A Community Based Study of Prepregnancy Awareness of Safe Maternity Amongst Rural Tribal Women

Research Article | DOI: https://doi.org/10.31579/2642-9756/151

A Community Based Study of Prepregnancy Awareness of Safe Maternity Amongst Rural Tribal Women

  • Chhabra S *
  • Rajani Jatkala 2
  • Kanchan Bhise 3

1Emeritus Professor, Obstetrics Gynaecology, Ex. Dean, Mahatma Gandhi Institute of Medical Sciences, Sevagram. Chief Executive Officer, Akanksha Shishu Kalyan Kendra, Sevagram. Officer On Special Duty, Dr. Sushila Nayar Hospital, Amravati, Kasturba Health Society, Sewagram, Wardha, Maharashtra, India.
2Senior Resident, Department of Obstetrics and Gynecology,Mahatma Gandhi Institute of Medical Science Sewagram, Wardha Mahashtra , India
3Medical Officer  ,Dr. Sushila Nayar Hospital, Utavali, Melghat, Amravati,India

*Corresponding Author: Chhabra S, Emeritus Professor, Obstetrics Gynaecology, Ex. Dean, Mahatma Gandhi Institute of Medical Sciences, Sevagram. Chief Executive Officer, Akanksha Shishu Kalyan Kendra, Sevagram. Officer On Special Duty, Dr. Sushila Nayar Hospital, Amravati, Kastu

Citation: Chhabra S ,Rajani Jatkala, Kanchan Bhise (2023), A Community Based Study of Prepregnancy Awareness of Safe Maternity Amongst Rural Tribal Women, J. Women Health Care and Issues. 6(3); DOI:10.31579/2642-9756/151

Copyright: © 2023, Chhabra S. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Received: 27 April 2023 | Accepted: 12 May 2023 | Published: 24 May 2023

Keywords: prepregnancy awareness disorders; anaemia; micronutrients; hygiene; effects

Abstract

Background
Every pregnant woman faces risk of complications during pregnancy, birth, not only due to pregnancy, birth related problems but preexisting disorders which get exaggerated during pregnancy. Prepregnancy awareness of various prepregnancy, peripregnancy factors for safe maternity is essential. 
Objective:
Community based study was to know awareness about prepregnancy issues for safe maternity. 
Material methods
Study was conducted in tribal communities of remote forestry hilly region. Randomly from each village 20 married women of 15-40 yr in whom pregnancy was possible, 2400 became study subjects in 100 villages around village with health facility. 
Results
Of 2400 study subjects, 1396 (58.2%) had scatchy awareness, 30.3% right age for pregnancy, 34.2% possibility of diseases running in family, 35.5% essentiality of knowing last menstruation date (LMD), 935 (35.10%) necessity of good health, 45.6% stress free life, 24.4% avoidance of heavy work and 30% need of care for good health during  pregnancy. Only 1247 (52%) were aware of prepregnancy anaemia, (27% said it was due to lack of food, 73% lack of supplements), 51.7% knew about need of extra micronutrients, (41.7% by blood improving tablets, 58.3% extra energy providing diet), 1039 (43.3%) were aware of need of prepregnancy prevention / treatment, of anaemia for preventing complications, (34.6% giddiness, 29.4% legs swelling, nausea, 36.0% dangers of bleeding), 1164 (48.5%) were aware of genital hygiene, (38.0% said prevented genital infection, 62.0% urinary infection, retention).     

Introduction

Every pregnant woman faces risk of complications during pregnancy, and birth which can lead to severe illnesses, even death of the mother and / or the baby. However many women and new-borns also die due to disorders which are present before pregnancy. Such disorders affect pregnancy and also get exaggerated during pregnancy and add risk to a woman’s and her baby’s life. Prepregnancy awareness about safe maternity is essential, for safe pregnancy, safe birth and safe future of the mother as well as the baby. It is opined that it remains unclear whether awareness translates into appropriate actions, but awareness should lead to better outcome. Women need to know about right age for having pregnancy, right interval between too pregnancies and many other issues which need to be taken care preconception and also during pregnancy. For all this prepregnancy care (PPC) is essential so that detection, treatment or counselling of pre-existing disorders and environmental, social conditions that may come in the way of safe maternity. Dangers of exposure to harmful practices, medication during early pregnancy and general health are all essential. It also includes encouraging behavioural change allowing early identification of risk factors and try prevention before pregnancy. So prepregnancy period has been proposed for improving pregnancy outcome. While results from studies have been encouraging, not much is known about women of rural remote regions.

