The Antenatal Attention And Postnatal Care Health

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The Antenatal Attention And Postnatal Care Health Essay.

Maternal mortality is defined as loss of life of women from motherhood- related problems occurring throughout pregnancy, labor, childbirth and in the postpartum period (up to the 42nd days after delivery (WHR, 2005). Maternal mortality is one of the major open public health concerns on the globe. Fatality during postnatal period is participating in an important role in increasing maternal mortality and morbidity ratio (BMMMR, 2010).The Antenatal Attention And Postnatal Care Health Essay.


Postnatal period (or called postpartum) is identified by the WHO as the time beginning one hour after the delivery of the placenta and carrying on until six weeks (42 days) following the birth of an infant. The first hours, days and nights and weeks after childbirth are a dangerous time for both mother and newborn baby. In this era, the physical study of the mom and proper counselling by skilled health service agency is very essential to prevent the health issues. The That has advised postnatal visit for at least three times. The first visit within 24 hours, second visit within 2-3 times and the fourth visit in the seventh day is the standard schedule for postnatal visit. These visits help to discover medical problems with time.

Antenatal good care (ANC) and postnatal attention (PNC) are the key indicators to gauge the maternal health, especially safe motherhood. Antenatal care is a very good predictor of safe delivery and provides health information and services that can improve the health of women and babies (Bloom, Lippeveld & Wypij, 1999; WHO & UNICEF, 2003). The primary goal of antenatal good care is to achieve, by the end of pregnancy, a wholesome mother and a healthy baby. In addition, antenatal attention has a positive impact on the use of postnatal healthcare service (Chakraborty, Islam, Chowdhury & Bari, 2002). Postnatal care and attention and intra-partum attention significantly reduces maternal mortality and morbidity because most maternal deaths happen in the first week after delivery (Campbell & Graham, 2006; Hurt et all, 2008).The Antenatal Attention And Postnatal Care Health Essay.

Despite improvements, motherhood – related complications remains the key cause of loss of life and impairment among women and of child bearing years disproportionately among different rural-urban dwellers, poor-rich communities, cultural communities and indigenous non indigenous teams (Gill & Ahmed, 2004; BDHS, 2007).

The present situation shows a noticable difference in the global maternal fatalities percentage (Hawkins, 2005). Globally 47 % maternal fatalities decline this year 2010 from 1990 (WHO, UNICEF, UNFPA & The World Bank estimations, 2010). However, improvement towards the Millennium Development Goals (MDG) has been very slow-moving in many countries (Bhutta, 2010).

Bangladesh has strengthened its emergency obstetric care and attention (EmOC) under the Directorate Standard of Health services through countrywide and international collaborations (Islam, Haque, Waxman, & Bhuiyan, 2006). The US Population Fund (UNFPA) commenced support of federal improvement of 64 maternal and child welfare centres for EmOC in 1993 (Gill & Ahmed, 2004). Furthermore, the Obstetrical and Gynaecological World of Bangladesh with the support of UNICEF improved EmOC in 11 district hospitals on a pilot basis in the period 1994-1998, with following development to other districts (Chakraborty, et. al, 2002). As a result ANC and PNC appointments increased substantially in Bangladesh from 1999-2000 to 2007. However, being pregnant related complications remains the best cause of loss of life and impairment among women.

Global urbanization has become a vital issue lately. The urban inhabitants is expected to increase by 84%, from 3. 4 billion in ’09 2009 to 6. 3 billion in 2050 (United Land, 2010). Bangladesh along with other Asian countries, has experienced fast urban expansion in the recent ages (NIPORT, 2008 & Uzma et all, 2004) This speedy urbanization in Bangladesh, increased with the progress of metropolitan slums, is likely to have profound implications on its health profile, especially on maternal and child health (NIPORT, 2008). Maternal and child health is strongly related with values and tactics around being pregnant and childbirth which has implications for the health of the kid and mother following the labor and birth (Choudhury et, all, 2012).

