Community Perspectives on Men's Role in the Utilisation of Maternal Health Services Among Saharia Tribes in Gwalior, Madhya Pradesh, India: Insights from a Qualitative Study

Perceptions of and challenges faced by primary healthcare workers about preconception services in rural India: A qualitative study using focus group discussion

Background

Providing preconception care through healthcare workers at the primary health care level is a crucial intervention to reduce adverse pregnancy outcomes, consequently reducing neonatal mortality. Despite the availability of evidence, this window of opportunity remains unaddressed in many countries, including India. The public health care system is primarily accessed by rural and tribal Indian population. It is essential to know the frontline healthcare workers perception about preconception care. The study aimed to identify barriers and suggestions for framing appropriate strategies for implementing preconception care through primary health centers.

Methods

The authors conducted a qualitative study using focus group discussions (FGDs) with 45 healthcare workers in four FGDs (8-14 participants in each), in four blocks of Nashik district. The transcribed discussions were analyzed in MAXQDA software using the Socio-Ecological Model as an initial coding guide, including four levels of factors (individual, interpersonal, community, and institutional) that influenced an individual's behavior to use preconception care services.

Results

Healthcare workers had some knowledge about preconception care, limited to adolescent health and family planning services. The interpersonal factors included heavy workload, stress, lack of support and co-operation, and paucity of appreciation, and motivation. The perceived community factors included poverty, migration, poor knowledge of preconception care, lack of felt need for preconception services, the influence of older women in the household decision, low male involvement, myths and misconceptions regarding preconception services. The identified institutional factors were lack of human resources, specialized services, logistics, and challenges in delivering adolescent health and family planning programs. Healthcare workers suggested the need for program-specific guidelines, training and capacity building of human resources, an un-interrupted supply of logistics, and a unique community awareness drive supporting preconception care services.

Conclusion

Multi-level factors of the Socio-Ecological Model influencing the preconception care services should be considered for framing strategies in the implementation of comprehensive preconception care as a part of a continuum of care for life cycle phases of women.

The Effects of the Maternal Health Improvement Project in the Louga Region of Senegal

Maternal mortality remains a major global health challenge in sub-Saharan Africa. Senegal is one of the countries in the region that lagged behind in reaching the Millennium Development Goal 5, the deadline of which passed in 2015. The objective of this study was to assess the effects of information, education, and communication (IEC) activities conducted in Louga, Senegal. Community groups and facilitators conducted IEC campaigns, home visits, and various awareness-raising activities. This study used secondary data as part of the baseline and mid-term evaluations. Participants included women and men who had one or more children under five years of age. It was found that the level of awareness of at least three danger signs of pregnancy recognised by men significantly increased, and husbands/partners more frequently accompanied their wives during antenatal care in 2019 than in 2018. Women's empowerment improved significantly in terms of women making their own health decisions, joining community decision-making associations or groups, and using contraception. This project indicates that policies and programs are needed to increase men's involvement and empower women to further women's reproductive health to achieve the Sustainable Development Goal 3 and reduce maternal mortality in Senegal.