Social Assessment
We undertake situation analysis or social assessment using case studies and qualitative research methods such as in-depth interviews, narrative method, and FGD. In recent years, this work has been mainly in the areas of quality of reproductive health and child care services, adolescent health, as also on sexuality and sexual behavior of young people.
Factors Contributing to Maternal Death :
A retrospective case-control study was carried out to explore non-medical factors responsible for persistent high maternal mortality in India. The study was conducted in three states: Andhra Pradesh, Madhya Pradesh and Orissa. In each state we selected two poor districts from where we selected households reporting maternal death (study group); households reporting delivery with serious complications (control-1) and households reporting normal delivery (control-2), during 6 months prior to the study.
Analysis of qualitative and quantitative data showed (Dying Needlessly in Childbirth) that nearly half of critical determinants of avoidable death were families’ lack of: awareness about pregnancy/delivery related complications, their lack of access to emergency transport, and un-preparedness of referral facilities to handle obstetric emergency. The study highlighted the need for health workers to maintain contact with pregnant women and provide care during third trimester and postnatal period. It also recommended developing protocol for appropriate referral to health facilities, bypassing the hierarchical referral system, if necessary.
Principal Investigator: Dr. Nirmala Murthy / Alka Barua
Co-Investigators:
Dr. Prakasamma, Academy of Nursing Studies, Hyderabad; AP
Dr. Saraswati Swain, National Institute of Applied Human Research Development, Cuttack; Orissa
Dr. M.L. Sharma, Mahila Chetana Manch, Bhopal. MP
Funding source: Population Council
Publication:- Dying Needlessly in Childbirth
The Nutrition and Gender Initiative :
This qualitative research study was undertaken in Udaipur district, to understand the community-level constraints in tackling the low-birth weight issue to help develop interventions targeted at adolescents, young couples, pre-pregnancy and early pregnancy periods. The study (Care and Support of Unmarried Adolescent Girls in Rajasthan) showed that many parents wanted to take extra care of their daughters’ health and nutrition in anticipation of her marriage and childbearing. They believed that early marriage causes poor health outcomes but were not able to overcome the social pressure to marry their daughters, early. After marriage, couples seemed to discuss and agree about when to have the first child, yet almost never resort to using contraception. Hence, many have their first child in the first year of marriage. Among pregnant women, reducing food intake during pregnancy (“eating down”) to ensure a small baby and easy delivery is less common than previously thought. However, women and their families frequently reported that women should continue doing their domestic and agricultural work to ensure easy delivery, except the heaviest work.
Principal Investigator: Dr. Alka Barua
Funding Source:- International Centre for Research on Women, New Delhi
Publication:- Care and Support of Unmarried Adolescent Girls
Delaying the First Pregnancy A Survey in Maharashtra, Rajasthan and Bangladesh
Understanding Health and Nutritional Concerns of Urban Poor :
This qualitative research study was undertaken in Udaipur district, to understand the community-level constraints in tackling the low-birth weight issue to help develop interventions targeted at adolescents, young couples, pre-pregnancy and early pregnancy periods. The study (Care and Support of Unmarried Adolescent Girls in Rajasthan) showed that many parents wanted to take extra care of their daughters’ health and nutrition in anticipation of her marriage and childbearing. They believed that early marriage causes poor health outcomes but were not able to overcome the social pressure to marry their daughters, early. After marriage, couples seemed to discuss and agree about when to have the first child, yet almost never resort to using contraception. Hence, many have their first child in the first year of marriage. Among pregnant women, reducing food intake during pregnancy (“eating down”) to ensure a small baby and easy delivery is less common than previously thought. However, women and their families frequently reported that women should continue doing their domestic and agricultural work to ensure easy delivery, except the heaviest work.
