INEQUALITY IN UTILIZATION OF MATERNAL HEALTH CARE SERVICES AMONG TEENAGE MARRIED WOMEN IN UTTAR...

Global Journal of Multidisciplinary Studies Available online at www.gjms.co.in Volume 3, Issue 10, September 2014 ISSN: - 2348-0459

An international double – blind peer reviewed, refereed and Indexed Journal

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INEQUALITY IN UTILIZATION OF MATERNAL HEALTH CARE SERVICES

AMONG TEENAGE MARRIED WOMEN IN UTTAR PRADESH: EVIDENCES

FORM NFHS-3

AMBARISH KUMAR RAI, PH. D.

INTERNATIONAL INSTITUTE FOR POPULATION SCIENCES, MUMBAI,

INDIA – 400088

BAL GOVIND CHAUHAN, M. PHIL.

INTERNATIONAL INSTITUTE FOR POPULATION SCIENCES, MUMBAI,

INDIA – 400088

ABSTRACT

Objectives: Coupled with the largest number of maternal deaths, maternal

care in India has received overriding importance due to early age at marriage

and poor accessibility of maternal health services. This study examines the

factors associated and assessed the economic inequality in utilization of

maternal health care services (full ANC, Safe delivery and PNC) among

teenage mothers in Uttar Pradesh.

Methods: third wave of National Family Health Survey (2005–06) data was

used for the study, Bi-variate analyses employed to determine the difference

in proportion, and logistic regression to understand the effect of predictor

variables on selected outcomes were applied, to access economic inequality,

CI index have calculated.

Results: significant differences have found in the utilization of maternal

healthcare services by Birth order & birth interval, caste, wealth index and

education. Teenage mothers from SC/ST, poorest quintile, Multiple birth

orders & 24< months of interval, and no educated were less likely than their

counterpart mothers. Economic inequality was highest in full ANC followed

by PNC and safe delivery among teenage mothers.

Conclusions: study found that all the previous programs related to

utilization of maternal care services were being far from their target;

although they are working but, not with the needed pace. Therefore, there is

a need to introduce a new policy intervention in accordance with region wise

which specially focuses on teenage mother and disadvantages mothers by

improve the information-communication facilities. The government should

ensure the local people participation to make efficient use of the

opportunities available.

Keywords: Full ANC, Safe Delivery, Postnatal Care, Teenage Mother,

Economic-Inequality, CI Index, Logistic Regression,



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Introduction

Pregnancy and its outcome as

childbearing are the most special

events in the women‟s life and their

families, hence, care of mother

during that partum period is the

necessary and effective

interventions for safer and

healthier outcome, and it is most

essentials if the mother is in

teenage stage. As a group, however,

teenagers have quite different

needs, in terms of reproductive

health services, from adults

mothers in different important

ways (1), but most of the developing

nations like India, it remains poorly

underserved. So, maternal health

care utilization became one of the

most important components of

MDGs during the ICPD 1994 with a

great emphasised on younger

mothers. In 2005, it was estimated

that about each second deaths

among mother only cause of

pregnancy related complications

over the worldwide (2, 3). The

„„greatest health divide in the world‟‟

is the gap of overall risk of death

caused by maternal causes

between develop and developing

nation. Globally, about four-fifth of

maternal death in women

contributed by haemorrhage,

sepsis, unsafe induced abortion,

hypertensive disorder of pregnancy

and obstructed labour and these

occurs only due to negotiate with

the needs of maternal care, but

these deaths are unjust and can be

prevented with some effective key

health interventions, like to insure

providing universal services of

maternal health care and assisted

safe delivery by health personnel (2,

4, 5).

In addition, the huge proportions

of the risk of maternal deaths were

not uniformly distributed across

globally, and it was more skewed

towards developing nations. In

2005, about 99% of total maternal

deaths occurred in the developing

world, and more drastically, 86% of

total maternal deaths of the world

concentrated in Sub-Saharan

Africa and South Asia alone.

