Research on Assessing the Role of Family Planning in Women Pdf

• Loading metrics

Open Access

Peer-reviewed

Research Commodity

Assessing the Impact of Family Planning Advice on Unmet Need and Contraceptive Use among Currently Married Women in Uttar Pradesh, India

• Preeti Dhillon

Assessing the Impact of Family Planning Advice on Unmet Need and Contraceptive Use amid Currently Married Women in Uttar Pradesh, India

• Diwakar Yadav,
• Preeti Dhillon

10

• Published: March 4, 2015
• https://doi.org/10.1371/journal.pone.0118584

Figures

Abstract

Background

Counseling/advice is i of the primal interventions to promote family planning (FP) in developing countries, including India. It helps to improve the quality of care and reduce maternal deaths. This newspaper investigates the continuity of maternal health (MH) service utilization from antenatal intendance to post-natal care and the touch on this service utilization has on contraceptive use and on meeting the demand for family planning among currently married women in rural Uttar Pradesh, Republic of india.

Methods and Findings

The study assesses the bear upon of FP advice on unmet need and contraceptive use by adopting the propensity score matching method. It uses data from the District Level Household Survey (DLHS) (2007–08) that covered 76,147 currently married women (CMW) in the age group xv–44 years in Uttar Pradesh. Results show that the utilization of MH services [Antenatal care (ANC), institutional delivery, Postnatal care (PNC)] and FP communication during ANC and PNC has led to increase in current use of contraception by 3.7% (p<.01), 7.iii% (p<.01) and 6.8% (p<.01), respectively. Even so, a greater utilization of these services has not translated into a reduction of unmet need for contraception at a like style.

Conclusion

MH service utilization including FP advice is more effective in increasing current use of spacing methods as compared to limiting methods. Findings support the need for "constructive FP advice" interventions to reduce unintended births and unmet demand. Nonetheless, women from Scheduled Caste/Scheduled Tribe communities are less probable to receive MH services. Thus, efforts are required to ensure that currently married women across socio-economic backgrounds have equal opportunity to receive MH services and data on contraceptive utilize to meet the demand for family planning methods.

Commendation: Yadav D, Dhillon P (2015) Assessing the Touch of Family unit Planning Advice on Unmet Need and Contraceptive Utilize among Currently Married Women in Uttar Pradesh, India. PLoS ONE 10(three): e0118584. https://doi.org/10.1371/journal.pone.0118584

Academic Editor: Yang Yu, Peiking university tertiary hospital, Communist china

Received: April 10, 2014; Accepted: Jan 21, 2015; Published: March iv, 2015

Copyright: © 2015 Yadav, Dhillon. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted apply, distribution, and reproduction in whatever medium, provided the original author and source are credited

Data Availability: The Data Request Form is available online and anyone can download information technology for viewing or printing. All the files are in PDF course. For DLHS Information delight visit our master website, http://www.iipsindia.org. Download the Data Request Form from the website. Please send a Hard Copy of the Information Request Form and the Draft/Cheque to the In-Charge, ICT Unit, International Institute for Population Sciences (IIPS), Deonar, Mumbai-400088.

Funding: The authors have declared that no competing interests be.

Competing interests: The authors take declared that no competing interests be.

Introduction

Use of family planning (FP) methods is the main strategy for prevention of unwanted pregnancies [1,2]. It is estimated that almost two,72,000 maternal deaths reported worldwide and 86,366 maternal deaths occurring in Republic of india every year could have been averted by the employ of FP methods [three]. It was in the early on 1950s that FP programs were beginning introduced in the developing countries to deadening down population growth. Later on in the 1980s global forums recommended that they exist merged with maternal and kid wellness (MCH) services for a more than integrated approach [4]. In developing countries, where integration was a key element of the health system, birth rates take declined, as more women have been able to avoid unintended pregnancies[5]. To improve delivery, India has integrated MCH and FP services through the National Population Policy-2000, the National Health Policy-2002, the Reproductive and Child Wellness Program (Stage I-1997–2004, Phase II-2005–10) and the National Rural Health Mission (2005–12)[six–9]. Despite a plethora of policies and programs India is far from achieving its fertility goals. This is due to lower contraceptive apply, high unmet need and unintended fertility [10].

The continuum of care including antenatal, natal and the post-natal care is critically important in high focus states of India. Here both mothers and children are vulnerable to a range of wellness risks resulting in loftier maternal and neonatal mortality. FP communication is an important component in the continuum of care. Information technology is central to improving health beliefs and wellness-care seeking during antenatal, natal and post-partum period [11]. The information provided during the antenatal care (ANC) enables women and their family unit members to subsequently take intendance of their new born, adopt healthy behaviors and to place and deed on medical emergencies that may arise during antenatal, natal and post-natal care (PNC) periods [12,13]. Advice on advisable FP methods ensures spacing between children and may contribute to preventing unwanted births. Although, previous studies testify that FP advice has an inconsistent role in ANC service utilization and skilled birth attendance in the developing state settings [fourteen–sixteen].

Communication on FP is part of the standard practice of intendance for women who take just given birth. Need for FP methods is potentially high after delivery and birth spacing plays a disquisitional role in improving MCH [3,17]. Post integration most recent multi-country studies based on Demographic and Wellness Survey (DHS) data report a positive relationship between MCH service and contraceptive use [18–21]. This comeback is not explained past exogenous variables [22]. ANC services provide opportunities to reach women who would be the chief target of FP services. This has been the rationale behind standard strategies using ANC as an entry point for the delivery of core reproductive health services, including FP [23].

