Sucharita Chakraborty*
Abstract
Communication has become widely accepted all over the developing world as a potent tool for rural development. Pregnancy and childbirth have a huge impact on the physical, mental, emotional, and socioeconomic health of women and their families. Pregnancy-related health outcomes are influenced by a woman’s health and other factors like race, ethnicity, age, and income. The application of mass communication to influence fertility is natural extension of the basic idea that the media can both inform and motivate people. Communication efforts have become increasingly widespread in the developing world as part of international technical assistance and government programs designed to reduce fertility. This paper is based on a study carried out to find out the “existing” knowledge and awareness related to maternal health and what communication media are used by rural women in Karimganj district as sources of information.
Introduction
The magnitude of women’s reproductive health problems in India is a matter of serious concern. Among the reproductive health parameters Antenatal Care (ANC) and safe delivery are important as these are directly related to maternal morbidity, mortality etc. Safe motherhood means ensuring that all women receive the care they need to be safe and healthy throughout pregnancy and childbirth. In 1996, safe motherhood and child health services were incorporated into the Reproductive and Child Health Programme (RCH). The Safe Motherhood Initiative is a global effort that aims to reduce deaths and illnesses among women and infants, especially in developing countries.
Communication is extremely important for women’s development and mass media play a significant role in it. Messages have been regular features of radio and more recently on television. Their content in several regional languages, sponsored by family welfare program, has traditionally related to contraception and more recently to such issues as immunization, antenatal care, age at marriage and dowry. The family welfare programme also promotes messages through traditional folk media which are widely accessible to much of rural India. Poor, rural women are the least likely to be exposed to the electronic or the print media. For them, traditional media continue to be the major source of information and most important among these is interpersonal discussions, at their doorsteps. In addition, women’s groups (Mahila Swasthya Sanghs) have been created; these groups are expected to assist ANMs in their activities while at the same time provide a forum for discussion of family welfare issues.
The status, employment and work performed by women in society are the indicator of a nation’s overall progress. Women are often considered the decision-makers and healthcare givers in the family across the globe. The multiple roles women play in the home profoundly influence the health of both their families and of themselves. In other words, the roles that a woman plays in the family not only influence the health of family members but may also influence the health of the woman herself.
Objectives
The following objectives were formulated to guide the study:
- To assess the “existing” knowledge and awareness related to maternal health among rural women in Karimganj district.
- To identify the major sources of information among the rural women in Karimganj district.
Material and methods
Study Setting
The sample for the present investigation was drawn from Karimganj district of Barak Valley, Assam. The district is comprised of seven blocks. One village from each block was covered for the project, Masly (Badarpur block), Sadarashi (North Karimganj block), Alongjuri (South Karimganj block), Moina (Patherkandi block), Sibergool (Lowairpoa block), Dargarbond (R.K. Nagar block) Beratuk (Dullavchera block).
Study Sample
A list of rural married women aged between 15 and 35 years was prepared from the area. The total sample size of the project is 350; 50 respondents from each village were selected on the basis of voter list.
Methodology
The assessment was conducted using a structured schedule. Face to face survey schedules were administered by the researcher because of the low literacy level amongst the women. The questions related to their awareness of antenatal checkups, immunization, breast feeding, health, hygiene, family planning. The survey schedule was prepared in English and took about 15-20 minutes to complete. Women were interviewed at their homes by the researcher.
Literature review
Findings of a study conducted by Shukla (2000) reported that the major source of information for rural people is the radio (87%). About 95% people reported that they are used to listening the radio either regularly or occasionally. Urban masses use all types of channels of information. But television and newspapers are the two most important sources of information.
Study done by Gupta (1992), on ”Mass Media and Social Change”, revealed that the maximum number of respondents preferred radio listening (73.33%) rather than reading the newspapers (66.67%) and television viewing (60.00%).
Ugboajah (1986) points out that “Oral media” are more appropriate for the oral and communalistic cultures of rural populations in Africa than the mass media which have been organized in the context of the already atomized western societies.
