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 Table of Contents  
ORIGINAL ARTICLE
Year : 2015  |  Volume : 2  |  Issue : 4  |  Page : 324-328

Knowledge, awareness, and utilization pattern of services under Janani Suraksha Yojana among beneficiaries in rural area of Himachal Pradesh


Department of Community Medicine, Indira Gandhi Medical College, Shimla, Himachal Pradesh, India

Date of Web Publication18-Sep-2015

Correspondence Address:
Anjali Mahajan
Department of Community Medicine, Indira Gandhi Medical College, Shimla - 171 001, Himachal Pradesh
India
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Source of Support: Nil., Conflict of Interest: There are no conflicts of interest.


DOI: 10.4103/2348-3334.165737

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  Abstract 

Introduction: Safe motherhood is perceived as a human right, and the health sector is always encouraged to provide quality services to ensure the same. Government of India launched a scheme called Janani Suraksha Yojana (JSY) on April 11, 2005, under the flagship of National Rural Health Mission to reduce maternal and neonatal mortality, by promoting institutional deliveries for which financial incentives are provided to mothers delivering in the health facilities. Objective: To study the knowledge, awareness, and utilization pattern of services under JSY among the beneficiaries in rural area of Shimla, Himachal Pradesh, India. Materials and Methods: This cross-sectional study was conducted among the 78 JSY beneficiaries residing in the rural field practice area of Indira Gandhi Medical College Shimla, Himachal Pradesh, India. These beneficiaries were interviewed with pretested, predesigned, semi-structured close ended questionnaire by house-to-house visits, after obtaining informed consent. Results: Majority of the JSY beneficiaries (50; 64%) were in the age group of 20–25 years and 43 (55.1%) of them heard about the JSY scheme before the present pregnancy. Anganwadi workers 78 (100%) and female health workers (62; 79.5%) were the main sources of information. More than half of the study participants (44; 56%) had good knowledge about the scheme and 42 (53.85%) registered their name in health institution during thefirst trimester of last pregnancy. Forty-four (56.4%) beneficiaries had undergone three antenatal checkups and only 11 (14.1%) of them received three postnatal (PN) visits. All the beneficiaries received the JSY incentives 1-week the following delivery. Conclusions: Awareness regarding the JSY scheme, early antenatal registration, minimum three antenatal care visits, and three PN visits is still low among rural women which needs strengthening through intensification of IEC activities.

Keywords: Antenatal check-up, beneficiaries, institutional delivery, Janani Suraksha Yojana, Janani Suraksha Yojana incentive, postnatal care


How to cite this article:
Chauhan PL, Dhadwal D, Mahajan A. Knowledge, awareness, and utilization pattern of services under Janani Suraksha Yojana among beneficiaries in rural area of Himachal Pradesh. CHRISMED J Health Res 2015;2:324-8

How to cite this URL:
Chauhan PL, Dhadwal D, Mahajan A. Knowledge, awareness, and utilization pattern of services under Janani Suraksha Yojana among beneficiaries in rural area of Himachal Pradesh. CHRISMED J Health Res [serial online] 2015 [cited 2019 Nov 14];2:324-8. Available from: http://www.cjhr.org/text.asp?2015/2/4/324/165737


  Introduction Top


India accounted for 19% of the globally estimated 287,000 maternal deaths in 2010.[1] Maternal mortality ratio of India has declined from 212/100,000 live births in 2007–2009 to 178/100,000 live births in 2010–2012.[2] Most of the neonatal deaths in developing countries occur at home, unattended by skilled health professionals.[3],[4]

Janani Suraksha Yojana (JSY) scheme was launched in Himachal Pradesh 7 years back to reduce maternal and neonatal mortality in the state by promoting institutional deliveries.[5] The present study was undertaken to estimate the level of knowledge, awareness, and utilization pattern of services among the beneficiaries under the scheme.