Studies have shown that in that location is a preference among health workers for promoting ANC and institutional commitment while FP advice is very limited [24–27]. Earlier enquiry suggests that an ANC parcel including FP advice significantly increased the quality of intendance[28]. In South asia region [29–31] especially in India, studies show that PNC is limited to inequality in service utilization [32–34].

Studies examining the value of integration accept mixed findings. A randomized control trial on educational interventions for contraceptive use reveals that women who received postpartum counseling with repeated contacts were more influenced to employ FP methods[35]. However a review of trials found that there was little impact of integrated service delivery on outcomes of integration, costs or health organisation operation in developing state settings[36]. Two other trials showed that integration of FP service delivery resulted in increased contraceptive use [37,38].

Being nigh populous state and having the low socio-economic status, Uttar Pradesh is high focused state with 25 (xix administrative districts by Government of India and additional 6 administrative districts by country Government of Uttar Pradesh) out of seventy administrative districts in 184 loftier priority districts in India under NRHM[9]. Although, NRHM was launched in 2005 with an integration approach, there is a dearth of literature especially in Uttar Pradesh place the role of MCH care in increment in contraceptive employ and decrease in unmet need for FP. Therefore, the present study is an attempt to investigate the continuity of service utilization from ANC to contraceptive use in a rural setting of Uttar Pradesh. This paper mainly assesses the role of FP communication provided as role of MH services, in increasing the use of contraceptives and reducing the unmet demand for FP among currently married women (CMW). This study of MH service utilization and peculiarly advice during ANC and PNC sessions would exist crucial for strengthening such public health service programme efforts further.

Materials and Methods

Upstanding argument

All respondents in this study provided written informed consent. The Commune Level Household and Facility Survey (DLHS) protocol and ethical clearance were obtained from the Ethics Committee of International Plant for Population Sciences, Bombay and the Ministry of Health and Family unit Welfare, Authorities of India, New Delhi. The DLHS dataset is available in the public domain for research and no formal approval from the institution is required. In addition, the survey musical instrument is bachelor on the DLHS website (www.rchiips.org).

Data and written report settings

The nowadays study utilises data from the third wave of DLHS (2007–08) that covered all 601 administrative districts from 34 states and wedlock territories of Republic of india. This survey provides estimates on MCH services and FP employ at the district level in lodge to monitor and provide cosmetic measures to the NRHM. The survey adopted a multi-stage stratified sampling blueprint and used a gear up of structured questionnaires for collection of data [39].

The present work focuses on rural population of Uttar Pradesh (Up). UP constitutes xviii.6% of the total rural population of India, one of the largest in the country [40]. It is significantly various in its socioeconomic, demographic, geographic and cultural profile[10]. It is currently passing through the third stage of demographic transition, with an estimated death rate of eight.2 per thousand population and infant mortality rate of 63 per g births[41]. A large proportion of the state's population suffers from poverty and fares poorly on indicators of gender equality such as female literacy and women's autonomy. In the Human Development Index, information technology ranked thirteen^thamong xv major states of India[42].

The trends in service utilization of MH and contraceptive use in Uttar Pradesh do not reflect much improvement over the last two decades [ten]. The recent Indian Demographic Health Survey (2005–06) for Uttar Pradesh reveals that a mere fourth (27%) of the pregnant women made 3+antenatal visits during their almost recent pregnancy. But nigh a fifth (21%) had their most recent deliveries in a health facility and only 15% of the women reported receiving PNC after their well-nigh contempo birth. Moreover, only 29% of women were using any modern contraceptives and unmet need for limiting methods (21%) is college than that for spacing methods (9%).

In DLHS-3, the information was gathered from a representative sample of 90, 415 households, 87,564 e'er-married women (aged 15–49 years) and 76, 147 CMW (aged 15–44 years) of 70 administrative districts in Uttar Pradesh. The study sample considered 31, 865 CMW in the age group 15–44, who had given birth during the reference catamenia. Data on antenatal, natal, post-natal care was collected from all women who had given birth in the 5 years preceding the survey and were restricted to the almost recent nativity. The household and e'er married women response rates were 94% and 84%, respectively. Appropriate weights given in the information are used.

Event variables

The study considers ii outcome variables, contraceptive apply and unmet demand for FP defined as:

Electric current apply of modern FP methods. Information was obtained from the CMW by asking them the question "whether you or your hubby are currently using any FP methods (Yes/No)?" Those who responded in the affirmative, were farther asked about name of the method. Contraceptive prevalence charge per unit (CPR) for spacing method is defined as the pct of CMW themselves or their husbands using an intrauterine device, oral pills, condoms, injectibles, foam or jelly and implants on the date of the survey (coded as Yep-current use and No-no use). CPR for the limiting method is divers as the per centum of CMW themselves or their husband using sterilization on the date of the survey (coded as Yep-electric current employ and No-no use). Total current employ of modern contraceptives includes the electric current use of both spacing and limiting methods (coded every bit 'Yeah') versus not using modern contraceptive methods (coded as 'No').

Unmet need for modern FP methods. Unmet demand for spacing methods includes the proportion of CMW who are neither in menopause nor a hysterectomy nor are currently pregnant, wanting more children afterward two years or later and are currently not using any FP method. The CMW who are unsure virtually having another child are as well included here and then are those still intending to accept one but are unsure of the timing. Unmet need for limiting methods includes the proportion of CMW who are neither in menopause nor had a hysterectomy nor are currently pregnant and practise non want whatsoever more children just are currently non using any FP method. Total unmet need refers to unmet need for limiting and spacing. Unmet need for FP variable was already given in data file, so we used the same variable and dichotomized as 1-unmet need for FP and 0-met need for FP.

