Safe motherhood prctices in Rukum By Khima Oli

SAFE MOTHERHOOD PRACTICE AMONG DALITS:
(A comparative case study on Safe Motherhood Practice among Dalits in Purtimkada VDC, Ward no. 4 and 5 in Rukum District)

By
KHIMA OLI
September, 2007

ABSTRACT
This study was based on the safe motherhood practice among Dalits in Purtimkanda VDC, Rukum. The study was mainly based on primary data with perception of married women having at least one child of less than five years in age. The main objectives of the study are: to study the socio-economic features of Dalit women, to examine the knowledge of safe motherhood among Dalit women, to study the level of utilization of safe motherhood services by Dalit women and to find out the level of family planning knowledge among Dalit women in the study area.
Census is taken to collect data from each household of Kami, Damai, Sarki and Badi. In this research, 134 households are included. Out of the total households, 130 households from ward no 4 and 4 households from ward no 5 are included. Similarly, 104 Kami, 18 Damai, 8 Sarki and 4 Badi female populations are studied as targeted respondents of aged 15-49 years. This research is more quantitative than qualitative.
On the basis of this study, safe motherhood practice among Kami, Damai, Sarki and Badi is found varied. Knowledge, education and occupation have effect on practice of safe motherhood. Of the total population in each caste, more than a half have knowledge about safe motherhood but practice is found lower as compared to the magnitude of known. Antenatal care is found better in comparison about safe motherhood is found some increased now than before. Family planning knowledge is found better as compared to antenatal, safe delivery and postnatal cares among this caste.
- Social services, type of house, food of pregnant women, knowledge and education have effect on safe motherhood practice.
- More than half of the total number of population have knowledge about safe motherhood in each caste but practice is seen lower.
- Sarki is seen higher position in the comparison of other caste followed by Damai and Badi.
- Knowledge about safe motherhood is found increased now than before.
- Family planning knowledge and practice is found better.
On the basis of conclusions the recommendation for policy implementation are suggested as follows:
- Basic physical needs such as drinking water, sanitation, electricity/solar which should be made available to all households.
- Mother groups which are organized should be strengthened, trained and services should be provided by those trained persons which are possible.
- Government and concerned organizations should promote and strengthen the status of literacy among Dalits.
-Training, seminar and meeting should be conducted to motivate women of reproductive age.





Date-------------

LETTER OF RECOMMENATION
This dissertation entitled "Safe Motherhood Practice Among Dalit: A Comparative Case Study on Safe Motherhood Practice of Kami, Damai, Sarki and Badi in Purtimkanda VDC ward no 4 and 5, by Khima Oli is Prepared under my supervision for partial fulfillment of the requirement for the degree of Masters of Arts in Rural Development . To the best of my knowledge the study is original and carries out useful information about safe motherhood practice. I recommend the dissertation committee for evaluation of the dissertation.


------------------------------
Mr. Gopal Khadka
Lecturer
T.U. Kirtipur
Kathmandu, Nepal








Date------------------

APPROVAL SHEET

This thesis entitled Safe Motherhood Practice among Dalits: A comparative case study of Purtimkanda VDC-4 and 5 Rukum District submitted by Khima Oli to the Central Department of Rural Development, Faculty of Humanities and Social Science has been accepted as the partial fulfillment of the requirement for the Master's Degree of Arts in Rural Development.



EVALUATION COMMITTEE
Pro.Dr. Pradeep Kumar Khadka -----------------------------
Head of the Department

Mr Gopal Khadka -----------------------------
Supervisor

----------------------------
External Examiner







ACKNOWELEDGEMENT

It is pleasure to submit this project report. The title "Safe Motherhood Practice among Dalits" as a case study of Purtimkada VDC, Rukum District has undertaken into study for the partial fulfillment of the requirements for the Master's Degree of Arts in Rural Development.

This report has been completed under the guidance of respected teacher Gopal Khadka. First of all, I would like to express my sincere gratitude to my supervisor Gopal khadka associated with Central Department of Rural Development, Tribhuvan University, Kirtipur for his active supervision, advice and regular guidance to complete the work.

I would like to express my sincere gratitude to Professor Dr. Pradeep Khadka, Head of department, Central Department of Rural Development, Tribhuvan University.

I am also indebted to all my family members, mostly my husband Ganga B.C, my little child Samyog B.C, and my faithful gratitude to my mother who provided with opportunity of education and always encouraged me in every step of my life.

Similarly, I would like to thank all the institutions in including District office, Rukum, Dalit people of Purtimkada VDC. My thanks go to all friends who helped me directly and indirectly to complete this work.
Thanks
Khima Oli
Central Department of Rural
September, 2007 Development, Tribhuvan University, Kirtipur




CHAPTER ONE
INTRODUCTION
1.1 Background of the Study

Among different components of demography fertility and mortality are leading causes of change in structure and composition of population. Fertility and mortality are biotical processes which happen to everybody. In demographic study reproductive health is an important concern along with other fertility related topics. Fertility is positively associated with the mother’s health. Safe, successful and planned fertility protects women’s life as well as born or unborn baby. High fertility and mortality also influence the reproductive health of women.

Status of women is lower in most of the developing countries like Nepal. Low literacy rate, high fertility rate, high maternal mortality rate; high infant and child mortality rate are some indicators of lower status of women. Further, they have no opportunities to get education, to have nutritional food, to make decision, to represent at various social sectors due to lower status and inaccessibility to empower. Nepal is a multi-ethnic/caste country; the contribution to the high level of national fertility rate made by the different caste/ethnic group needs to be addressed urgently.

Among these castes, Dalit women are backward due to racial discrimination, low literacy rate, high fertility rate, and high maternal mortality rate than other caste of women. Therefore, it can be said that women are dominated and treated as compared to men. In developing countries like Nepal this position of women exists not only in pregnancy period but also during the time of pregnancy through delivery to postnatal period. It is obvious that women are aware of their civil rights. Hardly a little number of women is aware and struggling for their rights and required services but also it can’t spread all over the country and village, as far remote and rural areas. Due to lack of awareness, inaccessibility to rights and economic hardship, majority of Nepalese women are not practicing safe motherhood services. Only 5 percent of women receive assistance from trained or skilled health personal during delivery and there are marked differences across socio-economic and regional levels (CBS, 1997).

International conference on population and Development Cairo 1994, The Fourth World Conference on Women Beijing 1995, The Safe Motherhood Consultation Colombo 1997 have helped to focus and attempt problems of reproductive health as well as reproductive rights. All the participant countries are committed to adopt the policy and programmed of action to their own country. Nepal has also agreed to these policies and programs.

Mother is the foundation of life. More than fifty percent of world population is covered by female. In most of the countries, females are discriminated. Nowadays, the issue of women has been given the priority. Among the various issues, health issues are prior subject on various levels. Fertility and mortality are the rule of nature, which influences family and society. Biologically, fertility process is more associated with women. As a result, fertility and women health are interrelated issues. Therefore, reproductive health and right of the women are primary concerns for everybody.

Safe motherhood means, creating the circumstance within which a women is able to choose whether she becomes pregnant. If she does, ensuring that she receives care for prevention and treatment of pregnancy. Complication, that she has access to trained birth assistance, and if she needs it to emergency obstetric care, are care after birth to prevent death or disability from the complication, that she has access to trained birth to prevent death or disability from the complication of pregnancy and child birth (MOH, 1998).

Pregnancy and childbirth are very risky. Many women die while giving birth to children. According to the report of the international Conference on Population and Development in Cairo in 1990 A.D. about half a million women die each year of pregnancy related complications in the world. Women in the developing countries have to face more complications. So maternity mortality is to be reduced by one fourth by 2015 A.D it is possible only when motherhood is safe. Motherhood is the method of protecting the mother from the complications of pregnancy and childbirth related problems. It requires care of the mother especially in the period of pregnancy and after the child birth.

In a country like Nepal, where the literacy rate of women is very low education on safe motherhood is in the worse condition. And lack of education on safe motherhood is the prime cause of maternal death and morbidity. Nepalese women and even parents have no knowledge of appropriate age at marriage, pregnancy and problems related to childbirth. This ignorance results in high maternal mortality rate. Apart from this, they do not know the benefits of birth spacing and having less number of children. They are ignorant of the fact that only a healthy mother can give birth to a healthy child. They need education to nourish and take care of their children. It is necessary to give adolescents information about the harms of early marriage, premature sexual activity, first pregnancy and the advantages of delayed marriage.