Aims and objectives

  • To estimate the level of the awareness and utilization pattern of the JSY scheme among the JSY beneficiaries in the rural field practice area of Department of Community Medicine Indira Gandhi Medical College (IGMC), Shimla, Himachal Pradesh, India
  • To determine the association between knowledge and service utilization with various sociodemographic variables.



  Materials and Methods Top


The present cross-sectional study was conducted among the 78 beneficiaries of the JSY scheme residing in the rural field practice area of Department of Community Medicine IGMC, Shimla, Himachal Pradesh, India, who had delivered and utilized/availed the services under JSY in the previous 1-year (w.e.f. April 1, 2012, to March 31, 2013). There were 822 deliveries registered in the rural field practice area during the same period and out of which 78 were eligible JSY beneficiaries who availed/utilized the services under the JSY scheme. A baseline list of all the JSY beneficiaries was taken from the register of block accountant of Rural Training Health Centre. All the beneficiaries under JSY were interviewed by a pretested, semi-structured, scheduled close ended questionnaire by the house-to-house visits after obtaining consent.

Inclusion criteria

  • Beneficiaries who delivered in between April 1, 2012, to March 31, 2013
  • Availed services under JSY and are permanent residents of Mashobra area
  • Willing to participate in the study.


Exclusion criteria

  • Age <19 years
  • Those delivered after March 31, 2013, and have more than two children
  • Members of above poverty-line families
  • Not willing to participate.


Study tools

Interview technique was used as a study tool in this study. A pretested, semi-structured, close ended questionnaire was used to collect the data from study participants. The questionnaire was pretested before administering to the study clients. This questionnaire comprised of following sections:

Section A: Sociodemographic variables of beneficiaries

Section B: Awareness about the JSY scheme among beneficiaries

Section C: Utilization pattern of the JSY scheme among beneficiaries.

Ethical aspect

This study was undertaken after taking ethical clearance from the Institutional Ethics Committee of IGMC, Shimla, Himachal Pradesh, India.

Data analysis

The data were collected, summarized, and analyzed through descriptive and inferential statistic using SPSS version 17.0 (IBM). A two-tailed P value of <0.05 would be considered as statistically significant. The categorical variables were analyzed using either Chi-square or Fisher's exact test as applied. The quantitative variables were described as mean ± standard deviations.


  Results Top


The study was conducted among the 78 beneficiaries of the JSY scheme who delivered between April 1, 2012, and March 31, 2013, and who had availed the benefits under the JSY scheme. The study found that majority of the JSY beneficiaries 50 (64%) were in the age group of 20–25 years, and the mean age of the study participants was 24.9 ± 2.3 years [Table 1]. The study found that more than half of the beneficiaries 41 (52.56%) were educated up to matriculation level. It was found that 53 (67.95%) of them belonged to scheduled caste category, and most of the participants (63; 80.77%) were housewives by occupation. It was found that most of them (56; 71.79%) belonged to joint families, and 68 (87%) of them belonged to the socioeconomic status of Class V as per modified BG Prasad classification.
Table1: Sociodemographic profile of the study population

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The study observed that 43 (55.1%) have heard about the JSY scheme before the present pregnancy and Anganwadi workers (AWWs) (100%) and female health workers (FHWs) (62; 79.5%) were the main sources of information regarding the JSY scheme to the beneficiaries [Table 2]. This study revealed that 42 (53.85%) of them registered their name in health institution during thefirst trimester of this pregnancy. It was observed that 44 (56.4%) and 15 (19.23%) study participants underwent three and four antenatal checkups (ANCs), respectively [Table 3]. The coverage of tetanus toxoid immunization was 100%, and nearly two-thirds of study participants 52 (62.7%) received 100 tablets of iron and folic acid. The study found that most of the study participants (64; 82%) delivered in government hospitals and only 14 (18%) delivered at home. It was also found that 45 (57.7%) of the beneficiaries reached the place of delivery by hiring a vehicle and 37 (47.4%) took half an hour to one hour to reach the place of delivery. This study has found that only 11 (14%) of the study participants received three postnatal (PN) visits and all the beneficiaries received JSY incentive after 1-week of delivery.
Table 2: Knowledge about the JSY scheme among the study population

