Abstract
Background:
Birth Preparedness and Complication Readiness (BPACR) is the intervention for planning of normal birth and anticipating the actions needed in case of complications. It is a comprehensive strategy to improve the use of skilled providers at birth, the key measure to reduce maternal mortality.
Objectives:
To assess the status of BPACR and associated sociodemographic factors among pregnant women in community.
Materials and Methods:
A community-based descriptive longitudinal study undertaken at urban slums among 156 pregnant women with >28 weeks of gestation. They were interviewed for BPACR components.
Results:
BPACR index was observed to be lower 48.3%. About 88% were aware about any one danger signs of pregnancy. Nearly, 77% of women availed antenatal care service in first trimester. About 85% women identified skilled birth attendant and mode of transport for delivery, 66% women saved money for delivery. Most common danger sign noted was abdominal pain (65.38%). Mother’s education, occupation, parity, and socioeconomic condition were significantly associated with three out of four components of BPACR.
Conclusion:
Low level of BPACR index was attributed to low level of awareness regarding government sponsored schemes and danger signs of pregnancy. This highlights need of more efforts in services provided by health care providers and workers. There is need of intense Information, Education and Communication activity focused on pregnant women and their family members.
Keywords: Danger signs, Janani Suraksha Yojana, Marathwada, Maternal and Child Health (MCH), Maternal Mortality Ratio
Introduction
India has miles to go to reduce maternal mortality ratio (MMR) as according to Sustainable Development Goal 3 (SDG3.1), we have to achieve MMR of less than 70 per 100000 live births by 2030 from the level of 113 per 100000 live births for the last 3 years reported by Sample Registration System (SRS).[1,2,3] Maternal Health Care is one of the important pillar of RMNCH+A (Reproductive Maternal Neonatal Child and Adolescent Health) Strategy which mainly focus on antenatal care and “at risk” cases management under National Health Mission (NHM) programme.[4] High levels of Maternal Mortality Ratio (MMR) (130 per 100000 live births), perinatal (23 per 1000), and neonatal (24 per 1000) mortality rate remain major public health challenge in India.[5,6]
In India social factors like socioeconomic status, family size, age at child birth, educational status, transportation problem, home delivery by untrained dais and many more along with obstetrics and nonobstetrics causes are determinants of maternal mortality.[7] Birth Preparedness and Complication Readiness (BPACR) assessment is an appropriate technology from primary health care point of view as it assesses awareness among pregnant women regarding preparedness for childbirth and related complications which helps primary care physician and health care workers to provide accessible, equitable, and affordable health care services at village level. Preparedness for birth and related complications of a child is a process to accelerate the timely use of skilled care, especially during childbirth.[8,9]
BPACR is the intervention for planning of normal birth and anticipating the actions needed in case of complications. Marathwada region in Maharashtra had poor record of MCH indicators in DLHS-4.[10] This study therefore aimed to assess the status of BPACR and associated sociodemographic factors among pregnant women residing in urban slums.
Materials and Methods
Study design, setting and duration
This study was a community-based observational descriptive longitudinal study undertaken at two randomly selected urban slums in Aurangabad. Aurangabad is important city in Marathawada region of Maharashtra with 11.75 lakh population and 87.5% literacy rate. There are 41723 households in slum areas of Aurangabad encompassing 18.81% of total city population.[11] Slums under study had total population of about 31000 with 5665 households. The population was covered by health care staff of health-post administered by Aurangabad Municipal Corporation. There were around 380 pregnant women present in study area as per records of health post staffs at the time of survey. Study was conducted from September 2017 to December 2018 which includes preparation, data collection, and data analysis phase.
Sample size and sampling technique
A community-based longitudinal study was conducted in two urban slums of city. Lottery method was used to select two slums randomly. Line listing of households and marking of households with pregnant women were done with help of health workers. Random number table method was used for selection of eligible cases from line listed cases. In sample size calculations, variable assumed was BPCR index (mean of seven indicators assessing the knowledge of community resources, planned actions, danger signs, and service utilization) of 47.5% in a study conducted at Madhya Pradesh.[12] By taking 8.5% as absolute precision and 5% alfa-error (95% confidence level), calculated sample size by using OpenEpi software was 133. Considering 10% loss to follow-up, it was 147. In study area, 192 pregnant women satisfying inclusion criteria (except willingness for participation) were found but 15 were not willing to participate and in 21 cases data was incomplete. So, final sample size was 156.
