INTRODUCTION:

Promotion and protection of maternal &child health has been one of the most important developmental goals in many countries like India. Maternal health is an important aspect for the development of any country in terms of increasing equity and reducing poverty. Maternal mortality ratio is one of the important indicators of the quality of health service in India. India has made remarkable progress in reducing maternal deaths in the last two decades.¹

The maternal mortality ratio of India for the period of 2016- 2018, as per the latest report of the national sample registration system data is 113/100,000 live birth, declining by 17 points, from 130/100,000 live birth in 2014- 2016. The infant mortality rate for India in 2021 was 28.771 deaths per 1000 live births, a 3.61% decline from 2020. The infant mortality rate for India in 2020 was 29.848 deaths per 1000 live births, a 3.48% decline from 2019.² According to the latest sample registration system (SRS) special bulletin on maternal mortality in India (2017- 2019), brought out by the office of the registrar General of India, Kerala’s MMR has dropped by, 12 points. The last SRS bulletin 2015- 2017 had put the state’s MMR at 42. Kerala has already achieved the target it had set for itself, based on the U. N.Kerala has registered an incredible maternal mortality ratio (MMR) of 19 (per one lakh live births) according to the latest Sample Registration System (SRS) special bulletin on Maternal Mortality in India (2018-20) brought out by the office of the Registrar General of India.³

Improving the well-being of mothers, infants and children is an important public health goal for the Government of India. A healthy woman forms the cornerstone of a healthy, dynamic and progressive nation. Safe pregnancy, child birth and postpartum period are important milestones in the continuum of care for women to achieve optimal maternal and neonatal outcomes that have a significant impact on the future of mothers, children and families in the long run. Government of India has made significant progress in reducing the maternal mortality ratio (MMR) from 556 per lakh in 1990 to 113 per lakh live births in 2016-18 (a decline of 80% compared to the global decline of 45%).

India is currently on track to achieve the Sustainable Development Goal 3 (SDG 3) target of an MMR below 70 by 2030. It is even more heartening to note that the socio-economically backward states referred to as the Empowered Action Group (EAG) States have registered the maximum decline in MMR over the last decade. Similarly, Infant Mortality Rate (IMR) has declined from 89/1000 live births in 1990 to 32/1000 live births in 2018 (a decline of 63% compared to the global decline of 55%) With the launch of various initiatives under National Health Mission (NHM), India has made a concerted push to increase access to quality maternal and newborn health services and reduce the large number of preventable, neonatal and infant deaths. Schemes like Janani Suraksha Yojana (JSY) and Janani Shishu Suraksha Karyakram (JSSK) brought significant gains in institutional deliveries and helped in improving coverage as well reducing out of pocket expenditures. As a result, institutional delivery rates improved from a mere 38 % in 2005 to 79 % in the year 2015-16 (NFHS 4).⁴

A prospective follow up study on utilization of JSSK and estimation of out-of-pocket expenditure among mothers and newborns in Chittoor. 228 mothers who delivered in the previous 2 days, were recruited from a secondary-level government hospital in Chittoor. Expenditure incurred under various components of JSSK was asked during the recruitment and subsequently through telephonic interviews. All components of JSSK, except transport, were fully utilized by the families. 138 mothers (60.5%, 95% CI: 54.0, 67.0), and all sick children (n=138, 100%) who visited government hospital, incurred OOPE in the form of transport cost. The median expenditure of transport (from home to hospital and hospital to home) of the mothers was 250 INR (IQR: 100-513 INR). Transport expenditure was greater for the rural families (300 INR) than the urban families (100 INR) (p<0.05). In multiple logistic regression, nuclear families were associated with high OOPE (AOR-2.0, 95% CI: 1.1- 3.7). Though education of the mother showed high association (AOR-2.7, 95% CI: 1.0-7.8), it was not statistically significant (p = 0.05). The families utilize most of the components of JSSK, except transport. Family-centric counselling of the beneficiaries during antenatal check-ups and home visits by the healthcare workers can reduce transport-related OOPE.⁵

OBJECTIVES:

Primary objectives:

1. Assess the knowledge regarding maternal and child health schemes.

2. Assess the utilization of maternal and child health schemes.

Secondary objectives:

1. Find out the association between knowledge of maternal and child health schemes and demographic variables.

2. Find out the association between knowledge and utilization of maternal and child health schemes.

MATERIALS AND METHODS:

Methods: A quantitative research approach and cross-sectional study design is used in this study. The variables include knowledge and utilization of Maternal and Child Health schemes and socio-demographic variables (Age, Education, Occupation, Place of residence, Type of family, Economic status, Type of delivery and Number of children). The setting was Postnatal wards of Sree Avittom Thirunal Hospital, Thiruvananthapuram and the population was 165 postnatal mothers selected through consecutive sampling technique.

Tools/instruments:

Tools used in the study were Semi structured questionnaire to assess the demographic data and knowledge regarding maternal and child health schemes and Checklist regarding utilization of Maternal and Child Health schemes including utilization of each service of the scheme which were validated by experts.

Data collection:

The data collection was done over a period of six weeks. Ethical clearance was obtained from the Institutional Ethics Committee. Permission was obtained from the SAT Hospital prior to the study. 165 postnatal mothers fulfilling the inclusion criteria were selected from the postnatal wards. Consent was obtained from the participants after detailed explanation of the purpose of the data collection and maintained a good rapport with the participants. A semi structured questionnaire was given to collect socio demographic data and knowledge regarding maternal and child health schemes. A checklist was used to assess the utilization of MCH services by postnatal mothers.

