STATEMENT OF PROBLEM

To study the barriers in the utilization of health services by mother and children. The
purpose of the study is to find out the co relation between the various factors affecting the
use of maternal and child health services.

INTRODUCTION
Maternal health is the integral part of the reproductive health, referring to the health of a
women during her pregnancy, delivery, and the post partum period (WHO, 2021).
Pregnancy and childbirth are the special opportunities in women’s lives and their families.
Although these are natural physiological process they become complicated risk for every
women. The consequences can be seen on both women and babies. According to United
Funds for Population Activities in 2011 estimated that 210 million women became pregnant
every year, in which 20% and 25% of global maternal and child death is seen in India. About
40% of mother experience general complication, whereas 15% bear life threatening
problems due to pregnancy and childbirth. According to World Bank Data in 2015, 174
women died per 100,000 live births, which comes around 5 women die per hour from
complications developing during child birth in India. 45,000 mothers die due to causes
related to child birth every year that accounts for 17% globally. In India Uttar Pradesh is
second in maternal mortality rate next to Assam, with Kerala having the least.

India’s maternal health is not at all satisfactory, it had the maximum number of death in the
world. In the year 2009, the count of maternal death was 212 on every 100,000 live births,
although theMMR dropped from 212 deaths per 100,000 live births in 2007-09 to 178 in
2010-12, yet India is behind the target of 103 deaths per 100,000 live births which has to be
achieved by 2015 under the United Nations mandated MDG, according to the findings of
”Targets Overviews of MDGs” it is slow and off track.

Most of these complications during pregnancy and after delivery can be prevented if women
get the proper access to safe motherhood services.

Acceptance and utilization of the services are crucial in averting the deaths and in
promoting the health of mother and children.
Irrespective of the tremendous efforts made by the government of India, the utilization of
mother and children health services continue to be very low among women belonging to
the lower socio economic status particularly among rural and urban slum areas. This
significantly upsets the country’s declining trend of maternal and infant mortality.

The various barriers that cause the hinderance in utilization of maternal and child health
services are as follows:-

1)Financial Barriers

2)Physical Barriers

3)Cognitive Barrier

4)Organisational Barrier

5)Physiological and Sociocultural Barrier

Therefore many studies have been undertaken to assess these barriers that cause
hinderance in utilization of maternal and child health services.

OBJECTIVES OF THE STUDY

The various objectives of the study are as follows:-
1)To study the factors associated with the utilization of maternal and child health services in
the rural area of the Aligarh district.
2)Their perception of needing the health services, relationship between MCH utilization and
social, economic, and demographic factors.
3)To assess the immunization status, ante natal and post natal care of the women.
4)To assess the immunization status and nutrition care of the infant.

HYPOTHESIS
The various hypothesis that can be formulated are :-
1)The rate of literacy impact on the rate of maternal mortality.
2)The higher the rate of illiteracy more is the rate of maternal mortality.
3)More the autonomy of women in the household decision more is the utilization of health
services.
4)The lesser the age, number of children, and years of married life lesser is the mortality
rate and higher is the level of utilization of the health services.
REVIEW OF LITERATURE
1)The prevalence and determination of use of maternal and child health care services in
two groups of Muslims in Malegoan. The study shows that the health facilities do not
provide all kind of services. Knowledge of women on importance of maternal and child
health care services is major factor that reduce the utilization of health care services. The
analysis demonstrate that in both the groups of Muslims, the prevalence of maternal and
child health care services exist, but there is a variation in the type of facility. It makes clear
that women with lesser number of children during 1-3 years of marriage and with primary
education use health care services more than their counterparts. The level of acceptance of
iron supplements in the pregnant women is low. The compounding factors suggest that
khandeshi women are using health care services more than the momin women. The
traditional influence is found on the women and their families as far as maternal and child
health is concerned. Quality of health services, accessibility towards health services and
education are significant factors as far as utilization of health servicesis concerned. There is
urgent need to improve the health facility and awareness about the facility in this place.
(Dr.Vijaya Khairkar, 2013).

2)The study showed that the direct measures of women’s position did exert a positive
influence on utilization of the health care services. Women having a say in household
decision are significantly using the health care services. However freedom to go out of
house did not significantly influence utilization of health services, perhaps because freedom
of movement by itself did not grant greater autonomy.

The socio economic and demographic variables are highly significant and consistent
predictors of health seeking behaviour of women in India. It is evident from the result that
women who have some education are more likely to use the health services. Likewise
women belonging to the higher society are about 2 to 5 times more likely to utilize MCH
services.

The study reinforces the importance of education and income as important determinants of
health care utilization. Determinants are examined using the third National Family Health
Survey. Bivariate analysis and logistic regression has been used for the purpose of this
analysis.(Sandhya Rani Mahapatra,2012).
3)The study was conducted in the state of Uttarakhand. According to the National Family
Health Survey 2005-06 showed the higher proportion of high risk pregnancies. A large
number of births take place outside the health system, the majority being attained by
untrained dais. These resulted in higher rate of maternal mortality and morbidity. The study
was conducted to find out the various possible factors influencing the use of maternal
health care services. Both bi-variate and multi-variate analysis were carried out for the study
by taking ante natal care and delivery care as dependent variables. The result revealed that
the educational level of women , birth order, and wealth index are the significant predictors
in explaining ante natal and delivery care.

