A l A m e e n J M e d S c i 2 0 2 1 ; 1 4 ( 3 ) : 2 5 3 - 2 6 1 ● US National Library of Medicine enlisted journal ● I S S N 0 9 7 4 - 1 1 4 3
ORIGINAL ARTICLE
CODEN: AAJMBG
A community based study on utilization of antenatal care services
by villagers in rural part of Eastern India
Kuntala Ray1 and Hironmoy Roy2*
1
Department of Community Medicine, Institute of Post Graduate Medical Education & Research, 244
AJC Bose Road, Kolkata-700020, West Bengal, India and 2Department of Anatomy, Institute of Post
Graduate Medical Education & Research, 244 AJC Bose Road, Kolkata-700020, West Bengal, India
Received: 21st February 2021; Accepted: 27th June 2021; Published: 01st July 2021
Abstract: Background: Antenatal care (ANC) is the care provided throughout pregnancy to help and ensure
that women go through pregnancy and childbirth in good health and that their newborns are healthy. In our
rural parts of India till not all the antenatal women seeks the care from proper set up, due to various influencing
reasons. Aim: This study aims to explore the trend of the antenatal care services sought by the pregnant mothers
in rural area and the factors that would influence their such behaviors. Methods & Material: For such this
descriptive community-based study was carried on in the Kawakhali village of Matigara-1 GP of Siliguri
subdivision; interviewing the 363 post-natal mothers. The data was interpret using the SPSS software.
Result: 88% were from Hindu, 76% were within 26yrs of age; 65% found to have educational level upto class
X standard and 98% were homemaker.84% had their delivery in hospital set up. 352 out of 363 postnatal
mothers had sought antenatal care and among them only two-third had faced regular antenatal visits. In
comparison between women who undergone for at least four ANC visits and who did for maximum thrice;
significant difference was observed in terms of age (p=0.002), religion (p=0.000), educational level (p=0.000),
socio economic status (SES) (p=0.000), timing of registration (p=0.000); although occupation of the incumbent,
type of family in which they belonged and the mode of delivery were not found to be significantly affected by
the socio demographic profile. Conclusion: There is a need to increase education about importance of
consumption of IFA tab, early detection of danger signs in pregnancy, increase education about family planning
after delivery.
Keywords: Antenatal care, Community study, Community health status, Family planning, Maternal mortality.
Introduction
Pregnancy is one of the most important periods in
the life of a woman, a family and a society
Antenatal care (ANC) is the care provided
throughout pregnancy to help and ensure that
women go through pregnancy and childbirth in
good health and that their newborns are healthy.
WHO defines ante natal care as ‘A care which
includes recording medical history, assessment of
individual needs, advice and guidance on
pregnancy and delivery, screening tests,
education on self-care during pregnancy,
identification of conditions detrimental to health
during pregnancy, first-line management and
referral if necessary.’ So, antenatal care
isthesystemic medical supervision of women
during pregnancy. It preserves the physiological
aspect of pregnancy and labor and to prevent
or detect, as early as possible, all that is
pathological [1]. The quality of care is more
important than the quantity [2].
Antenatal Care (ANC) can serve a role in
reduction of maternal mortality. ANC can
help prevents maternal and neonatal deaths by
identifying pregnancy-related complications
early. ANC also offers an opportunity to
educate women on obstetric danger signs and
motivate them and their families to seek
appropriate and timely referral. Accessing
antenatal care in a timely manner enables
women to receive information early in their
pregnancy concerning the full range of
screening tests available such as serologic
screening for Human Immunodeficiency
Virus (HIV) and syphilis. Other interventions
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Ray K & Roy H
such as routine iron and folic acid
supplementation, and routine measurement of
fundal height, and tetanus immunization are
beneficial to mother and child health [3]. The new
World Health Organization (WHO) antenatal care
model recommends a minimum of four visits and
provides detailed instructions on the basic
components of antenatal care across developed
and developing countries [4].
Subdivision. In this gram panchayat-1 out of
total 5 villages Kauakhali, kalamjote,
thiknikata villages were selected randomly.
This was the field practice area of North
Bengal Medical College.
