The utilization of the maternal health care services offered by an upgraded primary health care (PHC) facility in a rural area of West Bengal, India was assessed. Information on the use of the maternal services by pregnant women over a 5-year period was collected from a house-to-house sample of 100 families living less than 1 hour away from the health facility and having at least 1 child born into the family in the previous 5-year period. Women in 58% of the families used the prenatal services of the facility, 6% received prenatal care from private practitioners, and 36% received no prenatal care. Reasons given for not using the facility were 1) using the clinic was too time consuming, 2) the staff was unfriendly, 3) a lack of interest in the services provided. There was no significant differences between prenatal service utililizers and nonuser in regard to caste differences. Utilizers were somewhat more likely to live in households with a literate household head than nonusers. The number of visits made by the utilizers ranged from 1-5, but many respondents had difficulty recalling the exact number. Utilizers were no more likely than nonusers to use the delivery services of the PHC. Among the 58 women who used either the prenatal services of the PHC or of private practitioners, 34 had their deliveries at the PHC, 23 at home and 1 in the hospital. Among the 42 women who received no prenatal care, 15 gave birth at the PHC center, 20 at home, and 4 at nursing homes. Home deliveries were conducted either by untrained midwives or by family members. 3 cases of neonatal tetanus and 1 case of maternal tetanus were reported in the community during the 5 year period. All of these births occurred at home. Only 6% of the 100 mothers used the postnatal services of the PHC center. The findings indicate that the provision of upgraded services by itself is insufficient to overcome the lack of health care motivation on the part of the target population.

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This study examined the sociological characteristics, fertility patterns, and contraceptive practices of a random sample of the target population of a family planning program in Allahabad, India. The program's target population of 16,3000 married couple of reproductive age lived in the Jasara block of the city. Family planning services were provided at a hospital clinic located in the Jasara block. A questionnaire was used to collect information from a sample of 500 couples. 91.4% of the respondents were Hindu, 98.5% were uneducated, and the modal age of the sample was 20-30 years. The average number of children ever born to the respondents was 3.66, and the mean child loss was 0.54/couple. 25 couples had no children. The mean age at marriage for the women was 14.58 years, and parity decreased as marriage age increased. Among couples married 1-5 years, the mean number of children was 1.7, and among couples married 25 years or more, the mean number of children was 5.6. Women between the ages of 25-29 years had 3.67 children, and those over 40 years of age had 5.59 children. 310 couples lived in nuclear families, and the remaining couples lived in joint families. The average number of children decreased as the educational level of the father increased. Parity was higher among low income groups than among moderate income groups. 68% of the fathers were cultivators, 22% were agricultural laborers, and 9% were service workers. No differences in parity were observed for the occupational groups. The mean number of children among Muslim couples was 4.8, 3.7 among Hindus belonging to lower castes, and 3.1 among Hindus belong to upper castes. Social class was not related to parity. Only 52% of the couples ever used contraception. 36% of the 500 couples ever used condoms, 8.2% relied on tubectomies, and 5.4% ever used oral contraceptive (OCs) or IUDs. Condom use was equally distributed among different educational groups. 30% of couples with high school educations and 4% of the illiterate couples used sterilization. Couples with low incomes were more likely to use condoms, and couples with higher incomes were more likely to use sterilization. Couples in the lower and upper income groups were more likely to practice contraception than couples in the middle income group. Most of the women who had tubectomies had 3-4 children. There is a need to promote temporary methods among younger couples. Many couples, and especially illiterate couples, are concerned about the side effects of OCs and IUDs. They tend to use condoms until they are ready to accept sterilization. Efforts should be made to educate couples about the benefits of OCs and IUDs and to overcome their fear of these methods.

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177 children ranging in age from 9-23 months were included in this study designed to obtain information on the feasibility of the immunization program against measles in the Singur Block of Hooghly district, about 34 miles from Calcutta, India. 111 children were administered the measles vaccine; 66 children served as the control group. Special care was taken to exclude children who had illness suggestive of a previous attack of measles. Children who had received any other vaccine in the previous month also were excluded. Each child was checked within 7 days of the vaccination to record untoward reactions. Home visits were done monthly. The period of follow-up was extended for 2 years. 57% of the children were males. Of the 111 children in the study group, 8 children developed measles subsequently. During the follow-up period, 25 children in the control group had measles. The proportion of children suffering from measles was 37.9% for the control group and 7.2% for the vaccinated group. 93 (83.8%) of the vaccinated children did not present any untoward reaction to the vaccination. There were complications in 18 children: 1 child developed measles; 1 child had broncho-pneumonia; 4 children suffered from diarrhea; and 12 children had a fever. Episodes of different illnesses occurring during the entire period of follow-up consisted of 80 attacks of diarrhea, 34 attacks of fever, and 1 case of chicken pox for the vaccinated group. The corresponding figures for the control group were 149 episodes of diarrhea and 50 attacks of fever.

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