In India, where the more than half

of the population (about 55%) lies

in reproductive (15-50 years) age

group (6), the importance of

maternal health services utilization

automatically gets a significant

attention because of the need of

health care for such a huge chunk

of the population. Utilization of

antenatal, natal and postnatal care

is important for reducing maternal

morbidity and mortality. India

contributed about one-fourth of

total maternal deaths across

worldwide and Uttar Pradesh have

the largest share of these all

maternal deaths (7). Uttar Pradesh,

one of the prime and highly

populous states of India, continues

to have one of highly reported

figure of maternal mortality ratio



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i.e. 440 per 100, 000 live births and

still remains above the national

average (8). Uttar Pradesh,

however, is characterized by low

uptakes of maternal health

services, and it is one of the

deprived states of India in terms of

socio-economy and demographic

condition. Still there are a number

of health plans has executed

specially related to maternal health

care services, but that hasn't been

a change the expected scenario.

Earlier studies have underlined the

socioeconomic gradient in the

utilization of maternal health care

utilization among teenage mother

in the context of rural and urban

India (9, 10). About every second

mother, who was pregnant, only

able to seek any ANC care services

and even when they went for

services, it was the second

trimester with the sole purpose of

the confirmation of their pregnancy

in Uttar Pradesh. It is not so

surprisingly observation and so

common in Uttar Pradesh where

the utilization of maternal health

services is very low, and people are

not too much conscious about to

understand that pregnancy needs

any special attention (10).

Therefore, the extensive objective of

this study is to examine the

determinants and existing

inequality in utilization of maternal

health care services, in terms of,

full antenatal care, safe delivery

and postnatal care by wealth index

of the household in Uttar Pradesh.

Methods

Data

The present study utilizes data

from the third round of the

Demographic and Health Survey

(DHS), known as the National

Family Health Survey (NFHS),

carried out in India during 2005–

06. The NFHS is a large-scale,

multi-round survey conducted in a

representative sample of

households covering more than

99% of the population throughout

India. The main instrument for the

collection of the data in NFHS -3

was the set of structured

questionnaires. Information of the

maternal health care was from all

women who had given birth in the

five year preceding the survey. This

study considers only the most

recent live births and excludes

multiple births.

Outcome Variables

The term “Teenage Mother” refers

only to ever-married women who

have had the experience of

childbirth within 15–19 years of age

during the 5 years preceding the

survey date. The present study

measures three outcome variables:

Full Antenatal Care (Full ANC) has

been defines as at least three

antenatal care visits, consumed

90+ Iron Folic Acid (IFC) tablets



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and took two or more tetanus-

toxoid injections.

Safe Delivery defined as either

institutional delivery or home

delivery assisted by doctor,

auxiliary nurse midwife, nurse,

midwife, lady health visitor or any

other health personnel.

Postnatal Care indicates whether

the women received any checkups

of her own health within 2 days (48

hrs.) after the delivery of child.

Exposure Variables

The explanatory variables included

in the analysis are: Maternal Age

(recoded <18 years and 18-19

years), Birth Order & Birth Interval,

Caste/Tribe, Religion, Place of

Residence, Educational Level,

Wealth Index, Women‟s Work

Status, Exposure to Mass Media

and Household Structure. Birth

order and interval were categorized

as, first birth order, birth order

second or third and interval < 24

months, and birth order second or

third and interval 24 and more

months. The place of residence

variable is categorized as urban

and rural. Caste/Tribe is

categorized as SC/ST, other

backward caste (OBC) and others.

Religion is categorized as Hindu

and non-Hindu. The economic

status of the households has been

captured in the wealth index which

has been categorized into poorest,

poor, middle, richer and richest.

Education of women is used as a

categorized variable with four

categories; No education, primary,

secondary and higher. Exposure to

mass media is categorized as

exposed and not exposed to any

means of mass media (newspaper,

radio, television and cinema).