Singh and Singh in their study on communication and development came to the conclusion that there is a positive relationship between communication and development of a region/area. They believe that both communication and development processes support and reinforce each other (Singh and Singh: 1981:61).
Gupta (1995) cited that radio and television are the best sources for creating awareness and interest regarding a new message or idea “but when it comes to adoption of the idea, interpersonal sources such as extension agents, friends, neighbours, family members are the most effective” (Gupta, 1995, p.72).
Data analysis and results
TABLE 1: RESPONDENTS AWARENESS REGARDING CHILD IMMUNIZATION
| Option | Frequency | Percentage |
| OPV | 82 | 23.42 |
| BCG | 61 | 17.42 |
| DPT | 54 | 15.42 |
| Measles | 49 | 14.0 |
| Total no. of fully immunized | 246 | |
| Not immunized | 104 | 29.71 |
| Total | 350 |
According to the survey, 82 (23.42%) infants received OPV, 61 (17.42%) BCG, 54 (15.42%) DPT, a slightly lower proportion of children 49 (14.0%) received the measles vaccine and 104 (29.71%) were not immunized. In the case of female children, coverage was significantly higher among Hindus and in literate families. Knowledge about Hepatitis B was very limited.
Reasons for not immunizing children
Out of 104 who were not immunized, 60 (57.69%) mothers of the children are unaware of the need for immunization, followed by 18 (17.30%) who had no faith in vaccination, for 13 (12.5%) the place or time of vaccination was not known, 8 (7.69%) had family problems, and 5(4.80%) feared side effects.
TABLE 2: SOURCES OF INFORMATION ABOUT THE PROGRAMME
| Option | Frequency | Percentage |
| Health workers | 158 | 64.22 |
| Radio | 57 | 23.17 |
| Newspaper | 14 | 5.69 |
| TV | 10 | 4.06 |
| Hoarding | 7 | 2.84 |
| Folk media | – | – |
| Total | 246 |
Out of 246 sources of information about Vaccine Preventable Diseases the major one was mainly from health workers 158 (64.22%), followed by radio 57 (23.17%), newspapers14 (5.69%), TV 10 (4.06%) and hoardings 7 (2.84%). Most women reported that ANM and ASHA are the key facilitators for immunization and a trusted source of information and advice on health issues.
TABLE 3: RESPONDENTS AWARENESS REGARDING SPACING OF BIRTH
| Option | Frequency | Percentage |
| Not aware | 241 | 68.85 |
| Less than 24 months | 50 | 14.28 |
| 3 Years | 35 | 10.0 |
| 4 Years or more | 24 | 6.85 |
| Total | 350 |
Out of 350 respondents the majority of 241(68.85%) left this matter to God and they were actually not in favour of birth-spacing, followed by 50 (14.28%) who mentioned a ‘too short’ interval (less than 24 months) as ideal space between births, 35 (10.0%) preferred a gap of three years and 24 (6.85%) preferred four years or more.
TABLE 4: SOURCES OF INFORMATION TO THE RESPONDENTS
| Option | Frequency | Percentage |
| Health workers | 64 | 58.71 |
| Radio | 40 | 36.79 |
| Newspaper | 5 | 4.58 |
| TV | – | – |
| Hoarding | – | – |
| Folk media | – | – |
| Total | 109 |
Health workers were the most cited source of information by 64 (58.71%) respondents followed by 40 (36.79%) who said it was radio, for five (4.58%) it was TV.
TABLE 5: AWARENESS ABOUT TT IMMUNIZATION DURING PREGNENCY
| Option | Frequency | Percentage |
| Aware | 101 | 28.85 |
| Not Aware | 249 | 71.14 |
| Total | 350 |
Most of the respondents had little knowledge on immunization and received two or more tetanus injections while pregnant 101 (28.85%) and 249 (71.14%) had no knowledge about it at all. There were misconceptions like sterility and many respondents considered it as ineffective.
