1. Findings of Maternal Health Research Study Conducted in Assam
Keyur Sorathia
Department of Design, Indian Institute of Technology Guwahati
Tuesday 3 July 2012

2. Location of the study:
This study was conducted in 3 villages and 4 tea gardens of Assam, India.
These areas were selected on the basis of National Rural Health Mission (NRHM) authorityʼs recommendation having
higher maternal deaths in Assam, especially the areas of tea gardens in Dibrugardh district. It is considered to have
maximum maternal deaths in Assam.
User group:
The users (mothers) were selected on the criteria of illiterate/low literacy and low income group. However the team was
forced to abandon this selection criterion because mothers were found very shy to talk to researchers (male and female
both). In few cases, we had interviewed family member, especially husbands as mothers had died during pregnancy. The
users from tea gardens were mostly from Bangladesh and isolated from local community. However they were allowed to
avail services provided by NRHM.
Occupation:
Mostly into agriculture, local shops such as grocery shops, restaurants, pan and tea shops. In tea gardens, they were
workers (male & female) of those tea gardens
Education & Income level:
Villages: mostly primary education & income of 30 Rs. to 150 Rs. per day
Tea gardens: No education & income level 60-80 Rs per day
Tuesday 3 July 2012

3. Rural Areas: Belkona, Katin Pahar, Amingaon
General characteristics: In proximity of 50 kms from Guwahati, population of less than 50 thousand
Tea Garden: Tea gardens from Dibrugardh district (Beheating, Borborooah, Boughpara and Mancotta)
General characteristics: 450km from Guwahati, tea gardens
Tuesday 3 July 2012

4. Shyness
Women feel shy to talk about pregnancy. During interaction with female researcher, mothers did not talk and gave smile on every
question. One mother was found shy to call ambulance. She said “agar bula liya aur kuch nahi nikla to, sab bolenge ki abhi tak kuch
nahi hai phir bhi bula liya” (If i call and nothing happens, everyone will blame that she does not need ambulance but still called it).
In one case, child dies during first pregnancy and mother is pregnant second time. Till that date, she was unaware of the reason of
her childʼs death. She felt shy asking doctors or ASHA members.
Due to their shyness, they do not share their problems with doctors and ASHA members. Sometimes they feel shy talking to their
husbands. Typically they are guided by mother-in-law. But in some cases, mother-in-law does not allow her to go to hospital and
prefer traditional home based health care methods.
Tuesday 3 July 2012

5. Lack of family support
Husbands do not earn money, so mothers have to work. Husbandʼs work timings does not match with hospital timings, so husband
does not accompany mothers to hospital, which results in low utilization of health services. Husbands unaware of whether child is
delivered in hospital or home.
In one case, husband says, “jo ho gaya wo ho gaya ab kya kar sakte hain” (Whatever happened, it has happened, what to do now),
but never attempted to bring his wife to hospitals. In tea gardens, hospital timings and tea garden timings does not match that leads
to low utilization of maternal health services.
Tuesday 3 July 2012

6. Lack of information and family support
In this particular case (tea garden worker), mother has died during her second pregnancy. Husband is unaware of the cause of his
wifeʼs death and his childʼs death. At midnight, mother got labour pain, husband did not have any information related to emergency
ambulance number and nearby PHC. Being unaware and unplanned, he carried his wife in a lori to hospital and she died in
between. After two years of his wifeʼs death, he does not know the reason behind her death.
Tuesday 3 July 2012

7. Migration
Less stable jobs and unemployment causes families to migrate from one place to another for job hunting. This causes less utilization
of health services at hospitals, as every new hospitals requires mother to register again.
One mother did not receive NRHM money because her registration place and delivery place were different.
Tuesday 3 July 2012

8. Road condition
Low quality of infrastructure, especially road conditions restricts ambulance/emergency vehicles to reach at required places. In most
of the cases, mothers are brought to hospitals either on a cycle/lori or through a auto rickshaw chasing a longer route.
Tuesday 3 July 2012

9. Medical card
Mothers and family members rarely read the medical card and information provided inside medical card. They are typically taken out
only during the PHC visits
Tuesday 3 July 2012

