Mrs. Lovera Sureshms. K. Indira

Submitted to:Submitted by:

Mrs. Lovera SureshMs. K. Indira

Head of the Department1st year M. Sc. Nursing

Paediatriac NursingCommunity Health Nursing

2007-2009

Sarvodaya College of Nursing,Sarvodaya College of Nursing, Bangalore – 560 079 Bangalore – 560 079

RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES,

BANGALORE, KARNATAKA

PROFORMA FOR REGISTRATION OF SUBJECT FOR DISSERTATION

1. / NAME OF THE CANDIDATE & ADDRESS / Ms. K. Indira
1st year M. Sc. Nursing
Sarvodaya College of Nursing,
11/2, Agrahara Dasarahalli,
Magadi Main Road,
Bangalore – 560 079
2. / NAME OF THE INSTITUTION / Sarvodaya College of Nursing,
Bangalore – 560 079
3. / COURSE OF STUDY AND SUBJECT / 1st year M. Sc. Nursing
Community Health Nursing
4. / DATE OF ADMISSION OF COURSE / 01-06-2007
5. / TITLE OF THE STUDY / “A Study To Assess The Knowledge, Attitude And Practice On Reproductive Health Care Services Among Mothers, In A Selected Urban Community, Bangalore”
6. / BRIEF RESUME OF THE INTENDED WORK
6.1 Introduction
6.2 Need for the study
6.3 Statement of the problem
6.4 Objectives of the study
6.5 Operational definitions
6.6 Sampling criteria
6.7 Assumptions
6.8 Review of related literature / Enclosed
Enclosed
Enclosed
Enclosed
Enclosed
Enclosed
Enclosed
Enclosed
7. / MATERIALS AND METHODS
7.1 Source of data
Data will be collected from mothers aged between 18-45years.
7.2 Method of data collection – Structured interview schedule.
7.3 Does the study require any investigation or intervention to be conducted on the patient or other human beings or animals?
NO
7.4 Has ethical clearance has been obtained from your institution?
Yes, ethical clearance report is herewith enclosed.

RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES,

BANGALORE, KARNATAKA

PROFORMA FOR REGISTRATION OF SUBJECT FOR DISSERTATION

6. Brief resume of THE intended work

6.1 Introduction:

“Healthy Women build healthy community”

Health status in India is remarkable for its myrid contradictions and where the health situation in some states compares with the best of developing countries. In planning, organizing and administering health services special attention must be given for mothers as they form a large portion and vulnerable segment of the population. Their health indicates and determines the community health.1

Over half a million women from the developing world die each year of causes related to pregnancy and child birth. There are about 407 maternal deaths for every 100,000 live births, and around 10% of the pregnancies are at high risk. An important proximate determinant of maternal mortality is access to and use of quality health care services. Access to quality reproductive health services is also crucial for improved child survival and increased contraceptive use and consequent fertility decline in the developing countries. Utilization of reproductive health services is in turn related to their availability and socio economic, demographic and cultural factors such as women’s age, education, employment, caste and autonomy.2

Despite growing attention to women’s health needs the world over, the maternal mortality figures due to pregnancy and child birth have been a cause of concern. One of the major cause of very high level of maternal mortality levels in India is that of lack of medical attention at birth.3

At present only one third of the deliveries in India take place in a health facility, while remaining are home deliveries. In fact, this is the part of the problem faced by Indian women in relation to their access to basic and good quality health care services. Women’s access is often governed by their age, education, earning, occupational status and role in the family.4

Women’s health is important during all phases of their lives from childhood to adulthood. The reproductive health program addresses causes of maternal deaths have been identified as 29% - hemorrhage (ante partum & post partum), 8% - toxemia (hypertension during pregnancy), 9% - anemia, 10% - obstructed labour, 16% - puerperal sepsis and 9% - unsafe abortions.5

The department of Family Welfare took several new initiatives during the current ninth five year plan. Reproductive health launched in India on 15thOctober 1997 envisages provision of client centered, need based, and good quality integrated Reproductive health services for improving the health of women.6

Under Reproductive health program Government of India, Ministry of health and family welfare has defined Reproductive health as “People have the ability to reproduce and regulate their fertility. Women are able to go through pregnancy, child birth safely, the out come of pregnancy is successful in terms of maternal and infant survival and wellbeing and couples are able to have sexual relations free from fear of pregnancy and of contracting disease”. 6