Inclusion and exclusion criteria
Pregnant women with more than 28 weeks of gestation were included (as by that time most of BPACR criteria should have followed). Those with mentally incapable and not willing to participate in study were excluded.
Ethical commitment
Institutional Ethics Committee (IEC) permission was taken before data collection. With assurance of anonymity and confidentiality and after giving detailed information about study procedure in local language, a valid written informed consent was taken.
Data collection
Information about sociodemographic parameters and ante natal care utilization was collected at first visit. Information about ante natal care utilization was updated again in subsequent visit paid in around 37–39 weeks of gestation. They were interviewed with a pre-tested, semistructured interview schedule for BPACR components along with sociodemographic and other obstetrics factors. BPACR include many components, like: (a) Awareness about danger signs of pregnancy; (b) antenatal care (ANC) registration; (c) arrangement for transportation for delivery; (d) saved money for delivery; (e) identification of skilled birth attendant; (f) knowledge about financial assistance in JSY; and (g) transportation assistance under JSY.
Statistical analysis
BPACR Index was calculated using above components. BPACR index was developed by the John Hopkin Bloomberg School of Public health.[3] Socioeconomic classification was based on poverty line guidelines issued by Government of.[4] Data were entered using Microsoft Excel 2013 version and analyzed with SPSS-v. 16. Descriptive statistics like frequency and proportions were used for qualitative data, while mean and standard deviation were used for quantitative data. Chi-square test and multivariate analysis were used as inferential statistics (P < 0.05). Graphs and tables were used at appropriate places.
Results
In this study, total 156 pregnant women (>28 weeks of gestation) were interviewed. The mean ± standard D = deviation age of participants was 22.8 ± 3.26 years, ranging from 18 to 30 years. Mean age at marriage was 17.7 years (range 13–22 years) and mean age at 1st childbirth was 19.1 (14–27 years). Most of respondents were Muslims (80.8%) and rest were Hindus (19.2%). As depicted in Figure 1, out of 156, 66 (42.3%) were having nuclear family and 57.7% were having joint family. Average per capita income was 2173 ± 1095.6 INR. Only 30 (19.23%) participants belonged to above poverty line socioeconomic status and the rest (80.77%) were below poverty line. Educationally 12 (7.7%) were illiterate or educated up to primary level, whereas 144 (92.3%) were up to secondary or above. Among all respondents, 132 (84.6%) were home maker and 24 (15.4%) were employed. Considering pregnancy status 42 (26.9%) was primigravidae and highest parity was 3.
Figure 1.
Sociodemographic profile of study participants (n = 156)
Table 1 shows awareness and practices among pregnant women about ANC and danger signs during pregnancy and labor. Out of 156 respondents, 76.9% were registered in 1st trimester, whereas 19.23% and 3.85% were in 2nd and 3rd, respectively. Only 19.23% were aware about Mother and Child Tracking System (MCTS) number. One third of respondents (34.6%) were completed four or more ANC visits. Average ANC visits were 3 (range 1–7). Nearly, 66% women knew about significance of iron folic acid tablets during pregnancy. About 92% were aware about tetanus immunization. About 20% were having knowledge about financial assistance provided in JSY and only 3.85% were knowing about transport assistance in JSY. As seen in Table 1 among all participants 87.8% were aware about any one danger signs of pregnancy. None of the women knew >8 danger signs of pregnancy. Most common danger sign noted was abdominal pain (65.38%) followed by edema over face and extremities (62.18%) and bleeding per vaginum (53.85%). About 19% were knew about any one danger sign during labor. [Table 1]
Table 1.
