Maternal mortality is still very high in India owing to several preventable and treatable conditions like hemorrhage, sepsis, hypertensive disorders, obstructed labor and unsafe abortions. Regular antenatal care(ANC), effective & timely referral and safe delivery can help reduce the MMR to a considerable extent. Currently ANC is delivered in India via community health workers(CHW) but this model suffers from issues due to low-salary, minimal resource and not being self-sustainable. Hence in India ANC coverage is still abysmally low(19.6%) more so in rural areas (14.7%). In the rural areas of West Bengal state of India, ANC remained as low as 13.6%. For achieving MDG goal of 109 by 2015, it is imperative that universal access to reproductive health, specifically ANC has to be provided.
To bring more pregnant women in rural India under the full coverage of antenatal-care by ensuring four ANC visits as per WHO Basic Component ANC model targeting 100% safe-delivery, a Community Intervention Trial using pair-matched cluster randomization with a qualitative component (3 focus group discussions and 20 in depth interviews) has been designed.
The study introduces an enhanced Home based “Four visit ANC model” for India via “Trained Community Health Entrepreneur”(TCHE) under an income generating, low-resource, sustainable, social-enterprise model, owned by a motivated Health-Entrepreneur, delivered at doorstep, with support resources(e.g:telemedicine,training).This model will be sustained via community based co-operative insurance scheme.
Two rural areas in West Bengal have been identified as potential study sites(in Hooghly and CoochBehar district).Consenting women of childbearing age, who wish to become pregnant are identified as eligible study subjects. The study will be conducted over 2yrs in 40 communities,(20 each in intervention and control arm), each having 350 eligible household(having at least 1 eligible couple). The effectiveness of the intervention in terms of attaining 100% safe delivery will be estimated as the main outcome.
The goal of this project is
A) Establish and quantify one of the primary barriers towards achieving Maternal Mortality Rate (MMR) of 109 by 2015 (MDG5) in rural India, which is low percentage of full Antenatal Care(ANC) and
B) Developing, implementing and evaluating the proposed solution.
Primary Objective:
To bring more pregnant women in rural India under the full coverage of antenatal care by ensuring four ANC visits as per WHO Basic Component ANC model targeting 100% safe-delivery to a) prevent Hemorrhage by preventing anemia, b) prevent Convulsions and other hypertensive disorders by screening and timely referral, c) prevent & reduce underweight new-born and d) prevent any other complications during delivery (e.g: Sepsis, Obstructed labor etc) by educating and confirming institutional delivery
Secondary Objectives:
1) Ensure at-least one Postnatal Check within two weeks to reduce neo-natal mortality rate by educating the mother and family in well-being of mother’s and child’s health as per the WHO Guideline which is culturally and socially acceptable in rural India, such as, birth-spacing, safe-sex practices and options available (terminal & non-terminal), reinforcement of exclusive breast-feeding, oral rehydration for dysentery and diarrhea etc.
2) Educate and confirm immunization for under-five child to reduce Infant Mortality Rate(IMR) towards achieving MDG 4 goal of IMR 27
3) Continuous Family Planning & sexual health education, primarily targeting the adolescent girls, reinforcing the proper child-bearing age of Twenty.
Full ANC is defined by Government of India as at-least three visits for ANC, one TT injection received and 100 IFA tablets.