RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES

BANGALORE KARNATAKA
SYNOPSIS PROFORMA FOR REGISTRATION OFSUBJECTS
FOR DISSERTATION

Ms.JAYASHREE.G.R

1.

NAME OF THE CANDIDATE

Ist YEAR M.Sc. NURSING

AND ADDRESS

RATHNA COLLEGE OF NURSING

HASSAN

2.

NAME OF THE INSTITUTION

RATHNA COLLEGE OF NURSING

B.M.ROAD, HASSAN,KARNATAKA.

3.

COURSE OF STUDY AND SUBJECT

MASTER OF SCIENCE IN NUSING,

OBSTETRICS AND GYNAECOLOGY.

4.

DATE OF
ADMISSION TO THE COURSE

5.

TITLE OF THE
TOPIC

13.07.2011.

KNOWLEDGE ON JANANI SURAKSHA YOJANA

AMONG ANTENATAL MOTHERS.

A DESCRIPTIVE STUDY TO ASSESS THE

KNOWLEDGE ON JANANI SURAKSHA YOJANA

5.1

STATEMENT OF THE PROBLEM

AMONG ANTENATAL MOTHERS IN SELECTED

RURAL AREAS AT HASSAN DISTRICT WITH A
VIEW TO DEVELOP PAMPHLETS

6. BRIEF RESUME OF THE INTENDED STUDY;

INTRODUCTION
Only a prospective mothers knows what it is to carry, the onlookers notice her
illness and pity her, but she alone knows the travail

- Mahatma Gandhi
The act of giving birth is the only moment when both pain and pleasure
converge at a moment of time. This experience of transformation from womanhood or
wifehood into motherhood is a privilege reserved exclusively for women. Hence this
transformation phase that is pregnancy and following childbirth has been contributed
to have a great impact on both maternal and infant health1.
In any community, mother and children constitute a priority group; they
comprise approximately 71.14% of the population of the developing countries. In
India women of the child bearing age constitute 22.2% and children under 15 years of
age about 35.3% of the total population together they constitute nearly 57.5% of the
total population. Mother and children not only constitute a large group but they are
also a vulnerable or special risk group. The risk is connected with child bearing in the
case of women and survival in case of children2.
Global observation shows that in developed regions MMR averages at
13/100,000 live births, in developing regions the figure is 440 for the same number of
live births. From commonly accepted indices, it is evident that infant, child and MMR
are high in many developing countries. Further much of the sickness and deaths
among mother and children is largely preventable by improving the health of the
mother and children2.
India contributes around 20 percent of global births. Each year in India,
roughly 30 million women experience pregnancy and 27 million have a live birth. Of
these, an estimated 1, 36,000 maternal deaths and one million new born deaths occur
each year, thus pregnancy-related mortality and morbidity continues to take a huge
toll on the lives of Indian women and their new born. These considerations have led to
the formulation of specific health services for mother and child in India3.

Since 1951, on voluntary basis with democratic manner, the Government of

India, Ministry of Health and Family Welfare, has implemented different types of
programmes for the improvement of maternal health, child health and family welfare.
In light of the millennium development goals (MDG), National Population Policy
(NPP), and National Health Policy (NHP) the Government of India, Ministry of
Health and Family Welfare planned and launched National Rural Health Mission
(NRHM) in April 2005. All the efforts under NRHM are directly and indirectly aimed
to provide accessible, affordable, and effective healthcare to all citizens and
particularly to the poor and vulnerable sections of the society4.
According to the needs, experiences and feedbacks, various changes and
modifications have been incorporated from time to time. Several new approaches,
interventions, and alternatives were initiated to reduce maternal morbidity, mortality
ratio and child mortality rate. Maternal and Child Health (MCH), Child Survival and
Safe Motherhood (CSSM), Universal Immunisation Programmes (UIP), Oral
Rehydration Solution (ORS), dais training, medical termination of pregnancy (MTP),
postpartum programmes, National Maternal Benefit Scheme (NMBS) and Janani
Suraksha Yojana (JSY), are important and well-known efforts at both country and
state level1.As the health of the mothers is directly related to the childs health, the
Janani Suraksha Yojana has been launched with a view to bring down the maternal
and infant mortality rate4.
Janani Suraksha Yojana, under the overall umbrella of National Rural Health
Mission (NRHM), has been proposed by a way of modifying the National Maternity
Benefit Scheme (NMBS). While NMBS is linked to the provision of better diet for
pregnant women from Below Poverty Line (BPL) families, Janani Suraksha Yojana
integrates cash assistance with antenatal care during the pregnancy period,
institutional care during delivery and immediate postpartum period in a health centre
by establishing systems of coordinated care by the field level health workers. The
Janani Suraksha Yojana is a 100 percent centrally sponsored scheme launched by the
Honourable Prime Minister of our country on April 12, 2005 for reducing maternal
and neo-natal mortality4.
JSY integrates cash assistance with delivery and post-delivery care. The
success of the scheme would be determined by the increase in institutional deliveries