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Table3: Utilization of services among the beneficiaries under the JSY scheme

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The study also found that educational status of the beneficiaries had statistically significant association with timing of registration. The study found that 62% of the beneficiaries educated up to matriculation level and above got registered during thefirst trimester of pregnancy, while 80% of the study population educated below matriculation level registered their name during the second trimester of pregnancy and this was found to be statistically significant (P < 0.01). There is no statistically significant association between other sociodemographic variables and timing of registration among the beneficiaries [Table 4]. The study also found that there was no statistically significant association between various sociodemographic variables and the level of knowledge [Table 5].
Table 4: Association between the timing of registration and sociodemographic variables

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Table 5: Association between level of knowledge and sociodemographic variables

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  Discussion Top


The study found that majority of the beneficiaries (50; 64%) were in the age group of 20–25 years with a mean age of 24.9 ± 2.3 years [Table 1]. This study finding is similar to a study conducted in Madhya Pradesh [6] in which 63% of the beneficiaries were in the age group of 21–25 years. Similar finding was observed in a study conducted in Himachal Pradesh [7] by Center for Operations Research and Training (CORT), in which 92% of the beneficiaries were in the age group of 21–29 years, and the mean age of study participants was 23.6 years. This study found that 41 (52.5%) of them were educated up to matriculate level followed by 16.67% educated up to 12th standard. A study conducted in Haryana [8] also found that 35% of the study population was educated up to high school level and only 2.6% of the study participants were educated up to graduation level or above. The study findings are quite different from the findings conducted by CORT in Madhya Pradesh.[9] It was revealed in the present study that majority of them (53; 68%) belonged to scheduled caste category and 25 (32%) belonged to general caste category. This study finding is similar to the study findings observed in Orissa [10] in which they found that 75% of the study population belonged to the scheduled caste category.

This study found that AWWs (100%) and FHWs (62; 79.5%) were the main sources of information regarding the JSY scheme to the beneficiaries [Table 2]. A study conducted in Himachal Pradesh [7] by CORT Vadodara found that ANMs were the main source of information about JSY (48%) followed by AWWs (36%). This study found that 44 (56.4%) and 15 (19.23%) beneficiaries had conducted three and four ANCs, respectively. A study conducted by CORT Vadodara in Himachal Pradesh [7] found that 28% of the study participants had three ANCs. It was also found that 45 (70.5%) beneficiaries reached the place of delivery by hiring a vehicle and 8 (12.5%) reached by using personal vehicle. A study conducted in Jabalpur, Madhya Pradesh,[6] also observed the same finding as 67% of the beneficiaries have to hire vehicle to reach the place of delivery.

The study also observed that only 14% of the study population received 3 or more than 3 PN visits and further only 15.4% of the beneficiaries receivedfirst PN visits within the 1st week following delivery [Table 3]. A study conducted in Haryana [8] found that 63% of the mothers got three or more PN checkups done, while 2.7% did not receive any PN care. The study found that all of the beneficiaries received incentive 1-week after delivery usually in the 2nd or 3rd week following deliveries and majority of them (56; 71.8%) received JSY incentives in the form of cash. A study conducted in Himachal Pradesh by CORT Vadodara [7] revealed 28% of the women received the cash assistance much later after delivery and another 17% received the cash assistance within a week after delivery.


  Conclusion Top


This study revealed that the awareness regarding the JSY scheme, importance of early registration, number of ANCs, and PN visits among the beneficiaries of this rural area is still low. Delay in the payment of JSY incentive is another issue which needs to be adequately addressed and efforts should be made to provide it to the beneficiaries as per the guidelines.


