“Impact of awareness programme on maternity benefit scheme amongpregnant mothers of Rural Bangalore”

INTRODUCTION

Health is certainly more valuable than money, because it is by health that money is procured.

                                                                                                                                                              – Johnson 

Preamble

Women have always been regarded as the wreakers succumbed by various physical, mental and social problems since long. It’s the one group of society that has always been on the edge of sword. This has leaded to various maternal problems including high maternal mortality rates and deprived health services, especially in developing countries like India. But over time governments have made lot of efforts to revert this pathetic condition of mothers. And in pursuance of this, the government has started a number of programmes and schemes to make the mothers counted. One of such scheme is Janani Suraksha Yojana (JSY), a safe motherhood intervention started in 2005 with the objective to bring down the MMR by promoting institutional deliveries, decline in domiciliary delivery. 

Need for the study

The health of women actually represents the health of the country. Safe motherhood can only be reached if complete care is given to the mothers. It is a comprehensive total healthcare that can be offered to women.

According to World Health Organisation, “a maternal death is defined as the death of a woman while pregnant or within 42 days of termination of pregnancy, irrespective of the duration and site of the pregnancy, from any cause related to or aggravated by the pregnancy or its management but not from accidental or incidental causes.”10 Maternal mortality rate is the ratio of the number of maternal deaths per 1,00,000 live births. In 2003, the World Health Organisation, United Nation International Children Emergency Fund, produced a report with statistics on maternal mortality rate. The world average maternal mortality rate per 1,00,000 was 400, the average for developed regions were 20 and for developing regions 440. The worst countries were: Afghanistan-1,100, Zimbabwe, and Central Africa-1100 etc.

Objectives of the study

1. To assess the pre test level of knowledge on maternity benefit scheme Janani SurakshaYojana among eligible pregnant mothers.

2. To find the impact of awareness programme on maternity benefit scheme,Janani Suraksha Yojana among eligible pregnant mothers.

3. To find out the association of pre- test awareness programme on JSY among the eligible pregnant mother with selected demographic variables.

Hypotheses of the study

H1: There is a significant difference between the Pre-test and Post-test Knowledge scores of pregnant mothers regarding knowledge on Janani Suraksha Yojana.

H2: There is a significant association between pre-test knowledge scores and selected demographic variables of eligible pregnant mothers.

Variables 

Research Variables: Knowledge regarding maternity benefit scheme.

Socio-Demographic Variables:

Age, educational qualification, occupational status, religion, family income, type of family, education of husband, gravida, previous information.

Materials & Methods:

The research design used in the study was preexperimental one group pre-test and post-test design, on probability purposive sampling technique was used to draw sample. The data was collected from 500 pregnant mothers using the structured interview schedule. AP was conducted and post test was administered after 7 days using the same structured interview schedule to find out the impact of Awareness programme. The Main study was conducted from 01/04/2012 to 30/01/2013.

Criteria for Selection of the Sample

The sample was selected based on the following criteria:

Inclusion criteria

• Pregnant mothers who are attending the antenatal OPD, Rural Bangalore.

• Pregnant mothers above the age of 19 years who are below poverty line.

Exclusion criteria 

• Pregnant mothers with more than two living children.

The tool was developed by the investigator after reviewing the related literature and guidance from the experts in the field.

Section I

Section I comprised of demographic variables which are 10 in number. They are age, educational qualification, occupational status, religion, family income, type of family, education of husband, gravida, previous information of Janani Suraksha Yojana programme, and source of information.

Section II

The structured interview schedule on awareness regarding Janani Suraksha Yojana among pregnant mothers consisted of 42 items. The interview schedule had four main areas namely, knowledge of basic concepts of antenatal and postnatal care (13), introduction to JSY(3), Thayi Bhagya Programme (6), benefits and beneficiaries of Janani Suraksha Yojana (20). Each item has four options with one correct answer. The score for correct response to each item was “one” and incorrect response was “zero”. Thus for 42 items maximum obtainable score was 42 and minimum was zero. To interpret the level of knowledge, the scores were distributed as follows: 

Arbitrary scoring

Results:

Section I: Findings of Frequency Distribution of socio demographic characteristics of eligible pregnant mothers Majority 40.2% of the respondents were in the age group of 24-28 years The majority 40.0% of the respondents had completed middle school education,

The majority 53.6% of the respondents were house wife, 34.2% of the respondents were cooli workers

The distribution of respondents by religion shows that highest respondents (77.6%) were Hindus followed by (22.4%) of the respondents being Muslims.