The maternal mortality percentage (MMR) in Bangladesh was 320 per 100, 000 live births in 2001 which reduced to 194 per 100, 000 live births this year 2010 (BMMMS, 2010). Bangladesh is currently on track to attain the primary concentrate on of Millennium Development Goal (MDG) -5 with a goal to reduce the maternal mortality. Not surprisingly achievement the condition in metropolitan slums is worse compared to metropolitan non slum areas regarding antenatal care and attention by medically trained service provider (62% vs. 85%), delivery at a health facility ( 12% vs. 46%) and skilled assistance at delivery (18% vs. 56% ) respectively (NIPORT, 2008). This makes urban medical issues, especially of the slum dwellers a high priority. It is therefore crucial to talk about maternal health of the metropolitan slum dwellers in Bangladesh. Usually in metropolitan slums, the maternal health services are offered at home or in static service delivery sites handled by nongovernmental organization (NGO) field employees. In some illustration, services can be found at treatment centers or dispensaries managed by NGOs, the federal government or the private areas (NIPPORT, 2008).

Pregnancy and childbirth are the important event of life. However, the women are more susceptible to difficulties and the fatalities in this period. Therefore, the correct treatment and support is necessary from the motherhood to postnatal period. Just as the world, there are a wide variety of communities and religious groups, the way of treatment and support differs in being pregnant, childbirth and postnatal period. Some of the community applies their cultural methods during childbirth and postnatal health care. The study implies that have confidence in the supernatural things such as evil eye and spirits are still rooted in a few communities. In spite of religion, class, urban and rural roots, nearly all Bangladeshi people believe in the existences of any supernatural world (Afsana & Rasid, 2000). Medical care seeking behavior during being pregnant and child delivery are linked to women’s cultural and ethnical interpretation of disease and well-being and any difficulties in birth tend to be related to supernatural triggers (Afsana & Rasid, 2000).

Food taboo is also the strong in the folks especially during motherhood and postnatal period. It depends after the people’s beliefs. A study done by (Choudhury, et. al, 2012) shows that the moms are permitted to take only dried out food that was cooked without drinking water, and rice with mashed potato and dark-colored cumin seed because these food types are believed to keep stomach of the women cool and initiate the creation of breast milk. Another review also implies that there have been various dietary constraints enforced on the mothers which deprived them of proper nourishment consumption. Commonly, the moms were not permitted to have food during the first day after delivery to allow restoration of the delivery passage (Choudhury & Ahmed, 2011).

In some civilizations, the mom should stay static in isolation for few days after delivery. During that period mothers stay in a separate room. Matching to a report, the mom should stay in internal kimma (a private room) for 7-9 times. During this time, women sit down by the hearth, drink hot water, eat burning sodium with grain and place searing materials on their back (Islam, 2011). Another analysis also proved that the ladies have to stay in isolation for the first 5-9 days and nights after delivery because women are believed to be impure during this time period. They are not allowed to touch any food for organizing meals (Choudhury & Ahmed, 2011).

To enhance the maternal and child health of slum dwellers, many INGOs and NGOs will work in this field. BRAC is also employing the project called “MANOSHI” with the same target in every slums of Dhaka city. As the effect, the maternal and child health is increasing gradually.The Antenatal Attention And Postnatal Care Health Essay.

  1. 2 Rationale / Justification
    Maternal mortality is the major health problem in producing countries like Bangladesh. Alongside the improvement in knowledge and recognition degree of community and the many intervention put in place by government, the maternal healthcare service usage is increasing. However, the scope of service utilization is still low particularly natal and postnatal attention services. More than 29 out of 100 deliveries take place at home and only 27% seek postnatal treatment from health service provider (BDHS, 2011). Postnatal care and attention continues to be a neglected concern since it is not as emphasized as antenatal health care.

The maternal mortality and morbidity study shows that majority of deaths occurred anticipated to postnatal difficulties. Around 31% of total maternal fatalities occurred credited to haemorrhage. As a result, postpartum deaths now comprise a higher proportion of maternal deaths (73%) up from 67% in 2001(BMMMS, 2010). It indicates that postnatal good care interventions should get more priority. The federal government and other stakeholders should take consideration of PNC when employing the maternal health programs.

