Hostname: page-component-78c5997874-fbnjt Total loading time: 0 Render date: 2024-11-15T01:26:39.413Z Has data issue: false hasContentIssue false
  • English
  • Français

Improving use of maternal care services among married adolescent girls: an intervention study in rural India

Published online by Cambridge University Press:  24 April 2020

Ashok Dyalchand ,
Rohini Prabha Pande Open the ORCID record for Rohini Prabha Pande [Opens in a new window] ,
Gopal Kulkarni  and
Manisha Khale
Ashok Dyalchand
Affiliation:
Institute of Health Management, Pachod (IHMP), Maharashtra, India
Rohini Prabha Pande*
Affiliation:
Institute of Health Management, Pachod (IHMP), Maharashtra, India
Gopal Kulkarni
Affiliation:
Institute of Health Management, Pachod (IHMP), Maharashtra, India
Manisha Khale
Affiliation:
Institute of Health Management, Pachod (IHMP), Maharashtra, India
*
*Corresponding author. Email: [email protected]
Get access Rights & Permissions [Opens in a new window]

Abstract

This study examined the effect of the Safe Adolescent Transition and Health Initiative (SATHI) programme on the use of maternal care services among rural, pregnant adolescents in India. This was an intensive community-based, multi-site intervention project conducted in Maharashtra state between 2008 and 2011. Its aims were to improve the reproductive health of married adolescent girls and avert the adverse consequences of early motherhood. It had a quasi-experimental, case-control, pre-post design to enable rigorous evaluation. This study used cross-sectional data from 644 married girls aged under 19 years at baseline and 802 at endline to assess the maternal care outcomes of antenatal care, delivery and postnatal services and nutrition during pregnancy. Difference-in-differences analysis showed that all outcomes improved significantly in the study sites between baseline and endline, and the improvement in study sites was significantly larger than in the control sites. Multivariate analysis showed a statistically significant dose–response effect of intervention participation for antenatal care, pregnancy nutrition and postnatal care. Study participation was not statistically significantly associated with higher rates of safe or institutional delivery. The analysis suggests that training and supporting community health workers to work with married adolescent girls using interpersonal communication and interacting frequently with them and their families and communities can significantly improve the use of maternal care services among this population. With almost a million community health workers and 200,000 auxiliary nurse midwives at the community level providing primary level care in India, this intervention offers a proven strategy to replicate and scale-up to reach large numbers of married adolescent girls who do not currently use maternal care services.

Keywords

Adolescent reproductive healthMarried adolescentsIndia maternal health
Type
Research Article
Information
Journal of Biosocial Science , Volume 53 , Issue 3 , May 2021 , pp. 336 - 355
Copyright
© The Author(s), 2020. Published by Cambridge University Press