Awareness and practices about antenatal care (ANC) and danger signs during pregnancy and labor (n=156)
| No. of women | Percentage | |
|---|---|---|
| ANC Registration done during | ||
| 1st trimester | 120 | 76.92 |
| 2nd trimester | 30 | 19.23 |
| 3rd trimester | 6 | 3.85 |
| Awareness about mother and child tracking system (MCTS) no. | 30 | 19.23 |
| ≥4 antenatal visits | 54 | 34.62 |
| Iron folic acid (IFA) tablets | 102 | 65.38 |
| Immunization against tetanus (TT) | 144 | 92.31 |
| Awareness about financial assistance provided in Janani Suraksha Yojana (JSY) | 30 | 19.23 |
| Awareness about transportation provided in JSY | 6 | 3.85 |
| Awareness of danger signs during pregnancy | ||
| Severe hemorrhage per vaginum | 84 | 53.85 |
| Abdominal pain | 102 | 65.38 |
| Edema over face and extremities | 97 | 62.18 |
| Altered fetal movements | 78 | 50.00 |
| Leakage per vagina | 30 | 19.23 |
| Palpitations, easy fatigability, and breathlessness at rest | 9 | 5.77 |
| Fever for more than 24 h | 21 | 13.46 |
| Headache | 28 | 17.95 |
| Blurring of vision | 19 | 12.18 |
| Excessive vomiting | 36 | 23.08 |
| Awareness of danger signs during labor | ||
| Severe vaginal blood loss | 27 | 17.31 |
| Prolonged labor | 23 | 14.74 |
| Convulsions | 8 | 5.13 |
| Retained placenta | 3 | 1.92 |
Table 2 highlights levels of BPACR. None of women knew about more than eight danger signs of pregnancy. About one fifth of women were knowing about financial assistance provided by government in JSY. Only 3.8% were aware about transportation component of JSY. Nearly, 77% of women availed ANC service in first trimester. About 85% women identified skilled birth attendant and mode of transport for delivery. Two third women saved money for expenses to be occurred during delivery. BPACR was 48.3%.
Table 2.
Birth Preparedness and Complication Readiness Index (BPACR) (n=156)
| Factors | Frequency | Percentage |
|---|---|---|
| Percentage of the women who knew about >8 danger signs of pregnancy. | 0 | 0 |
| Percentage of the women who knew about financial assistance provided by government in Janani Suraksha Yojana (JSY). | 30 | 19.2 |
| Percentage of the women who knew about transportation provided by government in JSY. | 6 | 3.8 |
| Percentage of the women who availed Antenatal Care (ANC) in 1st trimester by skilled provider. | 120 | 76.9 |
| Percentage of the women who identified skilled birth attendant for delivery. | 137 | 87.8 |
| Percentage of the women who identified mode of transportation. | 132 | 84.6 |
| Percentage of the women who saved money to pay for expenses. | 102 | 65.4 |
| BPACR INDEX = Σ indicators/7 | 48.3 |
Association between maternal factors and various components of BPACR evident from Table 3. Mother’s age (P = 0.002), occupation (P = 0.046), religion (P = 0.025), and parity (P < 0.001) were statistically significantly associated with awareness about danger signs of pregnancy. But education and socio-economic status were not significantly associated. ANC registration in 1st trimester was significantly associated with socioeconomic status (P < 0.001), religion (P < 0.001), and education (P = 0.048). Mother’s education, occupation, parity, and socioeconomic condition were significantly associated with saving money for delivery and making arrangements for transportation.
Table 3.
