The Integrated Child Development Services
(ICDS) scheme was initiated in the year 1975 and later it became the
largest Governmental programme for mother care and child
development. The beneficiaries included children (0-6 yr), expectant
& lactating mothers, and women aged 15-45 years. Facilities provided
were supplementary nutrition, immunization, non-formal education of
preschool children, functional literacy of the women, and essential
health care and health surveillance [1]. We had studied the
utilization and availability of antenatal and perinatal care in 1991
[2]. To evaluate the progress made in availability and change in
utilization patterns of the services over a period of about 2
decades, we conducted this study during 2009-2010. We visited the
same ICDS block (Chaksu, District Jaipur, Rajasthan) as in previous
study and door to door survey of all lactating mothers was done
using similar questionnaire [2]. Lactating woman was defined as one
who had delivered a child (living or dead) within the last 12 months
and was not pregnant again during the same period.
TABLE I Comparison of the Data from 1991 and 2009-10
|
1991 |
2009-10 |
|
N =136 (%) |
N=182, (%) |
Age <18 yr |
3 (2.2) |
3 (1.7)
|
Age 18-35 yr |
127 (93.4) |
175 (96.2) |
Age >35 yr |
6 (4.4) |
4 (2.2) |
ANC received |
99 (72.8) |
178 (97.8) |
First ANC
|
First trimester |
15 (11) |
103 (56.6) |
Second trimester |
54 (39.7) |
64 (35.2) |
Third trimester
|
30 (22.1) |
11 (6.0) |
Number of ANCs
|
1-3 times |
84 (61.8) |
124 (69.7) |
4-5 times |
02 (1.5) |
42 (23.6) |
³6 times |
13 (9.6) |
12 (6.7) |
Receipt of Tetanus Toxoid
|
Two doses |
90 (66.2) |
178 (97.8) |
One dose |
3(2.2) |
0 |
Not received |
43 (31.6) |
04 (2.2%) |
Antenatal supplementation
|
Regularly |
46 (33.8) |
140 (76.9) |
Irregularly |
22 (16.2) |
19 (10.4) |
Nil |
136 (50) |
23 (12.6) |
Place of delivery
|
Sub center
|
2 (1.5) |
30 (16.5) |
PHC
|
4 (2.9) |
12 (6.6) |
Private Hosp
|
16 (11.8) |
26 (14.3) |
Hosp
|
6 (4.4) |
105 (57.7) |
Other
|
1(0.7) |
0 |
Home |
107 (78.6) |
09 (4.9)
|
Postnatal care* |
Untrained dai |
0 |
0 |
Trained dai |
0 |
0 |
ANM |
3 (2.2) |
02 (1.1) |
LHV |
0 |
0 |
Medical officer |
12 (8.8) |
117 (64.3) |
Other |
1 (0.7) |
0 |
Total received care |
16 (11.7) |
119 (65.4) |
Initiation of breastfeeding |
Within 6 hours |
23 (17.2) |
149(81.9) |
6-48 hours |
74 (54.5) |
21 (11.5 ) |
>48 hours |
39 (28.3) |
05 (2.7) |
Died |
|
7 (3.8) |
*0-10 days after birth |
Table I shows the comparative data in
year 1991 and 2009-2010. Overall, significant improvement in
delivery and coverage of services in ICDS scheme were observed in
terms of coverage of antenatal care (72.8% vs 97.8%), Tetanus
Toxoid (TT) administration (68.4% vs 97.8%) and Iron Folic
acid (IFA) supplementation (50% vs 87%) during pregnancy,
institutional deliveries (4.4% vs 57.7%) and breastfeeding
practices (initiation of breastfeeding within 6 hours of child
birth, 17.25 vs 81.9%). However, early marriage and child
birth were still a problem as 2.2% mothers were younger than 18
years in 1992 as well as 2010. The norm of having two children is
not yet established as 29% mothers were having 3 or more children in
year 2009-10, which also suggests inadequacy of birth control
measures.
There are many other areas where improvement was
suboptimal like first ANC visit in first trimester, >3 ANC visits,
ANC as well as TT at all, and not receiving IFA supplementation.
However, these data were better as compared to national figures
reported by Government of India where 11.5% pregnant mother did not
receive ANC and 26.5% did not receive TT [1] and also in the report
from Rajasthan (2010) only 55% pregnant women received TT [3].
Postnatal care was a relatively weak area of ICDS project as only
65.4% mothers received postnatal care as compared to national data
where 87% received PNC [3,4]. Postnatal home visits in initial 2
days after delivery has been shown to reduce neonatal mortality
rate; hence, it is very important to improvise this [4]. There was
increasing trend to have antenatal, natal and postnatal services
from medical officers and home deliveries were significantly reduced
from 78.6% in 1992 to 4.9% in 2010. However, the progress made in
many areas were also due to additional efforts made as part of Janai
Suraksha Yojna in National Rural Health Mission, which has its
primary focus on institutional deliveries.
To conclude, ICDS program has made significant
improvement in many areas but a lot need to be done for improvement
in postnatal care, promotion and initiation of breastfeeding within
2 hours of birth.
Contribution: MKK, SK & MG conceptualized the
study and drafted the manuscript; MKK, AKM &SK were involved in data
collection and MKK, MG analyzed the data.
References
1. Three decades of ICDS: An Appraisal; National
Institute of Public Cooperation and Child Development: Government of
India, Ministry of Health and Family Welfare 2006. Available from:
URL: http:// http://nipccd.nic.in/reports/eicds.pdf. Accessed May
15, 2012.
2. Kakkar M, Sharma U, Kabra A, Kakkar S.
Availability of antenatal and perinatal care in an ICDS area. Indian
Pediatr. 1995; 32: 597-9.
3. RCH II Outcomes: State Data Sheet, 2010
accessible from
http://www.mohfw.nic.in/NRHM/PRC_RA_Reports/Rajasthan/Chittorgarh/State%20Fact%20Sheet.pdf.
Accessed May 15, 2012.
4. National Rural Health Mission: Rajasthan State
Report, Government of India 2009Available from: URL: http://
www.mohfw.nic.in/..l ./Rajasthan_Report. Accessed May 15, 2012.
5. Gogia S, Ramji S, Piyush G, Gera T, Shah D,
Mathew JL, et al. Community Based Newborn Care: A Systematic
Review and Meta-analysis of Evidence: UNICEF-PHFI Series on Newborn
and Child Health, India. Indian Pediatr. 2011; 48:537-46.