among the poor families. The Yojana has identified The Accredited Social Health
Activist (ASHA), as an effective link between the Government and the poor pregnant
women in ten low performing states, namely the eight EAG states, Assam, Jammu and
Kashmir, and the remaining NE States. In other eligible states and UTs, wherever,
AWW and TBAs or ASHA-like activists have been engaged for this purpose, she can
be associated with this Yojana for providing the services4.
The concept of healthy mother and healthy baby is an important aspect of
reproductive health care programme. In a developing country like India, poverty,
illiteracy, multiple pregnancies and lack of health facility take their toll of mothers
health and that of the infant. Building national capacity in planning, implementing and
monitoring sexual and reproductive health programs is a major challenge in Asian
countries. Due to multidimensional factors, safe motherhood is still a dream for much
of India particularly for its rural and tribal population5.
So as nurses it is our responsibility to impart knowledge regarding the
national health programmes and the various facilities rendered by the government
which are implemented for the people to improve the health indicators and make our
country more prosperous and Janani Suraksha Yojana is one among them.

6.1 NEED FOR THE STUDY

Every pregnant woman hopes for a healthy baby and an uncomplicated
pregnancy. However, every day, about 1,500 women and adolescent girls die from
problems related to pregnancy and childbirth. Every year, some 10 million women
and adolescent girls experience complications during pregnancy, many of which leave
them and/or their children with infections and severe disabilities6.
According to WHO, globally estimating the maternal mortality rate, over 5,
00,000 die every year and in that 1,500 women in a day because of complications of
pregnancy and childbirth. Each year, approximately eight million women suffer
pregnancy-related complications and over half a million die. Some 99 per cent of all
maternal deaths occur in developing countries. Two thirds of maternal deaths in 2000
occurred in 13 of the world's poorest countries. During the same year, India alone
accounted for one quarter of all maternal deaths6.

According to Statistical Report, Registrar General of India, Maternal Mortality

Rate (MMR) of India in 2001-2003 was 301 per lakh live births. The state of
maternal, new born and child health in India is of global importance; in 2005, more
than 78,000 (20%) of 387 200 maternal deaths, and more than 1 million (31%) of 34
million neonatal deaths occurred in India. The maternal mortality ratio declined from
about 520 per 100,000 live births in 1,990 to nearly 290 per 1, 00,000 in 2005 and the
neonatal mortality rate decreased from 54 per 1000 live births in 1990 to 38 per 1000
in 2005. Despite this progress, the numbers of maternal and neonatal deaths remained
highin south East Asia7.
According to 2007 statistics the infant mortality rate in India was 34.6 deaths
per 1000 live births. The national average maternal mortality rate lies between 420540/1 lakh live births. It is recognised that Rajasthan is the state, which has highest
MMR in India, i. e., 670/one lakh live births8.
Pregnant women die in India due to a combination of important factors like,
poverty, ineffective or unaffordable health services, lack of political, managerial and
administrative will. All this culminates in a high proportion of home deliveries by
unskilled relatives and delays in seeking care and this in turn adds to the maternal
mortality ratios. The institutional delivery or delivery by skilled personal plays
major role in reducing MMR and IMR .In India, while 77% of pregnant women
receive some form of antenatal check-up, only 41% deliver in an institution. Even
though all services are free only 13% of the lowest income quintile delivers in a
hospital9.
A cross-sectional study was conducted to determine the performance of
institutional and non-institutional deliveries among 400 households in the slums of
Delhi. The results revealed that non-institutional deliveries were found to be about 46
percent. Factors such as economic status were identified as the ones for preference
for non-institutional deliveries. The researcher further concluded that improvement in
the economic condition of the people may promote institutional deliveries. Hence
researcher felt that there was a need to assess the knowledge of mothers regarding
Janani Suraksha Yojana as it provides financial assistance to the mothers 10.