Women‟s work status recoded as

not working, working, household

structure has been categorized as

nuclear, non-nuclear.

Analytical Approach

To identify factors associated with

selected maternal healthcare

utilization among adolescent

women, bivariate and multivariate

analyses were performed. Bivariate

analyses were performed to

examine the nature of association

between utilization of maternal

healthcare services by selected

socioeconomic and demographic

background characteristics.

Multivariate analyses used logistic

regression to investigate which

factors best explain and predict the

utilization of the health outcome.

Three outcome variables, namely

full antenatal care, safe delivery

and postnatal care (within 42 days

of delivery) were considered for the

multivariate analyses. The results

were presented by estimated odds

ratio with 95% confidence interval.

The appropriate sampling weight

has been supplemented to perform

the whole analysis. In order to

assess the economic inequality in



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maternal health care services

utilization, concentration curve

have been employed. The analyses

were conducted using SPSS version

21.0.

Results

Background Characteristics of

Teenage Mothers

Table 1: The background

characteristics of teenage mothers,

who had at least one live birth

during last five years in Uttar

Pradesh, illustrated that nearly

one-third teenagers became the

mother before their legal age at

marriage (18 years), and nearly

17% have multiple births with

births interval of less than 24

months. 84 percent of them were

from rural, one-third belongs to

socially deprived classes (SCs &

STs) and less than one-fifth of them

were non-Hindu (Table 1). Three-

fifth teenage mothers belong to

poor wealth quintile and more than

25% were from non-nuclear family.

Half of this teenage mother hadn‟t

any type of media exposure, 57% of

them were illiterate, and only one-

fifth of them were secondary

educated. Five out of six teenage

mothers were reported do not have

any work while more than 75% of

them reported their spouses were

working but as an unskilled

worker. The surprising result has

found in the study was that about

84% of the teenage mother who has

child stated that they wanted the

child.

Table 1: percent distribution of women who had at least one live birth

during the last five year preceding the survey by background

characteristic in up, 2005-06

Background characteristics % n

Mother Age

<18 Years 30.77 187

18-19 Years 69.23 421

Birth Order & BI

Birth Order 1 67.09 407

Higher Order & < 24 Months BI 16.66 101

Higher Order & 24 < Months BI 16.26 99

Sex of the Child

Male 51.7 311

Female 48.93 297

Place of Residence

Urban 16.54 101

Rural 83.46 507



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Caste/ Tribe

SC/ST 33.87 206

OBC 49.8 303

Others 16.34 99

Religion

Hindu 83.35 507

Non Hindu 16.65 101

Wealth Index

Poorest 26.58 162

Poor 30.42 185

Middle 21.19 129

Rich 14.3 87

Richest 7.5 46

Mother Education

No Education 56.26 342

Primary 15.48 94

Secondary 23.14 141

Higher 5.12 31

Father Education

No Education 25.99 156

Primary 11.79 71

Secondary 54.2 325

Higher 8.02 48

Working Status

Not Working 84.11 511

Working 15.89 96

Media exposure

No Exposure 51.27 312

Any Exposure 48.73 296

Wanted Last Child

Wanted 83.98 511

Unwanted 16.02 97

Household Structure

Nuclear 28.39 173

Non-Nuclear 71.61 435

Total 14.0 608

BI: Birth Interval, Higher Order: Birth Order more than one.



