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TBA Support Program Linking Services with Community

Taluka Jam Nawaz Ali District Sanghar

Baseline Survey Report

Reported By

Monitoring Evaluation and Research Program

HANDS

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Contents

Chapter Page

# Abbreviation 03

Acknowledgement 04

Executive Summary 05

Chapter : 01 Introduction

1.1 Background 11

1.2 Introduction of Sanghar District 11

1.3 Introduction of the project 12

Chapter : 02 Baseline Survey

2.1 Aim of the Study 14

2.2 Objectives of the Study 14

2.3 Universe of the study 14

2.4 Survey Tools/ Techniques 15

2.5 Sample Size 15

Chapter : 03 Results

3.1 In-depth Interview with TBA

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3.2 In-depth Interview with Clients

24

Annexure 32

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Abbreviations:

ANC Antenatal Checkup

MER Monitoring, Evaluation & Research

CBA Child Bearing Age

NGOs Non Government Organizations

CBOs Community Based Organizations

MCO Men Community Organization

WCO Women Community Organizations

HANDS Health and Nutrition Development Society

EPI Expanded Program on Immunization

MCH Mother & Child Health

IDI In Depth Interview

TT Tetanus Toxoid

UC Union Council

WHO World Health Organization

SBA Skill Birth Attendant

MWRA Married Women of Reproductive Age

MoH Ministry of Health

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Acknowledgement:

Our first acknowledgement is for the Almighty Allah who has bestowed His blessing on us.

FARAH project implemented in four Union Councils of Taluka Jam Nawaz Ali District Sanghar

with the objective of improvement in reproductive health practices and family planning status in

marginalized communities followed by the purpose of promote safe delivery and reduce maternal

and neonatal mortality through capacity building of TBAs and women of child bearing age of

targeted area This baseline study has been conducted for documenting the Knowledge, Attitude

and Practices (KAP) of TBAs and recently delivered women by TBAs regarding maternal

newborn and child care, status of access and quality of health care in the target area and status of

Maternal and Newborn and child Care services at Public Health Care facilities in the target area.

This publication is the reader friendly version that we have extracted from original work. The

objective of this publication is to make technical details of the baseline report easily and reader

friendly for different stakeholders.

We are thankful to our donor British Petroleum- BP, stakeholders and our eternal

acknowledgement and appreciation for the overwhelming support of District Government

Sanghar especially Health Department,

We are also thankful to Traditional Birth Attendants (TBAs) and mothers and our surveyors for

their extra ordinary efforts in collecting the data at field level. Data entry operator’s efforts are

also appreciable and our ME&R team is also acknowledged for their support in Data Validation,

Cleaning, Analysis, frequency tables and Report formatting.

It was a great pleasure and honor to serve with the highly supportive team of Senior General

Managers, General Managers, Senior Managers & all other staff of HANDS. In fact they

supported a lot with their constructive feedback and kind suggestions.

I am especially thankful to Dr. Sheikh Tanveer Ahmed (Chief Executive -HANDS), for his

technical support and continuous facilitation. I am indebted to the District Project Team, District

Executive Manager Sanghar and MER team at head office for their contribution in report

development.

Dr. Anjum Fatima

Senior General Manager

Monitoring, Evaluation & Research Unit

HANDS

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Executive Summary

Health And Nutrition Development Society in collaboration with British Petroleum (BP) signed an

agreement to launch a project named “FARAH “TBAs trainings in remote and underserved rural union

councils of Taluka Jam Nawaz Ali, District Sanghar, Sindh Province of Pakistan”. The project was

designed to improve Reproductive Health practices and Family Planning status in marginalized

communities with the purpose of purpose to promote safe delivery and to reduce maternal and neonate

mortality through capacity building of TBAs and women of child bearing age of the area

The report details the findings of the baseline study that was carried out to assess the overall situation of

Knowledge, Attitude and Practices, accessibility, availability and quality of health services. The core

objectives of the survey were:

To study knowledge, attitude and practices of Traditional Birth Attendants (TBAs)

regarding safe motherhood

To study knowledge, attitude and practices of mothers regarding safe motherhood

To identify the gaps for training and awareness raising in the target population

The survey was carried out in the 04 Union Councils of Taluka Jam Nawaz Ali, Distirct Sanghar. The

survey was based on a cross-sectional study design which is more explanatory and analytical in nature.

Survey results were obtained from both primary and secondary data. Secondary sources comprised of

PDHS, policies and research papers.

Primary data was collected through questionnaires, consisting of recently delivered mothers (women who

are delivered by TBAs) and TBAs. Sample size selected for the current survey comprised of 04 Union

Councils, the TBAs in the target area were interviewed for the Baseline information regarding

their Knowledge, attitude and practices for safe motherhood. A total of 68 TBAs were identified

from 57 villages in the target area for the interview of baseline survey. Similarly 104 clients (1-2

clients delivered by each interviewed TBA) were also selected for the interview.

Results about TBAs Interview:

Results from the current survey shows that TBAs who were interviewed were of 34 to 75 years old and

the mean age of TBAs was 52.7 years. No TBA was properly trained while only 4.4 percent TBAs had

skill to read and write. Therefore it is strongly recommended to design such a course which may be as per

level of TBAs. Little less than three fourth of TBAs had experience of more than 10 years. TBAs who

were interviewed had dealt total 11452 deliveries till date. The mean number pregnancies dealt by one

TBA were 168 and every TBA deal average 2.54 deliveries per month. Moreover, Data showed that 12

TBAs reported 20 maternal deaths in previous two years while majority of deaths happened due to

excessive bleeding.

Antenatal care (ANC) provides an opportunity to a pregnant woman to come in contact with a care

provider who can take her care as the birth attendant at the time of delivery. The care provider works out

to screen the pregnant woman and provides her some important advices. World Health Organization

(WHO) recommends that each pregnant woman should have at least four ANC visits.

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In surveyed area nearly 136 visits were conducted by 70 TBAs with a mean of 2.83 visits by each TBA.

Only 17 percent TBAs examined mothers for basic health while most of TBAs checked bleeding and mal

position of child during antenatal checkups followed by pain in lower abdomen and vomiting in fourth

month of pregnancy.

Referral in danger sign is essential to save mother and child health, majority of TBAs almost 90 percent

refer case to other facilities. Regarding time taken since start of labour pain to birth nearly five sixth

TBAs reported average 06 hours while same number of TBAs reported 04 hours in case of more than one

births. No TBAs used any drugs to foster labour pain.

During survey it was found that no TBA responded regarding cleanliness of cord cutting instruments.