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Adhikari, RK (2003) Early marriage and childbearing: risks and consequences. In Bott, S (ed.) Towards Adulthood: Exploring the Sexual and Reproductive Health of Adolescents in South Asia. World Health Organization, Geneva, pp. 62–66.Google Scholar
Barua, A and Kurz, K (2001) Reproductive health-seeking by married adolescent girls in Maharashtra, India. Reproductive Health Matters 9, 53–62.CrossRefGoogle ScholarPubMed
Bearinger, LH, Sieving, RE, Ferguson, J and Sharma, V (2007) Global perspectives on the sexual and reproductive health of adolescents: patterns, prevention, and potential. The Lancet 369, 1220–1231.CrossRefGoogle ScholarPubMed
Bhutta, ZA, Das, JK, Rizvi, A, Gaffey, MF, Walker, N, Horton, S et al. (2013) Evidence-based interventions for improvement of maternal and child nutrition: what can be done and at what cost? The Lancet 382, 452–477.CrossRefGoogle ScholarPubMed
Campbell, DT and Stanley, JC (1963) Experimental and Quasi-Experimental Designs for Research. Houghton Mifflin, Boston.Google Scholar
Campbell, OM, Graham, WJ and Lancet Maternal Survival Series Steering Group (2006) Strategies for reducing maternal mortality: getting on with what works. The Lancet 368, 1284–1299.CrossRefGoogle ScholarPubMed
Denno, DM, Hoopes, AJ and Chandra-Mouli, V (2015) Effective strategies to provide adolescent sexual and reproductive health services and to increase demand and community support. Journal of Adolescent Health 56, S22–S41.CrossRefGoogle ScholarPubMed
Doyle, AM, Mavedzenge, SN, Plummer, ML and Ross, DA (2012) The sexual behaviour of adolescents in sub-Saharan Africa: patterns and trends from national surveys. Tropical Medicine & International Health 17, 796–807.CrossRefGoogle ScholarPubMed
Drèze, J and Khera, R (2012) Regional patterns of human and child deprivation in India. Economic and Political Weekly 57, 42–49.Google Scholar
Efevbera, Y, Bhabha, J, Farmer, PE and Fink, G. (2017) Girl child marriage as a risk factor for early childhood development and stunting. Social Science & Medicine 185, 91–101.CrossRefGoogle ScholarPubMed
Girls Not Brides (n.d.) Child Marriage around the World. URL: https://www.girlsnotbrides.org/where-does-it-happen/ (accessed 20th March 2020).Google Scholar
Government of India (2014) Rashtriya Kishor Swaasthya Karyakram Strategy Handbook. Ministry of Health and Family Welfare, Government of India.Google Scholar
Griffiths, P and Stephenson, R (2001) Understanding users’ perspectives of barriers to maternal health care use in Maharashtra, India. Journal of Biosocial Science 33, 339–359.CrossRefGoogle ScholarPubMed
Guliani, H, Sepehri, A and Serieux, J (2012) What impact does contact with the prenatal care system have on women’s use of facility delivery? Evidence from low-income countries. Social Science & Medicine 74, 1882–1890.CrossRefGoogle ScholarPubMed
Gupta, I and Bhatia, M (n.d.) The Indian Health Care System. https://international.commonwealthfund.org/countries/india/ (accessed 28th March 2019).Google Scholar
Haberland, NA, McCarthy, KJ and Brady, M (2018) A systematic review of adolescent girl program implementation in low- and middle-income countries: evidence gaps and insights. Journal of Adolescent Health 63, 18–31.CrossRefGoogle ScholarPubMed
Hoopes, AJ, Aggarwal, P, Bull, S and Chandra-Mouli, V (2016) Measuring adolescent friendly health services in India: a scoping review of evaluations. Reproductive Health 13, article No. 137.CrossRefGoogle ScholarPubMed
Hughes, J and McCauley, AP (1998) Improving the fit: adolescents’ needs and future programs for sexual and reproductive health in developing countries. Studies in Family Planning 29, 233.CrossRefGoogle ScholarPubMed
IIPS (2010) District Level Household and Facility Survey (DLHS-3), 2007–08: India. Maharashtra. International Institute for Population Sciences, Mumbai.Google Scholar
IIPS (2014) District Level Household and Facility Survey (DLHS-4), 2012–13, India, Maharashtra. International Institute for Population Sciences, Mumbai.Google Scholar