Data analysis:

The collected data was entered in the excel sheet and coded and analysed using Statistical Package for Social Sciences, in accordance with the study objectives. The interpretation of data was done by using descriptive and inferential statistics. Socio-demographic data and knowledge and utilization of MCH schemes were described in terms of frequency and percentage. Chi square test was used to find the association between knowledge of mothers regarding MCH schemes and socio-demographic variables and association between knowledge and utilization of MCH schemes.

RESULTS:

Table 1: Distribution of postnatal mothers based on Education (n=165)

Education	Frequency	Percentage
Primary education	2	1.2
Secondary education	16	9.7
Higher secondary	71	43
Diploma	21	12.7
Degree	45	27.3
Post -graduation	10	6.1

Table 1 depicts that majority of the participants had higher secondary education.

Figure 1: Distribution of postnatal mothers based on Place of residence. (n=165)

Figure 1 shows majority of the participants reside in rural area, 22% reside in urban area and only 5% reside in semi urban

Table 2: Distribution of postnatal mothers based on Knowledge regarding MCH schemes (n=165)

Knowlede regarding MCH schemes	Frequency	Percentage
Poor	113	68.5
Average	50	30.3
Good	2	1.2

Table 2 shows 68.5% of the participants had poor knowledge, 30.3% had average knowledge and 1.2% had good knowledge

Table 3: Distribution of postnatal mothers based on overall utilization of Maternal and Child Health schemes (MCH) (n=165)

Utilization of MCH schemes	Frequency	Percentage
No utilization	0	0
Low utilization	53	32.1
Moderate utilization	112	67.9
Full utilization	0	0

Table 3 shows neither no participants had fully utilized nor not utilized the schemes. 32.1% had low utilization and 67.9% had moderate utilization of the MCH schemes.

Table 4: Association between knowledge of postnatal mothers and education (n=165)

Education	Knowledge				^ꭓ2	df	P value
	Poor		Average/good
	f	%	f	%
Primary –Higher secondary	71	62.8	23	44.2	5.03	1	0.02^**
Diploma- Post-graduation	42	37.2	29	55.8

** Significant at 0.01 level

Table 4 shows that the obtained chi- square value is significant at p value < 0.05 level of significance. Hence there is an association between knowledge of the participants and education.

Table 5: Association between knowledge of postnatal mothers and utilization of MCH schemes (n=165)

Utilization of MCH services	Knowledge				^ꭓ2	df	P value
	Poor		Average
	f	%	f	%
Fully utilized	0	0	0	0	2.85	1	0.09
Moderately utilized	72	63.7	40	76.9
Less utilized	41	36.3	12	23.1

Table 5 shows that the obtained chi- square value is not significant at p value < 0.05 level of significance. Hence there is no association between knowledge of participants and utilization of MCH schemes.

DISCUSSION:

The present study revealed that 68.5% of postnatal mothers had poor knowledge, 30.3% had average knowledge and 1.25% had good knowledge regarding MCH schemes.

A study was conducted in government hospital of Delhi to assess the knowledge and utilization of JSSK services among postnatal mothers depicted that majority (52%) of the postnatal mothers had poor knowledge regarding JSSK but majority (93%) had good utilization of the JSSK services during their antenatal, intra-natal, postnatal period and during the period of newborn care in the hospital.⁶ This review study was congruent with the present study.

The present study revealed that majority of the postnatal mothers were belonged to the age group of 24-28 years, majority had higher secondary education, majority of the postnatal mothers were home maker, majority was resided in rural area, 56.4% of participants belonged to nuclear family, 77% belonged to BPL, majority had normal delivery and 51.5% had single child.

The present study depicted that neither any postnatal mother had fully utilized the schemes or not utilized the schemes. The overall utilization of MCH schemes showed that 32.1% had low utilization and 67.9% had moderate utilization of the MCH services Regarding the utilization of each scheme, JSSK - 78.8% had fully utilized the schemes, JSY- only 1.2% had fully utilized schemes, PMMVY- 10.7% had fully utilized the schemes.

A community based cross sectional study was conducted to assess the Determinants of utilization of the maternity benefit schemes among mothers in urban slums of Davangere city, Karnataka. The result of the study showed that 57% of the mothers had utilized Janani Suraksha Yojana, 29% of mothers had utilized Prasuthi Araike Yojana, 65% of mothers had utilized Madilu Yojana and none of mothers had utilized Thayi Bhagya schemes. The prime source of information was health care workers. Major reason for non-utilization of maternity benefit schemes was lack of awareness.⁷ This study is incongruent with present study.

This present study revealed that among the socio-demographic variables only education of the mother had significant association with knowledge of the schemes. The present study findings were congruent with another cross-sectional study conducted to find out the Utilization of Maternal Health Services and Factors Influencing the Utilization among mothers in the urban slums of Lucknow during the period from July 2014 to march 2015. The result of the study observed that utilization of maternal health care services was sub-optimal, few indicators being low like postnatal care visits (5%). Socio-demographic factors like education of women, religion and parity was found to be significantly associated with Maternal health care utilization.⁸

REFERENCE:

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7. Determinants of utilization of maternity benefit schemes among mothers in urban slums of Davangere city, Karnataka, India | International Journal of Community Medicine and Public Health [Internet]. [cited 2023 Oct 12]. Available from: https://www.ijcmph.com/index.php/ijcmph/article/view/771

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Received on 02.11.2024 Revised on 12.12.2024

Accepted on 12.01.2025 Published on 18.02.2025

Available online from March 10, 2025

Int. J. of Advances in Nursing Management. 2025;13(1):37-40.

DOI: 10.52711/2454-2652.2025.00008

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