Objective:

Community based study was carried out to know about awareness of prepregnancy issues for safe maternity amongst tribal women in rural remote region.

Study Setting

Community based study was conducted in rural tribal communities of remote forestry hilly region in 100 villages near the village having health facility.

Study design

Descriptive research with predesigned tool. 

Study period – one year 

Study sample - 2400 sample calculated by descriptive study formula 1

Inclusion exclusion criteria 

Women of 15-40 years in whom pregnancy was possible were included. Women age <15years>40years those in whom pregnancy was not possible, cases of hysterectomy, total ligation, menopausal etc and not willing, though there were none, were excluded.

Results

The study revealed that, of 2400 study subjects, only 1396 (58.2%) had some scatchy awareness, [423 (30.3%) said they knew about right age for pregnancy, 477 (34.2%) possibility of diseases running in family and 496 (35.5%) essentiality of knowing the last menstrual date (LMD)]. Relationship of awareness with different variables like age, education, profession, economic status and previous birth is in table I (Table I). There was significant difference in number of women with awareness between illiterate and secondary school educated (p-value <0>(Table II). There was significant difference between number of women knowing the need of prepregnancy good health with age (p-value <0>(Table III). Also there was significant difference in numbers of illiterate and even primary school educated women (p-value <0> Overall of 2400 study subjects, 1240 (51.7%) were aware of need of extra micronutrients during pregnancy, [517 (41.7%) by blood improving tablets and 723 (58.3%) by extra energy providing diet]. Relation of awareness with age, education, profession, economic status, and number of births is in table IV (Table IV). Also there was significant difference with better education in women knowing need of extra micronutrient during pregnancy (p-value <0>

VariablesTotalPrepregnancy issues 
Age In YearYes%Right age for pregnancy%Diseases running in family %Last menstruation date %
15-1933626980.19936.89033.58029.7
20-29156488756.726730.130033.832036.1
30-4050024949.86626.58734.99638.6
Total2400139658.242330.347734.249635.5
Education         
Illiterate95345748.010723.418039.417037.2
Primary85055865.616830.118032.321037.6
Secondary / Higher Secondary59738163.814838.811730.711630.4
Total2400139658.242330.347734.249635.5
 Profession         
Home Maker27514050.92417.16042.95640.0
Agriculture Labourer95849952.116933.917034.116032.1
Casual Labourer*46825955.39235.57729.79034.7
Shop Keeper69949871.213827.717034.119038.2
Total2400139658.242330.347734.249635.5
 Economic Status         
Upper1477450.31418.93040.53040.5
upper middle1835932.21728.82237.32033.9
Middle54427851.18831.710036.09032.4
Upper lower66243966.317439.611526.215034.2
Lower86454663.213023.821038.520637.7
Total2400139658.242330.347734.249635.5
 Parity         
P01053533.31028.61542.91028.6
P1- P2106380675.832640.422027.326032.3
>P3121255545.88715.724243.622640.7
Total2400139658.242330.347734.249635.5

Table I: Prepregnancy Awareness About Needs for Safe Maternity

*Small Scale, (Food, Shoes making, Bamboo itoms) Industry, Welding Workshop, Brick furnace