Under Reproductive health program all aspects of women’s reproductive health across their reproductive cycle, from puberty to menopause are covered. Reproductive health program addresses the needs that are emerged over years of implementing family welfare program aims to be more in tune with the ground realities concerning over all health needs of women. 6

Reproductive health care services are an integrated approach of service which provide health services to young women through family welfare programs like antenatal, intra natal, post natal and family planning etc. The focus was, accordingly shifted from individualized vertical interventions to a more holistic and integrated life cycle approach giving more focused attention to reproductive health care. The maternal health program, which is a component of the reproductive and child health program aims at reducing maternal mortality to less than 100 by 2010.7

To ensure good health across life cycle all components of reproductive health program are implemented fully towards improving the overall health of women and that of society as a whole.

6.2 Need for study

Every minute one women some where in the world dies from a complication related to pregnancy or child birth. This is almost 600,000 women a year, world wide 90% of these deaths occur in developing countries.4

“In India, one women dies every 5 minutes from a pregnancy related cause”.4

For every three deaths of women in their reproductive years in some developing countries; one is the result of complications from pregnancy and child birth, 15% of deaths of women in the reproductive age in India are maternal deaths. In India 50% of maternal deaths of girls in the 15 to 19 years age group are due to unsafe complications arising out of unsafe abortions.4

Maternal mortality is not just a health issue; it is a human rights issue.Maternal mortality is the one public health indicator showing the maximum variation between developed and developing countries. In developed countries, the MMR is 27/100,000 live births as compared to 480 in developing countries. In India has an MMR of 540 deaths per 100,000 live births.4

A women’s life time risk of dying from pregnancy related complications or during child birth is one in 48 in developing countries, that figure is one in 1800 in developed countries.4

Maternal mortality by world region in 1995, according to W.H.O. (per lakh birth) was; in Africa-1000, Asia-276, Latin America-190, Europe-28, North America-11 and World total is of 400 deaths.7

Maternal mortality in South East Asia in 1995 (per lakh birth) was in Nepal-550; India-350; Indonesia, Bangladesh, Bhutan was -300; Maldives, Myanmar was-200; Thailand -60; Srilanka it was very low that is 30 deaths.7

Reasons for high maternal mortality in India are deliveries not conducted by trained personnel. Only 34% of the deliveries in India takes place in health care facilities and 42% of deliveries are unattended by trained medical professional.7

Women not seeking antenatal care, in India 34% did not receive an antenatal check up. Only 7% received antenatal checkups.Postnatal care is grossly deficient.7

The contributing factors for MMR are inadequate nutrition: In India the average weight gain is of pregnant women is just 7 kg compared to almost 9 kg in Thailand and Philippines and 12kg in developed countries. One rural study in Gujarat and Maharashtrafound that 90% of pregnant women are anemic by W.H.O. standards.4

Over 80% of Maternal deaths in India as else where in the world, are due to 6 medical causes i.e. Hemorrhage, Eclampsia, Obstructed labour, sepsis, Complications arising due to unsafe abortions. Only 60% of rural and 86% of urban women in India receive antenatal checkups.67% received two doses of T.T. vaccine, 48% received 100 IFA tablets and 44% received a minimum of 3 check ups during the period of pregnancy and only 34% of deliveries take place in health facilities.4

Absence of trained personal at delivery is another factor for maternal deaths and complications. In India only 42% deliveries were conducted by skilled personal,in some districts the figure drops to 5-10%.

60% of all maternal deaths occur after delivery, 17% of women in India not received any post partum care.4

In India nearly 7 million abortions take place annually. For each legal abortion there are at least 10 illegal abortions.4

MMR of bigger states in India, in 1998 was Rajasthan-670; U.P.-707; M.P.-498; Bihar-454; Orissa-367; Kerala-198; A.P.-159; Tamilnadu-79; Gujarat-28; In India the highest MMR was in U.P. and lowest was in Gujarat.7

Venkatesh R.R, Umakanth A.G, Yuvaraj J(2005) studied the factors influencing the utilization of health services in antenatal, intra natal, post natal period. The results of the study showed only 35.9% of the women had utilized all the three services. 70.4% of deliveries conducted by trained attendants, 64.7% of women had received at least one postnatal visit.8

The reason for choosing this study is developingcountries have greater risk of non utilization of health care services, especially reproductive health care services due to many reasons which are contributing to maternal mortality, social and economic losses and the children lose their mothers.

