Cash Transfers, Institutional Delivery and Quality of Care in India

first_imgPosted on June 29, 2011June 19, 2017By: KG Santhya, Associate, Population Council, New DelhiClick to share on Facebook (Opens in new window)Click to share on Twitter (Opens in new window)Click to share on LinkedIn (Opens in new window)Click to share on Reddit (Opens in new window)Click to email this to a friend (Opens in new window)Click to print (Opens in new window)This post is part of a series of posts on cash transfers and maternal health. To read other posts in the series, click here. If CCTs are a part of your work or research, we’d love to hear from you. Contact us at clindahl@engenderhealth.org if you are interested in writing a guest post on the topic.Today, in India, nine out of 10 pregnant women receive at least one antenatal check-up; three out of four deliver their babies in a health facility; and three out of five mothers receive a postpartum check-up within 10 days of delivery. Indeed, a remarkable achievement for a country that has struggled for decades – and continues to struggle – to make motherhood safe for its women. A major driver behind this surge is the Janani Suraksha Yojana.It is very heartening to see that millions of women are accessing maternal health services. But, how are they treated at the facility once they arrive for these services? Simply as numbers to be recorded in facility registers or as human beings endowed with the right to health? Have we short-changed quality for the sake of quantity? These were some of the questions that loomed large in our mind when we set out to talk to women who had recently delivered in two districts of the state of Rajasthan, a state where 388 maternal deaths take place for every 100,000 births. We conducted a survey and talked with nearly 5,000 women. The experiences of many suggest that the quality of care is unacceptably poor.Did the introduction of the JSY lead to this unacceptably poor quality of care received by women in our study? To answer this question, we compared the experiences of women who had delivered both before and after the JSY was introduced; their descriptions of experiences at the time of their two deliveries portray a mixed picture.Dhapu, a 24 year old mother of two children living in a town, was very unhappy with the introduction of the JSY; for her, the quality of care has indeed worsened “The condition has worsened; we have to wait for half-an-hour to see the doctor and then, the doctor gives you just five minutes.”Rekha, a 25 year old mother of 2 children living in a village, had diametrically opposite views; for her, the situation has improved remarkably “Of course, there is improvement in the health of mothers as well as that of children. Earlier, people were not so aware (about institutional delivery) and many deliveries in the village used to take place at home, attended only by traditional birth attendants. There used to be problems; for example, there were problems in cutting the umbilical cord, and also some children used to turn blue or die; but now, if they face any problem in the hospital, they can be checked and treated promptly. Earlier, in villages, ladies had to bear pain for many days if a problem occurred during delivery, and some mothers used to die; it doesn’t happen in the hospital as they go for an operation in case labour pain is prolonged. Earlier, we had to go to the hospital on our own and as we didn’t know the doctors, they didn’t take care of us properly; now, as the ASHA accompanies us to the hospital, doctors also talk properly and treat us properly. Before, we had to spend money from our own pockets, now we get Rs.1,400 from the scheme and we can at least pay the conveyance charges and purchase medicines etc. using that money.”For women, like Kamla, a 28 year old mother of four children, the poor quality of care received by them had nothing to do with the introduction of the JSY. It was the reality of their life before the JSY was introduced and continues to be the reality today as well: “Each time, I must have waited for at least half-an-hour to 45 minutes. When the nurse came, she gave me dard badane ka injection [for increasing the pain]. She didn’t check my temperature or pulse. Neither did she do any abdominal or vaginal examination… She pressed my stomach so heavily that I screamed. It was like this for all my four deliveries.”Kamla wasn’t an exception; women like her constituted the majority. Our survey findings documented that the JSY has led to improvements in a few aspects of the quality of maternal health care, but for most aspects, has had no effect on the quality of care, For example, the health care provider did not conduct essential examinations – abdominal examination, vaginal examination, checking temperature and pulse – for about three in four women when they were admitted to the hospital for delivery at both times, that is, before and after the JSY was introduced. Many women were subjected to harmful practices at both times. For example, the health care provider applied strong fundal pressure (pushed hard on the abdomen) on one in three women before they delivered; they gave injection for increasing labour pain (most likely oxytocin, a practice that can sometimes lead to perineal tears, uterine rupture and foetal distress). A few things, however, have improved with the introduction of the JSY. Women, by and large, are discharged from the facility after delivery much later than in the pre-JSY period and are allowed to have the person accompanying them — family member, ASHA for example – to remain with them during delivery.In short, while the JSY has succeeded in bringing women to the health facility and has neither compromised the quality nor improved it, there is a long way to go to make motherhood safe and the quality of maternal health services respectful for women in India. The same vigour that we have shown in getting women to the facility should be demonstrated in ensuring that they receive quality care, including the benefits of evidence-based best practices, once they reach it.Share this: ShareEmailPrint To learn more, read:last_img read more