Exposure variables

The study considers iii critical services namely-ANC visits (Yeah/No), institutional delivery(Yes/No) and PNC within 2 weeks of delivery (Yes/No) in MH service utilization. Further, women who reported using/attending all iii disquisitional services are considered as having received all MH services (coded as 'Yes'), a proxy for exposure to the MH program and the remaining as unexposed (coded as 'No').

The study considers the advice during ANC and PNC session every bit exposure to the MH program. Detailed information on advice received is as follows-Women were asked if they had received advice on seven essential components of specific MH care services during the ANC visit. These components include: (i) breastfeeding (Aye/No), (2) keeping the infant warm(Yes/No), (iii) importance of cleanliness at the time of commitment(Aye/No), (four) nutrition for mother and kid (Yes/No), (five) importance of institutional delivery (Aye/No), (6) spacing methods of FP (Yep/No) and (vii) limiting methods of FP (Yes/No). The exposure variable used in the analysis is the FP communication received during ANC visits, including spacing and limiting methods of FP (coded as 'Yes') and the remaining as unexposed (coded as 'No').

During the PNC visit, women were asked if they had received advice on four essential components of MH care specific services including (1) abdominal examination (Yes/No), (2) communication on breastfeeding (Yep/No), (iii) advice on infant intendance (Yes/No) and (four) communication on FP methods (Yep/No). The exposure variable FP communication received during PNC visit (coded equally 'Yeah') and the remaining as unexposed (coded as 'No') was used in the analysis.

Explanatory variables

Socioeconomic and demographic predictors such every bit the adult female's age, education, children e'er born, organized religion, ethnicity-caste and household wealth quintiles were included in this study. The women'due south ages were categorized into less than 25 years and 25 years or above. The educational level of women was defined using years of schooling and was categorized into less than 5 years of schooling, five–9 years of schooling and 10 years of schooling or above. The population was assigned to 2 religious categories Hindu and non-Hindu (Muslim, Jain, Sikh, Christian and others), because disaggregation of minorities had piddling statistical significance given their small numbers. The sample was categorized into: Scheduled Castes (SC)/Scheduled Tribes (ST), Other Backward Castes (OBC) and 'Others'. This nomenclature has used the terminology adopted past the Government of India, focusing more than on the socially disadvantaged castes/tribes while all privileged social groups are classified equally 'Others'.

In the absence of directly information on income in household surveys like the DLHS, the wealth index is widely used as a proxy indicator for assessing the household economical status. In developing countries the index has been found to correlate highly with income data [43,44]. The DLHS collects a whole range of data on consumer durables, housing atmospheric condition, water and sanitation facilities- used as a proxy for household economic status. In the third wave of the DLHS, the wealth index was created using main component assay (PCA) on items related to possession of durable assets, access to utilities and infrastructure and housing characteristics. The PCA scores in the dataset were weighted by the household sampling weights to ensure that the distribution was representative of all households in Uttar Pradesh following which the households were divided into quintiles. A detailed description on the methodology adopted to construct the wealth index in DLHS dataset is provided in the DLHS-iii national study [39].

Analytical arroyo

Bivariate analysis was conducted to assess the continuum of service utilization. The proportion of CMW using two or more than consecutive services in a sequential style as provided by the health system are analysed. The pct of those utilising two consecutive services in the sequence in which they are dispensed by the health service organisation are considered equally those who have utilised a continuum of service. The complement of this percentage provides the dropout. The Chi-foursquare examination is applied to examine the association between services in the bivariate assay. All tests are two tailed and a p-value of <0.05 is considered statistically meaning.

In gild to examine the impact of FP advice received during ANC/PNC sessions and MH care service utilization on unmet need and current use of modern FP methods, the written report adopted the Propensity Score Matching (PSM) [45,46]. This approach gives an opportunity to appraise the impact of exposure on programme outcomes through cross-sectional survey data [47–49]. The study used radius caliper method for matching that reduces the take chances of using poor matches equally information technology uses all the possible comparison grouping members within the maximum distance from caliper [45,50]. The common back up brake (to exclude data from exposed with a propensity score higher than that of whatever unexposed person) was imposed to better the quality of matching.

The propensity score is estimated by logistic regression, with the dichotomous exposure/treatment variable. For case, i = exposed to FP advice during ANC; 0 = unexposed to FP advice during ANC. Associated observed selected characteristics of the CMW and household namely women'south age, education, children always born, religion, caste and wealth alphabetize are used as predictor variables.

There are two key assumptions in PSM procedure; first, provisional independence assumption i.e. assignment to exposed and unexposed can exist considered as random after decision-making covariates. We checked this supposition by using <pscore> and <ptest> commands, former command examines the balancing belongings which states that, conditional on the propensity scores, the distribution of misreckoning factors are similar among exposed and matched unexposed and after gives covariate imbalance testing i.east., t examination (hateful) and χ2 examination (percentage) results to check the differences in groundwork characteristics of exposed with (matched) unexposed individuals. Second assumption nether PSM is on common back up condition i.east. for each value of covariates at that place is a positive probability of being exposed or unexposed. Used command <pscore> also gives data regarding mutual support area. We used <psgraph> for common support expanse graphing. All analysis was washed using STATA (version xi), and we used <psmatch2> package for PSM method[51].

PSM method explained to evaluate programs impacts have been recently facilitated by improvements in computing capacity and associated algorithms and matching approach[47]. In recent past, selected studies have carried out using this method to evaluate public health related programs in Republic of india[fifty,52–55]. These have shown a significant effect of the intervention programs on HIV related risk amidst the highly take a chance groups such as female sexual practice workers[53] and truck drivers[54].