In reproductive health, safe motherhood is a central part and it concerns at the period of development, during delivery and post-natal period. Development, the pregnancy care includes at least 4 time health check up, providing nutrition's food, relief from the physical work, extra diet like iron, calcium, vitamin, TT immunization, health education, including breast feeding and family planning counseling, and appropriate medical appointment. Safe delivery includes immediate care of new born and mother recovery, thermal control, obstetric first aid and immediate care for breast feeding. The post-natal care includes mother and new born health check up at least once within 24 hours of delivery and one time during the first week and then as needed, breast feeding, thermal control, immunization nutrition and hygiene temporary and permanent methods and supervision and monitoring which is supportive of the health care provider.

In Nepal, a poor country, majority of inhabitants are facing reproductive health related complication and treating with the causes of maternal deaths and child death. These cases are occurring due to lack of education, health service, drinking water sanitation and low incomes as well as due to cultural attitude. In this respect, this study will attempt to find out the; perception and utilization of safe motherhood, practices level knowledge of these Dalit women of Purtimkanda VDC of ward no 4 and 5 of Rukum District.

1.2 Statement of Problem

Nepal is a multi-caste and multi ethnic country, the part to the high level of national fertility rate made by the different caste group needs to be addressed urgently. In Nepal, lower caste group women are discriminated by upper caste. Women are discriminated by male in the Nepalese society. Women are dominated by male because of lack of women education, economic condition and social norms and values. Dalit people who are "Pani nachalne Chhiochhito halnuparne" live in rural area in western development and mid western development region. These people have very low socio-economic condition characterized by low literacy and education, low level of income and high level of unemployment. The socio-economic status of women of this community is even lower. So, these factors Dalit women's situation is very critical in terms of health seeking behavior.

This study attempts to find out the perception and utilization of safe motherhood practices, level of knowledge of these Dalit women of Purtimkanda VDC of Rukum district. It is believed that these women have low level of knowledge, perception and utilization of safe motherhood practices because these are the women who are lower caste and have low socio-economic condition and health status. Ten years long Moaist conflict also affected Dalit women because their husband participated in the war. At that time only women faced all problems which is related with theirs health problem directly. They did not have nutrition food and related other health facilities. No previous research had been done; this study till now, is considering these Dalit women as the focus population

In Nepal, a poor country, majority of inhabitants are facing reproductive health related complication and treating with the causes of maternal deaths and child death. These cases are occurring due to lack of education, health service, drinking water, sanitation and low incomes as well as due to cultural attitude. In this respect, there is big problem appropriate health problem, safe drinking water and lack of consciousness about safe motherhood. So, this study will be focused in Purtimkanda VDC ward no 4 and 5 of Rukum district. This study raised identify of the main problems and its conclusion also.

The research questions have led to the clear picture, whatever the researcher wants to identify. Based on the above-identified problems, the researcher has set following research questions.

I. What are the socio-economic characteristics of Dalit women?
II. How is the knowledge of safe motherhood practice among Dalit women in the study area?
III. How much level of utilization of safe motherhood services by Dalit women in the study?
Iv. How is the level of family planning knowledge among the Dalit women in the study area?





1.3 Objectives of the Study

The General objective of this study is to examine the utilization of safe motherhood services, level of knowledge and among the Dalit-women who are residing at the Purtimkanda VDC of Rukum District.

Following are the specific objectives of the study:
a) To study the socio-economic characteristics of Dalit women in the study area.
b) To examine the knowledge of safe motherhood practice among Dalit women in the study area.
c) To study the level of utilization of safe motherhood services by Dalit women in the study area.
d) To find the level of family planning knowledge among the Dalit women in the study area.

1.4 Significance of the Study

This study is designed to find out the extent of different social/caste groups of population, especially women of reproductive age groups. So this is a combined study of different groups in rural area of Nepal. Various studies are conducted in Nepal but rarely are in a form of a comparison.

The study carries the information about practice and knowledge of safe motherhood services comparatively, especially women of Badi, Kami, Sarkia and Damai which are called Dalit caste. They are more vulnerable to the comparison of other caste. They are in lower position in all sectors, education, economic, employment, political and social. As a result of inferior position in every sector they are facing complications of health risk as well as reproductive health. The result carried out by this study is important and useful for those people who want to know about their status. The finding can be used to understand the similarities and dissimilarities among this lower caste.

Furthermore, the study measures the causes of non practice of safe motherhood services among the study population. Similarly the resources which are they using likewise drinking water, sanitation, health environment and health related resources. The information and result may be the guideline for local level governmental and non-governmental organization to adopt to make policy for the future. The study is attempted to analyze, overall socio-economic status of these selected caste groups.
The major significance can be listed as follows:

a. The findings of the study will be useful to the local people to develop awareness towards health problems in Dalit Community

b. The result of the study will be helpful to women to take care of their own health and their children.

c. The result will be helpful for the concerned experts and teachers to frame curriculum accordingly in the area of health education.

d. It will be useful as a guide for further research in similar studies.

1.5 Limitations of the Study

Every study has some limitations. This study has also some limitations. They are as follows:
1. This study doesn't represent the exact level of the practice of safe motherhood among other caste and ethnic groups because this study covers the sample targeted population who has at least one live birth experienced or pregnancy.
2. This study covers Purtimkanda VDC ward No. 4 and 5 population especially Kami, Damai, Sarki and Badi women.
3. This research report will be conducted for practical fulfillment of the Master's Degree in Rural Development.

1.6 Organization of the Study

This research comprises six chapters. Introductory chapter is followed by review of literature and study methodology respectively for chapter one, two and three. The fourth chapter is devoted to socio-economic and demographics of the study area based on data from survey. Chapter five presents the analyses and interpretation of data of selected dependent and independent variables related to safe motherhood practice. Finally, summary, conclusion and recommendations implications and future area of research are presented in chapter six.


















CHAPTER TWO
LITERATURE REVIEW
Family planning and Child Health (MCH) Programs have played an important role in influencing population growth and improving the quality life and human resources development in the countries of Asia and Pacific. The success of family planning and MCH program is closely associated with the improved role and status of women; lower infant, child and maternal mortality rates; better birth spacing and breast feeding practices; and the delivery of services by trained personnel. Nevertheless much remains to be done. There is a urgent need to strength programs and adopt innovative approaches and strategies. To a large extent the success of programs depends upon empowering individuals, families and communities to plan and decide for them, as well as to design and implement, programs their own needs (Bali Declaration: 1992).
The national reproductive health strategy of Nepal (adapted in 1997) included the following components to make integrated reproductive health science available to all the people of Nepal (MOH, 1996). Family planning, Safe motherhood, care of the newborn baby , prevention and management of complication of abortion, prevention and management of RTIS, STDs, HIV and AIDS, Prevention and management of infertility, Adolescents reproduction health and Problems of elderly women, particularly reproductive tract cancer.
Indeed, data from the world fertility survey for developing countries indicate that, data from the world fertility survey for developing countries indicate that, on average, over one forty of birth in the year prior to the survey had not been desired. In addition, the decline in the prevalence of certain traditional practices, such as prolonged breast-feeding and past-partum abstinence, has increased the relative importance of not traditional family planning as a tool for the proper spacing of birth (Mexico, 1984).
All countries, with the support of all sections of the international community must expand the provision of maternal health services in the context of primary health care. These services, based on the concept of informed choice, should include education on safe motherhood, prenatal care that is focused and effective, maternal nutrition programs, adequate delivery assistance that avoids excessive resource to caesarian sections and provide for obstetric emergencies; referral services for pregnancy, child birth abortion complication; postnatal care and family planning. All births should be assisted by trained persons, preferably nurses and midwives, but at least by trained birth attendants. The underlying causes of maternal morbidity and mortality should be identified, and attendance should be given to the development strategies to overcome them and for adequate evaluation and monitoring mechanisms to access the progress being made in reducing maternal mortality and morbidity and to enhance the effectiveness of ongoing programs. Programs and education to engage men's support for maternal health and safe motherhood should be developed (Cairo, 1994).
Emphasize the elimination of harmful attitudes and practices, including female genital mutilation, son preference (which results in female infanticide), early marriage, including child marriage, violence against women, sexual exploitation, sexual abuse, which at times in conductive to infection with HIV/AIDS and other sexually transmitted diseases, drug abuse, discrimination against girls and women in food allocation and other harmful altitudes and practices related to the life, health and will-being of women, and reorganization that some these practices can be violations of human rights ethical medical principles', (Beijing, 1995).
The targets of safe motherhood program is to reduce maternal mortality to 400 per 1, 00,000 live births by the years 2000. This goal is to be achieved by increasing the number and quality of service out lets (MOH, 1993). An integrated R.H. care package has been adopted for Nepal and includes following necessary component for package program.
- Family planning.
- Safe motherhood.
- Child health (new born care)
- Prevention and management of complication of abortion.
- RTI/STD/HIV/AIDS
- Prevention and management of sub-fertility.
- Adolescent reproductive health
- Problem of elderly women i.e. uterine, cervical and breast cancer treatment at the tertiary level in the private sector.
The Ninth five year plan had targeted 3.06 million women for antenatal visits during pregnancy and 1.2 million women to receive at least 100 tablets of iron/foliate. Similarly, 30 per cent of expected pregnancies targeted to attend by trained health personnel and volunteer trained (NPC, 1997).
The status of women in the community strongly affects maternal mortality for a number of reasons among others, because it influences the pattern of child bearing (WHO, 1991).
The TT vaccination and iron/foliate supplementation are also provided from village level health centers. The most effective way of reducing the risk of death, among pregnant women is by increasing accessibility and size of essential obstetric services (WHO, 1991).
A major barrier for women to the achievement of the highest attainable standard of health is difference both between man and women and among women in different geographical regions social classes and indigenous and ethnic groups (World Conference on Women, 1995).
Overall, one in two pregnant women received antenatal care. Twenty eight per cent of mothers receive antenatal care either from a doctor (17.0) or a nurse of nurse or auxiliary nurse midwife (11.0%). Another (11.0%) of mother received antenatal care from a Health Assistant (HA) or Auxiliary Health Worker (AHW). Village Health Workers (VHWs) provided antenatal care to (6.0%) of women and maternal and child health workers (MCHWs) provided care to (3.0%) of mothers. Traditional Birth Attendants (TBAs) provided antenatal care less than (1.0%) of mother (DHS, 2001).
It is found from a study that illiterate women are 1.4 times likely to bear a baby with low birth weight than literate mothers. Mothers who did not go for antenatal care (ANC) are 1.29 times likely to bear a baby with low birth weight than those who have 3 or more ANC visit (pant, 1997). Similarly, another study (Pant and Acharya, 1997:56) also have found strong association between the risk of infants during their first week of life and between the first and fourth week of the life according to the also shows that infants of mother residing in rural areas experience a 33 per cent higher risk of dying during their first week of life compared with those in urban areas.
Pokharel (1997), in his study on Maternal Health in Nepal found that 79.08 per cent of women had not taken any ANC services about 10 per cent took antenatal services from doctors 7.44 form Nurse and only 1.28 per cent from TBSs. Majority did not consult for such check up. Among women who took antenatal care services from doctors the highest per cent followed by 20-24 year age group with 14.55%. The lowest per cent of women who took this kind of check up was from older aged women (i.e. 45 years ad above). Pokharel also found that only 2.75 per cent of them used such services.
Only, one in five of the Nepalese women receive ANC services. On the average Nepalese women make 0.7 ANC visit during pregnancy which severely falls short from the recommendation of safe motherhood program where women are expected to make at least three visits during a pregnancy (CBS/NPC, 1997).
Education is better health of mother and child, Nepal still facing the problem of low literacy rate among females. Female's constitute 49.7 per cent of the total population, the 1981 census shows that only 11.5 per cent females have received education and in 1991 the female population was 50.13 per cent and 25 per cent were literate (MOPE, 1997).
In one study conducted by Acharya (1998) in rural area of Nepal, it was found that women aged 25-39, who came from high socio-economic household and who belong to high cast Hindu and Tbeto-Mongolian ethnic groups were more likely to vaccinate their children similarly, he also found that the children's whose fathers with at least 8 years of schooling were two times more likely to vaccinated compared to the no schooling group. The death of women during pregnancy or child birth is not only a health issue but also a matter of social injustice (WHO, 1999).
Since the fourth world conference of women held in Beijing 1995, women's health issues are increasingly being included in development agencies. In South-east Asia region, women's health programs promote the integration of gender perspective in both WHO and national programs. They also promote the development of health policies, a technical unit for women's health was established in the regional office in 1997 (WHO 2000).
WHO Report says "the resulting death toll could be sharply reduced through wider use of key interventions and a "continuum of care." Approach for mother and child that begins before pregnancy and extends through childbirth and to the baby's childhood". (WHO, 2005).
The WHO report shows that 90 percent of all death among children fewer than five years of age is attributable to just six conditions. These are acute neonatal conditions, mainly prater birth asphyxia, and infections, which account for 37percent of the total, lower respiratory infections mostly pneumonic (19 percent), diarrhea (18 percent), malaria (8 percent ), measles (4 percent ), and HIV/AIDS (3 percent). Most of these deaths are avoidable through existing interventions that care simple, affordable and effective, they include oral dehydration therapy, antibiotics, anti-malarial drugs and insecticide treated bed nets, vitamin A and other micronutrients, promotion of breast feeding, immunization and to reduce the death toll the report calls for much greater use of these interventions, and advocates a "continuum of care" approach for other child that begins before pregnancy and extends through childbirth and in to the baby's childhood. (WHO, 2005).
In the world Health Report 2005 WHO estimates that out of a total of 136 million births a year worldwide less than two thirds of women in less developed countries and only one third in the least developed countries have their babies delivered by a skilled attendant. The report says this can make the difference between life and death for mother and child if complications arise. (WHO, 2005).
In the world 300 million women currently suffer from long term or short term illness by pregnancy or childbirth. The 52900 annual maternal deaths including 68000 deaths due to unsafe abortion are even more unsystematically spread than new born or child deaths: only 1 percent countries. There is a sense of progress backed by the tracking of indicators that show in uptake of care during pregnancy and child birth in all regions except, Sub-Sahare Africa (WHO Report 2005).
Nepal fertility, family planning and health survey (NFPHS, 1991) examined the knowledge, attitudes and practices about safe mother-hood including prenatal care, TT injection during pregnancy, delivery services and type of assistance during delivery which was conducted by ministry of health, FP/MCH Division and NIV joint venture. The out come of the study was only 18 per cent delivery were taken place under the supervision of trained health personal (11 per cent Doctor;4.2 per cent Nurse/Midwife and 2.3 per cent T3 A) only 24 per cent of women received TT injection during pregnancy including 15 per cent single lose and 27 per cent double close. More than 90 per cent delivery cases were observed at home.
Family Health Survey Nepal (NFHS, 1996) has reported that only 15 per cent women received prenatal services in 1988-91 and found 24 per cent in 1995/96. Prenatal care received by 20 per cent women in 1988-91 to 45 per cent in 1995/96 and only 33 per cent women received two or more dose of TT and additional 13 pre cent received only single dose and 54 per cent did not receive dose of T.T vaccine.
In Nepal, family plays a crucial role in promoting healthy pregnancies, reducing the chance of high risk pregnancies, seeking routine maternity care and recognizing and taking immediate action for obstetric emergencies. About 25 per cent pregnancies develop complication during different periods of pregnancy, delivery are responsible for death and loss of healthy life of a women and new born baby (MOH, 1996).
The maternity service factors: place and attended of antenatal care and attended at delivery, related to the period of pregnancy when death occur. In total, 28 per cent women died during pregnancy, 9.9 per cent during labor and 62.1 per cent died after delivery. The "high risk" pregnancies are too early or too late. While low risk of maternal death occurs in age group 20-39 years of age (MOH, 1998).
Khanal, Milan Kumari (2001) has made a study on "Maternal and Child Health Care Practices of Ganderve (Gaine) and lower Caste of Kaski District". The study has reported that among the total respondent mothers 83.3 per cent mothers reported that health checkup was done during pregnancy. 46.67 per cent of them reported that health check up was done during pregnancy for two timers. 10.0 per cent mother reported that only 1 tome.5 per cent of them reported more then three times health checks up during pregnancy. She has also found that most of them 71.67 per cent delivered their babies at home and 65 per cent were assisted by family member during delivery. Remaining per cent of mothers are assisted by health personnel's and TBA, during delivery.
In the developing countries, maternal and child mortality is higher than the developed countries. In the developing countries, there is per year 600000 women death by the completion of delivery and 1060000 child deaths per year. 95 percent women face by pregnancy related complication in the developing country. In African and sub-Saharan 16 per cent women face to pregnancy complication death per total pregnancy complication death per total pregnant women. In the developed countries only 1 percent of total pregnant women face to complication of death, which is lies in the 380 total pregnant women. In the developing world 42 percent women has can not get a safe motherhood service (WHO and MOH, 2005).