In Karnataka the maternal mortality rate is 195/one lakh live births and ranks
third among states. According to the SRS 1997, IMR in Karnataka is 52/1000 live
births. In Gulbarga district, the maternal mortality rate is 195 for every 1000
deliveries and the infant mortality is 55 for every 1000 deliveries. The infant mortality
rate in Udupi District is eight/1000 whereas maternal mortality rate is 65/one lakh. In
Mangalore the IMR is 65.5 deaths/1000 live births with MMR of 1-10/2500 live
births11.
The poor health of the mother, including diseases that were not adequately
treated before or during pregnancy, is often a factor contributing to new born deaths
or to babies born too early and/or with low birth weight, which can cause future
complications. Governments have a responsibility to ensure that every woman has
access to quality maternity care, including prenatal and post-natal services12.
In April, 2005, in response to the slow and varied progress in improvement of
maternal and neonatal health, the Government of India launched Janani Suraksha
Yojana an additional conditional cash transfer scheme to incentivize women of low
socioeconomic status to give birth in a health facility. The ultimate goal of the
programme is to reduce the number of maternal and neonatal deaths. JSY had a great
impact in reducing maternal and newborn health morbidities and mortalities. Since the
launch of JSY, the numbers of institutional deliveries have started increasing. Against
the 27.61 Lakh beneficiaries in 2006- 07, the number of beneficiaries jumped to 53.13
Lakh in 200713.
Many women, including adolescents, have difficulty accessing quality health
care due to poverty, distance, lack of information, inadequate services or cultural
practices. A community based cross sectional study Conducted from Jan 2009 to Dec
2009 among 3212 women to explore the reasons of Missed opportunities of Janani
Suraksha Yojana benefits among the beneficiaries of solapur slum area Out of 3,212
women 360 (11.20%) were eligible for getting the benefit of Janani Suraksha Yojana.
Among the 360 only 118 (32.78%) women got the benefit of JSY while, 242
(67.22%) missed the opportunity of getting JSY benefit due to Lack of information of
JSY in 37.19% women followed by difficulty in getting the documents and card was
not-filled in time by ANM were the common causes in 25.62% and 15.29% women
respectively. finding shows the poor IEC efforts in the implementation of JSY,

divulging most of the poor eligible women from their rights of JSY benefits. Hence,
continuous IEC activity with active involvement of health service provider like ANM,
MPW is needed.So there is a need to assess the knowledge of antenatal mothers
regarding Janani Suraksha Yojana and thereby imparting the knowledge about the
healthcare facilities provided by the government7.
A cross-sectional study was conducted under Rural Health Training Centre and
Urban Health Training Centre of the field practice area of department of Community
Medicine.To find out the difference in utilization of Janani Suraksha Yojana in rural
areas and urban slums. A total of 227 married women in reproductive age (15-49
years), who delivered in government hospital were considered for the study out of
which 88 women belonged to rural areas and 139 women were from urban slums. Out
of the total number of married women who delivered at govt. hospital i.e. 227,
majority (78.42%) were registered with some health personnel. Out of these, 74.15%
women were registered with ASHA and maximum number (83.64%) of these women
belonged to urban slums. Only 29.21% women went for three or more ANC visits and
the proportion was higher (33.64%) in urban slums. Only 48.31% women consumed
hundred IFA tablets and the proportion was high (79.41%) in rural women. All the
women received complete TT immunization. The study shows that utilization of JSY
was found to be low in rural areas i.e. 38.7% .Thus, IEC activities should be
strengthened and ASHAs work should be properly monitored14.
Reducing maternal and infant mortality rate is of prime importance for the
growth and development of the country. Even though the conveniences are made for
citizens, they are not utilising them up to the mark, which is rendered to them free of
cost. One such programme is Janani Suraksha Yojana, which provides cash assistance
for mother and her childs better health. Hence the researcher felt to assess the
knowledge of the mothers regarding Janani Suraksha Yojana.