IIPS and ICF (2018) National Family Health Survey (NFHS-4), India, 2015–16: Maharashtra. International Institute for Population Sciences, Mumbai.Google Scholar
IIPS and Macro International (2007) National Family Health Survey (NFHS-3), 2005–06: India. International Institute for Population Sciences, Mumbai.Google Scholar
IIPS and Macro International (2008) National Family Health Survey (NFHS-3), India, 2005–06: Maharashtra. International Institute for Population Sciences, Mumbai.Google Scholar
IIPS and Macro International (2017) National Family Health Survey (NFHS-4), 2015–16: India. International Institute for Population Sciences, Mumbai.Google Scholar
Jejeebhoy, S, Santhya, KG, Singh, SK, Rampal, S and Saxena, K (2014) Provision of Adolescent Reproductive and Sexual Health Services in India: Provider Perspectives. Population Council, New Delhi.CrossRefGoogle Scholar
Kavitha, N (2015) Are young mothers in India deprived of maternal health care services? A comparative study of urban and rural areas. Journal of Health Management 17, 204–220.CrossRefGoogle Scholar
Kennedy, P (1992) A Guide to Econometrics, 3rd edition. MIT Press, Cambridge, MA.Google Scholar
Kerber, KJ, de Graft-Johnson, JE, Bhutta, ZA, Okong, P, Starrs, A and Lawn, JE (2007) Continuum of care for maternal, newborn, and child health: from slogan to service delivery. The Lancet 370, 1358–1369.CrossRefGoogle ScholarPubMed
Khatun, S and Rahman, M (2008) Quality of antenatal care and its dose–response relationship with birth weight in a maternal and child health training institute in Bangladesh. Journal of Biosocial Science 40, 321–337.CrossRefGoogle Scholar
Kumar, C, Rai, PK, Singh, PK and Singh, L (2013) Socioeconomic disparities in maternity care among Indian adolescents, 1990–2006. PloS One 8, e69094.CrossRefGoogle ScholarPubMed
Live Mint (2017) Why Kerala is like Maldives and Uttar Pradesh, Pakistan. Live Mint, 21st April 2017. URL: https://www.livemint.com/Politics/3KhGMVXGxXcGYBRMsmDCFO/Why-Kerala-is-like-Maldives-and-Uttar-Pradesh-Pakistan.html (accessed 20th March 2020).Google Scholar
Magadi, MA, Agwanda, AO and Obare, FO (2007) A comparative analysis of the use of maternal health services between teenagers and older mothers in Sub-Saharan Africa: evidence from Demographic and Health Surveys (DHS). Social Science & Medicine 64, 1311–1325.CrossRefGoogle ScholarPubMed
Ministry of Health and Family Welfare and Statistics Division (2019) Rural Health Statistics 2018–19. Government of India, New Delhi.Google Scholar
Ministry of Statistics and Programme Implementation, Government of India (2015a) Indian States by GDP. URL: http://statisticstimes.com/economy/gdp-of-indian-states.php (accessed 28th March 2019).Google Scholar
Ministry of Statistics and Programme Implementation, Government of India (2015b) Indian States by GDP per capita. URL: http://statisticstimes.com/economy/gdp-capita-of-indian-states.php (accessed 28th March 2019).Google Scholar
National Health Mission, Ministry of Health & Family Welfare, Government of India (n.d.) About Accredited Social Health Activist (ASHA). URL: http://nhm.gov.in/communitisation/asha/about-asha.html (accessed 28th March 2019).Google Scholar
Nguyen, G, Costenbader, E, Plourde, KF, Kerner, B and Igrass, S (2019) Scaling-up normative change interventions for adolescent and youth reproductive health: an examination of the evidence. Journal of Adolescent Health 64, S16–S30.CrossRefGoogle ScholarPubMed
Pal, S (2015) Impact of hospital delivery on child mortality: an analysis of adolescent mothers in Bangladesh. Social Science & Medicine 143, 194–203.CrossRefGoogle ScholarPubMed
Pallikadavath, S, Foss, M and Stones, RW (2004) Antenatal care: provision and inequality in rural north India. Social Science & Medicine 59, 1147–1158.CrossRefGoogle ScholarPubMed
Pande, RP, Kathy, K, Walia, S, MacQuarrie, K and Jain, S (2006) Improving the Reproductive Health of Married and Unmarried Adolescents in India. ICRW, Washington DC and New Delhi.Google Scholar
