Maternal mortality is still very
high in India
owing to several preventable and treatable conditions like hemorrhage, sepsis,
hypertensive disorders, obstructed labor and unsafe abortions. Regular
antenatal care(ANC), effective & timely referral and safe delivery can help
reduce the MMR to a considerable extent. Currently ANC is delivered in India
via community health workers(CHW) but this model suffers from issues due to
low-salary, minimal resource and not being self-sustainable. Hence in India ANC
coverage is still abysmally low(19.6%) more so in rural areas (14.7%). In the
rural areas of West Bengal state of India , ANC remained as low as
13.6%. For achieving MDG goal of 109 by 2015, it is imperative that universal
access to reproductive health, specifically ANC has to be provided.
To bring more pregnant women in
rural India under the full coverage of antenatal-care by ensuring four ANC
visits as per WHO Basic Component ANC model targeting 100% safe-delivery, a
Community Intervention Trial using pair-matched cluster randomization with a
qualitative component (3 focus group discussions and 20 in depth interviews)
has been designed.
The study introduces an enhanced
Home based “Four visit ANC model” for India via “Trained Community Health
Entrepreneur"(TCHE) under an income generating, low-resource, sustainable,
social-enterprise model, owned by a motivated Health-Entrepreneur, delivered at
doorstep, with support resources(e.g:telemedicine,training).This model will be
sustained via community based co-operative insurance scheme.
Two rural areas in West Bengal
have been identified as potential study sites(in Hooghly
and CoochBehar district).Consenting women of childbearing age, who wish to
become pregnant are identified as eligible study subjects. The study will be
conducted over 2yrs in 40 communities,(20 each in intervention and control
arm), each having 350 eligible household(having at least 1 eligible couple).
The effectiveness of the intervention in terms of attaining 100% safe delivery
will be estimated as the main outcome.
The goal of this project is
A) Establish and quantify one of
the primary barriers towards achieving Maternal Mortality Rate (MMR) of 109 by
2015 (MDG5) in rural India ,
which is low percentage of full Antenatal Care(ANC) and
B) Developing, implementing and
evaluating the proposed solution.
Primary Objective:
To bring more pregnant women in
rural India under the full coverage of antenatal care by ensuring four ANC
visits as per WHO Basic Component ANC model targeting 100% safe-delivery to a)
prevent Hemorrhage by preventing anemia, b) prevent Convulsions and other
hypertensive disorders by screening and timely referral, c) prevent &
reduce underweight new-born and d) prevent any other complications during
delivery (e.g: Sepsis, Obstructed labor etc) by educating and confirming
institutional delivery
Secondary Objectives:
1) Ensure at-least one Postnatal
Check within two weeks to reduce neo-natal mortality rate by educating the
mother and family in well-being of mother’s and child’s health as per the WHO
Guideline which is culturally and socially acceptable in rural India, such as,
birth-spacing, safe-sex practices and options available (terminal &
non-terminal), reinforcement of exclusive breast-feeding, oral rehydration for
dysentery and diarrhea etc.
2) Educate and confirm
immunization for under-five child to reduce Infant Mortality Rate(IMR) towards
achieving MDG 4 goal of IMR 27
3) Continuous Family Planning
& sexual health education, primarily targeting the adolescent girls,
reinforcing the proper child-bearing age of Twenty.
Full ANC is defined by Government of India as at-least three visits for ANC, one TT injection received and 100 IFA tablets.