Introduction To Social Obstetrics: DR Raghuram V Professor and Head Dept of Community Medicine

INTRODUCTION TO SOCIAL
OBSTETRICS
Dr Raghuram V
Professor and Head
Dept of Community Medicine
Definition
 Study of relation between social and
environmental factors and human reproduction,
even in preconception and premarital period.
 It is a branch of preventive medicine

What does it deal with?
 Age at marriage
 Age at child bearing
 Birth spacing
 Family size
 Fertility pattern
 Level of education
 Economic status
 Role of woman in society
Evolution of the Concept
 The term was first used by WHO in 1966.
 The concept describes the influence of social

factors like Levels of education, degree of literacy
and the role of women in society on the process
of reproduction.
 The success or failure of childbirth depends as

much upon a wide variety of social influences as
upon the skills and knowledge of doctors and
nurses.
The Three Delays Model
 Delay in decision to seek care due to
 The low status of women

 Poor understanding of complications and risk
factors in pregnancy and when to seek medical
help
 Previous poor experience of health care
 Acceptance of maternal death
 Financial implications
Contd..
 Delay in reaching care due to;
 Distance to health centres and hospitals

 Availability of and cost of transportation
 Poor roads and infrastructure
 Geography e.g. mountainous terrain, rivers
Contd..
 Delay in receiving adequate health care due
to;
 Poor facilities and lack of medical supplies

 Inadequately trained and poorly motivated
medical staff
 Inadequate referral systems
Contd..
Basis
 Social obstetrics demands that
the patient be treated as a human being, a
member of a family and community
whose various environmental and other
factors influence her and her illness and
therefore necessitate the consideration
and understanding of these factors in
planning her treatment by the doctor.
Contd..
 Integrating family planning services with general
health care and more particularly maternal and
child health care .
SCENARIO IN DEVELOPING
COUNTRIES
 Influence of environmental factors on the
organization, delivery and utilization of obstetric
services by the community.
 Institutional deliveries-
Proportion of institutional deliveries
Current understanding
 Family planning- Family welfare-Reproductive
health
 The scope of social obstetrics now broadened to

include the role played by factors like female
literacy and socio-economic status on
reproduction.
Contd..
 The cause of maternal mortality is an outcome of
interaction of variety of factors namely
the distant factors (socio-
economic, cultural) which act through the
proximate or intermediate factors (health and
reproductive behavior,
access to health service) and in turn
influence outcome (pregnancy complication,
mortality)
Contd..
 Studies have found that steady rates of increase
in female literacy were associated with declining
maternal and infant mortality ratios as well.
 It has been found that female literacy programs

are of immense value in reducing maternal and
infant mortality ratios given their ability to yield
sustained reductions in mortality levels in
developing countries.
Female literacy and health service
utilization
 Strong association exists between the level
of women’s education and use
of reproductive maternal health services
 Literacy improves women’s status, increases

age at marriage, reduces unwanted fertility and
improves utilisation of health services
 It also contributes to women’s self

confidence, improving their maternal skills, increa
sing their exposure to information and thereby
altering the way others respond to them.
MATERNITY CYCLE
 Fertilization
 Antenatal and post-natal period
 Intranatal period
 Postnatal period
 Inter –conceptional period
What is maternal and child
health(MCH) ?
 MCH has many components.
 Obstetrics
 Paediatrics
 Family planning
 Knowledge of health administration
 The role of various health personnel
 A primary health centre
 The health team concept.
MCH Problems
 Malnutrition
 Infection
 Uncontrolled reproduction
What it emphasizes
 Mother and child together form a single unit and not
two.
 Currently obstetrics and paediatrics--working in water

tight compartments and not in an integrated manner.
 Integrated teaching between the two departments is

perhaps the only way to impress on the students'
minds the basic fact of the mother and child being one
unit.
How it should be practiced ?
 Social obstetrics having been redefined
to include delivery of comprehensive
maternal and child health and family
planning services, it is necessary· to have
a clear idea of the objectives of training students.
Objectives
 The first objective of training
students should be to instil into them
the concept of comprehensive maternal
and child care and remove from their
minds age old concept that obstetrics is
only antenatal, intranatal and postnatal
care, concerned mainly with technical skills.
 The second objective is to teach them how to

deliver an integrated MCH/
FP service in the rural areas.
Training in MCH/FP
 Training in the field
 Institutional training
TRAINING IN THE FIELD
 Training in the field requires a greater emphasis
than that given to it at present since the aim is to
prepare the student to deliver MCH/ FP service to
a rural community within the environment.
Contd..
 This does not mean ignoring of training in the
academic and scientific aspects of obstetrics now
being taught are very necessary as they are the
basis on which the technical skills necessary to
deliver the service are built.
Suggested training in MCH/FP
 The clinical and practical integration in MCH/ FP
could best be done by introducing the subject
early in the para- clinical years through the family
care of a mother under proper supervision and
periodic monitoring.
Contd..
 Continuous reinforcement of this concept is
necessary while teaching the three
disciplines(obstetrics, paediatrics and community
medicine)
Training in Urban and Rural Health
Centres
 A supervised and monitored family attachment in

the second clinical year, if not earlier, would be of
help.
 Residence at the rural health centre, for a short

period at least, at any time during the clinical
years, would be of value if there are teachers
from the three disciplines in the centre to teach
him.
Contd..
 Periodic visits to RHTC with integrated teaching
by these three departments is an alternative
option to residential posting.
 The aim should be to demonstrate to the student

the interplay of various environmental, social and
cultural factors in health and disease and the
delivery of MCH care under those conditions.
Contd..
 Training at the urban health centres is much less
difficult as it involves no residence.
 Periodic visits by these three departments as

frequently as possible.
Internship training
 Two months in Community medicine- UHTC and

RHTC
 Training in providing MCH/FP services
 Limitations of the rural MCH/FP service and learn

how to select referral to the parent hospitals.
 PGDMCH- IGNOU
THANK YOU

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INTRODUCTION TO SOCIAL

 It is a branch of preventive medicine

 The concept describes the influence of social

 The success or failure of childbirth depends as

 Delay in decision to seek care due to

 The low status of women

 Distance to health centres and hospitals

 Poor facilities and lack of medical supplies

 The scope of social obstetrics now broadened to

 It has been found that female literacy programs

 Literacy improves women’s status, increases

 It also contributes to women’s self

 Currently obstetrics and paediatrics--working in water

 Integrated teaching between the two departments is

 The second objective is to teach them how to

 A supervised and monitored family attachment in

 Residence at the rural health centre, for a short

 The aim should be to demonstrate to the student

 Periodic visits by these three departments as

 Two months in Community medicine- UHTC and

 Training in providing MCH/FP services

 Limitations of the rural MCH/FP service and learn

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