Community Based Study of Awareness of Maternity Dangers Amongst Rural, Tribal Preconception and Pregnant Women

Shakunthala Chhabra*
Department of Obstetrics Gynaecology, Mahatma Gandhi Insitute of Medical Sciences, Wardha, Maharashtra, India

*Correspondence to: Shakunthala Chhabra Department of Obstetrics Gynaecology, Mahatma Gandhi Institute of Medical Sciences, Wardha, Maharashtra, India; E-mail: chhabra_s@rediffmail.com
Received date: June 7, 2021; Accepted date: June 20, 2021; Published date: June 27, 2021
Citation: Chhabra S (2021) Community Based Study of Awareness of Maternity Dangers Amongst Rural, Tribal Preconception and Pregnant Women. J Obst Gynecol Surg 2(1): pp. 1-8. doi: 10.52916/jogs214013
Copyright: ©2021 Chhabra S. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution and reproduction in any medium, provided the original author and source are credited.

Abstract

Background: Every pregnant woman faces risk of complications which can cause severe illness or even death of mother and /or baby. Creating awareness about maternity dangers is crucial for safe birth, safe future of mother and baby. Although it remains unclear how awareness translates into appropriate actions, chances of better outcome are there.

Objectives: Community based study was carried out to know about rural, tribal preconception and pregnant women’s awareness and perceptions of maternity dangers.

Material and Methods: After approval of institute’s ethics committee, study was conducted in tribal communities of 100 villages of hilly forestry region, where mother child services were initiated after creating health facility in one village. Randomly minimum 20 and 10 preconception, pregnant women each, from every village, total 2400 preconception, 1040 pregnant women of 15 to 45 years age were interviewed by research assistant with help of pretested tool.

Results: Of 2400 Preconception women interviewed, 801 (33.4%) were aware of labour events, 298 (37.2%) mucoid discharge, 291 (36.3%) little bleeding, 212 (26.5%) labour pains. When asked about source of information, 300 (37.5%) said doctors, 291 (36.3%) Accredited Social Health Activists (ASHAs) and 210 (26.2%) nurse. Of 2400 preconception women, 1015 (42.29%) did talk of some maternity dangers, 403 (39.7%) said swelling over face and feet, 271 (26.7%) giddiness, 184 (18.13%) excessive vomiting and 157 (15.47%) bleeding, leaking with some overlap.

Of 1040 pregnant women, 910 (87.5%) were aware of labour events and 870 (83.7%) some maternity dangers, 474 (54.5%) preterm pains, 118 (13.5%) leaking, 97 (11.1%) epigastric pain, 73 (8.4%) headache, 67 (7.7%) vaginal bleeding and 41 (4.7%) loss of fetal movements with some overlap.

Conclusion: Only one third preconception and little more pregnant women had some awareness of maternity dangers, but it was scatchy.

Keywords:

Preconception, Pregnant women, Maternity Dangers, Awareness

Introduction

Every pregnant woman faces the risk of complications, some not even predictable. They could lead to serious illnesses, death of mother or baby or both [1]. Creating awareness of maternity dangers is crucial for safe birth, safe mother and baby and their safe future. While it remains unclear how awareness translates into recognition of danger signs and also appropriate actions, however awareness about dangers is essential to seek prompt care to avert severe morbidity and mortality [2]. Underestimation of pregnancy-associated health risks could compromise decision-making and reduce demand for service. Women encounter maternity dangers during pregnancy, birth and in postbirth period. It is important, that women and health providers know and prevent serious complications and initiate treatment earliest. Delay in seeking care is one of the key factors leading to maternal deaths, which is associated with lack of awareness about maternity dangers. So, it is essential that preconception and pregnant women are aware of maternity dangers so that they seek timely healthcare [3].

Objectives

Community based study was carried out to know about awareness and perceptions about maternity dangers in rural tribal preconception and pregnant women.