Multiple responses reported by TBAs in a question regarding steps taken during fits, 98 percent reported

they may refer patient, 92.6 percent TBAs asked for necessary arrangement like money and transport

while nearly 62% women were given something to eat.

Vaccination against tetanus during pregnancy prevents mother and newborn from tetanus. A 5-injection

vaccination course provides a lifelong protection to women over their reproductive life cycle. The whole

course completes within the duration of slightly more (one month) than two and a half year period.

However, whenever the 5-injection course is not feasible due to any reason, the 2-injection course should

instead be completed for each pregnancy irrespective of the duration and outcome of the previous

pregnancy. Thus, minimum of two injections at an interval of four weeks are recommended for an

adequate antibody response. In our sample, nearly 84 percent TBAs referred pregnant mothers for TT

vaccine while 16 percent did not ask mothers for TT vaccine. When TBAs were asked about for not

referring women for TT vaccine, no TBA responded.

Collected data showed that TBAs did few preparations before delivery. 95.6 percent TBAs removed nails,

91.6 percent removed rings followed by bangles, 85.3 percent TBAs folded hairs and nearly 80 percent

TBAs washed hands before delivery. Regarding steps taken by TBAs before delivery, it was known that

98.5 percent checked preparatory work while among 80 to 90 percent TBAs provided something to eat

followed by Walk before delivery and encouraged them. After delivery TBAs stayed nearly for 5 hours

and visited for 6.60 days.

All TBAs who were interviewed conducted regular visits in postnatal period and majority of visits were

intended to check the quantity of blood, 26 percent TBAs checked anemia. TBAs also endowed with few

advices to mothers, majority of TBAs asked mothers not to take heavy things, 75 percent TBAs each

emphasized on diet food and hygiene and 92 % TBAs asked women for space in next child. Regarding

checkup of newborn TBAs focused on Breastfeeding, umbilical cord, newborn color and eyes color while

98 percent TBAs advised for vaccination of newborn, 94 percent TBAs advised mother to breastfed

children and 95 percent TBAs asked mothers take care of cleanliness and hygiene of child.

TBAs were asked about if they advices mothers regarding family planning, nearly 78 percent advised for

FP while 22 percent did not advice. 53 TBAs advised 215 couples for FP in last two months. The mean

number of advices given by one TBA was 4.05. Data assessment showed that most of TBAs focused on

long term methods like Copper T, Vasectomy and Tube ligation. In contrast women who were

interviewed preferred temporary methods like OCP, injections and condoms.

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In the womb, mother provides the essential environment to the developing fetus; appropriate temperature

is one of the components of this environment. As newborn is delivered, the first encounter is with the

external temperature. The delicate skin of the newborn cannot withstand even moderate changes in

surrounding temperature; especially the low temperature affects a newborn more adversely. From data it

was assessed 95 percent TBAs wrapped newborn in a clean cloth after cleaned him with a separate piece

of cloth. All TBAs tied cord of child from one place and all TBAs used new blade to cut the cord. 98.5

percent TBAs used surma to rub on umbilical cord and 95.6 percent used sprit and oil too.

To provide appropriate temperature, it is recommended that immediately after delivery clean and dries the

newborn with a clean cotton cloth and then wrap in a cloth, like towel or a similar piece. If everything

goes fine, then bath should be delayed for a minimum of six hours. Otherwise, the first bath can be

further delayed depending upon the situation. In our sample 97 percent TBAs gave first bath in first hour

after birth, 92.6 percent gave bath just after birth and 86.6 percent TBAs gave first bath in 12 hours.

After delivery, newborn depends on oral feeding for survival. Breast milk is the most suitable feed for a

newborn and infant till the age of 4-6 months. Colostrums is the yellowish thick first milk which is

produced by the pregnant woman after the birth of a baby and it is considered to be very beneficial for the

newborn as far as immunity and gastro-intestinal motility is concerned. In surveyed area, nearly 96%

TBAs provided colostrums newborns as first drink and all TBAs asked mothers to breastfed their

newborn in one hour after delivery while no TBA used delivery kit during delivery.

In emergency or complication TBAs referred to facility where numbers of services are provided. In

baseline survey area nearly 94 percent TBAs referred to private hospital or facility where patients self

wanted to go, 89.7 percent TBAs referred patients to Taluka Head Quarter (THQ) and nearly 78 percent

patients were referred to District Head Quarter (DHQ) by TBAs.

Results about recently delivered mothers by TBAs Interview:

Result showed that women who were interviewed were between the age of 26 to 42 years and the mean

age of women were 27.81 years. Out of 104 interviews women only 9 were literate and can read & write

while 95 women were illiterate while women who were literate passed primary to class nine. Data showed

mothers reported number of pregnancies range from 01 to 14 while the mean number of pregnancies was

4.14. The mean number of live births was 3.65 while 31 women reported 10 still birth and 3 women

reported 02 still births. The mean number of abortions was 0.13 and 12 women reported one abortion.

Data analysis gave an impression that number of lived girls was higher than lived boys. The mean number

of lived girls was 1.93 as compared boys which were 1.72.

The children who were ever born reported by mothers 56.7 percent were girls and 43.3 percent were girls

while all deliveries were normal and conducted at homes by TBAs. Furthermore, only a quarter (N= 27)

of women went for antenatal checkups. Out of 27 women who received antenatal care, 16 women got care

once, 07 women got care twice and only one received care as per recommendation of WHO. Moreover,

19 percent women received care from a lady doctor, 5 percent received care from TBA. It shows, majority

of women received care from trained health care provider.

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Healthy food during postnatal period provides enough potency to mothers and it is essential for mothers

when they breastfed their newborn, when women were inquired regarding advice of healthy food given by

TBAs, it was assumed only 7.7 percent (N=8) were advised while 92.3 percent (N=96) did not provided

any answer. Data analysis shows that more than 92 percent women were not examined during pregnancy

only 8 percent women examined by care providers. All 08 women who reported for internal examination

during delivery were examined by TBAs while majority of TBAs washed their hands only before

examination. Only 1.9 percent TBAs used gloves.

Awareness regarding danger signs during pregnancy, delivery and postpartum period reduce maternal

deaths. Most of interviewed women were familiar with seven danger signs which were delay in delivery,

abnormal position of fetus, severe lower abdominal pain, swelling in legs, anemia, bleeding, headache

and dizziness.

It was assumed from the data average duration of delivery form start of pain to birth was around 02 hours.

If we further break it nearly 32.7 percent (N=34) reported 01 hour, nearly 31 percent (N=32) reported 2

hours while 20 percent (N=21) reported 3 hours or more. Furthermore, no TBA provided any medicine to

foster the pain.

