Health Workers’ Perceptions about Maternal and Adolescent Health among Marginalized Populations in India: A Multi-Centric Qualitative Study

Shantanu Sharma,Faiyaz Akhtar,Aditya Bhardwaj,Kanishtha Arora,Sunil Mehra

doi:10.3390/women1040021

Abstract

Frontline workers are instrumental in bridging the gap in the utilization of maternal health services. We performed a qualitative cross-sectional study with medical officers, accredited social health activists (ASHA), and auxiliary nurse midwifes (ANM), across 13 districts of India, in order to understand the barriers and enablers, at the system and population levels, for improving access of adolescents and mothers to services. The data were collected by means of in-depth interviews (IDI) with medical officers and focus group discussions (FGD) with ASHA and ANM in 2016. The interview guide was based on the conceptual framework of WHO health interventions to decrease maternal morbidity. Content analysis was performed. In total, 532 frontline workers participated in 52 FGD and 52 medical officers in IDI. Adolescent clinics seemed nonexistent in most places; however, services were provided, such as counselling, iron tablets, or sanitary pads. Frontline workers perceived limited awareness and access to facilities among women for antenatal care. There were challenges in receiving the cash under maternity benefit schemes. Mothers-in-law and husbands were major influencers in women’s access to health services. Adolescent clinics and antenatal or postnatal care visits should be seen as windows of opportunities for approaching adolescents and women with good quality services.

Highlights

Women and adolescents have long faced health challenges in the low- and middleincome countries of the world
Considering the lack of adequate evidence on frontline workers’ perceptions, regarding barriers in the utilization of maternal and adolescent health services and services they provide, we aimed to perform a qualitative study with medical officers, accredited social health activists (ASHA), and auxiliary nurse midwifes (ANM) across 13 districts of
This study was conducted as a part of the baseline assessment of key maternal and adolescent health indicators in a project that aims to improve the uptake of antenatal, postnatal, and adolescent health services across 13 districts of India

Summary

Introduction

Women and adolescents have long faced health challenges in the low- and middleincome countries of the world. Improvement in women’s health increases the productivity of the nation and free resources that can be used for childcare, feeding, and education, contributing to an increase in future productivity [1]. Pregnancy and childbirth are important phases in a woman’s life that have health implications over the rest of their lives. Maternal health, during and after pregnancy, has largely been focused on preventing maternal mortality and morbidity. The use of maternal health services reduces maternal mortality and improves the reproductive health of women [2]. There are wide disparities in access to maternal health services across regions. Limited availability and underutilization of available maternal services have been found in the populations that need them the most, i.e., marginalized people [3]

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Discussion

Conclusion