6.2 REVIEW OF LITERATURE

A survey was conducted to highlight the preference of women for home
deliveries and utilisation of antenatal and postnatal health facilities in three districts of
Karnataka. The result revealed that in spite of the exposure of primary healthcare
services, the deliveries conducted in the health institutions or deliveries assisted by

the trained personnel were very less. Time of delivery, illiteracy, economic conditions
of women, and customs of natal home, transportation and place of stay of health
workers had contributed to this phenomenon. Lack of health personnel and inadequate
facilities had also contributed to this. The researcher concluded that if women had
access to good antenatal services, adequate rest and nutrition during pregnancy and
proper counselling, this problem could have been minimised by promoting
institutional deliveries to reduce perinatal and neonatal mortality rates .15
A nationwide district-level household surveys done in 2002-04 and 2007-09 to
assess the effect of JSY on intervention coverage and health outcomes. Findings
shows that implementation of JSY in 2007-08 was highly variable by state from less
than 5% to 44% of women giving birth receiving cash payments from JSY. The
poorest and least educated women did not always have the highest odds of receiving
JSY payments. JSY had a significant effect on increasing antenatal care and in-facility
births. In the matching analysis, JSY payment was associated with a reduction of 37
perinatal deaths per 1000 pregnancies and 23 neonatal deaths per 1000 live births. In
the with-versus-without comparison, the reductions were 41 perinatal deaths per 1000
pregnancies and 24 neonatal deaths per 1000 live births. The findings of this
assessment are encouraging, but they also emphasise the need for improved targeting
of the poorest women and attention to quality of obstetric care in health facilities 16.
A descriptive study was conducted in N.S.C.B. Medical College, Jabalpur
(M.P. - India) during 2006-07 to assess the social profile, knowledge and utilization
pattern of 300 JSY beneficiaries. Findings show that among 300 beneficiaries77.66%
belonged to below poverty line (BPL) category. 67 % of the respondents arranged
their own / hired vehicle for transportation for delivery. Only 17.33 % were motivated
by ANM /Dai/ ASHA/ AWW for institutional delivery. It concludes that decision of
expenditure depends upon husband in one third of cases and the arrangement of
vehicle for transport is still a major issue of concern17.
A descriptive study was conducted to evaluate the utilisation of Janani
Suraksha Yojana among the 100 beneficiaries in Orissa. Beneficiaries were selected
randomly through probability proportionate to sample size (PPS). The results revealed
that major advantages of the JSY perceived by the beneficiaries were safe delivery at

