Title

A comparison of utilization of reproductive health services by currently married fertile women of 15-49 years (CMFW) in three different settings in Southern Punjab, Pakistan

Date of Award

2002

Document Type

Thesis

Degree Name

Master of Science in Epidemiology & Biostatistics (MSc Epidemiology & Biostats)

Department

Community Health Sciences

Abstract

To support the safe motherhood initiative and declarations of The International Conference on Population and Development (ICPD), Medecin du Monde (MDM), a French NGO started Women's Health care Project in November 1997 in Tehsil Khanpur, District Rahim Yar Khan. As part of the mid-term evaluation of the project a study was conducted to compare the utilization of reproductive health services in three areas with different level of services. In the absence of any baseline data, for project evaluation comparisons were made between two interventions and a non-intervention area individually. Cross-sectional sample surveys were conducted in all the three areas where about 1372 currently married fertile women of 15-49 years (CMFW) were interviewed (about 430 in each area). Besides, socioeconomic and demographic indicators of each household and CMFW living there, the survey also collected information on use of reproductive health services related to antenatal, prenatal and postnatal care. Moreover, data were also collected on knowledge of CMFW regarding danger signs of pregnancy, delivery and postnatal periods. After comparing prevalence of utilization of reproductive health services by CMFW by means of chi square test, two interventions were compared with m-intervention separately, through two models of logistic regression, to identify the association of different factors with two interventions. At this level we controlled for sociodemographic, economic and distance of the residence of CMFW to health care facility. These associated factors from both models then compared with each other to look for the difference in the two interventions. Our final models identified three variables associated with each of the two interventions. Place of antenatal check up was significantly associated with intervention-I [(BHU aOR =4.2, 95% Cl: 2.1-8.4), (RHC aOR = 3.0, 95% CI: 1.1-8.1) as well as perceived increase in diet during pregnancy (aOR = 2.4, 95% Cl: 1.4-4.4) and knowledge regarding danger signs of pregnancy (aOR = 1.2, 95% CI: 1.03-1.32). On the other hand, place of antenatal check up [(BHU aOR = 7.4, 95% CL 3.6-15.1), (RHC aOR = 10.6, 95% CI: 4.3-25.7)) and TT vaccination during pregnancy (aOR = 1.9, 95% CI: 1.03-3.5) were significantly associated with intervention-Il while knowledge regarding danger sings of delivery was associated but not to a significant level (aOR = 1.0, 95% CI: 0.99-1.01). Improvement in the quality of care through well-equipped and qualified staff may enhance the utilization of reproductive health services. By offering good salary package d security to the employees especially female workforce in the rural areas, progress in the performance can be expected. Provision of emergency obstetrics care round-the-clock would get confidence of the residents of the catchment area. Repeated health related messages in targeted health education sessions with the involvement of community leaders might result: in the change of behavior about the deeply rooted but hazardous practices; in the improvement of the knowledge regarding different aspects of maternal health like antenatal care, highlight the importance of medically trained attendant at delivery or delivery in health care facility. Monitoring of community-based activities with constructive feedback is needed for the improvement of the functioning of tee activities.

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