Association between maternal factors and components of Birth Preparedness and Complication Readiness
| Maternal factors | Awareness about danger signs of pregnancy | ANC registration in 1st trimester | Made arrangement for transport | Saved money | ||||
|---|---|---|---|---|---|---|---|---|
|
|
|
|
|
|||||
| Yes (n=137) (%) | No (n=19) (%) | Yes (n=120) (%) | No (n=36) (%) | Yes (n=132) (%) | No (n=24) (%) | Yes (n=102) (%) | No (n=54) (%) | |
| Religion | ||||||||
| Hindu (n=30) | 30 (100) | 0 (0) | 30 (100) | 0 (0) | 24 (80) | 6 (20) | 18 (60) | 12 (40) |
| Muslim (n=126) | 107 (84.9) | 19 (15.1) | 90 (71.4) | 36 (28.6) | 108 (85.7) | 18 (14.3) | 84 (66.7) | 42 (33.3) |
| P; cOR (95% CI) | 0.025*;† | <0.001 *;† | 0.44; 0.67 (0.24-1.86) | 0.49; 0.75 (0.33-1.70) | ||||
| Mother’s Age (years) | ||||||||
| <20 (n=48) | 36 (75) | 12 (25) | 36 (75) | 12 (25) | 36 (75) | 12 (25) | 30 (62.5) | 18 (37.5) |
| ≥20 (n=108) | 101 (93.5) | 7 (6.5) | 84 (77.8) | 24 (22.2) | 96 (88.9) | 12 (11.1) | 72 (66.7) | 36 (33.3) |
| P; cOR (95% CI) | 0.002 *‡; 0.21 (0.08-0.57) | 0.704; 0.86 (0.39-1.89) | 0.026 *‡; 0.38 (0.15-0.91) | 0.61; 0.83 (0.41-1.69) | ||||
| Education | ||||||||
| Illiterate and primary (n=12) | 12 (100) | 0 (0) | 12 (100) | 0 (0) | 0 (0) | 12 (100) | 0 (0) | 12 (100) |
| Secondary and above (n=144) | 125 (86.8) | 19 (13.2) | 108 (75) | 36 (25) | 132 (91.7) | 12 (8.3) | 102 (70.8) | 42 (29.2) |
| P; cOR (95% CI) | 0.363;† | 0.048 *;† | <0.001 *;† | <0.001 *;† | ||||
| Occupation | ||||||||
| Unemployed (n=132) | 113 (85.6) | 19 (14.4) | 102 (77.3) | 30 (22.7) | 108 (81.8) | 24 (18.2) | 78 (59.1) | 54 (40.9) |
| Employed (n=24) | 24 (100) | 0 (0) | 18 (75) | 6 (25) | 24 (100) | 0 (0) | 24 (100) | 0 (0) |
| P; cOR (95% CI) | 0.046*;† | 0.81; 1.13 (0.41-3.11) | 0.027*;† | <0.001 *;† | ||||
| Parity | ||||||||
| 0 (n=42) | 30 (71.4) | 12 (28.6) | 30 (71.4) | 12 (28.6) | 30 (71.4) | 12 (28.6) | 18 (42.9) | 24 (27.1) |
| ≥1 (n=114) | 107 (93.9) | 7 (6.1) | 90 (78.9) | 24 (21.1) | 102 (89.5) | 12 (10.5) | 84 (73.7) | 30 (26.3) |
| P; cOR (95% CI) | <0.001 *; 0.16 (0.06-0.45) | 0.32; 0.67 (0.29-1.49) | 0.006*; 0.29 (0.12-0.72) | <0.001*; 0.27 (0.13-0.56) | ||||
| Socioeconomic condition | ||||||||
| BPL (n=126) | 108 (85.7) | 18 (14.3) | 90 (71.4) | 36 (28.6) | 102 (81) | 24 (19) | 90 (71.4) | 36 (28.6) |
| APL (n=30) | 29 (96.7) | 1 (3.3) | 30 (100) | 0 (0) | 30 (100) | 0 (0) | 12 (40) | 18 (60) |
| P; cOR (95% CI) | 0.099; 0.21 (0.027-1.62) | <0.001 *;† | 0.005 *;† | 0.001*‡; 3.75 (1.64-8.57) | ||||
*Chi-square P value statistically significant; †crude odds ratio could not be calculated as observation in cell contain zero; ‡statistically significant P value of adjusted multivariate model. cOR: Crude Odds ratio; CI: Confidence interval; BPL: Below poverty line; APL: Above poverty line
The adjusted multivariate model showed that among all these significantly associated factors, age (P = 0.005) was significant predictor for awareness of danger signs of pregnancy and socioeconomic status (P = 0.003) for savings for delivery. It clearly stated that women with age more than or equal to 20 have higher awareness than women with age less than 20 (adjusted OR: 6.72, CI: 1.79–25.15) and women with below poverty line socioeconomic status did not saved money as compared to above poverty line status in terms of proportions (adjusted OR: 0.26, CI: 0.11–0.62).
