Contextual Factors Influencing Newborn Care Amongst Rural Poor in Western Uttar Pradesh

Abstract: One out of every 16 newborn dies in rural poor communities of Uttar Pradesh. Survival of newborns is influenced much by care provided by the family. This qualitative study identifies factors influencing newborn care in rural poor socially backward communities of Agra. Interviews and group discussions were conducted with mothers and grandmothers of newborns belonging to low socioeconomic status and traditional birth attendants (TBAs). Aspects enquired were birth preparedness, intra and postpartum care. Available responses were semi quantified. Home deliveries were common and conducted mostly by mother-in-laws (MILs) or TBAs who felt incompetent to handle complicated labour. Birth preparedness was uncommon. Nearly all newborns were left wet and naked on the floor until the placenta was delivered and bathed immediately after birth. Very few birth attendants washed their hands with soap prior to delivery. Of these, none let their hands air dry after washing. An unsterilized cord tie and new blade dipped in hot water before use was used to tie and cut the cord. No application was applied on cord stump. Majority of newborns were neither initiated breast feeding timely nor were they exclusively breast-fed. Behaviourial influencers included –i) MIL’s advice, ii) traditional beliefs or iii) following a practice because it was the done thing in the community. Barriers that emerged were –i) fear that if traditions are not followed the baby may be harmed, ii) families did not perceive any disadvantage of their current practice, iii) relating neonatal death to fate and iv) low maternal self-efficacy in practicing recommended behaviours because the MIL took final decision regarding newborn care. There is a need to engage collective dialogue with MILs and TBAs and assert the positive role they can play in promoting context responsive newborn care. Key words: Birth preparedness, delivery practices, newborn care, rural poo