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Issues of Maternal and Child Health Care Services among Rural and Urban Population in Selected Districts of Assam

In this paper we study the variation in the issues regarding maternal and child health care services among rural and urban population in some selected districts of Assam. Five districts are selected to study the issues of maternal and child health care. These districts are selected on the basis of region i.e. upper lower, middle and hills regions of Assam. Secondary data are collected for these five districts from various sources of government publication. The data has been analyzed with the help of frequencies, percentages, rates and ratios and are presented in different tables and graphs. Results of the analysis shows that regional difference along with education has impact on utilization of maternal and child health care services.


Introduction
Assam is the land of hills and valleys and mighty river Brahmaputra flows from east to west dividing the Assam into two parts. The name "Assam" is derived from" Asom" which, in Sanskrit means unequalled or unrivalled. Assam is one of the more prominent states in India and has been involved in the political and social issues of the nation for long time.
The population of Assam according to 2011 census stands at about 31 million making the 14 th most populated state in India with a growth rate of about 17% which is very close to the national growth rate of 17%.The literacy rate in the state is improved tremendously to 73% from the last decade which was 63.25%.The sex ratio in the state is 954 females to 1000 males and the child sex ratio is 962. These indicators show that Assam is developing itself to match up with the Nation"s development and progress.
Health is an essential component for a region for its development and internal stability. Assuring a minimum level of health care is vital for a region for its development. Safe motherhood practices and child survival programs are important in a region having high infant and child mortality. Assam is one of the states having high infant and child mortality, maternal mortality and has regional disparities of maternal and child health care.

Objective of the Study
Our objective of this paper to study the variation in the issues regarding maternal and child health care services among rural and urban population in some selected districts of Assam.

Methodology and Data Base
The study is based on purely secondary data. Districts are chosen such that it represent upper and lower and hills area of Assam. The selected districts are Dhubri, Kamrup, Karbi Anglong Jorhat and Tinsukia. Secondary data for these districts are collected from the source of Annual health survey 2011-2012, Fact sheet Assam and census of India, 2011. The available literatures on the studies conducted on maternal and child health care and utilization pattern has also used. The data has been analyzed with the help of frequencies, percentages, rates and ratios and are presented in table, graphs.

Brief Description of Selected Districts
Dhubri: Dhubri district is an administrative district in the state of Assam. It situated in the extreme west corner of Assam. The district head quarters are located in Dhubri town which is situated at 290 Km from Guwahati, the state capital. The river Brahmaputra flows through the district. The district is bounded both by inter-state and international border i.e. West Bengal and Bangladesh in the west , Goalpara and Bongaigaon district of Assam and Garo hills of Meghalaya in the east, Kokrajhar district in the north, Bangladesh and state Meghalaya in the south. Covering an area of 2838 sq. Kms. including forests, rivers, hills etc; the district has become the most densely populated district in India with a density of 1171 persons per sq. Kms.(as per 2011 Census). The district has four urban areas. As per the census 2011 the total population of Dhubri is 1,949,258. Literacy rate is 58.34 which is much below the state average level. Sex ratio Dhubri district is 953 per 1000 male according to 2011 census. But the child sex ratio is 968 which higher than state ratio. As per the 2011 census demographic profile of the district shows that 90.62% people live in rural areas. The sex ratio as per 2011 census is 949 and the sex ratio for children (0-4 years) is 970. But the overall sex ratios along rural and urban region are below than the state average sex ratio. It is the third highest district in the state in terms of literacy rate. The work participation rate shows that work participation rate is higher for the urban people but the people living in rural areas their work participation rate is lower than the state"s average. Tinsukia: Tinsukia is located in the upper part of Assam and is surrounded by Arunachal Pradesh in the south-east, Dibrugarh district in the south -west and Dhemaji district in the north. Tinsukia has a geographical area of 3790 square kilometer. It was declared as the 23 rd district of Assam on ist October 1989 with three subdivisions Tinsukia, Margherita and Sadiya. Tinsukia district is situated 480kilometers north east of Guwahati and 84 kilometers away from the border with Arunachal Pradesh. The sex ratio of the district for children and over all in urban region are below the state average level. The work participation rate is higher than the state average level which indicates that people are more active and eventually pulls up the state average.     First visit to the antenatal clinic as soon as pregnancy is suspected, 2 nd between 4 th and 6 th month(around 26 weeks), 3 rd at 8 th month (around 32 weeks) and 4 th at 9 th month(around 36 weeks) . The Safe Motherhood initiative proclaims that all pregnant women must receive basic but professional antenatal care. Antenatal care can contribute significantly to the reduction of maternal morbidity and mortality because it also includes advice on the correct diet and the provision of iron and folic acid tablets to pregnant women, besides medical care. Antenatal care constitutes one of the key elements to promote safe motherhood. Improved nutritional status, coupled with improved antenatal care, can help to reduce the incidence of low birth weight babies and thus reduce perinatal, neonatal and infant mortality. The Antenatal care can be studied through indicators like percentage of mothers who received any ANC, number of Antenatal checkup, percentage of mothers who received at least 3 or more ANC and so on. The number of ANC visits by currently married pregnant women indicates the intensity of utilization of maternal health care services by the pregnant women.