TABLE 6: SOURCES OF INFORMATION
| Option | Frequency | Percentage |
| Health workers | 59 | 58.41 |
| Radio | 36 | 35.64 |
| Newspaper | 6 | 5.94 |
| TV | – | – |
| Hoarding | – | – |
| Folk media | – | – |
| Total | 101 |
Out of 101 respondents, the majority 59 (58.41%) who had more frequent visits from health workers reported a significantly higher immunization rate, followed by 36 (35.64%), newspaper 6 (5.94%).
TABLE 7: AWARENESS ABOUT VARIOUS PROVISIONS GIVEN IN JSY SCHEME
| Option | Frequency | Percentage |
| Monetary benefit | 209 | 59.71 |
| Accompanying person | 87 | 24.85 |
| Accompanying person to escort pregnant women | 54 | 15.42 |
| Total | 350 |
The majority 209 (59.71%) was aware of monetary benefits and the exact amount of money given to beneficiaries, followed by 87 (24.85%)who were aware of payment for the accompanying person under the scheme, 54 (15.42%) respondents knew that there is a provision of a person escorting the pregnant woman to health care facility.
TABLE 8: SOURCES OF INFORMATION
| Option | Frequency | Percentage |
| Health workers | 277 | 79.14 |
| Radio | 58 | 16.57 |
| Newspaper | – | – |
| TV | 5 | 1.42 |
| Hoarding | 10 | 2.85 |
| Folk media | – | – |
| Total | 350 |
Source of information about these initiatives is predominantly ASHA/ANM for 277 (79.14%) respondents, followed by 58 (16.57%) radio, five (1.42%) TV and hoardings 10 (2.85%). Most of the mothers knew about the schemes from ASHA. They also reported having heard about the schemes from their relatives and friends.
TABLE 9: AWARENESS ABOUT FAMILY PLANNING
| Option | Frequency | Percentage |
| Aware | 297 | 84.85 |
| Not Aware | 53 | 15.14 |
| Total | 350 |
The majority of respondents 297 (84.85%) said that they considered family planning methods for the health of the mother and the children. Lack of knowledge of family planning was cited by 53 (15.14%) of women who do not intend to use this method.
TABLE 10: AWARENESS ABOUT THE VARIOUS METHODS OF FAMILY PLANNING
| Option | Frequency | Percentage |
| Sterilization | 51 | 53.68 |
| Copper-T | 25 | 26.31 |
| Oral Pills | 11 | 11.57 |
| Others | 8 | 8.42 |
| Total no. of adoption | 95 | |
| Not adopted | 202 | 68.01 |
| Total | 297 |
Out of 297 respondents, those who have children, only 95 (31.98%) have adopted permanent family planning methods and 202 (68.01%) respondents disapproved of contraceptive use. Out of 95, 51 (42.10%) respondents adopted sterilization followed by 25 (26.31%) copper-t, 11 (11.57%) oral pills and 8 (8.42%) others, not adopted 202 (68.01).
TABLE 11: SOURCES OF INFORMATION
| Option | Frequency | Percentage |
| Health workers | 233 | 78.45 |
| Radio | 47 | 15.82 |
| Newspaper | 8 | 2.69 |
| TV | 7 | 2.35 |
| Hoarding | 2 | 0.67 |
| Folk media | – | – |
| Total | 297 |
Out of 297 respondents, the main source of information was health workers as reported by 233 (78.45%), followed by 47 (15.82%) radio, eight (2.69%) TV, seven (2.35%) hoarding, two (0.67%) newspaper. More educated and better off women are more likely to have been exposed to family planning messages in the media.
TABLE 12: AWARENESS REGARDING INSTITUTIONAL DELIVERY
| Option | Frequency | Percentage |
| Home | 218 | 62.28 |
| Govt. Facility | 102 | 29.14 |
| Private Facility | 30 | 8.57 |
| Total | 350 |
Of the total respondents, a majority of 218 (62.28%) had child delivery at home claiming that home was the best place for giving birth where they were assisted by family members, followed by 102 (29.14%) who used government health facility for child birth and 30 (8.57%) sued the private facility.
