|BRIEF RESEARCH ARTICLE
|Year : 2015 | Volume
| Issue : 1 | Page : 54-57
A study on the effect of janani suraksha yojana on antenatal registration and institutional deliveries in the Agra district of Uttar pradesh
Vikas Kumar1, Sunil Kumar Misra2, Suneel Kumar Kaushal3, Subhash Chand Gupta4, Amir Maroof Khan5
1 Senior Resident, Department of Community Medicine, University College of Medical Sciences, New Delhi, India
2 Professor and Head, Department of Community Medicine, Sarojini Naidu Medical College, Agra, Uttar Pradesh, India
3 Assistant Professor, Department of Community Medicine, Sarojini Naidu Medical College, Agra, Uttar Pradesh, India
4 Ex. Professor and Head, Department of Community Medicine, Sarojini Naidu Medical College, Agra, Uttar Pradesh, India
5 Assistant Professor, Department of Community Medicine, University College of Medical Sciences, New Delhi, India
|Date of Web Publication||9-Mar-2015|
Senior Resident, Department of Community Medicine, University College of Medical Sciences, Dilshad Garden, New Delhi - 110 095
Source of Support: None, Conflict of Interest: None
| Abstract|| |
Janani Suraksha Yojana (JSY) was launched in April 2005, to promote institutional deliveries through provision of cash assistance, transport, escort, and referral services. An observational cross-sectional study was conducted to assess the antenatal registrations, postnatal checkups, and institutional deliveries, and to compare the various social groups. Married women of the reproductive age group, having at least two children, were interviewed regarding antenatal care, delivery, and postnatal care in both pregnancies, latest as well as previous. Post JSY implementation, antenatal registrations increased from 61.79 to 96.34%, Deliveries at the Government Health Facility increased from 25.20 to 53.25% and postnatal check-ups increased from 45.93 to 69.51%. In the post-JSY-implementation phase, the Government Health Facility was preferred more by Scheduled Castes (SC), Scheduled Tribes (ST), Other Backward Classes (OBC) (SC/ST = 56.87%, OBC = 60.2%, and general = 43.68%), educated (Illiterate = 17.39%, Primary = 88.14, and Middle or above = 81.94%) and the lower socioeconomic classes (Lower SEC 71.83% and Upper lower and above = 45.71%) for their deliveries. It appears that the socially backward groups have benefited more from JSY.
Keywords: Antenatal care, Institutional delivery, Janani Suraksha Yojana, Postnatal care, Social factors, Social groups
|How to cite this article:|
Kumar V, Misra SK, Kaushal SK, Gupta SC, Khan AM. A study on the effect of janani suraksha yojana on antenatal registration and institutional deliveries in the Agra district of Uttar pradesh. Indian J Public Health 2015;59:54-7
|How to cite this URL:|
Kumar V, Misra SK, Kaushal SK, Gupta SC, Khan AM. A study on the effect of janani suraksha yojana on antenatal registration and institutional deliveries in the Agra district of Uttar pradesh. Indian J Public Health [serial online] 2015 [cited 2019 Nov 13];59:54-7. Available from: http://www.ijph.in/text.asp?2015/59/1/54/152865
Mothers and children are the major consumers of health services, as they comprise of the major portion of the population and are also a vulnerable group or special-risk group.  The Government of India launched the Janani Suraksha Yojana (JSY) on April 12, 2005, as part of the National Rural Health Mission (NRHM), as an intervention for safe motherhood and for reducing maternal and neonatal mortality. This is envisaged to be achieved by providing adequate antenatal care, transportation to the health facility for delivery, an institutional delivery, and an incentive for care of the mother and new born.  This study was conducted to assess the antenatal registrations, postnatal checkups, and institutional deliveries in the pre- and post-JSY-implementation phases and to make a comparison among various social groups.
This is a cross-sectional observational descriptive type of study conducted in the Saiyan Block of the district of Agra, UP, between July 2010 and June 2011. The list of villages in the Saiyan Block was taken from the PHC Saiyan. A minimum sample size of 203 was calculated by the formula  , n = 4 pq/d  . The percentage of institutional deliveries in Uttar Pradesh as 47%  was taken as p; and permissible error (d) was taken as 15%. It was estimated that about 20 to 25 eligible subjects would be found in each village and about ten villages would be needed to complete the required sample size. Random sampling was used to select the ten villages. A house-to-house survey was done and all the women of these villages, having at least one child in the age group 0-5 years (delivered in the post-JSY-implementation phase) and another child of more than five years (delivered in the pre-JSY-phase), were included in the study. We found a total of 246 women fulfilling the inclusion criteria in these ten villages and decided to interview all of them. Informed verbal consent was taken from the subjects for taking their interview. A pretested, structured, close-ended schedule in the local language was used for interviewing the women in the study group. They were asked the same set of questions regarding antenatal care, delivery, and postnatal care in both pregnancies, latest as well as previous. Women who had a still birth or death of a child and who did not give consent were excluded from the study. A modified BG Prasad classification was used to assess the socioeconomic status. Data were entered in the Microsoft excel spreadsheet and analyzed. Proportions among various groups were calculated and compared. The chi square test was used as a test of significance.
