SOCIO–ECONOMIC AND CULTURAL BARRIERS FOR UTILIZATION OF PRE-NATAL HEALTH SERVICE IN URAWN COMMUNITY OF SUNSARI By Sunita Kumari Mehta Exam Roll N0: 2180123/2069 T.U. Regd. No. : 7-1-217-213-2004 A Thesis Submitted to Health Education Department in Partial Fulfillment of the Requirements for Master's Degree in Health Education TRIBHUWAN UNIVERSITY FACULTY OF EDUCATION JANATA MULTIPLE CAMPUS HEALTH EDUCATION DEPARTMENT ITAHARI-5, SUNSARI 2074 RECOMMENDATION This is to certify that Sunita Kumari Mehta has prepared the thesis entitled "Socio- Economic and Cultural Barriers to the Utilization of Prenatal Health Service in Urawn Community" under my guidance and supervision. I recommend this thesis for acceptance. ......................................... Mr. Manoj Kr. Chaudhary (Supervisor and Lecturer) Janata Multiple Campus Date: ii APPROVAL SHEET This thesis entitled "Socio-Economic and Cultural Barriers to the Utilization of Prenatal Health Service in Urawn Community" submitted by Sunita Kumari Mehta in partial fulfillment of the requirements for the Degree of Master's in health education has been approved. Thesis Evaluation Committee Signature Mr. Sanjib Kumar Yadav ....................... Head, Department of Health Education Chairman Janata Multiple Campus, Itahari, Sunsari Mr. Manoj Kumar Chaudhary ........................ Janata Multiple Campus, Teaching Assistant Supervisor Itahari, Sunsari .................................. External Observer Date: iii DECLARATION I hereby declare that this thesis has not been submitted for any other degree. Sunita Kumari Mehta iv ACKNOWLEDGEMENT My deepest gratitude goes to my teacher and thesis supervisor associate Lecturer Manoj Kr. Chaudhary, Health Education Department of Janata Multiple Campus, Itahari, Sunsari for his continued guidance, encouragement, motivation and support at each step of the study. His regular and extensive guidance and encouragement were the main source of inspiration to accomplish this study successfully. The special thanks go to the respondents of Urawn Community of Babiya, Inaruwa, Ward No. 9, for their help. I would like to express thanks to the librararian, Mrs……….. for providing important books and resource materials, without which the thesis would never be complete. Furthermore, my special thanks goes to my father Mr. Dev Narayan Mehta, my mother Hemo Mehta and my husband Rakesh Mahato and brother Debij Kumar Mehta for their support and great economic support during data collection, data entry, analysis and interpretation. I also like to remember supports by my class fellows Chandani and Renu. Pawan Mehata had done the typing and Dinesh Poudel has checked grammar errors that crept into my writing. Sunita Kumari Mehta M.Ed. 2nd Year Janata Multiple Campus v ABSTRACT This study was carried out to assess the scio-economic and cultural barriers for utilization of pre-natal health services in the Urawn community at Babiya, Inaruwa Municipality of Sunsari District. The general objectives of the study is to find out the present demographic, socio-cultural and economic status, to identify the existing knowledge and practices about prenatal health services and to explore the socio- economic and cultural barriers for utilization of prenatal health service in the Urawn community. The study was quantitative as well as qualitative type in nature. The study mainly focused on obtaining information about married women of age group 15-45 years with socio-economic and cultural barriers for utilization of prenatal health services of Babiya, Inaruwa who were the target population of Urawn community for the study. The total population of the study area was 412, among them 156 or 38% in the sample size of study by using random sampling method. The required data for this study was collected from primary source by applying interview schedule. The population record of Inaruwa Municipality Office report, district development profile related book, journals and hospital records were the used as secondary source of information. After the collection of primary data they were edited and presented in the final report. The social economic condition of the Urawn people is very poor. More than 68% women are illiterate. Daily wage labour is the main occupation of that community people. Only a few household have their own land to farm. Half of the female respondents (50.62%) were married. Near about 43% of the respondents did not take additional food during pregnancy. One third of the respondents did not receive TT injection during pregnancy period. A high proportion of respondents (40%) went to village doctors for their treatment at first. Among the total respondents 55.77% were engaged in daily wages and 21.79% had been earning money from agricultural farm. Most