Vaccination of Tetanus Toxoid during pregnancy prevents mother and newborn from tetanus. During data

analysis it was came to know nearly half of women did not receive a single TT vaccine. Out of 54

Women who received TT vaccine, 39 received vaccine twice while 12 women received injection only

once. PDHS 2006-07 reports that 60% mothers with a birth in the five years preceding the survey were

protected against neonatal tetanus, with more than half (53%) of pregnant women receiving two or more

tetanus injections during the last pregnancy. TBAs were the main source to advise most of women to get

TT vaccine.

More than 90 percent TBAs prepared themselves before conducting delivery, 93 TBAs washed their

hands, 92 folded pregnant women hairs, 88 removed nails and 83 brushed teeth. Regarding steps taken

during delivery it was cited TBAs took multiple steps for safe delivery. 77 percent TBAs checked

preparatory arrangements, same percentage of TBAs checked position of child, 73 percent TBAs pressed

stomach to push child while more than 84 percent TBAs rubbed some type of oil on stomach. After

delivery TBAs stayed with mothers for maximum 7 hours and 49 women shared TBAs stayed with them

for maximum 07 days. Moreover, 70 percent mothers shared TBAs checked newborn’s color, 75 percent

mothers reported that they were asked for child vaccination.

Family Planning services are not at that extent on which it had to be, especially in rural areas. In response

to a question regarding TBAs advised for FP, only 16.3 percent mothers reported that they were asked for

space in next pregnancy while remaining mothers did not get any information regarding FP.

After delivery care of newborn in very essential and it also shows the practices of Care provider. In

baseline data it was assumed 89 percent (N=93) women shared that TBA wrapped newborn in clean

towel, 30 percent (N=31) women shared TBAs wrapped newborn in a cloth after clean with towel while

12 percent mothers shared that after cleaning TBAs handover newborn to them. Besides that, 89 percent

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mothers responded that TBAs tied cord from one place and used a new blade to cut the cord and asked

mothers to use surma,

One third of women visited near health facility and contacted private doctor for complications during

delivery. All TBAs visited to mothers regularly during postnatal period and nearly 81 percent TBAs

checked only quantity of bleeding 13 percent TBAs checked for anemia and fever. TBAs also provided

few advises in postnatal checkup, 98 percent mothers reported that TBAs focused on breastfeeding

followed by hygiene, 89 percent mothers reported that they were prohibited to carry heavy things while

20 percent mothers reported that they were advise for birth spacing.

In the womb, mother provides the essential environment to the developing fetus; appropriate temperature

is one of the components of this environment. As newborn is delivered, the first encounter is with the

external temperature. The delicate skin of the newborn cannot withstand even moderate changes in

surrounding temperature; especially the low temperature affects a newborn more adversely. To provide

appropriate temperature, it is recommended that immediately after delivery clean and dries the newborn

with a clean cotton cloth and then wrap in a cloth, like towel or a similar piece. If everything goes fine,

then bath should be delayed for a minimum of six hours. Otherwise, the first bath can be further delayed

depending upon the situation. About two fifth women in surveyed area gave bath to the newborn in their

households within 1 hour of delivery and a quarter gave bath within 1-4 hours. In baseline area 87 women

shared that TBAs gave first both in very early hour of delivery while 71 percent mothers shared TBAs

given colostrums to newborn.

Nearly 77 percent women breastfed their newborn in first hour, 30 percent breastfed within two to three

hours while 27 percent breastfed within 4 to 6 hours. No TBA used delivery kit. 98 women shared that

they paid some amount to TBAs after delivery. 60 percent women shared that they offered Rupees 500 to

TBAs while 10 women gave rupees 1000. Besides that TBAs were also offered Roti, Kapray, Dopatta and

other things in kind.

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Chapter 01

Introduction

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1. Introduction:

1.1 BACKGROUND

Health can be defined as a serene state of physique, mind and social well being, other than the

absence of diseases and immunity from pathogenic organisms. For the attainment of highest

standards of life, it is essential that the women should be safeguarded against all sorts of ailment

that curtails their mental as well physical proclivities to share in the day to day domestic and

communal affairs. Women health involves their emotional, social and physical well being and is,

therefore, determined in the social, political and economical context.

Pakistan has a high maternal mortality rate, estimated at approximately 350–500 maternal deaths

per 100,000 live births. This translates into about 30,000 maternal deaths each year, or one

maternal death every 20 minutes. Reducing maternal mortality is one of the major objectives of

the Government of Pakistan and is one of the Millennium Development Goals to which the

Pakistan is a signatory. Most maternal deaths occur in rural areas and urban slums and are

attributed to non availability of trained staff and delays in making the decision to seek

emergency care and transporting the mother to proper emergency care.

1.2 Introduction of Sanghar District:

2. Sanghar is predominantly a rural district in Sindh with more than three fourth of its population living in

rural areas. The overall estimated population of the district was 1,916,786 in 2008, with a population

density of 179 people per square kilometer. Sanghar shares borders with Khairpur district to north, Nawab

Shah District to its north-west, Jaisalmir and Jodhpur (India) to its east, Mirpur Khas and Umerkot to its

south and Hyderabad district to its south and southeast. Sanghar covers a total area of 10,728 square

kilometers. People living in the district belong to different castes and tribes, mainly Syed Nizamani,

Mari, Keeria, Khaskheli, Shar, Lashari, Mehar, Jat, Rajar, Sama, Meghwar, Kohli and Bheel. The

majority of population is Muslim (79.2 percent). Hindus make up a large proportion of the minority

population in Sanghar (19.3 percent). Sindhi is the most commonly spoken language in the district,

followed by Urdu, Punjabi, Balochi, Pushto and Saraiki. Women in the district are also engaged in

making rillies and local traditional embroidery. People in the district also work on making ajraks,

khurzins, carpets, woken khathas and khes, which are very popular throughout the county.

The district has a number of educational and health institution (Population Census Organization, 2000).

According to the UNDP Pakistan National Human Development report 2003, Sanghar stood 56th among

91 districts of Pakistan on the Human Development Index. District level data, based on the Pakistan

Social and Living Standards Measurement Survey, 2004-05, were examined for various measures of

education, gender equity, infant mortality and environment sustainability. In these comparisons, Sanghar

ranked on below average on most measures of education, literacy and immunization, and above average

on water supply availability. In fact, Sanghar ranked 12th nationally out of 98 districts on sanitation

(Planning Commission of Pakistan, 2006).

