COMPARISON OF UTILIZATION OF MATERNAL SERVICES BY MOTHERS OF ICDS AND NON-ICDS AREAS IN URBAN SLUMS OF LUCKNOW Madhu Agarwal ABSTRACT Objective: To study the differences in the extent of utilization of maternal services by the mothers of the ICDS and the non-ICDS areas. Also, to suggest appropriate strategies for the improvement of available services in both the areas. Subject and Methods: A sample consisting of 400 households was covered from the Aliganj ICDS Project (urban) and the non-ICDS slum areas in the neighbourhood of the ICDS Project of Lucknow district of Uttar Pradesh, having the youngest child withia the age group of a year. Data obtained was statistically analysed by adopting percentage analysis. Observations: In the ICDS are, around 79 percent of the mothers had taken special care in the form of extra food, tonics, extra rest, less hours of work during advanced pregnancy, as ‘compared to around 60 percent mothers in the non-ICDS area. A large proportion of the mothers had home deliveries, in both the areas {ICDS-59.0 percent, non-ICDS-73.4 percent), but more deliveries took place in the institutions, in the ICDS as compared fo the non-ICDS area. Largely, non-institutional deliveries were attended by the untrained personnel, including the traditional birth attendants, family members or neighbours (ICDS-31 percent, non-ICDS-50.7 percent). However, higher percentage of mothers in the non-ICDS area received postnatal care by untrained staff as compared to their counterparts in the ICDS area. Thirty-five percent of children in the ICDS and 24 percent in the non-ICDS area were fully vaccinated. Conclusion: it shows that although the level of utilisation of maternal services was by and Jarge low in-both the areas, but it was slightly better in the ICDS area as compared to the non- ICDS area. Thus, there is a need for involvement of the community and a strengthened network of the health services in the urban areas. There is also essential need to strengthen the knowledge of mothers about the need of antenatal, neonatal and prenatal care in both the areas. In addition better linkage are to be developed between the AWW, community and health siatf. Key words: Tetanus Toxoid, iron and Folic Acid, antenatal checkups, traditional bisth attendants, Anganwadi Worker. 1. 41/110, Society Park, Narahi, Lucknow-226 001 Index Medicus (IMSEAR), INSDOC, NCI Current Content, Database of Alcohol & Drug Abuse, National Database in TB & Alled Diseases, IndMED, Entered in WHO CD ROM for South East Asia.Madhu Agrawal Comparison of utilization of maternal services by mothers of ICDS & non-ICDS areas INTRODUCTION { Heaith of the females is an important factor in determining the overall health of the society. Malnourished women are more likely to give birth to weaker babies, leading to higher Infant Mortality Rate. Infant mortality is a sensitive indicator of the quality of maternal and child health services provided by a country. During the past two decades, Infant Mortality Rate has improved i.e., IMR has come down from114 in 1981 to 66 in 2001 (SRS-2003). However, IMR has been stagnating since 1993. The causes of high rates of infant mortality especially, neonatal mortality are linked to untimely pregnancies, low birth-rate, pre-term birth, unsafe delivery, neonatal tetanus, high fertility rates, etc, Pregnancy and childbirth are the leading causes maternal mortality. Majority of the maternal deaths in pregnancy are due to anaemia, malnutrition, improper birth spacing and common complications of pregnancy. Maternity mortality and, the complications related to the pregnancy, are very high in india ie., 407 women deaths out of 1,00,000 live births (SRS 1998) NFHS-I! results in the State of Uttar Pradesh show that although almost two, in every five currently married women reported, atleast one reproductive health problem. This could be symptomatic of a more serious reproductive tract infection. Three-quarter of these women bear the problem silently without consulting a doctor. These findings highlight the need to educate women regarding the symptoms and consequences of reproductive health problems. There is an urgent need to expand counselling and reproductive health services in both rural and urban areas. Over the years, Government and non-government organisations have made concerted efforts to improve the health of women and children. The National Health Policy adopted by the Government of India in 1982, recognized the high rates of mortality affecting women and children and the extent of malnutrition and diseases among these groups. It proposed the adoption of a comprehensive primary healthcare approach, which emphasizes preventive health, improved health awareness and involvement of the community in all aspects of health-care. Today, Integrated Child Development Services (ICDS) Scheme is one of the world's largest and the most unique outreach programme for the care of young children in matters of health, nutrition, care of pregnant women and lactation. Awareness of mothers regarding the services provided under the scheme, accessibility and utilization constitute an important strategy in the ICDS Scheme. Indian J. Prev. Soc. Med Vol. 35 No.3L 4 128 Juby.-Dec., 2004poe FN HPL a agate ve Madhu Agrawal Comparison of utilization of maternal services by mothers of ICDS & non-ICDS areas ** However, few researchers have reported that the utilization of health services by the mothers from the lower socio-economic communities was slightly better in the ICDS areas, as compared to the non- ICDS areas". The ICDS Scheme is now poised for a wider expansion. Considering the magnitude of foreseen expansion, it has become imperative to assess and compare the status of utilization of maternal services by the mothers in the ICDS Projects vis-a-vis, mothers in the non-ICDS areas. Tus would go a long way in identifying operational problems in utilizing services by the beneficiaries. Appropriate strategy could accordingly be suggested for improving the health services. Against this background, this study was undertaken to compare the extent of utilization of maternal services by mothers of the ICDS and the non-ICDS areas. The study also, suggested strategies for the improvement of available health services. SUBJECTS AND METHODS The present study was carried out in Lucknow district, which is located in the central region of Uttar Pradesh. From the Lucknow district, Aliganj ICDS Project (urban) that was sanctioned during tie year 1979, was selected as it is one of the oldest urban blocks in the district. Since, there was no jre- project information available in the ICDS Project area, so it became imperative to select a non-ICDS area for the purpose of comparison. A non-iCDS area where, the ICDS was not in operation was selected in the neighbourhood of the ICDS Project, to compare and study the impact. sites A two-stage sampling design was adopted. Selection of slums in the first stage and households in these selected slums in the second stage. Ten slums having Anganwadi centres from the Aliganj (CDS Project were selected. From each sector, two-three centres were taken randomly in the ICDS area. Purposive sampling was done to select the households as the study required only such families which had at least one child aged less than 12 months of age. From each slum, 20 mothers were contacted who had male/female child upto 12 months of age for eliciting ihe information. A sample consisting of 200 households from the Aliganj ICDS Project and another 200 households from the non-CDS area was taken. In this area also, 200 households from 10 siums scattered in the different comers of Lucknow city were contacted for data collection. in all, 400 mothers belonging to 20 slums from the ICDS Project and the non-ICDS area, were studied from different localities of Lucknow city. Indian J. Prev. Soc. Med Vol 35 No.3L4 129 Suly.Dec., 2004