Issues of Maternal and Child Health Care Services
The graphs below indicate the intensity of utilization of maternal health services by pregnant women. From the graph it can be seen that amongst currently married pregnant women in rural & urban region in all the selected districts, who receives any antenatal checkup, visits antenatal checkup in the first trimester and taking tetanus toxoid vaccines Jorhat , Tinsukia and Kamrup are ahead than other two region. Similarly for pregnant women taking IFA tablets performance of Jorhat and Kamrup are better than the remaining districts. In rural and urban Assam performance of Jorhat is better than other districts regarding mother health care services.

Immunization
The immunization of children against six serious but preventable diseases namely tuberculosis, diphtheria, pertusis, poliomyelitis and measles is the main component of the child survival program. As part of the national Health Policy, the National Immunization Program is being implemented on a priority basis. The Government of India initiated the Expanded program on Immunization (EPI) in 1978 with the objective of reducing morbidity, mortality and disabilities among children from six diseases. The information on childhood immunization i.e. vaccination coverage, has been collected on six vaccine preventable diseases viz. tuberculosis, diphtheria, whooping cough, tetanus, polio and measles for all living children. Vitamin A , Iron Folic supplement, birth weight, child feeding practices are some indicators associated with child health.
In this section the details of immunization has been shown in the graphs below along with birth weight and childhood diseases amongst the selected districts. Amongst the selected districts, Tinsukia fares the best regarding full immunization, immunization of polio, B.C.G performance etc. Amongst the selected districts though in urban region performance of Dhubri"s urban region is better in terms of check up of new born, but fares worse in terms of the utilization of child health services like children who did not receive any vaccination, polio ,measles , BCG vaccination ,and vitamin A supplementation.

Breast Feeding
Educating mothers on correct breastfeeding practices and child nutrition is one of the components of the RCH program. Infant feeding practices have significant effects on the health of both mother and children. Breastfeeding practices affect fertility and the length of birth intervals in general and postpartum fertility in particular. These effects vary according to the duration and intensity of breastfeeding. Proper infant feeding, starting from the time of birth, is important for the physical and mental development of the child. Breastfeeding improves the nutritional status of young children and reduces morbidity and mortality. Breast milk not only provides important nutrients, but also protects the child against infection. The timing and type of supplementary foods introduced in an infant"s diet have significant effects on the child"s nutritional status.

