PRAGMATIC ANALYSIS OF AWARENESS AND UTILIZATION OF WOMEN S REPRODUCTIVE HEALTHCARE SCHEMES IN RAJASTHAN

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1 KAAV INTERNATIONAL JOURNAL OF ARTS, HUMANITIES & SOCIAL SCIENCES A REFEREED BLIND PEER REVIEW QUARTERLY JOURNAL KIJAHS/JUL-SEP2017/VOL-4/ISS-3/A50 PAGE NO ISSN: IMPACT FACTOR (2017) PRAGMATIC ANALYSIS OF AWARENESS AND UTILIZATION OF WOMEN S REPRODUCTIVE HEALTHCARE SCHEMES IN RAJASTHAN 1 MS. KAMLESH SINGH 1 Research Scholar, Department of Nursing NIMS University, Jaipur, Rajasthan 2 DR KOCHUTHRESIAMMA THOMAS 2 Professor & PhD Coordinator, Department of Nursing NIMS University, Jaipur, Rajasthan. 3 DR RK MANOHAR 3 Prof & HOD, Department of PSM, NIMS University, Jaipur, Rajasthan ABSTRACT Mother and child constitute a vulnerable section of society and around eight million women suffer pregnancy related complications and over half a million die every year. Janani Suraksha Yojana (JSY), a safe motherhood intervention under the overall umbrella of National Rural Health Mission (NRHM) was launched on 12th April 2005 with an aim to reduce maternal and neonatal mortality. People existing in rural India do not have proper hospital facilities and access to health care. In spite of increased availability and easy accessibility of maternal health care services there is still unawareness and under utilization of maternal services especially among rural poor and urban slum populations for varying reasons. Rajasthan specially lags behind despite several efforts by the government. Therefore, the objective of current research study is to identify and empirically analyze the awareness and utilization of Government health schemes among 42 women from Chandwaji and 79 women from Achrol of Amber Block, Jaipur, Rajasthan.The Rajasthan Government Maternal benefit s considered in this study are Janani Suraksha Yojna (JSY) and Kalewa Yojna. Women having underfive children and attending the PHCs were interviewed with pretested, predesigned, semi-structured questionnaire after obtaining informed consent. This cross-sectional descriptive study was comparative in nature. Quantitative approach was used to analyze the awareness and utilization of the health schemes. Various statistical measures were applied on demographic and other variants of beneficiaries and results of statistical analysis ( Correlation and ANOVA) is found to be significant. Therefore hypothesis H 0 -There is 282

2 no significant difference between awareness and utilization among women between the two selected PHC areas is rejected and alternate hypothesis H 1 There is significant difference between awareness and utilization among women between the two selected PHC areas is accepted and proved. Further efforts are needed to increase the overall awareness of various entitlements of Government Health s among pregnant women to increase the utilization of the benefits of the schemes and thus indirectly helping in reducing MMR and IMR. KEYWORDS- Janani Suraksha Yojna, Kalewa Yojna, Women, Pregnancy, Rajasthan. Introduction:- A recent global report of Lancet, stated that India accounts for 15% of world s maternal deaths as of According to this report, while the total number of global maternal deaths had almost halved since 1990, one-third maternal deaths in 2015 happened in India and Nigeria. 1 The number of women dying due to complications during pregnancy and childbirth had decreased by 43% from an estimated in 1990 to in The progress was notable, but the annual rate of decline was less than half of what was needed to achieve the Millennium Development Goal (MDG) target of reducing the maternal mortality ratio by 75% between 1990 and Despite massive program efforts and availability of technology needed to avert maternal deaths, the maternal mortality ratio (MMR) in India continues to be high. Population-based estimates of MMR are lacking. Under its flagship National Rural Health Mission and Janani Suraksha Yojana (JSY), or Safe Motherhood, the Indian government uses cash incentives to encourage women to give birth in health facilities. Indian society is caught in the crossroads; emerging from the traditional methods of child birth, government schemes, awareness, knowledge and empowerment of women. In India people living in rural areas do not have proper hospital facilities and access to health care. A high proportion of them continue to suffer and die from preventable diseases; pregnancy and child birth related complications as well as malnutrition. In Rajasthan State, as per the Second report of GS &SS 2017 (Period ) analysis of data relating to pregnant women registered for ANC in Rajasthan State revealed that against the targets of lakh institutional deliveries in the State, the achievement was only lakh (76.89 per cent) during The rural public health care systems in the country are in an unsatisfactory state which leads to impoverishment of poor households due to expensive private sector health care. Therefore, the aim of this study was to pragmatically analyze the awareness and utilization of Government health schemes among women in Rajasthan. The Rajasthan Government Maternal benefit s considered in this study are Janani Suraksha Yojna (JSY) and Kalewa Yojna. Janani Suraksha Yojna (JSY) JSY is a safe motherhood intervention being implemented with the objective maternal and neo-natal mortality by promoting institutional delivery among the poor pregnant women. The focus is on registering each beneficiary under this Yojna and tracking them through a JSY Card along with a MCH card. ASHA/AWW/ any other health worker are required to effectively help the pregnant women to have a safe delivery with proper antenatal and post natal care. It is a cash assistance scheme linked to institutional delivery. In the rural area, the Gram Pradhan or Ward member certifies the BPL status of the pregnant women. In Low Performing State like Rajasthan, in the rural area, the mothers package is Rs 1400/ and ASHA package is Rs 600/-. Disbursement of cash assistance to the mother is mainly to meet the cost of delivery, which should be disbursed effectively at the institution itself. For those women going to Public Health institution for delivery, the entire cash should be disbursed to her in one go, at the health institution. Some women, who go to accredited private health institution, would require financial assistance for meeting the cost of minimum three antenatal visits including TT injections. They should be given at least 3/4 th of the cash assistance at one go, importantly, at the time of delivery