Principal Investigator: Dr. Alka Barua
Funding Source:- International Centre for Research on Women, New Delhi
Client Perceptions about Quality and Access to Abortion Care :
This study was carried out in three blocks of Ranchi district in Jharkhand, to understand client perceptions of quality of abortion care, and constraints they face in accessing abortion care in the state. In-depth interviews were conducted with abortion service clients, providers, and key informants in the three blocks and district headquarters. Findings (Quality of abortion care: Perspectives of clients and providers in Jharkhand) suggest that while both clients and providers perceive a similar set of elements in their definitions of quality (example: provision of information, confidentiality, provider-client interaction, technical competence, facilities, cost, post-abortion care, and counselling), the priority placed on individual elements varied considerably. While providers ranked technical skills of provider above all, clients gave relatively more priority to confidentiality, provider attitudes, cost and up-keep of the facility. Neither providers nor clients identified the need for information as an important aspect of quality. Not a single client referred to provision of information or absence of spousal consent as being important in her choice of provider. Our findings suggest that the unambiguous stipulations of the MTP Act to ensure provider skills and physical standards of the facility, while obviously necessary, are far from sufficient in attracting clients to certified providers and registered facilities.
Principal Investigator: Dr. Alka Barua
Funding Source:- The Population Council, New Delhi
Publication:- Quality of Abortion Care Perspectives of Clients and Providers in Jharkhand
Review of Quality of Women’s Reproductive Health Services in India :
As a part of the World Bank SAS/HNP unit’s Analytical and Advisory Activity (AAA) on “Better Reproductive Health for Poor Women in South Asia” FRHS carried out a study to understand how poor women define quality of reproductive health (RH) care and what barriers they encounter in accessing quality RH services. The study was carried out in rural areas of Chhattigarh, Karnataka and Rajasthan.
This review (Review of Quality of Women’s Reproductive Health Services in India: A Report) noted that comprehensive reproductive health is still a distant goal for poor women resulting in significant health inequities between the poor and non-poor, between rural and urban residents; between the illiterate and the educated. For program planners and service providers, service quality meant being able to handle medical emergencies. For improving service quality, they suggested controlling quackery, making emergency transport available, increasing medicine supply and reducing workload of health staff (or increase staff strength). Women clients also seemed to agree with this view. They rated service quality as good if they received immediate attention, proper examination, deftness in handling complications, and effective treatment. However the various programs designed to improve service quality could benefit women only to the extent they could access services. The study identified 6 factors that seemed to determine poor women’s access to “quality” services. These were: awareness of the problem, felt need for the service, acceptability of service provider, family support, and service quality as perceived by women. These factors came out of over 450 case studies of poor and non-poor women who had experienced various RH problems.
The study culled out strengths and weaknesses of care providers in the public, private, the NGO sector and informal sector and windows of opportunity for collective actions by them to provide health care for the poor. This analysis showed that the public health sector though operated at a larger scale and was resource rich and maintained certain competency standards, the private sector, both formal and informal, was closer to the poor clients and more acceptable. The NGO sector had better reputation but smaller reach. Therefore, a structure that provides primary care through intermediation of private and NGO facilities and tertiary care at district and sub-district level government hospitals, might serve the poor, better.
Principal Investigator: Dr. Nirmala Murthy
Funding Source:- The World Bank, New Delhi
Use of Reproductive Health Services by Married Adolescent Females :
A study was done in Parner block of Ahmednagar district in Maharashtra to understand the knowledge, attitude and behaviour and the reproductive health needs of married adolescent girls as perceived by them and by their influential members. Data was collected through in-depth interviews from married adolescent girls, their husbands and mothers-in-law.
The data (Use of Reproductive Health Services byMarried Adolescent Females: A Report) showed that childbearing was perceived by all as a normal physiological phenomenon with negligible associated risks, and gynaecological problems as an unavoidable aspect of being a woman. Delivery and post natal period in particular were viewed as entirely “Women’s domain” by both the sexes. Modern spacing methods were preferred by girls and natural spacing or “self control” by the mothers-in-law. MTP was seen as an acceptable form of limiting family by a number of husbands.
The girls were either unaware that their reproductive problems were treatable or were discouraged by family members from mentioning their condition. While husbands were either ignorant of or believed that women’ illnesses were in `Women’s domain’. Those aware helped their wives seek treatment. Mothers-in-law, though better informed generally endorsed more traditional treatments, many of which were inconsistent with modern medicine. The study suggested that it would be more realistic to build reproductive health services for adolescent married girls within the existing women’s health services and make them gender (male) sensitive as the husbands and mothers-in-law influenced women's health seeking behaviour.
Principal Investigator: Dr. Alka Barua
Funding Source:- International Centre for Research on Women, Washington DC