CHAPTER THREE
RESEARCH METHODOLOGY
First of all, this chapter deals with the introduction to this research. The research is based on rural area of Nepal and lower caste. Rural population has lower social status as compared to urban population. Various studies have shown population of lower caste is in lowest position in comparison to higher caste. It is not found any study or research in this area among Kami, Damai, Sarki and Badi. In this respect, this study mainly includes the safe motherhood practice among Kami, Damai, Sarki and Badi women from Purtimkanda VDC ward no 4 and 5 in Rukum District. Census is taken to collect data from each household of Kami, Damai, Sarki and Badi
3.1 Selection of the study area
Rukum district lies in the Mid-western Development Region and Rapti zone which is around 800 K.M. far from the capital of Nepal. In the Rukun district 2 electoral region and 43 VDCs. It extends between 28.29' and 25.0'Northlatirude and 2.12' and 2.53' east longitude.The total area of this district is 2877 square kilometer, of the total area. According to the census of 2001, the total population of this district is 188438 out of which 95432 are males and 93006 are females and total household no. is 33501.
It is a hilly area and less developed, such as lack of communication, education, infrastructure development, health and other facilities. Rukum is also known as remote district. The district's socio-economic and educational status is at low level and also health sector is at just developing stage. The contraceptive prevalence rate (CPR) is 30.3% only and 8410 women visits health workers in pregnant period. The percent of delivery by health workers is 9.9% among the total population. (UNICEF district profile 2005) According to district office of health service Rukum, maternal mortality rate is 539 per 100000; child death rate is 91 per 1000.Purtimkanda VDC is the study area selected for this research. Among the 3913 VDCs of the kingdom of Nepal, Purtimkanda VDC of Rukum district lies in the Rapti zone of mid-western development region. It is about 5 K.M. far from its district headquater musikot.
The weather condition of this VDC is very fine. It is neither too hot nor too cold. The average temperature is about 18 oc to 27 oc. The rainy season starts from Jestha and continue till Ashbin causing 500-700 mm, rainfall in average. There is a lower secondary school, 4 primary schools, a sub agro-vet center, a sub -health post. There is not motor able road and PCO.
Purtimkanda VDC is a hilly area where there is lack of development and also lack of communication, education, infrastructure development, health and other facilities. The VDC socio-economic and educational status is at low level and also health sector is at just developing stage. The VDC consists of various cast, ethnic groups and different religious. The Dalit community is residing in the bank of the VDC. We can reach in the study area in 4 hour from the district various modern facilities and services which need to be improved for people.
According to the census of 2058, the total population of this VDC is 4382 of which 2207 are male and 2175 are female. There is only one sub health post. Peoples must walk 5 hour long for checkup doctor in headquarter of district. This VDC lies in the western part from the district headquarter. Large group of Dalit community live in this VDC. They are very poor and very low level of socio-economic condition.
In the context of safe motherhood practice, mostly Dalit women are disadvantaged than other cast due to socio-economic condition and racial decimation. So, researcher selects the area of Dalit community of purtimkanda VDC 4 and 5 Rukum.

3.2 Research Design
This research is designed to identify the safe motherhood practice among Kami, Damai, Sarki and Badi women from Purtimkanda VDC in Rukum District. Census is taken to collect data from each household of Kami, Damai, Sarki and Badi. In this research 134 household are included. Out of the total households, 130 from ward no 4 and 5 from ward no 4 are studied. A total of 104 households of Kami, 18 households of Damai, 8 households of Sarki from ward no 4 and 4 household of Badi from ward no 5 are included. Similarly 104 Kami, 18 Damai, 8 Sarki and 4 Badi female populations are studied as targeted respondents of aged 15-49 years. This research is more quantitative than qualitative.
3.3 Sources of Data
Data are collected from the study population of selected area through interview on the basis of structured questionnaire. So, the study is quantitative as well as qualitative. The respondents are divided in three parts, they are as follows:
a. Head of the household or who can give information of his/her house to the question which are asked from questionnaire.
b. The individual questionnaires are asked to those women of reproductive age (15-45) years who have the experience of a pregnancy and delivery at least one.
c. Census is taken from each household
3.4 Data Collection, Sample Design and Sample Size
This study calculated the total Kami, Damai, Sarki and Badi population of women of the reproductive age (15-49) years who have the experience of pregnancy and child birth at least one from Purtimkanda VDC ward no 4 and 5. Since the researcher is from the same locality, it was not difficult to identify the study population therefore Census was taken from each household.
3.5 Questionnaire Design
a. Household questionnaires are conducted to all the numbers of household. Though the household questionnaires information on, age, sex, family size, caste/ethnicity, educational status, marital status, drinking water, electricity, type of house, radio, television, health facilities and occupation were collected. The sample of the household questionnaire is given in Appendix I.
b. Individual questionnaire was designed for all women of reproductive age (15-49) years who have experience of pregnancy and child birth at least one. Information on the practice of safe motherhood services ANC, delivery care PNC services from each targeted population was collected. The sample of individual questionnaire is also given in Appendix II.
3.6 Method of Data Tabulation and Analysis
a. After collection of data from the study population Badi, Kami, Sarki and Damai, frequency and per cent distribution were tabulated according to the variable, jointly or each 5 years age group (15-49) of female population by caste.
b. Analysis of data
The following dependent and independent variables were analyzed;
a. Dependent Variable
- Prenatal/Antenatal cares
- Delivery care
- Postnatal care
- Practice of FP services
b. Independent Variable
- Education and SMP.
- Knowledge and SMP.
- Attitudes and SMP.
- Occupation and SMP.
c. Tools for analyzing data
- Frequency distribution table
- Percentage distribution table
- Central tendency (Mean)
These tools are used which are supported by data including information.








CHAPTER- FOUR
SOCIO-ECONOMIC AND DEMOGRAPHIC
CHARACTERISTICS OF THE STUDY AREA
4.1 Background
This chapter deals with the social status of the study area. Living house toilet, drinking water, transportation, telephone, radio, T.V., health facility, school etc. are the most important determinants of social development. Similarly, income and occupation show the economic status. Size of population, age composition, marriage, birth, death etc. shows the demographic status of the society. So, this chapter is attempted to identify the socio-economic and demographic status of the study area.
4.1.1 Household of the Study Population
This study is based on only Kami, Damai, Sarki and Badi in Purtimkanda VDC (4-5). As the result of survey, the number of household and type of household are presented in the table 1 and table 2 below respectively.
Table 4.1 Distribution of Households of the Study Area by Caste
Kami
Damai
Sarki
Badi
Total
104
18
8
4
134
Source: Field Survey, 200
Table 4.1 shows that out of total 134 household s 104 houses are of Kami, followed 18 houses by Damai, 8 houses of Sarki and 4 houses of Badi. Above table is also shown in the following figure:
Figure: 4.1
4.1.2 Housing Condition
Table 4.2 Household Distribution by Type of the Study Area

Kami
Damai
Sarki
Badi
Total

Cimented
1
-
-
-
No
%
1
0.76
Stone with Mudjoint
82
17
5
1
105
78.35
Cottage
21
1
3
3
28
20.89
Total
104
18
8
4
134
100
Source: Field Survey, 2007
The above table shows that of the total 134 household, only1 (0.76%) houses are cemented, 105(78.35%) houses are stone with mud-joint and 28(20.89%) households are made of cottage.
Among the four castes only Kami have 1 cemented house. 82 houses of Kami are stone with mud joint and 21 houses are cottage. 17 houses of Damai are stone with mud joint and 1 house is of cottage. Similarly, 5 houses of Sarki are made of stone with mud joint and 3 houses are cottage. Finally, 3 houses of Badi are of cottage and 1 is stone with mud joint.
4.1.3 Situation of Toilet of the Study Area
Toilet is the fixed place for stool or urine control. For the sanitation of area inhabited by people toilet has a grate importance. A well managed toilet saves human as well as other from several kinds of diseases and keep clean environment. In various settings people are not using fixed and well managed toilets, so they are facing different problems related to toilet. The study area's people are using only open toilets.
4.1.4 Situation of Drinking Water
Drinking water is essential not only for human beings but also for other animals. Water is needed for all living things. It is considered that piped water is safe drinking water. Situation of drinking water among the people of study area is presented in the table 4.3 below.