Plourde, KF, Fischer, S, Cunningham, J, Brady, K and McCarraher, DR (2016) Improving the paradigm of approaches to adolescent sexual and reproductive health. Reproductive Health 13, article No. 72.CrossRefGoogle ScholarPubMed
Prakash, R, Singh, A, Pathak, PK and Parasuraman, S (2011) Early marriage, poor reproductive health status of mother and child well-being in India. Journal of Family Planning and Reproductive Health Care 37, 136–145.CrossRefGoogle ScholarPubMed
Reynolds, HW, Wong, EL and Tucker, H (2006) Adolescents’ use of maternal and child health services in developing countries. International Family Planning Perspectives 32(1), 6–16.CrossRefGoogle ScholarPubMed
Santhya, KG (2011) Early marriage and sexual and reproductive health vulnerabilities of young women: a synthesis of recent evidence from developing countries. Current Opinion in Obstetrics and Gynecology 23, 334–339.CrossRefGoogle ScholarPubMed
Santhya, KG and Jejeebhoy, S (2003) Sexual and reproductive health needs of married adolescent girls. Economic and Political Weekly 38(41), 4370–4377.Google Scholar
Sarkar, A, Chandra-Mouli, V, Jain, K, Behera, J, Mishra, SK and Mehra, S (2015) Community based reproductive health interventions for young married couples in resource-constrained settings: a systematic review. BMC Public Health 15, 1037.CrossRefGoogle ScholarPubMed
Singh, L, Rai, RK and Singh, PK (2012) Assessing the utilization of maternal and child health care among married adolescent women: evidence from India. Journal of Biosocial Science 44, 1–26.CrossRefGoogle ScholarPubMed
Singh, PK, Rai, PK, Alagarajan, M and Singh, L (2012) Determinants of maternity care services utilization among married adolescents in rural India. PloS One 7, e31666.CrossRefGoogle ScholarPubMed
Singh, PK and Singh, L (2014) Examining inter-generational differentials in maternal health care service utilization: insights from the Indian Demographic and Health Survey. Journal of Biosocial Science 46, 366–385.Google ScholarPubMed
Speizer, IS, Magnani, RJ and Colvin, CE (2003) The effectiveness of adolescent reproductive health interventions in developing countries: a review of the evidence. Journal of Adolescent Health 33, 324–348.CrossRefGoogle ScholarPubMed
Svanemyr, J, Amin, A, Robles, OJ and Greene, ME (2015) Creating an enabling environment for adolescent sexual and reproductive health: a framework and promising approaches. Journal of Adolescent Health 56, S7–S14.Google ScholarPubMed
Syed, U, Khadka, N, Khan, A and Wall, S (2008) Care-seeking practices in South Asia: using formative research to design program interventions to save newborn lives. Journal of Perinatology 28, S9–S13.CrossRefGoogle ScholarPubMed
Turpin, L (2017) Effectively comparing differences in proportions. Journal of Modern Applied Statistical Methods 16, 186–199.CrossRefGoogle Scholar
UNICEF (2018) Child Marriage. UNICEF.Google Scholar
Vellakkal, S, Reddy, H, Gupta, A, Chandran, A, Fledderjohann, J and Stuckler, D (2017) A Qualitative study of factors impacting accessing of institutional delivery care in the context of India’s cash incentive program. Social Science & Medicine 178, 55–65.CrossRefGoogle ScholarPubMed
Vidler, M, Ramadurg, U, Charantimath, U, Katageri, G, Karadiguddi, C, Sawchuk, D (2016) Utilization of maternal health care services and their determinants in Karnataka State, India. Reproductive Health 13(Supplement 1), 37.Google ScholarPubMed
Warren, C, Daly, P, Toure, L and Mangi, P (2006) Postnatal care. In Opportunities for Africa’s Newborns: Practical Data, Policy and Programmatic Support for Newborn Care in Africa. Partnership for Maternal, Newborn and Child Health, pp. 79–90.Google Scholar
Wing, C, Kosali, S and Bello-Gomez, RA (2018) Designing difference in difference studies: best practices for public health policy research. Annual Review of Public Health 39, 453–469.CrossRefGoogle ScholarPubMed