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Taluka Jam Nawaz Ali is one the rural and deprived Taluka of District Sanghar which lagging behind

regarding all basic facilities, especially health. Maternal and child health in four union councils is not

good as compare to other talukas. Majority of population received services from Traditional Birth

Attendant regarding maternal and child health. In this regard it was essential to build the capacity of those

available sources at village level as they could be effective part of the community.

1.3 Introduction of the Project

One of the major problems facing the people of Pakistan, especially in rural areas, is the non-

availability of health care facilities. Basic health centers dispensaries etc are scattered at distance,

but they do not satiate the health requirements of the communities. As the results, Hundreds and

thousands of men, women and children die or become disabled. The condition in the interior

Sindh for worse No health facilities are found at miles distance. The poor people have to either

walk or use public transport, not easily available, to reach the central town and cities for

treatment the government hospitals, centers and dispensaries do not have required facilities of the

people have to access private doctors or quacks. Those who cannot afford the high cost of private

doctors use traditional remedial methods and in most of the cases jeopardize their lives.

Unfortunately, the women, especially in the third world and developing countries like Pakistan,

are deprived their right to basic health facilities. A major barrier for women to the attainment of

the highest standard of the health is gender bias and inequality, both between men and women

and among women in different geographical regions, social classes and indigenous and ethnic

groups. In national and international forums, women have emphasized that to attain optimal

health throughout the life cycle, equality, including the sharing the family responsibilities;

development and peace are necessary conditions for the dream of peaceful and utopian society to

come true. Women have biased access to and use of basic health resources, including primary

health services for the prevention and treatment of childhood diseases, malnutrition, anemia,

diarrhea and communicable diseases, malaria and other tropical diseases including tuberculoses.

They also have prejudiced and unequal opportunities for the protection promotion and

maintenance of their health, the lack of emergency obstetric service are also a matter of

particular concern. Health policies and programs often perpetuate gender stereotype and fail to

consider social-economic disparities and other differences among women and do not fully take

account of the lack of autonomy of women regarding their health.

Health facilities are inadequate in the rural localities. The facilities are not been available at near

place, medical staff, particularly females, is no t available in the remote areas and government

provided health facilities are not functioning in the targeted areas consequently males, females

and children are suffering from various health disorders particularly women and children are the

most affected part of the population.

Health risk for 50% of women in reproductive age is reduced through HANDS trained TBA’s in

150 targeted villages of 4 UCs of Taluka Jamnawaz in district Sanghar.

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Chapter 02

Baseline Survey

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2.1 Aim of the Study:

The aim of the study was to assess the knowledge, attitude and practices in the target area

regarding safe motherhood.

2.2 Objectives of the Study:

The objective of the study was

To study knowledge, attitude and practices of Traditional Birth Attendants (TBAs)

regarding safe motherhood

To study knowledge, attitude and practices of mothers regarding safe motherhood

To identify the gaps for training and awareness raising in the target population

Baseline Survey:

The baseline survey was conducted in the target area of Taluka Jamnawaz Ali to collect

information from the TBAs and newly delivered clients of the TBAs to identify the practices

for safe motherhood which includes antenatal, natal and postnatal care. The objective of the

baseline was to identify the gaps in the knowledge, attitude and practices of the TBAs that could

be addressed through the training for safe motherhood practices. The delivered clients of the

TBAs were also interviewed to not only study the general knowledge, attitude and practices

prevailing in the target population but also to ascertain the practices of the TBAs in the target

population.

Themes of the Study:

The thematic areas of the study with reference to safe motherhood practices included

Knowledge, attitude and practices of TBAs regarding safe motherhood

Knowledge, attitude and practices of mothers regarding safe motherhood

Duration of the Study:

Total allocated time will be four months. It will include the time for logistic planning and

development of questionnaires, data collection, data entry, management, and analysis; and report

writing and submission.

2.3 Universe of the study

The baseline survey was conducted in 4 Union Councils of Taluka Jamnawaz Ali in district

Sanghar. The TBAs in the target population of Taluka Jamnawaz Ali and their clients who were

delivered by the interviewed TBAs were also interviewed.

The study population comprised of following groups

Traditional Birth Attendants (TBAs)

Clients of each interviewed TBA

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2.4 Survey Tools/ Techniques:

A questionnaire was designed with both quantitative and qualitative variables for the interviews

of TBAs. Similarly another questionnaire was designed for the clients delivered by the TBAs

2.5 Sample Size:

The TBAs in the target area were interviewed for the Baseline to gather information regarding

their Knowledge, attitude and practices for safe motherhood. A total of 68 TBAs were identified

from 57 villages in the target area for the interview of baseline survey. Similarly 104 clients (1-2

clients delivered by each interviewed TBA) were also selected for the interview.

Pre-testing & Finalization of Instruments:

The survey instruments were pre-tested before the start of real field level data collection. Then

the questionnaires were examined with a view that the data collected was amenable to analysis.

The survey tools were finalized in view of the pretesting conducted.

Analysis Plan:

Validation of 10% of the data was done through the supervisors of the baseline team. Excel was

used for data feeding at HANDS head office. All the data was analyzed on SPSS and then

tabulation graphs were developed and report was generated.

Tradition Birth Attendant Support Program (TBASP) is a skills enhancement in service support

program.

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Chapter 03

Results

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3.1 In Depth Interview with TBA

Age

A total of 68 TBAs were interviewed for the survey from the target

area. The average age of 57 percent TBAs was 50 years and below

while the age of remaining 43 percent TBAs was above 50 years.

Mean age was 52.6 years while range was 34-75 years.

Education

When TBAs were asked regarding education, it was found only 4.4 percent TBAs can read and write and

remaining 95.6 percent had never been to school.

Experience

Mostly in rural areas, TBAs are the only source to deal with

deliveries and mostly doesn’t go through formal training program,

therefore they learn with time and experience. According to

survey 33.8% TBAs have experience between 1 to 10 years while

remaining 66.2% had experience of above 10 years. The mean

experience of each TBA was 17.8 years and the range of

experience was 5 to 40 years.

No. of deliveries:

A total of 11452 deliveries were dealt by 68 TBAs in last two

years. 75% TBAs conducted deliveries less than 100 while 25%

TBAs conducted more than 100 deliveries. Mean number of

deliveries by one TBA was 168.4 and the range of deliveries was

1 to 1500.

Average deliveries in a month:

In response to question about monthly deliveries conducted by

TBAs the data showed that 19.1% (N=13) TBAs conducted

average one delivery in a month, 38.2% (N=26) conducted 2

deliveries, 23% (N=16) conducted 3 deliveries, 10.3% (N=7)

conducted 4 deliveries, 7.4% (N=5) Conducted 5 deliveries while

only 1.5% (N=1) conducted 7 deliveries in a month. The mean

number of deliveries in a month was 2.54 while the range of

deliveries was 1 to 7.

