Introduction
Methodology
Study design
Study setting
Study population and study period
Sample size
Quantitative study tools
Qualitative
Statistical analysis
1 |
Reasons for migration to the place of work
|
---|---|
1.2 | Repayment of loan |
1.3 | Inability to earn livelihood at the place of origin |
1.4 | Delayed disbursement of NREGA payments |
2.1 |
Work pattern in brick kilns
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2.2 | Labor intense work |
2.3 | Long working hours |
3 |
Facilities available at brick kilns
|
4 |
Public health system at the place of work
|
5.1 |
Available health care
|
5.2 | Non-utilization of public health facilities |
5.3 | Private health system at the place of work |
6.1 |
Maternal health care availed by laborers
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6.2 | Janani Suraksha Yojana |
6.3 | Knowledge about emergency transport facility |
7 |
Utilization of social service schemes
|
8 |
National health insurance coverage (RSBY)
|
9.1 |
Inability to avail maternal health care
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9.2 | Lack of time, and awareness |
9.3 | Failure of public health system in planning migrant health services |
9.4 | Private providers more appealing to laborers |
10 |
Possible ways to deliver health care to migrant laborers in brick kilns
|
Ethical issues
Results
Quantitative
Sl no | Variables | Number | Percentage |
---|---|---|---|
1 |
State of origin
| ||
Chhattisgarh | 363 | 70.1 | |
Uttar Pradesh | 56 | 10.8 | |
Rajasthan | 24 | 4.6 | |
Others | 75 | 14.5 | |
2 | Education status of women (illiterate) | 349 | 67.3 |
3 | Education status of husband (illiterate) | 187 | 36.1 |
3 | Involved in agricultural work in native place | 476 | 91.9 |
4 |
Caste
| ||
SC/ST | 423 | 81.7 | |
Others | 95 | 18.3 | |
5 |
Most important reason for working in brick kilns
| ||
Repayment of debt | 230 | 44.4 | |
More money in brick kilns | 145 | 28.0 | |
No work in native place | 131 | 25.3 | |
6 | Mean years of working in brick kilns (SD) | 7.4 (3.7) | – |
7 | Women’s mean hours of working in brick kilns (SD) | 10.7 (2.5) | – |
8 | Median income per season | ₹ 30,000 | – |
Sl no | Variable | Number | Percentage |
---|---|---|---|
1 |
Details of last pregnancy
| ||
1.1 | Received some antenatal care during the last pregnancy | 389 | 75.1 |
1.2 | Received iron and folic acid tablet | 200 | 38.6 |
1.3 | Haemoglobin test done | 336 | 64.9 |
1.4 | Received tetanus toxoid injection | 416 | 80.3 |
2 |
Place of delivery
| ||
2.1 | Home delivery | 399 | 77.1 |
2.2 | Hospital delivery | 119 | 22.9 |
3 |
Contraceptive usage
| ||
3.1 | Ever used any contraceptive | 145 | 28.0 |
3.2 | Underwent tubectomy (n = 145) | 106 | 73.1 |
4 |
Facilities available for pregnant women
| ||
4.1 | Ever heard about JSY services | 233 | 45.0 |
4.2 | Ever received JSY money | 159 | 30.7 |
4.3 | Ever heard about free ambulance facility | 381 | 73.6 |
4.4 | Ever used free ambulance facility | 189 | 36.5 |
Variable | Antenatal carea | p value | Place of delivery | p value | ||
---|---|---|---|---|---|---|
Adequate (n = 278) | Inadequate (n = 240) | Institutional (n = 175) | Home (n = 343) | |||
Mean age (SD)
| 28.2 (6.3) | 32 (6.9) | 0.000 | 26.1 (5.1) | 31.9 (6.8) | 0.000 |
Stay in brick kiln
| ||||||
Long | 95 (18.3) | 130 (25.1) | 0.000 | 58 (11.2) | 167 (31.7) | |
Short | 183 (35.3) | 110 (21.2) | 117 (22.6) | 179 (34.6) | 0.000 | |
Participant Education
| ||||||
Illiterate | 169 (32.6) | 180 (34.8) | 92 (17.8) | 257 (49.6) | ||
Literate | 109 (21.0) | 60 (11.6) | 0.001 | 83 (16.0) | 86 (16.6) | 0.000 |
Occupation
| ||||||
Agriculture | 238 (45.0) | 165 (31.8) | 126 (24.3) | 102 (19.7) | ||
Others | 40 (7.7) | 75 (14.5) | 0.000 | 49 (9.5) | 241 (46.5) | 0.000 |
Income
| ||||||
≤25,000 | 97 (18.7) | 112 (21.6) | 89 (17.2) | 120 (23.2) | ||
>25,000 | 181 (34.9) | 128 (46.3) | 0.006 | 86 (16.6) | 223 (43.1) | 0.000 |
H visit
| ||||||
Yes | 225 (43.4) | 105 (20.3) | 107 (20.7) | 223 (43.1) | ||
No | 53 (10.2) | 135 (46.3) | 0.000 | 68 (13.1) | 120 (23.2) | 0.386 |
ASHA visit
| ||||||
Yes | 247 (47.7) | 160 (30.9) | 139 (26.8) | 268 (51.7) | ||
No | 31 (6.0) | 80 (15.4) | 0.000 | 36 (7.0) | 75 (14.5) | 0.734 |
Used ambulance
| ||||||
Yes | – | – | 87 (16.8) | 102 (19.7) | ||
No | – | – | – | 88(17.0) | 241 (46.5) | 0.000 |
Preference for general ailments (n = 509)a | Reason for preference | Number (Percent) | Preference for maternal care (n = 505)b | Reason for preference | Number (Percent) |
---|---|---|---|---|---|
Government 204 (39.8) | Accessible | 23 (11.3) | Government 340 (67.4) | Accessible | 17 (5.0) |