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Prevalence and Differential in

Utilization of Maternal Health

Care Services

Birth order and interval, place of

residence, caste, wealth quintile,

education of women and her

spouses and media exposure

played an important role to

determine the level of maternal

health care services in teenage

mothers in Uttar Pradesh. Only 3%

of teenage mothers were able to

access the full antenatal care, less

than one-third went for safe

delivery and only every tenth

teenage mother were able to get

postnatal care after the childbirth

(Table 2). The result illustrate that

the teenage mothers of first parity

have higher chances (4.1% used

ANC, 38% safe delivery and 15%

used PNC) to go for maternal health

care services compared to those of

more than one parity. Those

mothers who had birth interval of

less than 24 month were less

accessible for full ANC (1.1%) than

those who had birth interval more

than 24 months (3.4%). Urban

teenage mothers were more

utilizing of maternal health care

services (7.7% ANC, 49% sage

delivery & 30% PNC) than rural

(2.7% ANC, 30% Safe delivery &

11% PNC).

Table 2: Percentage of women who had at least one live birth in their

teens (aged 15–19) during the last five years preceding the survey by

usage pattern of maternity and child health care services and by

background characteristics in Uttar Pradesh, 2005–06

Background

Characteristics

Full

ANC

Safe

Delivery PNC n

Age

<18 3.0 31.8 11.4 179

18-19 3.7 33.4 14.9 429

Birth Order & BI

Birth Order 1 4.1 38.4 15.4 401

Higher Order & < 24

month BI 1.1 23.2 13.3 106

Higher Order & 24< month

BI 3.4 20.5 8.1 100

Sex of the Child

Male - - 56.1 310

Female - - 41.5 297

Place of Residence



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Urban 7.7 49.4 30.3 156

Rural 2.7 29.6 10.6 452

Caste/Tribe

SC/ST 1.6 23.3 10.3 195

OBC 4.1 34.8 12.7 309

Others 5.6 47.2 24.8 104

Religion

Hindu 3.9 33.7 13.9 482

Non- Hindu 1.2 29.0 13.6 126

Mother Education

No Education 1.0 22.0 8.0 335

Primary 4.7 38.0 17.9 95

Secondary 5.6 46.9 21.5 147

Higher 17.9 74.8 32.0 31

Paternal Education

No Education 0.7 22.3 8.8 157

Primary 3.2 23.7 8.1 73

Secondary 2.4 36.2 16.2 319

Higher 20.8 62.6 25.6 50

Wealth Index

Poorest 1.4 19.4 4.9 144

Poor 0.6 23.1 10.9 172

Middle 2.6 36.5 11.4 129

Rich 6.6 50 22.1 101

Richest 19.3 77.7 48.9 62

Mother Work Status

Not Working 3.7 33.7 15.0 517

Working 1.2 29.1 8.2 90

Media Exposure

No Exposure 0.7 27.0 9.0 299

Exposure 6.4 39.2 18.9 309

Wanted Last child

Wanted 3.3 32.2 13.6 513

Unwanted 4.6 36.8 15.0 95

Household Structure

Nuclear 2.6 21.6 8.6 180



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Non-Nuclear 3.8 37.4 16.0 428

Total 3.5 32.9 13.8 608

BI: Birth Interval, Higher Order: Birth Order more than one

Social groups also had shown

uneven utilization of maternal

health care services among teenage

mothers. Only 1.6% of SCs/STs

teenage mothers received full ANC

while, in OBC and others group, it

was 4.1% and 5.6% respectively.

Less than one-fourth SC and STs

teenage mothers were used the safe

delivery services while, in OBCs,

and others social group mothers, it

was nearly 35% and 47%

respectively. The PNC services were

more accessible (25%) by other

caste mothers than SC/ST (10%)

and OBC group (13%) of teenage

mothers. There was a huge

disparity among different wealth

quintile teenage mothers for

accessing the maternal health

services. From poorest wealth

quintile, only about 1% of teenage

mothers accessed the ANC, 19%

went for safe delivery and 5% used

PNC services, while about one-fifth

mother used ANC, more than three-

fourth were accessed the safe

delivery and nearly every second

teenage mother get the postnatal

care from richest quintile of teenage

mothers. The mother who were

higher educated, nearly 18% of

them used antenatal care, about

three-fourth went for safe delivery

services and one-third woman

accessed the postnatal care, while

for not educated mother this

prevalence were 1%, 22% and 8%

respectively. An interesting result

had seen that the working teenage

women were less accessed the

maternal health care services than

their counterparts. Media exposed

teenage mothers were more

accessed the maternal health care

services (6.4% of ANC, 39% safe

delivery and 19% PNC) than their

counterparts mothers (1% ANC,

27% safe delivery & 9% PNC).