4)The study was conducted in the state of Odisha. The main aim of the study was to assess
the level and pattern of maternal health care services utilization among different sub groups
of women in Odisha with a special focus on the regional, economic, and educational
inequality using the latest District Level Household and District Level Survey 2007-08.
Descriptive statics and bivariate and multivariate analysis were used to understand the
pattern of MCH services among the women of different background characteristics. Results
revealed wide regional variation in the utilization of MCH services. The utilization of services
is more concentrated among the affluent households. Enhancing literacy among women and
improving health infrastructure and its quality in rural and disadvantaged regions may be
prioritized to improve the maternal health in Odisha.(Ranjan Kumar Prusty and Jitendra
Gouda).

5)The book deals with the maternal health condition and awareness of the migrant women
for HIV/AIDS. Maternal mortality accounts for the largest or near largest proportion of
deaths among women in the developing countries than developed nations. The writer talks
about ANC, PNC, nutrition and their importance. The descriptive research design was used
to get the detailed account of knowledge/awareness and condition of the migrant women
with respect to their HIV/AIDS and maternal health conditions respectively. Data was
collected by structured questionnaire which acted as a primary data and secondary data
was collected from different libraries. The conclusion from the study was that socio
economic condition among the migrant women is similar be it Hindu, Muslim or Christian. It
is found that quite high percentage of migrant women are uneducated. The study revealed
that health during and after pregnancy is not given much needed attention as the data
collected suggests.(Dr.Qurratul Aein Ali, 2017).

6)T he study was conducted to bring out the relationship between the socio demograph and
the utilization of the maternal health services. The two variables used were the ANC services
and the assistance during delivery. The third objective of the study was to illustrate the
probabilities of use of ante natal care and delivery assistance using some selected
independent variables in India. Third round National Family Health Survey(NFHS-III) was
used to carry out the study. 1,24,385 women sample was selected between the age of 15-45
years. Interview was conducted using structured questionnaire. Data analysis was done
using SPSS. Bivariate analysis was done by taking each independent variables and calculated
the proportion of use of ante natal services and delivery assistance. The study concluded
that 77.0% women received ANC from health professional. Rural women (72.1%) were less
likely to receive ANC when compared with urban women (90.6%). 46.7% of women gave
birth with assistance from health professional. Rural women (37.5%) are less likely to use in
comparison from urban (73.6%). From the study it was concluded that poor and uneducated
women were less likely than wealthier and highly educated women to use health care
services. Birth order also played a significant role in utilization of health services. (Krishna
Kumar Pandey and R.D.Singh, 2015).

UNIVERSE OF STUDY
The study is to be conducted in the rural area of Aligarh district, Uttar Pradesh, a state in the
north zone of India and is most populous state in India, falls in the category of BIMARU
state. There are 13 blocks in the district namely, Akrabad, Atrauli, Bijauli, Chandaus,
Danipur, Gangiri, Gonda, Iglas, Jawan, Khair, Lodha, Tappal and Dadon.

The total area is 3,650 sq km with a total population of 36,73,889 of which males are
19,51,996 and females are 17,21,893. According to Census India 2011, literacy rate is
68.52% higher than state average of 67.68%, in which male literacy is 73.52% and female
literacy rate is 62.93%. There are total of 1210 villages in the district with male population of
13,08,923 and female population of 11,47,775.

Hindus are around 55.36% and Muslims are 42.4% followed by Christians.
VARIABLES
Independent variables are the women in the age group of 16 to 37 who have delivered
between the period of 2015 to 2018 and the infants. Dependent variables are the barriers in
utilization of ante natal care, delivery and post natal care.

SAMPLE SIZE
“When purposive sampling is employed, the researcher herself/himself can decide the
sufficient number of respondents. In such cases, generalization is concerned with quality
rather than quantity” (Ahuja, 2009). 10% of the total population will be the size of the
sample which will include the variables according to the religion, caste, socio economic and
literacy rate. The area covered here will be the rural area of the Aligarh city.

SAMPLING TECHNIQUE
Purposive sampling technique is used for the collection of the relevant data. In this
technique the researcher purposely chooses persons who in his/her opinion have the
required characteristics which are relevant to the research topic. In this technique, some
variables are given importance and it represents the universe but the selection of units is
deliberate and based on prior judgement.

TOOLS AND METHODS OF DATA COLLECTION

Data in the study will be collected using predesigned, pretested semi structured
questionnaire. The determination of content validity is subjective and judgemental and
indicates the accuracy with which a specific domain of content is sampled and that the
instruments have the items covering all the aspects of the variables being measured. Main
domains in the questionnaire covered will be details related to the socioeconomic status
and socio demographic factors related to the mother and about the ante natal care, delivery
and postnatal care. The organised data is then analysed using descriptive analysis wherein
the raw data is made meaningful through frequency distribution. An indepth interview
guide will also be used to collect the data.

GAP ANALYSIS
The gap analysis is conducted to find out the reasons for the under utilization of the
healthcare services by the women and children.
TENTATIVE CHAPTER SCHEME
The chapters to be included in the study are as follows:-

1)Introduction

2)Review of Literature

3)Research Methodology

Universe of study

Variables

Sample size

Sampling technique

Tools and method

4)Socioeconomic Restrictions

5)Conclusion

6)Bibliography

REFERENCES
1)