Free treatment | 139 (68.1) | Ambulance | 54 (15.9) | ||
Quality care | 34 (16.7) | Free treatment | 159 (46.8) | ||
Others | 8 (3.9) | Quality care | 45 (13.2) | ||
– | JSY | 43 (12.6) | |||
– | Others | 22 (6.5) | |||
Sub-total | 204 (100) | 340 (100) | |||
Private 305 (59.5) | Government not good | 41 (13.4) | Private 164 (32.6) | Accessible | 26 (15.9) |
Accessible | 84 (27.5) | Doctor came home | 8 (4.9) | ||
Doctor came home | 37(12.1) | Quality care | 57 (34.8) | ||
Quality care | 126 (41.3) | Others | 73 (44.5) | ||
Others | 17 (5.6) | – | |||
Sub-total | 305 (100) | 164 (100) |
Sl no | Predictor variable | Antenatal carea | Odds ratio with 95% confidence interval | |
---|---|---|---|---|
Adequate (n = 278) | Inadequate (n = 240) | |||
1 |
Participant age
| |||
17–25 (n = 178) | 71.35 | 28.65 | 1 | |
26–35 (n = 236) | 48.73 | 51.27 | 0.7 (0.6–1.0) | |
36–45 (n = 104) | 34.62 | 65.38 | 2.25 (1.63–3.12) | |
2 |
Participant education
| |||
Literate (n = 109) | 64.50 | 35.50 | 1 | |
Illiterate (n = 169) | 48.42 | 51.58 | 1.07 (.67–1.68) | |
3 |
Stay in brick kilns
| |||
Short (n = 293) | 62.46 | 37.54 | 1 | |
Long (n = 225) | 42.22 | 57.78 | 1.27 (.82–1.97) | |
4 |
Income
| |||
> 25,000 (n = 309) | 58.58 | 41.42 | 1 | |
≤25,000 (n = 209) | 46.41 | 53.59 | .61 (.40–.92) | |
5 |
Work in native place
| |||
Agriculture (403) | 59.06 | 40.94 | 1 | |
Non agriculture (n = 115) | 34.78 | 65.22 | 2.17 (1.33–3.53) | |
6 |
Health worker visit
| |||
Yes (n = 330) | 68.18 | 31.82 | 1 | |
No (n = 188) | 28.19 | 71.81 | 4.06 (2.57–6.42) | |
7 |
ASHA worker visit
| |||
Yes (n = 407) | 60.69 | 39.31 | 1 | |
No (n = 111) | 27.93 | 72.07 | 1.96 (1.12–3.41) |
Sl no | Predictor variable | Place of delivery | Odds ration with 95% confidence interval | |
---|---|---|---|---|
Institutional (n = 175) | Home (n = 343) | |||
1 |
Participant age
| |||
17–25 (n = 178) | 57.30 | 42.70 | 1 | |
26–35 (n = 236) | 27.54 | 72.46 | .9 (.6–1.2) | |
36–45 (n = 104) | 7.69 | 92.31 | 2.88 (2.03–4.08) | |
2 |
Participant education
| 1.64 (1.03–2.59) | ||
Literate (n = 109) | 49.11 | 50.89 | 1 | |
Illiterate (n = 169) | 26.36 | 73.64 | 1.60 (1.0–2.5) | |
3 |
ANC utilization
a
| |||
Adequate (n = 278) | 41.01 | 58.99 | 1 | |
Inadequate (n = 240) | 25.42 | 74.58 | 1.5 (.9–2.4) | |
4 |
Income
| |||
> 25,000 (n = 309) | 27.83 | 72.17 | 1 | |
≤25,000 (n = 209) | 42.58 | 57.42 | 2.3 (1.5–3.7) | |
5 |
Work in native place
| |||
Agriculture (403) | 31.27 | 68.73 | 1 | |
Non agriculture (n = 115) | 42.61 | 57.39 | .34(.2–.5) | |
6 |
Used ambulance
| |||
Yes (n = 189) | 46.03 | 53.97 | 1 | |
No (n = 329) | 26.75 | 73.25 | 2.3 (1.4–3.8) |
Qualitative
Thematic framework components and quotes
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Codes
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Summary
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Categories
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Subthemes
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Themes
a
|
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Reasons for migration to the place of work
“NREGA payment is made after 2 ½ months...there is no timely payment of wages [at the place of origin]” “There is no work at my native place” | Employment issues at the place of origin | Failure of government to make timely NREGA payments along with lack of provision generating income compelled migrants to seek work elsewhere | Difficulty in earning livelihood at the place of origin | Delayed disbursement of NREGA | 1 |
Labour intense work in brick kilns
“We usually work from 4 in the morning till 7 in evening…once in a fortnight we get 2–3 days off” “Work here is strenuous” | Working condition of migrant laborers working in brick kilns | Many laborers including pregnant women worked for a long time in the brick kilns and also availed few number of leaves as obliged by their employer | Difficult working conditions prevalent in the brick kilns | Long working hours involving strenuous work. | 2 |
Public health system at the place of work
“Pregnant females are unaware about health matters” “People have told us that doctor comes here [brick kilns] to check pregnant females” | Presence of public health facilities | Due to faulty perceptions, lack of awareness migrant laborers rarely availed health services from the public health facilities | Unawareness about local public health facilities | Local public health system less utilized | 3 |
Private health system at the place of work