The Government of India is committed to
achieving the Millennium Development Goal of
reducing the maternal mortality ratio by three
quarters between 1990 and 2015. Therefore,
reproductive and child health (RCH) program is
strongly advocated in the current national plan to
improve maternal health. In west Bengal 76.5%
women take 4 or more antenatal visits, 75.2%
practice institutional deliveries and 28.0% take
100 IFA tablets [5]. High maternal mortality can
also be reduced by early registration of
pregnancy, taking at least 4 antenatal visits,
prevention and treatment of complications likeeclampsia, malpresentations, diabetes and
hypertension.
Z α/2= confidence level at 95% (standard value
of 1.96)
Keeping this in mind, a study was conducted
among the mothers who had delivered in
preceding 12 months with the following
objectives:
1. To assess utilization of antenatal care services
of the women of reproductive age group (1549 yrs) residing in Kwakhali village of
Matigara block.
2. To determine the underlying factors
influencing the utilization of antenatal care
services in rural areas.
Material and Methods
A community based descriptive study with crosssectional design was conducted from April - June
2015 among married women in the reproductive
age group (15-49 years) who had delivered in
preceding 12 months [to get all information of
ANC services she had received] residing in study
area. Unmarried mothers, seriously ill mothers,
divorcee and nonresident women of study area
mothers not available during the time of data
collection were excluded from the study.
The study was done in Matigara 1 gram
panchayat of Matigara block of siliguri
Sample size and Sampling technique: it was
done using the formula(Z α/2)2 P(1-P)/d 2 = n
P= women who had three or more ANC was
66% in Darjeeling district of West Bengal [5].
d= margin of error at 5% (standard value of
0.05)
The calculated sample size was 345. Taking
5% non response rate the final sample size
was 363. Systematic random sampling
technique was followed First house was
chosen with the help of local health worker
from the list of eligible women supplied from
sub centre and consecutively women were
interviewed until reach the total sample.
Permission to conduct the study was obtained
from the Institutional Ethics Committee,
North Bengal Medical College and informed
consent from the mothers was taken. The
purpose of the study was explained to the
respondents. Age of child was ascertained
from birth certificate, hospital discharge
certificate, mother and child protection card
(MCPC).
The data were collected using a predesigned
pretested structured interview schedule and
relevant records and reports (antenatal card,
laboratory
investigation
reports
and
prescriptions). In the proforma the questions
were asked about the age of the mother’s at
birth, parity, religion, type of families,
educational status and occupational status,
socioeconomic status (Modified BG Prasad
classification 2015) and as predictor variables
of maternal health care seeking behaviour.
All the information regarding antenatal check
up (ANC), iron and folic acid tablets
consumption during pregnancy place of
delivery, number of ANC visit, mode of
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Al Ameen J Med Sci; Volume 14, No.3, 2021
delivery
immunization
status,
physical
examination in 4 visits, laboratory investigation
done, health education related to Rest, Diet,
Personal hygiene, Breast feeding, Family
planning,
Danger
sign
and
Counting
foetalmovement, were reviewed from available
records.
Local health worker was contacted and purpose
of our study was briefed. Her cooperation was
sought for smooth conduction of the study. Data
were collected using face-to-face interviews with
individual
women
using
a
structured
questionnaire at their home or in their village.
Prior to data collection women were informed of
the aim of the study and assured that their identity
and the information they provided would be
treated as confidential and they would remain
anonymous. Verbal consent was obtained before
collecting information. Maximum 3 times visit
was given to every house to minimize drop out.
During the collection of data records review was
done from Mother & Child Protection Card or
any other documents related to ANC services.
The records related to other previous pregnancies
were also consulted. All collected data was
compiled in a master table manually. Data was
analysed using principles of descriptive statistics
and all data was presented using frequency
distribution table and by suitable diagrams. For
categorical variables Frequency and percentage
were calculated. The Chi-square test was used to
compare between the study participants, who took
at least three antenatal care visits and more and
who did not. Criteria of significance used in the
study were p<0.05.
Results
Total 363 women were interviewed. As shown in
table 1, out of total study population 88.15% were
Hindu and more than 76% belongs to 20- 25 yrs
of age group. 67.22% of women belong to
schedule caste and more than 65% has completed
class V-X. 95.8 % of the study population was
home maker and more than 57% were belongs to
nuclear family.
Among the study population 33.8% of the
mothers belonged to high class family followed
by 28.6% were belonged to upper middle class
family and 5.5 % were belonged to poor
socioeconomic class. Majority (84.8%) of the
Ray K & Roy H
mothers had delivered their children at North
Bengal medical college & hospital followed
by 8.2% at home and only 6.8% at private
hospital. Majority (66.1%) of the children had
delivered by normal vaginal route followed by
33.9% by Caesarean Section.
