India contributes to 22% of the global burden of maternal mortality. With the recent implementation of Janani Suraksha Yojana (JSY), a governmental program giving incentives for institutional deliveries, the National Rural Health Mission (NRHM) has made an extensive change in the maternal practices. The target is to make at least 80% of the women deliver in hospitals and thus reduce the Maternal Mortality Ratio (MMR).
The study aimed to increase the knowledge on the different perspectives after the recent change from home births to incentive-based institutional deliveries in the Hathras District, U.P., India. The main focus of my investigation was to enlighten the perspective of the women, and to see their experiences in relation to the perspective of health officials and midwives. Research questions comprised request about which parts of the NRHM/JST were utilized and why, and how this would affect the situation.
Methodology and research design
Data was collected through semi-structured interviews from two different informant groups: 22 women who had recently delivered in a governmental institution and five health officials working on different levels in the NRHM. A third perspective was gained through the researcher’s participation at an Indian midwife conference.
The women in the Hathras District were overall satisfied with the experiences in the maternity institutions, even though a clear gap was identified between theory and practice in most of the investigated fields. Utilization of the services was highly associated with the work of the Accredited Social Health Activist (ASHA), but the mother-in-law seemed to be the main decision maker. Determination factors for delivering their babies in institutions were desire for medical safety and assistance, poor hygiene or lack of assistance in the homes and instructions from community leaders. The financial incentives were not mentioned as a reason for going to the facilities. The women’s experiences in the institution revealed several questions around the quality of care, most urgent the frequent use of Oxytocin. Also the unofficial payments in the facilities represent a challenge. The movement toward institutional deliveries was found to have a possible influence on the women’s relation to the health care system and on their way of viewing child birth as a natural versus a medical event. It was also found to possibly influence the family structure and contribute to empowerment of women.
Findings from this study suggest the importance of measuring what happens in the gap between intentions and implementations of NRHM and JSY, and the importance of investigating possibilities for improvements at this stage. Both quantitative and extended qualitative research is needed on the users’ experiences. Research on health professionals’ skills and attitudes will also be of importance for planning the future steps of the programs and understanding the mechanisms regarding sustainability. Finally, awareness and research on how to increase the empowerment of women should be encouraged.