  Recommendation Top


Intensification of IEC activities about the JSY scheme in rural area by health department and various other agencies, that is, nongovernmental organizations, youth clubs, Mahila Mandals and PRIs, etc., is the need of hour to increase the knowledge and awareness about the scheme and importance of ensuring comprehensive care during pregnancy among women and their family members. Men should be sensitized on maternal health services as male involvement is important to encourage the involvement of women to seek comprehensive maternal health care. JSY incentive should be ensured to be paid at the time of delivery in the institution and moreover 50% of the incentive should be paid to the beneficiaries in the last trimester of pregnancy.

 
  References Top

1.
WHO, UNICEF, UNFPA and World Bank Estimates. Trends in Maternal Mortality: 1990 to 2010. 2012. Available from: http://www.who.int/reproductivehealth/publications/monitoring/9789241503631/en/. [Last accessed on 2014 Oct 04].  Back to cited text no. 1
    
2.
Special bulletin on maternal mortality in India, 2010-2012. Sample Registration System. Office of Registrar General, India. Available from: http://www.censusindia.gov.in/vital_statistics/SRS Bulletins/MMR Bulletin-2010-12.pdf. [Last accessed on 2014 Oct 08].  Back to cited text no. 2
    
3.
Lawn JE, Cousens S, Bhutta ZA, Darmstadt GL, Martines J, Paul V, et al. Why are 4 million newborn babies dying each year? Lancet 2004;364:399-401.  Back to cited text no. 3
    
4.
Knippenberg R, Lawn JE, Darmstadt GL, Begkoyian G, Fogstad H, Walelign N, et al. Systematic scaling up of neonatal care in countries. Lancet 2005;365:1087-98.  Back to cited text no. 4
    
5.
Janani Suraksha Yojana: Features and Frequently Asked Questions and Answers. Ministry of Health and Family Welfare. Maternal Health Division, Government of India. New Delhi: 2006. Available from: http://www.mohfw.nic.in/WriteReadData/l892s/file28-99526408.pdf. [Last accessed on 2014 Oct 04].  Back to cited text no. 5
    
6.
Gupta SK, Pal DK, Tiwari R, Garg R, Sarawagi R, Kumar A: Assessment of Janani Suraksha Yojana (JSY) - in Jabalpur, Madhya Pradesh: knowledge, attitude and utilization pattern of beneficiaries: A descriptive study. International Journal of Current Biological and Medical Science 2011;1:6-11.  Back to cited text no. 6
    
7.
Uttekar BP, Sharma J, Uttekar V, Barge S, Deshpande Y, Shahane S. Assessment of Janani Suraksha Yojana in Himachal Pradesh. Centre for Operations Research and Training. Vadodara, UNFPA sponsored study. New Delhi: 2007. p. 35-49. Available from: http://www.cortindia.in/RP%5CRP-2007-0302.pdf. [Last accessed on 2014 Oct 08].  Back to cited text no. 7
    
8.
Malik JS, Kalhan M, Punia A, Sachdeva S, Behera BK. Utilization of health services under Janani Suraksha Yojana in rural Haryana. Int J Med Public Health 2013:3:176-9.  Back to cited text no. 8
    
9.
Uttekar BP, Sharma J, Uttekar V, Barge S, Deshpande Y, Shahane S. Assessment of Janani Suraksha Yojana in Madhya Pradesh. Centre for Operations Research and Training. Vadodara, UNFPA sponsored study. New Delhi: 2007. p. 35-49. Available from: http://www.cortindia.in/RP%5CRP-2007-0302.pdf. [Last accessed on 2014 Oct 08].  Back to cited text no. 9
    
10.
Nandan D, Malini S, Tripathi RM, Khattar P, Nair KS, Tekhre YL, et al. A rapid appraisal on functioning of Janani Suraksha Yojana in South Orissa. Health Pop: Perspectives Issues 2008;31:126-31.  Back to cited text no. 10
    



 
 
    Tables

  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5]



 

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