Material and Methods

The study was conducted amongst tribal communities of 100 villages of hilly and forestry region, Melghat of Amravati, Maharashtra, India after taking approval of ethics committee of the institute. Community based mother and child care activities were initiated in these 100 villages, after having created a health facility in one of these villages. Minimum 20 preconception women from each village, making 2400 preconception and minimum 10 pregnant women from each village making 1040 pregnant women of 15 to 45 years included randomly, became the study subjects. Information was collected by interviewing women in the villages through pretested tool using language which women understood with some questions for yes or no answers and others for short answers. Information was collected about awareness regarding maternity dangers amongst preconception and pregnant women.

Results

Of 2400 preconception women interviewed, only 801 (33.4%) knew about the labour events, 298 (37.2%) mucoid discharge, 291 (36.3%) slight bleeding and 212 (26.5%) labour pains with some overlap. When asked about source of information, 300 (37.5%) said doctors, 291 (36.3%) Accredited Social Health Activist (ASHA) and 210 (26.2%) nurse. Of 2400 study subjects, 828 (34.5%) were of 20-24 years, 314 (37.9%) knew about labour events, 152 (48.4%) mucoid discharge, 97 (30.7%) bleeding, (20.7%) labour pains with some overlap. Sources of information were ASHAs in 174 (55.4%). Total 57 (77%) of 74 preconception women of 40-45 years could tell about labour events. Of 2400 study subjects, only 216 (30.9%) of 699 who worked away from their own villages knew about labour events, 106 (49.1%) said slight bleeding, 62 (28.7%) labour pains and 48 (22.2%) mucoid discharge. In 104 (48.9%) doctors were the source of information. Of 2400 study subjects, 89 women (60.5%) of 147 belonging to upper economic class were aware of labour events and 45 (50.6%) said slight bleeding. In 49 (55.1%) doctors were the source of information. Similarly 275 (31.5%) of 864 women of lower economic class were aware of labour events and 142 (51.6%) did talk of labour pains. In most cases (165 (60%)) ASHAs were the source of information. Of 2400 study subjects, 78 (74.3%) of 105 women who had one child were aware of labour events and 44 (56.4%) said slight bleeding. In 53 (67.9%) ASHAs were the source of information. Similarly 243 (47.9%) of 509 women with 5 or more children were aware of labour events, 81 (33.3%) labour pains, 85 (34.9%) mucoid discharge and 77 (31.7%) slight bleeding. Sources of information were doctors in 109 (44.9%), ASHAs in 104 (42.8%) and nurses in 30 (12.3%).

Of 2400 preconception women, 1015 (42.29%) were aware of some maternity dangers, 403 (39.7%) said swelling over face and feet, 271 (26.7%) giddiness, 184 (18.13%) excessive vomiting and 157 (15.47%) bleeding and leaking with some overlap. Overall awareness was scatchy.

Overall of 1040 pregnant women, 910 (87.5%) were aware of labour events. 319 (98.8%) of 323 of 15 to 19 years, 29 (51.8%) of 56 illiterate, all 66 and 43 (100%) graduate and postgraduate studied, 901 (95.5%) of 943 housewives, 19 (47.5%) of 40 labourer, 91 (77.8%) of 117 women with more than five children were aware of labor events. (Table 1-3).

Overall of 1040 pregnant study subjects, 870 (83.7%) were aware of some maternity dangers, 474 (54.5%) said preterm pains, 118 (13.5%) leaking, 97 (11.1%) epigastric pain, 73 (8.4%) headache, 67 (7.7%) vaginal bleeding and 41 (4.7%) decrease in fetal movements, with some overlap. However awareness was scatchy. Of 1040 women, 536 (51.53%) were of 20-24 years and 416 (77.6%) of them were aware of some maternity dangers, 122 (29.3%) said less fetal movements, 106 (25.5%) vaginal bleeding, 78 (18.8%) preterm pains, 66 (15.9%) leaking, 33 (7.9%) headache and 11 (2.6%) said epigastric pain. Of 1040 women, 56 (5.3%) were illiterate and of them only 15 (26.8%) were aware of some maternity dangers, 11 (73.3%) leaking, 4 (26.7%) headache, 36 (83.7%) of 43 post graduate studied were aware of some dangers, 21 (58.3%) preterm pains, 10 (27.8%) headache and 5 (13.9%) leaking. Of 1040 women, 43 (40.13%) were of upper economic class, 41 (95.3%) of them were aware of some dangers, 31 (75.6%) preterm pains, 6 (14.6%) leaking and 4 (9.8%) headache. Overall 195 (31.6%) of 618 of lower economic class were aware of some maternity dangers, 44 (22.6%) preterm pains, 21 (10.8%) leaking, 12 (6.2%) vaginal bleeding, 12 (6.2%) less fetal movements, 97 (49.7%) headache and 9 (4.6%) epigastric pain.

Of 1040 pregnant women, 943 (90.67%) were housewives and of them, 643 (68.2%) were aware of some maternity dangers, 256 (39.8%) about preterm pains. Of 1040 women, 94 (80.3%) out of 117 with one child were aware of some dangers, 54 (57.4%) preterm pains, 403 (87.4%) of 461 with many children talked of dangers, 209 (51.9%) preterm pains, 66 (16.4%) epigastric pain and 51 (12.7%) vaginal bleeding. In most cases there was some overlap, but even postgraduate studied didn’t talk about heavy vaginal bleeding, during pregnancy, epigastric pain, convulsions, hand or cord prolapse, intra uterine death of baby, rupture uterine, inversion, retained placenta, post-partum hemorrhage etc. (Table 4,5).

Discussion

Maternity related dangers are the major health problems and cause of mortality among women in developing countries. Key dangers during labor, postbirth include, severe bleeding, prolonged labor, obstructed labour, convulsions, retained placenta, loss of consciousness, post-partum bleeding and fever in postpartum period too.

Recognizing maternity complications and action needed should significantly increase the capacity of women, their families, to take appropriate steps to ensure safe birth and to seek timely skilled care to remain healthy. Félix et al. [4] in their study to identify the scores on the pregnant women’s knowledge related to alertness about labor, found correlation of the scores with the maternal age, number of children and the guidance they received during pregnancy. Parity was a better predictor than educational level about knowledge of severe vaginal bleeding as a key danger during pregnancy. Those pregnant women who did not receive any kind of guidance, had lower scores of the correct answers, which showed the importance of guiding the women during their prenatal consultation. Ijang et al5 did a facility-based cross sectional study in North West, Cameroon and reported that 46.1% were aware of birth preparedness and complications readiness. The practice of birth preparedness and complications readiness was unsatisfactory as only 18.8% were considered prepared. Amenu et al. [6] reported that significant proportion of respondents were not knowledgeable about dangers in Southwest Ethiopia and in their study, educational status, place of last delivery, and antenatal visits were found important to predict awareness of BPCR

Also, Sahithi et al. [7] reported low knowledge of dangers during labour and delivery, and new born in Kamineni Academy of Medical Sciences and Research Center, India. Hailu et al. [8] reported that the knowledge level of pregnant women about maternity dangers was low in Southern Ethiopia and was affected by residential area and researchers advocated that the identified deficiencies in awareness should be addressed through maternal and child health services by designing appropriate strategies including provision of targeted information, education and communication. The same was found in the present study also. Women had low and scatchy awareness. Of 2400 preconception women interviewed, only 801 (33.4%) talked about the labour events, around 60% did not talk of any. Of 2400 preconception women, 1015 (42.29%) were aware of some maternity dangers. Those who talked something also did not talk of real dangers and overall awareness was scatchy. Of 1040 pregnant women, 910 (87.5%) were aware of labour events and 870 (83.7%) were aware of some maternity dangers. So memory seemed to play a big role. More of pregnant women who had met health workers in recent past, could talk of events and dangers, 474 (54.5%) said preterm pains, 118 (13.5%) leaking, 97 (11.1%) epigastric pain, 73 (8.4%) headache, 67 (7.7%) vaginal bleeding and 41 (4.7%) decrease in fetal movements, with some overlap. But they also did not talk of real maternity dangers, like heavy viginal bleeding, convulsions, severe epigastric pain rupture uterus, retained placenta etc.

