Health  Vol.5 No.8 D , August 2013
Newborn care practices: A case study of tribal women, Gujarat

Plateaued rate of decline in neonatal mortality rate is one of the major obstacles in achieving Millennium Development Goal 4 especially in developing countries. Even in India, nationwide interventions targeting safe mother and newborn care have not yielded the desired impact, indicating the necessity to combat neonatal mortality rate at population specific level. The objective of this study is to identify the newborn care practices and beliefs, analyze their harmful or beneficial characteristics, describe the deviations from the essential newborn care practices during hospital/home delivery, explain barriers to care seeking and identify areas of potential resistance for behavior change; and utilize study findings to tailor-make cost-effective essential newborn care package. The study uses qualitative data from in-depth interview of mothers who had experienced neonatal death and key-informant interviews with healthcare personnel and birth attendants. 33 cases were randomly selected from the registered neonatal deaths across Bharuch district of Gujarat, India. Key finding of this study is less prevalent practice of essential newborn care among all cases irrespective of place of delivery and the health-care personnel facilitating delivery. Habitual traditional/tribal newborn care methods challenge the practice of prescribed essential newborn care. Clustering of deaths in few households added significantly to the existing burden of neonatal deaths, attributed to superstition “Ratewa” by tribal. Study has concluded that the introduction and implementation of essential newborn care at hospital and community/ household level are the need of the hour. Quality home based neonatal care through cost effective interventions is deemed necessary where accessing institutional care is not possible in the immediate term. Community health workers can contribute to the eradication of harmful newborn care practices and the sustenance of essential practices through community education and behavior change communication.

Cite this paper: Shah, B. and Dwivedi, L. (2013) Newborn care practices: A case study of tribal women, Gujarat. Health, 5, 29-40. doi: 10.4236/health.2013.58A4005.

[1]   Tinker, A., Hoope-Bender, P., Azfar, S., Bustreo, F. and Bell, R. (2005) A continuum of care to save newborn lives. Lancet, 365, 822-825. doi:10.1016/S0140-6736(05)71016-3

[2]   Arulampalam, W. and Bhalotra, S. (2006) Sibling death clustering in India: State dependence vs. unobserved heterogeneity. IZA Discussion Paper No. 2251.

[3]   Black, R.E., Morris, S.S. and Bryce, J. (2003) Where and why are 10 million children dying every year? Lancet, 361, 2226-2234. doi:10.1016/S0140-6736(03)13779-8

[4]   Bryce, J., Daelmans, B., Dwivedi, A., Fauveau, V., Lawn, J.E., Mason, E., Newby, H., et al. (2008) Countdown to 2015 for maternal, newborn, and child survival: The 2008 report on tracking coverage of interventions. Lancet, 371, 1247-1258. doi:10.1016/S0140-6736(08)60559-0

[5]   Lawn, J.E., Cousens, S. and Zupan, J. (2005) 4 million neonatal deaths: When? Where? Why? Lancet, 365, 891-900. doi:10.1016/S0140-6736(05)71048-5

[6]   Darmstadt, G.L., Bhutta, Z.A., Cousens, S., Adam, T., Walker, N. and de Bernis, L. (2005) Evidence-based, costeffective interventions: How many newborn babies can we save? Lancet neonatal survival steering team. Lancet, 365, 977-988. doi:10.1016/S0140-6736(05)71088-6

[7]   Lawn, J.E., Cousens, S., Bhutta, Z.A., Darmstadt, G.L., Martines, J., Paul, V., et al. (2004) Why are 4 million babies dying each year? Lancet, 364, 399-401. doi:10.1016/S0140-6736(04)16783-4

[8]   Bang, A., Paul, V., Reddy, H. and Baitule, S. (2005) Why do neonates die in rural Gadchiroli, India? (Part I): Primary causes of death assigned by neonatologist based on prospectively observed records. Journal of Perinatology, 25, S29-S34. doi:10.1038/

[9]   Dutta, A.K. (2009) Home-based newborn care: How effective and feasible? Indian Pediatrics, 46, 835-840.

[10]   Marsh, D.R., Darmstadt, G.L., Moore, J., Daly, P., Oot, D. and Tinker, A. (2002) Advancing newborn health and survival in developing countries: A conceptual framework. Journal of Perinatology, 2, 572-576. doi:10.1038/

[11]   Campbell, O.M. and Graham, W.J. (2006) Strategies for reducing maternal mortality: Getting on with what works. Lancet, 368, 1284-1299. doi:10.1016/S0140-6736(06)69381-1

[12]   Khan, M.H., Khan, F., Noman, N., Hashmi, G., Gul1, S., Ali, A. and Babar, K.S. (2006) Essential newborn care practice in hospital versus home deliveries. Gomal Journal of Medical Sciences, 4, 1.

[13]   Graneheim, U.H. and Lundman, B. (2004) Qualitative content analysis in nursing research: Concepts, procedures and measures to achieve trustworthiness. Nurse Education Today, 24, 105-112. doi:10.1016/j.nedt.2003.10.001

[14]   Thaddeus, S. and Maine, D. (1991) Too far to walk: Maternal mortality in context. Women’s Global Network for Reproductive Rights, 36, 22-24.

