Does institutional delivery help in improving infant and child health care practices and health promotion related parameters? A study from Bellary, Karnataka

Abstract

Introduction Inspite of emphasis on institutional delivery, a considerable number of births are being conducted at home and by traditional birth attendant (TBA). Institutional delivery is hypothesized to improve the health seeking behavior and health care practices related to infant and child care. In this paper we report that in a poorly performing district institutional delivery does not seem to change the health care practices of the people. Methods The data presented here is a part of a larger two years long study funded by ICMR and conducted at Bellary and Dakshina Kannada district of Karnataka. The results reported pertain to the cross sectional community based house to house survey carried out among 2158 households at Bellary regarding births during the five-year period before survey to ever-married women. The Institutional Ethics Committee had approved this study. Results A total of 1010 deliveries were at the institution while 1148 deliveries took place at home, of which 891 deliveries were conducted by the dais. Majority of mothers who delivered with the help of a dai had not been explained about breastfeeding and its importance. Delayed breastfeeding beyond 2 hours after birth was seen in 38% of institutional deliveries as opposed to 62% home deliveries. Though 79% babies delivered at home were given pre-lacteal feeds, a large number (57%) of those delivered at institution also received pre-lacteal feeds. The weaning practices were also very similar in both the groups. Majority of the women delivered at home (by dais) had undergone antenatal check up by either a doctor (Private 41% and government 21%) or a nurse (12.7%). More than half of the houses where delivery was at home or by a dai were in close proximity (within 5Km in 62 %) to a health facility. Treatment seeking behavior for childhood illness was similar in the institutional and the home birth group. The majority went to private clinic or hospitals (55% home delivery vs 60% hospital) followed by chemist shop (without prescription) and alternate system of medicine. Discussion The health seeking behavior and health care practices depend on the beliefs and awareness among people. Availing antenatal care is hypothesised to promote institutional delivery but this did not seem to be the case in Bellary. Institutional deliveries too did not help in doing away with practices related to delayed breastfeeding and supplementary feeding as well as pre-lacteal feeds. Mere emphasis on institutional delivery seemed to be ineffective in changing the perception and beliefs of people leading to practices which may be harmful to child’s health. Non-utilization of health facilities for delivery in spite of proximity calls for a relook at the availability, affordability and quality of services at these facilities. Institutional delivery per se may not be the answer for infant and child care practices. Sustained efforts by means of campaigns and awareness activities coupled with the use of mass media may help in improving the health care practices. Health systems research and study of local traditions are needed before implementing a tailor-made strategy for improving the health care practices and behavior in a district/region. [509 words]