Figure 1: Concentration curves showing inequalities in Maternal Health

Care services by Wealth Quintile of Teenage Mothers in Uttar Pradesh,

2005-06



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Economic Inequalities in Maternal Health Care Utilization

In order to assess the economic

inequality in Utilization of maternal

health care (full ANC, safe delivery

& PNC) services, concentration

indices (CI) and concentration

curves (CC) have employed (Figure

1). Findings indicate substantially

large, consistent and pro-rich

inequalities in the utilization of

these three indicators of maternal

healthcare services among teenage

mothers in Uttar Pradesh. The

magnitude of economic inequality

in utilization of full ANC was

highest (CI: 0.54) followed by PNC

(CI: 0.36) and lowest for safe

delivery (CI: 0.25) in Uttar Pradesh

during 2005-06. It indicates that

few numbers of the teenage mother

were able to access the ANC care

while, for safe delivery, most

women visited health facilities.

Probably it‟s only due to have any

type of pregnancy complication

rather than they aware.

Determinants of Maternal Health

Care Utilization

Birth order & birth interval, caste

of the teenage mother, wealth index

and education of the mother were

the most significant variables that

highly influenced the level of


services in teenage mothers, in

Uttar Pradesh (Table 3). The

results illustrate that the teenage

mothers, had birth interval of less

than 24 months, were less likely to

get the antenatal care, safe delivery

and PNC services than the teenage

mother of their reference category

mother. Rural mother were less

likely to use PNC services than

their counterparts (p=0.546 at 95%

of CI). Teenage mothers from OBC

and Others category were 40% and

80% more likely (p=1.405 (OBC) &

1.842 (others) at 95% CI) for using

the safe delivery services than



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SC/ST teenage mothers. Others

caste mother were 65% were more

likely to use the PNC services than

their reference category mothers.

The mothers from richest quintile

were 13 times more likely to use

the ANC services than the poorest

quintile of mothers. The non-poor

quintile mothers were more likely to

go for safe delivery and PNC

services than their reference

category. Media exposed mothers

were three times more likely to use

ANC services than the mothers who

hadn‟t any type of media exposure.

Above primary educated teenage

mothers were more likely for safe

delivery and PNC than primary

educated. Non-working and joint-

family women were about 60% and

40% respectively more likely to go

for safe delivery services than their

counterpart mothers. One

important variable was the sex of

the child which determined the

postnatal care services utilized by

teenage mothers. For the female

births, mothers were about 60%

less likely to get the PNC service,

than the mothers who birthed male

child.

Table 3: Result of Logistic Regression (Odds Ratio for the CI of 95%)