Conclusion
From the above study we have seen that Dhubri and Karbi Anglong are lagging behind in the socio economic indices like the literacy, sex ratio, work participation rate etc. These seem to have a direct implication on the mother and child health care, especially literacy rate. These two districts are lagging behind the rest in all the health care indices. Even between Karbi Anglong and Dhubri, Karbi Anglong is ahead of literacy rate in urban population, also in the health care indices. The only index in vital statistics Dhubri is ahead of the rest is Crude Birth Rate, which is highest among the Rural Population all districts.
When we look at the Antenatal care we see that Jorhat and Kamrup are well ahead of the rest of the districts, also there is hardly any difference between the indices of rural and urban population in these two districts. If we look at the other three districts, there is a stark difference in indices of When we look at delivery care, the same story repeats. Dhubri lags all other districts in providing proper delivery care to the mothers. But here, urban population in Dhubri district seems to be better off. The same is true for the postnatal care. Here, Dhubri"s rural population lags by a significant amount, but the urban population either matches or ahead of the rest of the districts.
Coming to child health care, when we look at the immunization data of these districts, we can see that Tinsukia and Kamrup are ahead of the rest. Here, the urban population of each district is ahead of its rural counterparts.
When we look at the graph use for showing children suffer from diseases, we see that Jorhat and Tinsukia are ahead of the rest. Here Dhubri seems to be doing well in both number of children suffering from either diarrhea or acute respiratory infection. Karbi Anglong along with Dhubri seems to provide better care for children, where as Jorhat and Tinsukia lags in these aspects. If we compare these results with the socio economic and demographic situations of these districts, we can see that districts with higher work population seem to lag in child care.
We can infer from these analysis is that there must be awareness among the illiterates mothers for antenatal and post natal care. Literacy helps in these cases, but for the illiterate people there must be schemes to attract them health care institutes. India"s health and welfare ministry has come out with different schemes in this regard, but the message has not reached the illiterate people. Government working in collaboration with NGOs working in these areas must try to reach out these under privileged people for proper health care for the pregnant woman, new mothers and children.
The data seem to suggest that the working population neglect the child health care. Children healthcare is paramount and this message must go to the working parents.
This study has not taken into consideration the availability of proper health care facility in the rural areas. But if we see data for child healthcare seem to infer availability of some health care facility to the total population. What probably lacking is the proper awareness drive. Government initiatives must work towards building the awareness of healthcare among all the people. India"s health care spending (as a percentage of GDP) is one of the lowest in the world. Same is the case with education. To build the future, Assam must take care that these two basic facilities reach its total population.

Conclusion
From the above study we have seen that Dhubri and Karbi Anglong are lagging behind in the socio economic indices like the literacy, sex ratio, work participation rate etc. These seem to have a direct implication on the mother and child health care, especially literacy rate. These two districts are lagging behind the rest in all the health care indices. Even between Karbi Anglong and Dhubri, Karbi Anglong is ahead of literacy rate in urban population, also in the health care indices. The only index in vital statistics Dhubri is ahead of the rest is Crude Birth Rate, which is highest among the Rural Population all districts.
When we look at the Antenatal care we see that Jorhat and Kamrup are well ahead of the rest of the districts, also there is hardly any difference between the indices of rural and urban population in these two districts. If we look at the other three districts, there is a stark difference in indices of rural and urban population. Among the all five districts under consideration, Dhubri lags the rest.
When we look at delivery care, the same story repeats. Dhubri lags all other districts in providing proper delivery care to the mothers. But here, urban population in Dhubri district seems to be better off. The same is true for the postnatal care. Here, Dhubri"s rural population lags by a significant amount, but the urban population either matches or ahead of the rest of the districts.
Coming to child health care, when we look at the immunization data of these districts, we can see that Tinsukia and Kamrup are ahead of the rest. Here, the urban population of each district is ahead of its rural counterparts. When we look at the graph use for showing children suffer from diseases, we see that Jorhat and Tinsukia are ahead of the rest. Here Dhubri seems to be doing well in both number of children suffering from either diarrhea or acute respiratory infection. Karbi Anglong along with Dhubri seems to provide better care for children, where as Jorhat and Tinsukia lags in these aspects. If we compare these results with the socio economic and demographic situations of these districts, we can see that districts with higher work population seem to lag in child care.
We can infer from these analysis is that there must be awareness among the illiterates mothers for antenatal and post natal care. Literacy helps in these cases, but for the illiterate people there must be schemes to attract them health care institutes. India"s health and welfare ministry has come out with different schemes in this regard, but the message has not reached the illiterate people. Government working in collaboration with NGOs working in these areas must try to reach out these under privileged people for proper health care for the pregnant woman, new mothers and children.
The data seem to suggest that the working population neglect the child health care. Children healthcare is paramount and this message must go to the working parents.
This study has not taken into consideration the availability of proper health care facility in the rural areas. But if we see data for child healthcare seem to infer availability of some health care facility to the total population. What probably lacking is the proper awareness drive. Government initiatives must work towards building the awareness of healthcare among all the people. India"s health care spending (as a percentage of GDP) is one of the lowest in the world. Same is the case with education. To build the future , Assam must take care that these two basic facilities reach its total population .