Abstract
BackgroundIndia is committed to improving maternal and newborn health in order to achieve the targets for India’s Millennium Development Goal 4. Considering their role as a link between community and health systems, frontline workers (FLWs) can be effectively utilized in strengthening maternal and newborn care. In this paper, we set out to examine the effect of intensity of contact with FLWs on key maternal and newborn health behaviors and to determine if this association varies by status of Self Help Group (SHG) membership.MethodsThis population-based cross-sectional study included 2208 currently married women aged 15–49 years who had delivered a baby during the last 15 months prior to the survey and selected through a multi-stage cluster sampling from rural villages and urban wards. The outcome of interest included variables related to key knowledge and practice of healthy behavior in relation to maternal and newborn health and exposure variable considered was intensity of contact with FLWs.ResultsOf the women interviewed, 1729 (78%) belonged to SHG household. For knowledge on the need for at least 3 antenatal care (ANC) check-ups, two tetanus toxoid (TT) injections and consumption of 100 or more iron-folic acid (IFA) tablets, proportion of those who were aware of these practices increased with increasing number of contacts with FLWs (P value < 0.001). Practice for TT injections showed an increasing trend with increasing number of contacts with FLW. An increase in the odds of delivering in an institution was observed in those who had higher number of contacts as compared to those with no contacts (P value < 0.001). With regard to newborn healthy behavior practice, breastfeeding within 1 h of delivery showed significant association and the odds of this practice improved in those who had ≥ 3 contacts with FLW as compared to those had no contacts. Except for consumption of 100 or more IFA tablets, there was no interaction of these associations by SHG status.ConclusionThere was an overall low prevalence of both knowledge and practice of key maternal and newborn healthy behaviors and only a few of these were associated with frequency of contacts with FLW. Findings not only highlight the urgent need for effectively leveraging FLWs to strengthen maternal and newborn care but also to improve the quality of services provided by them.
Highlights
India is committed to improving maternal and newborn health in order to achieve the targets for India’s Millennium Development Goal 4
Analysis was done on a total of 2208 women, of whom 78% belonged to Self Help Group (SHG) household
The results show that during pregnancy, about 91% of women had some contact with at least one of the frontline workers (FLW) of whom 14% had 1–2 contacts and 77% had 3 or more contacts
Summary
India is committed to improving maternal and newborn health in order to achieve the targets for India’s Millennium Development Goal 4. Considering their role as a link between community and health systems, frontline workers (FLWs) can be effectively utilized in strengthening maternal and newborn care. Post 2015, the Sustainable Development Goals (SDGs) have set the agenda for prioritizing maternal and newborn health by applying lessons learnt from the MDGs and are working towards developing strategies that will achieve a steeper decline Aggressive steps at this point are crucial to accelerate the progress in reducing maternal and newborn mortality in order to meet the SDG targets. In resource-constrained settings like ours, there is a huge potential for the role of community health workers in improving maternal and newborn care
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