Frequency

(Deliveries)

Number Percent

1 13 19.1

2 26 38.2

3 16 23.5

4 7 10.3

5 5 7.4

7 1 1.5

Total 68 100.0

33.8

66.2

Experience

1-10 Years More than 10 Years

75%

25%

No. of Deliveries

1-100 More than 100

95.6

4.40

50

100

150

Can Read Write

Illiterate

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Deaths during Last 2 years:

Nearly, 20 (17.6%) deaths were reported by 12 TBAs during

last 2 years while 56 (82.4%) TBAs reported no death. When

question was asked regarding reasons of those deaths, 11

respondents shared, deaths were happened due to bleeding

and 1 death reported because of Fits/Eclampsia.

Training:

Out of 68 TBAs who were interviewed no one has gone through proper training. It shows that TBAs were

providing services according to their experiences and practices. Therefore, no TBA was using delivery kit

during delivery.

Antenatal Checkups:

During antenatal checkup care provider screens the pregnant

women and gives her imperative counseling. Data showed

that only 29.4% (N=20) practiced antenatal checkup while

nearly 70.6% (N=48) did not practice antenatal checkup

during visit.

Antenatal Checkups (number):

World Health Organization (WHO) recommends that each pregnant woman should have at least four

ANC visits. When TBAs were asked about ANC visits to pregnant women it was come to know only 136

visits were conducted by TBAs. The mean number of visits were 2.83 and 1 to 8 visits was the range.

Danger signs during Antenatal, Natal and Postnatal:

Awareness regarding danger signs of different phases helps in reduction of any complexity. The TBAs

were asked what danger signs they viewed during Antenatal, natal and Postnatal period. Out of eleven

danger signs bleeding & mal position of child were mostly viewed by 64% respondents, delay in delivery

of placenta viewed by 56% TBAs, lower abdominal pain cited by nearly 44% of TBAs while vomiting in

third month and prolong labor viewed by 35% TBAs each. 24% TBAs viewed anemia, 21% TBAs

showed edema on hands and feet, 14% viewed fits.

Frequency Number Percent

No 20 29.4

Yes 48 70.6

Total 68 100.0

17.6

82.4

Deaths during last 2 years

Yes No

24

64

44

35

21

14

35

64

56

16 14

Anemia

Bleeding

pain in lower abdomen

Vomiting continued after 3rd month of pregnancyEdema on hands and feet

Fits

Prolong labor

Malposition of child

Delay in delivery of placenta

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Bleeding:

When TBAs were asked, if bleeding started during

pregnancy what step may taken. TBAs shared multiple

responses. 73% shared give something to eat and 91.2%

shared for referral and arrangement of money &

transport each, only 19% shared keep women warm.

Most of respondents did not share about steps taken

during bleeding.

Time taken from start of labor pain to birth:

Regarding time taken from start of labor pain to birth,

nearly 59% respondent replied it took 6 hours during

birth of first baby, 14.7% respondents answered 2 hours

and 10.3% shared 3 hours while mean time taken from

start of labour pain to birth of first baby was 4.68 hours

with a range from 1 to 6 hours.

In contrast, during birth of second or more children

nearly 58% TBAs shared it took 4 hours, nearly 20%

each respondents shared 1 and 2 hours. The mean time

taken during more than one births was 3.01 hours with a

range from 1 to 5 hours.

No TBA used any medicine which fosters the process of labor pain and also no TBA answered on

interrogating regarding steps taken for cleaning of cord

cutting instruments.

Steps taken during fits:

In terms of steps taken if woman face fits during

pregnancy, 98.5% TBAs agreed on referral, 92% did not

know, nearly 62% provided other reasons while 17.6%

agreed on massage of hands and feet.

Refer pregnant women for TT

83.8% (N=57) TBAs referred pregnant women for TT

shots while remaining 16.2% (N=11) did not refer any

women. When TBAs were asked about number of

women referred during last 6 months for TT vaccine,

only 03 TBAs had referred 06 women while rest of

TBAs did not respond. Moreover, they also did not

respond about reasons of not referring.

Bleeding Frequency Percent

Keep feet at height 0 0

Give something to eat 50 73.5

Divert body to left 5 7.4

Keep body warm 13 19.1

Examine heart beating of

fetus

6 8.8

Referral 62 91.2

Arrangement of

money/transport

62 91.2

5.914.7 10.3

2.9 7.4

58.8

Time of labor pain

1 Hour 2 Hours 3 Hours 4 Hours 5 Hours 6 Hours

19.1 20.6

1.5

57.4

1.5

Steps taken during fits

1 Hour 2 Hours 3 Hours 4 Hours 5 Hours

83.8

16.2

Refer for TT

Yes No

20

Preparation for delivery:

It is common trend in rural areas care provider do some preparatory work before forthcoming delivery.

During survey about preparation of pregnancy it was found nearly 87% (N=59) removed bangles, 91%

(N=62) removed rings, 96% (N=65) removed nails, 85% (N=58) folded hairs, 79% (54) washed hands.

Steps taken during delivery:

TBAs were also asked about steps they took

during delivery. In response, 98.5% shared they

checked preparation before delivery, nearly 90%

provided something to eat, little more than 85%

asked woman to walk, 82.4% asked for attention

and 35.3% TBA rubbed oil on stomach while in

contrast 94% TBAs did not check newborn

position, nearly 22% TBAs checked for

vaccination, 72% TBAs did not

console/encourage pregnant woman, 78% did not

injected pregnant women.

Duration of stay after delivery:

48 TBAs used to stay for maximum 5 hours after

pregnancy while the mean of stay was 4.96 hours

and remaining 20 TBAs stayed for long time

approximately 3 to 8 days after delivery. The

mean time of stay of at 48 TBAs who spent

maximum 5 hours was 4.96 while the mean

umber of stayed day is 6.60.

Examination during Postnatal:

All 68 TBAs used to conduct visit on regular

basis during postnatal period to check mother and

newborn for avoiding any danger. Survey data

showed that during postnatal checkups, 98.5%

TBAs examined quantity of bleeding, 26.5%

TBAs assessed anemic problems while 97%

TBAs did not focused on fever. Assessment of

data showed that TBAs mostly examined those

signs about which they had information or

knowledge.