3 Kalewa Yojna ( KY) KY is funded by NHRM and implemented by DWCD wherein free warm and nutritious food is provided for two days to women who have delivered in health facility especially at CHC level. This food is cooked by self-help groups. 5 Review of literature:- Rosamma Thomas. (June 2, 2017). In an article on, Amount offered under maternity plan inadequate stated that. Rs 6000/-being offered by the Govt. has not kept pace with minimum wages and inflation over time. Additional to that, the amount released in installments, and conditions have been imposed for the release of each installment. The article also highlights that NHFS-4 data shows that only 84% of mothers in the state deliver their babies in hospital. A large number of the most vulnerable and poor would thus, be unable to avail benefits under the new scheme. 6 Thongkong et al. (2017) conducted a study in which they prospectively collected data on 3,682 births (in ) from a demographic surveillance system in five districts in Jharkhand and Odisha state, India. Linear probability models were used to identify the determinants of receipt of JSY benefits. Poor-rich inequality in the receipt of JSY benefits was measured by a corrected concentration index (CI), and the most important drivers of this inequality were identified using decomposition techniques. While the majority of women had heard of the scheme (94% in Odisha, 85% in Jharkhand), receipt of JSY benefits was comparatively low (62% in Odisha, 20% in Jharkhand). The findings of this study concluded that JSY benefits were not equally distributed, favouring wealthier groups. These inequalities in turn reflected pro-rich inequalities in the institutional delivery. The JSY scheme is currently not sufficient to close the poor-rich gap in institutional delivery rate. Important barriers to institutional delivery remain to be addressed and more support is needed for low performing districts and states. 7 Dereje Kifle et al (2017) conducted a triangulated community-based cross-sectional study on, Maternal health care service seeking behaviors and associated factors among women in rural Haramaya District, Eastern Ethiopia 561 women in reproductive age group who gave birth in the last 2 years were randomly included. Bivariate and multivariate logistic regressions model was used to identify the associated factors. Odds ratios with 95% CI were used to measure the strength of association. It was found that maternal health care service seeking behavior of women was ; antenatal care 74.3% (95% CI; 72.5, 76.14), attending institutional delivery 28.7% (95% CI; 26.8, 30.6) and postnatal care 22.6% (95% CI; 20.84, 24.36). Knowledge of pregnancy complications, educational status, and religion of women were found to be significantly associated with antenatal health care, delivery and postnatal health care service seeking behaviors triangulated with individual, institutional and socio-cultural qualitative data. It was recommended that, focused health education with kind and supportive health care provider counseling will improve the maternal health care seeking behaviors of women. 8 Sonu Goel et al (2017) in a community based cross-sectional mixed method concurrent study on, Factors influencing Janani Suraksha Yojana utilization in a northern city of India, conducted from August 2012 to March 2014 in Chandigarh city among 100 women residing in the catchment areas of primary and secondary level health care facilities of Chandigarh. Mothers who gave birth in proceeding two years (2011 and 2012) were interviewed using a structured questionnaire and in-depth interview checklist by trained field investigators. Findings of Logistic regression model suggested that more than 3 ANC visits by women was significantly associated with the uptake of JSY benefit (OR= 17.4). The factors influencing decreased uptake of scheme were sub-optimal incentive, delayed payment, problem in arranging for a residence proof and lot of administrative paper work. It was concluded that there is a need to remove the bottlenecks and thus ensure smooth delivery of cash benefits. 9 Geddam JB et al. (2017) conducted a community based cross sectional study to understand the determinants of utilization of reproductive health services by migrant population living in non-notified slums of Hyderabad city in the Indian state 284

