Description
Introduction:
Childbirth is a vulnerable period for women, inducing many to migrate to their maternal homes during the final trimester of pregnancy—a practice notably entrenched in South Asian countries. This tradition has far-reaching implications for the public health system, prompting the Indian government to implement measures to ensure a "continuum of care" for migrant beneficiaries. This study seeks empirical evidence to assess the accessibility of essential nutrition and health services, including the effectiveness of recent measures. Employing participant observation and ethnographic interviews, the research aims to uncover facilitators and barriers in utilising the Integrated Child Development Services (ICDS) faced by pregnant women and preschool infants during temporary migration.
Methodology:
This qualitative study employs participant observation and semi-structured ethnographic interviews, documenting the experiences of pregnant women and infants during temporary migrations for childbirth. Inclusion and exclusion criteria are established to ensure diverse participant representation, with a specific focus on districts in Maharashtra reflecting varying percentages of pregnant women engaged in temporary migration. The study involves participant observation in 28 childcare centres (Anganwadi) in the Nashik district of Maharashtra, India.
Results and Discussion:
Maternal migration significantly affects access to ICDS services such as supplementary nutrition, breastfeeding counselling, immunisation, and home visits crucial during pregnancy and the initial months of the child's life. Demand-driven accounting is deemed necessary, highlighting challenges and opportunities within the ICDS framework. The study identifies barriers, including limited awareness among temporary migrant pregnant women about their entitlements, documentation requirements, and a missed technological opportunity with the migration module in the Poshan Tracker application. Frontline workers' low qualifications, workload issues, and lack of incentives further hinder the overall effectiveness of ICDS services for temporary beneficiaries. The study also illustrates how differential access to specific services is a result of the differing roles of frontline workers in the health and women and child development departments.
The study notes that both beneficiaries and Anganwadi Workers (AWWs) at the source and destination possess information about migration timing and services needed, affording some control over the process. The beneficiary, linked to the AWW's survey and community through their maternal house, provides some access to ICDS services at the destination. However, the absence of policy guidelines addressing temporary migration places the responsibility on beneficiaries to locate and register at an Anganwadi Centre (AWC), inhibiting even first-level access.
Conclusion:
In low-resource settings, public health systems need to successfully assure continuity of care throughout pregnancy, birth, and after delivery. But this requires recognising the gaps and the factors contributing to them. Post-covid, the shift towards e-governance has expanded opportunities, but further constructive efforts are needed to enhance accessibility. The current research makes a notable contribution by shedding light on the widely observed but often ignored phenomenon of temporary migration during pregnancy, emphasising the urgent need for policy reforms and programmatic enhancements in maternal and infant health services. The aim is to contribute to the development of more inclusive and effective nutrition policies, ensuring equity for pregnant women and infants irrespective of their temporary migration status.
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