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PS4 ships 7 million worldwide outsells Xbox One in Europe 71

first_imgUpdate, 4/18/2014: Microsoft has finally released updated Xbox One sales numbers, and has stated that five million Xbox Ones have been sold to date. Meanwhile, earlier this month Sony reached seven million PS4s sold — not just shipped — and the sales gap between the two consoles has been growing. For more details, head over here. When we checked in with the PS4 last month, Sony managed to sell six million units since the console’s mid-November release last year, which was one million units ahead of Sony’s own estimate. Just one month later, more numbers have been revealed: Sony has shipped seven million PS4s worldwide, which is about three million more than the Xbox One. At the end of the day, a four-million-unit gap isn’t too gigantic. However, when compared with, for instance, the PS4’s sales compared to the Xbox One’s sales in Europe during the month of March — an eyebrow-raising seven to one lead — a different story is told. That 7:1 sales lead accounts for (more or less) the last week in March, beginning on the 17. During that period, the PS4 sold 180,000 units, while the Xbox One only managed 25,000. Unfortunately for Microsoft, the Xbox One’s biggest game, Titanfall, released just one week prior, and did not appear to help sell the console just one week later. Of course, seven million units compared to four million units isn’t anywhere close to a death knell for the Xbox One. Whenever this console cycle winds down, the final figures for both the PS4 and Xbox One might be the same. For the majority of last generation, the Xbox 360 had a significant lead on the PS3, and for similar reasons. Sony botched the PS3 launch in a variety of ways — the console was gigantic, came out too late, and was too expensive. Microsoft didn’t botch the launch of the Xbox One, but definitely botched the reveal. However, in the end, the PS3 and Xbox 360 were neck-and-neck in sales. It’s entirely possible that Microsoft’s botched Xbox One reveal will eventually wither away, and the console will catch up when all is said and one. For now, though, Sony is enjoying success, and Microsoft is sitting in the strange dual-state of succeeding while losing. The next stage in the battle will begin when both consoles finally have more triple-A exclusives.last_img read more

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Go back to the enewsletter The Landmark Mandari

first_imgGo back to the e-newsletter >The Landmark Mandarin Oriental, Hong Kong  is delighted to announce a beautiful new redesign of all of its guestrooms and suites. Providing a peaceful and comfortable residential experience, all of the guestrooms and suites have been given a fresh and contemporary makeover by the award-winning Hong Kong designer Joyce Wang. Each room is complemented by bespoke furniture and lighting options to create a sense of relaxation; a calming colour palette and luxurious fabrics have been used throughout; while the signature bathrooms with deep soaking tubs and power showers have a sleek light-filled feel. A daily selection of culinary in-room amenities, prepared by Michelin-starred Amber restaurant, will also be featured in a stylish cooling vitrine. The in-room entertainment includes a personalised TV streaming in all rooms and suites on new 48-inch and 55-inch TV screens respectively, together with perfectly positioned BOSE speakers for personal access.“We are delighted to unveil our newly refurbished and refreshed rooms, which offer guests an extremely comfortable yet entirely stylish home away from home, with all the personal services they require when travelling to Hong Kong,” General Manager, Torsten van Dullemen said. “The Landmark Mandarin Oriental is located in the heart of one of the world’s most dynamic cities, surrounded by prestigious fashion brands, businesses and international clientèle, and this redesign provides our guests with a luxurious retreat from the urban bustle and excitement.”Go back to the e-newsletter >last_img read more

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