Variables TotalDuring Pregnancy
Age In YearYes%Stress free life during pregnancy%Avoidance of heavy work during pregnancy%Health care during pregnancy%
15-1933611835.11210.22319.58370.3
20-29156454935.134061.98715.812222.2
30-4050026853.67427.611844.07628.4
Total240093539.042645.622824.428130.1
 Education         
Illiterate95340442.421453.07618.811428.2
Primary85037243.814839.813235.59224.7
Secondary / Higher Secondary59715926.66440.32012.67547.2
Total240093539.042645.622824.428130.1
 Profession         
Home Maker27517764.415989.8116.274.0
Agriculture Labourer95836938.512533.912233.112233.1
Casual Labourer*46817036.38348.82615.36135.9
Shop Keeper69921931.35926.96931.59141.6
Total240093539.042645.622824.428130.1
 Economic Status         
Upper14710269.41211.81716.77371.6
upper middle1833519.11645.71234.3720.0
Middle54427550.618768.03813.85018.2
Upper lower66222734.38135.712856.4187.9
Lower86429634.313043.93311.113344.9
Total240093539.042645.622824.428130.1
Parity         
P01057369.51216.41216.44967.1
P1-P2108328626.419969.63311.55418.9
>P3121257647.521537.318331.817830.9
Total240093539.042645.622824.428130.1

*Small Scale, (Food, Shoes making, Bamboo itoms) Industry, Welding Workshop, Brick furnace

Table II: Prepregnancy Awareness of Essentialities During Pregnancy

Variable TotalAwareness of Anaemia and Its Causes
Age In YearsYes%Lack Of Food%Lack Of Iron%
15-1933616348.56841.79558.3
20-29156485754.822025.763774.3
30-4050022745.44921.617878.4
Total2400124752.033727.091073.0
 Education       
Illiterate95358461.319733.738766.3
Primary85042650.17918.534781.5
Secondary / Higher Secondary59723739.76125.717674.3
Total2400124752.033727.091073.0
 Profession       
Home Maker2757226.24156.93143.1
Agriculture Labourer95855658.017230.938469.1
Casual Labourer*46826757.18130.318669.7
Shop Keeper69935250.44312.230987.8
Total2400124752.033727.091073.0
 Economic Status       
Upper1477953.73341.84658.2
Upper Middle1835127.92854.92345.1
Middle54423142.56929.916270.1
Upper Lower66222834.44218.418681.6
Lower86465876.216525.149374.9
Total2400124752.033727.091073.0
 Parity       
P01057773.33646.84153.2
P1 - P2108346542.916936.329663.7
>P3121270758.313218.757581.3
Total2400124752.033727.091073.0

 

*Small Scale, (Food, Shoes making, Bamboo itoms) Industry, Welding Workshop, Brick furnace

Table III: Awareness of Prepregnancy Anaemia

Variable TotalYes%Prevented Giddiness%Prevented legs Swelling, Nausea Vomiting%Prevents Dangers Due to Bleeding%
Age In Years
15-1933611734.84437.63933.33429.1
20-29156472446.327237.622130.523131.9
30-4050019839.64723.74522.7168.1
Total2400103943.336034.630529.437436.0
 Education         
Illiterate95347649.918839.513027.315833.2
Primary85036042.49025.08122.518952.5
Secondary / Higher Secondary59720334.08139.99446.32813.8
Total2400103943.336034.630529.437436.0
 Profession         
Home Maker2757326.52939.71621.92838.4
Agriculture  Labourer95840342.110927.010626.318846.7
Casual Labourer*46824251.715162.46526.92610.7
Shop Keeper69932145.97122.111836.813241.1
Total2400103943.336034.630529.437436.0
Economic Status         
Upper1478859.92022.74045.52831.8
Upper Middle1836233.91625.82337.12337.1
Middle54415829.06641.84931.04327.2
Upper Lower66231747.911937.59630.310232.2
Lower86441447.913933.69723.417843.0
Total2400103943.336034.630529.437436.0
 Patiry         
P01056360.02031.71727.02641.3
P1- P2108355751.425946.511320.318533.2
>P3121241934.68319.817441.516439.1
Total2400103943.336034.630529.437436.0

*Small Scale, (Food, Shoes making, Bamboo itoms) Industry, Welding Workshop, Brick furnace

