Attitudes and Practices of Auxiliary Nurse Midwives and Accredited Social Health Activists in Uttar Pradesh and Bihar Regarding Polio Immunization in India

Auxiliary nurse midwives (ANMs) are the most peripheral health providers and manage the rural health sub-centre in a community. They mediate directly between the community and the health system for the management of Maternal and Child Health Programme in India. The purpose of this study was to find out the role of cultural factors, such as ANMs’ caste, age, marital status, being non-resident in the working village and other social factors regarding their acceptance in the community. The study is exploratory and qualitative. The area of study was a multi-caste remote village, Mavaibhachan, in Kanpur Dehat district of Uttar Pradesh, India. Data were collected through in-depth interviews and fieldwork notes taken during and immediately after the interviews with ANMs, and thematically analyzed. Our results show that if ANMs belong to a different caste group, do not live in the working village and are relatively younger, they are socially insecure and stressed and the community hardly accepts them. Despite direct interface with the community, their social status and lowest position in the health system is reflected in acceptability and recognition. The position of ANMs needs to be strengthened, within society and the health system. In order to make public health services effective and efficient the health system has to reduce stratification based on role and status.

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Nurses' and auxiliary nurse midwives' adherence to essential birth practices with peer coaching in Uttar Pradesh, India: a secondary analysis of the BetterBirth trial

Implementation Science ◽

10.1186/s13012-019-0962-7 ◽

2020 ◽

Vol 15 (1) ◽

Cited By ~ 5

Author(s):

Rose L. Molina ◽

Brandon J. Neal ◽

Lauren Bobanski ◽

Vinay Pratap Singh ◽

Bridget A. Neville ◽

...

Keyword(s):

Peer Coaching ◽

Secondary Analysis ◽

Uttar Pradesh ◽

Staff Nurses ◽

Birth Attendants ◽

Coaching Intervention ◽

Safe Childbirth Checklist ◽

Auxiliary Nurse ◽

Nurse Midwives ◽

Safe Childbirth

Abstract Background The BetterBirth trial tested the effect of a peer coaching program around the WHO Safe Childbirth Checklist for birth attendants in primary-level facilities in Uttar Pradesh, India on a composite measure of perinatal and maternal mortality and maternal morbidity. This study aimed to examine the adherence to essential birth practices between two different cadres of birth attendants—nurses and auxiliary nurse midwives (ANMs)—during and after a peer coaching intervention for the WHO Safe Childbirth Checklist. Methods This is a secondary analysis of birth attendant characteristics, coaching visits, and behavior uptake during the BetterBirth trial through birth attendant surveys, coach observations, and independent observations. Descriptive statistics were calculated overall, and by staffing cadre (staff nurses and ANMs) for demographic characteristics. Logistic regression using the Pearson overdispersion correction (to account for clustering by site) was used to assess differences between staff nurses and ANMs in the intervention group during regular coaching (2-month time point) and 4 months after the coaching program ended (12-month time point). Results Of the 570 birth attendants who responded to the survey in intervention and control arms, 474 were staff nurses (83.2%) and 96 were ANMs (16.8%). In the intervention arm, more staff nurses (240/260, 92.3%) received coaching at all pause points compared to ANMs (40/53, 75.5%). At baseline, adherence to practices was similar between ANMs and staff nurses (~ 30%). Overall percent adherence to essential birth practices among ANMs and nurses was highest at 2 months after intervention initiation, when frequent coaching visits occurred (68.1% and 64.1%, respectively, p = 0.76). Practice adherence tapered to 49.2% among ANMs and 56.1% among staff nurses at 12 months, which was 4 months after coaching had ended (p = 0.68). Conclusions Overall, ANMs and nurses responded similarly to the coaching intervention with the greatest increase in percent adherence to essential birth practices after 2 months of coaching and subsequent decrease in adherence 4 months after coaching ended. While coaching is an effective strategy to support some aspects of birth attendant competency, the structure, content, and frequency of coaching may need to be customized according to the birth attendant training and competency. Trial registration ClinicalTrials.gov: NCT2148952; Universal Trial Number: U1111–1131-5647.

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