Table 4.3 Household Distribution by Source of Drinking Water
Source
Kami
Damai
Sarki
Badi
Total
No
%
Piped water
54
10
5
-
69
51.49
Well /Pound
4
1
-
-
5
3.73
River/Stream
39
5
2
4
50
37.31
Other
7
2
1
-
10
7.46
Total
104
18
8
4
134
100
Source: Field Survey, 2007.
It is obvious from the above table that of the total 134 households, 69 (51.49%) houses have piped water, 5 (3.73%) houses have well/pond water, 50 (37.31%) houses are having river/stream water and 10 (7.46%) houses are using drinking water from no fixed sources.
Table 4.3 reveals that out of total 104 households of Kami, only 54 households have got piped water, whereas Damai and Sarki have got clean drinking/piped water in 10 and 5 households respectively. 4 households of Kami and 1 house hold of Damai are using weii/ pound water. Up to now 39 households of Kami
5 households of Damai, 2 households of Sarki and 4 households of Badi are using River/ Stream water.
4.1.5 Facilities of Transport, Communication and Electricity
To achieve the services for healthy life, physical means like transport, communication and electricity etc. are important. Because of unavailable and inaccessibility of these facilities, rural people are living a difficult life. The accessibility to health facility is seen very limited in rural area of Nepal due to difficult terrain, lack of roads and transport facilities. No telephone, means of transport and any other means of communication except radio are available. In the study area, only one household has T.V and solar power. The data from the survey is presented below in the Table4.5.
Table 4.4 Household Distribution by Means of Transport, Communication and Electricity /Solar
Means
Kami
Damai
Sarki
Badi
Total
No
%
Electricity/Solar
4
-
-
-
4
5.714
Radio
47
12
3
3
65
92.857
Television
1
-
-
-
1
1.428
Total
52
12
3
3
70
100
e: Field : Survey , 2007.
From the above table it is obvious that only radio one of the major means of communication among the study households. 2 households of Kami have electricity (solar power) and television. Out of the total 104 households of Kami, 52 households have radio, 18 households of Damai, 12 households have radio. Similarly out of total 8 households of Sarki, 3 houses have radion and 4 households of Badi are listening radio as a means of communication. Not any house has any means of transport for their personal or family use.
4.2 Socio-economic Status of the Study Population
4.2.1 Age Composition
In this study, the women of reproductive age (15-49) were taken as sample population and their age distribution presented in table 4.6 below.


Table 4.5 Distribution of Respondents by Five Age Group
Age Group
No. of Respondents
Percent (%)
15-19
12
8.955
20-24
30
22.383
25-29
28
20.895
30-34
24
17.910
35-39
19
14.179
40-44
17
12.686
45-49
4
2.985
Total
134
100
Source: Field Survey, 2007.
Table 4.6 shows that largest number of respondents was in the age group 20-24 which was 22.383 per cent. Similarly lowest percentage of respondent was in age group 45-49 which was 2.985 per cent. The age group 25-29 had 20.895 per cent respondents and 8.955 per cent in the age group 15-19 years. Similarly, 17.910 per cent were in 30-34 age group, 14.179 per cent in 35-39 age groups and 12.686 per cent respondent in the age group of 40-44. Above table is also shown in the following figure:
Figure: 4.2
4.2.2 Age at Marriage
Age at marriage is another important factor which determines safe motherhood practices. The age at marriage of women in this study is was very low. This low age at marriage is determined by the social, cultural and economic background of the community. Majority (91.2 percent) of Dalit community respondents were married under the age of 20 years.









Table 4.6 Distribution of Respondents by Age at Marriage
Age group
Number of Respondents
Percent (%)
10-14
15
11.194
15-19
104
77.611
20-24
14
10.447
25-29
-
-
30-34
1
0.746
35-39
-
-
40-44
-
-
45-49
-
-
Total
134
100
Source: Field Survey, 2007.
Above table shows that great majority of respondents' married at the age group of 15-19. Only one respondent got married at the age between 30-34 years. About 11.194 per cent respondent got married at 10-14 years of age. The table shows that prevalence of young marriage practices is higher in the study area.
4.2.3 Age at First Child Birth
The women of "Dalit" community have low mean age at marriage and given birth to first child at very early age.


Table 4.7 Distribution of Respondents by Age at First Birth
Age group
Number of respondents
Percent (%)
15-19
92
68.65
20-24
38
28.35
25-29
2
1.49
30-34
2
1.49
35-39
-
-
40-45
-
-
Total
134
100
Source: Field Survey, 2007.
Above table shows that highest, 68.65 percentages of the respondents gave birth to first child at the age of 15-19, which is followed by 28.35 per cent women in the age group of 20-24. Similarly, 1.49 per cent two respondents gave birth to their first child in the age of 25-29 and 30-34 years
4.3 Literacy Status
People who can read and write are known as literate. National Population Census, 2001 has revealed 58.1 per cent male and 37.5 per cent female are literate and total literacy of Nepal is 53.7 per cent. The following table shows the literacy status of the study population over 5 years of age by sex.
The result of the survey reveals that among the four castes literate number of male is higher than female. Over the age 39 in each caste no one female is literate. For the detail literacy status of the four castes Kami, Damai, Sarki and Badi population, it is tabulated by sex in the following table4.7
Table 4.8 Population Distribution by Literacy Status by Sex Over 5 Years of Age
Sex Caste
Kami
Damai
Sarki
Badi
Lit(%)
Illit(%)
Lit(%)
Illit(%)
Lit(%)
Illit(%)
Lit(%)
Illit(%)
Male
31.2
68
67.9
32.1
51.7
48.3
16.7
83.3
Female
19.0
81.0
35.1
64.9
26.9
73.1
4.8
95.2
Total
25.1
74.9
54.4
45.6
45.6
60.0
10.3
89.7
Source: Field Survey, 2007.
It is obvious from the above table that the number of literate population of Kami is 25.1%, Damai 54.4%, Sarki 45.6 and Badi 10.3%.The number of literate male over 5 years among Kami are 31.2%, Damai 67.0%, Sarki 51.7% and Badi 16.7%. Similarly, the number of literate female among Kami is 19.0%, Damai 35.1%, Sarki 26.9% and Badi 4.8%. The literate population of the study are classified on the basis of passed level by sex is presented in Table 4.8 below
Table 4.9 Total Population Distribution by Literacy Status Including Passed level
Passed Level/Sex
Male
Female
No
%
No
%
Pre-primary
26
13.13
12
15
Primary
95
47.8
28
35
Lower Secondary
55
27.8
19
23.75
Secondary
11
5.55
16
20
SLC
6
3.03
5
6.25
SLC+
5
2.52
-
-
Total
198
100
80
100
Source: Field Survey, 2007.
From the above table it is obvious that among the literate male and female higher number of population have completed primary level in comparison to the other level, Lower secondary which is in the second position. SLC and over passed population are very little. No one female has passed SLC+ level of any caste of the four.
4.4 Marital Status
Marriage is one of the social norms of human community. In various societies girls are married early in comparison to boys. The marital status of the study population over age 10 years is presented in Table 4.10 below.


Table 4.10 Population Distribution by Marital Status over Age 10 Years
Marital Status
Kami
Damai
Sarki
Badi

Married
M
F
M
F
M
F
M
F
103
104
15
13
8
7
4
3
Unmarried
84
75
9
7
5
6
4
3
Widow/Widower
9
12
-
1
1
-
-
1
Divorced
-
-
-
-
-
1
-
1
Total
196
191
24
21
14
14
8
8
Source: Survey, 2007.
It is obvious from the above table that out of total191 female population of Kami, 104 female are married and 75 female are unmarried. Number of unmarried and married female of Damai is 7 and 13 respectively. Similarly, number of married and unmarried female of Sarki is 7 and 6 respectively. And married and unmarried number of Badi female is 3 and 3 respectively. From the above table it is clear that number of unmarried male is higher in comparison to the unmarried female. It is the evidence of early marriage of girls in this study area also.
4.5 Occupation
Table 4.11 Distribution of Household Population by Major Occupation
Types of Occupation
Number of Household
Percent (%)
Daily wages
126
94.02
Business
2
1.49
Private/Services
1
0.74
Agriculture
5
3.73
Total
134
100
Source: Field Survey, 2007.
Above table presented in 134 households, 94.02 percent are still adapted, (in their traditional work sewing, making metals tools, making shoes) daily wage occupation. 1.49 percent people were found to be engaged in business. On the other hand only 0.74 percent Dalit people was engaged in private services. According to the study, it showed that majority of people had a small unit of own land for cultivation. So they had to involve in daily wages. In the study 3.73 percent of households were found to be engaged in agriculture. Above table is also shown in the following figure:
Figure: 4.3
4.6 Monthly Income
Table 4.12 Distribution of Household by level of Income
Level of Income (Rs)
No. of Household
Percent
1000-2000
75
55.97
2000-3000
24
17.91
3000-4000
15
11.19
4000-5000
11
8.28
5000-6000
6
4.47
6000+
3
2.23
Total
134
100
Source: Field Survey, 2007.
The level of income is one of the main indicators which determine the economic status of people. Table 4.12 shows that in the study are, 55.97 percent household had monthly income ranging between 1000-2000 rupees. About 17.91 percent household income is 3000-4000 rupees monthly. R.s, 4000-5000 monthly income is of 8.28 percent household. Rs, 5000-6000 monthly income is of 4.47 percent household. 2.23 percent households incomes 6000 rupees or above. So, present income level shows that large number of Dalit population has poor economic condition in the study area. Above table is also shown in the following figure:
Figure: 4.4





CHAPTER FIVE
ANALYSIS AND INTERPRETATION OF DATA
This chapter attempts to carry out the results of knowledge and independent variable's relationship. As of final result of the survey data dependent and independent variable are presented below respectively.
5.1 Knowledge about Safe Motherhood by Caste
This study compared the safe motherhood paretic based on some selected cases among Kami, Damai, Sarki and Badi and their knowledge about safe motherhood, which is presented in the Table 5.1 below.
Table 5.1 Population Distribution by knowledge about Safe Motherhood
Caste
Kami(%)
Damai(%)
Sarki(%)
Badi(%)

Total (%)
Yes
53(50.96)
10(55.55)
4(50)
2(50)
69(51.49)
No
51(49.03)
8 (44.44)
4 (50)
2(50)
65(48.50)
Total
104(100)
18 (100)
8 (100)
4(100)

134(100)
Source: Field Survey, 2007.
It is clear from the above table that Kami 50.96%, Damai 55.559%, Sarki 50% and Badi 50 % woman have the knowledge about safe motherhood. Knowledge is widely considered as determinant variable for practice of safe motherhood services. The comparison of knowledge of Damai is in the higher position followed by Kami, Badi and Sarki. Of the total 134 women, only 69 (51.49%) have knowledge about safe motherhood.

5.2 Attitude on safe Motherhood Practices
Safe motherhood practice is based on the attitude of individual or cultural factors. Safe motherhood practice on not only taking services of ANC, safe delivery care and postnatal care but also number of births, birth space, knowledge about complication of pregnancy, etc. who are aware of their life and new born baby must take attention. Respondents were asked about their satisfaction and answer can help to know the attitude of the study population.
Table 5.2 Population Distribution by Attitude of the Providing System of Safe Motherhood Services at Health Facility
Attitude
Kami(%)
Damai(%)
Sarki(%)
Badi(%)
Yes
94(90.38)
18(100)
7(87.5)
4(100)
No
10(9.615)
-
1(12.5)
-
Total
104(100)
18(100)
8(100)
4(100)
Source: Field Survey, 2007.
From the above table it is obvious that10 (9.615%) Kami and 1(12.5%) Sarki have negative attitude toward the safe motherhood practice. It is also by uneducated people.
5.3 Practice of Antenatal/ Prenatal Services
In this section, the study attempts to carry out the result of antenatal/prenatal practice of services among four different castes. The cases are pregnancy check up, service provider, place of service receive, time to visit. T.T.immunization, feeding, helps for relief at physical work. The results of this section associated to the services by the women at least one pregnancy or birth. Then practice of ANC services, like pregnancy checkup T.T immunization and other services like vitamin, pregnancy at last birth. Services of prenatal care and awareness are examined at last because accessibility of services is increasing now than before. This section also finds out the major causes some determinant factor for not used any services for every pregnancy.
5.3.1 Ever Pregnancy Check up
To the sufficient development of fetus and to know probabilities of complication due to and during pregnancy period it is necessary to check up pregnancy at least four times. The result of survey shows the following status of the population in the study area. The results of the survey are given in the Table below.
5.3 Population Distribution by Ever Checked up Their Pregnancy and Health During and Due to Pregnancy
Cast
Kami(%)
Damai(%)
Sarki(%)
Badi(%)
No. of Population
30(28.84)
8(44.44)
4(50)
2(50)
Source: Field Survey, 2007.
The above table shows that Kami 30(28%), Damai 8(44.44%), Sarki 4(50%) and Badi 2(50%) have ever checked up pregnancy.
5.3.2 Visited Time to Check up Pregnancy
When women become pregnant they need to check up pregnancy as well as their health to be informed about the pregnancy. The development of fetus increases per time regularly. Due to various causes pregnancy may be complicated and may cause maternal death, or miscarriages or stillbirth. So it needs to check up frequently since pregnancy is suspected to the time of delivery. At least four times pregnancy check up is essential for the pregnant women. The result of the survey in the study population is presented in the following Table.
5.4 Population Distribution by Time of Visiting

Kami(%)
Damai(%)
Sarki(%)
Badi(%)
<> 4 time
7(23.33)
3(37.5)
1(25)
-
Total
30(100)
8(100)
4(100)
2(100)
Source: Field Survey, 2007.
From the above table, it is clear that majority of population had visited less than 4 times to check up the pregnancy. Visiting time to check up pregnancy is seen different by caste. 2(100%) Badi have check up less than 4 times followed by Sarki 3(75%), Damai 5(62.5%) and Kami16 (53.33%). And 4 and greater than 4 times pregnancy check up is considered as sufficient check up. Only 1(25%) Sarki, 3(37%) Damai and 7(23.33%) Kami have checked up their pregnancy 4 and greater than 4 times.
5.3.3 T. T. Immunization
T.T. vaccine is given to women at the time of pregnancy to protect them and new born baby from the tetanus taxied disease. The provision of T.T. vaccine by the health facility is increasing now. The number of women who are immunized by T.T. is presented in the table below.


Table 5.5 Population Distribution by T.T. Immunization
T.T. dose
Kami(%)
Damai(%)
Sarki(%)
Badi(%)
One
13(12.5)
1(5.55)
1(12.5)
-
Two
8(7.69)
4(22.22)
1(12.5)
1(25)
Two+
42(40.38)
7(38.88)
3(37.5)
-
No/Missing
13(12.5)
1(5.55)
1(12.5)
1(25)
Don't know
28(26.97)
5(27.77)
2(25)
2(50)
Total
104(100)
18(100)
8(100)
4(100)
Source: Field Survey, 2007.
Number in the brackets represents per cent.
The above table shows that the coverage of T.T. immunization is lower. Only 42(40.38%) Kami, 7(38.88%) Damai and 3(37%) Badi population have immunized by two+ dose of T.T. Sarki population have no immunized of two+ dose of T.T. The number of no/missing and don't know is seen high. T.T. immunizationis is seen lower among Badi followed by Kami, Sarki and Damai.
5.3.4 Feeding in Pregnancy
For the healthy development of fetus and fulfilling the energy, pregnant women need extra diet. Population of the study area having food at pregnancy period is presented by tabulating the data from the survey result.