Table-1: Socio-demographic profile of the
study population (N=363)
Factors
Frequency Percentage
1. Distribution of the subjects according to their
‘age group’
<20
27
7.43
20-25
276
76.03
26-30
52
14.34
>30
8
2.20
2. Distribution of subjects according to their
‘Religion’
Hindu
320
88.15
Muslim
43
11.85
3. Distribution of subjects according to their
‘Caste’
Scheduled caste
244
67.22
Scheduled Tribe
19
5.23
Other Backward
44
12.12
Caste
General
56
15.43
4. Distribution of subjects according to their
‘Education level’
Illiterate
47
12.95
Non formal
4
1.10
education
Class I-IV
32
8.81
Class V-X
236
65.02
Above Class X
44
12.12
5. Distribution of the subjects according to their
‘Occupational status’
Home Maker
348
95.87
Work outside
15
4.13
6. Distribution of subjects according to the
‘Type of family’ in which they belong
Joint
208
57.30
Nuclear
155
42.70
7. Distribution of the subjects according to their
‘Socioeconomic status’ they belong
I poor
20
5.50
II lowere middle
60
16.54
III upper middle
104
28.65
IV high
123
33.88
V upper high
56
15.43
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Al Ameen J Med Sci; Volume 14, No.3, 2021
Factors
Frequency
Percentage
8. Distribution of subjects according to their ‘Place
of delivery’
Government
Medical College
308
84.84
hospital (NBMC)
Private Hospital
25
6.89
Home delivery
30
8.27
9. Distribution of subjects according to the ‘Type of
delivery’ as they underwent
Normal Vaginal
240
66.11
Caesarean Section
123
33.89
10. Distribution of subjects according to the
‘Delivery outcome’
Life Birth
352
96.97
Still Birth
11
3.03
11. Distribution of subjects according to their ‘Age
at first pregnancy’
<18
32
8.82
18-20
156
42.97
21-25
114
31.40
>25
24
6.61
Fig-1: Distribution of the study population according
to their registration status in antenatal care services.
[N= 363]
Figure 1 revealed that out of total (363)
participant almost 97% (352) were registered
during ante natal period. As found in table 2,
89.7% had registered in Government hospital set
up and 48.8% were registered during first
trimester (≤12weeks).
Ray K & Roy H
Table-2: Pattern of utilisation of antenatal
services [n=352]
Ante natal care
Frequency Percentage
(ANC) services
1. Distribution of the study population who
received antenatal services; according to their
‘place of ANC registration’ [n=352]
Government setup
316
89.77
Private
36
10.23
2. Distribution of Distribution of the study
population who received antenatal services;
according to their ‘Gestational age at registration
(in weeks)’[n=352]
≤12
172
48.86
≥13
180
51.14
3. Distribution of the study population who
received antenatal services; according to their
‘Number of ANC visits’ [n=352]
Only 1
352
100.00
Maximum 2
336
95.45
3
300
85.22
All 4 and or more
235
66.76
4. Distribution of the study population who
received IFA tablets amongst who
utilisedantenatal services [n=352]
Yes
347
98.57
No
5
1.43
5. Distribution of the study population who
received IFA tablets amongst who utilised
antenatal services; according to ‘number of IFA
tablets received’ [n=347]
<=30
8
2.30
31-60
12
3.45
61-100
89
25.75
101-149
208
59.95
150-180
30
8.65
6. Distribution of the study population who
received IFA tablets amongst who utilised
antenatal services; according to ‘number of IFA
tablets consumed’ [n=347]
<=30
10
2.88
31-60
10
2.88
61-100
99
28.53
101-149
201
57.93
150-180
27
7.78
7. Distribution of the study population who
received injection tetanus toxoid amongst who
utilisedantenatal services [n=352]
Yes
345
98.01
No
7
1.99
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Al Ameen J Med Sci; Volume 14, No.3, 2021
Ante natal care
Frequency Percentage
(ANC) services
8. Distribution of the study population who received
injection tetanus toxoid amongst who
utilisedantenatal services; according to number of
tetanus toxoid injection as they received [n=345]
1
12
3.48
2
333
96.52
9. Distribution of the study population who received
antenatal care according to type of examinations
received [n=345]
BP
324
92.05
Weight
340
96.60
Pallor
188
53.41
Oedema
152
43.18
PA Examination
230
65.34
10. Distribution of the study population who
received antenatal care according to type of
investigations suggested and undergone [n=345]
Blood for
336
95.45
Haemoglobin
ABO grouping & Rh
336
95.45
typing
VDRL
289
82.10
Fasting (FBS) and
Post Prandial
295
83.80
blood sugar (PPBS)
Others (HBsAg for
Hepatitis B,
274
77.84
HIV, TSH etc.)
