Assessing the Effect of Integrated Health Interventions on Maternal and Neonatal Health Outcomes in an Aspirational District of Uttar Pradesh: A Mixed Method Study
DOI:
https://doi.org/10.47203/IJCH.2026.v38i01.037Keywords:
Asphyxia Neonatorum, Maternal Health,, Infant Health, Postpartum HemorrhageAbstract
Background: Maternal and neonatal mortality remain major public health challenges in India, particularly in aspirational districts like Shrawasti, Uttar Pradesh. Birth asphyxia and postpartum haemorrhage (PPH) are leading causes of preventable deaths, necessitating integrated interventions to improve outcomes. Aims & Objective: To assess the effect of integrated interventions on maternal and neonatal health outcomes, with focus on birth asphyxia and PPH, and to compare pre- and post-intervention complications in Shrawasti. Methodology: A retrospective observational study analyzed quantitative data from labour rooms of the district hospital, four community health centres, and the special newborn care unit (SNCU) in Shrawasti. Qualitative insights were derived from in-depth interviews with healthcare providers. Based on baseline findings interventions were implemented between June 2022 and May 2023. Results: SNCU admissions due to perinatal asphyxia declined from 67% to 42.3% (P <0.001). Stillbirths reduced from 3.5% to 1.9% (P = 0.001), while PPH decreased from 6.6% to 3.9% (P <0.001). Neonatal mortality also showed a declining trend (22.6% to 17.9%). Qualitative findings highlighted rational oxytocin use, effective training, improved staff behaviour, enhanced patient awareness, and strengthened documentation as key contributors to improved outcomes. Conclusion: Integrated interventions substantially improved maternal and neonatal health in Shrawasti. Addressing misuse of oxytocin, strengthening training, enhancing awareness, and improving documentation were pivotal in reducing adverse outcomes.
Downloads
References
World Health Organization. India has achieved groundbreaking success in reducing maternal mortality [Internet]. 2018 [cited 2023 Nov 28]. Available from: https://www.who.int/southeastasia/news/detail/10-06-2018-india-has-achieved-groundbreaking-success-in-reducing-maternal-mortality
Press Information Bureau, Government of India. India achieves significant landmarks in reduction of child mortality [Internet]. [cited 2023 Nov 28]. Available from: https://pib.gov.in/pib.gov.in/Pressreleaseshare.aspx?PRID=1861710
Sankar MJ, Neogi SB, Sharma J, Chauhan M, Srivastava R, Prabhakar PK, et al. State of newborn health in India. J Perinatol. 2016;36(Suppl 3):S3–8. doi:10.1038/jp.2016.183
United Nations Inter-agency Group for Child Mortality Estimation (UN IGME). Levels & trends in child mortality report 2018 [Internet]. 2018 [cited 2023 Nov 28]. Available from: https://www.unicef.org/media/47626/file/UN-IGME-Child-Mortality-Report-2018.pdf
Lawn JE, Blencowe H, Waiswa P, Amouzou A, Mathers C, Hogan D, et al. Stillbirths: rates, risk factors, and acceleration towards 2030. Lancet. 2016;387(10018):587–603. doi:10.1016/S0140-6736(15)00837-5
Usman F, Imam A, Farouk ZL, Dayyabu AL. Newborn mortality in sub-Saharan Africa: why is perinatal asphyxia still a major cause? Ann Glob Health. 2019;85(1):112. doi:10.5334/aogh.2541
Enweronu-Laryea CC, Andoh HD, Frimpong-Barfi A, Asenso-Boadi FM. Parental costs for in-patient neonatal services for perinatal asphyxia and low birth weight in Ghana. PLoS One. 2018;13(10):e0204410. doi:10.1371/journal.pone.0204410