Mwilike et al. [2] reported that women in Urban Tanzania took appropriate action about seeking health care after recognizing dangers during pregnancy, however, majority had low knowledge of maternity dangers. In the study by Hibstu [9] it was revealed that maternal and paternal education, maternal age, paternal occupation, place of residence and time taken to reach health facility on foot were the main factors associated with knowledge of maternity dangers in women of Southern Ethiopia. Gebrehiwot et al. [10] suggested that health extension workers should strengthen their awareness creation activities by health education and community mobilization. Nurgi et al. [11] reported that the majority of their participants in Debre Berhan, Ethiopia who had knowledge of dangers had good practice, but overall participants’ knowledge and attitude still needed intervention to maximize their knowledge and needed to work with positive attitude.

Nithya et al. [12] suggested, lack of exposure to formal awareness, lack of health counseling as modifiable risk factors to improve knowledge about maternity dangers. Hibstu et al. [9] as well as Hailu et al. [13] reported that educational status of the mother, place of delivery were independently associated with knowledge of women about maternity dangers in Southern Ethiopia. Provision of information, education and communication targeting women, family and the general community on maternity dangers was recommended. Raising awareness of women about the maternity dangers is the first essential step in accepting appropriate and timely referral. In the present study even post graduate studied did not talk about real maternity dangers. Mellon et al. [14] did a study in California USA to assess the knowledge of pregnant women and male partners about several health risks posed by pregnancy to identify potential gaps in reproductive health literacy and reported that pregnant women and male partners had significant knowledge deficiencies concerning common and serious health hazards associated with pregnancy.

Perreira et al. [15] in their study evaluated the effectiveness of a set of information, education, and communication strategies designed to increase the awareness of maternity dangers among pregnant women of 4 regions of Southwestern Guatemala and reported that among women using health clinics, the likelihood of having heard of maternity dangers nearly tripled, when the clinic interventions were fully implemented. Those who had heard radio messages or participated in women’s groups were, respectively, 3 times and 5 times more likely to have heard of maternity dangers. A study by Okour et al. [16] to assess the level and determinants of awareness of the maternity dangers among pregnant Jordanian women revealed that awareness of danger signs was low and a need existed to provide prenatal care that included sufficient information about maternity dangers. Researchers opined that additional studies were warranted to address the knowledge gap and to plan interventions for improving health literacy. It was recommended to have structured mandatory health literacy sessions addressing the maternity dangers.

Doctor et al. [17] did a study in Northern Nigeria to better understand the pathways through which the sociodemographic environment affected awareness of maternity dangers, preparations for delivery, and skilled birth attendance and found that less than one-third pregnant women knew three or more danger signs of pregnancy or labor and delivery. Higher socioeconomic status was associated with knowledge of maternity dangers, but not with knowledge of life-threatening, critical dangers as was seen in the present study also. Of 1040 women, 94 (80.3%) out of 117 with one child were aware of some dangers, 54 (57.4%) preterm pains, 403 (87.4%) of 461 with many children talked of dangers, 209 (51.9%) preterm pains, 66 (16.4%) epigastric pain and 51 (12.7%) vaginal bleeding.

Sahithi et al. [7] did a study at KAMSRC, India to assess the awareness of maternity dangers among the women attending the outpatients and reported 73.5% of the respondents knew at least one danger sign during pregnancy, 67.5% respondents knew at least one maternity danger. Shamanewadi et al. [18] did a study in Southern India to assess the awareness of maternity dangers among pregnant women attending antenatal clinics at primary health centers and reported women knew only 3 danger signs, vaginal bleeding, loss of consciousness and convulsions. Every pregnant woman faces the risk of sudden, unpredictable complications that could end in death or injury to her or her infant. Hence, it is necessary to employ strategies to overcome such problems as they arise. Felix et al. [3] did a study in India aimed to assess level of awareness about danger signs of pregnancy among antenatal women and to assess the factors associated with it and reported that level of awareness about danger signs among pregnant women was average. Researchers recommended interventions provision of health education, empowering women and improving the quality of health services.

Conclusion

Little more pregnant women than preconception women had awareness of undesirable maternity events and not really maternity dangers, but awareness was scatchy. Only one third rural tribal preconception women had awareness of undesirable events not really maternity dangers that too scatchy. Hardly anyone talked of real maternity dangers. A lot is needed to create awareness of maternity dangers which are preventable and treatable but less kill many rural women during pregnancy, birth and post birth.

Conflict of interest:

None.

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