4 of Telangana. 761 rural to urban internal migrant mothers with a child of less than 2 years of age residing for a period minimum of 30 days and not more than 10 years were selected through cluster random sampling method. Multinomial logistic regression analysis was carried out for analysis of determinants of adequate ANC utilization. Univariate regression analysis was carried out of each variable against dependent variable to determine its independence. The findings disclosed that mothers receiving at least 4 antenatal care visits and institutional deliveries in migrants were 69.6% and 69% respectively, compared to 85.8% and 97% in general population of Hyderabad city. The likelihood of mothers receiving adequate care is 6.7 times higher in mothers with secondary education compared to formal education. The likelihood of institutional delivery is 7.8 times higher in mothers availing adequate antenatal care versus inadequate care and 2.2 times higher in mothers with secondary education versus formal education. The conclusion drawn was that utilization of antenatal care services and promotion of institutional deliveries can be improved by acting on the supply side barriers such as health care infrastructure and demand side barriers such as indirect consumer costs, financial constraints and community engagement. 10 In the light of the preceding review of the studies carried out in this area, researcher found that there are very few studies focusing on awareness and utilization among women between the two selected PHC areas in Jaipur, Rajasthan. Thus to fill this lacunae the current research study was framed to analyze. Objectives:- a) To assess the awareness regarding Selected Govt. health s and their benefits among women. b) To assess the utilization of the services provided by selected Govt. health s for women. Hypothesis:- Ho. There is no significant difference between awareness and utilization among women between the two selected PHC areas. Material and Methods:- The research methodology used for the present study is a community based descriptive study, comparative in nature. The study has been conducted in two Primary Health Centres (PHC) s selected by cluster (Strata) multi stage sampling method. In the present study, survey (quantitative analysis) is used to find out the awareness and utilization of the two Rajasthan Government health schemes namely, Janani Suraksha Yojna and Kalewa Yojna, among women of reproductive age group and having under five children, attending the antenatal clinic of PHCs (Achrol and Chandwaji) of Amber Block, Jaipur district. Sample- All married women between the reproductive age group (15-49) having under five children and attending the clinic at selected Primary Health Centres. Sample Size: It was conducted on 42 on beneficiaries from Chandwaji and 79 beneficiaries from Achrol of Amber Block, Jaipur, Rajasthan. Data collection tool: Study instrument was semi-structured pretested questionnaire in local hindi language which was used after content validation by experts as well as translation and back translation method. Reliability was tested using split half method. Data was collected from all married women having underfive children and attending antenatal OPD in both the Primary Health Centres i.e., Achrol PHC which is a Public Private Model of PHC and Chandwaji PHC which is a government run PHC. The study was done from 21 Nov-31 Dec RESULTS & ANALYSIS:- 4.1 Demographic details of Beneficiaries: Demographic study means study of both quantitative and qualitative aspects of selected human population. Quantitative aspects include composition, age, gender, size, and structure of the population. Qualitative aspects are the research specific factors such as live children, birth order, place of birth etc of 285

5 Beneficiaries, which are related with specific research design. Results of demographic analysis are elaborated in table 1 below: FIG. 1 DEMOGRAPHIC DETAIL OF BENEFICIARIES 286