PHCs and CHCs, helpful in population control, payment of cheque after delivery and
full protection after delivery. Hence the researcher concluded that Janani Suraksha
Yojana is a safe motherhood intervention for the health and welfare of the mothers.18
A descriptive study was conducted to assess the effectiveness of Janani Suraksha
Yojana among 200 beneficiaries in the selected districts of Rajasthan. The results
revealed that 178 beneficiaries received payment in cash and 22 by cheque. Home
deliveries decreased. Overall status of ANC and PNC services also increased.
Seventy-two percent of the beneficiaries were registered within three months,
received three ANC check-ups, used IFA tablets, postnatal check-up, received cash
amount, and ASHA was with them at the time of delivery. It concludes that Seventy
percent of the beneficiaries were pre-aware about at least one of the aims and vision
of Janani Suraksha Yojana.19
A study conducted to assess the gaps in delivery services and utilization of
resources at Basic and Comprehensive Emergency Obstetric Care Centres, accredited
sub centres and private hospitals in district Jaipur, Rajasthan. The study was
undertaken during October-December 2008 in 31 selected health facilities in district
Jaipur. Data was collected by facility survey, interview of service providers and
beneficiaries. Result shows that there is an increase in institutional deliveries
following implementation of JSY. Though the normal deliveries were conducted 24
hours by the Basic and CEmOCs however the necessary drugs were in short, supply
and use of partograph was absent at the health facilities. The quality of emergency
obstetric care services was still poor due to the lack of blood storage units and
anaesthetists in CEmOCs. Private accredited hospitals fared better as they had the
manpower and managed more complicated cases as compared to government
facilities. The study concludes that JSY is perceived as an effective scheme by the
beneficiaries but gaps in resources and lack of quality of services needs to be
adequately dealt with20.
A study conducted to assess and evaluate the operational mechanism,
utilization, non-utilization, awareness and perception of mothers on Janani suraksha
yojana in two blocks each district of south Orissa. The study revealed that there was a
lack of orientation of the health staff other than ASHA on JSY. ASHA played a major
role in motivation for institutional deliveries in two third of the utilizers, Most of the

utilizers expressed problem of communication and transport. Further no availability of

24x7 facilities and lack of staff were major deterrents for prospective mothers in
accessing JSY services. The study recommends for streamlining of funds flow,
accreditation of private hospitals, intensification of IEC activities and community
leaders and women group for utilization of JSY benefits21.
A cross-sectional study was conducted to review the implementation process
of JSY in the state and to provide inputs for any corrective action in the three districts
of Orissa. The study revealed that at the district, block and sub-centre level there was
a shortage of medical and paramedical staff, inadequate facilities for institutional
delivery. However, available staff was well trained on various implementation
procedures under JSY. IEC activities were also being implemented efficiently.
Beneficiaries revealed that HW (F) and ASHAs were playing the key roles in
generating awareness regarding JSY. Still many non-beneficiaries were not aware
about the JSY. Hence the researcher concludes with two major recommendations:
(i) strengthening of infrastructure, supplies and human resources at all levels under
the JSY, and (ii) Streamlining the fund flow mechanism at two levels: immediate
compensation to the beneficiary after the delivery and regular payments/salaries to the
ASHA.22

STATEMENT OF THE PROBLEM

A DESCRIPTIVE STUDY TO ASSESS THE KNOWLEDGE ON JANANI
SURAKSHA YOJANA AMONG ANTENATAL MOTHERS IN SELECTED
RURAL AREAS AT HASSAN DISTRICT WITH A VIEW TO DEVELOP
PAMPHLETS.

6.3 OBJECTIVES
The objectives are :

To assess the knowledge on Janani Suraksha Yojana among antenatal

mothers in selected rural areas at Hassan district.

To find out the association between knowledge scores with selected

demographic variables.

To develop and distribute pamphlets on Janani Suraksha Yojana among

antenatal mothers.

6.4 RESEARCH HYPOTHESIS

H1:

There will be significant association between knowledge scores with

selected demographic variables on Janani Suraksha Yojana among
antenatal mothers.

6.5 ASSUMPTIONS
The investigator assumed that:
1.

Antenatal mothers may have some knowledge regarding Janani

Suraksha Yojana.

2.

Pamphlets will enhance the knowledge of the antenatal mothers

regarding Janani Suraksha Yojana

6.6 OPERATIONAL DEFNITIONS

Knowledge: In this study, knowledge refers to responses given by the

antenatal mothers to the structured knowledge questionnaire through
interview schedule regarding Janani Suraksha Yojana as measured bytwo
point scales.

Antenatal Mothers: In this study, it refers to the mothers who are

pregnant for the first and second time and who are willing to participate in
study.

Rural area: In this study, it refers to a selected geographical area outside

cities and towns which comes under Alur PHC. The rural area is easily
reachable and is about 16 kms away from the college.