Discussion
BPACR is a managerial tool for primary care physician as it assesses performance of baseline health care staff like ASHA workers, multipurpose workers (MPWs), auxiliary nurse midwife (ANM), etc., regarding creating awareness among women for proper antenatal care, mitigating danger signs during antenatal period and labor, benefits of beforehand identification of transportation and childbirth facility and use of various national health schemes. Beside this BPACR is a strategy to accelerate the timely use of skilled maternal and neonatal care, especially during childbirth, based on a fact that preparing for childbirth and readiness for complications reduces delays in availing this care.[12]
In this study it was noted that ANC registration during first trimester (76.92%) was higher than findings noted in District Level Health Survey (DLHS) 4 i.e. (67.8%).[13] Previous studies done in REWA also reported less ANC registration in 1st trimester (31.9%).[12] Present study reported about 35% women completed four or more ANC visits which was lower than findings noted in DLHS-4, NFHS-4 and study done by Kakaire et al. in Uganda.[13,14,15] Marginally higher prevalence of tetanus toxoid immunized women (92.31) and women who had consumed 100 IFA tablets (65.38%) was noted in our study as compared to DLHS-4 report (90.6% and 42.5%, respectively).[13] Awareness and participation of women in government sponsored schemes like financial assistance and transport facility under Janani Suraksha Yojana (JSY) and registration under Mother and Child Tracking System (MCTS) were very less than 20% which is needed to be addressed through proper channel.
Current study found out that about 88% were aware about any one danger signs of pregnancy. Most common danger sign were noted was abdominal pain (65.38%) followed by edema over face and extremities (62.18%) and bleeding per vaginum (53.85%) which was differ from findings of the previous study done Ethiopia which stated that only 15.4% mentioned at least one danger sign and most common danger sign noted was vaginal bleeding (10.9%), blurred vision (2.2%), and swollen hand/face (5.2%) but findings regarding danger signs during labor matched with our study at certain level.[16]
BPACR index was calculated based on seven components and was observed 48.3% which closely matches with BPACR index found in study done in REWA (47.5%). Though 88% were knowing about any one danger sign of pregnancy but none knew about > 8 danger sign of pregnancy.[12] Also higher proportion was noted in case of 1st trimester registration (76.9%), women who had identified mode of transportation (84.6%) and saved money for expenses (65.4%) than findings observed in study done in REWA i.e. (24.1%, 18.6%, and 44.2%, respectively).[12] Study conducted in Ethiopia among 743 pregnant women, it was highlighted that only one fourth (20.5%) of pregnant women identified skilled provider which grossly lower than present study finding (87.7%).[17] Study done by Akshaya et al.[18] in Karnataka reported much higher levels of BPACR (79.3%) than present study findings. This difference might be due to lower levels of education, less proportion of institutional delivery and other social factors. Comparable levels of BPACR were reported by studies done in Nepal (31 to 65%) and Tanzania (58.2%).[19,20]
Study done by Wayessa et al.[21] reported 46.3% women practiced four or more BPACR steps. Debelie et al.[22] conducted a study on 1620 pregnant women found that prevalence of BPCR plan during pregnancy and the practice at the time of delivery were 66.1% and 73.5%, respectively. Only 15% were able to tell at least three of the five basic components of BPACR in study done by Saaka et al.[23] Findings of above studies are consistent with present study.
On statistical analysis mother’s education, occupation, parity, and socioeconomic condition was significantly associated with three out of four components of BPACR and age were associated with two components. Study done in north Ethiopia stated that maternal education was a strong predictor in preparation for birth and complication, there was a statistically significant association between parity and birth planning. Our study reported slightly different finding than this as age of mother and socioeconomic status were significant predictor of birth plan.[12] Many studies reported significant association of literacy levels with BPACR levels but current study did not observed such statistically significant association. This finding was similar to finding reported by Akshaya et al.[18] and Timsïa et al.[24]
Study done by Limenih et al.[25] in Ethiopia stated that residence, educational status, antenatal care follow-up, history of stillbirth, knowledge of BPACR plans, knowledge of key danger signs during pregnancy, child birth, and postpartum period were significantly associated with practice of BPACR plan. Debelie et al.[22] stated that frequency of ANC visits, larger number of family in the household, highest wealth asset, multigravidity, husband involvement in decision making, counseled on BPCR were found to be significantly associated with BPCR practice. Findings of these studies are quite similar to present study. Tunkara-Bah et al.[26] reported similar findings in their study along with highlighted importance of educating men on maternal health can improve their involvement in birth preparedness.
Conclusion
This study highlights not only positive things like good ANC registration, higher level of awareness towards IFA supplementation and TT immunization, making arrangement for delivery in terms of transportation and saving of money but also negative things like low awareness regarding danger signs of pregnancy and government sponsored schemes for safe motherhood. BPACR index was observed less (48.3%) in this study which was mainly attributed to low level of awareness and participation in government sponsored schemes like JSY and also low awareness regarding danger signs of pregnancy. This signifies extra efforts that are needed to be exerted by health system through health care providers and health care workers.