Steps taken during deliver Frequency Percent

Encouragement 19 27.9

Give something to eat 61 89.7

Asked women to walk 58 85.3

Get attention 56 82.4

Vaccination 15 22.1

Massage of oil on stomach 24 35.3

Put pressure on stomach of

woman

0

Asked women to push 0

Support women at the time of

delivery

0

Check position of fetus 4 5.9

Checked preparation of delivery 67 98.5

Asked women to sit on feet 1 1.5

Examined duration of pain 21 30.9

Asked for urine/letine 20 29.4

N Minimum Maximum

Mean

Hours 48 3 5 4.96

Days 20 3 8 6.60

Examination during postnatal Frequency Percent

Anemia 18 26.5

Checked size of vagina 2 2.9

Temperature 2 2.9

Swelling of breast 10 14.7

Quantity of bleeding 67 98.5

Urine/latrine 3 4.4

Did not examine 4 5.9

21

Advices during Postnatal:

When respondents were asked about advices

given to mother during postnatal, it was cited that

75% (n=51) emphasized on food, same number of

TBAs advised about hygiene, more than 98%

(n=67) prohibited for picking heavy items, 92%

(n=63) advised for Family planning (spacing) and

only 23.5% (n=16) asked them walk slowly while

more than 92.6% (n=63) did not advice for rest.

Data showed majority of TBAs knew about

importance and benefits of birth spacing.

Examination of neonatal:

Significance of newborn health in a family is

more important and during assessment it is

observed that most of TBAs focused on

newborn’s health. 97% (n=66) TBAs emphasized

on hygiene and color of newborn, 95.6% (n=65)

each checked eyes of newborn and umbilical

cord, 92.6% (n=63) checked mother feeding

while advices regarding neonatal period, 94%

(n=64) advised for breast feeding, 95.6% (n=65)

advised for newborn’s hygiene and cleanliness,

98.5% (n=67) each advised for use of penicillin

on umbilical cord while only 23.5% (n=16) asked

mothers for care of food.

Advice for FP & FP Methods:

Nearly 78% TBAs advised and counsel 215

couples for spacing in children. The mean of

advices given to couples were 4.05 when the

range was 1 to 14 couples. Data showed that

76.5% (n=52) TBAs advised couples regarding

Vasectomy followed by Tube ligation 70.6%

(n=48) and Copper T 63.2%. Data gives

impression that TBAs focused on long or

permanent methods by considering multi

dimensional conditions faced by Couples in

targeted area.

Advise during postnatal Frequency Percent

For food 51 75.0

For hygiene/cleanliness 51 75.0

For not to carry heavy things 67 98.5

For taking rest 05 7.4

Walk slowly 16 23.5

For family planning 63 92.6

Don’t advice 01 1.5

Examination of neonatal Frequency Percent

Breastfeeding 63 92.6

Umbilical cord 65 95.6

Color of newborn 66 97.1

Eyes of newborn 65 95.6

Fever 17 25.0

Vaccination 17 25.0

Urine/latrine 06 8.8

77.9

22.1

Advice for Family Planning & FP Methods

Yes No

22

Wrapping of neonatal:

After delivery, care of newborn is very essential and it depends upon the practices of care provider. In

Baseline Survey area 95.6% TBAs practiced that they cleaned newborn with a clean cloth then wrapped

in other clean cloth to keep him/her warm, 21% TBAs wrapped in clean cloth while 19% cleaned

newborn with a clean cloth then wrapped in other clean cloth and handed over to mother.

Tying of Cord & Instruments used for cord cutting:

In surveyed area TBAs tied cord from one place and

all TBAs used new blade for cord cutting. It was also

cited that around 98.5% (n=67) advised mother to use

Surma and 95.6% (n=65) each asked to use sprit and

oil.

First Bath of new born:

In the womb, mother provides the essential

environment to the developing fetus; appropriate

temperature is one of the components of this

environment. As a newborn is delivered, the first

encounter is with the external temperature. The

delicate skin of the newborn cannot withstand even moderate changes in surrounding temperature;

especially low temperature, which affects a newborn more adversely. To provide appropriate

temperature, it is recommended that immediately after delivery the newborn is wiped with a clean cotton

cloth and then wrapped in a cloth or towel. If everything goes fine, then bath should be delayed for a

minimum of six hours. Otherwise, the first bath can be further delayed depending upon the situation.

When the TBAs in the survey were asked about the timing of the first bath given to the newborn, nearly

97% (n=66) TBAs reported giving bath within 1 – 6 hours of the delivery. 92% (n=63) reported just after

birth and nearly 87% (n=59) reported after 12 hours.

1st Drink after birth:

After delivery newborn depends on the oral feeding

for survival and Colostrums is the yellowish thick

first milk which is produced by the pregnant woman

after the birth of a baby. It is considered to be very

beneficial for the newborn as far as immunity and

gastro-intestinal motility is concerned. Because of

its advantages, it is recommended that colostrums

should be the first feed of a newborn. 95.6%

Interviewed TBAs advised for same colostrums

while rest of 4.4 % TBAs advised for other drinks.

Frequency Percent

Oil 65 95.6

Surma 67 98.5

Sprit 65 95.6

First bath Frequency Percent

Just after birth 63 92.6

After one hour 66 97.0

After 12 hours 59 86.8

95.6

4.4

1st Drink after Birth

Colostrums Other

23

Use of dai (delivery) kit:

It was assessed during baseline survey that all TBAs used Dai kits in every case. This showed availability

of delivery kits in outskirts of Sanghar.

Referral place in case of complication:

To know the referral place in case of complications

question was asked with multiple choices and it was

noted that nearly 94% TBAs referred to private hospital

and facility of own wish, 89% TBAs referred to THQ

and more than 77% referred to DHQ.

No. of visits during postnatal period:

All 68 TBAs used to conduct visit on regular basis during postnatal period to check mother and newborn

for avoiding any danger.

Examination during Postnatal:

Survey data showed that during postnatal checkups, 98.5% TBAs examined quantity of bleeding, 26.5%

TBAs assessed anemic problems while 97% TBAs did not focused on fever. Assessment of data showed

that TBAs mostly examined those signs about which they had information or knowledge.

Advices during Postnatal:

When respondents were asked about advices given to mother during postnatal, it was cited that 75%

(n=51) emphasized on food, same number of TBAs advised about hygiene, more than 98% (n=67)

prohibited for picking heavy items, 92% (n=63) advised for Family planning (spacing) and only 23.5%

(n=16) asked them walk slowly while more than 92.6% (n=63) did not advice for rest. Data showed

majority of TBAs knew about importance and benefits of birth spacing.