Urine for
Routine examination
305
86.64
(RE) with Albumin
and sugar
Stool for OPC
98
27.84
Ultrasonogram (USG)
208
59.09
11. Distribution of the study population who
received antenatal care according to type of advices
given [n=345]
Diet
305
86.64
Rest/sleep
215
61.07
Immunization
305
86.64
Physical activity
154
43.75
Personal cleanliness
98
27.84
smoking, alcohol
76
21.59
consumption, others
Family planning
261
74.14
Breastfeeding and
300
85.22
Newborn care
Warning/Danger sign
56
15.90
Ray K & Roy H
Among the registered women more than 85%
had more than three antenatal visits and
almost one third had all 4 antenatal visits.
Majority of the women (96%) were fully
immunized with TT vaccine followed by 3.48
% i.e., received only one dose of TT vaccine.
Among the study population 65.7% of women
consumed 100 or more IFA tablets followed
by 28.5% of women received 61-100 IFA
tablets. During antenatal visits, progression of
overall weights wese measured in 96.6% of
cases, 92.05% women had their blood
pressure measured, 65.34% women had an
abdominal examination but only 53.4%
women had experienced pallor examination.
On laboratory investigations, 95.45% reported
of having a blood test for haemoglobin
estimation and Blood grouping; 82.1% had a
blood test for VDRL; 83.8% had their blood
for FBS/PPBS and 77.84% reported of testing
a blood for HBsAg/ HIV/TSH etc., About
86% had an urine examination for R/E
including albumin. About 27.8% reported of
having
stool
test
for
Oligomeric
Procyanthocyanides (OPC) and 59.09% had
ultrasonography (USG) of pregnancy profile.
Regarding counselling/advice related to ANC,
again 86.64% of the study population was
advised about diet and immunisation followed
by breast feeding and new born care (85.22%)
and family planning (74.14%). However
advice regarding personal cleanliness
(27.84%), smoking and alcohol consumption
(21.59%), and warning signs (15.9%) was not
adequate.
In comparison between women who
undergone for at least four ANC visits and
who did 1-3; significant difference was
observed in terms of age, religion, educational
level, socio economic status (SES), timing of
registration. About 53.58% of the study
population who took at least four ANC visits
were of age group more than 25 years while
69.26% were 25 years and below and the
difference was statistically significant (P <
0.05). Among Hindu 71.02% had completed
at least 4 ANC visits where as only 31.58%
had done it (p<0.000). Similarly 76.62% of
the study population who had education above
primary level had more number of ANC visits
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Ray K & Roy H
than 25% who were either illiterate or non
formally educated and it was statistically
significant (P < 0.01). Significantly more women
with a higher SES (Class I, II and III) (60.12%)
utilised ANC services as compared to those of
lower SES (Class IV and V) (73.56%, P < 0.01).
Again 56.98% of the pregnant women who got
them registered early, went for more number of
antenatal check-ups than 39.45% women who
registered late which was also statistically
significant (P < 0.01). Concerning the place of
delivery, the women who had delivered their
children at institution (69.3%) had adequate
ANC as compared to home (30.4%)
(P<0.0001). The influence of type of family
and occupation, mode of delivery was not
statistically significant (P > 0.05) [Table-3].