Millennium development goal (MDG 5) is attainable in Bangladesh because of treatment by the federal government. However, people surviving in the rural and urban slums are not utilizing the maternal health services effectively. Socio social factors are the main factor that can play important role in changing the health seeking behavior. The behaviour can’t be changed unless knowing the socio-cultural norms in the contemporary society.

This study aimed to explore the potential factors that can affect utilization of postnatal care and attention services. Findings from this study will give a reflection of maternal health status as well as amount of post natal attention service utilization which can be used to increase the utilization of post natal treatment in metropolitan slums.The Antenatal Attention And Postnatal Care Health Essay.

  1. 3 Operational definition
    Postnatal period: The period beginning 1 hour after the delivery of the placenta and carrying on until six weeks (42 days) following the birth of an infant. It is the most critical period for mom because the majority of the maternal fatalities occur in this period.

Postnatal care: All of the cares provided by family members, traditional delivery attendance or healthcare providers during postnatal period. It includes attention in home or in health service.

Cultural practice: The practice performed corresponding to traditional norms and ethnical beliefs by slum dwellers. It includes diet practice, host to delivery, isolation, untouchability etc.

Food taboos: The prohibition on certain diet to mom during postnatal period thinking unsafe for health. It depends upon the individuals’ perceptions and beliefs.

Family support: It included support in physical work and psychosocial support to the mother by members of the family during postnatal period.

Danger indications: The indications of physical or mental abnormalities that seem during postnatal period, which includes fever, severe, lower abdominal pain, hypertension and sepsis during postnatal period.

PNC visit: The typical scheduled sessions to health care service providers for health check-up during postnatal period. Health service providers conduct the physical examination of mother, appropriate counselling of mom and the newborn, supplementation of iron and vitamin supplements A of these visits.

Personal health: Those activities that are completed to keep the mom clean during delivery and postnatal attention.

Health seeking behaviour: It’s the behaviour where in fact the moms go for health seeking during postnatal treatment. It includes formal and informal care.The Antenatal Attention And Postnatal Care Health Essay.

Cultural beliefs: It offers the values of mothers regarding postnatal health care. It includes beliefs on food taboos, bad attention, untouchability etc.

  1. 4 Objectives of the study
    General objective:
    To understand the perceptions of women, their members of the family and healthcare providers on postnatal treatment in a Dhaka slum of Bangladesh

Specific objectives:
To explore cultural values and norms regarding post-natal care

To explore the ethnic methods of postnatal good care among ladies in urban slums

To explore the obstacles women face in seeking post natal good care from health care centres in slum areas

Chapter II

  1. 1 Research design
    The study used the qualitative exploratory research design to explore the mentioned target as enumerated because it is a delicate issue and related to socio social behaviour. The purpose of this study procedure is by using multiple resources of data to explore the same phenomena from different sides. Qualitative research provides in-depth and contextual information that cannot be obtained from quantitative research exclusively. Therefore a great deal of in- depth interviews and concentrate group talk were conducted to understand the notion and practices towards postnatal treatment.The Antenatal Attention And Postnatal Care Health Essay.
  2. 2 Review site
    The analysis site was Sattar- Molla slum, Mirpur, Dhaka where BRAC is implementing Manoshi program to improve maternal and child health. This slum was chosen for the analysis because slums are neglected area by the government. There is absolutely no any governmental health service for slum dwellers.
  3. 3 Research population
    The study society were slum dweller moms who have 6 weeks to 1 12 months children. Six weeks after beginning is postnatal period so the respondent were taken from the moms who got completed the postnatal period and the moms who had less than 12 months child since there is less potential for memory or reporting bias. Besides them, their mother in regulations and their husbands were also used as the foundation of information because mom in laws and husbands are the key decision manufacturers in most of the families. In addition, Shasthya Sebika (SS), Shasthya Kormi (SK) and Urban Delivery Attendent (UBA) who get excited about that field were included as key informants.The Antenatal Attention And Postnatal Care Health Essay.
  4. 4 Sampling method and technique
    Purposive sampling method will be employed in this analysis because only particular women who acquired experienced on postnatal period and having one year child were interviewed.
  5. 5 Data collection methods
    The study employed the utilization of multiple qualitative methods to triangulate the info.