In this case, divergence in unmet need and current use of modernistic FP methods betwixt exposed and control groups tin can exist directly compared to show the impact of exposure on the exposed group. This is known as boilerplate treatment effect on those treated (ATT). Additionally, comparing the deviation in unmet need and electric current use of modern FP methods between control and matched exposed groups tin can evidence the bear on of exposure on the unexposed group. This is known equally average treatment effect on the untreated (ATU). These two average furnishings were weighted by the proportion of women in exposed and command groups, respectively, to make it at the impact of the service received on unmet need and current utilize of modern FP, known as average handling issue (ATE). This measured the change in unmet need and electric current use of FP due to FP communication and maternal health intendance service utilization.

Exposed CMW and the matched control CMW were compared on parameters of unmet demand and current use of modern FP methods to examine the bear on of FP advice. To appraise whether the average effect is statistically pregnant, bootstrapped SE around the estimates[56,57] is calculated. The written report has used STATA xi.0[51] bundle for the entire analysis.

Results

Continuum of maternal health service utilization and contraceptive use

Fig. 1 shows the continuum of MH service utilization and contraceptive use in rural Uttar Pradesh at different stages of service provision. Near 63% CMW accept received any ANC. Out of those simply 29% have delivered their babies in institutions compared to 11% of those who did not receive whatever ANC.

Among the CMW who received both prior services, 68% take availed PNC services as compared to 24% among those who received any ANC and skipped institutional delivery. The proportion of CMW who did not utilise any ANC but had adopted institutional deliveries and received PNC services is 62%. Merely 17% of women who did not avail both ANC and institutional delivery utilised PNC services. Of the CMW who received all these three disquisitional services 24% are currently using mod contraceptive methods in dissimilarity to 14.0% amid who have non availed any MH services. It is evident from this analysis that the utilization of a service is more probable if the woman avails the service provided prior to information technology as function of the continuum of MH services. The continuum of MH service utilization too encourages contraceptive employ.

Levels of maternal wellness service utilization by groundwork characteristics of women

The mean age of CMW interviewed was 26.8 years. Of the 31865 CMW, nigh 70% had less than 5 years of school education, 84% were Hindu, 25% belonged to SC/ST categories and 26% were in the poorest wealth quintile. A total of 3905 (12.iii%) CMWs utilized all maternal health service namely- whatever ANC, had institutional deliveries and received PNC. CMW aged beneath 25 years (15%), with 10 or more years of education (38%), were Hindu (13%), belonging to non-SC/ST/OBC (22%) categories and from the richest wealth quintile of households (37%) had utilised all MH services (Table ane).

Only 4495 (14%) and 2396 (vii.5%) CMWs had received FP advice during ANC and PNC session, respectively. The advice on FP during ANC and PNC sessions were received more among CMW who had teaching of 10 years or more, were non-SC/ST/OBC and from households in the richest wealth quintile.

Unmet demand and contraceptive utilize past different maternal health service utilization

The electric current utilize of modern contraceptive methods among CMW who received all MH services (any ANC, Institutional delivery, PNC) in 2007–08 is 24% in contrast to 17% amid those who did non receive these services. The proportion of CMW using modern contraceptive methods was higher, at 27% if they received advice during ANC visit and withal more at 29% among those who were counselled during the PNC visit. These bivariate results reveal that advice on FP specially during PNC has motivated CMW to employ modern contraceptive methods. PNC has had a 12% upshot on the increase of electric current use of FP. However, the CMW's characteristics were non controlled in this assay.

16% and 9% of those who received all MH services employ spacing and limiting methods respectively as compared to just well-nigh eight% and 9% among those who take not received such services. Of those who received advice during ANC visits 16% and 11% used spacing and limiting methods respectively, while the figures are xviii% and eleven% among those who have received advice during PNC. These findings propose MH services utilization has influenced FP use particularly spacing methods. Thus advice during ANC and PNC has been effective in increasing CPR for the spacing method past eight% (p<0.01) and 9% (p<0.01) respectively.

The paper highlights the outcome of MH service utilization on reducing unmet demand for FP through bivariate analysis equally shown in Table 2. It reveals that about 35% of CMW who have received all MH services have unmet demand for FP in comparison to 39% who have non received such services. Near 34% of the CMW who have received FP advice during ANC or PNC reported unmet need for FP. These results reveal that all MH service utilization and FP communication has marginal result on unmet demand for FP. Yet, of the 2 FP methods utilization of MH services and advice during ANC or PNC visits have greater impact on reducing unmet for limiting methods. MH service utilization has a higher impact on increasing employ of modern methods; however, these are not sufficient for reducing unmet need for FP.

Impact of advice received on contraceptive use and unmet demand for family planning

The study estimates the affect of service utilization on current use of contraceptive and unmet need for FP past the estimated difference in both the outcomes, between the treated (receivers) and the matched control (non-receivers) groups. The utility of this matching analysis is that one gets to see the actual bear upon of the treatment as it controls background variables besides as the characteristics of women who were non treated or did non participate. This latter could exist the effect of selected women receiving services or the health provider's selection bias. An Indian study using the aforementioned information gear up reveals that women from lower socio-economic backgrounds are less likely to receive MCH advice[58]. The effect of the program on the group who did non participate, that is, if they could have participated what would be the issue on result, is given.

Results from Table three, the average handling outcome (ATE) of all MH service utilization on electric current use of contraception is 3.7% (p<0.01). The ATEs of receiving FP communication during ANC and PNC visit are 7.3% (p<0.01) and 6.8% (p<0.01), respectively. This slightly higher effect of ANC is due to the college effect on the untreated group, i.eastward. the effect when the women who did non go could have gone for ANC. On the other hand, ATE of utilization of all MH services on reducing unmet need for FP is only 0.5%. Receiving advice during ANC and PNC have led to reduction in unmet need by iii.1% and ane.4% points, respectively. The ATEs of exposure to MH services by blazon of method are estimated consistently higher for spacing methods. ATEs of availing all MH services are 2.nine% (spacing) and 0.viii% (limiting), of receiving FP advice during ANC were 4.0% (spacing) and 3.3% (limiting), and of receiving advice during PNC are 3.6% (spacing) and 3.2% (limiting).

