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Maternal Health and Maternal Mortality: a Study of Four Selected Districts of Assam

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Maternal Health and Maternal Mortality: a Study of Four Selected Districts of Assam Maternal Health and Maternal Mortality: A Study of Four Selected Districts of Assam A thesis submitted to Indian Institute of Technology Guwahati in partial fulfilment of the requirements for the degree of Doctor of Philosophy By Pranti Dutta Registration No: 11614109 Department of Humanities and Social Sciences Indian Institute of Technology Guwahati Guwahati, India 2018 Dedicated to My Parents Prafulla Kr. Dutta and Binu Dutta i TH-1681_11614109. Indian Institute of Technology Guwahati Department of Humanities and Social Sciences Guwahati-781039, Assam, India Declaration This thesis entitled “Maternal Health and Maternal Mortality: A Study of Four Selected Districts of Assam” submitted for the degree of Doctor of Philosophy has not been previously submitted for any other degree of this or any other university and is my original work. In keeping with the general practice of reporting scientific observations, due acknowledgement has been made wherever the work described is based on the findings of other investigations. IIT Guwahati (PRANTI DUTTA) February, 2018 Research Scholar Department of Humanities and Social Sciences ii TH-1681_11614109. Indian Institute of Technology Guwahati Department of Humanities and Social Sciences Guwahati-781039, Assam, India Certificate This is to certify that Miss Pranti Dutta has prepared the thesis entitled “Maternal Health and Maternal Mortality: A Study of Four Selected Districts of Assam” for the degree of Doctor of Philosophy at the Indian Institute of Technology Guwahati. The work was carried out under my supervision and in strict conformity with the rules laid down for the purpose. The thesis is the result of her investigations and has not been submitted either in whole or in part to any other university/ institution for a research degree. IIT Guwahati (Dr. Bodhisattva Sengupta) February, 2018 Supervisor iii TH-1681_11614109. Acknowledgements I would like to express my sincere thanks to many teachers, friends and members of my family who provided me with support and advice while I was working on this thesis. At the outset, I would like to express gratitude to my supervisor, Dr. Bodhisattva Sengupta, for his sincere guidance, support, encouragement and kindness from the beginning till the end of my work. I am immensely grateful to him for his generous and constant effort in providing me with positive feedback on all my writings. I do express my deep sense of gratitude to the members of my doctoral committee. I sincerely thank Prof. Saundarjya Borbora, Dr. Mrinal Kranti Dutta and Dr. Debarshi Das for their insightful comments, suggestions and encouragement. Their suggestions and comments have enriched my research from various perspectives. I would also like to express my sincere gratitude to Dr. Hiranya Kumar Nath, Dr. Rajshree Bedamatta and Sriparna Bandopadhyay for their helpful suggestions. I am grateful to the Department of Humanities and Social Sciences (HSS), Indian Institute of Technology Guwahati (IITG) for providing me the opportunity to carry out my research. I am grateful to the office staff of Department of HSS, Bandana Khataniar, Parag Kalita and Durga Sarma for their kindness and ready administrative help. I would also like to take this opportunity to express my sincere thanks to the Ministry of Human Resource Development (MHRD) for providing me with fellowship assistance to conduct my research smoothly. The IIT Guwahati Central Library (Lakshminath Bezbaroa Central Library) has been an asset with ample resources for the thesis. I also owe my thanks to the different libraries like Krishna Kanta Handique Library, Gauhati University, Omeo Kumar Das Institute of Social Change and Development, Guwahati, Indian Institute of Public Administration, Delhi, Institute of Human Development Delhi, International Institute for Population Science Mumbai, Indian Institute of Technology Mumbai, Tata Institute of Social Science Mumbai, Gokhale Institute of Politics and Economics, Pune, Jadavpur University, Kolkata, Indian Statistical Institute, Kolkata, Institute of Development Studies, Kolkata during the course of literature review. iv TH-1681_11614109. I am extremely indebted to numerous people for their kind support, time and ready-help provided during my fieldwork in different districts of Assam namely- Kamrup, Dibrugarh, Sonitpur and Cachar. Without their help it would have been difficult to carry out my survey to collect data on maternal health. I would also like to thank village-heads, medical officers, ANMs and ASHA workers who extensively supported and cooperated during my field visits to different villages of Muhimari, Patgaon, Lepetakatta, Jazimukh, Kadamani, Sakamato, Motinagar and Silcoorie. I also sincerely thank NRHM-Assam for extending their helping hand in accessing data on maternal health. I would also like to take this opportunity to acknowledge my