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4.2.1 Data Sources:

study utilises data from The District Level Household and Facility Survey-4
(DLHS-4). This is the fourth round of the district level household survey which
was conducted during 2012-13. the main objective was to provide reproductive
and child health related database at district level in India.. Details on age, age at marriage, place of birth, educational
attainment, number of biological children ever born and surviving by sex were
collected. Accounts of ante-natal checks, experience of pregnancy related
complications, place of delivery, delivery attendant and postpartum care,
together with history of contraceptive use, of children and fertility
intentions were recorded. DLHS-4 surveyed a total of 24,836 ever married
women in reproductive age between 15 to 49 years with 94.4 percent response
rate. This study is based on District Level Household and Facility Survey
(DLHS-4) 2012-13 of West Bengal. Here for the analysis we use the district
level and state fact sheet and the unit level data of ever married women who
belongs to age group 15 to 49 and the data of Clinical, Anthropometric and Bio-Chemical tests (CAB) of Ever Married
Women (age 15-49) from DLHS-4 and the respective date of DLHS-3.

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4.2.2 Methodology


The study area is restricted to 19 districts of West
Bengal. Obviously the culture and the structure is not uniform across the districts
and there are regional variations.


a) We construct Safe Motherhood Index. The index is
measured by the normalized inverse Euclidean distance of the dimension indices
from their ideal values (Sarma, 2008). In the first place, we have calculated
the dimension index for each indicator of safe motherhood .However,
comprehensive index of safe motherhood (SMHI), is computed by using the
following formula:


                            SMHI =1-



Depending on the estimated value of SMHI states of
India and districts of West Bengal are categorised. The indicators those are chosen for the construction
of Safe Motherhood index are:

i) Antenatal care, ii) Post
natal care, iii) Institutional delivery, IV) Non anaemic women.


Motherhood Index: The safe
motherhood index is constructed using the following four dimensions.

Dimension 1- Antenatal
Care (ANC): This is a kind of medical supervision
given to a pregnant woman and her baby starting from the beginning time up to
the delivery of the baby. It includes regular monitoring of the woman and her
baby throughout pregnancy by various means including a variety of routine
regular examinations, tests and treatments of various kinds. Antenatal care
helps to maintain the mother in good health during pregnancy. The local level
sub-health centers are given the responsibility of providing such antenatal
care to the pregnant woman. Here we take percentage of women who took three or more
ANC visit.

Dimension 1I – Postnatal Care (PNC): A
postnatal period is immediately after the birth
of a child and exceeding for about six weeks. It is a critical phase in the
lives of mothers and newborn babies. As per WHO, the first hours, days
and weeks after childbirth are a dangerous time for both mother and newborn
infant. Most deaths occur during or immediately after childbirth. Appropriate
care in the first hours and days after childbirth could prevent the great
majority of these deaths. Thus, it has been recommended that skilled health
professionals attend all births, to assure the best possible outcome for both
mother and newborn infant. Here percentage of mother who received post natal care
within 48 hours of institutional delivery is taken.

Dimension 1II- Institutional Delivery Care: It is a known
fact that giving birth in medical institutions under the supervision of trained
health care providers increases the chance of child survival and reduces the
risk of maternal mortality. However, in spite of this, institutional deliveries
are avoided in many areas where people opt for deliveries at home. Still in
West Bengal 24.1% cases are delivery at home. Out of which 28.9% are in rural
area and 12.6% are in urban area.

Dimension 1V- Non-anemic
Women: Hemoglobin level is the indicator which
detects whether a person is anemic or non anemic. Anaemia, characterized by a low level of haemoglobin
in the blood, is major health problem in countries, especially among young
children and pregnant women. Anaemia among women may be an underlying cause of
maternal mortality, spontaneous abortion, premature births, and low birth
weight. In this round first time in DLHS-4 Clinical Anthropometric Biochemical (CAB) Test is
done. From the unit data the women of age group 15-49 whose haemoglobin label
is >11gm/dl are treated as non anaemic person. From the state fact sheet it
seen that 79% of pregnant women in West Bengal are anaemic.

b) Determinants of Safe Motherhood Index:

To examine the determinants
of safe motherhood in west Bengal according to different districts our choices
of explanatory variables are based both on economic theory and on empirical
evidence from earlier work in this area. The binary logistic regression methods
are used to determine the major determinant of safe motherhood. As SMHI is constructed for states of India and
districts of West Bengal, so to find the determinant of SMHI sample becomes
very low. To overcome the problem, here the programme related dimensions are
taken as dependent variable. With the same independent variable indirectly the determinants
of SMHI are identified.


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