showing the determinant of Maternal Health Care services in Uttar Pradesh,

2005-06

Background Characteristics Full ANC Safe

Delivery PNC

Birth Order& Interval

Birth-Order 1®

Higher Order & <24 month BI 0.175** 0.426*** 0.921

Higher Order & 24< month BI 1.227 0.426*** 0.561**

Sex of Child

Male®

Female -- -- 0.591***

Residence

Urban®

Rural 2.197 0.98 0.546***

Cast/Tribe

SC/ST®

OBC 2.164* 1.405* 0.986

Others 2.209 1.842*** 1.659*

Religion

Hindu®

Non-Hindu 0.359* 0.706* 0.971

Wealth

Poorest®



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Poor 0.426 1.11 1.854

Middle 1.353 1.801*** 1.581

Rich 2.374 3.231*** 2.648**

Richest 13.424*** 8.245*** 6.543***

Media Exposure

No Exposure®

Exposure 3.563* 0.843 1.202

Mother Education

Primary®

Secondary 2.745 1.645** 1.971**

Middle 1.326 1.61*** 1.576**

Higher 0.954 3.953*** 1.688

Husband's Education

Primary®

Secondary 2.72 0.869 0.786

Middle 1.112 1.075 1.136

Higher 7.309** 1.722* 1.052

Work Status of Mother

Working®

Not working 0.963 1.631** 1.07

Child status

Wanted®

Unwanted 1.007 1.24 0.948

Household structure

Nuclear®

Non nuclear 0.53 1.396* 1.409*

®: Reference category; ***p<0.01; **p<0.05; *p<0.1 (at 95% of CI)

Abbreviation: BI: Birth Interval, Higher Order: Birth Order more than one,

CI: Confidence Interval

Reason for not delivering the

Birth in Health Facility

Women who did not deliver their

last child in a health facility were

asked about the reason for not

delivering in a health facility (11).

There seem to be several reasons.

The major reasons given (Figure 2),

it was found that, in Uttar Pradesh,

about 81% teenage mother

responded “not necessary” while,

for every fourth teenager, it was too

much costly. For 7% teenage

mothers, health facility was either

too far or not available, and a

similar number of teenage did not

go because their husband/family

did not allow them.



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Figure 2: Percentage of women who had a live birth in the five year

preceding the survey by reason for not delivering the most recent live

birth in a health facility, india-2005-06

Note: Percentage is not 100 due to multiple responses by respondent

(n=455)

Discussion and Conclusion

Several numbers of governmental

and non-governmental organization

made their efforts to enhance the

level of maternal health care

services and made it more

accessible and effective in the last

decade. Early marriages of the girl

child and its negative impact on

their health have been seen widely

(12, 13), and, in most of the

developing countries, we found that

younger age mother were severe

threatening towards delivery

complications, which enhances the

chances of death of mother or poor

health of mothers (14, 15, 16).

Studies from developing countries

illustrate that women, for their first

delivery, are significantly more

likely to utilize the maternal

healthcare services (17, 18, 19).

Literature suggested that the

women having higher parity were

less likely to go for safe delivery by

health professionals (20), and the

same pattern has been seen a

study made in six developing

countries. Although it is not clearly

says why higher order younger age

mothers are less likely to utilize

safe delivery services (21), it may be

argue that the chances of the

higher number of parity exist to

those mothers only who were less



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educated or from poor

socioeconomic stratum, so due to

lack of knowledge and due to time

and resource constraints, she does

not expose towards safe delivery

(22, 23, 24). Few other studies also

argued that lower parity women

tend to pay her full attention

towards seeking assistance by

health professionals during her

delivery due to her inexperience

with pregnancy and high risks for

women and child health (20, 25).

This study suggests the immediate

need for intense research to

understand the factors that being

obstacles in the path of utilization

of maternal healthcare services, in

higher birth order young age

mothers.

In teenage mothers, the utilization

of recommended ANC, safe delivery

and PNC services were higher in

urban than in rural areas. The

same finding has been seen that,

rural women give birth at home in

the absence of skilled care, in a

study conducted in eight other

West African countries, (26). The

urban teenage mothers have many

advantages over their counterparts,

like having higher levels of

knowledge due to media exposure,

more accessible towards services

and actively participation in health

promotion programs (27, 28). To

improve the level of maternal health

services a more comprehensive and

people participation based

approaches are needed in rural

population.

In the social groups, the difference

in healthcare service utilization

could be linked with the well

determine factors like social norms,

cultural beliefs and practices (29,

30). The study of Hausa community

has shown a number of negative

health experiences due to the

pregnancy on younger age of

mothers (29). Child marriage was

directly linked to the low level of

educational attainment and further

it associated with starting child

bearing at younger and high order

of births with narrow birth intervals

among young age mothers of the

Hausa/ Fulani/Kanuri social

groups and significantly influences

their healthcare utilization (31). So

this study underscore about

spreading awareness by

community-based interventions

that can change the behavior and

mentality of this underserved social

group about their specific health-

damaging cultural norms and

perceptions.