Table-3: Socioeconomic factors influencing the trends of ANC visits among the study population
(n=352)
1-3 visits done
(n= 117)
All 4 visits done
(N=235)
chi2 test(p value)
≤25 (n=296)
91(30.74)
205(69.26)
chi2 = 5.22
26 & above (n=56)
26(46.42)
30(53.58)
p=0.002
Hindu (n=314)
91(28.98)
223 (71.02)
chi2 = 23.78
Muslim (n= 38)
26(68.42)
12(31.58)
p=0.000
Illiterate and NF literate (n=48)
36(75.00)
12(25.00)
Class I –X (n=261)
61(23.38)
200(76.62)
Above class X (n= 43)
20(46.51)
23(53.49)
Home Maker (n=337)
113
224
chi2= 0.304
Work outside (n= 15)
4
11
p=0.580
Joint (n=201)
74(36.81)
127 (63.19)
chi2= 0.27
Nuclear (n=151)
43(28.47)
108(71.53)
p=0.1
Up to class III (n=178)
71(39.88)
107(60.12)
chi2 = 7.17
Class IV & V (n= 174)
46(26.43)
128(73.56)
p=0.003
≤ 12 wks (n=172)
34(19.77)
138(80.23)
chi2 =30.15
>12 wks (n=180)
83(46.11)
97(53.89)
p=0.000
Normal Vaginal (n= 233)
76(32.61)
157(67.39)
chi2=0.11
Caesarean Section (n=119)
41(34.45)
78(65.55)
p=0.99
Institutional (n=329)
101(30.70)
228(69.30)
chi2 =14.63
Home delivery (n=23)
16(69.56)
7(30.44)
p=0.000
Socio-demographic profile
Age group(in yrs)
Religion
Education
chi2 = 52.58
p=0.000
Occupation
Type of family
Socio-Economic Status
Timing of registration
Mode of delivery
Place of delivery
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Al Ameen J Med Sci; Volume 14, No.3, 2021
Discussion
The present study was conducted in rural areas of
Matigara block of siliguri Subdivision of
Darjeeling district, West Bengal to study the
utilization of antenatal care services among the
women having the children of less than one year
of age. The study was conducted during the
period of April – June 2015.majority of the
women(76.03%) in this study were in the age
group of 20-25 years where Kakati R et al. [6] in
a study done in rural area of Jorhat district
Assam, found that 50% of the women were in the
age group of 26-30 years.
This study showed 97% registration of
pregnancy, of which 48.8% registered within 12
weeks. According to NFHS III – India [6], 76%
women preceding the survey received ANC, and
only 44% started antenatal care during the first
trimester of pregnancy. The extent of registration
and early registration was in accordance with the
findings of previous studies in India and abroad;
such as studies conducted by Basuet al. at
Kolkata [7] (100%, 65.26%) Roy et al., at
Lucknow [8] (100% and 53.7%), Sharma et al., at
Lucknow [9] (98.6% and 58.5%), Ashwini et al.,
at Belgaum [10] (100% and 42.6%), Javaliet al.,
at Karnataka [11] (100% and 56.5%), Koppadet
al., at Kakati [12] (96.6% registration), Birmeta et
al., at Ethiopia [13] (87% and 42%), Zhao et al.,
at Shanghai (90.1% registration but only 19.7%
early registration) [14].
In the present study 84.8% women had delivered
in govt. hospital followed by 8.2% had delivered
at home. The findings of the present study is
found to be similar with the study done by Kakati
R et al at Jorhat district Assam [6] (79.6%
institutional delivery and 10% home delivery)
and also better than the similar study conducted
by Srivastava A et al in Rohilkhand Region [15]
revealed that 50.4% had delivered at government
hospital followed 32% at home.
In the present study 66.7% of the women had
more the three antenatal visits. Similar findings
were found in the study by Kakati R et al [6]
where 68.7% women had more than 3 ANC
visits. This result is contrast to the similar study
conducted by Shrivastava A [15] find that only
16.3% of women had three ANC. The study done
by Basu et al. [7] revealed that 91.05% of the
Ray K & Roy H
study population took at least three ante natal
services during their last pregnancy period. As
per NFHS-4 [5] India, about 51% had at least
four ANC visits.
In this study, it was evident that 68.6% of
pregnant women had received and consumed
more than100 tablets of IFA; similar to study
at Karnataka [11] where 65.6%, mothers
consumed at least 100 IFA tablets. Moreover
NFHS-4 [5] revealed that Seventy-eight
percent of all women with a birth in the past
five years were given or purchased iron and
folic acid (IFA) tablets during the pregnancy
for their most recent birth, but only 30 percent
took the tablets for at least 100 days. On the
contrary, 43.96% of the study population took
at least 100 IFA tablets at Kolkata (Basu et al)
[7], Kakati [12] where 48.4% mothers
consumed at least 100 IFA tablets.