Examination of neonatal:

Significance of newborn health in a family is more important and during assessment it is observed that

most of TBAs focused on newborn’s health. 97% (n=66) TBAs emphasized on hygiene, 95.6% (n=65)

each checked eyes of newborn. 92.6% (n=63) checked mother feeding while advices regarding neonatal

period, 94% (n=64) advised for breast feeding, 95.6% (n=65) advised for newborn’s hygiene and

cleanliness, 98.5% (n=67) each advised for use of penicillin on umbilical cord while only 23.5% (n=16)

asked mothers for care of food.

Referral Places Frequency Percent

RHC 2 2.9

FP center 01 1.5

THQ 61 89.7

DHQ 53 77.9

Private clinic 64 94.1

Only advice to go 64 94.1

24

3.2 In Depth Interview with Client

Age & Education:

Mean age of the respondents was 27.8 years of age. 91.3%

(N=95) of these 104women could read and write their name.

According to the information provided.

Information about Reproductive Health

It order to reduce

the health risks of

the mother and the

child, it is very

important that the

baby is delivered

in a safe and

controlled environment by a trained/skilled birth attendant.

Since the respondents were the recently delivered clients of

the interviewed TBAs therefore all the deliveries reported

were normal home deliveries conducted by TBAs.

A total of 431 pregnancies were reported by 104 respondents, the mean of pregnancies was 4.14. Total

live births were 380 (88.1%) and a total of 33 women reported 37 (8.5%) still births while 13 women

reported 14 (3.2%) abortions. The data showed a total of 380 alive children 179 (47%) were boys and 201

(53%) were girls. Mean number of living children is 3.6.

PDHS 2006-07 shows that in Pakistan, the mean number of children ever born is 3.88 and the mean

number of living children is 3.47.

Variables N %

Pregnancies

Total Pregnancies reported by 104 women 431

1-5 87 90.48

5> 17 9.52

Live births

Total live births reported by 104 women 380

Maximum 13

Mean 3.65

Still Births

Total still births reported by 104 women 37

0 71 68.3

1 31 29.8

3 2 1.9

Abortions

Total still births reported by 104 women 14

0 91 86.5

01 12 11.5

02 01 1.9

91.3

8.7

0

20

40

60

80

100

Can Read Write Illitirate

Education

Boys47%

Girls53%

Current Live Children

25

Mode of pregnancy:

100% deliveries reported by respondents were normal and all deliveries were conducted at home by TBA.

Antenatal Checkups:

Antenatal care (ANC) provides an opportunity to a

pregnant woman to come in contact with a care

provider who can take care of her as the birth

attendant at the time of delivery. The care provider

screens the pregnant woman and gives her

important advice. World Health Organization

(WHO) recommends that each pregnant woman

should have at least four ANC visits.

In baseline area three fourth of women did not

examine herself for antenatal while only a quarter

of respondents examined for antenatal checkup.

Out of 27 women who received antenatal care 16

got checkups once, 07 women received care twice

while only 01 woman received care as per

recommendation of WHO. In contrast to this,

PDHS 2006-07 reports that one-fourth (28%) of

the pregnant woman of Pakistan make four or more

prenatal care visits during their entire pregnancy.

Also, urban women (48%) are more than twice as likely as rural women (20%) to have four or

more prenatal visits.

Check up from:

20 (19%) women received antenatal care from a

lady doctor, 5 (4.8%) received care from TBA

while 1% woman each received care from Doctor

and LHW.

Advice about diet food:

Only 7.7% women reported that they were given

advice regarding healthy food while 92.3% women

did not respond.

No of A/N Checkups N

1 16

2

7

3

2

4

1

5

1

A/N Checkups from N

Dai

5

Doctor

1

Lady Doctor

20

LHW

1

26%

74%

Antenatal Checkups

Yes

No

26

Internal Examination:

When women were asked about internal

examination during delivery, only 7.7% (n=8)

responded in yes they were examined while

remaining 92.3% (n=96) were not examined.

Women who received internal examination

reported that only 06 (5.8%) care providers

washed their hands before examination, 2 (1.9%)

used gloves while same 2 (1.9%) rubbed

something on hands.

Danger signs during pregnancy, delivery and postpartum period:

Awareness about the danger signs of different phases of a gestational cycle helps in reducing the first

delay of an obstetrical emergency. Early and correct recognition of any danger sign helps in the decision

for transporting the woman in obstetrical emergency to an appropriate health facility in time.

When women were asked about danger signs it was observed high delay in delivery of placenta and mal

position of child was most frequently cited by the women and the percentage was 86 followed by severe

pain in lower abdomen. 28% respondents cited vomiting continued after first trimester, 27% respondents

each observed prolong labor and lower abdominal pain. 23%respondents observed edema on hands and

feet.

96

8

0

20

40

60

80

100

120

Yes No

Internal Examination

14 16

27 2823

5

27

86 86

4

Danger Signs Anemia

Bleeding

pain in lower abdomen

Vomiting continued after 3rd month of pregnancy

Edema on hands and feet

Fits

Prolong labor

Malposition of child

Delay in delivery of placenta

Palpitation and Cold body

27

Delivery Pain

To assess about delivery pain duration almost

68% of clients reported 2 or less hours of

delivery pain while 32 had delivery 3 to 5 hours

of delivery pain the mean time was 2 hours,

additional question was asked about receiving

any medicine for increasing the pain of delivery,

and none of them has received any medicine for

increasing pain.

Tetanus Toxoid Vaccination

Vaccination against tetanus during pregnancy

prevents mother and newborn from tetanus. A

5-injection vaccination course provides a

lifelong protection to women over their

reproductive life cycle. The whole course

completes within the duration of slightly more

(one month) than two and a half year period.

However, whenever the 5-injection course is

not feasible due to any reason, the 2-injection

course should instead be completed for each

pregnancy irrespective of the duration and

outcome of the previous pregnancy. Thus,

minimum of two injections at an interval of four

weeks are recommended for an adequate

antibody response.

In our sample, 48% (50) respondents did not take a single injection of Tetanus Toxoid (TT), 54 (52%)

were able to receive it. Out of 54 women who received TT vaccine, 39 received only one TT injection, 12

women received two TT injections while only 3 received more than two injections. According to PDHS

2006-07, 60% mothers with a birth in the five years preceding the survey were protected against neonatal

tetanus, with more than half (53%) of pregnant women receiving two or more tetanus injections during

the last pregnancy.

Advice for TT Vaccine:

54 women who went for TT vaccine definitely they were

advised by care provider. Out of 54 women 41 women went

on advice of TBA, 5 women each received advice from

doctor and LHW while 2 women went by self. Regarding

services taken for TT vaccine it was noticed half of women

received facility from Government Hospital, 19 went to

private hospital, 12 visited NGO clinics. When reason was

asked about not availing TT vaccine 99% women did not

respond while one shared she did not know.