The majority (45.8%) of the respondents had a family income between Rs.2001- 4000 per month

The majority of respondents (40.2%) belongs to nuclear family

The majority (30%) of the respondent's husband had completed middle school education

The majority (63.6%) of the respondents were primigravida, and remaining (36.4%) of the respondents were multi gravida.

The majority (57.8%) of the respondents had previous knowledge on Janani Suraksha Yojana programme

The majority (20.0%) of respondents gets the source of knowledge on JSY services from health personnel

Findings related to Area wise Mean Pre-test and Post-test Knowledge on Janani Suraksha Yojana

Area wise mean pre-test and post-test knowledge on Janani suraksha yojana. shows that the pretest means knowledge score regarding the basic concept of Ante natal and postnatal care pretest score was (39.3%) and the post-test score is (77.7%). The enhancement of the knowledge is found to be (38.4%). Regarding Introduction to JananiSurakshaYojana the pre-test score was (29.9%) and post-test score is (80.7%) with enhancement of (50.8%). The pre-test score regarding Thayi Bhagya aspect was (41.9%) and post-test score is (81.2%) with enhancement of (39.3%). The aspect of Benefits & Beneficiaries of Janani Suraksha Yojanapre-test score was (35.1%) and post-test score is (78.1%) with enhancement of (43.0%).

 Figure shows that pre-test mean% knowledge score found to be (35.1%) as compared to overall posttest mean% knowledge score noticed as (78.1%), the gain knowledge score found to be (43.0%). The data subjected for satisfied paired t-test showed a highly significant difference (p<0.05) existing between pre-test and post-test over all mean% knowledge score (t=76.31). There for it is inferred that the awareness programme on jsy was found to be effective

DISCUSSION

Related to socio-demographic variables

Age: Table 1 reveals that distribution of respondents by age. Majority (40.2%) of the respondents were in the age group of 19-23 years, followed by 33.8% in the age group of 24-28 years, and 26.0% in the age group of 29-33 years. The findings are consistent with study conducted by Begum R,Joseph GA that 53.5% of the participants belongs to the age group of 20-25 years while 37.8% were from 26-30 years and 8.5% were from the age group of 31-35 years.

Educational status: Majority (40.0%) of the respondents had completed middle school education, 34.2% of the respondents had primary education, and 25.8% of the respondents were illiterate. A similar study was conducted by Begum R, Joseph GA. The findings of the study are consistent with the present study findings that majority 56.8% were illiterates.19.6% of them were literates, out of which 13.7% had primary education.

Occupational status: Majority (53%) of the respondents were housewives, 34.2% of the respondents were coolie workers, and 12.2% of the respondents were agriculturists. Which was supported by the findings of Sharma 2008 that majority 53% of the respondents were housewives and 19% of the respondents were agriculturists39 and a similar study was supported by Begum R, Joseph GA. The findings of the study are consistent with the present study findings that majority 81.9% of respondents were engaged in daily labour work and 14.6% of them were agriculturist, only 3.5%were home makers without work engagement. Religion: The classification of respondents by religion shows that highest respondents (77.6%) were Hindus followed by 22.4% Muslims similar findings were found by Sharma R 2008 where majority 83% of respondents were Hindus & 4% were Muslims& 1% were Christians39 and asimilar study was supported by Begum R, Joseph GA.The findings of the study are consistent with the present study findings that majority 91.8% of them were Hindus and 8.2% them were muslims. No Christians or any other communities.

Family income: Majority (42.8%) of the respondents had a family income between Rs. 2001-2000 per month, 28% of respondents were in the income range of Rs. 4001-6000, and 26.2% of the respondents were below earning less than Rs. 2000.A similar study findings of Gupta SK,Pal DK,Tiwari R,Garg R,shrivastav AK,Sarawagi R,et al2012 were consistent that 44.8% of them belonged to middle class family, 38.46% of them were belonged to upper middle class,6.4% of them were lower middle class family.