Limitations
Major limitation of study was recall bias about minute details of ante natal care utilization. Partial awareness of few participants about components of BPACR was another limitation.
Recommendations
BPACR assessment should be frequently conducted by primary care physicians especially in slums, tribal and rural areas to assess performance of baseline health care workers regarding increasing level of awareness among beneficiaries. Bases on assessment intense Information, Education and Communication (IEC) activity focused on pregnant women and their family members. Antenatal care with vigorous counseling regarding safer birth planning is need of a time which will ultimately result in safer motherhood and childhood.
Declaration of patient consent
The authors certify that they have obtained all appropriate patient consent forms. In the form, the patient (s) has/have given his/her/ their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.
Key Message
Frequent BPACR assessment especially in slums, tribal, and rural areas is key in the hands of primary care physicians for safer motherhood and childhood by reducing maternal and infant mortality.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
References
- 1.World Health Organization. World health statistics 2021: Monitoring health for the SDGs. 2021. [Last accessed on 2021 Jun 26]. Available from: https://cdn.who.int/media/docs/default-source/gho-documents/world-health-statistic-reports/2021/whs-2021_20may.pdf?sfvrsn=55c7c6f2_18 .
- 2.Ministry of Health and Family Welfare. Maternal Mortality Rate 2021. The Sample Registration System (SRS) report by Registrar General of India (RGI) [Last accessed on 2021 Jun 26]. Available from: https://www.pib.gov.in/PressReleasePage.aspx?PRID=1697441 .
- 3.Govt. of India. National Health Profile- 14th Issue-Central Bureau of Health. [Last accessed on 2021 Jun 26]. Available from: http://www.cbhidghs.nic.in/showfile.php?lid=1147 .
- 4.Reproductive, maternal, newborn, child and adolescent health. National Health Mission. [Last accessed on 2021 Sep 30]. Available from: https://nhm.gov.in/images/pdf/RMNCH+A/RMNCH+A_Strategy.pdf .
- 5.Govt. of India. Special Bulletin on Maternal Mortality in India 2014-16. SRS, Dec. 2018, Office of Registrar General of India. 2018. [Last accessed on 2019 Dec 25]. Available from: http://censusindia.gov.in/2011-Common/Sample_Registration_System.html .
- 6.Govt. of India. Sample Registration System Statistical Report 2016, Office of Registrar, General of India. 2017. [Last acessed on 2019 Dec 25]. Available from: http://censusindia.gov.in/vital_statistics/SRS_Statistical_Report.html .
- 7.Park K. Preventive medicine in obstetrics, paediatrics and geriatrics. Textbook of Preventive and Social Medicine. 26th ed. Jabalpur: Banarasidas Bhanot Publishers; 2021. pp. 590–610. [Google Scholar]
- 8.Baya B, Sangli G, Maiga A. Measuring the Effects of Behavior Change Interventions in Burkina Faso with Population-Based Survey Results. Baltimore, Maryland. USA: JHPIEGO; 2004. [Last accessed on 2019 Dec 25]. pp. 18–45. Available from: http://reprolineplus.org/system/files/resources/bci_%20burkina.pdf . [Google Scholar]
- 9.Maternal and Neonatal Health Programme. Birth Preparedness and Complication Readiness: A Matrix of Shared Responsibilities. Baltimore, MD: JHPIEGO; 2001. p. 12. [Google Scholar]
- 10.International Institute for Population Sciences (IIPS). District Level Household and Facility Survey (DLHS-4) Aurangabad, Maharashtra. IIPS Mumbai 2012-13. [Last accessed on 2019 Dec 25]. Available from: http://rchiips.org/nfhs/FCTS/MH/MH_FactSheet_515_Aurangabad.pdf .
- 11.Govt. of India. Aurangabad City Census 2011 data. Office of Registrar, General of India. [Last accessed on 2019 Dec 25]. Available from: https://www.census2011.co.in/census/city/360-aurangabad.html .