Table IV: Advantages of Prevention and Treatment of Anaemia Prepregnancy

Variable  TotalModes of Getting Micronutrients 
Age In YearsYes%Blood Improving Tablets%Energy Providing Food%
15-19106952749.327552.225247.8
20-29116460552.022336.938263.1
30-4016710864.71917.68982.4
Total2400124051.751741.772358.3
 Education       
Illiterate95352955.531960.321039.7
Primary85039746.712431.227368.8
Secondary / Higher Secondary59731452.67423.624076.4
Total2400124051.751741.772358.3
 Profession       
Home Maker27520173.19346.310853.7
Agriculture Labourer95853856.217031.636868.4
Casual Labourer*46827057.711241.515858.5
Shop Keeper69923133.014261.58938.5
Total2400124051.751741.772358.3
Economic Status       
Upper14710168.75857.44342.6
Upper Middle18311663.41210.310489.7
Middle54434162.715846.318353.7
Upper Lower66225338.213352.612047.4
Lower86442949.715636.427363.6
Total2400124051.751741.772358.3
 Parity       
P01056360.02946.03454.0
P1- P2108349946.129458.920541.1
>P3121267855.919428.648471.4
Total2400124051.751741.772358.3

*Small Scale, (Food, Shoes making, Bamboo itoms) Industry, Welding Workshop, Brick furnace

Table V: Awareness Of Extra Micronutrients In pregnancy

Variable Total Advantages of good hygiene
Age In YearsYes%Prevention of genital disease%Prevention of urinary infection%
15-1933615546.15837.49762.6
20-29156470945.328740.542259.5
30-4050030060.09732.320367.7
Total2400116448.544238.072262.0
 Education       
Illiterate95337239.012333.124966.9
Primary85054664.225146.029554.0
Secondary / Higher Secondary59724641.26827.617872.4
Total2400116448.544238.072262.0
 Profession       
Home Maker27512846.56349.26550.8
Agriculture Labourer95840542.316741.223858.8
Casual Labourer*46822948.98135.414864.6
Shop Keeper69940257.513132.627167.4
Total2400116448.544238.072262.0
Economic Status       
Upper14710068.02828.07272.0
Upper Middle18313473.26447.87052.2
Middle54415829.07849.48050.6
Upper Lower66231046.813142.317957.7
Lower86446253.514130.532169.5
Total2400116448.544238.072262.0
 Parity       
P01057571.41520.06080.0
P1- P250916933.24526.612473.4
>P3121260549.918530.642069.4
Total2400116448.544238.072262.0

*Small Scale, (Food, Shoes making, Bamboo itoms) Industry, Welding Workshop, Brick furnace