[15]   Thaddeus, S. and Maine, D. (1994) Too far to walk: Maternal mortality in context. Social Science and Medicine, 38, 1091-1110. doi:10.1016/0277-9536(94)90226-7

[16]   Kesterton, A.J. and Cleland, J. (2009) Neonatal care in rural Karnataka: Healthy and harmful practices, the potential for change. BMC Pregnancy and Childbirth, 9, 20. doi:10.1186/1471-2393-9-20

[17]   Jeffery, R. and Jeffery, P.M. (1993) Traditional birth attendants in rural North India: The social organization of childbearing. Knowledge, power, and practice: The anthropology of medicine in everyday life. Nova Science Publishers, Inc., New York.

[18]   Pinto, S. (2008) Where there is no midwife: Birth and loss in rural India. Berghahn Books, New York.

[19]   World Health Organization (1996) Essential newborn care: A report of a technical working group. World Health Organization, Geneva.

[20]   Ambe, P., Bello, M., Yahaya, S.J. and Omotara, B.A. (2009) Umbilical cord care practices in Konduga local government area of Borno State North-Eastern Nigeria. The Internet Journal of Tropical Medicine, 5, 2.

[21]   Darmstadt, G.L., Hassan, M., Balsara, Z.P., Winch, P.J., Gipson, R. and Santosham, M. (2009) Impact of clean delivery-kit use on newborn umbilical cord and maternal puerperal infections in Egypt. Journal of Health Population and Nutrition, 2, 6746-6754.

[22]   Baqui, A.H., Williams, E.K., Darmstadt, G.L., Kumar, V., Kiran, T.U., Panwar, D., Sharma, R.K., et al. (2007) Newborn care in rural Uttar Pradesh. Indian Journal of Pediatrics, 74, 241-247. doi:10.1007/s12098-007-0038-6

[23]   Manandhar, D.S., Osrin, D., Shrestha, B.P., Mesko, N., Morrison, J., Tumbahangphe, K.M., Tamang, S., et al. (2004) Effect of a participatory intervention with women’s groups on birth outcomes in Nepal: Cluster-randomised controlled trial. Lancet, 364, 970-979. doi:10.1016/S0140-6736(04)17021-9

[24]   Nandan, D. and Mishra, S.K. (1996) Delivery practices in west Uttar Pradesh. Indian Journal of Public Health, 40, 20-21.

[25]   Osrin, D., Tumbahangphe, K.M., Shrestha, D., Mesko, N., Shrestha, B.P., Manandhar, M.K., Standing, H., Manandhar, D.S. and De L. Costello, A.M. (2002) Cross sectional, community based study of care of newborn infants in Nepal. British Medical Journal, 325, 1063. doi:10.1136/bmj.325.7372.1063

[26]   Darmstat, G.L., Kumar, V., Yadav, R., Singh, V., Singh, P., Mohanty, S., Baqui, A.H., et al. (2006) Introduction of community-based skinto-skin care in rural Uttar Pradesh, India. Journal of Perinatology, 26, 597-604. doi:10.1038/

[27]   Edmond, K.M., Zandoh, C., Quigley, M.A., Amenga-Etego, S., Owusu-Agyei, S. and Kirkwood, B.R. (2006) Delayed breast-feeding initiation increases risk of neonatal mortality. Pediatrics, 117, 380-386. doi:10.1542/peds.2005-1496

[28]   Sharma, R.K. (2010) Newborn care among tribes of central India experiences from micro level studies. Social Change, 40, 117-137. doi:10.1177/004908571004000202

[29]   Huffman, S.L., Zehner, E.R. and Victora, C. (2001) Can improvements in breast-feeding practices reduce neonatal mortality in developing countries? Midwifery, 17, 80-92. doi:10.1054/midw.2001.0253

[30]   Fikree, F.F., Ali, T.S., Durocher, J.M. and Rahbar, M.H. (2005) Newborn care practices in low socioeconomic settlements of Karachi, Pakistan. Social Science and Medicine, 60, 911-921. doi:10.1016/j.socscimed.2004.06.034

[31]   Holman, D.J. and Grimes, M.A. (2001) Colostrum feeding behavior and initiation of breast-feeding in rural Bangladesh. Journal of Biosocial Science, 33, 139-154. doi:10.1017/S0021932001001390

[32]   Choudhury, A.M., Nargis, S., Mollah, A.H., Kabir, L.M. and Sarkar, R.N. (2010) Determination of risk factors of neonatal pneumonia. Mymensingh Medical Journal, 1, 323-329.

[33]   Shah, B.D. and Dwivedi, L.K. (2011) Causes of neonatal deaths among tribal women in Gujarat, India. Population Research and Policy Review, 30, 517-536. doi:10.1007/s11113-010-9199-5

[34]   Williams, E.K., Hossain, M.B., Sharma, R.K., Kumar, V., Pandey, C.M. and Baqui, A.H. (2008) Birth interval and risk of still birth or neonatal death: Findings from rural North India. Journal of Tropical Pediatrics, 54, 321-327. doi:10.1093/tropej/fmn027

[35]   Agarwal, S., Agarwal, A., Bansal, A.K., Agarwal, D.K. and Agarwal, K.N. (2002) Birth weight patterns in rural undernourished pregnant women. Indian Pediatrics, 39, 244-253.