The overall bulletin from this assay is that the MH service utilization including FP communication during ANC and PNC visit have led to an increase in electric current utilize of contraceptives. Yet, these services have non motivated a reject in unmet need at the same stride. ATEs of these exposure variables are higher on current apply of spacing method than that on limiting methods. There is non much difference in ATE of MH services utilization (including advice) on unmet need for FP past blazon of method.

When we compare average treatment effect on treated (ATT) and average handling effect on untreated (ATU) (Table 3), because all MH service utilization as exposure variable, nosotros do not discover differences between ATT and ATU. However, ATU is higher than ATT when exposure variable is 'brash received on FP during ANC visit'. Information technology suggests that the women who could not receive advice on FP during ANC, if they would have been advised the contraception apply outcomes would exist at college level.

Discussion

This study shows the continuity of different MH services and its effect on contraceptive use by comparing the utilization of succeeding services betwixt two groups. The data from Uttar Pradesh has shown lower levels of service utilization with higher discontinuation of MH and FP services despite the loftier priority given to the RCH program[59]. These results bear witness that prior service utilization promotes subsequent service utilization. The highest dropout is observed at the first level of intendance, i.east. ANC visit and later at institutional delivery level in rural Uttar Pradesh. If women go for institutional delivery there is high possibility that they volition go for PNC. Use of modern contraceptives is 24% for those who availed all prior services (ANC, ID, PNC) in comparison to only 14% amongst those who had not received any service.

NRHM has increased the level of MH service utilization and contraceptive use through the RCH program in India[9]. The integrative approach is cost constructive. The net savings and benefits accruing to the health system outweigh the initial costs [sixty]; It improves household incomes, enables greater investment in health, education and well-existence[61].

Our findings reveals in rural Uttar Pradesh, women with low socio-economic profile were less likely to receive MH services, advice on FP during ANC and PNC visit. This is also supported by other research suggests that in that location is significant inequality among social groups in receiving communication on FP during ANC/PNC visits. The poor women are less likely to receive FP advice [34,58]. Such anomalies depend not only on the system's efficiency merely are also associated with cultural or social barriers. Therefore, study recommends that women with low socio-economic contour should be target to leverage service utilization with convergence of MH and FP.

The written report finds that the utilization of critical MH services (any ANC, institutional commitment, PNC) encourages subsequent contraceptive use and reduces the unmet need for FP marginally. The increase in FP however could also exist the result of a confounder such as integration of MH and FP services in Republic of india[38,62]. In that location is a need to strengthen this integration to reduce unmet need for contraceptive employ. While comparing by type of methods, MH service utilization is more effective in increasing the use of spacing method and reducing unmet need for limiting method.

Inquiry from developing countries indicates that FP communication recipients are more likely to use contraception than those who do not receive it[63]. A contempo study from adult country amid women establish counseling regarding FP methods to be more effective in increasing contraceptive utilize[64]. Like results are found in the present enquiry that the advice on FP during ANC/PNC sessions has improved both contraceptive behavior outcomes. Advice during PNC is institute to be more effective followed by, communication received during ANC to improve contraceptive behavior every bit institute in previous studies [65–68]. This has a programmatic implications that advice on FP during PNC and ANC visits should be promoted with more efforts to increase contraceptive utilise and to reduce unmet need for FP. In the current Authorities programme, Md, front line health workers including (accredited social wellness activist, auxiliary nurse midwives & anganwadi worker) are majorly responsible to provide FP communication or counseling during ANC and PNC period. With the present study nosotros could not bear witness the impact of quality and source of counseling. However, the advice by blazon of method has been explored.

While comparing betwixt two outcome indicators contraceptive utilise in compare to unmet need for FP is institute to be more influenced by counseling during MH services. Every bit unmet need for FP depends on contraceptive utilize and demand for FP. Further, demand for FP is derived from the pregnancy intention in terms of limiting family unit size and nascence spacing. If counseling on FP has generated more demand for FP (limiting and spacing) than the increase in use of contraceptives, unmet need may non reduce with same pace as contraception utilize has increased.

In a depression-resources setting such as Uttar Pradesh, the health organization approach to improving ANC/PNC services should be prioritized with more than constructive communication on FP to reduce unintended births. FP communication is part of the routine PNC services and the opportunity to receive data and support for FP use should be available to all women irrespective of their social background.

Although findings of this study offer of import insights about MH outcomes and its clan with contraceptive use and unmet demand for FP, these results must be interpreted in the lite of study limitations. In DLHS-Iii, the information on communication on FP during ANC/PNC session was obtained from women at the time of survey and thus responses of communication might be afflicted past recall bias. The analysis was also restricted simply to the last nativity that took place in the three years preceding the survey. The study could not examine the quality of PNC services offered in public/individual wellness facilities. Even so, our findings hold important implications for planning and implementation of programs.

Acknowledgments

The author is thankful to the editor and anonymous reviewers for their comments and feedbacks on an earlier draft of this paper. Further, we would like to acknowledge Dr. Bidhubhushan Mahapatra, ICIMOD, Kathmandu, Nepal for providing technical support in PSM analysis.

Author Contributions

Conceived and designed the experiments: DY PD. Performed the experiments: DY. Analyzed the data: DY. Contributed reagents/materials/analysis tools: DY PD. Wrote the newspaper: DY.