TABLE 13: SOURCES OF INFORMATION
| Option | Frequency | Percentage |
| Health workers | 79 | 59.84 |
| Radio | 44 | 33.3 |
| Newspaper | 6 | 4.54 |
| TV | 3 | 2.27 |
| Hoarding | – | – |
| Folk media | – | – |
| Total | 132 |
Out of 132 those who are aware about institutional delivery, the main source of information was the health worker, as reported by 79 (59.84%) followed by 44 (33.3%) who said it was radio, while six (4.54%) said it was TV and three (2.27%) said the source was the newspaper. JSY seeks to promote institutional delivery by providing a cash incentive to mothers who deliver their babies in a health facility.
TABLE 14: AWARENESS REGARDING ANTI-NATAL CHECK UP
| Option | Frequency | Percentage |
| Aware | 82 | 23.42 |
| Not Aware | 268 | 76.57 |
| Total | 350 |
The prevalence of antenatal care coverage is still low among women. Among those who did obtain care only 82 (23.42%) received antenatal care before the sixth month of pregnancy from a medically trained provider (i.e. doctor/ nurse/ midwife) while majority 268 (76.57%) did not obtain any care.
TABLE 15: SOURCES OF INFORMATION
| Option | Frequency | Percentage |
| Health workers | 41 | 50.00 |
| Radio | 27 | 32.92 |
| Newspaper | 8 | 9.72 |
| TV | 6 | 7.31 |
| Hoarding | – | – |
| Folk media | – | – |
| Total | 82 |
About antenatal care, out of 82 respondents a majority of 41 (50.00%) reported hearing about it through health workers, followed by 27 (32.92%) radio, eight (9.75%) newspaper and six (7.31%) TV.
TABLE 16: AWARENESS ABOUT BREASTFEEDING
| Option | Frequency | Percentage |
| After One Hour | 208 | 59.42 |
| Six Hour Later | 90 | 25.71 |
| Twelve Hours Later or more | 52 | 14.85 |
| Total | 350 |
Women in rural areas have a very positive attitude toward the initiation of breastfeeding. About 208 (59.42%) of the children below three years were breastfed after one hour of birth followed by 90 (25.71%) six hours later, 52 (14.85%) twelve hours later or more. Majority of the women had admitted that someone had helped them out in initiating breastfeeding. Many sources have been responsible for this initiation.
TABLE 17: SOURCES OF INFORMATION
| Option | Frequency | Percentage |
| Health workers | 271 | 77.42 |
| Radio | 44 | 12.57 |
| Newspaper | 18 | 5.14 |
| TV | 10 | 2.85 |
| Hoarding | 7 | 2.00 |
| Folk media | – | – |
| Total | 350 |
The majority 271 (77.42%) of the mothers were influenced by health workers or elderly female family members like mother, mother-in law/ grandma, regarding breastfeeding , followed by 44 (12.57%) radio, 18 (5.14%) newspaper, 10 (2.85%) TV and seven (2.00%) by hoardings.
Conclusion
The above findings mirrored a number of similar previous research findings about the realities of communication in the rural sector. Low literacy level among rural women in Karimganj district is one of the major barriers to exposure to the print media. The study has also showed the relative less importance of the mass media, with the exception of radio, as sources of information and the importance of such interpersonal communication channels such as health workers and relatives. In the context rural women in Karimganj district it is gratifying to note from the findings of this study that radio and health workers (ASHA) are major sources of development information among the rural women.
Folk media are part and parcel of rural people, but their viewership/utilization is gradually reduced. With regard to the general awareness or awareness about socio-economic issues like health and education, it is revealed that the role of folk media as a source of information is insignificant. Yet, since a considerable number of respondents said that they are interested in folk media, the potentialities of folk media cannot be underestimated/ undermined.
From the analysis, it is event that any strategy for effectively communicating development programs for rural women in Karimganj district must combine both folk/mass media, particularly radio, with interpersonal interaction. Such a strategy will not only complement the power of the mass media to widely disseminate messages but also can create awareness among rural women of Karimganj district for development.
References
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