Key Informant Interview (KII)

Key Informant Interviews were conducted with SS, UBA and SK of BRAC health program because they were involved in the maternal and child health program and got close connection with mothers. A total of 3 KIIs, each from SS, SK and UBA were conducted. The KII gave the researcher an improved understanding of the situation of the preferred slums regarding postnatal good care or related interventions in this field. Regarding to Patton (2002), key informants are useful in helping the researcher to understand what is happening and just why it is going on. Using key informants is a good option for the researcher to comprehend the cultural framework regarding postnatal treatment practices. A semi organised key informant interview guide was used as an instrument for interview.The Antenatal Attention And Postnatal Care Health Essay.

In-Depth Interview (IDI)

In-Depth Interviews were conducted because of this particular study because it allows participants to share with their encounters and their reviews at length about happening on an individual basis. Fifteen IDIs were completed with mothers having 6 weeks to 1 12 months child. In-depth interviews involve conducting intensive specific interviews with a little number of individuals to explore their perspectives on a particular idea, program, or situation. An in- depth interview guideline was used for interview.

Focus Group Discussion (FGD)

Focus group conversations were conducted with mom in laws and husbands of women individually. Two FGDs – one with mom in regulations and one with husbands were completed. Matching to Mack et all (2005), FGD provides a huge quantity of information over a brief time frame and is also effective for being able to access a broad range of views on a specific topic instead of reaching group consensus. Focus group dialogue guide was used for information collection.The Antenatal Attention And Postnatal Care Health Essay.

  1. 6 Data analysis technique
    The qualitative data have no limited words like quantitative data. These data are words somewhat than numbers. Therefore the data were collected by using the speech recorders as well as taking records. A Bangladeshi research associate was used for data collection who also performed translation of the information from Bengali to British. The translated data were manually analyzed in the platform of content and thematic qualitative data analysis.

The collected data were transcribed verbatim and all the information were registered and mentioned from field take note, memo and audio tracks record. The data were familiarized through multiple readings of every specific and focus group dialogue interview transcript. This helped me to understand and start taking into consideration the structuring and company from it into significant parts. Coding was performed and then appearing habits and categories were determined. The data coded on wide categories were further sorted out with specific coding and analysis was done.

Data were displayed utilizing the data screen matrices. Matrices included quotes, repeated verbatims, major ideas, designs and memos. Conclusions and verifications were further drawn from the display matrices especially with the rising themes. Reflective codes were used to sketch conclusions especially with the information attracted from different designs.The Antenatal Attention And Postnatal Care Health Essay.

  1. 7 Research team
    The researcher and one Research Associate (RA) collected the info. Before collecting the info, all research musical instruments (IDI, KII, FGD guidelines) were translated from British to Bengali with the aid of RA to minimize the errors. After data collection, data were again translated from Bengali to British for further analysis.
  2. 8 Ethical consideration
    Ethical authorization was obtained from the Ethical Review Committee of James P. Grant University of Public Health and the researcher followed all guidelines. Informed verbal consent was taken from the prospective participants before collecting the data. All members were then up to date about the nature and reason for the study, to withdrawal, and option to refuse to answer any question. Anonymity and confidentiality of information were maintained at every level of the analysis. No name of any respondent was used through the final write up of the thesis. Authorization for taking images and for documenting their words was taken before doing each interview and emphasis group talk.The Antenatal Attention And Postnatal Care Health Essay.

Chapter III
The findings of this analysis are divided and provided in three different sections based on the precise objectives of the study, previously set ideas and replies from the members. The first section details belief on PNC and social values on postnatal good care based on the reactions from the members. The second section describes ethnical practices performed during the last postnatal period. And the 3rd section details about some of the barriers and difficulties confronted by the individuals on seeking postnatal attention service from health facilities.The Antenatal Attention And Postnatal Care Health Essay.