TBA-A Critical Link in MCH

West Bengal Experience.

Consortium on “The Role of Dai in the NRHM”.

New Delhi-1st May 2008

Voice from the ground

• “Kapal kharap thakle hospital e jete hai” (cited by a village women of Falta Block)

• “Sesh belai dakle jete-i hai,training thakle valo to habeii” ( cited by local UTD).

• “Dai der upor manusher biswas ekhono beshi,oder proshikkhhan khub darkar,or a mayeder bojhateo pare valo”

( quoted by GP member)

Pathos of a face!!

EDD- 21.09.07--Delivery date-2.09.2007.

Joytsana Bibi, aged 18 ,got married with Kutubiddin Mondal. After one & half years of marriage, she conceived .She got registered at sub center & received two TT & 100 IFA.

Through out the period she was fit & fine ,yet on 2nd September at around 4 am she suddenly felt mild pain in lower abdomen along with cramp on her legs. Since then she could not also perceive foetal movement as stated by her. But she could not discuss it with her family members.

Continue-

At around 8.30 am, she felt severe pain abdomen. Her family members informed local Dai without delay. She came and examined. Then she informed that delivery would take place within very short time and she could conduct delivery of her own as foetal position is normal. Unfortunately after an hour of labor, she informed that doctor is required as situation is bit critical.

Family members then called upon a local quack as PHC was bit far. He came around 10 am and gave an injection. Within five minutes after induction, part of the buttock of the baby came out from vagina. After few minutes leg came up and then he manipulated the delivery.

Unfortunately it was a dead baby boy.

WHY????

.

• Faith in traditional beliefs & practices,

• Faith in home delivery,

• Familiarity and confidentiality

• Inaccessible service from remotest village,

WHY????

.

• Lack of awareness,

• Lack of decision making skills

• Well equipped service yet a challenge.

• Unavailability of quality of care,

Urban Scenario (WB)-

. Trend in Institutional delivery (urban)

60

65

70

75

80

85

Series1

Series1 67 80 79

NFHS 1 NFHS 2 NFHS 3

Rural Scenario (WB)-

Trend in Institutional delivery (Rural)

0

10

20

30

40

Series1

Series1 23 31 34

NFHS 1 NFHS 2 NFHS 3

Few Districts highlights-

Districts with better ID status

0.00%

10.00%

20.00%

30.00%

40.00%

50.00%

60.00%

70.00%

80.00%

Series1

Series1 69.70% 57.50% 51.10%

Darjeeling Nadia Bankura

Few Districts highlights-

Districts with lower ID status

0.00%

5.00%

10.00%

15.00%

20.00%

25.00%

Series1

Series1 23.60% 17.40% 16.70%

Malda Dinajpur (N) 24 PGS (S)

Scenario of CINI area-Rural

. Delivery status of CINI field area (-24 PGS(S)

0.00%

10.00%

20.00%

30.00%

40.00%

50.00%

Series1

Series1 42.21% 14.45% 23.28% 20.06%

Doctor ANM/Nurse Delivery by Delivery by

Scenario of CINI area-Urban

. Delivery Status of CINI Urban Area

0%

10%

20%

30%

40%

50%

60%

Series1

Series1 57% 34% 10%

Institutional delivery

Delivery by trained Dai

Delivery by untrained Dai

Training of TBA-Essentiality

• Creating awareness for proper pregnancy

care.

• Timely referral for institutional delivery.

• Equipped them to conduct safe delivery at

home at the time of emergency,

Long March Yet to Go…..

THANK YOU