Table 5.6 Population Distribution by Type of Food Having
Cast
Type of Food
Kami
Damai
Sarki
Badi
No.
%
No.
%
No.
%
No.
%
Simple
50
48.07
8
44.44
4
50
2
50
Nutritious
12
11.53
7
38.88
2
25
1
25
Mulnutricious
42
40.38
3
16.66
2
25
1
25
Total
104
100
18
100
8
100
4
100
Source: Field Survey, 2007.
Note: Nutritious food added extra things, fruit, meat, egg, fish, milk, green vegetable etc. and mulnutricious, poor food, without iodine.
The above table shows that majority of population having simple food. Mulnutricious food takes second positions. Less number of populations is using nutritious food. Type of food having is the indicator of lower status of any society and lower income also.
5.3.5 Help at Pregnancy Period from Hard Physical Works
Pregnant women need rest as well as help at hard physical works for the husband and other relatives and friend have the vital role in providing help at pregnancy period at hard work. Hard work at pregnancy period may cause maternal and infant death. The data form the survey help at pregnancy period at hard period at hard physical work is presented in the Table 5.7 below.


Table 5.7 Distribution of Population by Help at Pregnancy Period
Helper
Kami(%)
Damai(%)
Sarki(%)
Badi(%)
Family member
31 (29.80)
7 (38.88)
2 (25)
1 (25)
Husband
58 (55.76)
8 (44.44)
3 (37.5)
2 (50)
No one
15 (14.42)
3 (16.66)
3 (37.5)
1 (25)
Total
104 (100)
18 (100)
8(100)
4(100)
Source: Field Survey, 2007.
Note: Number in brackets represent per cent.
It is obvious from the above table that 29.80% Kami, 38.88% Damai, 25% Sarki and 25% Badi are helped from the family member. Similarly, 55.76% Kami, 44.44% Damai, 37.5% Sarki and 50% Badi are helped by their own husband and 14.42% Kami, 16.66% Damai, 37.5% Sarki and 25% Badi have no any helper. Husband role is found higher for help of pregnant women. And 37.5% Sarki are not helped by any one. 25% Badi followed by 16.66% Damai and 14.42% Kami are not provided help.
5.4 Delivery Care
In this section, the study is attempted to find the practice of the care of delivery services. This is the critical period to the women. The pregnant women meet. The pregnant women meet an alive or dead new face as the out put of 9th month (generally) of pregnancy. But this study is trying to examine the care at delivery not the maternal death. The study is concerned on place of delivery, attendance at birth, status of labour and services provider.

5.4.1 Place of Delivery
To deliver baby safely, place of delivery has the important role. It clears the environment of delivery care of women. A study conducted by MOH 1991, FP/MCH division and NIV Joint Venture reveals that 90 per cent delivery was found at home. Study population reported their delivery place at last birth which is presented in the table below.
Table 5.7 Population Distribution by Place at Delivery at Last Birth
Delivery Place
Kami (%)
Damai (%)
Sarki (%)
Badi (%)
Home
98 (94.23)
16 (88.88)
7 (87.5)
4 (100)
Health Facility
6 (5.76)
2 (11.11)
1 (12.5)
-
Total
104 (100)
18 (100)
8 (100)
4 (100)
Source: Field Survey, 2007.
It is clear from the above table that among four different castes, out of 104 Kami, 94.23% were delivered at home, only 5.76% women at health facility. Out of 18 Damai, 88.88% women delivered at home and 11.11% women were delivered at health facility. Similarly out of 8 Sarki, 87.5% women were delivered at home and 12.5% women were delivered at health facility. No one Badi delivered at health facility. For the care of safe delivery Damai is found some aware among four caste. Health facilities are considered as safe place for delivery. Among the literate, 5.76% Kami only delivered at health facility at last birth.
5.5 Family Planning
Family planning saves women's lives and health in many ways. It helps avoiding unsafe abortion, limiting child birth, spacing child between two, limiting number of births and limiting exposure to the health risks of pregnancy and child birth. In this section, the study is attempted to find the knowledge about family planning, use of family planning devices causes of choice of family planning devices condom.
5.5.1 Knowledge and Practice of Family Planning
Couples are using family planning to different causes. Without knowledge, use of family planning has low meaning. Who have sufficient knowledge can be benefited in reproductive life or hole life of sexual contact. The respondent's knowledge of family planning is presented in the following table.
Table 5.8 Population Distribution by Knowledge and Practice of Family Planning
Knowledge
Kami (%)
Damai (%)
Sarki (%)
Badi (%)
Yes
82 (78.84)
16 (88.88)
7 (87.5)
3 (75)
No
22 (21.15)
2 (11.11)
1 (12.5)
1 (25)
Total
104 (100)
18 (100)
8 (100)
4 (100)
Source: Field Survey, 2007.
The above table shows that 78.84% Kami women have the knowledge about family planning. Similarly, 88.88% Damai, 87.5% Sarki and 75% Badi have knowledge about family planning. The per cent of respondents is found higher to Damai, followed by Sarki, Kami and Badi who have knowledge about family Planning.




CHAPTER SIX
SUMMARY CONCLUSION AND RECOMMENDATIONS
6.1 Summary
This dissertation is the comparative study of safe motherhood practice among Kami, Damai, Sarki and Badi in Purtimkanda VDC (4-5) of Rukum District. The study is based on some selected castes. The data which are used in the study are primary data. Two types of questionnaires were designed for the collection of data. Household questionnaire is used to choose the eligible respondents and to find out the social, economic and demographic status of the study population as well as study area. Individual questionnaire were designed to collect information about safe motherhood practice by the women at aged 15-49 years who are married and have the experience of child birth or at least one pregnancy. Data, used in this study are collected by interview as a census.
» A total of 134 household were enumerated for the purpose of which 104 Kami, 18 Damai, 8 Sarki and 4 Badi household were enumerated.
» To study the social status of the study area type of household, toilet situation, drinking water, facilities of electricity, communication, health facility, and distance to the health facilities were studied.
» The provision of clean drinking water is some how better to the comparison of toilet facility except Badi.
» The provision of transport, communication and electricity is seen poor whereas radio is one of the means of communication.
» The provision of health facility is found poor.
» Literacy per cent is higher of Damai (54.4%) followed by Sssarki (45.6%), Kami (25.1%) and Badi (10.3%) of the total population.
» Targeted population in each caste, Kami, Damai, Sarki and Badi are 104, 18, 8 and 4 respectively.
» Knowledge about safe motherhood is higher of Damai followed by Badi, Kami and Sarki in per cent.
» Attitude of the providing system of safe motherhood service is found higher for Damai and Badi followed by Kami and Sarki.
» In per cent that have ever checked pregnancy is higher for Sarki and Badi followed by Damai and Kami.
» Visiting time to check up pregnancy 4 or. 4 times is higher for Kami followed by Damai and Sarki.
» T.T. immunization is seen lower for Badi followed by Kami, Sarki and Damai who have taken at least one dose.
» Pouplation who has taken nutricious food is seen higher for Damai followed by Sarki, Kami and Badi.
» Husband role is higher within compare to other for help pregnant women.
» The place of delivery at home in per cent is higher for Badi, followed by Kami, sarki and Damai.
» Knowledge of family planning is higher for Damai, followed by Sarki, Kami and Badi.
6.2 Conclusions
On the basis of this analysis, safe motherhood practice among Kami, Damai, Sarki and Badi is found varied. The social status of these castes is also differing which is one of the most important determinant factors to bring differ for their practice. The existing social services like health facilities their homes, drinking water, toilet which are better the practice is found better also. Similarly, knowledge, education and occupation have effect on practice of safe motherhood.
Of the total population in each caste, ,more than a half have knowledge about safe motherhood but practice is found lower as compared to the magnitude of known. Knowledge about safe motherhood is found some increased now than before. Family planning knowledge and practice is found better as compared to safe delivery and postnatal care among this caste. Sarki is found some how good in practice of safe motherhood services among these and followed by Damai, Kami and Badi.
» Social services, type of house, food of pregnant women, knowledge and education have effect on fafe motherhood practice.
» More than half of the total number of population have knowledge about safe motherhood in each caste but practice is seen lower.
» Sarki is seen higher position in the comparison of other caste followed by Damai and Badi.
» Knowledge about safe motherhood is found increased now than before.
» Family planning knowledge and practice is found better.
6.3 Recommendation
On the basis of conclusions the recommendation for policy implication and future area of research are suggested as follows:
6.3.1 Recommendation for Policy Implications
Policy makers, planners' local authorities and interested persons or organizations need to recognize the problems of people in that area to make change and improvement in the condition of the people. Following are some recommendations for safe motherhood practice in the study population.
∞ Basic physical needs such as drinking water, sanitation, electricity/solar which should be made available to all households.
∞ Mother Groups which are organized should be strengthened and trained and services should be provided by those trained persons which are possible.
∞ Government should plan to construct low cost houses in low interest ret for how income groups so that their living will be improved.
∞ Newspaper and magazine about safe motherhood should be provided for people, especially women of reproductive age through mother groups.
∞ Badi community who are landless should be provided land and rehabilitation programme should be made.
∞ Government and concerned organizations should promote and strengthen the status of literacy among Dalits.
∞ Female staff should be posted in every health facilities so that the hesitation will be minimized for safe motherhood practice to all women.
∞ Training, seminar and meeting should be conducted to motivate women of reproductive age.
∞ Midwifery training should be provided by caste.
6.3.2 Recommendation for Future Area of Research
Researchers who are interested to study the safe motherhood practice in this are for future, following are some recommendation. They are as follows:
▫ All castes should be covered to study in the future.
▫ All age groups not only 15-49 years should be studied.
▫ Study should be made on other aspects of reproductive health.
▫ Study should be made for equal number in terms of not vast difference so that we can compare the situation among various caste and results will be accurate.