References

1. 1. Singh S, Darroch JE, Ashford LS, Vlassoff M (2009) Adding it up: the costs and benefi ts of investing in family planning and maternal and newborn health. New York: Guttmacher Found and Un Population Fund.
2. ii. Liu 50, Becker S, Tsui A, Ahmed S (2008) Three methods of estimating births averted nationally by contraception. Popul Stud (Camb) 62: 191–210. pmid:18587694
   • View Article
   • PubMed/NCBI
   • Google Scholar
3. three. Ahmed S, Li Q, Liu L, Tsui AO (2012) Maternal deaths averted by contraceptive use: an analysis of 172 countries. The Lancet 380: 111–125.
   • View Commodity
   • Google Scholar
4. 4. Waddington C, Egger D (2008) Integrated Health Services—What and why? Geneva World Health Organization.
5. five. Ringheim G, Gribble J, Foreman M (2011) Integrating Family Planning and Maternal and Child Health Care: Saving Lives, Money, and Time. Policy Brief. Washington: Population Reference Bureau.
6. 6. MoHFW (1997) Reproductive and Child Health Programme: Schemes for Implementation. New Delhi: Ministry building of Health & Family Welfare, Authorities of Republic of india.
7. vii. MoHFW (2000) National Population Policy 2000. New delhi: Ministry building of Health and Family unit Welfare, Authorities of Republic of india.
8. 8. MoHFW (2002) National Health Policy 2002. New Delhi: Ministry of Health & Family Welfare, Regime of Bharat.
9. nine. MoHFW (2005) National Rural Health Mission (2005–2012): Mission Document. New Delhi: Ministry building of Health & Family Welfare, Regime of Bharat.
10. 10. IIPS, MI (2007) National Family Wellness Survey (NFHS-3), 2005–2006. Bombay: IIPS.
11. eleven. Nikiéma B, Beninguisse G, Haggerty JL (2009) Providing information on pregnancy complications during antenatal visits: unmet educational needs in sub-Saharan Africa. Wellness Policy and Planning 24: 367–376. pmid:19401360
    • View Article
    • PubMed/NCBI
    • Google Scholar
12. 12. Renkert S, Nutbeam D (2001) Opportunities to meliorate maternal health literacy through antenatal education: an exploratory study. Health Promotion International 16: 381–388. pmid:11733456
    • View Article
    • PubMed/NCBI
    • Google Scholar
13. 13. WHO (2003) Working with individuals, families and communities to amend maternal and new born health Geneva 27, Switzerland: World Health Organisation. pmid:14711754
14. 14. Pembe AB, Urassa DP, Carlstedt A, Lindmark G, Nystrom L, et al. (2009) Rural Tanzanian women's sensation of danger signs of obstetric complications. BMC Pregnancy Childbirth 9: 12. pmid:19323836
    • View Article
    • PubMed/NCBI
    • Google Scholar
15. fifteen. Magoma M, Requejo J, Campbell OM, Cousens S, Filippi V (2010) High ANC coverage and low skilled omnipresence in a rural Tanzanian district: a example for implementing a nascence plan intervention. BMC Pregnancy Childbirth 10: 13. pmid:20302625
    • View Commodity
    • PubMed/NCBI
    • Google Scholar
16. 16. Magoma M, Requejo J, Merialdi Grand, Campbell OM, Cousens Due south, et al. (2011) How much time is available for antenatal care consultations? Assessment of the quality of intendance in rural Tanzania. BMC Pregnancy Childbirth 11: 64. pmid:21943347
    • View Article
    • PubMed/NCBI
    • Google Scholar
17. 17. Levitt C, Shaw Eastward, Wong S, Kaczorowski J, Springate R, et al. (2004) Systematic review of the literature on postpartum care: selected contraception methods, postpartum Papanicolaou test, and rubella immunization. Nascency 31: 203–212. pmid:15330883
    • View Article
    • PubMed/NCBI
    • Google Scholar
18. 18. Zerai A, Tsui AO (2001) The relationship between prenatal care and subsequent modern contraceptive use in Bolivia, Egypt and Thailand. Afr J Reprod Health 5: 68–82. pmid:12471915
    • View Commodity
    • PubMed/NCBI
    • Google Scholar
19. nineteen. Hotchkiss DR, Magnani RJ, Rous JJ, Azelmat M, Mroz TA, et al. (1999) The furnishings of maternal-child health service utilization on subsequent contraceptive use in Morocco. J Biosoc Sci 31: 145–165. pmid:10333649
    • View Commodity
    • PubMed/NCBI
    • Google Scholar
20. 20. Hotchkiss D, Rous J, Seiber East, Berruti A (2005) Is Maternal and Child Health Service employ a Causal Gateway to Subsequent Contraceptive utilise?: A Multi-Country Study. Population Enquiry and Policy Review 24: 543–571.
    • View Article
    • Google Scholar
21. 21. Seiber EE, Hotchkiss DR, Rous JJ, Berruti AA (2005) Maternal and child health and family planning service utilization in Guatemala: implications for service integration. Soc Sci Med 61: 279–291. pmid:15893045
    • View Article
    • PubMed/NCBI
    • Google Scholar
22. 22. Ahmed S, Mosley WH (2002) Simultaneity in the employ of maternal-child wellness care and contraceptives: evidence from developing countries. Demography 39: 75–93. pmid:11852841
    • View Commodity
    • PubMed/NCBI
    • Google Scholar
23. 23. WHO (2004) Reproductive Health Strategy to Accelerate Progress Towards the Attainment of International Development Goals and Targets. Geneva: World Health Organization.