10. Lack of information and ASHA
Mothers blindly follow what ASHA proposes. One mother received all the tests and checkups, but did not receive any money. When
asked she says, “ab ASHA se ladai to nahi kar sakte” (We cannot fight with ASHA). Mother walked to hospital for delivery. Mothers
do not have any clue about which tests are performed during pregnancy and why they are performed? Mother do not know how
much money they are suppose the receive.
Information regarding maternal health is not shared frequently. Mother of one house did not know about ANC, NRHM services etc.
while mother in neighbor house received complete ANC checkup and NRHM services.
Tuesday 3 July 2012

11. Culture and rituals
Evening gossip and get together is a culture is every village. Male community of village perform various activities such as gossip at
pan shop, playing carrom, chess and cards. Most talks are regarding the news and updates about the same village or nearby
villages.
Local uncertified doctors (dai/vaidh) play an important role and has more significance than PHC doctors. A mother, despite of her 11
day child being infected, checkup was done by local vaidh instead of a doctor. According to her and her family members, every
house in that village have shown the local vaidh for health related problems.
Culturally, every mother in her last trimester of pregnancy is invited to every house of the village for lunch. This lunch is found to be
flooded with fish and chicken based food.
Tuesday 3 July 2012

12. Financial constraints
Ultrasound test is not provided in NRHM services. Most mothers did not go for ultrasound test due to lack of money. One mother
stated that she got pregnant because she did not have money to buy “Saheli” (Birth control pill).
Tuesday 3 July 2012

13. Anemia, salt based tea and unawareness
People in tea gardens have habit of drinking salt based tea instead of using sugar. This was considered major cause of anemia.
However, when asked, none was aware of salt based tea being major cause of anemia. Even most mothers were unaware of the
term “anemia”. Another cause of anemia was availability of hook warm in tea gardens.
Tuesday 3 July 2012

14. Food consumption
Most mothers were unaware of proper diet, food and fruits to be taken. There was no food instruction provided by doctors or ASHA
members. Suggestions given by doctors were to eat good food, no specific food was mentioned during instruction. It was food that
few local available food is very nutritious but consumption was very low. e.g. banana flower is found cheap and frequent in Assam
which is a good cure for anemic condition, but never suggested by doctors or ASHA members.
Tuesday 3 July 2012

15. Technology usage
All interviewed houses had a mobile phone, However they were used by husbands or elderly of the house. Mother who had mobile
phone took proper care of their mobile phone. One mother (husband died and earns 25-30 Rs. a day) used her phone in such a way
that battery remains for almost a week as there were frequent electricity failures. A mother who worked as a maid, she charged her
phone at her workplace due to electricity failures in her village.
Most of the houses in villages and tea gardens had tata sky or dish tv and a radio or tap recorder.
Tuesday 3 July 2012

16. Emergency numbers
Few mothers were found aware of 108 emergency numbers. No mothers had ASHA or PHC doctorʼs number. In few cases, mothers
did not have their husbandʼs contact number. No mother was aware of 104 telephone service provided by NRHM
Tuesday 3 July 2012

17. Unawareness of ASHA members
ASHA members (especially from tea gardens) were found unaware of the term “ultrasound test”. When asked, they were not aware
of the reason of provided tests and check ups. According to them, their work is to find out a pregnant women and request her to go
to hospital for further checkup.
Tuesday 3 July 2012

18. Other findings
Social status:
mothers from lower caste (ST/SC) were less likely to go for ANC checkups. Issues such as husband work timings, social status,
female not allowed to talk to male etc. were found to be barrier for mothers to go to health centers
Sometimes doctors:
Few mothers mentioned the attitude of doctors, where doctors never explained anything, are not on time, and most of time check up
done by available nurses
Hospital conditions:
Hospital conditions are found to be inappropriate and not updated. One hospital discharged mothers within 2 hours of delivery. When
asked, doctors mentioned that they have only 3 beds and can not allow to stay mothers for longer time period
Tea garden managers:
Tea garden workers are unaware of ultrasound test funded by tea garden owners.
Lack of family planning, HIV test and postnatal test are also found negligible among mothers
Tuesday 3 July 2012

19. Thank you
Tuesday 3 July 2012