Academic journal article Journal of Health Population and Nutrition

Maternal Health in Gujarat, India: A Case Study

Academic journal article Journal of Health Population and Nutrition

Maternal Health in Gujarat, India: A Case Study

Article excerpt

INTRODUCTION

Gujarat state, situated on the west coast of India, accounts for 6% of the area of the country and 5% (51 million) of the population of India making it rank tenth in the country (1). The decadal population growth rate (1991-2001) of the state has been 22.6%, which is higher than that of India (21.5%) (2).

It is one of the most urbanized states in India, with 37% urban population, perhaps because agriculture is highly unstable, leaving small farmers and farm-labourers in poverty. The eastern tribal belt and the northern dry region remain underdeveloped parts of the state. Overall, Gujarat has 25 districts subdivided into 226 blocks, 18,618 villages, and 242 towns (3). Table 1 provides a comparison of India and Gujarat on important demographic and health indicators.

Table 1 shows that Gujarat is doing better than the national average for most demographic and health indicators. It has a higher literacy rate, lower total fertility rate (TFR), higher life expectancy at birth for women, and less population per sq km. Its infant mortality rate (IMR) is 53 versus the national rate of 58 (4), and the child mortality rate (CMR) is 16 vs 17.3 respectively. A higher IMR among girls was observed compared to boys in urban Gujarat. As per the maternal mortality study conducted by the Registrar General of India, based on the Sample Registration System (SRS), the maternal mortality ratio (MMR) for Gujarat was 172 compared to 301 for India for 2001-2003 (5). Gujarat has a 14.8% population of backward tribes, called Scheduled Tribes and 7.1% backward castes, called Scheduled Castes (6).

Status of women

Female literacy is low (59%) compared to male literacy (81%) in Gujarat. Although Gujarat has a higher female literacy rate than the national average, the sex ratio is more adverse for females. This indicates son preference and low status of women in society. Ahmedabad, Mehsana, Gandhinagar, and Rajkot districts with a female literacy rate of above 60% have low sex ratios, but Dahod, Dangs, and Narmada with hardly 35-40% of female literacy have better sex ratios (7). The age of effective marriage for women is the same for India and Gujarat at 20 years.

The purpose of the case study was to analyze the present situation in Gujarat regarding maternal health compared to that in India and to understand the constraints to, and possibilities of, improving maternal healthcare in the state.

MATERIALS AND METHODS

This paper is based on the case-study methodology used in management studies. Case studies generally document real situations of organizations from multiple perspectives and include a description of the organization, key data in terms of inputs, process, outputs, and perspectives of key individuals obtained through interviews. As opposed to focused research, there may not be a clear hypothesis; however, the problems faced by the organizations and some analyses are provided.

This case study analyzes how the current situation of the healthcare system affects the performance indicators of maternal health. Past efforts in the maternal health area were analyzed to know their impact and challenges. New initiatives were studied to understand their potential. The case study is based on a review of literature (published and unpublished reports of government and non-governmental agencies), collection of secondary data from the management information systems of the national, state and district levels, interviews with stakeholders, study of key institutional processes, roles and authority of key actors, and organizational structure and function. Quantitative data on maternal health were taken from the three National Family Health Surveys (NFHSs) (1992-2006) (8-11) and District Level Household Survey (DLHS) (2002-2003) (12). Information regarding health infrastructure and human resources was collected from a nationwide facility survey (2004-2005) which included Gujarat. Data and information are also obtained from official website of the health and family welfare department of the Gujarat Government. …

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