Table VI: Awareness About Hygiene During Pregnancy

Discussion

Preconception care (PCC) refers to things, women could do before and between pregnancies for safe pregnancy, safe birth and safe future of the mother as well as the baby. Unfortunately, millions of women in the world have no access to getting pre-pregnancy information and care and both are essential. Antenatal care is too late to reduce the harmful effects of many preexisting disorders and undesired happenings preconception, periconception and during early pregnancy. Raising awareness of women about right age of pregnancy, right interval between two pregnancies, good health at onset of pregnancy and during pregnancy and clean hygiene, all are essential. Also protection from ill effects of pre-existing disorders and environmental issues is essential. There are modest additional requirements for energy and protein during pregnancy and women need to know. Martine  [2] also reported that awareness of anaemia, a public health problem responsible for a big proportion of maternal deaths was very essential. In the present study only 1247 (52%) women were aware of essentiality of treatment of anaemia pre-pregnancy. Mason [3] opined that there was convincing evidence that health problems and nutritional problems, contributed to poor pregnancy outcome and it was essential that women were aware. Stephenson et al [4] from USA reported that despite a high level of pregnancy planning, awareness of preconception health among women and health professionals was low. However, many women were motivated to adopt healthy behaviour preconception. Doke et al  [5] also reported that very few countries including India implemented comprehensive packages of PCC. In their study, PCC was rolled out among all women, who desired to be pregnant in a year. Their study in central India revealed that only 50% pregnancies were planned. The decision about first pregnancy was influenced more by the mother-in-law. Women knew that pregnancy should not occur in teen age and inadequate weight had adverse impact on the health of new-born. Women had some knowledge about adverse effects of tobacco and alcohol use in pregnancy. Most of them did not practice behaviour or accessed services of PCC. In the present study, of 2400 study subjects, only 1396 (58.2%) had some scatchy awareness of prepregnancy issues which affected pregnancy. Of them, only 423 (17.7%) women talked about right age for having pregnancy, 477 (19.8%) talked of possibility of diseases running in family, and 496 (20.6%) women said it was essential to know LMD. No one talked of preexisting disorders in the mother, interval between two pregnancies and so many other issues. Only 549 (22.87%) women were aware of necessity of prepregnancy good health, 340 (14.16%) said stress free life was essential and only 87 (3.6%) said for remaining healthy it was essential to avoid heavy work during pregnancy. However women did not talk of protection from environmental issues or medication, specially periconception and in early pregnancy. Umar et al [6] from North-Western, Nigeria reported poor awareness but good perceptions and acceptability of PCC by women, and opined that there was a need to create awareness and it needed to be incorporated into maternal health services. Akinajo et al 7 reported high awareness of PCC (76%) in many, but practice was low (34.2%) before index pregnancy and reported a huge disconnect between awareness and practice in Nigeria. Ojifinni et al [8] reported that in Nigeria participants stated that there were neither defined PCC services in the health system nor guidelines. PCC services were however provided when health workers perceived a need or when clients demanded health information, treatment modification, medical check-up, screening or education and counselling. Alemu et al [9] from Ethiopia reported significantly low knowledge and utilisation of PCC. Educational status and antenatal care were shown to affect PCC knowledge. Age and sound knowledge of PCC had significant association with utilisation of PCC. It has been opined that although it remains unclear how awareness translated into appropriate actions, chances of better outcome are there. Ayelew et al 10 from Ethiopia reported that overall knowledge of PCC was in 27.5% women with secondary school education and more 25 to 34 years, were having knowledge of PCC than their other counterparts. In the present study also, of 850 women with primary school education, 34.4% had some scatchy awareness and of 91 with women who had higher secondary school education, 64.8% were aware, significantly more (p-value 0000.1). Of 105 women who had no birth, 73 (3.04%) were aware about essentiality of prepregnancy good health and only 12 (0.5%) talked of stress free life, 12 (0.5%) avoidance of heavy work and 49 (2.04%) talked about need of regular check up during pregnancy. Of 275 home makers, 201 (73%) were aware of need of micronutrients.  Of 147 women from upper economic class, 101 (68.7%) were aware and of 864 from lower economic class, 429 (49.65%) were aware of need of micronutrients, significant difference (p value <0>Summary and Conclusion
Over all it was revealed only some women had scatchy prepregnancy awareness. No one talked of appropriate interval, existing disorders, effects of environment, or medication, although the health care before pregnancy and during pregnancy was talked by some. Only 30.1% women knew disorders needed treatment before pregnancy, and 51.67 % women were aware of the extra micronutrient required in pregnancy, 48.50% women were aware about hygiene during pregnancy. Awareness was directly proportional to variables like age, literacy, economic status and occupation. Overall there seems a real need of creating prepregnancy awareness, provide PCC services for promoting maternal and new-born health and preventing maternal and new-born mortality.

Conflict of Interest – Nil

References

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Douglas Miyazaki

We are grateful for this opportunity to provide a glowing recommendation to the Journal of Psychiatry and Psychotherapy. We found that the editorial team were very supportive, helpful, kept us abreast of timelines and over all very professional in nature. The peer review process was rigorous, efficient and constructive that really enhanced our article submission. The experience with this journal remains one of our best ever and we look forward to providing future submissions in the near future.