of the respondents (70%) have got knowledge about how many times they should get check up, and only a few (4%) have checked three times during pregnancy period. Out of the total respondents 57% received TT Injection and 38% of the total received Iron tablet. Majority of the respondents (83%) said that they did not consult a specialist or hospital and only 17% had consulted with specialist or hospital. The majority of the respondents had not checked pregnancy owing to lack of money and a few (4%) respondents had not been able to get permission from their husband for vi check. Most of the respondents (40%) visited female community health volunteers and a few (6%) respondents visited hospital for prenatal check up. This study reveals that poverty, lack of money and lack of knowledge about government health care facilities. The lack of medicines at health post and unfriendly behaviors of service providers were the barriers to Urawn women to access and utilize pre-natal health care service. vii TABLE OF CONTENTS Title Page No. TITLE PAGE i DECLARATION ii RECOMMENDATION iii APPROVAL SHEET iv ABSTRACT v ACKNOWLEDGEMENT vii TABLE OF CONTENTS viii LIST OF TABLES xi LIST OF FIGURES xii ABBREVIATION xiii CHAPTER : I INTRODUCTION 1-8 1.1 Background of the Study 1 1.2 Statement of the Problem 5 1.3 Objective of Study 6 1.4 Research questions 6 1.5 Significance of the Study 6 1.6 Delimitation of Study 7 1.7 Definition of Important Terms Used 8 CHAPTER : II REVIEW OF RELATED LITERATURE 9-18 2.1 Theoretical Study 9 2.2 Empirical Study 10 2.3 Implication of Literature Review 17 2.4 Conceptual Framework of Study 17 CHAPTER : III RESEARCH METHODOLOGY 20-21 3.1 Introduction 20 3.2 Research Design 20 3.3 Source of Data/Population 20 3.4 Sampling Procedure and Sample Size 20 3.5 Data Collection Tools 21 3.6 Validation of Tools 21 3.7 Data Collection Procedure 21 viii 3.8 Method of Data Analysis and Interpretation 21 CHAPTER IV : ANALYSIS AND INTERPRETATION OF RESULTS 22-45 4.1 Demographic, Socio-Cultural and Economic Status 22 4.1.1 Age and Sex Structure 22 4.1.2 Marital Status of the Study Household 23 4.1.3 Occupation Status of the Study Population 24 4.1.4 Annual Income and their Sources of the 24 4.1.5 Educational Status of the 26 4.1.6 Educational and Occupational Status of Respondent 26 4.2 Knowledge and Practices of Pre-natal Health Services 27 4.2.1 Age at First Pregnancy 27 4.2.2 Additional Food during Pregnancy 298 4.2.3 Awareness and Health Checkup during Pregnancy 30 4.2.4 Receiving TT Injection and Iron Tablets during Pregnancy 31 4.2.5 Complication during Delivery Period and its Treatment 32 4.2.6 Facilities and Utilization of Health Services 34 4.2.7 Concept of the Respondent about on Sub-Health Post 35 4.3 The Socio-Economic Barriers to Utilization of Health Services 36 4.3.1 Centers for Check-up and Barriers for not Checking during Pregnancy 36 4.3.2 Barriers for not Getting TT Injection and Iron Table 38 4.3.3 The Barriers for not Going to Hospital or Sub-Health Post for Treatment 39 4.3.4 Sickness and Barriers for not Going to Sub-Health Post for their Treatment 40 4.3.5 Sickness and Barriers for not Consulting with Good Doctor or Governmental Hospital 41 4.3.6 Barriers to Utilization of Health Services Provided by District Hospital 42 4.4 Summary 43 4.5 Discussion of Findings 43 4.5.1 Demographic, socio-culture and Economic Status 43 4.5.2 Knowledge and Practice of Pre-natal Health Service 44 4.5.3 The Socio-Economic and Cultural Barriers to Utilization of Pre-natal Health Service 45 CHAPTER V : CONCLUSION AND RECOMMENDATION 46-48 ix 5.1 Conclusion 46 5.2 Recommendation 46 5.2.1 Policy Related 46 5.2.2 Practice Related 47 5.2.3 Further Research Related 47 REFERENCES 49 APPENDIX x LIST OF TABLES Table No. Title Page No. 1. Age and Sex Structure 22 2. Marital Status of the Study Household 23 3. Occupation of the Study Population 24 4. Income and their Source of the Household 25 5. Educational and Occupational Status of the Respondents 27 6. Additional Food During Pregnancy 29 7. Knowledge and Health Check up during pregnancy period 31 8. Complication During Delivery Period and It's Treatment 33 9. The Concept of Respondent about on Sub-health Post 35 10. Centers for Prenatal Check-up and Barriers for not Check up 37 11. Barriers for not getting TT Injection and Iron Tablet 38 12. Sickness and Barriers for not Going to Sub-health Post 40 13. Sickness and Barriers for not Consulting Doctors/Hospital 41 14. Barriers to Utilization of Health Services 42 xi LIST OF FIGURES Figure No. Title Page No. 1. Conceptual Figures for Barriers of Prenatal Health Services 18 2. Educational Attainment in Study Population 26 3. Age at First Pregnancy 28 4. Receiving TT Injection and Iron Tablets During Pregnancy 32 5.