[Table 1] depicts that the antenatal registration, delivery at home, and postnatal checkups among the same group of women had changed from 61.79, 54.88, and 45.93% in the pre-JSY-implementation phase to 96.34, 30.49, and 69.51% in the post-JSY-implementation phase, respectively. The status of antenatal registration and the women's choice for delivery at the Government Health Facility, in the pre- and post-JSY-implementation phases among the same cohort of study subjects, was compared among the various social groups [Table 2].
|Table 1: Status of Antenatal Registration, Place of delivery, and Postnatal Checkups in Pre-JSY and Post-JSY-implementation phases|
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|Table 2: Status of antenatal registration and deliveries at the Government Health Facility among various social groups, in the Pre-JSYimplementation|
phase and Post-JSY-implementation phase
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It was evident from the results that antenatal registrations had increased among all social groups and simultaneously postnatal checkups had also increased, while the Government Health Facility became a more popular choice for delivery among pregnant women; 96.34% of the women got antenatal registration in the post-JSY-implementation phase. Almost a similar level of registration was also reported in the studies by The United Nations Population Fund UNFPA (2008)  in UP (95%) and Uttekar et al.  (2008) (88%). The overall coverage of the first postnatal check-up increased in the post-JSY-implementation phase (69.51%) compared to the pre-JSY-implementation phase (45.93%). Lower prenatal care (PNC) coverage than the present study was reported by Kaushal (2006)  in rural Kanpur (34.6%). The difference was perhaps that the quoted studies were conducted in the pre-JSY-implementation phase when the coverage of institutional deliveries was relatively low, the first PNC at day zero was an inevitable part of the institutional deliveries.
The status of antenatal registration during the pre-JSY-implementation phase was 70.12% in the general, 58.16% in the OBC, and 56.86% in SC/ST, whereas, in the post-JSY-implementation phase it was found to be 98.86, 95.92, and 94.11% in the general, OBC, and SC/ST respectively. Kaushal (2006),  had reported a similar pattern of caste-wise distribution of women receiving antenatal registration in their study in rural Kanpur. However, the study reported a comparatively less number of antenatal registrations in each caste being 96.88, 78.57, and 84.62% in the general, OBC, and SC/ST, respectively. The reason could be because of the variation in awareness of the community and motivation of the health workers, and also their study was conducted five years back, during the initial phase of inception of the JSY. We found a higher status of antenatal registration in more educated women in the pre-JSY-implementation phase (48.70% in illiterate, 71.19% in those educated up to the primary class, and 75% in those educated up to the middle class or more) as well as in the post-JSY-implementation phase (93.05, 98.31, and 100%, respectively, among illiterates, educated up to primary, and up to the middle classes or more). Kaushal (2006)  had reported almost a similar pattern.
The present study shows that in the post-JSY-implementation phase, deliveries at the Government Health Facility were 60.20, 56.87, and 43.68%, respectively, in the OBC, SC/ST, and general category. This shows that women from the backward social classes benefited more by having their deliveries at the Government Health Facility. We found that in the post-JSY-implementation phase 88.14% of the educated, up to primary class, 81.94% up to middle or more, and 17.39% of the illiterate women delivered at the Government Health Facility. It showed that educated women benefited more than the illiterate ones by using the Government Health Facility as a place for delivery. In the socioeconomical (SE) classes, 45.71% in the upper-lower and above and 71.83% in the lower socioeconomic class preferred the Government Health Facility in the post-JSY-implementation phase. More number of women from the lower socioeconomic class had benefited compared to SE class upper-lower and above. Various studies related to the social factors and other determinants of utilization of maternal health services, in India as well as other developing countries, were done by some authors like Amy J Kesterton et al.  and et al.  All of them agreed that education of the mother, ethnicity, religion, culture, and economic status played an important role in utilizing the available maternal health services.
Although the sample size of this study was adequate, the sampling in our study had a few inherent limitations, in the sense that a women who had recently delivered and had also delivered prior to JSY implementation, were obligate candidates for the study. Therefore, the results could not be generalized. Recall bias was also the limitation of this study, because we had asked them about both the recent as well as previous delivery before inception of the JSY.
In the last decade, the sociocultural and maternal health service-related factors, including JSY and others, have changed a lot. Long time duration for recall may act as a confounder. JSY implementation is taken as a time demarcation and the situation during these two periods (pre-JSY-implementation phase and post-JSY-implementation phase) are studied and compared to see the changes attributable to JSY as well as other programs and efforts.
Since the implementation of the Janani Suraksha Yojana, there has been an increment in antenatal registration and institutional deliveries, postnatal checkups have also increased, and the socioeconomically deprived classes have benefited more.
| References|| |
Park K. Park's Textbook of Preventive and Social Medicine. 21 [st]
ed. Jabalpur: Banarsidas Bhanot Publishers; 2011; p. 481.
Uttekar BP, Uttekar V, Chakrawar BB, Sharma J, Shahane S. Assessment of Janani Suraksha Yojana in Uttar Pradesh. Centre for Operations Research and Training, Vadodara: UNICEF, New Delhi; 2008. p. 33-4.
Suryakantha AH. Community Medicine with Recent Advances. 2 [nd]
ed. New Delhi: Jaypee Brothers Medical Publishers Ltd.; 2009. p. 646-7.
United Nations Population Fund (UNFPA). Concurrent Assessment of Janani Suraksha Yojana Scheme in Selected States of India New Delhi: Development and Research Services Ltd.; 2008. p. 7-8.
Kaushal SK. An Evaluation of RCH Services in Intensive and Twilight Areas of a PHC in Kalyanpur Block, Kanpur. Faculty of Medical Sciences. Kanpur: C.S.J.M. University; 2006. p. 45, 58.
Kesterton AJ, Cleland J, Sloggett A, Ronsmans C. Institutional delivery in rural India: The relative importance of accessibility and economic status. BMC Pregnancy Childbirth 2010;10:30.
Utilization of maternal health care services in Southern India. 2002;55:1849-69.
[Table 1], [Table 2]