesses (tuberculosis, diphtheria, pertussis, tetanus, polio, and measles) at any time before the survey. However, most children are at least partially vaccinated; only 8 percent have not received any vaccinations at all.
Integrated Child Development Services (ICDS)
The ICDS programme pro-vides nutrition and health services for children under age six years and pregnant or breastfeeding women, as well as preschool activities for children age 3-5 years. These services are provided through community-based anganwadi centres.
12. Breast feeding , nutrition and anaemia
Infant feeding
Although breastfeeding is nearly universal in Maharashtra, only 57 percent of children under 6 months are exclusively breastfed, as the World Health Organization (WHO) recommends. While the initiation of breastfeeding indicators shows an improvement since NFHS-3, many infants are still deprived of the highly nutritious first milk (colostrum) and the antibodies it contains.
WHO has several recommendations for infant and young child feeding (IYCF) practices for children age 6-23 months. The key IYCF indicators measure the adequacy of dietary diversity and meal frequency for breastfed and non breastfed children. Over one-fourth (29%) of children age 6-23 months are fed the recommended minimum number of times per day and even fewer (22%) are fed from the appropriate number of food groups. Only 7 percent are fed according to all three recommended practices.
Micronutrient deficiency is a major contributor to childhood morbidity and mortality. Vitamin A is an essential nutrient for the immune system. Iron deficiency is a primary cause of anaemia.
13. Children’s nutritional status
Thirty-four percent of children under age five years are stunted, or too short for their age, which indicates that they have been undernourished for some time. Twenty-six percent are wasted, or too thin for their height, which may result from inadequate recent food intake or a recent illness causing weight loss, and 9 percent are severely wasted. Thirty-six percent are underweight, which takes into account both chronic and acute undernutrition. Even during the first six months of life when almost all babies are breastfed, 19 percent of children are stunted, 40 percent are wasted, and 23 percent are underweight.
14. Adults’s nutritional status
More than two-fifths (47%) of women and 43 percent of men are either too thin or overweight or obese. Among women age 15-49, the proportion overweight or obese is 23 percent, which is considerably higher than a decade ago (15% in NFHS-3).
Undernutrition is particularly common in the younger age groups, in rural areas, and among scheduled tribes. Overweight and obesity are most prevalent in older adults, those in urban areas, and well-educated men as well as women.
Anaemia can result in maternal mortality, weakness, diminished physical and mental capacity, increased morbidity from infectious diseases, perinatal mortality, premature delivery, low birth weight, and (in children) impaired cognitive performance, motor development, and scholastic achievement. Anaemia is a major health problem in Maharashtra, especially among women and children.
15. Women’s hygiene
Using a hygienic method of menstrual protection is important for women’s health and personal hygiene. In NFHS-4, young women age 15-24 were asked what method or methods they use for menstrual protection, if anything. In Maharashtra, 50 percent each use sanitary napkins and cloth, 17 percent use locally prepared napkins, and 3 percent use tampons. Overall, 66 percent of women age 15-24 use a hygienic method of menstrual protection. Women with at least 12 years of schooling are more than three times as likely to be using a hygienic method as women with no schooling. Notably, only 56 percent of rural women use a hygienic method of menstrual protection, compared with 77 percent of urban women.
16. Domestic violence
Among women age 15-49, 21 percent have ever experienced physical violence and 3 percent have ever experienced sexual violence. In all, 21 percent of women in Maharashtra have experienced physical or sexual violence. Among those who experienced physical violence since age 15, the most common perpetrator for ever-married women was by far the current husband.
Violence during pregnancy
Three percent of women who have ever been pregnant have ever experienced physical violence during one or more of their pregnancies. Women with no schooling, women with five or more children and women who are widowed/divorced/separated/deserted, at 6-7 percent, are more likely than women in any other group to have experienced violence during pregnancy.
17. Poverty
BPL cards are held by 27 percent of households.
18. Mental health conditions
Antenatal depression and anxiety can also result in adverse obstetric outcomes, such as placental insufficiency, preterm labour, low birth weight, conduct disorders and emotional imbalance in children. According to WHO report on depression in India, the reported prevalence of post party depression in India ranges between 15.3% and 23% with an incidence of 11%. Many cases also go unaccounted for, thereby increasing the hidden burden of the prevalence. Around 14% mothers have reported symptoms of depression till up to 6 months of post delivery.