family for their constant support who deserves more than words could express. I am extremely grateful to my parents and elder sister Dr. Rinti Dutta and Bother-in-Law Pranab Bhajani for their love and encouragement to work hard, stay focused and who have always been sources of inspiration in my life. I feel privileged to express my sincere thanks to my aunt Mrs. Gayatri Dutta and all family members for their sincere help, love and support throughout my research work. Among my friends, special thanks go to Prerana Hazarika, Jimlee Saharia, Bikram Baruah, Anuj Athparia, Chandita Baruah, Deepa Gupta, Suparana Katyaini, Samarpita Basu, Rinshu Dwivedi for constantly encouraging me during my work. I must extend my special thanks to Bharat Konwar, Mahsina Rahman, Rajashree Bargohain, Munmi Saikia, Nirmala Devi, Sariful Rahman, Bhasker Pegu, Pankaj Kalita, Bhupen Mili, Mizingsa Daimary, Rakesh Soud, Suju Kumar Baglari, Hemanta Barman, Luke Horo, Baban Bayan, Halim Hussain, Rupan Boro, Jitu Tamuli and many others who were extremely cooperative throughout the study and provided me with moral support during the entire period. Finally, I express my deepest acknowledgement to Aniruddha (Ani) for offering me his wonderful companionship, time and support and thorough encouragement during my work. I truly believe that without his constant care and understanding it would have been difficult for me to remain persistent and complete this thesis. (Pranti Dutta) February, 2018 v TH-1681_11614109. Contents Page No. Dedication i Declaration ii Certificate iii Acknowledgment iv List of Tables xi List of Figures xvi Abbreviation xvii Abstract xix Chapter 1: Introduction 1.1. Background of the Study 1 1.1.1. Women’s Health and Maternal Mortality 1 1.2 Statement of the Problem 5 1.3 Objectives of the Study 5 1.4 Data Sources and Methodology 6 1.5 Layout of the Chapters 8 Appendix 1 A 9 Chapter 2: Maternal Health in Perspective 2.1 Issus of Maternal Health 11 2.1.1 Definitions 11 vi TH-1681_11614109. 2.1.2 Measuring Maternal Mortality 12 2.1.3 Magnitudes of Maternal Deaths in India 14 2.1.4 Maternal Mortality: Getting Priority in Healthcare Sector 15 2.2 Factors Behind Maternal Mortality: A Brief Review 18 2.2.1 Production of Health 18 2.2.2 Review on Factors Influencing Maternal Mortality 26 a. Strategies to Reduce Maternal Mortality-Across Globe and National Level 26 b. Factors Influencing: Different Regions and India 31 c. Factors Influencing: Assam and Northeast India 35 2.3 Conclusions 37 Appendix 2 A 38 Chapter 3: Maternal Health Scenario of Assam 3.1 Background Characteristics: Assam 39 3.1.1 Location, Demography and State Economy 39 3.1.2 Current Healthcare System- Structure and Scenario of Assam 40 a. Current Health Status 40 b. Health System Structure 40 3.2 Trend of Maternal Deaths and Maternal Illness in Assam 41 vii TH-1681_11614109. 3.3 Operational Schemes on Maternal Health 46 a. State Programmes 47 b. National Schemes 47 3.4 Maternal Healthcare in Assam: A District Level Analysis 49 3.4.1 Trend and Socio-Demographic Factors of MMR 49 3.4.2 Sources of Data 50 3.4.3 Spearman’s Rank Correlation Analysis of Socioeconomic Variables 51 3.4.4 Cluster Analysis 52 3.4.5 Discussions 54 3.5 Availability of Maternal Care Facilities at District Level 55 3.5.1 Spearman’s Correlation Analysis for Maternal care Facilities 58 3.5.2 Cluster Analysis 59 3.6 Conclusions 62 Appendix 3 A 64 Chapter 4: Field Description and Sample Profile 4.1 Purpose of Field Study 85 4.2 Selection of the Area for the Field Study 85 4.3 Data Collection 89 viii TH-1681_11614109. 4.4 Broad Profile of the Sample Villages 91 4.4.1 Geography and Demography of the Sample Villages 92 4.4.2 Socio-Economic Characteristics of the Samples 94 4.4.3 Maternal Health Status of the Sample Villages 100 4.5 Conclusions 103 Map: Location of the study Areas and Sample Villages 104 Chapter 5: Determinants of Maternal Anemia at Disaggregated Level 5.1 Profile of Maternal Deaths Cases 105 5.1.1 Perspective of Maternal Anemia 107 5.1.2 Maternal Anemia in Studied Sample 108 5.2 Iron Bioavailability and Dietary Concern in the Studied Areas 111 5.2.1 Observation from Field 112 5.3 Socio–Economic Causes of Maternal Anemia in the Studied Areas 114 5.3.1 Functional Form of the Model 117 5.3.2 Results 119 5.3.3 Discussions 122 5.4 Conclusions 124 Appendix 5A 126 ix TH-1681_11614109. Chapter 6: Barriers to Maternal Health Seeking Behavior 6.1 Conceptual Framework of Maternal Health Seeking Behavior 129 6.2 Health Seeking Behavior in Sample 134 6.3 Methodology 136 6.3.1 Rationale for Model Selection: Bayesian Approach 136 6.3.2 Conceptual Framework of Bayesian Approach 138 6.3.3 Description of Likelihood and Priors 140 6.3.4 Bayesian Binary Logistic Model 141 6.3.5 Computational Methods 142 6.4 Results for Health Seeking Behavior 143 6.5 Discussion 147 6.6 Conclusion 149 Appendix 6A 151 Chapter 7: Summery of Findings and Policy Suggestions 7.1 Summary of the Findings 156 7.2 Conclusions and Contributions 158 7.3 Policy Implications 159 7.4 Future Scope of the Research 160 Bibliography 163 x TH-1681_11614109.
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