This study illustrates that the

utilization of ANC, safe delivery and

PNC services are significantly

associated with wealth quintile

status of teenage mothers. The

same finding has been seen in

previous widely available literature,

and one of the evidence from

African countries highlights the

significant economic inequality in

healthcare service utilization (32



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33, 34). This may be due to the

poor are busy to earn their bread

and butter rather than to go for the

healthcare expenditure until unless

that is not severe while the people

from rich households can easily

affords and spend a higher

proportion of their own earning for

healthcare (35). Since teenage

mother has less exposure of

education and rare chances to

engage in earning, and hence there

may be chances to expand a

minimum for their good health

care. A community based approach

must be needed for utilization of

maternal health care services that

target the special group of poor and

especially teenage mothers. In

addition to providing reproductive

health information and services,

they also address a wide range of

needs including life skills, literacy,

vocational training, and livelihood

activities (36).

The findings of the study also

shows the significant positive

effects of the educational

attainment on maternal health

service utilization among teenage

mothers and are consistent with

other studies from developing

African countries (37, 38, 39) and

in India too (9, 10). Probably

educated women have better access

to health services and related

information along with improved

perceptions of the root causes of

disease and can utilize such

information optimally so for that

the positive association between

mother education and maternal

health service utilization has been

seen (31). Greater autonomy comes

only through the high attainment of

education in women, and that

helps to make decisions and have a

greater ability to use quality

healthcare inputs (19, 40).

The findings of this study confirm

that, along with mother‟s

education, there was a positive

effect of husband‟s education on

maternity care utilization has been

seen among teenage mothers of

Uttar Pradesh. Several studies have

been shown that male educational

attainment and his engagement in

women‟s health needs enhances

the chances of women‟s maternal

and reproductive healthcare

choices and their utilization (41,

42, 43, 44, 45, 46, 47, 48) and

support the same finding of this

study.

The effect of mass media exposure

on recommended ANC, safe delivery

and PNC services utilization are

positively associated and consistent

with previous studies (49, 50).

Existing studies clearly illustrated

that the mass media which is an

effective in information

dissemination, works to spread

awareness about healthcare

facilities that are available and

impetus inter-personnel

communication rapidly and that

could facilitate behavioral changes

(51). There is a need to broadcast



85

the educational programs through

electronic media and it also insure

that it could reach the teenage

mothers, along with to all those

belong to disadvantaged social

groups, and specifically, to the low

privileged teenage mothers living in

rural areas. One of the important

indicators, sex of child at birth,

illustrated that for male birth, large

number of teenage mother in Uttar

Pradesh, went for postnatal care

services compare to their counter

parts. The sex preference for child

birth is still high in State like Uttar

Pradesh, and similar result also

have been seen in the different

study (52, 53) which stated that,

due to strong desire of son

preference at births, mother as well

as child have been treated

accordingly, after the birth of child.

Implications for Policy and/or

Policy

The evidence of the study found

that all the previous programs

related to enhance the level of


services are far from their target;

although they are working but, not

with the needed pace. Therefore,

there is a need to adopt different

health policy intervention in

accordance with the urban and

rural area which specially focuses

on younger age mother and

socioeconomically disadvantages

mothers by improve the

information education

communication facilities with a

focus on rural area. The

government should collaborate and

co-operate with local level health

care agencies and ensure the local

people participation to make

efficient use of the opportunities

available. The need of the time is

weigh the available options and

stabilize up a weak health

infrastructure to minimize a

disaster as the road ahead is

uncertain, but definitely not short.

Acknowledgement

The authors acknowledge the editor

and anonymous reviewers whose

constructive suggestions helped

immensely to improve this paper.

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