Brahmawar Mohan S, Sommerfelt H, Frøen JF, Taneja S, Kumar T, Bhatia K, et al. Antenatal uterotonics as a risk factor for intrapartum stillbirth and first-day death in Haryana, India: a nested case-control study. Epidemiology. 2020;31(5):668–76. doi:10.1097/EDE.0000000000001224
Lovold A, Stanton C, Armbruster D. How to avoid iatrogenic morbidity and mortality while increasing availability of oxytocin and misoprostol for PPH prevention? Int J Gynaecol Obstet. 2008;103(3):276–82. doi:10.1016/j.ijgo.2008.08.009
Ellis M, Manandhar N, Manandhar DS, Costello AM. Risk factors for neonatal encephalopathy in Kathmandu, Nepal: unmatched case-control study. BMJ. 2000;320(7244):1229–36. doi:10.1136/bmj.320.7244.1229
International Journal of Gynecology & Obstetrics. Oxytocin-related study [Internet]. Available from: https://doi.org/10.1016/0020-7292(95)02389-T
Belghiti J, Kayem G, Dupont C, Rudigoz RC, Bouvier-Colle MH, Deneux-Tharaux C. Oxytocin during labour and risk of severe postpartum haemorrhage: a population-based, cohort-nested case-control study. BMJ Open. 2011;1(2):e000514. doi:10.1136/bmjopen-2011-000514
NITI Aayog. Aspirational Districts Programme [Internet]. [cited 2023 Nov 28]. Available from: https://www.niti.gov.in/aspirational-districts-programme
NITI Aayog. Health & Nutrition dashboard [Internet]. [cited 2023 Dec 4]. Available from: https://limararuv5gr0sh-nitiprdadw.adb.ap-mumbai-1.oraclecloudapps.com/ords/f?p=100:3
Chuni N. Analysis of uterine rupture in a tertiary center in Eastern Nepal: lessons for obstetric care. J Obstet Gynaecol Res. 2006;32(6):574–9. doi:10.1111/j.1447-0756.2006.00461.x
Rama Rao S, Caleb L, Khan ME, Townsend JW. Safer maternal health in rural Uttar Pradesh: do primary health services contribute? Health Policy Plan. 2001;16(3):256–63. doi:10.1093/heapol/16.3.256
Jeffery P, Jeffery R, Lyon A. Labour pains and labour power: women and childbearing in India. London: Zed Books; 1989.
Pinto S. Development without institutions: ersatz medicine and the politics of everyday life in rural north India. Cult Anthropol. 2004.
Sharan M, Strobino D, Ahmed S. Intrapartum oxytocin use for labor acceleration in rural India. Int J Gynaecol Obstet. 2005;90(3):251–7. doi:10.1016/j.ijgo.2005.05.008
Jeffery R, Jeffery P, Rao M. Safe motherhood initiatives: contributions from small-scale studies. Indian J Gend Stud. 2007;14(2):285–94. doi:10.1177/097152150701400204
Karachiwala B, Matthews Z, Kilaru A. The use and misuse of oxytocin: a study in rural Karnataka, India. BMC Proc. 2012;6(Suppl 1):P12. doi:10.1186/1753-6561-6-S1-P12
Selin L, Almström E, Wallin G, Berg M. Use and abuse of oxytocin for augmentation of labor. Acta Obstet Gynecol Scand. 2009;88(12):1352–7. doi:10.3109/00016340903358812
Singh S, Chandhiok N, Dubey R, Goel R, Kashyap J. Barriers to optimal and appropriate use of uterotonics during active labour and for prevention of postpartum haemorrhage in public health care facilities: an exploratory study in five states of India. Sex Reprod Healthc. 2021;29:100624. doi:10.1016/j.srhc.2021.100624
Deepak NN, Mirzabagi E, Koski A, Tripathi V. Knowledge, attitudes, and practices related to uterotonic drugs during childbirth in Karnataka, India: a qualitative research study. PLoS One. 2013;8(4):e62801.
Downloads
Published
How to Cite
License
Copyright (c) 2026 Surbhi Yadav, Shamshad Ahmad, Pallavi Lohani, Mahendra Kumar, Anju Gahlot
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