- 12.Nandan D, Kushwah SS, Dubey DK, Singh G, Shivdasani JP, Adish V. National Institute of Health and Family Welfare. New Delhi: 2009. [Last accessed on 2021 Oct 05]. A study for assessing Birth Preparedness and Complication Readiness intervention in Rewa district of Madhya Pradesh. http://www.nihfw.org/doc/RAHIII%20Reports/REWA.pdf. [Google Scholar]
- 13.International Institute for Population Sciences (IIPS) District Level Household and Facility Survey (DLHS-4) India. Maharashtra, Mumbai: IIPS; [Last accessed on 2019 Dec 25]. pp. 12–5. 2012-13. Available from: http://rchiips.org/DLHS-4.html . [Google Scholar]
- 14.Govt. of India. Maharashtra fact sheet. NFHS-4-National Family Health Survey. Ministry of Health and Family Welfare, 2015-16. [Last accessed on 2019 Dec 25]. pp. 1–8. Available from: http://rchiips.org/NFHS/factsheet_NFHS-4.shtml .
- 15.Kakaire O, Kaye DK, Osinde MO. Male involvement in birth preparedness and complication readiness for emergency obstetric referrals in rural Uganda. Reprod Health. 2011;8:12. doi: 10.1186/1742-4755-8-12. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 16.Hiluf M, Fantahun M. Birth preparedness and complication readiness among women in Adigrat town, north Ethiopia. Ethiop J Health Dev. 2007;22:14–20. [Google Scholar]
- 17.Hailu M, Gebremariam A, Alemseged F, Deribe K. Birth preparedness and complication readiness among pregnant women in Southern Ethiopia. PLoS One. 2011;6:e21432. doi: 10.1371/journal.pone.0021432. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 18.Akshaya KM, Shivalli S. Birth preparedness and complication readiness among the women beneficiaries of selected rural primary health centers of Dakshina Kannada district, Karnataka, India. PLoS One. 2017;12:e0183739. doi: 10.1371/journal.pone.0183739. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 19.Karkee R, Lee AH, Binns CW. Birth preparedness and skilled attendance at birth in Nepal:Implications for achieving millennium development goal 5. Midwifery. 2013;29:1206–10. doi: 10.1016/j.midw.2013.05.002. [DOI] [PubMed] [Google Scholar]
- 20.Bintabara D, Mohamed MA, Mghamba J, Wasswa P, Mpembeni RNM. Birth preparedness and complication readiness among recently delivered women in chamwino district, central Tanzania:A cross sectional study. Reprod Health. 2015;12:44. doi: 10.1186/s12978-015-0041-8. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 21.Wayessa Z, Tegegne K. Birth preparation and complication readiness among antenatal care attendants in Bule Hora governmental health facilities in Oromia region, Ethiopia, in 2019. J Midwifery Reprod Health. 2021;9:2669–78. [Google Scholar]
- 22.Debelie TZ, Abdo AA, Anteneh KT, Limenih MA, Asaye MM, Lake Aynalem G, et al. Birth preparedness and complication readiness practice and associated factors among pregnant women in Northwest Ethiopia:2018. PLoS One. 2021;16:e0249083. doi: 10.1371/journal.pone.0249083. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 23.Saaka M, Alhassan L. Prevalence and predictors of birth preparedness and complication readiness in the Kassena-Nankana district of Ghana:An analytical cross-sectional study. BMJ Open. 2021;11:e042906. doi: 10.1136/bmjopen-2020-042906. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 24.Timsïa L, Marrone G, Ekirapa E, Waiswa P. Strategies for helping families prepare for birth:Experiences from eastern central Uganda. Glob Health Action. 2015;8:23969. doi: 10.3402/gha.v8.23969. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 25.Limenih MA, Belay HG, Tassew HA. Birth preparedness, readiness planning and associated factors among mothers in Farta district, Ethiopia:A cross-sectional study. BMC Pregnancy Childbirth. 2019;19:171. doi: 10.1186/s12884-019-2325-4. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 26.Tunkara-Bah H, Adeyemo FO, Okonofua FE. Effects of health education on spousal knowledge and participation in birth preparedness in Farafenni Regional Hospital, The Gambia:A randomized trial. BMC Pregnancy Childbirth. 2021;21:129. doi: 10.1186/s12884-021-03605-y. [DOI] [PMC free article] [PubMed] [Google Scholar]