24. 24. Matthews Z, Mahendra S, Kilaru A, Ganapathy S (2001) Antenatal intendance, careseeking and morbidity in rural Karnataka, India: results of a prospective written report. Asia-Pacific Population Periodical 16: xi–28.
    • View Article
    • Google Scholar
25. 25. Pallikadavath South, Foss Chiliad, Stones RW (2004) Antenatal intendance: provision and inequality in rural north India. Soc Sci Med 59: 1147–1158. pmid:15210087
    • View Article
    • PubMed/NCBI
    • Google Scholar
26. 26. Ram F, Singh A (2006) Is antenatal care effective in improving maternal health in rural uttar pradesh? Show from a district level household survey. J Biosoc Sci 38: 433–448. pmid:16762083
    • View Article
    • PubMed/NCBI
    • Google Scholar
27. 27. Sugathan KS, Mishra V, Retherford RD (2001) Promoting Institutional Delievries in Rural India: The Function of Antenatal-Care Services. Mumbai: International Plant for Population Sciences, Mumbai, India and East-West Center, Population and Wellness Studies, Honolulu, Hwaii, The states. xx twenty.
28. 28. Birungi H, Onyango-Ouma W (2006) Acceptability and Sustainability of the WHO Focused Antenatal Care package in Kenya. Washington, DC: Population Council, Frontiers in Reporductive Health.
29. 29. Sines E, Syed U, Wall S, Worley H (2007) Postnatal Care: A Critical Opportunity to Salve Mothers and Newborns. Washington, DC: Population Reference Bureau.
30. 30. Dhakal Southward, Chapman GN, Simkhada PP, van Teijlingen ER, Stephens J, et al. (2007) Utilisation of postnatal care among rural women in Nepal. BMC Pregnancy Childbirth 7: 19. pmid:17767710
    • View Article
    • PubMed/NCBI
    • Google Scholar
31. 31. Anwar ATMI, Killewo J, Chowdhury M-E-EK, Sushil , Dasgupta Thousand (2004) People's republic of bangladesh: Inequalities in Utilization of Maternal Health Intendance Services-Show from MATLAB. Washington, DC: The Earth Bank.
32. 32. Jat TR, Ng N, San Sebastian K (2011) Factors affecting the use of maternal health services in Madhya Pradesh country of India: a multilevel analysis. Int J Equity Health 10: 59. pmid:22142036
    • View Article
    • PubMed/NCBI
    • Google Scholar
33. 33. Mistry R, Galal O, Lu M (2009) "Women's autonomy and pregnancy care in rural Republic of india: a contextual analysis". Soc Sci Med 69: 926–933. pmid:19656604
    • View Commodity
    • PubMed/NCBI
    • Google Scholar
34. 34. Singh A, Padmadas SS, Mishra US, Pallikadavath S, Johnson FA, et al. (2012) Socio-economic inequalities in the apply of postnatal care in India. PLoS One vii: e37037. pmid:22623976
    • View Article
    • PubMed/NCBI
    • Google Scholar
35. 35. Lopez LM, Hiller JE, Grimes DA, Chen Grand (2012) Education for contraceptive use past women after childbirth. Cochrane Database Syst Rev viii: CD001863. pmid:22895923
    • View Article
    • PubMed/NCBI
    • Google Scholar
36. 36. Briggs CJ, Capdegelle P, Garner P (2001) Strategies for integrating primary wellness services in heart- and low-income countries: effects on functioning, costs and patient outcomes. Cochrane Database Syst Rev: CD003318. pmid:11687187
    • View Commodity
    • PubMed/NCBI
    • Google Scholar
37. 37. Huntington D, Aplogan A (1994) The integration of family planning and childhood immunization services in Togo. Stud Fam Plann 25: 176–183. pmid:7940622
    • View Article
    • PubMed/NCBI
    • Google Scholar
38. 38. Taylor CE, Parker RL (1987) Integrating PHC services: evidence from Narangwal, India. Health Policy and Planning 2: 150–161.
    • View Article
    • Google Scholar
39. 39. IIPS (2010) District Level Household and Facility Survey (DLHS-3), 2007–08. In: IIPS, editor. Bombay: International Institute for Population Sciences. https://doi.org/10.1371/journal.pone.0071584 pmid:24592593
40. 40. India Get (2011) Census of Bharat 2011: Conditional Population Totals, Paper one of 2011, Bharat, Series one. New Delhi: Office of Registrar General & Census Commissioner, Regime of India (GOI).
41. 41. RGI (2011) Sample Registration System (SRS), Statistical Report 2011. New Delhi: Office of the Registrar General, Governemnt of Bharat.
42. 42. Commission P (2011) India Human Development Reprot 2011, Towards Social Inclusion. New Delhi: Planning Commission, Authorities of India. 568 p.
43. 43. Howe LD, Hargreaves JR, Gabrysch South, Huttly SR (2009) Is the wealth index a proxy for consumption expenditure? A systematic review. J Epidemiol Community Health 63: 871–877. pmid:19406742
    • View Article
    • PubMed/NCBI
    • Google Scholar
44. 44. Vyas S, Kumaranayake L (2006) Constructing socio-economical status indices: how to use primary components assay. Health Policy Plan 21: 459–468. pmid:17030551
    • View Article
    • PubMed/NCBI
    • Google Scholar
45. 45. Rosenbaum PR, Rubin DB (1985) Amalgam a Control Group Using Multivariate Matched Sampling Methods That Contain the Propensity Score. The American Statistician 39: 33–38.
    • View Article
    • Google Scholar
46. 46. Stuart EA (2010) Matching methods for causal inference: A review and a look forwards. Stat Sci 25: one–21. pmid:20871802
    • View Article
    • PubMed/NCBI
    • Google Scholar
47. 47. Rosenbaum PR, Rubin DB (1983) The fundamental role of the propensity score in observational studies for causal effects. Biometrika 70: 41–55.