Hours N Percent

0.30 6 5.8

1.00 34 32.7

2.00 32 30.8

3.00 21 20.2

4.00 4 3.8

5.00 7 6.7

Total 104 100.0

Refer for TT Shots

N Percent

No advice 50 48.1

Dai 41 39.4

Doctor 5 4.8

LHW 5 4.8

Sehat Markaz 1 1.0

Self 2 1.9

Total 104 100.0

12

39

50

3

0

10

20

30

40

50

60

2 injections 1 injection No injections More than 2

Tetanus Vaccination

28

TBA’s Preparation for delivery:

Graph shows the preparation of

delivery that almost 90%TBAs

washing their hands before delivery

followed by 88.5% tied hair, 85%

clipped the nails. 84% TBAs changed

their cloths and almost 53% TBAs

using Dai Kit and only as per data only

6.7% taking off their bangles before

delivery

Steps taken during delivery:

Women were also asked about the

steps taken by TBA during delivery

and multiple responses comes as per

bar graph those 85% clients reported

that TBAs applied ghee / oil on

abdominal followed by 74% did

Counseling, 77%Gave something to

eat, 14.4% Asked to walk around,

17.3% taken Examination and gave

Injection, 73% Applied pressure on

abdominal, 77% Checked position of

baby and Assess preparation of

delivery, 12% asked to squatting and

almost 83% assessed duration of labor

pain by putting hand on abdominal.

Clients were also asked about the stay

duration of TBA after the delivery. 30

(29%) women reported that TBA came

and stayed at home. The minimum

duration was 1 hour while maximum

was 2 hours and mean duration was 4

hours

Complication during delivery:

Only 02 women responded they faced complications during delivery. In reply to reason of complications

both women did not respond and TBAs identified regarding the complication. While one third women

replied they went to facility for cure. It was also cited during complications majority of women private

hospital followed by LHV.

6.767.3

84.6

79.8

88.5

89.4

52.9

83.7

Preparatin of Delivery

Take off bangle Take off rings Nail Clipping

Brush Tie Hair Hand washing

Dai Kit Change Cloths

74

76.9

14.4

17.3

17.3

84.6

73.1

76.9

76.9

12.5

82.7

0 20 40 60 80 100

Counseling

Gave something to eat

Asked to walk around

Examination

Injection

Applied ghee / oil on abdominal

Applied pressure on abdominal

Checked position of baby

Assess preparation of delivery

Squatting

Assess duration of labor pain by …

Steps during delivery

29

Postnatal Visits and Examination:

Data showed that 100% TBAs regularly visited

during postnatal period. Survey data showed

that during postnatal checkups, nearly 81%

TBAs examined quantity of bleeding, nearly

13.5% respondents’ shared that TBAs assessed

fever. 12.5 % assessed urine/stool while 23.1%

women did not examine.

Advices given by TBAs during Postnatal:

When respondents were asked about advices

given by TBAs during postnatal, it was cited

that 98% (n=102) emphasized on breast

feeding, 100% of TBAs advised about hygiene,

same number prevented mothers not to take

heavy things, more than 89% (n=93) advised

for rest and slow walk, 20% advised for Family

planning (spacing) and

Examination of neonatal:

During assessment it was observed that most of

TBAs focused on breast feeding, 79% (n=82)

TBAs checked newborn’s color, 70.2% women

shared TBAs asked about breastfeeding.

Regarding advices for newborns during

postnatal, 69.2% advised for breast feeding,

nearly same number of TBAs prevented mother

not to rub anything on umbilical cord, 75 %

advised for healthy food and cleanliness, 75%

asked for vaccination.

Advice for Family Planning:

World Health Organization recommended that

there should be at least 3 years space from one

birth to other to keep mother and child healthy.

From baseline data it was assessed that 83.7%

respondents shared that they were advised for

FP while only 16.3% respondents replied in no.

80.8

13.5 12.5

23.1

0

20

40

60

80

100

Bleeding Fever Urine / Stool No examination

Postnatal Checkups

100 10098 89.4 89.4

19.2

050

100150

Advise by TBA

70.2

2.9

78.8

10.6 12.5 15.48.7 8.7

0

20

40

60

80

100 Neonatal Examination

0

20

40

60

80

100

Yes No

83.7

16.3

Family Planning

30

Wrapping of neonatal:

After delivery, care of newborn is very essential and it depends upon the practices of care provider. In

Baseline Survey it was assessed 89.4% (93) TBAs wrapped newborn with a clean towel/cloth nearly 30%

(31) TBAs cleaned newborn with separate cloth then wrapped in other clean cloth to keep him/her warm,

while only 12% TBAs cleaned newborn with a clean cloth then wrapped in other clean cloth and handed

over to mother.

Tying of Cord & Instruments used for cord cutting:

Regarding tying of cord mothers shared that all TBAs tied cord from one place. 11% respondents shared

that TBA tied cord from two places while all TBAs used new blade for cord cutting. Moreover, it was

cited that around 81% advised mother to use oil, nearly 90% TBAs advised for usage of surma, 28%

advised for use of boiled water and 20% each suggested for use of sprit.

First Bath of new born:

87 (83.7%) respondents shared that TBAs gave first bath within one hour of delivery.

1st Drink after birth:

70.6% women shared TBA gave child other

than honey, ghutti, colostrums and goat milk.

28% women shared TBAs asked mothers to

give colostrums while 8.7% respondents shared

TBAs gave ghutti & goat milk as first drink

after birth.

Time of 1st breast feed

Women were asked about the starting of 1st

breast feed, nearly 77% reported that they start

the breast feeding in half to one hour and 23%

reported 4-6 hours.

Use of delivery kit:

In contrary to TBAs statement regarding use of delivery kit all mother responded that no TBA used

delivery kit. The data in PDHS 2006-07, however, shows that more than one-fourth (32%) of the women

whose last birth was not delivered in a health facility used a safe delivery kit. The urban-rural differential

was very high, with 42% of urban women using safe delivery kits compared with 29% of rural women.

Fees received after delivery:

98 women told that TBAs charged fees from them after delivery and 59.6% women shared TBAs charged

500 rupees for delivery while 10 women shared they gave 1000 rupees for delivery. In rural areas TBAs

are offered something in kind too and in survey area mothers shared they gave TBAs Poti, Kapry, Dopatta

and others.

11.5 8.727.9

8.7

70.2

020406080

77%

23%

Half - one hour

4 - 6 hours

31

Chapter 04

Annexes

32

33

34

35

36

37

38

39

40

41

42

43