6 Above demographic details interoperates that on the basis of age, majority (45.56%) of women from Achrol were of years of age and the same was represented in Chandwaji where 52.38% were the Beneficiaries. On the basis of Religion, more women were Hindus in both Achrol and Chandwaji comprising the percentage of 51.89% and 59.52% respectively. On the basis educational status, maximum Beneficiaries had primary education only i.e. (Achrol-58.22%) and (Chandwaji-45.23%). As per caste distribution, it was noted that in Achrol majority of the women were in OBC category (36.70%), followed by SC/ST (30.37%), General (22.78%) and others (10.12%) respectively. Whereas in Chandwaji majority of the women were in SC/ST category i.e.( 38%) followed by General (28.57%), OBC (21.42%) and Others (11.90%) respectively. The findings revealed that, majority of the women of Achrol (65.82%) as well as of Chandwaji (54.76%) were above poverty line. On the basis of place of delivery of last pregnancy also it was observed that 70.88% of the women of Achrol and 73.8% of them of Chandwaji had their last delivery in Government hospitals. 4.2 Awareness of Govt. health s Awareness as the key variable of current research study was analyzed among the sample Beneficiaries. Outcome of awareness among various Beneficiaries is analyzed in tables below:- Table 2. General awareness about health schemes for women by Rajasthan Government.. General Awareness Achrol Beneficiaries (N=79) Chandwaji Beneficiaries (N=42) YES NO YES NO 68 (86.075%) 11 (13.92%) 34 (80.95%) 8 (19%) Fig. 2 GENERAL AWARENESS ABOUT HEALTH SCHEMES FOR WOMEN BY RAJASTHAN GOVT. ` 287

7 The above details interoperates that a higher percentage of women attending Achrol PHC (86.75%) were aware of the health schemes for women as compared to the women attending Chandwaji PHC(80.95%). TABLE 3 AWARENESS ABOUT JSY AND KALEWA YOJANA HEALTH SCHEMES FOR WOMAN BY RAJASTHAN GOVT. Maternal Health s Achrol Beneficiaries (N=79) Chandwaji Beneficiaries (N=42) YES NO YES NO JSY 51 (64.55%) 28 (34.44%) 34 (80.95%) 8 (19%) KALEWA YOJANA 56 (70.88) 23 (29.11) 31 (73.80%) 11 (26.19%) FIGURE 3 AWARENESS ABOUT JSY AND KALEWA YOJANA HEALTH SCHEMES FOR WOMAN BY RAJASTHAN GOVT It is noted from the above table that 64.55% of the women of Achrol PHC were aware of Janani Suraksha Yojna and 70.88% of them about Kalewa Yojana. In Chandwaji PHC the findings were surprisingly higher ie 80.95% of the women were aware about JSY and 73.80% were aware of Kalewa Yojana. TABLE 4 AWARENESS TIME OF JSY AND KY HEALTH SCHEMES FOR WOMEN BY RAJASTHAN GOVT. Awareness Time frame Achrol Beneficiaries (N=79) Chandwaji Beneficiaries (N=42) JSY KY JSY KY Before Pregnancy 19 (24%) 28 (35.44%) 21 (50%) 26 (61.90%) During Pregnancy 46 (58.22%) 49 (62%) 15 (35.71%) 8 (19%) After Delivery 14 (17.72%) 2 (2.5%) 6 (14.28%) 8 (19%) In the above table is seen that majority (58.22%) of the women attending Achrol PHC had heard about the JSY and 62% of them had heard about Kalewa Yojna during pregnancy. Whereas among women 288

8 attending Chandwaji PHC, it was noted that almost 50% of them had heard about JSY and 61.90% about Kalewa Yojana before pregnancy 4.3 Utilization of Govt. health s Utilization of Health s for Women by Rajasthan Govt. being the key variant of current research study was analyzed among the sample beneficiaries. Utilization of Free Ambulance Services (104) TABLE 5. UTILIZATION OF JANANI EXPRESS SCHEME Achrol Beneficiaries (N=79) Chandwaji Beneficiaries (N=42) YES NO YES NO 59 (74.68%) 20 (25.31%) 38 (90.47%) 4 (9.52%) Maximum Beneficiaries from Achrol (74.68%) and Chandwaji (90.47%) used the ambulance services provided by the health facility during ANC. However, it was noted that majority of the women from Chandwaji had utilized this service compared to women attending Achrol PHC. TABLE 6. UTILIZATION OF MEDICINES PROVIDED UNDER JSY Achrol Beneficiaries (N=79) Chandwaji Beneficiaries (N=42) YES NO YES NO Consumption of Iron and Folic Acid (IFA) tablets Taking Tetanus Toxoid (TT) Injections 61 (77.21%) 18 (22.78%) 36 (85.71%) 6 (14.28%) 54 (68.35%) 25 (31.64%) 31 (85.71%) 11 (26.19%) From the above table it is observed that (77.21%) of women from Achrol PHC had consumed Iron and Folic Acid tablets, as against (85.71%) from Chandwaji. Similarly, majority (85/71%) of the women from Chandwaji PHC had received Tetanus Toxoid Injections as against 68.35% of the women from Achrol PHC. TABLE 7 UTILIZATION OF CASH AND OTHER BENEFITS UNDER JSY AND KALEWA YOJANA HEALTH SCHEMES. Utilization Achrol Beneficiaries (N=79) Chandwaji Beneficiaries (N=42) YES NO YES NO Received any cash incentive 56(70.88%) 23(29.11%) 22 (52.3%) 20 (47.61%) Received 5 litres of Desi Ghee/Milk Coupon after delivery in the health facility Received free and warm cooked food during their stay in the health facility post delivery 71 (89.87%) 8 (10.12%) 24 (57.14%) 18 (42.85%) 73(92.40%) 6(7.59%) 29 (69.04%) 13 (30.95%) 289

9 From the above table it was clear that maximum percentage of beneficiaries from Achrol got the cash incentive (70.88%) whereas around half the beneficiaries of Chandwaji got cash incentives (52.30%). Similarly Achrol and Chandwaji beneficiaries who received five liters of Desi ghee or milk coupons after their delivery in healthy facility were 89.87% and 57.14% respectively. In another variable of study i.e warm and free cooked food during their stay in the health facility post delivery results obtained from various beneficiaries clearly predicted that % of the beneficiaries of Achrol as against 69.04% of Chandwaji beneficiaries availed the facilities of free and warm food post delivery. The findings show that utilization of cash benefits, Desi ghee and free warm food was better among beneficiaries attending Achrol PHC than those attending Chandwaji PHC. 4.4 HYPOTHESIS TESTING (a) Correlation Analysis Correlation test has been used to find out the relationship between the various Government health s in two selected PHC's ie JSY, and Kalewa Yojna. Correlation analysis results are as follows:- TABLE 8. CORRELATION ANALYSIS OF RELATIONSHIP BETWEEN THE VARIOUS GOVERNMENT HEALTH SCHEMES IN TWO SELECTED PHC'S IE JSY, AND KALEWA YOJNA. Method Variables Value Achrol Chandwaji Janani Suraksha Kalewa Yojna Janani Suraksha Kalewa Yojna Kendall's tau_b Spearman's rho Janani Suraksha Kalewa Yojna Janani Suraksha Kalewa Yojna r value p value r value p value r value p value r value p value FINDINGS The findings in the above table shows that, in the correlation study for awareness and utilization of health schemes at Achrol and Chandwaji the p value is highly significant at 0.00 for both the health schemes in Achrol whereas p value is slightly less significant i.e and for JSY and KYS respectively in Chandwaji. OUTCOME- As stated from above correlation analysis and r value found it is significant that the hypothesis H 0 -There is no significant difference between awareness and utilization among women between the two selected PHC areas is rejected and alternate hypothesis H 1 There is significant difference between awareness and utilization among women between the two selected PHC areas is accepted and proved. 290

10 (b) ANOVA One way Analysis of Variance (ANOVA) has been calculated for both results obtained from above research study to test the hypothesis. Results are presented in table below:- TABLE 9 ANOVA FOR ACHROL AND CHANDWAJI BENEFICIARIES FINDINGS It is been observed from One Way ANOVA study for awareness and utilization of health schemes at Achrol and Chandwaji from above table that the values are highly significant at and level for both the health schemes in Achrol whereas significance values for Chandwaji is less significant i.e for JSY and there is no significance found for Kalewa Yojna at value. Hence, as stated from above ANOVA analysis, it is seen that hypothesis H 0 -There is no significant difference between awareness and utilization among women between the two selected PHC areas is rejected and alternate hypothesis H 1 There is significant difference between awareness and utilization among women between the two selected PHC areas is accepted and proved. 5. DISCUSSION:- 79 beneficiaries from Achrol PHC and 49 beneficiaries from Chandwaji PHC were interviewed In the present study, most of the beneficiaries were in the age range of years (45.56%) in PHC Achrol (52.38%) in PHC Chandwaji. According to a similar study on JSY in Rajasthan and Madhya Pradesh, 76% and 83% of the beneficiaries were aged years respectively. 11&12 According to this study majority (38%) of the beneficiaries in PHC Chandwaji were in SC/ST category and were aware of the JSY and Kalewa before pregnancy as compared to beneficiaries in PHC Achrol majority (36.%) 291