JananiSuraksha Yojana: In this study, it refers to a nationalizedhealth

programme,which provides cash assistance for antenatal mothers with

antenatal care, institutional delivery with care and immediate postnatal

care in the health centre itself, also reduces maternal mortality rate and
infant mortality rate.

Pamphlets: In this study it refers to a self-learning information material

prepared by the investigator in Kannada on Janani Suraksha Yojana. It
provides adequate and relevant information, criteria to be benefited for the
antenatal mothers.

6.7 CONCEPTUAL FRAMEWORK

The study is based on Becker, Drachman RH and Kircht TP Health belief
Model (1974)

7.0 MATERIALS AND METHODS

7.1 SOURCE OF DATA
Mothers who are attending the antenatal clinics of selected rural areas, Hassan.

7.2 METHODS OF COLLECTING DATA.

7.2.1 RESEARCH APPROACH
Descriptive approach will be used to conduct the study.

7.2.2 RESEARCH DESIGN

Descriptive design will be adopted to carry out the study.

7.2.3 POPULATION
In the present study the population comprised of antenatal mothers.

7.2.4 SAMPLE

The antenatal mothers who are attending antenatal clinic, who fulfills the
inclusion criteria.

7.2.5 SAMPLE SIZE

The sample for the present study consisted of 100 antenatal mothers
who meet the inclusion criteria from selected rural areas of Hassan.

7.2.6 SAMPLING TECHNIQU

Non probability Purposive sampling technique will be adopted to select the
samples.

7.2.7 SELECTION OF TOOL

The tool used to collect data consist of two sections
Section A: socio demographic variables
Section B: structured knowledge questionnaire on Janani suraksha yojana.

7.2.8 CRITERIA FOR SAMPLE SELECTION

Inclusion criteria
Mothers:
1.

Gravida 1and gravida 2 only.

2.

Who could understand Kannada.

3.

Who are willing to participate in the study.

4.

Who are available at the time of the data collection.

Exclusion criteria
Mothers:
1.

Who are in third gravida and above.

2.

Who are not willing to participate.

7.2.9 Delimitations
The study is delimited to:

The antenatal mothers residing in the selected rural areas at

Hassan district.

100 antenatal mothers.

Data collection period is 4-6 weeks.

Knowledge is assessing through closed-ended structured

interview schedule.

7.2.10 SIGNIFICANCE OF THE STUDY

The study signifies the assessment of knowledge regarding Janani suraksha
yojana. it will enhance the knowledge of antenatal mothers.

7.2.11 SETTING OF THE STUDY

Study will be conducted in selected rural areas of Hassan.

7.2.12 PILOT STUDY

The pilot study will be conducted on 10%of total sample, in selected rural
areas, that will be excluded from main study.

7.2.13 VARIABLES
1. Independent Variable:
In the study there is no independent variable.
2. Dependent Variable:
Knowledge of antenatal mothers regarding janani suraksha yojana.
3. Extraneous variable:

Age, religion, type of family, educational status of mothers, gravida,

family income per year, history of infant death in the family, sources of
information, and distance from the referral unit are the extraneous variables in
this study.

7.2.14 DATA ANALYSIS METHOD

The collected

data will be analyzed through descriptive and inferential

Statistics.

Descriptive statistics:
Frequency, percentage, mean and standard deviation will be used to
describe demographic variables and knowledge scores.

Inferential statistics:
Chi square test will be used to find out the association between knowledge
score and with selected demographic variables.

7.3. DOES THE STUDY REQUIRE ANY INTERVENTIONS TO BE

CARRIED OUT ON PATIENTS OR OTHER HUMANS?
There is no need of any investigations or interventions on human beings or
animals.

7.4. HAS ETHICAL CLEARANCE BEEN OBTAINED FROM

YOUR INSTITUTION?
Yes. Permission will be obtained from the research committee of Rathna
college of nursing , authorities of Health officer,Alur PHC and subjects who are
selected for the study.

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