    • View Commodity
    • Google Scholar
48. 48. Rubin DB, Thomas N (1996) Matching using estimated propensity scores: relating theory to practice. Biometrics 52: 249–264. pmid:8934595
    • View Article
    • PubMed/NCBI
    • Google Scholar
49. 49. Williamson E, Morley R, Lucas A, Carpenter J (2012) Propensity scores: from naive enthusiasm to intuitive agreement. Stat Methods Med Res 21: 273–293. pmid:21262780
    • View Article
    • PubMed/NCBI
    • Google Scholar
50. l. Guha Grand, Baschieri A, Bharat S, Bhatnagar T, Sane SS, et al. (2012) Risk reduction and perceived collective efficacy and community support amidst female sex workers in Tamil Nadu and Maharashtra, India: the importance of context. Journal of Epidemiology and Community Health 66: ii55–ii61. pmid:22760217
    • View Commodity
    • PubMed/NCBI
    • Google Scholar
51. 51. StataCorp (2009) Stata Statistical Software: Release 12. Higher Station, TX: StataCorp LP.
52. 52. Bhattacharjee P, Prakash R, Pillai P, Isac S, Haranahalli K, et al. (2013) Understanding the role of peer group membership in reducing HIV-related chance and vulnerability amid female person sexual activity workers in Karnataka, India. AIDS Care 25: S46–S54. pmid:23745630
    • View Article
    • PubMed/NCBI
    • Google Scholar
53. 53. Yadav D, Ramanathan Due south, Goswami P, Ramakrishnan L, Saggurti N, et al. (2013) Role of community group exposure in reducing sexually transmitted infection-related risk among female person sexual activity workers in Bharat. PLoS One 8: e78361. pmid:24205210
    • View Commodity
    • PubMed/NCBI
    • Google Scholar
54. 54. Juneja S, Rao Tirumalasetti V, Mishra RM, Sethu South, Singh IR (2013) Bear upon of an HIV Prevention Intervention on Rubber Use amidst Long Distance Truckers in India. AIDS and Behavior 17: 1040–1051. pmid:23008122
    • View Article
    • PubMed/NCBI
    • Google Scholar
55. 55. Dixit P, Dwivedi LK, Ram F (2013) Strategies to Meliorate Child Immunization via Antenatal Care Visits in India: A Propensity Score Matching Assay. PLoS Ane 8: e66175. pmid:23824555
    • View Article
    • PubMed/NCBI
    • Google Scholar
56. 56. Lechner Thousand (2002) Some applied issues in the evaluation of heterogeneous labour market programmes by matching methods. Periodical of the Royal Statistical Gild: Series A (Statistics in Gild) 165: 59–82.
    • View Article
    • Google Scholar
57. 57. Oakes JM, Kaufman JS, editors (2006) Methods in Social Epidemiology. San Francisco, CA: John Wiley & Sons.
58. 58. Singh A, Pallikadavath S, Ram F, Ogollah R (2012) Inequalities in communication provided past public health workers to women during antenatal sessions in rural India. PLoS I vii: e44931. pmid:23028688
    • View Article
    • PubMed/NCBI
    • Google Scholar
59. 59. Yadav D (2012) A Study of synergies between maternal-kid wellness and family planning services utilization in rural Uttar Pradesh. Bombay: International Institute for Population Sciences.
60. 60. Rodriguez-Barocio R, Garcia-Nunez J, Urbina-Funtes 1000, Wulf D (1980) Fertility and Family Planning in United mexican states. International Family unit Planning Perspectives 6: 2–9.
    • View Article
    • Google Scholar
61. 61. Joshi S, Schultz TP (2007) Family unit Planning every bit an Investment in Development: Evaluation of a Programme's Consequences in Matlab, Bangladesh. New Haven, CT: Economic Growth Center, Yale University.
62. 62. Toth C (2008) The Correct Message-to the Right People-at the Correct Time.
63. 63. Do M, Hotchkiss D (2013) Relationships betwixt antenatal and postnatal intendance and post-partum modernistic contraceptive utilize: testify from population surveys in Kenya and Zambia. BMC Wellness Serv Res xiii: half dozen. pmid:23289547
    • View Article
    • PubMed/NCBI
    • Google Scholar
64. 64. Lee JK, Parisi SM, Akers AY, Borrero S, Schwarz EB (2011) The impact of contraceptive counseling in main intendance on contraceptive employ. Journal of General Internal Medicine 26: 731–736. pmid:21301983
    • View Article
    • PubMed/NCBI
    • Google Scholar
65. 65. Koenig MA, Rob U, Khan MA, Chakraborty J, Fauveau V (1992) Contraceptive use in Matlab, Bangladesh in 1990: levels, trends, and explanations. Stud Fam Plann 23: 352–364. pmid:1293859
    • View Article
    • PubMed/NCBI
    • Google Scholar
66. 66. Glasier AF, Logan J, McGlew TJ (1996) Who gives advice about postpartum contraception? Contraception 53: 217–220. pmid:8706439
    • View Article
    • PubMed/NCBI
    • Google Scholar
67. 67. Ozvaris SB, Akin A, Yildiran M (1997) Acceptability of postpartum contraception in Turkey. Advances in Contraceptive Delivery Systems 13: 63–71.
    • View Commodity
    • Google Scholar
68. 68. Fagan EB, Rodman E, Sorensen EA, Landis S, Colvin GF (2009) A survey of mothers' comfort discussing contraception with babe providers at well-child visits. Southward Med J 102: 260–264. pmid:19204612
    • View Article
    • PubMed/NCBI
    • Google Scholar

corbouldowelp1975.blogspot.com

Source: https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0118584

Share this post