11 of who belonged to OBC category. Similar findings had been observed in a study in Rajasthan where onethrid of the JSY beneficiaries belonged to SC/ST category and one-half belonged to OBC category. 11&12 Awareness regarding JSY was (86.75%) among beneficiaries in PHC Achrol as compared to beneficiaries of Chandwaji. ie. (80.95 %). Utilization of Cash benefit, Desi ghee and Kalewa Yojna among beneficiaries in PHC Achrol was 70.88%, 89.87% and 92.40% respectively as against beneficiaries in PHC Chandwaji which was found to be 52.3%, 57.14% and 69.04% respectively. In a similar study, N Ramakrishna Reddy et al in Bangalore (2016), out of 120 post natal mothers, 78.35% were aware of the JSY, 82.9% had received cash incentive. Awareness and utilization of the was found to be satisfactory. 13 Cities illustrate the fact that the availability of health care does not necessarily lead to its use nor it is the same in every region. 6. CONCLUSION:- The purpose of this study was to determine to identify and empirically analyze the of awareness and utilization of Government health schemes among women in Rajasthan. The Rajasthan Government Maternal benefit s considered in this study is Janani Suraksha Yojna (JSY), Kalewa Yojna. To improve maternal and newborn health and survival, it is generally agreed that women should be assisted during delivery by trained healthcare professionals with appropriate equipment, medications and access to referral systems. The findings of this study revealed that correlation analysis and r value was found to be significant. Significant difference is noted between women of the two PHCs in their awareness and utilization pattern. Therefore null hypothesis H 0 - That, there is no significant difference between awareness and utilization among women between the two selected PHC areas is rejected and alternate hypothesis H 1 There is significant difference between awareness and utilization among women between the two selected PHC areas is accepted and proved. In conclusion, the findings show that a gap still exists, in the awareness and utilization of JSY in the rural population. This needs to be addressed through concerted efforts towards education, and communication to bring about behavior change. With the goal of sustainable development, there is still scope for improving awareness and utilization of health schemes in these two communities. A larger sample research will bring out the true picture of regarding impact of the scheme on awareness and utilization of these services and comparisons can be made authentically between the two communities. REFERENCES 1. Rate in India: Issues and challenges Last Updated:March 16, Munjial M, Kaushik P, Agnihotri S. A Comparative analysis of institutional and non institutional delivery.2009;32(3): Second report of GS &SS 2017 (Period ) Analysis of data relating to pregnant women registered for ANC in Rajasthan State. 4. Janani Suraksha Yojna. Min of Health and Family Welfare. Govt. of india, New Delhi. mohfw.nic.in/writereaddata/l892s/file pdf. Feb 23, 2011.p s of Government of Rajasthan in Health. State Institute of Health and Family Welfare, Jaipur. SIHFW: an ISO 9001:2008 certified Institution. 6. Rosamma Thomas. (June2, 2017). Amount offered under maternity plan inadequate. The Times of India, Jaipur.Page-3 7. Thongkong et al. How equitable is the uptake of conditional cash transfers for maternity care in India? Evidence from the Janani Suraksha Yojana scheme in Odisha and Jharkhand. International Journal for Equity in Health (2017) 16:

12 8. Dereje Kifle.,Telake Azale.,Yalemzewod Assefa Gelaw and Sayehirad Alemu Melsew Maternal health care service seeking behaviors and associated factors among women in rural Haramaya District, Eastern Ethiopia:. Reproductive Health2017;14:6 9. Sonu Goel., Deepak Sharma., Soma Rani. Factors influencing Janani Suraksha Yojana utilization in a northern city of India. Int J Reprod Contracept Obstet Gynecol Feb;6(2): Geddam JB, Ponna SN, Kommu PR, Kokku SB, Mamidi RS, Bontha VB. Utilization of maternal health services by the migrant population living in the non-notified slums of Hyderabad city, India. Indian J Comm Health. 2017; 29, 1: Uttekar BP et al. Assessment of ASHA and Janani Suraksha Yojna in Rajasthan, Centre for Operations Research and Training, Vadodara, India. April Uttekar BP, Sharma /j et al. Assessment of ASHA and Janani suaksha Yojna in Madhya Pradesh, Centre for Operations Research and Training, Vadodara, India. April Reddy NR et al. A study to assess the knowledge and utilization of Janani Suraksha Yojana among postnatal mothers attending the urban health centre of Bangalore medical college and research institute International Journal of Community Medicine and Public Health Feb;3(2):