Statistics given the evidence that mothers are not utilizing the Reproductive health care facilities available for them. So this study will motivate the people to improve the utilization of health care services and upgrade their standard of living.

In India the prevailing MMR is 407/100,000 live births and 1 in 57 women had a chance of dying from complications of pregnancy, child birth or unsafe abortion during her life time.

This shows that utilization of Reproductive health care services has to out reach the Indian population very effectively. Inspite of wide range of availability of reproductive health care services and mass media campaigns, mothers are unaware of the Reproductive health care services due to ignorance, many mothers are not taking TT vaccination, IFA, delivery at hospital by trained personnel,which imposes threat to their life.

So by assessing mothers knowledge, attitude and practice of Reproductive health care services, programs can be developed for enhancing such knowledge and creating a demand for services there by reducing high risk pregnancies and inculcating a sense of responsible parent hood.

“Empower women, enhance their decision making abilities and increase their choices and use of health care services. This is crucial to ensure safe mother hood”.

6.3 Statement of the problem

“A Study To Assess The Knowledge, Attitude And Practice On Reproductive Health Care Services Among Mothers, In A Selected Urban Community, Bangalore”.

6.4 Objectives of the study

To assess the knowledge, attitude and practice on reproductive health care services among mothers.
To find out the relation between knowledge, attitude and practice of reproductive health care services among mothers.
To determine the association between knowledge, attitude and practice on reproductive health care services among mothers and selected variables.

6.5 Operational definitions

Knowledge: It refers to awareness of the mothers about reproductive health care services as measured by responses to the structured interview schedule.
Attitude:It refers to the feeling or perception of the mothers towards reproductive health care services.
Practice:It refers to the utilization of reproductive health care services by the mothers.
Reproductive health care services:The services which are provided by the government health care agencies for mothers which include antenatal, intra natal and post natal services including family planning.
Mothers:It refers to the women between the age group 18 – 45 years.

6.6 Assumptions

It is assumed that mothers will have inadequate knowledge, negative attitude and poor practice regarding reproductive health care services.

6.7 Sampling criteria

I) Inclusion criteria

Mothers who are willing to participate.
Mothers who are present at the time of data collection.

II) Exclusion criteria

Women more than 45 years age group.

6.8 Review of related literature

BanarjeeB (2006) conducted a study to assess the coverage of maternal care delivered at an urban health center of Kolkata. The results revealed that 100% registration, 72% of antenatal mothers have received all services, and 96% had routine investigations, 84% had received IFA and 80% got injection TT and full pregnancy care had been received by 86% of the mothers. Only 86% of the mothers received all services.9

Joseph B, Charles S, Clement Prakash T.J, Vikas Sudan, Jasmine G(2005) conducted a study on utilization of antenatal services in apparel manufacturing factories in Bangalore, Karnataka with the aim to identify the outcomes of the services that are provided to the pregnant women employed in the apparel factories. The result of study was a majority of the workers had availed of adequate antenatal care and most of the workers are under local employer state insurance (ESI) hospital.10

Rajeswari Balaji, Dilip T.R, Ravi Duggal(2003) in Nasik, did a study to find out the link between uses of institutional facility for delivery care and cost of delivery care services in population. Results indicates that higher incidence of home deliveries in rural areas than in urban areas is due to their lack of access to delivery care at a nominal care.3

A study conducted by Paula Griffiths, Stephen Rob(2001) described key social, economic and cultural factors influencing women’s decisions to use maternal health care and places used for child delivery, the accessibility of facilities available in the local area. The results revealed that a large number of women perceived private services to be superior to those provided by the government, although cost often meant they were unable to use them.11

NavaneethamK, Dharmalingam A (2000), in their study examined the patterns and determinants of maternal health care use across different social setting in south India: states of Andhra Pradesh, Karnataka, and Tamilnadu. The level of utilization of maternal health care services was found to be highest in Tamilnadu followed by Andhra Pradesh and Karnataka.2

Michael D. Kogan, Joyce A Martin, Greg R Alexander, Milton Kotelchuck, Stephanie J Ventura, Fedrick D. Frigoletto (1998) compared older and newer indices in the monitoring of prenatal care trends in the United States from 1981 to 1995 and examined factors associated with receiving intensive utilization. The results were intensive or adequate use, 32% in 1981 to 47.1% in 1995. Prenatal care utilization was 18.4% in 1981 to 28.8% in 1995. Intensive use among low risk women also increased steadily each year.12

7. Materials And Methods:

7.1 Source of data:

Data will be collected from mothers aged between 18-45years.

