Maternal and Newborn Care Practices Among the Urban Poor in Indore, India

This report, funded by the United States Agency for International Development (USAID) and presented by the Urban Health Resource Center (UHRC), describes maternal-newborn care practices and care of infants aged 2-4 months (feeding practices, morbidity status, immunisation status, and nutritional status) in urban slum dwellings of Indore city, Madya Pradesh (India). The findings presented in this report are from a study carried out by UHRC between December 2004 and February 2006 in 11 out of 79 slums where its Indore Urban Health Program has been operational since April 2003. Also discussed in this report are reasons for following these practices, what facilitates and what hinders following optimal practices, and potential programme options for their improvement.

The methods used in this research include: interviews with mothers of infants 2-4 months old, with mothers of low birth weight infants who were thriving, and slum-based traditional birth attendants (sTBAs); assessment of cold stress, hypothermia, and associated danger signs on newborns; assessment of under-nutrition amongst infants and newborns; and group discussions (GDs) with citizen based organisations (CBOs) and mothers of infants.


Strategies for supporting mothers and newborns through antinatal care include:

• Enable families (pregnant women, their husbands, and in-laws) to perceive the benefits of appropriate antenatal care practices through persuasive reinforcement of optimal practices by trained slum-based CBOs and involving early adopters as change aides in group meetings/home visits. Early adopters include: a progressive early adopter/relative/neighbour/an elder lady of the community.
• Encourage families and/or pregnant women to join a health savings fund group from which they can draw money if needed for health care.
• Train ‘Basti’ Community Based Organisations (BCBOs) through pictorial and group discussion, accommodating literacy issues, to monitor behaviours of mothers and assess their progress.
• Establish telephone links of slum-based birthing huts with public or private medical facilities that can offer support.
• Establish "outreach camps" for individual appointments, particularly in the evenings, and group discussions. Attempt to partner with private medical providers when possible to increase confidence in outreach camps.
• Enabling community members to analyse the benefit of and harm of not practising optimal behaviours through discussions using case narratives and/or use of pictorial material by CBOs.
• Refresher training for BCBOs and TBAs, related to resuscitation; cutting and tying the cord tie and thermal protection.
• Engaging in collective dialogue with mothers-in-law (MILs), elder ladies of the community and TBAs to: a) assert the positive role they can play in promoting optimal delivery practices; and b) discuss ways of avoiding harmful traditions.

Strategies for supporting mothers and newborns through postnatal care include:

• Systematic capacity building of active BCBO members and sTBAs, continued refreshers as well as regular supportive supervision;
• Health volunteers trained in lactation-related counselling to support and encourage mothers;
• Providing the BCBOs with pictorial material that can enable them to: a) counsel and conduct post-natal visits; and b) maintain records of mothers;
• Specific strategy mothers who migrate to native villages for delivery; perhaps, a take-home pictorial card or poster and persuasive counselling;
• MILs and other elder women of the community counselled as influencers of practices in the family, especially those pertaining to breast feeding (BF) initiation;
• Television programmes with messages promoting timely initiation of BF and its health benefits for the baby; and
• Strengthening of linkage of community with affordable public and private hospitals that are already accessed by slum dwellers.