“We usually take medicines from one RMPa doctors who come in bicycle [to brick kiln]…and give their mobile numbers…when in need we will call them…for fever and cough we will have to spend ₹100 and for fluid infusion ₹1000..” | Private health care easily available at the place of work | Failure of public health system to identify and step up in providing health services, makes unqualified practitioners more appealing to the laborers, who usually provide substandard but costly health services. | Private health care delivered at the place of work | Substandard but costly health care availed from private providers Visiting brick kilns private providers induce migrants labourers to utilize private health service | 4 |
Maternal health care availed by laborers
“Sometimes we send pregnant women back home [place of origin] for delivery…in case of emergency we call our supervisor to take patient to government hospital” “We know of a RMP here and a hospital in Chhattisgarh. We have no information about ambulance.” | Health care during pregnancy and child birth | For child birth public health facility was preferred. However, many sent pregnant women to their place of origin for child birth resulting in discontinuation of health services. Lack of information about ambulance facilities at the place of work. | Discontinuation in availing maternal health care | Pregnant women working in brick kilns sent home for child birth | 5 |
Perceived inability to avail maternal health care
“There is no time left [to visit health facilities]” “We don’t know what kind of services are available here for pregnant women. Even if someone becomes ill we don’t know what to do” | Barriers for universal health coverage | Long working hours perceived to be barrier to visit nearby health facilities. Also, geographical location of brick kilns restricted laborers from visiting health centers after work hours. | Poor utilization of health services | Lack of time in brick kilns for visiting health facilities | 6 |
Possible ways to deliver health care to migrant laborers in brick kilns
“Doctors should visit bhatta [brick kiln] in evening” “It [visit to brick kilns by health providers] is good time in afternoon for health services” | Concerted efforts required | Need for health providers from the public health system for providing primary care in brick kilns was strongly desired. | Migrant population need to be covered under public health system | Need for providing primary health care in brick kilns Outreach services in brick kilns | 7 |
Male participant 4: “We have no information about ambulance”.
Male participant 2: “We usually take medicines from one RMP doctor [private provider] who come in bicycle [to brick kiln]…”.Female participant 8: “RMP charges rupees 150 for medicines and rupees 500 for injections”.
Female participant 10: “Sometimes we send pregnant women back home [place of origin] for delivery…in case of emergency we call our supervisor to take patient to government hospital”.
Female participant 12: “We don’t know what kinds of services are available here for pregnant women. Even if someone becomes ill we don’t know what to do”.
Barriers | Solutions |
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Lack of income generating activities in the place of origin resulting in migration | Rural employment Government must step up efforts such as NREGA to improve the livelihood of people; early payment of NREGA wages; |
Low awareness | IEC about the maternal health issues |
Prolonged working hours in the brick kilns | Prescribing minimum work time for the labourers working in unorganised sector |
Unfamiliarity of local setting in the place of work | Assistance from the brick kiln employers; IEC |
Private providers capitalizing on the prevailing situation of migrant labourers preventing them from seeking basic public health care | Sensitizing private providers about the need for migrant labourers to have access for universal health coverage; Regulation of unqualified private providers; |
Absence of an existing channel thorough which public health care can be delivered to migrant labourers; Disruption in continuing maternal health care at the place of work | Deployment of health providers such as ASHA; Migrant mobile health unit to help migrant labourers continue accessing public health system even at the place of work |
Underutilization of emergency transport facility, JSY | Awareness campaign regarding birth preparedness and complication readiness |
Issues in availing benefits from the national insurance scheme | Strengthening of RSBY to achieve universal health coverage |
Public health system’s apathy in providing migrant specific health care | Strategies targeting migrant labourers to be incorporated in the National health programmes such as NHM |