7.2 Methods of data collection:

Research design: Descriptive study
Setting: Selected urban community, Bangalore
Sample size: 60
Sampling technique: Convenient sampling
Method of data collection: Interview
Tool for data collection: Structured interview schedule.
Method of data analysis

and interpretation: Use appropriate statistical data analysis and present in the form of tables and diagrams

The data will be analyzed by using descriptive and inferential statistics.

Demographic profile: Distribution percentage
Knowledge, attitude and practice: Frequency distribution and percentage.
The relation between knowledge, attitude and practice will be analyzed using correlation co-efficient
Chi-square will be used to determine the association between knowledge, attitude, practice and selected variables.

Duration of the study:4 weeks
Research variables: Knowledge, attitude and practice on reproductive health care services
Demographic variables: Age, Education, Income, Marital status,

Number of children

Projected Outcome:

The finding will reveal the existing knowledge, attitude and practice on Reproductive Health Care services among mothers.

7.3 Does the study require any investigation or intervention to be conducted on the patient or other human beings or animals?

7.4 Has ethical clearance has been obtained from your institution?

Yes

8. BIBLIOGRAPHY

Jain M, Nandan D, Misra S K. Qualitative assessment of health seeking behavior and perceptions regarding quality of health care services among rural community of District Agra. Indian Journal of Community [serial online] 2006 Jan 6 [cited 2007 Aug. 13]; 31(3): [P. 1-8]. Available from: URL:http// php?jounalid.
Navaneetham K, Dharmalingam A. utilization of maternal health care services in South India. [serial online] 2000 Oct 8 [cited 2007 Aug 17]; 15(4): [P. 1-3] Available from: URL: 307.pdf.
Rajeswari Balaji, Dilip T.R, Ravi Duggal.Utilization of and expenditure on delivery care services: some observations from Nasik District, Maharashtra. [serial online] 2003 Nov 4 [cited 2007 Aug 17]; 7(2): [P. 1-4] Available from:URL:
The realities and contributing factors. [serial online] 2006 Dec 10 [cited 2007 Aug 17]; Available fromURL: htm.
Park K, Text book of Preventive and social medicine.18th ed.Jabalpur: Banarsidas Banhot Publications; 2005.P. 412-4.
Gulani K K, Community Health Nursing principles and practices.1st ed. Delhi: Kumar Publishing House; 2006.P. 345-53.
Rehana Kausar.Maternal mortality in India – magnitude, causes and concerns. Indian Journal for the practicing Doctor. 2005 Jun 15; 2(2): P. 1-4.
Venkatesh R.R , Umakanth A.G, Yuvaraj J. Safe motherhood status in the urban slums of Davangere City. Indian Journal of Community Medicine. 2005 Jan 19; 30(1): P. 6-7.
Banerjee B. Maternal care rendered at an urban health care center of metropolitan city. Indian Journalof Community Medicine. 2006 Sep 27; 31(3) : P.183-4.
Joseph B,Charles S, Clement Prakash T.J, Vikas Sudan, Jasmin G.Utilization of antenatal services in apparel manufacturing factories Bangalore.Indian Journal of Occupational and Environmental Medicine. 2005 Jul 4; 9(3): P.107-10.
Paula Griffiths and Stephen Rob.Understanding the users perspective of barriers to maternal health care use in Maharastra, India. Journalof Bio Social Science.[serial online] 2001 Jul 30 [cited 2007 Aug 17]; 33(4): [P. 339-59] Available from: URL:http//
Michel D Kogan, Joyce A Martin, Greg R. Alexander, Milton Kotelchuck, Stephanie J Ventura, Fredrick D. Frigoletto. The changing pattern of prenatal care utilization in the United States.Journal of American Medical Association 1998 May 27; 279(20): P.1-2.

9. Signature of Candidate: