Experiences of neonatal deaths among the urban poor in Metropolitan Delhi: poor commination, poor quality, and an overwhelmed system
Abstract
Background: India has the highest number of neonatal deaths in the world, with extreme inequality by class, caste, religion, and region. Earlier studies mainly addressed levels, trends and determinants of neonatal mortality at... [ view full abstract ]
Background: India has the highest number of neonatal deaths in the world, with extreme inequality by class, caste, religion, and region. Earlier studies mainly addressed levels, trends and determinants of neonatal mortality at a national or sub-national level using macro data, but few studies looked more in depth at women’s experiences of the pathway leading to neonatal deaths.
Methods: The Health Department of North East district of Delhi identified Neonatal deaths that occurred in a nine-month period in selected clusters of the concerned district. We interviewed mothers of deceased neonates through semi-structured questionnaires. Additionally, a group of health service providers from the Public Health Facilities were interviewed to understand the demand-supply balance of health care services.
Results: The majority of women who lost neonates belonged to deprived castes, low-income level, low education level and were recent poor migrants, living in an extremely poor urban environment. Although government health facilities are supposed to provide free services to those women, poor quality of services compelled them either to withdraw from the facilities or to continue with great dissatisfaction. Among women going to public health care facilities, educated women were successful in negotiating with the health service providers for quality services. On the supply side, doctors in government facilities are overburdened with increasing demands due to migration from neighboring regions of Delhi. The mismatch between demand and supply of health care services leads to poor quality of antenatal, intrapartum, and postnatal care, which increase the risk of neonatal mortality.
Conclusion: Women belonging to the lower socio-economic strata in Delhi receive poor quality reproductive care. Health education and counseling to women from low socio-economic subgroups is urgently needed so that they can negotiate better for higher quality services in those facilities. The quality of health services in public hospitals need to strengthen.
Authors
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Jayanta Bora
(Public health Foundation of India)
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Nandita Saikia
(Jawaharlal Nehru University)
Topic Areas
V. Healthcare Service 5.1 Accessibility of healthcare services and its optimization 5.2 He , VI. Methodologies and technologies 6.1 Methodological issues in health research (e.g., MAU
Session
PS-3 » POSTER SESSION 3 (12:15 - Sunday, 3rd April, TBA)
Paper
Paper-ICUH_2016-NS.doc
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