REFERENCES
Acharya, L.B. (1998). " Effect of Mobile Health Workers on BCG Vaccination in Rural Areas of Western and Mid-western hill Districts of Nepal", Population and Environment, Vol. 1 (Kathmandu: MOPE), pp. 1:88-89.
CBS/NPC (1997). Nepal Multiple Individuals Surveillance (Kathmandu).
Khanal, M.K.(2001). Maternal and Child Health Care Practices of Gandarve (Gaine) and Pore Caste of Kaski Districts, Unpublished Master's Degree Thesis (Kathmandu).
MOH (1993). Nepal Fertility Family Planning and Health Survey, "Knowledge Attitudes and Practices about Safe Motherhood" (Kathnandu).
MOH (1996). National maternity Care Guidelines Nepal (Kathmandu: Family Health Division).
MOH (1998). National Reproductive Health Strategy ( Kathmandu: Department of Health Services).
MOPE (1997). Population Projection for Nepal 1996-2016: National and Urban Projections, Vol. I (Kathmandu).
NFHS (1996). Parental Care and Women of Nepal: A Situation Analysis, Kathmandu, Nepal.
NPC (1997) Ninth Five Year Plan (1997-2002) (Kathmandu).
Pant, P.D., and L.B. Acharya, (1997). Health Care Factors Related to Early Infant survival in Nepal (Kathmandu: MOH).
Pant, P.D., (1997). Selected Socio-economic, Demographic and Health Related characteristics of Mother and Pregnancy outcome: A Risk Analysis Based on the NMIS 1997 (Kathmandu: CBS).
Pokharel, R.,(1997) Maternal Health in Nepal (Kathmandu: Central Department of Population Studies, T.U.).
United Nations (1984). Report of the International Conference on Population, Mexico City, 6-14 August, 1984.
United Nations (1992). Bali, Declaration on Population and Sustainable Development, Fourth Asian and Pacific Population Conference,(Bali, Declaration, Indonesia).
United Nations (1994). International Conference on Population and Development (ICPD) Cairo, Egypt, 5-13, September 1994.
United Nations (1995). Report of the Fourth World Conference on Women Beijing, September 4-15, 1995.
WHO ( 1991). Maternal Mortality: A Global Fact Book, (Geneva).
WHO (1999). World Health Day, Safe Motherhood, (Geneva).
WHO (2005). New Approach to save lives of Mothers and Children, (WHO, Report, 2005).








APPENDIX - 1
Household Questionnaire Design
Name of Household Head: Religion:
Name of Respondent: Caste:
Ward no
: House no. :
SN
Name of family members
Sex
Age
Education
Marital status
Occupation
1






2






3






4






5






6






7






8






Questions
1) What is the main source of drinking water for your household?
(a) Piped (b) Well/Pound (c) River/Stream (d) Others
2) What type of toilet does you using?
(a) Pitched (b) Passed (c) Open (d) Others

3) Do you have the following facilities?
(a) Electricity /Solar (b) Bio-gas (c) Radio (d) Television
4) Is there any health center near to your home?
(a) Yes (b) No (c) Don't know
5) How do you go there?
(a) By foot (b) By motor (c) By others
6) Does your household have own land?
(a) Yes (b) No
7) If yes how much land?
(a) ........Ropani (b) .....Ana (c) Others
8) Which type of your house?
(a)Cemented (b) Stone with mud joint (c) Cottage (d) others









APPENDEX-II
INDIVIDUAL QUESTIONNAIRE
House Number:
Ward No:
Respondents Name:
1) How old are you? -Age:
2) What was your age when you got married? - Age:
3) Can you read and write?
(a) Yes (b) No
4) What is your husband's educational level?
(a) Primary (b) Lower secondary (c) Secondary (d) Above
5) What is your educational level?
(a) Level.... (b) Illiterate (c) Nothing
6) What is your occupation?
(a) Agriculture (b) Service (c) Business (d) House work
(e) Daily wages (f) others
7) How much do you earn per month? - .....
8) What was your age when you gave birth to your first child? - Age:
9) How many children have you ever born? -........
10) Are you currently pregnant?
(a) Yes (b) No
11). Have you ever heard about safe motherhood? If yes, what are the sources of your knowledge?
(a) Yes (b) No
(a) Radio (b) Television (c) Health workers (d) Family
(e) Private clinics/doctors (f) Mother in low (g) others
12) Do you think it is necessary to utilize safe motherhood service by pregnant women?
(a) Yes (b) No (c) Don't know
13) Did you check up our pregnancy and health?
(a) Yes (b) No
14) To whom did you visit?
((a) Doctor/Nurse (b) ANMs (c) CMA (d) HA (e) others
15) Do you take TT vaccine?
(a) One dose (b) Two dose (c) No/Missing (d) Don't know
16) When did you last birth?
(a) Month..... (b) Year....
17) Have you had antenatal care?
(a) Yes (b) No


18) What were the services?
(a) Pregnancy check up (b) TT vaccine (c) other (specific)
19) During pregnancy how many times did you check up?
Time ( )
20) Whether you have had antenatal care for every pregnancy?
(a) Yes (b) No
21) Did you take iron tablets?
(a) Yes (b) No
22) If yes, how many times did you take?
Month ( )
23) During and due to pregnancy did you rest?
(a) Yes (b) No
24) Where did you deliver your last child?
(a) Home (b) Health facilities (c) Other places
25) Did you big help during labor?
(a) Yes (b) No
26) If yes who helped you?
(a) Family member (b) Friends/Relation (c) Others
27) After birth did you get any health problems related to birth?
(a) Yes (b) No
28) What were the problems?
(a) Sever bleeding (b) Related to placenta (c) Others
29) Did you visit to solve the problems?
(a) Yes (b) No
30) To whom did you visit?
(a) Dhami/Jhankri (b) Doctor/Nurse (c) TBAs (d) ANMs (d) Others
31) Do you know about family planning devices?
(a) Yes (b) No
32) Do you need information and education of safe motherhood services?
(a) Yes (b) No
33) Did you fell any discomfort while answering of these questions?
(a) Yes (b) No

second day

I am eager to keep news in my personal blog but some how diificult to update.I promised daily update.

Beginings

It is my first glance to creat blog. Hoping to inform underground information which I get.