Type of family: Majority of the respondents (59.8%) belonged to joint family as compared to 40.2% of the respondents living in nuclear family. A similar study was conducted by R. Sharma (2008) where majority (57%) of the respondents belonged to nuclear family.39 and another study by Begum R findings where supported that 54.3% of them living in nuclear family while 2.4% of them were belonged to joint family.

Education status of husbands: The majority (30%) of the respondents’ husbands had completed middle school education, 26.2% of them had completed primary education, 24% of them had completed high school, and 19.8% of them were illiterate. It was supported by Dilip K Mandal (2009) on JSY benefits for mothers. The results revealed that husband’s education was positively associated.

Gravida: Majority (63.6%) of the respondents were primigravida, and remaining (36.4%) respondents were multi gravida. In this study findings found that by Gupta S. K., et. al. in Madhya Pradesh where there was significant decrease in maternal death in multigravida after implementation of JSY.79and a similar study findings of Gupta SK,Pal DK,Tiwari R,Garg R,shrivastav AK,Sarawagi R,et al 2012 findings were supported that 35.8% were primigravida , and 64.23% were multigravida.

Previous source of Knowledge: The majority (57.8%) of the respondents had previous knowledge on JananiSurakshaYojana programme and only (42.2%) of the respondents were not aware of Janani Suraksha Yojana. A similar study conducted by Dr.Ramakanth Sharma between 2007-08 has shown consistent results where out of the 200 beneficiaries all had not aware of JSY.

Sources of Information: The majority (20.0%) of respondents had the source of knowledge on JSY services from health personnel, followed by elders or by relatives (14.0%) and from friends and others (18.8%) and (42.2%) of the respondents were not aware of JSY. The similar findings of Begum R were supported that all 100% of respondents knew about JSY, 72.7% of them had information from the neighbours.

Knowledge scores ofpregnant mothers on Janani Suraksha Yojana

In the present study mean pre-test knowledge is 35.1% & post-test mean knowledge is 78.1%.so there is increase in knowledge found to be 43%. The ststistical paired ‘t’ test implies significant difference in the enhancement of knowledge between pre and post-test(t=76.31**,p<0.05) this shows that there is a impact of knowledge of pregnant mothers about awareness programme on JSY. Similar findings are revealed by Gupta SK,Pal DK,Tiwari R,Garg R,shrivastav AK,Sarawagi R,et al 2012 study correlates the the present study findings that the awareness programme on JSY after introducing the maternity benefit scheme in India has increased the institutional deliveries from 40% in 2005-2006,which upto 72% 2009.

Another study by Begum R findings were consistent that the utilization increased in low performing state of Bihar from 13.3%-18.6% because of awareness programme conducted on maternity benefit scheme.

Impact of awareness programme 

Shows that the obtained chi square value for educational level (χ2=7.81) , occupation (χ2=6.30), religion (χ2=8.84) , type of family (χ2=4.22) , source of information (χ2=10.17) is greater than the tabled value at 0.05 level of significance. Hence it is inferred that there is a significant association of mean pre-test knowledge score with educational level, occupation, religion, type of family and source of information.

The findings were supported by Begum R that 67.7% were registered near sub-centre & 32.3% never registered. Comparatively there is significant association between source of information & utilization of services.

Similar findings are revealed by Gupta SK,Pal DK,Tiwari R,Garg R,shrivastav AK,Sarawagi R,et al 2012 that there is significant in utilization of services with low economic status because of incentive benefits during pregnancy. Over all there is 79.8% assisted to improve financial conditions. So there is increase in utilization of services during pregnancy & obtaining institutional deliveries & there is decline in the maternal and neonatal mortality & morbidity rates in India.

Major Implications of the Study

Over all the present study is very useful, the study findings can be published in national journals and monthly bulletin, Government of Karnataka, Health and Family welfare department and may utilize the study findings for future research purpose and documentation.

RECOMMENDATIONS

• A similar study may be conducted on a larger sample for wider generalisation.

• A study can be done to assess the knowledge and practices of health worker regarding RCH services.

• The study can be conducted in different settings.

• Various teaching methods can be adopted to impart knowledge and to see effectiveness of planned teaching method on knowledge of mothers regarding Janani Suraksha Yojana.

• A comparative study can be conducted to find out the difference and similarities between rural and urban mothers.