In the present study 96.5% of the women were
immunized with 2 doses of TT. This findings
are a bit higher than the similar study
conducted by Srivastava A [15] (83.4%).
comparable to NFHS-4 (89%) [5], Kolkata
(100%),(Basu et al) [7] Lucknow (95.5%) [9],
Belgaun (98.4%) [10], Jorhat (90%) [6]. In
contrast, lower results were observed at
Kakati (50%) [12] And at Etawah (46%) [16].
In the present study, the study population
were asked about the components of ANC
offered at least once; recording of weight and
blood pressure was done for 96.6% and
92.05% of the study population respectively
65.34% had an abdominal examination,
95.45% had their blood test for haemoglobin
and blood grouping; 86.64% had routine urine
test; and ultra-sonography was the least
utilised component (59.09%); which was
almost similar to some other previous studies
conducted at Kolkata (basu et al) [7] Lucknow
[9], Belgaum [10], Karnataka [11].
In our study, 91.05% of the study population
took at least three ante natal services during
their last pregnancy period which was
corroborative with the findings by Roy et al.,
(85.5%) [8], Sharma et al., (78.4%) [9],
Javaliet al., (83.1%) [11]. However findings
of some other previous studies conducted by
Ashwini et al. [10], Birmeta et al. [13], and
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Al Ameen J Med Sci; Volume 14, No.3, 2021
Ray K & Roy H
Zhao et al. [14], demonstrated lower results
where 29.8%, 66.3% and 49.7% respectively had
at least three ante natal check-ups. As per NFHS4 [5] India, 51% had at least 4 ANC visits.
In the present study utilization of antenatal care
services were significantly associated with the
age of the women at last child birth, religion,
education, socio-economic status, time of
registration and place of delivery (P<0.05). Our
findings are consistent with report of Basu et al.
[7]. The association between the utilization of
ANC services with occupation and type of family
were found to be statistically not significant in the
present study similarly Kakati R et al. [6] and
Basu et al. [7] in their study find these not
significant (p<0.05).
Among the different determinant this study
revealed that less age was the determinant for
more ANC visits. Maternal education is a very
strong and consistent predictor of utilization of
ante natal services; In our study, more women of
higher SES utilized ANC services more as
compared to women with poor SES; it may be
due to transport cost to the health facilities where
the ANC services are being provided. The good
effect of early registration was also found on
utilisation of antenatal care in this study.
Encouraging early registration may ensure better
maternal health in near future.
Conclusion
Maternal mortality is an important public health
problem in developing country like India. Early
detection of risk factors can reduce maternal
mortality. This could be achieved through proper
antenatal screening and health care services
throughout the pregnancy period. Analyzing the
Financial Support and sponsorship: Nil
information revealed from the current study it
is concluded that, receiving and utilizing ANC
services is not satisfactory related to delayed
registration, <4 ANC visits, <100 tablet
intake. There is a need to increase education
about importance of consumption of IFA tab,
early detection of danger signs in pregnancy.
There is also a need to increase education
about family planning after delivery.
Recommendations:
1. To educate people by village level worker
like ASHA regarding early registration of
pregnancy and adequate number of ANC
visit
2. Improvement of facility for investigation
such as HIV testing, HBsAG, VDRL by
proper implementation of RCH II
guideline
3. Counseling
regarding
contraception
should be ensured for proper birth
spacing.
4. The situation can be improved and women
may be more receptive by improving
educational status of the couple.
Acknowledgement
Authors sincerely acknowledge the authorities of
the North Bengal Medical College and Panchayet
of Matigara village of Siluguri Sub division; for
providing all necessary permissions to carry on the
study. They are especially obliged to late Prof
Manasi Chakraborty, the-then HOD of the
Department of Community Medicine, who guided
overall. Authors do feel obliged to ASHA works,
health care works for helping in data collection as
well as the villagers, the respondents of the study
for participating in the study.
Conflicts of interest: There are no conflicts of interest.
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Cite this article as: Ray K and Roy H. A community
based study on utilization of antenatal care services by
villagers in rural part of Eastern India. Al Ameen J Med
Sci 2021; 14(3):253-261.
This is an open access article distributed under the terms of the
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4.0) License, which allows others to remix, adapt and build
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*All correspondences to: Dr. Hironmoy Roy, Associate Professor, Department of Anatomy, Institute of Post Graduate Medical Education
& Research, 244 AJC Bose Road, Kolkata-700020, West Bengal, India. E-mail: hironmoy19@gmail.com
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