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Dr Griffith

I am very pleased to serve as EBM of the journal, I hope many years of my experience in stem cells can help the journal from one way or another. As we know, stem cells hold great potential for regenerative medicine, which are mostly used to promote the repair response of diseased, dysfunctional or injured tissue using stem cells or their derivatives. I think Stem Cell Research and Therapeutics International is a great platform to publish and share the understanding towards the biology and translational or clinical application of stem cells.

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Dr Tong Ming Liu

I would like to give my testimony in the support I have got by the peer review process and to support the editorial office where they were of asset to support young author like me to be encouraged to publish their work in your respected journal and globalize and share knowledge across the globe. I really give my great gratitude to your journal and the peer review including the editorial office.

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Husain Taha Radhi

I am delighted to publish our manuscript entitled "A Perspective on Cocaine Induced Stroke - Its Mechanisms and Management" in the Journal of Neuroscience and Neurological Surgery. The peer review process, support from the editorial office, and quality of the journal are excellent. The manuscripts published are of high quality and of excellent scientific value. I recommend this journal very much to colleagues.

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S Munshi

Dr.Tania Muñoz, My experience as researcher and author of a review article in The Journal Clinical Cardiology and Interventions has been very enriching and stimulating. The editorial team is excellent, performs its work with absolute responsibility and delivery. They are proactive, dynamic and receptive to all proposals. Supporting at all times the vast universe of authors who choose them as an option for publication. The team of review specialists, members of the editorial board, are brilliant professionals, with remarkable performance in medical research and scientific methodology. Together they form a frontline team that consolidates the JCCI as a magnificent option for the publication and review of high-level medical articles and broad collective interest. I am honored to be able to share my review article and open to receive all your comments.

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Tania Munoz

“The peer review process of JPMHC is quick and effective. Authors are benefited by good and professional reviewers with huge experience in the field of psychology and mental health. The support from the editorial office is very professional. People to contact to are friendly and happy to help and assist any query authors might have. Quality of the Journal is scientific and publishes ground-breaking research on mental health that is useful for other professionals in the field”.

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George Varvatsoulias

Dear editorial department: On behalf of our team, I hereby certify the reliability and superiority of the International Journal of Clinical Case Reports and Reviews in the peer review process, editorial support, and journal quality. Firstly, the peer review process of the International Journal of Clinical Case Reports and Reviews is rigorous, fair, transparent, fast, and of high quality. The editorial department invites experts from relevant fields as anonymous reviewers to review all submitted manuscripts. These experts have rich academic backgrounds and experience, and can accurately evaluate the academic quality, originality, and suitability of manuscripts. The editorial department is committed to ensuring the rigor of the peer review process, while also making every effort to ensure a fast review cycle to meet the needs of authors and the academic community. Secondly, the editorial team of the International Journal of Clinical Case Reports and Reviews is composed of a group of senior scholars and professionals with rich experience and professional knowledge in related fields. The editorial department is committed to assisting authors in improving their manuscripts, ensuring their academic accuracy, clarity, and completeness. Editors actively collaborate with authors, providing useful suggestions and feedback to promote the improvement and development of the manuscript. We believe that the support of the editorial department is one of the key factors in ensuring the quality of the journal. Finally, the International Journal of Clinical Case Reports and Reviews is renowned for its high- quality articles and strict academic standards. The editorial department is committed to publishing innovative and academically valuable research results to promote the development and progress of related fields. The International Journal of Clinical Case Reports and Reviews is reasonably priced and ensures excellent service and quality ratio, allowing authors to obtain high-level academic publishing opportunities in an affordable manner. I hereby solemnly declare that the International Journal of Clinical Case Reports and Reviews has a high level of credibility and superiority in terms of peer review process, editorial support, reasonable fees, and journal quality. Sincerely, Rui Tao.

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Rui Tao

Clinical Cardiology and Cardiovascular Interventions I testity the covering of the peer review process, support from the editorial office, and quality of the journal.

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Khurram Arshad